Healthcare Global - October 2014

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Embracing Wayfinding For a Brighter Patient Experience

Navigating the Changing Healthcare Real Estate Market iPhone 6: Lifesaver? 0 1 P O T EST HIGH ING GROSSTALS HOSPI


Paving the foundation to success P AT I E N T S AT I S F A C T I O N I S O N E

of the most important

issues to consider when a hospital is trying to set itself apart from its competition. Wayfinding – how patients and staff are able to easily and quickly find care areas – is a concept that hospitals are increasingly beginning to incorporate into their design plans. In this issue of Healthcare Global, we review how aesthetics and atmosphere drive a hospital’s success and how to overcome some of the obstacles that may come with this incorporation. Additionally, the healthcare real estate market is facing a fundamental shift and the location of medical facilities, along with their design, are being heavily researched before integration into a community. We report on how outsourcing can prove effective for biotech and pharma companies and how to prepare if this method is chosen, and take a look at Apple’s latest release, the iPhone 6, to determine how beneficial it is for healthcare providers. We wrap up the October issue with the top 10 highest grossing for-profit hospitals across the United States. We hope you enjoy this issue and wish you the best of health!

Stephanie C. Ocano Editor 3



Hospitals Embracing Wayfinding for a Brighter Patient Experience

16 Finance How to Navigate the Changing Healthcare Real Estate Market




Technology iPhone 6: Lifesaver? Apple’s Integration into the Health Care Market

TOP 10

Highest Grossing For-Profit Hospitals Across the US

38 Supply Chain How To Make Regulatory Outsourcing Effective for Pharma, Biotech Industries


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EMBRACING WAYFINDING FOR A BRIGHTER PATIENT EXPERIENCE Aesthetics and atmosphere help to set a hospital apart from its competition not only with patients, but also in recruiting top-tier physicians Wr i t t e n by: J u l i e S t e f f e n s, N C I D Q , La w re n c e G ro u p

WHEN A NATIONAL standardized hospital patient satisfaction survey was formally endorsed in 2005, the healthcare industry was granted an effective vehicle to make meaningful comparisons between hospitals on issues important to patients. Quietness, cleanliness and ease of transition of care are among the basic topics covered, 8

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all of which are achieved only in a hospital setting designed for a pleasing overall aesthetic. Wayfinding – how patients and staff are able to easily and quickly find care areas – is one of the most important factors contributing to a positive environment. A hospital’s improved wayfinding can have a strong impact on its patient

satisfaction scores. However, it is also important to consider the challenges involved in cost, time commitment, and return on investment. Creative Options As part of a total construction project, the cost for wayfinding is figured through an in-depth budget exercise to determine the appropriate percentage

based on industry standards. The time commitment to the wayfinding plan should ideally be tied into the overall design and construction process to avoid becoming an after-thought following completion. When included in the initial design planning, wayfinding elements, such as lighting, wall space, background color and niches for artwork, can be 9


‘..color blocking and floor striping are useful tools. Color blocking gives each department or space its own color so entry points and decisionmaking points have a guiding consistency’ incorporated at a much lower expense as opposed to adding on later. Informing the design team early about wayfinding ideas will help involve everyone to plan for these elements. Consistent branding at all entry points is essential to successful wayfinding. Creative options abound to replace signage everywhere with a home-like element: colors, art, plants or other symbols can be added to key decision points. To help patients find the right offices, color blocking and floor striping are useful tools. Color blocking gives each department or space its own color

Graphic designers 10

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so entry points and decision-making points have a guiding consistency. A floor pattern forming a stripe or path straight from the front entry to main elevators reduces the scale of an otherwise intimidating distance. Color palettes should be selected based on usage with an overall approach, rather than room-by-room. Materials should be standardized, such as wall paint and doorframe colors, for consistency throughout the facility. The results can provide a cohesive environment, calming for patients. The Role of Artwork A genuinely calm, soothing atmosphere also is greatly enhanced by the presence of artwork as part of the wayfinding plan. Significant studies have been made over the years with positive evidence highlighting artwork’s


Colored blocks are the basis of good information design advantageous role in healing. Viewing calming images of nature specifically targets the threat of stress. Landscapes, for example, are a great choice, and are proven to provide positive distraction. With artwork, a hospital can involve the community in an exciting way by engaging local artists. A local gallery curator can help link healthcare leaders with the local art culture and send out a call for submissions. By also inviting staff members who dabble in photography or art to also submit a human resource aspect is also integrated. Artists are then

selected and commissioned to create pieces specifically for the space. Often the building is a neutral palette, allowing the artwork to be the leading color highlight of the overall design. Local artists often are best equipped to capture a region’s particular spirit and nuances. A replacement hospital in rural Kansas commissioned Lawrence Group to select and specify furniture, artwork and signage. Iconic Kansan images such as sunflowers and wheat sprays were chosen to designate different departments throughout the facility. The community had such 11


Stone textures combined with green plants are highly effective stress relieving elements a positive reaction that the hospital was able to move toward being a single source for ancillary medical services. The hospital’s goals and vision were clearly understood, which resulted in a well-coordinated facility. 12

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For a cancer center in Illinois, several pieces by local artists were commissioned for the lobby area, family waiting and quiet room. Criteria were set for the media used and the art community was contacted


