Getting Hospitals Back on Track: Safely Bringing Healthcare Back Online

How to Prepare Our Hospitals to Balance COVID and Non-COVID Care

May 21, 2020

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.

 

Since the middle of March, nearly all elective surgeries and medical procedures in America were postponed to create capacity for the first wave of Covid-19 patients. While the curve has started to flatten and many facilities are reactivating their procedural platforms, there is still hesitation in patients seeking in-person care for fear of inadvertently exposing themselves to the virus. As a result, many patients with both chronic and acute conditions are putting off necessary health maintenance and avoiding trips to the hospital.

For the healthcare industry, this is devastating both in terms of its impact on patient care and its bottom lines. Hospitals — especially non-profit hospitals — historically operate on extremely narrow financial margins. With so many departments sidelined, the average American hospital has seen an estimated average drop in operating revenue of 40 – 45%, resulting in significant furloughs. These actions take a huge emotional toll on staff, many of whom were bracing for battle only a month ago and are now suddenly without a job.

America can’t afford to continue putting its wider healthcare system on pause in the likely event of another patient surge in the summer or fall. So what solutions could help keep appointments and procedures on track? And how can we ensure that they are performed in a safe manner?

All entrances, lobbies and screening processes should look calm and well-organized to assure patients that the facility is in control of the situation and safety is the number one staff priority.

There are many design changes that can make this happen and many of them begin before patients set foot on hospital grounds. Hospitals should use their websites to present clear communications with patients so they are aware of the safety precautions and instructions for their arrival.

Inside the hospitals, there needs to be legible signage that communicates cleaning and disinfecting processes for the facility. For example, many hospitals have existing digital signage outside of rooms that previously communicated room occupancy. This can be repurposed to communicate cleaning frequency and efficacy. This can be as simple as something like “This room was cleaned three minutes ago and is ready for use.”

Thoughtfully planned wayfinding will be equally important. These need to demarcate separate pathways for those with and without Covid-19 symptoms entering the site, covering the patient journey from the parking to the entrance to the treatment areas. Wayfinding solutions could use unique colors and shapes – such as the color pink or a triangle shape – to help messages stand out.

Planning hospital flow for optimal safety

Accommodating coronavirus and non-coronavirus patients in the same hospital requires thoughtfully planned and clearly delineated processing and treatment zones. The Centers for Medicare & Medicaid Services recommends establishing distinct zones for each group. In the coronavirus care areas, symptomatic patients will be identified, screened and receive appropriate medical guidance and contract tracing efforts. Where possible, these areas should be physically separate from other hospital services — this could be a different building, a dedicated room/floor with its own entrance, or pop-up tents adjacent to the hospital.

For patients with Covid-19 who come for treatment of other issues and conditions, a bespoke multidisciplinary clinic can be set up to address their needs. For patients who have yet to be screened, administrators can work together to plan uni-directional flows throughout hospitals so those coming in and going out don’t cross paths with one another.

This will also require consideration for features like elevators to ensure they don’t become contamination zones — potentially by having designated staff operate them, reducing the number of persons allowed in at any given time, and identifying separate elevators for coronavirus and non-coronavirus patients.

Rethinking the waiting room

Balancing care for coronavirus and non-coronavirus patients in parallel may require rethinking the traditional waiting room entirely. Hospitals are designing new patient experience systems to alleviate patients’ anxiety by limiting the amount of time in the hospital outside of direct appointments and treatment.

After being screened for Covid-19 at a triage tent, patients can wait outside the hospital until they receive a text that their doctor is ready to see them, at which point they are taken straight into a treatment room to promptly be seen by their provider. By using mobile communication tools, these hospitals are decentralizing and streamlining the waiting room experience.

For the majority of Americans who access hospitals with their own vehicle, cars could become the new waiting room. For those living in more urban settings, hospitals can consider converting larger and more spacious rooms like cafeterias and conference rooms into waiting areas. This would allow for greater distance between patients waiting to be seen. Reconfiguring furniture for appropriate spacing, leaving signs on chairs and tables after they’ve been cleaned, and using markers to establish appropriate distancing for any lines are all immediately actionable solutions.

All of these considerations will change as PPE supplies, Covid-19 screening, antibody testing, and tracing programs continue to evolve. By closely aligning thoughtful and innovative hospital programming and operations with solutions that project a sense of safety and care, we can start to reconfigure our hospitals and healthcare facilities to operate within this new reality.

 

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.

Banner image courtesy Benjamin Benschneider.

