November/December 2013 | Volume ...
Healthcare leader


Today’s thoughts on the facility of tomorrow
Compiled by Constance Nestor



David Ennis, senior vice president
(retired), Kaufman Hall Associates
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MCD Healthcare Leader Predictions featuring Mark Herzog and Dr. Steven Driggers


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Mark Herzog, CEO and President of Holy Family Memorial and Dr. Steven Driggers, Cheif Medical Officer of Holy Family Memorial provide their insights into how to effectively evolve healthcare facilities over the next ten years.

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MCD Healthcare Leader Predictions featuring Mark Herzog and Dr. Steven Driggers

  2. 2. Healthcare leader PREDICTIONS Today’s thoughts on the facility of tomorrow Compiled by Constance Nestor IT’S A VERY NEW FUTURE THAT’S FACING HEALTHCARE PROVIDERS. Healthcare as we knew it is a thing of the past. The Health Care Institute wanted to know how healthcare c-suite leaders are coping with this reality and their prescriptions for healthcare facility environments during the next 10 years. Thoughts on these challenges were found while conducting the HCI 2013 Healthcare C-Suite Leaders Survey. The survey included healthcare institutions of various sizes and types and from a range of U.S. geographic regions. Although common threads such as efficiency, remaining competitive and containing costs will always be at the forefront, the following is a portion of common themes discovered through the survey. Additional leader predictions and advice will appear in the next issue of MCD. TECHNOLOGY TRENDS AND IMPLICATIONS ON DESIGN AND OPERATIONS John White, M.D., surgery dept. chairman, Advocate Lutheran General Hospital The hospital of the future will have significantly more technology. The operating room needs to change in support of patient safety — the reality of today’s facilities is that we’re retrofitting technology into an OR configuration that was designed in 1889 by Dr. Charlie Mayo. The Mayo design hasn’t changed to embrace new technologies. The rooms aren’t the least bit interactive with the patient, which is a big error with respect to eliminating medical errors in the ORs. Not enough people are dealing with this. Mark Herzog, CEO, Holy Family Memorial Health Reducing the need for and use of expensive technology and care settings and a population health-management approach are the only methods that will meaningfully and permanently change the cost curve. Lean approaches, the safest care and outstanding quality will be minimal requirements for successful healthcare providers in the very near future. Tom DeFauw, CEO, Port Huron Hospital We must rely on more cost-effective use of outpatient facilities. Another clear capital priority is our current investment in electronic health record technology, a very costly endeavor. While our age of plant is a concern, our IT financial commitment must come first. 24  Medical Construction & Design | November/December 2013 EVOLVING PATIENT POPULATIONS Eileen Gillespie, chief nursing officer, Presence Mercy Medical Center The most important factor is and will continue to be the ability to adapt to emerging disease and treatment modalities; to handle air flow and prevent the spreading of infectious disease. The future demands optimal environments that prevent the spread of infections. New and renovated facilities should be planned and designed with efficiency and an aging workforce in mind. Compact, efficient buildings with short walking distances are needed. How can we start to cluster around operationalized pods and teams? How can facilities help to better engage families in the care of their loved ones? Technology must be leveraged to spare footsteps and accelerate the timely delivery of care. Real-time decision support technology for patient surveillance is critical. Steve Driggers, M.D., chief medical officer, Holy Family Memorial Health More room options should be provided, especially for the increase in obese patients; and larger bathrooms. Swinging doors cause a lot of falls. Pocket doors, that can be left open most of the time, will be better. Mechanisms need to be found to unclutter rooms for the sake of cleanliness and visual orientation. Facilities need spaces for group patient forums and meetings. Statistically, diabetes patients treated in groups have better outcomes — resulting in more economical, more efficient education and wellness. Bryan Becker, M.D., associate vice president, University of Illinois Chicago Medical Center Healthcare executives are more willing to take risks and contemplate facilities and technologies from a patientcentered perspective. The ambulatory setting is untapped. Medical Construction & Design Magazine © 2013 PART 1 OF 2
