January 30, 2014
By Brian McFarlane AIA, Principal and Group Director for Healthcare Development, HKS, Inc. and David Prusha, AIA, Principal and Federal Healthcare Team Leader, HKS, Inc.

As new reimbursement models, care protocols and technology are transforming the healthcare field, HKS planners and designers are providing a responsible and creative approach to addressing healthcare needs. Careful analysis and flexible design are critical to creating facilities that will serve communities well in today’s changing healthcare environment, and also be responsive to changes that occur down the road.

Given the new healthcare landscape, every facility must now be approached as a greenfield project. Prior assumptions no longer apply.

With universal insurance coverage through the Affordable Care Act (ACA), many patients will have a broader choice for hospital care; people who previously may have needed to travel to a large, central nonprofit or public hospital will likely choose to be treated closer to home. This has the potential to distribute the inpatient population across a greater number of hospitals.

Universal coverage is also intended to increase primary care utilization, preventing the scenario in which patients go to the emergency room to be treated for a cough. Wellness and preventive care must be emphasized, especially when treating common conditions like high blood pressure and diabetes that can escalate into acute inpatient status if left untreated.

The ACA is also meant to limit hospital readmissions. As one measure of the healthcare law, the Centers for Medicare and Medicaid Services are reducing payments to hospitals who readmit too many patients with certain conditions too soon (within 30 days) after the patients are discharged.

Medical advances are contributing to an ongoing shift away from lengthy inpatient stays. Cardiac care, for example, has progressed in large part from major surgery to minimally invasive procedures. Nine million people participate in e-medicine annually. As more physicians adopt virtual visits and telemedicine, this number is projected to grow.

All of these factors must be considered in determining an appropriate hospital design. Analyzing a community’s true healthcare needs is essential to establishing the proper adjacencies, square footage and number of inpatient beds.

Buildings are set in concrete and steel, but community needs are not. The only constant in healthcare is change; this, too, is a key design consideration. Solutions are based on available information, and while that information will inevitably become outdated, hospital facilities don’t have to.

A hospital designed with an open core and flexible infrastructure is adaptable to future needs. Techniques like stacking the vertical risers and mechanical systems of patient units create clean spaces that can be utilized a number of ways without extensive renovation. In this sense, a hospital’s most important design features may be essentially invisible. What you can’t see – behind the walls and above the ceiling – are key as care protocols and patient populations continue to change.

A design process that thoughtfully examines immediate and future needs makes good use of healthcare resources. Facilities that allow for incremental growth will remain “just right” for their communities: neither overbuilt nor undersized, ready to meet the challenges of caring for patients today and tomorrow.

Tagged AHA healthcare design, Brian McFarlane, David Prusha, designing smart, new rules for healthcare design, Smart Healthcare