Rethinking the Medical Campus

Three Steps Hospitals Can Take to Better Utilize Their Office Space

January 7, 2021

Healthcare Partner, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

This post initially appeared on Forbes. It was co-authored by Ryan Hullinger and Sarah Markovitz.

 

The Covid-19 pandemic has many industries reevaluating the office needs of employees, and healthcare is no exception. While ICUs are once again seeing surges of Covid-19 patients, not all spaces inside hospitals are being utilized effectively. Roughly one third of academic medical centers is dedicated to non-clinical hospital workspace. By rethinking administrative space, hospitals have an opportunity to elevate the workplace experience and free space for new (and more productive) uses. With this in mind, here are three steps hospitals can take to analyze and then efficiently utilize administrative space.

 

Measure the Current State

To create a more productive and effective workplace, hospitals first need to better understand how existing workspaces are being used. Space utilization studies, employing smart occupancy sensors and staff preference surveys, can help determine how frequently each space is occupied and why. This gives valuable information that can help identify underutilized and high usage spaces and create a data-driven foundation for decision-making. Hospitals also need to evaluate administrative space in terms of adjacencies, function, team dynamics and role requirements in order to understand how effectively space is being used and how it might change to better align with patient care and organizational needs.

This deeper understanding of space usage can then be aligned with current and anticipated workforce trends. The Covid-19 pandemic demonstrates that many tasks, especially in departments like administration, finance, medical records, case management, support and IT — can be done effectively from home at least part of the time. For some hospitals, it may make sense from a financial and productivity standpoint to enable certain positions to continue working remotely. Such a move could also help with talent attraction and retention, as a 2018 survey from Becker’s Hospital Review finds that 80% of healthcare workers want the ability to work remotely. Yet it’s important to note that there is no one size fits all solution — each hospital needs to weigh the specific costs and benefits of such moves and determine which employees should be on-site, remote, or a mix of both.

 

Rethink Workplace Design

Design can play a fundamental role in creating workspaces that foster a better workplace experience while using space more effectively. For hospitals pursuing a more wide-scale remote work policy, the reduced need for workstations and offices opens a number of possibilities. If remote workers are going to be in the office part-time, shared workstations may be an option which occupies far less space. Staggered shifts could also be implemented, allowing more people to use the same space, and modular furniture and partition systems set up which occupy less space but provide far more flexibility.

Hospital workspace could become more of a hub for project team work, multi-disciplinary consultation and collaboration, and hands-on learning and mentoring and social connection, while concentrated heads-down work happens at home. Hospitals could consider how outdoor space can be used for amenities, informal collaboration and connecting to nature, effectively expanding the usable office without increasing the square footage. With less space dedicated to offices and workstations, more engaging amenity and teaming spaces could also be carved out within the existing footprint.

The private physician offices, which typically range in scale from 80 to 120 square feet or larger for director level positions, are another area for consideration. While recent trends point to smaller offices and increased team space, academic medical centers still offer far more private offices and relatively little meeting space when compared to contemporary high performing corporate workplaces. Yet this is changing as systems begin to reevaluate the return on investment for this space. Some have found that when departments are required to lease space using their own funds, many physicians opt not to have a private office, and choose instead to allocate that funding to other areas of the department.

However, there may be opportunities to retain the prestige and advantages of private offices without needing to dedicate the actual office space — which can be costly to build and maintain. For instance, private offices could be consolidated into shared workspaces, with access to a physicians-only, amenity-focused lounge that encourages new levels of collaboration. Alternately, physicians could be provided resources to outfit their home offices with high-end technology and furniture, freeing office space on campus while still maintaining physicians’ private offices in considerably less expensive residential settings. With the expansion of telehealth and physicians’ ability to work from home, this latter option may become more prevalent.

 

Evaluate New Uses

For some hospitals, the process of understanding space and adopting new workplace design strategies will result in consolidated office footprints or smaller clusters of offices. The question then becomes how to put the newly emptied space to better use. Some hospitals may opt to expand IT, digital and virtual capabilities into the vacated space, creating electronic ICUs, command centers for monitoring patients, or centers for telemedicine.

Other hospitals may look to use the excess space to expand fast-growing service lines into adjacent, previously unavailable workspace. With significant wait times for many key procedures at hospitals, the chance to extend clinical capabilities without building new space is a unique opportunity. Alternately, hospitals may opt to expand staff wellness spaces or services, or services which typically have difficulty finding space such as occupational and physical therapy, holistic and wellness services, community education hubs, or patient support groups. Some of these programs could even be accommodated after hours in hybrid spaces used during the day as offices, amenities or team spaces. Hospitals may also use space to improve safety and infection prevention, such as areas for rapid testing for employees — both now and for potential future pandemics.

