Healthcare Revolution: The New Care Environment

LifeStructures Knowledge ANALYTICS

HEALTHCARE REVOLUTION:

THE NEW CARE ENVIRONMENT GARY VANCE FAIA, FACHA, LEED AP DEREK SELKE AIA OCTOBER 9, 2014

INSIGHT

STRATEGY

OCTOBER 2014 | W H I T E P A P E R

The Changing Face of Healthcare United States healthcare delivery is changing. A common consensus is that the system will be unsustainable as solutions to fix it lack the creativity and energy to carry it into the future.

Gazing at considerable hospital structures and mammoth health campuses, it’s no wonder costs in the U.S. are ranked among the world’s highest while clinical outcomes remain mediocre.

Maintaining aging facilities or even building new is becoming capital intensive as healthcare continues along an evolution challenged by economy influences and legislation.

There needs to be revolutionary change in the planning, design and construction of these environments in order for sustainability to occur. The focus is on patient-centric approaches and with advancing technology the ability to overhaul and transform a built environment into a new care environment is closer than we think. Flexible treatment modules that offer an array of health services could be here before the remaining Baby Boomer generation reaches retirement.

Is this the moment when United States healthcare jumps the shark, or will the right revolution change everything?

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W H I T E P A P E R | OCTOBER 2014

Current Healthcare Costs & Facility-Centered Thinking Healthcare has seemingly grown to encompass a very facility-centric approach. Approximately 50 percent of the square footage in hospital structures does not offer direct patient care. In addition, the estimated annual cost for the operation of the physical plant is $10 per square foot.

Considering many facilities average 250,000 square feet, the number can end up in the upwards of $2,500,000 a year. This includes both the operation and maintenance of the space.

Recent economic and legislation changes create new challenges for physically modifying facilities in order to keep up with care demands. Planning inpatient areas, surgical units, and treatment centers may be less challenging for new construction; however, the price tag for building new can deter owners into reusing older facilities. Depending on the structure, many renovations can be just a cost intensive and more difficult well before mandatory regulations are considered into a project.

As funds are funneled into projects, the rate of hospital inpatient use continues to follow a projected decline. Outpatient care involves excessive steps for parking, navigating facilities, registering, waiting and departing – all of which require additional space beyond the exam room.

When analyzing these statistics, it is easy to think that a major challenge and concern for care providers is trying to make built environments work with as few substantial costs as possible. The problem with this constant concern and focus on facility is that it moves us further and further from the patient.

TOTAL SQUARE FEET PER BED IN COMMUNITY

AGE SOURCE: Fishbeck, Paul. “Us-Europe Comparisons of Health Risk For Specific Gender-Age Groups.” Carnegie Mellon University; September, 2009

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HOSPITALS – MAIN CAMPUS

LEFT: The rapid rate of obsolescence of the Community Hospital based on the inpatient bed model.

SQUARE FEET PER BED

ANNUAL PER CAPITA HEALTHCARE COSTS

HEALTHCARE COSTS BY AGE CATEGORIES

YEARS IN DECADES SOURCE: LifeStructures Metrics, BSA LifeStructures

© 2014 BSA LifeStructures / Patent Pending

OCTOBER 2014 | W H I T E P A P E R

Efficiency Without Patient Focus Misses the Bar Potential capital cost expenditures are enough to make anyone seek new and innovative ways to be more efficient; however, cost efficiency is not always inclusive of patient-centric care.

The complexity of hospital organization charts oftentimes positions decision makers at the top while in between them and the patient are layers of departments, divisions, management and offices. This setup supports operational efficiency; however, it maintains a gap between the patient and those who have the greatest impact on care and environment.

Patient dissatisfaction and high costs attribute to why many individuals select to receive care at various off-campus ambulatory facilities. In addition, the convenience and savings found at clinics within popular retail stores may become more appealing to individuals, even though some experts voice concerns in the quality of care.

Ambulatory centers have removed the difficulty of navigating parking lots and unfamiliar structures while diminishing complex organizational charts to include an ever-growing of hierarchal management. However, consistency in service along with the care environment challenges of noise, temperature and cleanliness can be even more prevalent in these types of facilities.