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Fear Factor

Seven Choices for Work Environments that Underscore the Need to Respond, Not React

May 20, 2020

Partner, NBBJ

@ryanjmullenix

COVID-19 illuminates the world to many pitfalls in current workplace design. Issues of density, location and balance have been laid wide open for all to attack. That’s a good thing. But in the ensuing conversation, are emerging ideas actually more regressive?

During a time of unknown, humans desperately want answers. When we’re inundated with information and anxious about the world around us, we often look for quick solutions. We also miss long-standing cues, touting reactions as fresh ideas instead of acknowledging them as changes that should have already occurred (look no further than the 35-year notion of biophilia). But more dangerously, we can generate solutions without considering what makes us who we are: human. As this unfortunate crisis fuels a long-needed conversation about where and how work is done, I’m most wary of ideas that celebrate the expected to the detriment of those doing their jobs.

Below are predictions made from a reactionary mindset, coupled with realities that have been in front of businesses for some time. These positions are countered by responses that, instead of holding our working society back, seek to pull it toward lasting results.

Reaction: We will need to de-densify
Reality: Employees have already made this decision

Yes, fewer people with greater distance in-between means less likelihood of spreading or contracting disease. But we’ve known the implications of density on holistic human health since the industrial revolution. It’s no coincidence that as the number of square feet per person has decreased in an office, so has floor efficiency as more people work remotely due to these conditions. For the last 15+ years, technology has enabled workers to vote with their feet to create “preferred density.”

There’s a strong desire to solve problems with concrete measures like physical space metrics and basic division (overall square feet divided by total population). However, this challenge seems better suited for organizational strategies that align work modes with the proper environments to support them. It’s beyond simply offering the chance to work from home – it also means not designing ubiquitous spaces that try to be everything to everyone, an aspect of the “open office” that many despise. This attitude will allow companies to reduce the number of people in a space at one time (less density) while increasing the number of employees a space serves (more use). The resulting choreography should increase job satisfaction while reducing congestion on the road or on public transit, an outcome our planet and nervous systems would greatly appreciate.

Reaction: We will need a six foot physical boundary around us
Reality: People will return to the office to overcome barriers, not to create them

In addition to reducing density, establishing physical separation between people is being advocated through the return of the protective cubicle (sneeze guard included). As much as my engineering mind loves games like Tetris, repeatable system layouts that drive how people do their work are rarely the right place to start. And what are the correct dimensions? Testing is showing just how variable the range of a virus can be.

It’s not necessarily a coincidence that when the movie Office Space appeared, cubicles nearly disappeared. Cubicles are isolating and demoralizing, they block light and view, and most use porous acoustic material (aka virus breeding grounds). Why come to an office for that? I hope that before putting this solution into action, we fully understand the risk of adding these anachronisms to our offices – and then landfills – again.

Reaction: We can fuse social interaction and isolation into one space
Reality: It’s impossible to go against our hard-wired brains

There are suggestions that we should build workplaces that enable us to be together and yet apart. Is the office of the future the awkward middle school dance of my past? Or will it be a game of tag, where we can’t help but try to guess who’s “it” – an outcome that soberly could lead to inadvertent discrimination.

We all appreciate the importance of engaging others in our personal and professional lives, especially now. With that comes the beautifully organic, somewhat unpredictable means of interaction. As a result, there will always be pinch points. Visit any grocery store now to feel this in full effect. At the height of this crisis, even strangers are challenged to respect mandated personal space. Although spatial configuration, RFID mapping, and visual cues may offer a quick but uncomfortable solution, advanced health screening and progressive quarantine protocols should provide greater confidence in our interactions. This trust-based attribute is important to team risk-taking and creativity. It’s also more inclusive for those with impairments.

Reaction: We must limit our sharing of technology, and potentially, space
Reality: Nobody wanted to use someone else’s keyboard anyway

Reducing the transfer of communicable disease through what we touch is important, but let’s be honest, sharing work supplies is almost as bad as getting the warm chair in a conference room. Although I hope the share economy continues in many forms, “hot-desking” has forced a bigger conversation around blurring personal preferences with professional support (if we ever want that concept to return, we should rethink the name).

The opportunity in this moment is to better discern the significant distinction between individual and communal uses. Such insight will be crucial to reimagining post-COVID buildings that can still become 24-hour shared resources. Psychology and urban design provide much-needed expertise in identifying the spaces and places that humans will accept as co-habitable.

Reaction: We must upgrade our air filtration systems
Reality: We’ve been breathing bad air for some time. Improving health goes beyond filtration.