With the financial implications of the pandemic still unfolding, there is a heightened need to make better use of existing real estate assets. This is a complex task that will lead to different outcomes for each hospital, but the process can reap significant benefits — both in financial terms, and in the workplace experience and productivity of staff.

 

Banner image courtesy Sean Airhart.

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Rethinking Healthcare Hubs In The Post-Covid Era

Three ways technological advances will shift healthcare delivery, from the traditional hospital to at home services.

November 2, 2020

Principal, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

This post initially appeared on Forbes. It was co-authored by Sarah Markovitz and Ryan Hullinger.

 

The explosion of telehealth prompted by the COVID-19 pandemic has accelerated a shift in care delivery away from the hospital and clinic and into homes and communities. While hospitals have historically been the main hub of care, technology and new care models are enabling a different approach to care delivery. Rather than episodic preventative care, in which a patient periodically goes to a physician or hospital with a health concern, this new model of care is continuous and ubiquitous — with ongoing care reinforced in the home, office, school and throughout the community. There are three key aspects to this shift: advancing technology, new care settings, and the future evolution of hospitals.

 

Advancing Technology

Healthcare may follow a familiar path blazed by online retail. It was not that long ago that virtually everyone preferred in-person retail experiences to shopping online. The technology that would later make online shopping experiences superior to brick and mortar just didn’t exist. Telehealth, by comparison, is still in the dial-up days. It’s difficult to imagine now, but based on the patterns we have seen clearly in other technology sectors, it’s probable that some healthcare experiences will be better remotely than in-person—more convenient, and less stressful and time consuming. The technology that will transform telehealth is on the horizon. It will take several R&D cycles, but it will come. In fact, there’s evidence that in areas like behavioral health telehealth is already comparable in efficacy to in-person care.

What might the next generation of telehealth look like? For one, rather than sequential visits with separate specialists, patients may be able to connect to a suite of caregivers, all working collaboratively to provide more coordinated, effective care. The type of continuous, convenient touch-bases and flow of information enabled by telehealth and wearable devices could be particularly effective for the elderly and those with chronic conditions, where communication and ensuring compliance with medication and preventive care are often an issue. There will also likely be an expansion in the types of care and services that can be provided, including everything from post-surgical appointments, to ED triaging, and eventually more complex tests as new diagnostic technologies emerge.

Automated technologies and artificial intelligence will also play an increasingly vital role in improving health throughout the community. AI technologies are being used to scan patient records, identify patients with hypertension and diabetes, and remind physicians to check in regularly with them. Hospitals have already shown good results using telehealth, texting and improved monitoring to help vulnerable populations and those with chronic conditions. Improved telehealth and health data capabilities could extend widescale efforts like these, improving population health efforts.

 

New Care Settings

With technology acting as a facilitator, more and more forms of care, especially routine procedures, will migrate away from hospitals and clinics. The home could become the new healthcare hub, with prefabricated telehealth units for the home that integrate medical technologies with telehealth capabilities. The explosion of smart home, home health and health monitoring devices, encompassing everything from sensors that detect sudden falls to smart watches that monitor heart rate and O2 levels, is only the tip of the iceberg. With the ability to monitor health data and communicate effectively with caregivers, the home could be a crucial site for preventive medicine, chronic disease management and ongoing care.

The home health model is only one possible model—the technologies that enable it may have shortcomings, or prove unaffordable to large segments of the population, further exacerbating health inequities and the digital divide. But healthcare can still be provided in a wide range of locations distributed throughout communities. Libraries, schools, community centers, homeless shelters and pharmacies could become hubs for telehealth resources and care, serving a vital role in improving the health of communities. A key consideration will be access and location—ensuring that healthy equity and care for vulnerable populations drives where these new care hubs emerge.

 

How Hospitals May Evolve

As care becomes increasingly continuous and ubiquitous, the role of the hospital may evolve. Rather than serving as a destination for all patient types, it will become increasingly specialized and streamlined, focusing on high acuity cases. They may expand their capabilities and efficiency in areas like perioperative and high-end imaging that are not available in community settings. In the process, hospitals are likely to become more compact, high performing and efficient by narrowing their focus. As part of this evolution, hospitals may also need to bolster their ability to expand capacity by 50-100% in anticipation of emergencies like epidemics, mass casualties and weather-related crises.