‘Significant studies have been made over the years with positive evidence highlighting artwork’s advantageous role in healing’ to submit concepts. A committee composed of a local gallery curator, a local artists group, the design team and a center representative made the final selections. In this case, commissions were paid to the artists. The initiative helped establish a strong community connection and spur public fundraising for half of the cancer center’s building fund. Art made from nature’s elements such as water, stones and plant life also is effective in relieving stressors and relaxing patients. The calming sounds of running water in a waterfall pool and the viewing of indigenous plant life from the exterior brought indoors can be standout features. When placed at key decision points like intersections, these features help to gently spark people’s memory and guide them throughout the space. The challenges in cost, time commitment and return on investment of a hospital wayfinding plan can be overcome when creative options such as color, lighting and artwork

are incorporated. Favorable patient responses to a positive wayfinding experience can impact survey scores and go a long way in helping a hospital to outshine its competition. Parking and Access As hospitals improve and grow, many, because of a landlocked site, are faced with a lack of parking due to limited room to expand. The result can be a wayfinding nightmare, with the distance between parking and the hospital entry stretching well beyond what is realistic for patients and visitors. Patients find it easy to get lost while navigating to the main building and, on their return, are unable to find their car in a large parking structure or lot. Language barriers, especially in urban areas, can be another challenge in communicating directions. A new vision of clarity can be reached by updating the existing parking infrastructure. A lighting concept in one hospital parking structure is a sustainable solution 13

H O S P I TA L S with an LED lighting system that self-adjusts based on the level of sunlight and the presence of activity. Color blocking on each floor of a parking structure is both helpful and bright. Auditory cues in the elevator announce the color of each floor. A solution for language barriers is to integrate signage and wayfinding elements throughout parking areas. Multiple languages on touch screen signs can be used, as well as having translators posted at various areas. Along with a shuttle service from parking lot to main entrance to alleviate long distances, volunteer navigators, escorts and greeters can extend a hand in leading patients to the next destination and put a friendlier, human face on the hospital experience. Julie Steffens is a senior associate for Lawrence Group’s healthcare studio with over 15 years of experience. Her responsibilities include developing and implementing interior design master plans with comprehensive furniture and finish standard programs. She can be contacted at julie.steffens@


October 2014


A genuinely calm, soothing atmosphere is greatly enhanced by the presence of artwork


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How to Navigate the Changing Healthcare Real Estate Market A fundamental shift is occurring in healthcare real estate, specifically where medical facilities are located and how they are being designed Writt e n by: N oah To l s o n, AIA , LE ED BD+C

H e a lt h c a r e R e a l E s tat e

While the rollout of the Affordable Care Act (ACA) has garnered a lot of attention, there are significant trends associated with its implementation that are impacting healthcare real estate. The first trend is focused on numbers, specifically the estimated 32 million new patients that will be covered under the ACA. Newly insured patients are not the only surge on the horizon. The senior population aged 65 and over is projected to increase by 79.2 percent through 2030. This “double hit� increase in patients will place a strain on aging hospital facilities and infrastructure already stretched to the breaking point. Can your real estate portfolio handle the influx of new patients? The second trend is the increase in mergers and acquisitions by healthcare organizations. Motivated in large part by the desire to capture more market share, the healthcare competitive landscape has intensified significantly and facilities are becoming increasingly important to attracting patients and physicians. How can health systems keep up? Finally, the steady march of technology promises to continue unabated. Due to the ACA and related incentives regarding electronic medical 17

f i n a n ce records, combined with advancements made in telemedicine - IT support and capacity have become critical drivers in the healthcare real estate market for both new and renovated medical facilities. Can your facilities support the expanded IT requirements? Do you have answers to the questions posed above? With pressure on your bottom line due to changing reimbursements and increased competition, many hospitals are taking a closer look at their real estate portfolio and facilities in an effort to control costs in response to revenue constraints and operating cost pressure. What to Look For in a Health Care Architect and Developer The passage and implementation of the ACA has been responsible for a boom in the healthcare industry. As a result, all types of firms are trying to break into the healthcare market. Just because someone can develop, design and build a commercial office building, that does not mean they have the expertise and experience to guide you through the design of today’s medical facilities. That is why you need to retain professionals who bring extensive healthcare knowledge and experience. 18 October 2014

Your developer must understand the community context and have a firm grasp of your competition as well as understand the benefit of different leasing and purchasing arrangements. Your architect must offer an extensive portfolio of healthcare projects of all types and price points and recognize the importance of designing to support your brand. It is important that they understand the local zoning and code requirements, as many have changed with recent updates to the codes.

‘Your developer must understand the community context and have a firm grasp of your competition as well as understand the benefit of different leasing and purchasing arrangements.’

N a v i g at e t h e H e a lt h c a r e R e a l E s tat e M a r k e t

It is important that both the developer and architect have a proven process for engaging stakeholders across the spectrum to achieve consensus on goals. If you utilize a lease-back arrangement, it is important that your architect understands the nuances of programming for users and healthcare institutions and balance that with the needs of the developer, and contractor to design a building that serves the needs of the hospital and patients for a price that fits within the lease structure.

Changing Market Impacts Facility Design The Urban Land Institute estimates that 64 million square feet of additional medical office space will be required during the next decade to meet the increased demand, and it will cost more to construct. According to REED Construction, the average cost of a medical office building across 25 metropolitan markets last year came in at over $240 per square foot, with New York, San Francisco, Boston,


f i n a n ce Chicago and Philadelphia having the highest medical office building costs at $257 to $303 per square foot. Hospitals can affect those costs by understanding how the market is impacting medical facility design. The types of services being offered in an outpatient setting have increased. As a result, the complexity of the environments required to support these services has increased exponentially. New models of multi-disciplinary care are evolving to support Accountable Care Organizations, the Medical Home and other evolving care models. As a result, the standard 96’ x 200’ floor plate may not be appropriate. Adjacencies of key departments in ambulatory/surgical facilities require complex building infrastructure and may require MEP services enhanced with additional capacity and redundancy. Integration of physician practices can reduce duplication of services/ resources/space/personnel resulting in cost savings. Design should also support an environment that facilitates information sharing and cross-referrals. Patient satisfaction is becoming critical for full reimbursement – collocating services in one place is a key patient satisfier. Streamlining 20 October 2014