Š 2014 BSA LifeStructures / Patent Pending

TOTAL POPULATION (2011–2021)

115

INPATIENT USE RATES (PER 1000 POPULATION)

Recent studies on patient experiences have revealed that facility-related satisfaction is ranked among the lowest for the U.S. Many responses to care evaluations have shown that most frustrations deal with temperature, noise and cleanliness. The common solutions for addressing these concerns result in relocation of common areas or patient rooms, specialized materials and advanced systems. Correcting issues oftentimes increase costs to care providers, which trickle down through an organization to the end-user.

MILLIMAN PROJECTIONS FOR INPATIENT USE RATES FOR

YEAR

SOURCE: Private Study Conducted in 2011 by Milliman for Kaufman, Hall & Associates, Inc.

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W H I T E P A P E R | OCTOBER 2014

At the Intersection of Patient-Centric Environments and Technologic Advancements As innovators are creating smarter, faster, smaller and more accessible devices, technological advancements in healthcare can become the bridge between patients and a new care environment. Innovations and advancements are already appearing in all of the multidisciplinary aspects of our healthcare system and industry. It’s only a matter of time before we see what’s next.

Science and technology will allow healthcare to move toward a precision based model.

As we further understand the human genome, the industry will transform to personalized medicine.

Science and technology will allow healthcare to move toward a predictive analytic model.

Results in the access to actionable patient information.

Innovation will allow medical equipment to be smaller, less obtrusive and less intimidating.

Results in a more patient-centric environment.

Innovation will allow medical equipment to be more portable and even located in patient treatment areas.

Patient does not have to move from treatment area.

Innovation will allow for the consolidation of multiple elements into less equipment.

Results in a more patient-centric environment.

Technology advancements will allow patients to fully control and personalize their treatment environment.

Results in the control of lighting, color, exterior light, images, media, temperature, noise, cleanliness and all aspects of the environment.

Integrating these many possible elements into the built environment is the key strategic step for leveraging technology advancements. In the past, we have considered these elements individually as opposed to a fully integrated and coordinated approach to care.

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ABOVE: Sharp’s medical monitoring device monitors health and sends vital statistics to doctors.1

ABOVE: Large Scale 3D printer at work.

(Steven Keating, Mediated Matter Group)

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© 2014 BSA LifeStructures / Patent Pending

OCTOBER 2014 | W H I T E P A P E R

The Voice of the Customer and Patient-Centric Environments As with other facets of healthcare, the voice of the customer has become extremely important to the built environment. The need and requirements for true patient-centric environments has now become the expectation by patients and their families. This is due to many factors: • • • • •

• •

Evolution of consumerism in healthcare.

Ease of patient access to health knowledge and information.

Movement towards preventable health measures by patients.

Improvements in patient satisfaction systems (technology/software).

Implementation of HCAHPS scores and the related factor of hospital reimbursement being connected to these scores. (HCAHPS - Hospital Consumer Assessment of Healthcare Providers and Systems) Increased pressure on reducing the cost of healthcare services - for both insurers and consumers.

Patient expectation of the best possible outcomes with their healthcare experiences.

Due to changes in private insurance and the Affordable Care Act; patients and their families have the incentive to manage their health. This incentive is both a quality of life matter and financial consideration. As a result, patients are becoming highly involved in all aspects of their health and healthcare experience. The evolution of this patient trend and empowerment has become known as the “Voice of the Customer.”

Voice of the Customer

Patient wants the best outcome possible.

Patient wants cost effective healthcare.

Provide a model that allows complete control and management of the care environment.

Provide a healthcare built environment that is not costly to build, maintain and update. Make it patient-centric.

Patient wants the latest, best and state-of-the-art technology.

Patient wants to customize their environment to their choices, preferences and amenities.

Work with inventors, designers and manufacturers to create patient centric technology that can work in any type of environment.

Provide a built environment that can be customized from patient to patient.

Patient wants a patient-centric approach and healthcare experience where everything and everybody comes to them.