In the last 20 years, many hospitals have invested heavily in improving patient comfort and satisfaction, and have even borrowed processes and designs directly from the hospitality industry—creating patient environments that nearly resemble hotel lobbies and guestrooms. Patient satisfaction will continue to be a driver, but the environments that promote satisfaction are likely to change drastically. New environments that convey a sense of safety and cleanness will begin to feel more comfortable than the hospitality-informed designs of the past.

As this shift and gradual downsizing takes place, there may be opportunities to adapt existing space for other uses. The COVID-19 pandemic has demonstrated the dramatic impact of stress on healthcare workers. Hospitals now have an opportunity to provide sufficient and appropriate space for staff, helping to build resiliency to counter staff burnout and ensure the well-being of these truly essential workers. Hospitals could also aim to provide more community, patient and staff resources, such as spaces to demonstrate telehealth technologies and how to use them, or new hybrid offices equipped for telehealth.

As technologies, new care settings, and hospitals evolve, care will become more embedded in our daily lives. The pandemic may have spurred new interest in telehealth, but the trends shaping the future of care predate social distancing. They will continue to transform how and where care is delivered, ushering in a new era of ubiquitous healthcare.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

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How Can We Mitigate Stress for Frontline Healthcare Workers?

Evidence-based Strategies to Build Worker Resilience During the Covid-19 Pandemic and Beyond

September 28, 2020

NCIDQ LEED® AP Senior Associate I Interior Designer, NBBJ

Editor’s Note: This post was co-authored by Katie Davis, Sarah Markovitz and Andrea Rufe. 

 

The impact of Covid-19 touches all aspects of healthcare, but is especially acute when it comes to the wellbeing of frontline workers. Communities look to first responders during times of crisis, which is why the wellness of these individuals is critically important now. The pandemic’s impact on the mental health of these workers is profound, causing psychological distress. It also increases burnout, which can lower work performance and raise the risk of errors. Yet the coronavirus crisis also creates opportunities for positive change.

Key neuroscience insights illuminate strategies to help alleviate the challenges frontline workers face. These findings paired with designs that bring moments of calm and foster connections can create a roadmap for healthcare facilities — from hospitals to ambulatory centers and clinics — now and in the months ahead.

Backed by neuroscience research from NBBJ’s Fellowship Program, this post examines three ways to boost healthcare employee resilience through changes to physical environments, operational protocols and organizational systems. The ideas center on a variety of practices and respite areas — each of which can be implemented at various scales — both in traditional and non-traditional healthcare settings.

 

Support Spaces

Spaces that offer opportunities for caregivers to turn to one another for support and share solutions, especially through talk therapy, can strengthen resilience and happiness. Offer frontline workers ways to connect with someone trained to listen, such as dedicated staff or virtual mental health services. Existing rooms that provide privacy can be repurposed for these conversations with comfortable seating and couches, tables and video conference support. Furthermore, a focus on total wellness via health coaching stations with programmed nutrition, mental health and exercise classes can offer a comprehensive growth-oriented suite of amenities to build a strong support network, improve memory, enhance cognitive function and create a better quality of life.

Restorative Zones

Restorative zones create space for frontline caregivers to recharge — in the good times, but especially so in times of crisis. Restorative zones are hyper flexible: they can leverage underutilized spaces for a moment’s rest such as a quiet alcove at the end of a hallway with a window that overlooks a garden. They could include comfortable high-backed sound-absorbing chairs with ottomans to rest one’s feet and a table to place a rejuvenating refreshment or inspiring book. On a larger scale, a refuge room filled with plants, natural light and the sound of running water — or even a digital wall of nature imagery — can provide an immersive sensory experience.

Mindfulness Rooms

Spaces that facilitate mindfulness can promote mental wellness and greater resilience to challenging situations. Mindfulness can be promoted at various scales. A small niche with room for a yoga mat can help build mindfulness techniques, like deep breathing, that can be called upon anytime during the workday. Mindfulness micro practices can also be cultivated during daily routines by incorporating biophilic design in transitional spaces like stairwells. In addition, meditation, yoga and massage rooms can offer regular mindfulness sessions and promote connections between staff outside of their normal work tasks.

 

Wellness for frontline staff encompasses a whole-health approach for individuals, departments and organizations. It’s powered by meaningful work, relationships and uplifting spaces that support strength in and outside the work environment.

These ideas are part of a comprehensive report by the NBBJ Fellowship Program which outlines ways to mitigate stress for frontline healthcare workers, how to create new work rhythms and how to remain human in a hybrid virtual-physical world. To learn more about these concepts and the supporting research, please email socialmedia@nbbj.com.

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