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‘It is important that both the developer and architect have a proven process for engaging stakeholders across the spectrum to achieve consensus on goals’’

the check-in and in-take process through features such as kiosks and pre-admission registration has changed the design of waiting rooms. With antiquated facilities on hospital campuses, many organizations are looking to move as many services to newer facilities, sometimes choosing to use the older spaces for post acute care. With the increased focus on preventative care, the types of services being offered by traditional physician practices is expanding and now feature wellness elements such as fitness, nutrition, counseling and preventative screening. Facilities are being placed in retail areas in the suburbs to provide access and convenience for patients, as well as extending brand recognition for the system. Many healthcare organizations are looking at non-traditional real estate such as abandoned “big box” retail stores and repurposing general office buildings. New Real Estate Options for Hospitals While the greatest monthly expense most successful medical organizations have is employment, the second is real estate. With that in mind, 21

f i n a n ce having a trusted real estate advisor reviewing your organization’s real estate usage and options could contribute to a healthier bottom line. With the numerous market, regulatory and reimbursement changes of the past year, a review of the following areas by a developer focused on the healthcare market could provide significant savings. Does your ambulatory portfolio and hospital location support your strategic plan? What assets are underperforming or have become obsolete? Return

on assets in healthcare lags virtually every other industry. Due to the increase in hospitalemployed physicians and the uptick in acquisition of physician practices by hospitals, many hospitals have seen their lease management activities increase rapidly and are outsourcing lease administration. As more physician practices merge, in an effort to control their finances, shorter leases are becoming more common. Stark and Anti-Kickback Statute Patient satisfaction is becoming critical for full reimbursement

22 October 2014

N a v i g at e t h e H e a lt h c a r e R e a l E s tat e M a r k e t

‘..many hospitals have seen their lease management activities increase exponentially and are outsourcing lease administration’

laws have been in place for over 20 years, however following the ACA implementation, they have become more stringent and enforced with more vigilance. Many healthcare organizations lack the specialized expertise to ensure that self reporting is in place so that CMS reimbursements will not be jeopardized. Strategies to Stay Ahead of the Curve As the medical and healthcare industry continues to evolve, there are strategies that your developer/real estate

representative and architect can utilize to help you remain on an appropriate course. When designing and constructing facilities, flexibility should be a key driver. Modalities of care are changing rapidly and your facilities will need to respond just as quickly. Consider standardization wherever possible so your facilities can be easily, and more cost effectively adapted to other uses. Also, consider investing in the design of a prototype for your ambulatory care and medical facilities; there is no need to reinvent the wheel with each project. Determine 23

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what works for your organization and replicate it across your service area. A side benefit: increased brand recognition and speed to market. Finally, manage your real estate and facility assets wisely. Determine if you can support the staffing levels to handle the increased complexity of leases, ROI and asset management 24 October 2014

so that your facilities are contributing profitably to your bottom line. If not, consider hiring specialists who can. With offices in New York, Pennsylvania, Ohio, Texas, Florida and Washington, DC, Array Architects is currently assisting clients across the country with a variety of projects to update their real estate portfolio to

N a v i g at e t h e H e a lt h c a r e R e a l E s tat e M a r k e t

‘With offices in New York, Pennsylvania, Ohio, Texas, Florida and Washington, DC, Array Architects is currently assisting clients across the country with a variety of projects’

ensure the best return on investments. With 30 years of exclusively healthcare planning and design experience, Array brings the users’ perspectives along with knowledge of life-cycle costs, appropriate/durable materials and, sustainable systems to keep the building efficient for the long-term.

author biography Noah Tolson, Array Architects’ Planning Practice Area Leader, can be reached at or (610) 270-0599. Read more from Noah at: http://blog.array-architects. com/kc/author/noah-tolson.



How To Make Regulatory Outsourcing Effective for Pharma, Biotech Industries With a strain on resources and a decline in revenues, outsourcing can prove effective for companies that need expertise and guidance. Healthcare Global takes a look at the best methods for ensuring biotech and pharma companies are prepared when they choose to outsource Writte n by: STE PHAN I E C. OCANO


S U P P LY C H A I N A DECLINE IN REVENUES FROM approved products and rising competition in generics is placing added pressure on resources at all pharmaceutical, biotechnology and medical device companies. Company resources continue to decrease and approval processes and post-approval requirements have become more complex. Outsourcing can provide a solution and deliver a competitive advantage for companies that lack the resources or expertise to guide a product to approval. Companies, however, need to ensure the outsourcing partner they choose will fit within their current business structure. According to a white paper recently published by the Cardinal Health Regulatory Sciences team, there are four key factors that can help pharmaceutical and biotech companies become successful in choosing an effective regulatory outsourcing partner. 28

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Know When to Consider Outsourcing Shortage of employees is one of the primary reasons companies choose to outsource during the regulatory approval process. Additionally, a company may have more products in development than internal staff is available to guide to approval in a timely manner. External staff can alleviate both of these issues by handling routine regulatory maintenance so internal staff can focus their attention on highpriority development programs. Partnering with regulatory experts can also save valuable time and unnecessary work; especially if there have been recent changes to regulations. By using such experts on an “as-needed” basis, costs can be minimized rather than keeping individuals on staff long-term. Determine What Functions are Best Outsourced While entire pharmaceutical, biologic, or device


A company may have more products in development than internal staff is available to guide to approval in a timely manner.

‘Outsourcing can provide a solution and deliver a competitive advantage for companies that lack the resources or expertise to guide a product to approval’

development processes can be outsourced, companies generally outsource either discrete processes, such as clinical trials, or those that require a high level of expertise, such as regulatory affair processes or the formulation of development processes. Both consultative and tactical functions are good candidates for outsourcing, according to the report. From a consultative viewpoint, the right partner can advise a company 29

S U P P LY C H A I N on strategic and specific information that regulatory agencies will be expecting to see in a submission. Tactical functions, such as CMC and medical writing, are also prime candidates for outsourcing. Regulatory documents and scientific communications require a high level of precision and adherence to format, which may be best left to an experienced partner.