Patient wants the best care available either locally, regionally or anywhere in the United States (virtual healthcare).

Place the patient at the center of healthcare within a new built environment model.

Provide a combination of technology and IT to anywhere in the United States.

Built Environment Response

© 2014 BSA LifeStructures / Patent Pending

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W H I T E P A P E R | OCTOBER 2014

The New Care Environment: Modules A healthcare revolution will not be found by adapting the same methods that have been used over generations. Large multi-faceted facilities will no longer be feasible if health providers cannot afford the cost and upkeep of new or aging buildings. And a healthcare revolution cannot exist in environments where patients experience repeated frustrations.

Individual Treatment Modules is what healthcare delivery looks like when you start over and start right – a healthcare revolution.

Each care environment is designed to be self-sufficient with the capability to provide any or all of the required functions. In addition, the individual units can be either freestanding or grouped to form new typologies.

HOME BASED This module will serve both the aging-in-person as well as the person who can have medical care provided at home. As a result, this module may be connected to the home for only a few days or may be located there for years.

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WELLNESS/ DIAGNOSTIC This module will serve in a preventative care mode as well as a physician clinic type setting. The care provided will be on an intermittent basis or as part of a structured program.

AMBULATORY

INVASIVE

This module will serve those persons who require some type of ambulatory procedure, which is not invasive. As a result, only a short stay will be required with minimal component support.

This module will serve for minor procedures that require performing invasive methods.

In some instances, it may require only a few hours stay from start to finish. In other instances it may require an overnight stay based on the recovery process and time.

ACADEMIC

MEDICAL CENTER It is important to note that while the built environment for the Academic Medical Center requires changes and improvements, these centers will still exist within the new care environment revolution. Its tertiary and quaternary role for the treatment of patients with multiple disorders, diseases and life threatening illnesses is an essential component of our healthcare system. In addition, its role in the innovation, research and clinical trials is critically vital today and will remain so in the future.

Š 2014 BSA LifeStructures / Patent Pending

OCTOBER 2014 | W H I T E P A P E R

M IN

G

INF R

A

R ST

UC

TOILET/ GROOMING

INVASIVE MODULE

© 2014 BSA LifeStructures / Patent Pending

CAREGIVER

TOILET/ GROOMING

PATIENT

FAMILY

PATIENT

FAMILY

COMPONENTS – TYPE AND FUNCTIONS

CAREGIVER

MEDICAL SUPPORT

OO

R

MEDICAL SUPPORT

GR

TU

Wellness, Diagnostic and Home-Based Modules are settings where the function of components differ from those of medical treatment modules due to fewer needs for technology and supplies. It is important to note that component size (by length) can vary based on the technology or amount of supplies needed for the particular care required.

Similarly, there can also be future customization within a module as procedures are added or newer technologies and devices are created.

MEP/ SERVICES

&

Mechanical Services Electrical Services Plumbing Services Fire Protection Services Medical Gasses Component & Module Supplies

The flexibility of this built environment design allows for the inclusion of specific components based on medical protocols and required support. The Invasive Module and Ambulatory Module diagrams indicate how additional components provide for ambulatory or invasive needs while maintaining the patient-centric concept. Once proper components are added, the New Care Environment can serve as an Ambulatory Module, Invasive Module, or Wellness Module – just to name a few.

MEDICAL TECH.

T

• • • • • •

Family Lounge Education Resources Kitchenette

MEP/ SERVICES

Water Closet Lavatory Grooming Area Tub And/Or Shower Wardrobe Personal Items

I

LE

PATIENT

• • • •

The New Care Environment meets these needs through specific functional components that are identified in the Components – Type and Function diagram. In essence, the components function as a kit of parts that “plug and play” with the patient component, which is the most central component and where the patient resides. The responsiveness between the functional components provides a built environment where true patientcentric healthcare can be achieved as all caregiver, family member, equipment, support and medical needs are immediately adjacent to the patient.