  3. 3. EVOLVING MODELS OF CARE SPOTLIGHT ON MAINTENANCE David Ennis, senior vice president (retired), Kaufman Hall Associates Ultimately, to make healthcare affordable in our country, it will be essential to lower the historic rate of growth in expenditures for care. The pressure to reduce growth and lower costs will be seen in lower payment rates to healthcare providers. As payment rates decline, so must the cost structure. Jay Grinney, CEO, HealthSouth There are several things facility managers can do to enhance a company’s bottom line: ensure all hospitals are maintained to all applicable regulatory standards; transition from a “reactive” to a “pro-active” approach for facility maintenance and upgrades; operate each hospital as cost-effectively as possible and collaborate with operations to identify ways to drive operational improvement through facility design. Rick Mace, CEO, Adventist Bolingbrook Hospital Across the continuum of care services spectrum, acute care facilities (hospitals) will become a cost center. Hospitals will be going through a metamorphosis of understanding where they fit into the continuum of care. Patients may not be instructed to go to hospital campuses in the future. We’ll want to educate the patient to go to the physician office for healthcare, not the hospital. This may require the passing of an entire generation to teach the patient population how to navigate the new health system. Jay Grinney, CEO, HealthSouth From a post-acute perspective, I anticipate our facilities will become more multipurpose as the healthcare industry evolves. The facility needs of today’s postacute providers are dictated by Medicare reimbursement policies; Medicare has created post-acute silos through rules and regulations that exist solely to determine how Medicare will pay particular post-acute providers. This has created a fragmented and inefficient post-acute industry where the needs of the patient are subservient to the needs of the payor. In an accountable-care environment, the needs of patients, hopefully, will prevail. From a facility perspective this means flexible, multi-purpose post-acute buildings that can accommodate a broad spectrum of patients. Steve Driggers, M.D., chief medical officer, Holy Family Memorial Health At Holy Family, in addition to establishing medical home physician practices in local nursing homes, we are developing the concept of inpatient home where caregiver teams (a set of staff plus 1-2 hospitalists) provide patient care, thus bringing a pool of patients the continuity of a single provider team as opposed to an everchanging chain of caregivers. Facilities need to reflect this. Ken Lukhard, south market president, Advocate Health Care Historically, hospitals and health systems have been caught between funding inpatient expansion projects and addition of private beds, infrastructure demands and the high cost of clinical technology. Continuous preventive maintenance programs competed for shrinking capital as reimbursement has fallen. With the growing demand for broader outpatient platforms and multiple sites of care along with aging physical plants, staying on top of infrastructure needs will remain a challenge. It will be difficult to meet all of those demands. ADDITIONAL THOUGHTS Jeff Glassroth, M.D., dean of clinical affairs, University of Chicago The current architectural arms race and the architectural wow factor that is expected is going to have to change. A better balance between architectural/artistic high-end hotel-like environments and the mission must be achieved. There must be a balance between healing environments, technical needs and cost. Kevin Larkin, CFO, Presence Mercy Medical Center To be successful in the future, it will be critical for providers to achieve a robust margin, including contributions from Medicare and Medicaid. The formula for success involves eliminating unnecessary costs and process steps, while ensuring favorable patient outcomes, wowing patients and striving to be the best-of-class performers. Key cost controls include risk sharing, managing by exception, optimizing productivity, staffing to daily census/volumes, including support services, avoiding nice-to-haves and simply being great stewards of business resources. Doug Silverstein, president, NorthShore University HealthSystem Evanston Hospital The industry has experienced anywhere from a 5-15 percent decrease in inpatient business. Yet in an increasingly competitive consumer-driven environment, inpatient facilities need to be stateof-the-art. Flexibility is incredibly important. We must be prepared and positioned for moving in many directions. Strategies are also needed that will take costs out of our construction/capital budgets. “Can do” healthcare provider cultures are required where committed and talented people can make a difference. Editor’s Note: Health Care Institute survey results and interviews were conducted by Constance Nestor, FACHE, EDAC, LEAN, Health Care Institute vice president for research and Gary Collins, AIA, NCARB, principal of PFB Architects and Health Care Institute vice president. The second part of this article will appear in the January/February issue of MCD. For more information, visit November/December 2013 | Medical Construction & Design    25 Medical Construction & Design Magazine © 2013 Mark Herzog, CEO, Holy Family Memorial Health Historically, healthcare providers have striven to provide services in a passive manner, being ready when patients seek care. Increasingly, we must focus on providing services outside the hospital’s historical core that help community members achieve healthier lives. In doing so, healthcare must move from an inpatient-centric model to an outpatient and outreach structure as articulated in the AHA White Paper Hospitals and Care Systems of the Future (Fall 2011).