The right strategic partner will work closely with a company 30

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‘The right partner can advise a company on strategic and specific information that regulatory agencies will be expecting to see in a submission’


Learn How Your Company Can Benefit Outsourcing provides companies with a plethora of benefits from flexibility, on-demand capacity and anticipating and preventing obstacles. In times of need, a company can augment or add a new team when work levels are high. This helps keep budgets in line but also allows companies to bring in the exact skills required for a specific project at any given time. In addition to augmenting staff, outsourcing also allows companies to add to their capacity when products require resources unexpectedly. Regulatory consultants can often step in and resolve unforeseen outcomes or late-breaking changes that may affect a product’s development cycle. Regulatory scientists understand the entire research and development continuum, which allows them to build the required components into research so the study design, resulting data and documentation are appropriate prior to submission. They can also review nonclinical, clinical, CMC and compliance documents and use their expertise to anticipate any new requirements that may pose challenges.

Asking the right questions Select the Right Partner The right strategic partner will work with a company to ensure that the regulatory product is brought in at the appropriate time and work towards the company’s goal. By starting early, discussing the process and setting checkpoints, both the company and the partner can establish a long-term relationship and smooth collaboration. It is important to ask questions about a partner’s background, track record and experience. A partner who lacks the expertise required for approval or who fails to deliver on time can result in a costly operation. The right partner should also have experience in the entire development process to foresee and prevent any issues from arising. Ideally, companies should seek a partner who can become an extension of their organization. 31


iPhone 6: Lifesaver? Apple’s Integration into the Health Care Market Apple’s latest release of their iPhone 6 has certainly caused a stir amongst Apple fans and those looking for the latest technology. But is it all it was made out to be for healthcare providers? Writte n by: STE PHAN I E C . OCAN O


October 2014


TECHNOLOGY WITH THE RECENT launch of the highly anticipated Apple iPhone 6 and iPhone 6 Plus release taking place last month, there is a lot of buzz in regards to the larger screen sizes, dramatically slimmer model and curved cover glass. What you should be excited for, however, is the plethora of health-related features. As Apple puts it, “it’s a comprehensive health and fitness companion.” The Apple Watch


October 2014

Patient-Doctor File Sharing Out of the 1.3 million apps available on the iPhone, one of the most impressive is HealthKit. The application, which can also monitor your caffeine intake and heart rate, gives patients the capability of sending compiled data to doctors. All-Day Fitness Tracker “The Apple Watch is designed to


help anyone who wears it lead a healthier life by being more active,” said Jay Blahnik. Integrated with the HealthKit platform, the Apple Watch measures three aspects of movement: Move, Exercise and Stand. Real-Time Workout Statistics The Workout app on the Apple Watch displays real-time stats such as calories, time, distance and pace for individual workouts. You can set goals, chart your progress and earn awards as you track specific workouts such as walking, running and cycling. Heart Rate/Pulse Monitoring Infrared and visible-light LED’s, along with photosensors, on the Apple Watch detect a wearer’s heart rate. The tracking and storage of an individual’s heart rate and pulse information in BPM (beats per minute) could prove invaluable to those who suffer from arrhythmias or irregular heartbeats. Weight Management Another equally as impressive app is Healthbook. Of its three primary tabs dedicated to fitness tracking is weight. Statistics like

‘The application Healthbook offers the option to track a user’s blood sugar levels and notify him/ her of any unusual spikes or drops’ BMI (Body Mass Index) and body fat percentage can be calculated upon entering your height and weight and progress can be tracked daily, weekly, monthly and yearly. Diet Intake Said app can also monitor what you put in your mouth and how it affects your overall health. Keeping a log of your diet choices will also allow users to make changes where needed and be conscious of the choices they are making. Blood Sugar (Glucose) Tracking Approximately 26 million individuals in the United States have diabetes, according to a 2013 statistic from the American Diabetes Association. 35

TECHNOLOGY iPhone 6 and the Apple Watch


October 2014


The application Healthbook offers the option to track a user’s blood sugar levels and notify him/her of any unusual spikes or drops. Emergency Contact Information Storage A feature in the Healthbook app allows users to store their name,

‘The Apple Watch is designed to help anyone who wears it lead a healthier life by being more active’ birthdate, medication information, weight, eye color, blood type, organ donor status and location. This information is critical for an emergency technician, doctor or hospital staffer who may need to identify and treat a patient if they fall ill and are unable to speak for themselves. Hiking Experience A barometer rooted in the iPhone 6’s system will be able to sense air pressure and measure relative elevation, determining if you are going up molehills or mountains.

Health App

Sleep Cycle Monitoring Healthbook will have the ability to track sleep cycles and, based on rumors, be able to produce algorithms to track movement during sleep and provide users with graphs to present sleep quality over time. 37

TOP 10

TOP10 The American Hospital Directory recently released a CMS cost report that determined the highest grossing for-profit hospitals in the United States based on gross revenue. Data compiled was for short-term acute-care hospitals, critical access hospitals and children’s health care hospitals. Here are the Top 10 highest grossing for-profit hospitals Written by: Stephanie C. Ocano

Highest G Hospitals

Grossing For-Profit s Across the United States


TOP 10


Las Palmas Medical Center (El Paso, Texas) – $2.96 Billion

This 327-bed hospital is a full service acute-care facility offering special expertise in emergency room medicine, cardiology, women’s services, labor and delivery, pediatric care and more. A free-standing 40-bed, in-patient rehabilitation hospital that specializes in treating patients with orthopedic problems, strokes, and brain and spinal cord injury is also present at the center. 40

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Hahnemann University Hospital (Philadelphia, Pennsylvania) – $3.11 Billion

Based in the heart of Philadelphia, Hahnemann is a tertiary care institution with a large percentage of beds dedicated to intensive care. Housing 496 beds, the center offers specialized care in cardiac services, heart failure and transplantation, OB/GYN, and bone marrow transplantation, amongst others.


