CONSUMERISM AND TECHNOLOGY DRIVE HEALTHCARE DESIGN AND CONSTRUCTION AS FACILITIES BECOME LESS STERILE AND MORE RESORT-LIKE
BY LISA KOPOCHINSKI
Earlier this year, results of a hospital market survey conducted by AGC of America and Sage Construction and Real Estate — a market leader in end-to-end construction and property management software — indicated that this market segment would expand in 2020.
However, with the current labor shortage and the “do more with less” mantra, construction professionals are being forced to get more creative when it comes to building patient-centric healthcare facilities, such as deciding if working in existing spaces is a better solution than large hospital renovations; and of course, the COVID-19 pandemic.
One of the top trends currently being seen is a shift from large acute care hospitals toward smaller specialty clinics and ambulatory surgery centers (ASCs). This is being driven by several factors, says Rob Chartier, vice president of healthcare at Miron Construction Co. Inc. in Neenah, Wisconsin, an AGC of Wisconsin and AGC of Greater Milwaukee member.
“First, healthcare providers have been focusing on population health,” he says. “To do this effectively, they have realized they must provide the necessary care — primary care, diagnostics, specialty care, therapy and more — within easy access of their target populations.”
A new mentality of consumerism is also creating pressure for healthcare providers to offer services at a more competitive and transparent cost.
“Smaller satellite specialty clinics and ASCs can operate more efficiently than their multi-specialty campus counterparts,” explains Chartier.
“Entrepreneurism is also leading some specialty practices to break away from their large system partners. As reimbursement rates drop, practices are looking for ways to preserve their margins. Practicing within a specialty clinic versus a large tertiary care center offers significant opportunities for overhead reduction and gains in patient volumes.”
Jeff Crawford and Jon Friedrichsen are senior project managers at GLY Construction, a Bellevue, Washington-based general contractor and an AGC of Washington member.
Crawford says current trends in healthcare construction include greater levels of standardization in room layouts.
“For example, our current work at Overlake Hospital [in Bellevue, Washington] — Project FutureCare — features universal room layouts that make it easy for doctors and clinicians to move between different floors without having to think about how to find things.”
Crawford says flow and Lean processes have always been important, “but we’re seeing a real emphasis on thoughtful adjacencies, better lines of site between providers and patients, more efficient flow of supplies and equipment, and logical storage locations. To support successful implementation, we’re working with clients and broader user groups to help them visualize the space before construction — when it gets much more challenging and expensive to make changes.”
Adds Friedrichsen, “We’ve had great group work sessions between design teams and user groups where we create quick drawings that the construction team is able to go out and mock-up. The architecture and design team produce visual mock-ups in Revit that allow the users to experience the space digitally. Then we create a physical mock-up. The combination of the two techniques is effective because — while digital representations give a strong visual image — there is still no substitute for allowing stakeholders to experience the three-dimensional space in a physical mock-up. We have found that physical mock-ups encourage collaboration, productive dialogue and more integrated solutions.”
CHANGES IN TRENDS
Much has changed in healthcare construction trends over the past five years.
“We now see a broad range of stakeholder engagement from providers and supply chain representatives to the public,” says Crawford. “We welcome it because it results in an optimized solution for everyone, but it does require a significant effort to organize the input and keep the project on track.”
The other trend being witnessed, he says, is that function is driving the design of the spaces — rather than the actual building footprint.
“Function is increasingly more important than form. For example, the form of Overlake’s New East Tower responds to design criteria related to increased square footage of patient rooms, access to natural light and grouping of like services. Our construction logistics approach needed to evolve with the building’s form to effectively plan our pour sequencing, tower crane location and worker circulation during the build among many other considerations.”
Chartier says facilities are being planned to provide patients and visitors more amenities to ease the anxiety associated with a healthcare encounter and also to empower the patient or visitor to schedule, check-in, self-room and monitor patient progress.
“Concierge services and patient navigators are helping to bring an aspect of hospitality to the patient visit. Service offerings such as patient education, alternative medicine and comfort offerings like cafés or “grab and go” food services are an improvement on the coffee station of the past. Following the lead of the airline industry, registration kiosks are becoming more commonplace in healthcare lobbies and registration stations. These kiosks facilitate self-check-in, scheduling follow-up appointments and are even making way for self-rooming. Patients are able and expected to find their exam rooms and await a visit from their caregiver.”
Working along with this model is also a trend toward “on-stage/off-stage” spaces, Chartier adds.
“Here, the patient only sees and has access to the warm, inviting public waiting areas, corridors and their exam room. This is called the “on-stage” area. Caregivers spend their non-encounter time in work and collaboration spaces that are not accessible to patients. This model is very reminiscent of the operations at Disney World.”
CONSUMERISM AND THE HEALTHCARE INDUSTRY
Few can also dispute the impact consumerism is having on the healthcare industry today.
“Consumerism is very much driving the decisions of healthcare systems, providers and designers,” says Chartier.
“In the era of increased insurance deductibles and premiums, patients are clearly shopping for their non-critical and elective healthcare. Virtually all of our healthcare work has been in the construction of stand-alone specialty clinics and the creation of specialty practices on hospital campuses.”