MEDICAL TECHNOLOGY

TO

• • • • • •

Sterile Supplies Sterilization Equipment Clean Supplies Clean Linen Soiled Linen/Supplies Code Blue Supplies

E

Required Equipment Portable Equipment Required Technology Anesthesia Support Imaging Support 24/7 Support (Food, Housekeeping, etc.)

• • • • • •

COMPONE NT

TECHNO DICAL L MEAND 24/7 SUPPOROGY T

Monitoring • Telemedicine • Information Technology Support • Caregiver Collaboration • Pharmacy Supplies/Prep • Caregiver Respite • Caregiver Toilet

Consistent with the patient-centric concept; the New Care Environment is designed as a modular system to meet the specific needs of each patient. This requires a high concentration on customization of the environment in order to offer the extensive variety of possible care procedures.

&

ILY FAM

• • • • • •

ER IV G •

MEDICA LS UP PO RT

LY PP SU

CA RE

ENT PON M CO

The New Care Environment: Components

AMBULATORY MODULE

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W H I T E P A P E R | OCTOBER 2014

ABOVE: Specialized equipment and diagnostic information fully integrated with the patient zone and connected via telemedicine.

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Š 2014 BSA LifeStructures / Patent Pending

OCTOBER 2014 | W H I T E P A P E R

Inside the New Care Environment Telemedicine and mobile app technology will shift healthcare delivery into the home.

Designers able to understand and translate these trends into a healing environment will help influence and transform the patient experience. It is important to remember that a good patient experience is still dependent on valuing human beings over technology.

• • •

• • •

Treatment modules house specialized medical equipment fully integrated into the space to provide real time monitoring of the patient.

High resolution imaging scanners slide past and rotate around the patient zone.

Digital displays provide a variety of information including diagnostic, patient entertainment, telemedicine, patient education, mobile apps, personal graphics and pictures, etc...

Medical equipment in the patient zone monitors the patient in real time, communicates back to central monitor and archives into Electronic Health Record (EHR).

“Big Data” proactively manages patient populations.

Enable adequate access to needed health care information and decision support tools.

Patient comfort is a critical component to the healing process. Comfort is improved when one has control of his/her personal environment. The ultimate goal is to reduce patient anxiety and stress during the healing process.

• • •

• • •

Views to the outdoors/nature and natural light via large glass walls, skylights, customized digital displays.

State-of-the-art technology provides a sense of comfort. The design of the treatment module provides flexibility to personalize the care of each patient.

Control of personal environment – patient zone canopy with digital customization that can be rotated for flexibility. Personal control of lighting, air temperature, window treatment, TV, music and images.

Treatment module can be connected to personal devices similar to the automotive industry.

Optional outdoor space/patio fosters a connection to nature and beauty.

Low temperature indirect lighting (warm light) at night helps balance our circadian rhythm by dropping our bodies core temperature and increasing our melatonin production. Light of different temperatures also affects blood pressure and heart rate.

ABOVE: Flexibility and control of the patient’s personal environment reduces stress and anxiety.

© 2014 BSA LifeStructures / Patent Pending

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W H I T E P A P E R | OCTOBER 2014

ABOVE: Support Modules organized around the patient zone.

Outside the New Care Environment

Patient and staff safety is crucial to enhance the quality of patient care. Standardization and simplification of the spaces can be used to improve healthcare outcomes.

•

•

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Mobile equipment, mechanical equipment, supplies and other elements are stored in dedicated support modules adjacent to the treatment module.

Caregiver Zone and Hygiene Zone are in close proximity to the patient and customized according to the patient type.

Both spaces are in dedicated support modules directly adjacent to the treatment module.

• • •

Patient lifts are standard in every treatment module.

Surface materials are durable and easily decontaminated.

Advanced ventilation and filtration systems to control and prevent the spread of infections (e.g. multiple rings of air curtains to encapsulate the patient zone).

© 2014 BSA LifeStructures / Patent Pending

OCTOBER 2014 | W H I T E P A P E R

Meeting the Changing Needs of the Boomer Population As the Baby Boomer generation becomes the dominant demographic who will be utilizing the United States healthcare system, they will also be very different patients and consumers than previous generations. The primary theme of these changing needs is the increased focus on patient-centered care and the related built environment.