TOP 10


Brookwood Medical Center (Birmingham, Alaska) – $3.21 Billion

Founded in 1973, Brookwood Medical Center established Alabama’s first hospital focusing on women’s health. The 631-bed full service medical facility staffs more than 900 privately practicing physicians and has over 2,500 employees and volunteer staff that support the center.


October 2014

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Medical City Hospital (Dallas, Texas) – 3.23 Billion

Medical City Hospital focuses on six key aspects: exceptional care, patient loyalty, employee pride, physician engagement, fiscal performance, and community involvement. The 12-story, 367-bed hospital is operated under the Hospital Corporation of America. 43

TOP 10


Sunrise Hospital & Medical Center (Las Vegas, Nevada) – $3.33 Billion

Established more than 55 years ago, Sunrise Hospital & Medical Center provides the most comprehensive quality health care in Southern Nevada. The hospital offers an accredited chest pain center; neuroscience institute; cancer, breast and epilepsy centers; and a children’s hospital.


October 2014

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Oklahoma University Medical Center (Oklahoma City, Oklahoma) –$3.46 Billion

Now a member of Oklahoma University Medicine, OU Medical Center provides a full range of hospital services from treating brain tumors, transplanting bone marrow, and offering radiation therapy. The center is one of Oklahoma’s largest and most comprehensive hospitals with a trauma center and women’s and newborn center. 45

TOP 10


Doctors Medical Center of Modesto (Modesto, California) – $3.49 Billion

Opened in 1962 by a group of local physicians, Doctors Medical Center has established itself as a provider of quality care and treatment. Undergoing a recent $72 million expansion, the 465-bed center specializes in trauma, cancer and stroke care.


October 2014

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CJW Medical Center-Chippenham Campus (Richmond, Virginia) – $3.8 Billion

With 466 beds, CJW specializes in heart care and emotional and mental health services. Their emergency room is a state-authorized Level III Trauma Center and houses Central Virginia’s only pediatric ER staff.


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H I G H E S T G R O S S I N G F O R - P R O F I T U S H O S P I TA L S


Baptist Medical Center (San Antonio, Texas) – $5.3 Billion

Baptist Medical Center offers specialty care in cardiovascular services, rehabilitation and breast care. Founded in 1903, the center has grown into a nationally ranked facility committed to providing state-of-the-art medicine. The center takes the second place ranking, coming in with revenue of $5.3 billion. 49

TOP 10


Methodist Hospital (San Antonio, Texas) – $5.69 Billion

Methodist Hospital opened in 1963 as the first hospital in the South Texas Medical Center. The hospital offers a broad range of specialties including cardiology, oncology, bone marrow transplants, emergency medicine, gynecology and more. Accredited by the Joint Commission in stroke care 50

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and designated as a chest pain center, it is the flagship hospital of the Methodist Healthcare System. With a revenue of $5.69 billion, they take our number one spot amongst the highest grossing for-profit hospitals in the United States.


Healthcare Facilities Symposium & Expo HFSE


Healthcare Facilities Symposium & Expo Fosters Collabora Chicago Conference Author name: Liz Miller , Marketing Director



ation & Innovation in Annual



The Healthcare Facilities Symposium & Expo is the original event that examines the trends in healthcare and the trends in healthcare design as one single movement. Industry leaders from design firms to healthcare owners come together for three days of education and collaboration. The Healthcare Facilities Symposium & Expo will take place September 30 - October 2, 2014 in Chicago with pre-conference events on September 29, 2014. Resonating through the event is the theme of Building Connections. The Healthcare Facilities 54

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Symposium & Expo is known as a collaborative environment where connections are formed through networking opportunities, sparked by creative ideas, and answering the challenges of attendees by connecting them with solution providers or expert speakers. A hallmark of the event is the willingness of attendees to look past competition and share ideas to further the mission of turning brilliant design into improved healthcare delivery. Building Connections is also echoed by keynote presenter John S. Milne, MD, MBA, FACEP, Founder


and CEO, Avnew Health. Milne will explore the rapid transformation of healthcare delivery and discuss trends including ACO structures, mobile apps, and big data. “I am incredibly excited to be addressing healthcare planners and facility designers at this year’s Healthcare Facilities Symposium & Expo” says Milne. “I hope that through my presentation, they will see the connections between care delivery trends and the built environment and be inspired to transform the way patients experience healthcare” The conference program will feature sessions presented

by leading healthcare facilities and design firms. Case-studies and instructional sessions will tackle issues challenging design teams today including integrating technology, influence of the Affordable Care Act, sustainability, renovation projects, and the task of doing more with less. Returning for the second year is the Student Charette sponsored by CannonDesign and in partnership with AIA Chicago, the AIA Chicago Healthcare Knowledge Community and The Caritas Project. Promoting interaction and idea exchange between university students and w w w. h c a re f a c i l i t i e s . c o m



attendees, this year’s design challenge will be Completely Reimagining Outpatient Health and Wellness Environments. A Technology Pavilion featured in the Exhibit Hall will bring big data alive in an enticing visual display where attendees will interact and explore how technologies are helping us view, investigate, 56

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analyze data and understand how technology can make a difference for a health system seeking to know their patients and proactively manage their health. “Two years ago the advisory board of the Healthcare Facilities Symposium & Expo saw a need to bring technology to the exhibit floor” said Gary Collins, Principal, PFB


Architects. “Something that would capture the interest and imagination of the younger tech generation yet offer real solutions for today’s Healthcare leaders. I was fortunate that Jenabeth Ferguson, VP, Symposium Director, and her staff believed in my Technology Pavilion idea and now we are preparing to launch an immersion experience

like no other.” The project is led by Sensory Technologies, Blue Cottage, Power Construction, PFB Architects, KaziaLi Design Collaborative, Koroseal Interior Products, and Interface. Details: The 2014 Healthcare Facilities Symposium & Expo includes: w w w. h c a re f a c i l i t i e s . c o m



John Milne

• Educational sessions featuring case-studies and instructional sessions presented by the upper echelon of thought leaders and industry authorities. • Exclusive networking opportunities on the show floor and 58

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off-site, including The Symposium Party with activities, music and the Annual Raffle which will benefit The Cure It Foundation. • An Exhibit Hall with the latest products and solutions critical to designing cutting-edge facilities.