Clean air is something we’ve struggled to achieve in the office for 40 years. Our fascination with sealing buildings entirely in the 1980s left us with a false sense of domination.  When our environments became artificial – lighting, heating, cooling, etc. – our minds felt we were controlling nature while our bodies knew otherwise. This arrogance blinded us from the reality that CO2 buildup in our conference rooms was impacting our thinking.

Instead of only upgrading filtration, rethink the entire mechanical approach. Thermal mass, radiant systems, and self-shading require less air to be conditioned and then circulated. Where possible, increased natural air changes are obviously ideal. Don’t forget to address exhausted air; what we spew out of our buildings not only impacts global warming but the health of our neighbors next door.

Reaction: We require chemicals to achieve healthy workplaces
Reality: Wait, more chemicals in our environments? Let’s focus on awareness.

Understandable anxiety around the unseen prompts us to default to what we know works. It also reveals the danger of environments being curative, not preventative. Yes, chemicals can eliminate viruses, but let’s not lose sight of the fact we had just committed to getting hazards out of our spaces.

While sanitation is important, much of a healthy environment is derived from individual attentiveness and choice. Practitioner insights and raised awareness around personal hygiene, general cleanliness, and bathroom etiquette will hopefully keep us from having to take an untested blanket approach. Nature (surprise!) may also have an answer. We continue to learn more about daylight and temperature as allies in fighting viruses. We can also proactively bolster immune systems through universally-accessible pinenes like cedar and rosemary, both which smell better than disinfectant.

Reaction: We won’t need offices anymore
Reality: What is an “office” anyway?

This definition depends on the work you do and how you do it. Sure, technology has increased the number of tasks we can do remotely. But it hasn’t satisfied our desire for social interaction, or the heightened sentience and better ideas that can come from it. It also hasn’t changed the fact that physical space helps reinforce the tangible ethos and culture of an organization. Without these relationships, we risk becoming teams of task-based contractors searching for identity and connection to mission.

We continue to have a dualistic mindset of work happening in either an office or at home, but as we’ve known for years, work for some people can happen everywhere. How it’s done best, however, is dependent on you, the work you’re doing, and the experience you seek. Today I’m less intrigued about fewer days in the office and more interested in fewer hours in one place, office or not. We can all benefit from mapping out what makes our individual workdays rewarding.

In light of constantly emerging and often-changing information, responding to causes versus reacting to symptoms is essential. It’s a challenging feat – we as humans will never be free of compulsive reactions because we want the surety that quick answers seem to offer. Unfortunately, though, those answers usually lie within our own spheres of influence. Broader exposure to science, history, and design thinking is critical to ensuring meaningful progress. Don’t rush ahead because you’re afraid of being left behind. Use this pause to interpret that fear, and then respond with your way of working. Exemplify awareness… your fellow humans need it.

 

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

Banner image courtesy Sean Airhart.

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Is Your Real Estate Strategy Prepared for What’s Next?

Questions to Consider and What to Do If You Don’t Have a Strategy in Place

May 19, 2020

Senior Associate, NBBJ

Editor’s Note: This post was co-authored by Jonathan Bahe and Kelly Griffin.

 

The coronavirus crisis and social distancing are reshaping how we work on a global level. For some of us, our homes are now our offices. Even when it’s safe to return to the workplace, some will feel most productive completing solo tasks from home at least part of the time.

As such, the workplace may evolve to become the “central nervous system” of organizational culture and collaboration, offering people the flexibility and professional trust to find spaces that serve their needs best. While the office of tomorrow will look different for each company, the COVID-19 crisis presents a moment for all organizations to pause and ask key questions about their real estate strategy. Below are a series of nine questions to help determine the right pivot approach, if you have a strategy in place, as well as ideas on how to help adapt the workplace — not just in the short term, but for the long term as well. If you don’t yet have a strategy in place, we also outline steps to create one toward the end.

 

Re-Think Existing Real Estate Strategies

1. Is your real estate strategy aligned with your workplace strategy? Do you distinguish between the two? For many organizations, a real estate strategy might be more financially and macro-scale focused, while the workplace strategy might be more people and micro-scaled focused. These are both critical components to a robust plan for the future.

2. Has the pandemic shifted long-term business priorities for your organization that would also require changes to your real estate and workplace models?

