Five Priorities for Healthcare Design and Consulting

Lessons from a Clinician at the Intersection of Healthcare Delivery and Healthcare Design

July 13, 2017

Healthcare Consultant, NBBJ

Editor’s Note: This post was originally published as part of the Healthcare Design series “Take 5,” which asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

1. Design firms should have nurse leaders on their healthcare teams.

When they augment their inherent clinical expertise with design knowledge, nurse leaders can be especially useful to architects and medical planners in validating design assumptions about healthcare delivery. Furthermore, their experience in marketing, writing, presenting, critical thinking, performance improvement, and personnel management enhances project performance and client deliverables. Consistent with the hallmarks of healthcare professionals, nurses are fundamentally caring individuals, possess palpable integrity, demonstrate respect for all, and have a quest for excellence through a commitment to personal growth and life-long learning. Honestly, what more could a healthcare design team ask for!

2. Satisfy the staff and you’ll satisfy the patients.

Design that focuses on the needs of care providers will benefit patients more than design that solely focuses on consumer amenities. This point was powerfully expressed to me recently by an acute rehabilitation hospital CEO, who relayed the feedback she got from patients involved in user groups during the design of their replacement hospital: they said, “Give the staff what they need, so that they can give us what we need.” She elaborated: “Those in need of rehab know firsthand it is the work of the therapists, researchers, doctors and nurses that get them to a state of ability and independence.” She made the point that a major component of patient satisfaction springs from satisfaction with the care experience and the care providers who create that experience. Therefore, take care of the staff’s design requirements too, and they will take care of the patients’ needs.

3. Address the full spectrum of safety.

All healthcare organizations aspire to an error-free culture of safety as part of a relentless pursuit of continuous quality improvement. Great progress has been made over the last few decades, but healthcare providers are still challenged by nosocomial infections, medication administration mistakes, work-related staff injuries, patient falls, incorrect diagnoses – the list goes on. The list of potential solutions is endless as well: strategies such as creating standard processes, mitigating distractions, establishing performance expectations, and requiring additional training and education. But one often overlooked answer is design. Some don’t even realize the range of opportunity for improvement made possible through the built environment. For instance, even the layout of a patient room can decrease errors, increase hand-washing and reduce fall rates; adjacencies can decrease travel time and supply utilization; decentralized work stations can increase patient engagement. As designers and nurse leaders, we should be more effective in communicating these benefits!

4. Technology integration can’t be an afterthought.

New healthcare designs always include a vision for advanced technology – indeed, it is often required to optimize the environment. Although this opportunity shouldn’t be passed up, it creates an extraordinary demand on the enterprise during the transition to the new setting. The information systems department is particularly pressured to have the prerequisite IT integration plan in place and functioning in time for a building’s opening. As well, there is a huge knowledge transfer requirement that affects all user departments, not to mention the department(s) responsible for educating them. Technology is a project requirement whose success or failure has a direct effect on the most important components of the client’s business: patient care and finances. It is an area that must be well thought out from the beginning.

5. Design intent is one thing – activating that design is a whole different story.

It is a thrilling time when a project is in the construction administration phase and materializing before everyone’s eyes. However, it is also the most critical and complex time, as the organization must plan to occupy and activate the new setting. It requires an extraordinary amount of effort and expertise to transition and activate the building safely and on time. Not only must new spaces and systems be fully operational, but staff must be comfortable with the space and a new way of doing business. It requires a remarkable amount of logistical coordination that cannot be underestimated or left to chance. Thankfully, many healthcare organizations seek expert assistance and advice during this time, and designers would do well to encourage them to continue to do so. Ultimately it is the design and the designer that will be assigned the blame if the activation doesn’t go well. Conversely, they will be ones to receive accolades if the activation goes smoothly and safely – with their design performing as perfectly as it was intended.

Image courtesy of Sean Airhart/NBBJ.

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How Will The Senate’s American Health Care Act (AHCA) Bill Affect Hospitals and Health Systems?

Despite Uncertainty in Healthcare Policy, Some Strategies Remain Unchanged

June 23, 2017

Healthcare Strategist, NBBJ

@dbellef

Editor’s Note: This post has been updated to reflect the name of the Senate bill.

On June 22, Senate Republicans released their version of the American Health Care Act (AHCA), the Better Care Reconciliation Act (BCRA), a proposal to repeal and replace Obamacare. While it has differences in timing and method from the House bill, it maintains core Republican tenets of states’ rights and freedom of choice.

 

What does the Senate bill do?

Whatever final version of the Republican repeal-and-replace legislation emerges from conference, it will almost certainly:

  • Give states much greater latitude in designing their Medicaid programs and individual commercial insurance markets.
  • Put more choice and purchasing power into the customer-patient’s hands, including the option not to purchase health insurance at all.
  • Not add net new dollars into the system, even with the “puts and takes” of tax credits, subsidies and the restoration of disproportionate share hospital (DSH) payments.

And if that isn’t enough, other transitions are already underway:

  • Medicare continues to change how it pays for care, using a variety of methods: bundled payments, accountable care organizations and more.
  • Commercial insurers, in response to their customers, continue to develop a variety of different products to lower the cost to employers, which inevitably passes higher cost on to the customer-patient.

 

What doesn’t the Senate bill do?

It does not address the continuing rise in the cost to produce and deliver healthcare. Whether Republicare, Medicare or commercial care, everyone is just reshuffling how the payer pays — and hopefully reducing the amount. Obamacare was the exception: it put more money into the system but still did nothing to control the rise in cost.