Company Information INDUSTRY


: 5520 Park Avenue, Suite 305 Trumbull, CT 06611

• Facility tours of the Northwestern Medicine’s 259 East Erie Facility and the Erie Family Health Center (Waukegan). For more information on the Healthcare Facilities Symposium & Expo please visit www. .

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Anywhere Healthcare

Anywhere Healthcare: Bringing healthcare to all of Australia

By enabling specialist healthcare via video consultations across the country, Anywhere Healthcare has made a name for itself in the future of healthcare. Written by: Laura Close Produced by: Jeff Soboleski >>>




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Anywhere Healthcare Bringing healthcare to all of Australia


nywhere Healthcare, a subsidiary business of Medibank, is a health services organisation that provides a range of healthcare initiatives to the state and federal government and large corporate and non-profit companies. Because Anywhere Healthcare was developed in a governmentbacked environment, the organisation was not necessarily born out of a strong underlying business strategy. However, as innovators in their field, the Anywhere Healthcare team has worked to develop a model that is both scalable and sustainable. They have achieved the scale part of the equation, as the organisation now understands the dynamics of running a purely online medical practice. To make their operation sustainable, Anywhere Healthcare is looking to make the medical consultation process more efficient through a number of initiatives. Samuel Holt, director of online care, knows innovation is key:


“The answer isn’t in just trying to replicate what happens in the faceto-face world, it is in looking at healthcare and streamlining care so that maybe it can be potentially faster and more efficient.” Video consultation technology The core of Anywhere Healthcare’s service is to enable patients to connect with a healthcare provider via video. To encourage regional doctors to connect their patients in rural or difficult-to-reach areas with city specialists, there are incentives and other government funding available under the Medicare system. The organisation employs cloud-based practice-management software, used by clinicians and practice management staff to store patient referrals, images and scans provided by their network of 1,000-plus referring practitioners across the country. Vidyo, a video conferencing platform, make the video consultations possible. Technology moves fast, so Anywhere Healthcare is always


looking for new and better solutions to improve their services. Australia does not have ubiquitous access to one backbone of Internet, so Internet access can be relatively poor in less populated areas. The organisation is always looking for technology that can provide a more stable environment through which people can access consultations. Moving forward, Anywhere Healthcare is looking to provide patients with access to general practitioners and allied health practitioners for consultations. These services will be offered at a 100 percent out-of-pocket fee, as there is currently no funding for an individual to talk to a general practitioner or allied health practitioner online. This service focuses specifically on convenience and accessibility for patients in rural and regional areas. Anywhere Healthcare intends to use apps to provide additional and improved services to interested patients. Instead of making an appointment to see a specialist online, patients will be able to take a picture of their wound or

skin lesion and, using an app, be able to collect the information required by a specialist to make a remote diagnosis. The process would include capturing the relevant information, sending it to Anywhere Healthcare and having an appropriate specialist review


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Supplier Profile

WDM Group WDM Group retains a diverse portfolio of nineteen industry and territory specific brands – each producing its own digital magazine, website, mobile apps and weekly e-newsletter. These unique products keep high-level professionals informed on the latest news from within their competitive business markets. As innovators in digital technology, WDM Group leverages their content across a wide range of digital platforms including iPad applications, social media sites, and more. Website: Visit us online:

Anywhere Healthcare is looking to make the medical consultation process more efficient through the use of technology

the images and notes, with a diagnosis potentially being available in as little as 24 hours. Continuous Improvement Anywhere Healthcare is constantly evaluating its practice and services offered to ensure that they are clinically relevant and appropriate. They have engaged approximately 30 specialists in varied fields of practice, and have 14 employees who focus on the clinical, IT and marketing aspects to support and build the practice. It is not hard for an organisation like Anywhere Healthcare to attract employees, as people like the work the company is doing. Their employees, specialists and referring GPs believe in equitable access to healthcare and in improving healthcare in regional or remote areas. Anywhere Healthcare enables specialists to work flexible hours, and to fit a telehealth practice around their other public and private practice commitments. Anywhere Healthcare also enables specialists to work from any location within Australia, provided they have access to the Internet, which particularly suits specialists OCTOBER

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Anywhere Healthcare Bringing healthcare to all of Australia

who have young children or who are winding down from the long hours generally required to maintain a full time practice, as well as those who wish to live in regional areas but do not have sufficient local patient demand to make it viable. Anywhere Healthcare has experienced strong growth; since the practice was launched in October 2012, the number of 66

consultations they conduct has grown on average by around 30 percent compound, month on month. Holt believes there’s significant untapped potential for health consultations online. Currently, approximately one percent of all psychiatry consultations in Australia are conducted online, and there is the opportunity for most areas



Company Name: Anywhere Healthcare Industry: Healthcare Key People/Titles: Samuel Holt, director of online care

of healthcare to reflect similar numbers. With more than 100 million consultations conducted in Australia each year, Anywhere Healthcare has a large market to target. In three to five years’ time, the organisation aims to be conducting somewhere between 300,000 to a million video consultations and asynchronous healthcare interactions each year.