  • Perhaps you are a healthcare organization that has both heroically supported our communities through one of the most difficult times in our history, and yet face significant financial headwinds. How might this moment shift thinking about your real estate strategy and portfolio? Do people need to work on campus all day, every day? Can organizational hierarchy in the assignment of real estate give way to creative models for allowing people to do their best work?
  • Or perhaps many members of your organization were already out of the office frequently, meeting with clients or executing client work. Will the realization and acceptance of video conferencing at scale actually keep people in the office more frequently?
  • Or perhaps the economic headwinds have slowed the growth projections of your company, and you are asking what’s next? How do you be smarter about real estate costs in the future?

3. Is your existing real estate strategy focused on financial metrics or on people metrics?

  • If financial metrics are your biggest driver, you might choose to take this moment to re-examine what and how you measure success. Newer, modern workplaces, particularly those that embrace a more flexible workplace, will have different metrics than traditional cost per SF or SF per person than previous environments.
  • If people metrics power your business, how can your workplace support dispersed teams and flexible work modes, while still maintaining (or increasing) your organizational culture? What are existing people metrics — net promoter scores, employee engagement survey results, etc. — telling you about workplace environments, or about your culture that a new workplace might address?

4. Do your HR team members have a work from home policy in place that aligns with your real estate strategy?

  • If not, what steps might you need to take to align them?

5. What is your organizational approach to seat sharing and/or hoteling?

  • If seat sharing is part of your strategy, how will you operationalize the needed resources to ensure the safety and cleanliness of the workplace?
  • If seat sharing is not a part of your strategy, how are you going to effectively manage workplace capital spending for a future where more people will work remotely, versus being at their desk 100% of the time (which was already the case for many organizations pre-COVID)?

6. What elements of your strategy were already working well, and have proven effective as you’ve responded to COVID-19?

  • Maybe you already embraced flexibility, or had begun making investments in video conferencing and virtual collaboration platforms. If so, you’ve likely been more successful than others at the transition.

7. What are key elements about your culture that you want your workplace to reinforce, and is the design of your current workplace doing that successfully?

  • Will it still be successful if you have a blended approach to working from home and working in the office?
  • Do you have the right mix of collaboration spaces, focus spaces and amenity spaces to support your culture in a more flexible work environment?

8. Have you reviewed upcoming leases to see if any shifts in strategy might be implemented immediately and generate near-term savings opportunities, versus those which might be implemented on new projects moving forward?

  • Do you have any lease termination rights, or the opportunity to exercise an early termination option on part of the portfolio? Or perhaps you are in a position to negotiate an early extension with your landlord in return for concessions?
  • Having a committed team in place as a key part of your real estate strategy can help you answer the variety of questions and scenarios that will support the implementation of your new approach.

9. For projects currently in the design and construction pipeline, what shifts (if any) might you need to make to adapt to this new strategy?

  • If you are currently planning a 1:1 approach to seating, but your new strategy indicates that hoteling (at even a small ratio) might be a good fit, what redesign or renegotiation might need to happen to support that change?

 

Create a New Real Estate Strategy

Of course, the questions above are only relevant if you’re among the companies that already operate with a real estate strategy in place. If you don’t yet have a strategy, which would put you in good company as the majority do not, it’s not too late! Whether you are the CEO, the COO, a corporate real estate executive, or a leader in your organization, the development of a real estate strategy can: 1) Provide your organization with a clearer map for the future; 2) Better align your talented staff, the way they work and your organizational culture; and 3) Better project, manage and perhaps even reduce CapEx and OpEx real estate expenses for your organization. A win, win, win all around.

An integral step in developing a real estate strategy is establishing an effective workplace strategy, highlighted in the “congruence model” below. This model aligns multiple systems to create a holistic workplace experience and enhance human performance. Once you determine how your space will be utilized now and in the future — as well as how remote work policies and virtual collaboration tools will be deployed — your teams can make better decisions about their real estate needs.

 

Embrace Uncertainty to Adapt to the Future

No company could fully prepare for the difficulty of our current times. How we recover and go back to work (pre-vaccine) will continue to be debated, tested, and adapted as we learn more. The next 12-18 months will be filled with questions, uncertainties and unknowns — all of which will increase stressors on leaders and our workplaces.

Yet with a robust real estate strategy as your guide, organizational decisions about the future will become clearer. As optimists, we’re excited about workplaces that nurture employee health, connection and creativity, while also aligning design strategy with organizational strategy. Leading organizations will embrace this moment as one of the many inevitable, unknown disruptors to their best-laid strategic plans, and flex their organizational muscles to adapt for a new future.

 

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

Banner image courtesy Edmon Leong.

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