But payers don’t provide care, nor can they control cost. This leaves it in the hands of care providers to figure out new ways of producing and delivering care, as all payers — from individuals, to insurers, to the Federal government — reduce the amount they are willing to pay. It cannot be overstated: no matter what Congress does, over time there will be less third-party money coming into the system, and the customer-patient will be expected to pay more and more out of pocket.

 

What now?

Because this trend will continue independent of healthcare policy, our advice hasn’t changed. Hospitals and health systems should continue to:

  • Form more partnerships with community organizations and others who have deep interests in improving community health.
  • Accelerate the development of lower-cost ambulatory and digital healthcare offerings. We are moving inexorably toward a future where healthcare is highly distributed, in the community, the home and the person.
  • Seek greater operational efficiency. Efficiency and quality go together, and we must raise the bar on both. Technologies and systems now exist in healthcare that can do this, and they should be applied to hospital and ambulatory care alike.

Regardless of whether the Senate proposal passes in its current form, in an altered form or not at all, hospitals and health systems need to accelerate their transition to becoming providers of highly reliable care that is high in quality, is error-free and provides the results it intends to provide. This is what will lower the cost of producing and delivering healthcare for us all.

 

Image courtesy of Benjamin Benschneider/NBBJ.

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Caring for Caregivers

Five Workplace Amenities that Support Healthcare Workers

June 13, 2017

Healthcare Practice Leader, NBBJ

Editor’s Note: This post was coauthored by George Takoudes and Kelly Griffin.

Millions of dedicated clinicians and medical professionals work in hospitals and clinics around the world. Unfortunately some of these employees experience long hours, occupational injuries and stress due to the nature of their work. Not surprisingly, in a survey of the most stressful jobs, RNs, surgeons, social workers and emergency dispatchers all placed in the top 10.

As a result, many healthcare organizations are increasingly focused on designing amenities, policies and workplaces to better support their clinicians, health providers and administrators. Interestingly, healthcare facilities — academic medical centers in particular — are wrestling with similar issues as corporate workplaces. Both seek to increase productivity, collaboration and work-life balance, and an improved workplace environment can help facilitate these goals.

Here are a few of the unique needs clinicians and other medical professionals face and the ways new workplaces — and specifically workplace amenities — have the potential to help:

Variety. A day in the life of a medical professional is varied and filled with physical movement — from reviewing patients, sitting with colleagues and teaching, to hands-on work interrupted by ringing pagers. Amidst this controlled chaos, doctors and clinicians also need places to wrap up emails and consult with colleagues. In terms of physical space for medical professionals, it’s about balance: finding the right ratio of shared spaces to individual workspaces to support spaces. It can also be about smart spaces that support improved processes and workflows.

Privacy. Patient privacy rules require healthcare workplaces to keep information confidential and discussed verbally only in a secure environment. Yet clinicians, clinical faculty and medical professionals also need privacy to decompress and, sometimes, to grieve the loss of a patient. As in corporate workplaces, allocating a range of quiet workspaces — from private offices to individual workstations to phone spaces — is key. While traditionally healthcare facilities feature more private offices than most corporate workspaces, some academic medical centers are experimenting with an unusual office approach, with as little as 60% individual workspaces and as much as 40% shared spaces.

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Staff lounge at the University of Washington Medical Center Montlake Tower (Benjamin Benschneider/NBBJ)

Respite. Many clinicians and medical professionals, especially those in palliative care, have difficult jobs supporting sick patients and their families. The workplace must give them the space to think, grieve and recuperate, and thus help prevent physician burnout. Amenities that are now commonly found on corporate tech campuses providing visual and acoustic privacy — retreat spaces, yoga rooms, support lounges and soothing gardens — can help bring calmness to a clinician’s or medical professional’s day. In Seattle, the University of Washington Montlake Tower features a room for exercising and relaxing with views of Mount Rainier and the Montlake Cut. On the east coast, Brigham and Women’s Hospital has a dedicated garden for staff, while at Massachusetts General Hospital, the surgical floors have access to daylight, which helps energize surgical teams who may spend long hours in the OR.

Community. Team-based medicine requires opportunities for group communication, and just like corporate office workers, clinicians and medical staff also need places to build community and celebrate events like birthdays and the lives of patients who recover as well as those who pass away. These can include home-like areas for gathering, welcoming visitors and sharing meals, which often facilitate social support. Yet areas for engagement and community-building are not just limited to indoors — the health care and insurance provider Kaiser Permanente is hosting farmers’ markets across the U.S. outside of their health centers and clinics.

Collaboration. Finding creative, flexible ways to encourage knowledge-sharing and idea-generation is essential to improving patient care. In a healthcare setting, this can mean trading private offices for shared space. For clinicians, it’s about providing shared spaces large and small that help ease the workday transition from clinical to office to community space. Departmental organization matters, too: at the OhioHealth Riverside Methodist Hospital Neuroscience Center in Columbus, Ohio, neuroscience, heart and vascular clinicians work together in one building, fostering an interdisciplinary approach to improve neuroscience patients’ experiences. In Boston, the newest medical technology at Massachusetts General Hospital syncs to smartphones so clinicians and nurses can communicate more easily, quickly and quietly.

 

The most successful amenities are not just “nice-to-haves” but crucial elements that make life better, easier and more joyous. The benefits are many, for employers — workforce recruitment, engagement and satisfaction — and for employees — stress-relief, refuge, privacy and emotional support — alike. In a healthcare setting, the lives of patients, loved ones and colleagues depend on facilities that support both the functional and emotional needs of clinicians, medical professionals and caregivers.

Banner image courtesy of Benjamin Benschneider/NBBJ.

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