These specialty clinics offer care such as orthopedics, neuroscience, ENT, urology, oncology, cardiology/pulmonary and diagnostic imaging.
“A current project we are about to complete is the new Aurora BayCare ASC and Clinic in Kaukauna, Wisconsin,” he says. “As population health expands, Aurora BayCare recognized Kaukauna as a community that was underserved with local, accessible healthcare. Residents were primarily served by other nearby cities. This clinic will provide a local offering for ambulatory surgery, urgent care, diagnostics, various specialists and orthopedic rehab.”
Crawford says as our society becomes increasingly multi-cultural, hospital room design is changing to accommodate the different ways families wish to gather and visit their loved ones.
“For example, patient room sizes in the birthing center have increased to accommodate larger families. It is increasingly important to consider signage and wayfinding to make it as easy as possible for people to find their way from the parking garage to a hospital bed — no matter which language they speak.”
Friedrichsen adds that hospitality continues to strongly influence healthcare design.
“Overlake’s new Childbirth Center has many characteristics that feel more like a high-end resort than a sterile hospital. We’re seeing more amenities such as expanded waiting areas, wi-fi, food service and a concierge. There is a strong emphasis on natural light and a real awareness of acoustics. Circadian lighting, sound masking and enhanced lighting controls are all being considered as a part of the design, showing the greater appreciation of the role the environment plays in healing.”
TECHNOLOGY AND COVID-19
Technology has had a major impact in every market sector — especially healthcare — where the evolution of major medical equipment continues to improve detection and treatment.
“Robotic surgery is becoming more commonplace,” says Chartier. “Miron Construction is performing a fair number of retrofits to accommodate the technology. We’re taking notice that healthcare strategy professionals are pushing their equipment planners and designers to use creativity and vision to design flexibility into new construction that can accommodate the next big thing.”
Technology is also having a large impact on the doctor/patient encounter and may be contributing to the biggest innovation in the patient experience. For example, telemedicine is rapidly becoming commonplace and — particularly in the COVID-19 era — is about to see a major surge in utilization.
“Telemedicine spaces are finding their way into traditional care platforms where doctors can practice it interspersed with traditional face-to-face encounters,” explains Chartier.
“Near-universal possession of hand-held mobile devices is also allowing for the expansion of telemedicine. Hand-held devices and registration patient kiosks are changing the way that patients are navigating their face-to-face encounters with healthcare providers.”
And, while there is great potential for the expansion of these technologies for virtual care and navigation, what will be the non-monetary cost?
“Many providers are resistant to becoming too reliant on these technologies due to a loss of control of the process and for the obvious reduction or elimination of human interaction,” Chartier continues. “This may prove to be an outdated concept as the industry forms a new paradigm post-COVID-19. Time will tell.”
Crawford and Friedrichsen say GLY Construction is constantly evolving its use of technology on all its projects.
“Our best results often happen when we find a new use or application for an ‘out-of-the-box’ technology,” says Crawford.
“In light of the recent health crisis, we’ve accelerated our adoption of a suite of technologies, such as BIM360, tower crane camera capture and drone image capture that allow us to ‘remote in’ to the jobsite through an easy dashboard interface and track and monitor jobsite activity in real time.”
Adds Friedrichsen, “We’ve also created virtual mock-ups using HoloLens technology to create a virtual image of a particular site before building walls. However, the most successful outcomes are possible when the virtual converges with the physical. For example, at Overlake’s South Tower, which now ties into the New East Tower, the elevators opened into the lobby to offer spectacular views of the mountain. But the project phasing called for a solid temporary wall that would completely cut off the view. We built a virtual mock-up to show the client how the temporary wall could still offer protection, but by punching a couple of large windows in it we could preserve the sense of arrival and mountain views.”
As for what the near future holds for construction in the healthcare sector, Chartier says he would have answered this question very differently prior to the current global pandemic.
“Nearly all our efforts have gone into creating testing and treatment centers, away from the hospital proper, in response to COVID-19. It’s my feeling that hospital systems and specialty clinics will begin to respond to the need to isolate infectious disease and create centers that offer separation from the vulnerable population and from caregivers.”
As the post-9/11 era gave rise to disaster and terrorist response measures such as enhancements to security, decontamination and triage, he says COVID-19 will create an immediate need for epidemic/pandemic response centers.
“These new centers will be highly clinical with low touch/low interaction, leveraging technology like telemedicine. I believe we will see a near-immediate increase in renovations to existing facilities to eliminate non-scrubable surfaces in patient areas and eliminate or process-engineer a phase-out of the use of large waiting areas, traditional cafeterias and education spaces.”
Crawford says that COVID-19 has accelerated the adoption of virtual medicine as more patients are being asked to call in or schedule virtual visits with their providers to prevent spreading infection in hospitals. “We continue to push the envelope of universal design and can see this incorporating a greater degree of virtual medicine provision. The happiest possible outcome would be an increased demand for birthing centers when this is all over!”