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SPECIAL FOCUS: RURAL HEALTH

Universal platforms A new approach to facilities design BY JENNIFER KLUND, AIA, ACHA, AND AMY DOUMA, AIA, LEED AP

T

he many challenges facing health care institutions are intensified when hospitals are located in rural areas. Ever-tightening budgets, aging facilities, shifting demographics, and the rapid evolution of technologies are among the concerns hospital administrators are working to address. For Critical Access Hospitals (CAH), these concerns are compounded by additional uncertainties; rumors of potential revisions to the CAH program abound, which could mean changes in reimbursement, staffing, and service delivery. All of these issues could have significant impact on the future of rural health care delivery, creating an environment of uncertainty for system administrators and the communities they serve. Many rural facilities require upgrades now, however administrators simply cannot wait until the future of health care becomes clear in order to address pressing needs. Despite an uncertain environment that may last years—or even decades—rural health care systems must continue to provide the best in care, staffing, and support to the diverse populations they serve. Given ongoing financial challenges, many are searching for new approaches to deliver high-quality, cost-effective care.

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Architectural innovation Our role as health care architects is to innovate the most practical and efficient solutions possible to support rural facilities and CAHs as they navigate an unknown future. While working with multiple health care providers across the country, we developed one solution: A universal “platform” of spaces that is adaptable, scalable, and flexible in order to meet changing and future needs, demographics, and care models. One of our clients, CentraCare Health in Central Minnesota, has adopted this universal platform concept for new and renovated facilities. Our projects for CentraCare Health include a new 65,000-square-foot clinic and hospital in Long Prairie and a major hospital addition in Melrose, which will open this fall. By employing the universal platform model, these projects reap both immediate and long-term benefits. In the short term, initial project costs were reduced by eliminating redundant space within departments. Long-term benefits include the ability to adapt the space—with minimal disruption or cost—to changes in volume, service lines, or community needs. This approach positions the facilities for success despite the uncertainties of rural health care by providing the flexibility to quickly adapt to changing demands.

Defining the universal platform In our CentraCare models, the universal platform isn’t a traditional department. Instead, it’s a modular set of rooms that serve multiple departments, such as emergency, surgery, or diagnostic imaging. The rooms are designed to be flexible, so they can be used for more than one purpose throughout the day, and from day to day. The rooms are adaptable, and are flexible enough to accommodate new functions or service lines with minimal change. The platform itself, comprised of these flexible and adaptable rooms, is scalable, so it can be easily expanded should the need arise (see Figure 1). On any given day, a room may be used for surgery or imaging prep and recovery during the day and transition to emergency or urgent care as that volume grows in the evening. Rooms could also be used for chemotherapy, infusion, pain management, or pre-surgical consultation. The rooms may include a recliner instead of a bed; a flexible headwall system for gases and technology; and multi-function lighting to accommodate various purposes. Mobile carts equipped for different care needs can be moved easily in and out of rooms. To provide an aesthetic appropriate to everything from an emergency visit to a physician consult, warm, tactile finishes and artwork are incorporated into the design. The universal platform’s premise is that its co-located rooms are designed to accommodate a variety of uses to minimize duplication of space, and to adapt to different functions if necessary with minimal cost and disruption.

Involving the staff during design phases Many top-level health care facility administrators welcome the idea of the universal platform given its flexible use of space and its ability to adapt to future needs. To illustrate the concept, we provide interactive models that demonstrate how the platform’s use evolves over time. We describe how the universal platform eliminates redundant, under-utilized space; re-supports operational and patientcare efficiencies; and, therefore, lowers operating and building costs.

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NOVEMBER 2017 MINNESOTA PHYSICIAN

Minnesota physician November 2017  

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