Based on current and future patient attitudes, opinions and preferences; a new care environment responds to these changing needs.

This new revolutionary care module approach provides the following benefits and features for the patient: • • • • • • •

Patient does not have to move – all of the required caregivers, technology and support come to the patient.

Patient does not have to move – not exposed to others with infectious and contagious diseases.

Patient can customize and control care environment – lighting, temperature, interiors, artwork/images, music, etc...

Noise is dramatically reduced – there is no other hospital environment surrounding the module.

Improved housekeeping within the care environment – materials, surfaces and products utilized which resist microbes.

Improved housekeeping within the toilet/grooming component – materials, surfaces and products that resist microbes.

Family is nearby but not within the care environment – separate family component adjacent to patient.

© 2014 BSA LifeStructures / Patent Pending

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W H I T E P A P E R | OCTOBER 2014

A Cost Effective Alternative The development and implementation of the new care environment will revolutionize where and how patients receive their healthcare treatment and preventive care. As a result of this new treatment module approach, a more cost effective built environment will translate into a more cost effective alternative for the healthcare system.

CURRENT STATE

FUTURE STATE

TOTAL SQUARE FEET PER BED IN COMMUNITY HOSPITALS – MAIN CAMPUS

TOTAL SQUARE FEET PER PATIENT CARE ENVIRONMENT – NEW TYPOLOGY

This more cost effective approach will be realized through a variety methods including: • • • • • •

Less square feet per patient treatment module – results in less facility operational cost.

Opportunity for patient centered care in different locations – results in less movement of patient and family.

Improved outcomes and safer patient care – results in improved reimbursement due to reduced readmissions.

Procedures and treatments that can be performed in patient care modules – results in less cost per procedure/treatment.

Includes Wellness/Diagnostic module for preventative medicine/healthcare – results in reduced costs per patient.

Includes opportunity for telemedicine and virtual consults – results in less travel and expenses related to travel to tertiary health centers.

BASED ON OCCUPIED BEDS

Presently, a new patient-centered care environment, which is a cost effective alternative, is in the planning and development stages. A new care environment is closer than we think. This could be the healthcare revolution.

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BASED ON NEW CARE ENVIRONMENT

BASED ON AVAILABLE BEDS BASED ON LICENSED BEDS

SOURCE: LifeStructures Metrics, BSA LifeStructures

© 2014 BSA LifeStructures / Patent Pending

DEVELOPMENT TEAM CONCEPT DEVELOPMENT AND PLANNER

GRAPHIC DESIGNER

GARY VANCE

TARA KEMPF

FAIA, FACHA, LEED AP

gvance@bsalifestructures.com

tkempf@bsalifestructures.com

CONCEPT DESIGN AND ARCHITECT

3D GRAPHICS / RENDERINGS

DEREK SELKE

KEVIN DANE

AIA

dselke@bsalifestructures.com

kdane@bsalifestructures.com

WHITE PAPER WRITER / EDITOR

DIANE KERN

dkern@bsalifestructures.com

LifeStructures Knowledge is a collection of industry-leading expertise from the professional teams at BSA LifeStructures.

In-depth analysis, thoughtful insight and refined strategies are promoted across all disciplines to encourage research and drive innovation. Constantly raising the standards of

BIBLIOGRAPHY

excellence, LifeStructures Knowledge serves as a key platform for transcending industry standards to provide solutions that improve lives.

1

Pugh, John. "Doctor Chair Brings Healthcare Into the Living Room." psfk.com,

23 October 2013. Web. 4 September 2014. <http://www.psfk.com/2013/10/ sharp-health-chair.html#!bPJ5CX>.

2

Mirani, Leo. "Architects are starting to 3D print houses – but without a house-sized printer." qz.com, Quartz. 29 March 2013. Web. 4 September 2014. <http://qz.com/68780/architects-are-starting-to-3d-print-houses-but- without-a-house-sized-printer/>.

3 Meskó, Bertalan. The Guide to the Future of Medicine: Technology and the Human Touch. Webicina Kft, 2014. Print.

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