Products: healthcare consultations via video Revenue: $5.9 billion Employees: 4,800 Website:

Visit us online:


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Hospital Moinhos de Vento

Inaugurates Facilities Of the institution’s 14 expansion projects, 9 have been completed Written by Tania Franco | Produced by Taybele Piven




oinhos de Vento Hospital, the renowned health care conglomerate located in the city of Porto Alegre in the state of Rio Grande do Sul, is inaugurating facilities included in its expansion project. The project, which began in 2009, is slated to be finished in 2015. Of the total investment of approximately R$ 320 million, R$ 100 million was allocated to a social project that includes the Restinga and Extremo-Sul Hospital. The expansion plan includes expansion of the existing areas and the creation of new space, which will generate nearly 900 direct jobs. Restinga and Extremo-Sul Complex Inaugurated on July 1st, the Restinga and Extremo-Sul Hospital began its operations gradually with Quick Care, a unit with a capacity to serve up to 13,000 children and adults per month. In addition to the 25 beds in the Quick Care unit, 62 beds were made available to patients requiring admission. In this opening stage, the hospital had 250 employees to

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photo credit Itamar Aguiar


serve 110,000 residents of six different neighborhoods in Porto Alegre, including Restinga, Lageado, Lami, Belém Novo, Ponta Grossa and Chapéu do Sol. During its first month of operation, 8,300 services were carried out in the Quick Care unit. Of this, 65% of the patients were adults and 35% were children. In addition, approximately 1,300 imaging exams, including x-rays and tomography, were carried out. When the hospital is fully functioning in mid-2015, it will also offer more hospital beds. It is slated to have a total of 121 in-patient beds and 48 beds for outpatients. In addition, the hospital complex will also feature: • A Center for Specialties, a space designed for specialized ambulatory service, multi medical specialties, and dentistry services. It will have 20 offices. • A Diagnostic Unit to serve the demands of the hospital and the Basic Health Units and Family Health Units of the Restinga and Extremow w w. h o s p i t a l m o i n h o s . o r g . b r


The same trust as always, right in your hands. A brand new logo for your eyes. Intelimed is the leading provider of medical devices for Orthopedics, Traumatology, Neurology, Cardiovascular Surgery and Oral and Maxillofacial procedures in Southern Brazil. It has consolidated its reputation over the last 20 years, through the quality of the products it distributes and the efficiency and innovation of its services. Now, the company's visual identity is also evolving. - Porto Alegre: 55 51 3320.4000 - Passo Fundo: 55 54 3045.7190 - Florian贸polis: 55 48 3222.5000 - S茫o Paulo: 55 11 3926-5946


Restinga and Extremo-Sul Hospital emergency room

Sul region. • Surgical Center, Obstetrics Center and Adult Intensive Therapy Center • A School for Health Care Management, responsible for training and qualifying staff. Eco-Efficiency The buzzword surrounding the construction of the Restinga and Extremo-Sul Hospital is sustainability. The building features central airconditioning, light sensors, dimmers, rainwater recovery systems and the use of solar panels for heating water. Generators and uninterrupted power supplies will allow for continuous energy supply in emergency areas and fire escape routes. A modern IT system will integrate data taken from patients at health clinics, medical offices and the hospital. The complex, built in partnership with the Ministry of Health, the State w w w. h o s p i t a l m o i n h o s . o r g . b r



Medication room

Dialysis provides security and privacy

Grand Rounds open space for detailed clinical discussions 74

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Department of Health and the City Department of Health, is part of the Regional Health System project that includes the neighborhoods of Restinga, Lami, Lageado, Belém Novo, Ponta Grossa and Chapéu do Sol. With the hospital’s construction, approximately 110,000 residents/ patients of the Unique Health System (known by its Portuguese acronym “SUS”) of Restinga and Extremo-Sul will be served. Other Construction Projects Nine of the fourteen construction projects of the Moinhos de Vento Hospital expansion are now complete. Among them, the following stand out: The Helda Gerdau Johannpeter Maternity Hospital; the Center for Neo-Natal Intensive Care; Centers for Traumatology and


Restinga and Extremo-Sul Hospital Inpatient unit

Orthopedics, Neurology and Neurosurgery; Endoscopy and Dialysis Unit; Surgical Center, A1 Hospitalization Unit, and the Emergency Unit. “We are going to add another 130 beds to the 473 beds currently in place for in-patients and support. Added to the 169 beds at Restinga and Extremo-Sul Hospital, the Moinhos de Vento Hospital Association will have a total of 772 beds”, says Fernando Andreatta Torelly, Executive Superintendent of Moinhos de Vento Hospital. The expansion of the Surgical Center meets safe surgery standards and international patient safety goals. Specific checklist and time out monitors were installed in operating rooms and electronic medicine dispensers were installed in recovery rooms. The area has five new operating

“We are going to add another 130 beds to the 473 beds currently in place for in-patients and support. Added to the 169 beds at Restinga and Extremo-Sul Hospital, the Moinhos de Vento Hospital Association will have a total of 772 beds” – Fernando Andreatta Torelly, Executive Superintendent

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M O I N H O S D E V E N T O H O S P I TA L rooms (17 in total), 12 new recovery beds (43 in total) and six observation beds in addition to the pre-operative assessment rooms. In the Dialysis Unit, which opened in September 2013, the number of beds for patients with chronic renal failure was expanded from 14 to 22. Patient monitoring is done in real time via dialysis machines connected to computers. The unit also has four Hemodiafiltration machines – modern technology for the treatment of renal failure. No other hospital in the state currently offers this technology. To meet the goals of its 2013-2016 Strategic Plan, the Moinhos de Vento Hospital’s Department of Health Services developed projects for qualifying nursing services, such as preparation for the Magnet Recognition Program. This certification system is based

