BY DAVID MCLEMORE, AIA, ACHA, LEED AP, Executive Vice President, Kirksey Architecture, Healthcare Team Leader
Since the passage of the Affordable Care Act, there has been much speculation and discussion as to how the new law would change the way that healthcare is practiced moving forward. The healthcare industry is evolving year to year, in conjunction with the modifications and updates that are ongoing with the details of the law. Several facets to this evolution seem to be emerging. Consolidation of healthcare systems is one clear result, as we have seen happen right here in Houston when St. Luke’s merged with Catholic Healthcare Initiative, to name just one of several. Another facet is the ongoing expansion into the suburban areas of our city at large, as all the major institutions work to grow and strengthen physician networks to serve the larger number of insured families and individuals covered under the law. This expansion is not just happening in the acute care services, a.k.a. hospitals, but it is also happening with outpatient and clinical services, and the pace seems to be picking up as evidence by the rapid expansions seen in multi-specialty care such as Kelsey-Seybold.
While outpatient clinical services continue to grow in and around the Loop, and especially outside to the Beltway and beyond, the ways that buildings are being studied and designed for construction in these growth areas are not necessarily the same as they were looked at pre-ACA.
Doing More with Less
Clinical teams and doctors are having to identify strategies to do more with less in the outpatient setting as the nation seeks to control and even reduce the cost of care. While this trend is not something new, the trend in outpatient environments is far more fluid than with the inpatient setting, as laws and regulations dictate much, much more of the inpatient environment relative to size, shape and quality — to ensure minimum standards are adhered to for patient and clinician safety, suitability of workflow, and support of best practices. All of this is equally important in the outpatient setting, and is still considered every step of the way, but the fact remains that clinical teams are often allowed to be more rapidly adaptive and innovative in the outpatient setting, where the complexity of care is not the same as a hospital, codes are less prescriptive and thus medical practitioners can have more immediate influence on the continuous evolution of the patient care environment.
Another key driver to the ongoing changes in clinical design is the accountability requirements of the ACA. The implementation of integrated, electronic medical records systems certainly plays a huge role in addressing the accountability requirement, as it is ultimately an integrated communication tool between the multiple members of the clinical team. Not all patient care related communication happens digitally though, and this fact is still what’s driving the major design solutions to assist clinical care team members in better communication environments. Couple this with the need to do more with less, and you have several interesting recent trends:
1. The potential extinction of the isolated physician’s office, or at the very least, the emergence of a hybrid office.
1. A move toward “offstage” clinical care teams, previously coming about many years ago in hospital design, but now finding its way more and more in the world of outpatient care.
While the term “offstage” might lead one to believe the care team is moved remotely from the patient care area, it actually is the insertion of the care team directly in the center of the care environment, to maximize direct communication of all team members, and minimize their travel distance to their patients. More time with patients is what both clinicians and patients are seeking.
Greater Communication Equals Better Care As to the previously mentioned trend in physician’s offices, these seem to be moving ever closer to the patient care environment, getting smaller, being shared by multiple practitioners, moving into alcoves directly on hallways, or placed right into the center of the clinical care team side by side with nurses, physician assistants, and nurse practitioners. The bottom line is that the old-school mentality to the hierarchy of personal space is being cast aside, to help reduce the cost of building and maintaining the built environment utilized for patient care. Physicians and healthcare systems can save significant construction dollars coupled with significant lifecycle dollars related to the long-term operation of space. While the potential cost savings from a denser, more efficient built area are significantly helping to control healthcare delivery costs, the real savings, according to our physician clients, is the reduction in time wasted moving about to communicate with fellow caregivers, and this savings in movement time results in greater communication opportunity which is expected to produce better patient outcomes.
Technology in the Field
Both the hybrid office model and the clinical care team model do share one very common design component, relative to communication and collaborative care: technology integration. One of the key components to the ACA was the push for electronic medical records (EMR) systems. Clinicians are now demanding greater numbers of access points to these systems, and this is affecting the comprehensive design coordination of these spaces. While mobile access technologies continue to play an ever greater role, the need to have EMR access points that can not walk away is still critical, and these elements have to have the minimum possible impact on space utilization, to support the trend towards more efficient outpatient care environments. All of the major furniture systems designers have worked closely with clinical teams across the country over the past seven years since the passage of the ACA, and the result is much better integration of technology into the patient care areas, with a higher degree of adaptability. This overlay of digital communication design with physical communication design has helped usher in a new era of collaborative care, and it will be very interesting to see exactly what fruits it will bear in support of improved patient outcomes.