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Part 1: New Hospital Designs Focus on Reducing Cost, Improving Health and Flexibility
By Steve Gressel and Kelly Hilands
September 2008 -
Health Care Facilities Article Use Policy
The rapid transformation of health care is changing the face of health care facilities. There are several factors contributing to this rapid change, including competition among providers, advanced medical practices and technology, patient privacy, safety for patients and staff, healing environments, operational efficiency and evidence-based design. Moreover, an aging stock of inefficient facilities and an aging population continue to drive a need for new, upgraded or renovated health care facilities.
Changes in health care delivery strategies, including diagnostic and treatment modalities, are significantly affecting facility strategies as well. For example, an increasing number of procedures are performed on an outpatient basis, leading to a growing number of outpatient surgery and related support facilities.
Similarly, health care providers are integrating health care treatment services related to specific types of disease, injury, or category of patient. Health care providers are building specialized facilities for heart disease, orthopedics, cancer, women and children.
For example, Shands HealthCare is a private, not-for-profit health care system affiliated with the University of Florida and the university’s Health Science Center campuses in Gainesville and Jacksonville. Shands is building a cancer hospital in Gainesville that will house 192 private inpatient beds for a variety of patients, including those receiving diagnostic and therapeutic oncology services. Services to be provided at the 500,000-square-foot Shands at University of Florida Cancer Hospital, which is scheduled to open November 2009, include hematology/oncology, surgical oncology, the bone marrow transplant inpatient unit, the bone marrow transplant outpatient clinic, trauma and emergency. The new facility is being built across the street from Shands at University of Florida, a 660-bed academic medical center. Also nearby is the 280,000-square-foot University of Florida Cancer Research and Genetics Institute building, which opened in 2006.
Besides advances in diagnostic and treatment modalities, the driving force behind many changes in health care delivery patterns can be traced to factors such as advanced medical technology, cost and quality issues, and competition.
New technology is being rapidly adopted in the medical profession, which is leading to changes in the way health care facilities are designed and built. Robotic surgery, intra-operative magnetic resonance imaging (MRI), all-digital or paperless communications and data storage, and proton therapy cancer treatment are a few examples of advanced technologies that continue to change health care facilities.
Implementing new technologies requires a great deal of planning and a specialized construction expertise because of the requirements for housing this sophisticated equipment. Proton therapy cancer treatment, for instance, involves heavy equipment that must be located in a heavy building structure. The accelerator typically weighs 200 to 300 tons. The gantry apparatus usually adds another 100 tons. Proton therapy equipment requires a substantial building structure surrounding the proton beam generator, conveyance and treatment for structural support of the equipment and for radiation shielding. The shielding typically comprises steel plating and concrete walls, floors and roofs ranging from 6 to 12 feet thick.
A proton therapy treatment program requires two to five treatment rooms, an accelerator vault, beam line space, control rooms, simulation rooms, accelerator support spaces, typical patient care spaces (waiting, exam, gowning and nurse stations), administration and building support spaces.
Exponential advances in medical imaging equipment and procedures over the last decade also have led to major expansions of diagnostic imaging/radiology departments. In particular, these advances have increased magnetic shielding requirements and the number of cysto- and interventional-radiology rooms, and also have had significant impacts on MEP systems and equipment supports. This has led to a greater awareness of the requirement to plan and design for the removal and replacement of large imaging equipment to keep up with technological advances.
Another factor transforming health care design and construction is the growth of translational medicine (“bench to bedside”), primarily in academic medical centers, where research facilities are adjacent to or incorporated within a hospital to enable rapid “translation” of research discoveries into patient treatment.
For example, design of the North Carolina Cancer Hospital in Chapel Hill facilitates a continuous cycle of knowledge, discovery and dissemination of new ideas for delivering health care. A new 315,000-square-foot hospital includes outpatient clinics, inpatient beds, research laboratories involving clinical trial work related to research protocols, a radiology center with three linear accelerators and a CyberKnife radio-surgery facility, chemotherapy infusion center, radiation oncology center, and patient education and support facilities.
Over the past 10 years, most hospitals have experienced increasing competition with other hospitals in their markets, not only to attract patients, but also to recruit and retain physicians, nurses and other professional staff from a shrinking pool of qualified health care professionals.
It is also becoming increasingly common for hospitals to find themselves competing with physician groups, which are forming to build, own and operate independent outpatient surgery or imaging centers. Physician groups market their centers to patients as alternatives to hospital-based services.
To gain a competitive edge, hospitals are building more attractive, better-equipped and more user-friendly outpatient and inpatient facilities. In some one-hospital towns, competition can play a significant role in planning major projects because patients will travel to a different location if they feel another hospital is better equipped to handle their needs.
The days of institutional-looking, semi-private patient rooms are fading fast. Patients and their families are demanding the privacy of single-bed rooms, where they are not disturbed by roommates and roommates’ guests. Patients want larger, more aesthetically pleasing rooms with large windows overlooking natural settings and control over the environment in their room, especially lighting and HVAC controls. Patients also prefer furniture and casework that hide medical gas outlets and other equipment.
In addition, family members are looking for in-room accommodations that enable them to stay overnight with their loved ones — on a comfortable recliner or window seat that converts to a bed — plus a work surface on which to place a laptop computer. Internet access is also key.
Simply put, patients and families want a hospital room that looks like their bedroom at home or a nice hotel. Moreover, there is evidence suggesting that patients can recover faster in this kind of “healing environment.”
Methodist Stone Oak Hospital in San Antonio, Texas, for example, is designed to convey warmth, welcome and respect for patient dignity. Scheduled for completion in early 2009, phase one, a 132-bed acute care hospital with outpatient services, was designed for ease of access and navigation. The facility entrance includes easily identifiable centers of care designed to reduce confusion and frustration for patients, families and visitors. Abundant daylight and use of natural materials, such as wood and stone, contribute to a positive environment. Patient rooms that take the bathroom out of the headwall (inboard canted) shorten the distances nurses have to walk to reach their patients and enable them to see their patients from the door.
Hospitals are constantly looking for ways to improve staff and physician efficiencies in a way that improves patients’ medical outcomes while lowering the cost of care. Their survival depends on it, given quality initiatives, cost pressures from declining reimbursement rates from third-party payers, and increasing rates of uncompensated care.
As a result, over the last decade, it has become standard practice to improve operational efficiencies by optimizing patient and staff flow, equipment location, nursing unit configuration, and patient visibility.
Increasing interest in sustainable design and construction, including LEED certification, is also affecting health care facilities, particularly with respect to energy sourcing, mechanical/electrical/plumbing design, lighting, outdoor and indoor air quality, and selection of environmentally responsible materials. The goal of green building is consistent with the mission of hospitals — to create a healthy, safe and productive environment.
Finally, because the only certainty in health care is change, hospitals and other providers are building flexibility into design and construction of new facilities — especially structural components, mechanical/electrical systems and building perimeters — to enable them to adapt to the changing face of health care in the future.
Design and Construction
Part 2: Brief: Improving Patient and Staff Safety