Dialysis unit 76

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Control over the medication administration

on quality indicators and best practice standards for nursing of the American Nurses Association and the Scope and Standards for Nurse Administrators. International Partnership Since August 2013, Moinhos de Vento Hospital has had a partnership with the U.S.-based Johns Hopkins Medicine International. The agreement, which has an initial duration of 10 years, will promote the exchange of best practices in medical services, research, education and management. One of the main initiatives of the first year of affiliation will be the promotion of grand rounds, or presentations on day-to-day w w w. h o s p i t a l m o i n h o s . o r g . b r



Affiliation to Johns Hopkins Medicine International was signed in August at Moi

medical practices. Through this agreement with Johns Hopkins Medicine International, the Comprehensive Unit-based Safety Program (CUSP), an innovative nursing and patient safety method created by Johns Hopkins, will be implemented at Moinhos de Vento Hospital. In addition, the institutions will work together to establish a research center for clinical specializations such as neurology, neurosurgery, cardiology and oncology. “Moinhos de Vento Hospital defined its new vision: to be a hospital internationally recognized for excellence in medical support practices and for generating knowledge and innovation and staffed by a high-performance team�, said the executive. 78

October 2014


Company Information INDUSTRY


Porto Alegre - Brazil FOUNDED


General hospital with an emphasis on Cardiology, Maternal and child, Neurology and Neurosurgery, Oncology, Orthopedics and Traumatology

inhos de Vento Hospital

“To maintain our high level of medical support quality – recognized nationally and internationally -, we restructured our medical area and are further fostering the synergy of our professionals on the clinical team with the institution”, he added. Moinhos de Vento Hospital is the first Brazilian hospital to become affiliated with Johns Hopkins Medicine International (JHI).


President: José Adroaldo Oppermann Executive Superintendent: Fernando Andreatta Torelly

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C o

Cremer focuses on positioning as a strategic partner Leader in disposable healthcare products invests in innovation, product development, acquisitions and partnerships. Written by: Tania Franco Produced by: Taybele Piven




trong and solid brand reputation, ability to direct distribution at the national level, and structure development through partners as well as internal products lines. Besides adding all these requirements in its operations for disposable healthcare products for the Brazilian market, and export to over 10 countries, Cremer – a company based in Blumenau, Santa Catarina - focuses on new challenge. “We seek to become the best provider in disposable healthcare products and have a complete portfolio, understand the business of our clients and help them improving their business. We also seek a position not only as a company that sells products, but as a strategic partner,� explains the CEO, Leonardo Almeida Byrro. According to the executive, to achieve this goal the company is working hard on new acquisitions, internal development of new products, investments in factories, opening new distribution centers and investment in qualified staff.


October 2014


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CREMER The sector of disposable healthcare products includes textiles and adhesives, syringes and needles, surgical gloves, disinfectants and electronics, among others. In this market, Cremer’s performance covers three major divisions. The largest - that corresponds for 60 per cent of the company’s revenue - is to supply disposable products to hospitals, clinics and laboratories nationwide. The second division, which amounted to 25 per cent of its revenue, is called Retail or Consumer where the products are sold to the final consumer in pharmacies and supermarkets throughout Brazil. The third business segment, responsible for 13 per cent of company’s revenue, focuses to distribute products and dental care. Through its distribution network, Cremer provides for approximately 40,000 customers and professionals nationwide. In order to cover it all, Cremer has six factories concentrated in Santa Catarina, São Paulo and Minas Gerais, as well as distribution centers ranging from Fortaleza to Blumenau.


October 2014


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Cremer First Aid Line


In mid-2008 the company changed its ownership and Cremer transitioned to a new management role. At that time, the company already had high market share and leadership position in the industry. According to the CEO, the company saw the need to grow through innovation, implement ways to differentiate their products, adding new product categories to its portfolio and become more efficient and marketoriented. “Five years ago, we promoted this transformation aiming to become an organization focused on the market, where sales, marketing, innovation and product development are the flagship of the company.” Innovation has been strongly applied in Cremer’s operations. “By bringing innovation within your operations, somehow you end up degrading the processes a little bit which generates some kind of discomfort.” Our challenge is to figure out how to bring innovation to our products and the market, but maintaining the efficiency and productivity

Zig-Zag Cotton

Cremer Advanced Bandage

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Complete Line of Cremer and Topz Products

levels required by the company. “Besides the robust structure of operations, Cremer constantly invests in modernization of machines, systems and processes. The last five years alone, the company invested around US$ 100 million in improvements. As part of the growth strategy, three new companies were acquired between 2011 and 2013, that produce items not manufactured by Cremer. “This acquisition is a way to grow our products portfolio and to develop partnerships with companies overseas,” highlights Leonardo de Almeida Byrro. Through the partnership, Cremer uses its distribution system, and its national presence, to introduce these products in Brazil. One of the positive results after these acquisitions is that the company entered in a totally new segment that it never served before - disposable plastic products for healthcare - through partnerships with Embramed 88

October 2014


and Psimon. “We have made these acquisitions in 2011 and 2012. Due to our structure, we are managing a much bigger rate of growth than what those companies product line were having alone,” he says. Currently, the plastic products is the fastest growing platform in the company. In 2013, sales in this segment grew 25%. Another innovative step was some new international partnerships. The American company Deroyal, partner since 2013, manufactures plastic products with technology solutions that do not exist in Brazil and Cremer sells these items nationwide. Another partner, Ansell, is a manufacturer of specialty surgical gloves. “We signed the partnership in 2014 and we will bring the product line of this global company to the Brazilian market,” adds Byrro. All the innovations implemented at Cremer is in addition to the greatest attribute of the brand the quality and value of its products recognized by consumers is: “We have very strict control in our industrial processes and operations, strong quality control, certifications and good manufacturing practices that often go beyond what is required by public agencies, bids or private hospitals.”

Company Information NAME



Blumenau, Santa Catarina - Brazil E S TA B L I S H E D


Products for first aid areas, surgery, treatment, hygiene and welfare. Leaders in the market of gauze pads, surgical pads, plaster bandages, plasters, cotton wool, cloth diaper and more.

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