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Taking Healthcare Design beyond Budgetary Issues
The process of designing and building a cutting-edge healthcare facility is never an easy endeavor; the complexity compounds if the undertaking requires adding onto an existing facility. Many times, the final outcome of such projects differs greatly from what was initially designed. Although planners, designers and hospital administrators and staff make a concerted effort to create a cohesive facility, the resulting structure is often similar to the pre-existing facility. Such results demonstrate an obvious failure of vision and follow-through.
Why does this type of situation occur? Implementation delays are a major part of the problem. Senior management in healthcare facilities spend a great deal of time organizing staff expertise in preparation for a master plan that will employ leading-edge technology and design. However, delays in decision making may keep the plan with senior management for several years before it is executed. By then, the master plan is virtually obsolete, having not kept up with the latest changes in design, implementation and delivery of medical services and relevant technology. The budget established for the original project is another obvious stumbling block. If a market bond is being used to fund the project, the hospital chooses to stick with the original budget because a new larger request may be denied or trigger a higher interest rate. Essentially, the budget becomes the driving force in the project.
Consequently, cost-cutting takes place. Facilities will solicit the services of professionals who can work within the budget. Architects, engineers and construction managers employ a process called “value engineering” to bring down the total costs. However, this concept is positive only if it is employed to improve the quality of services and not to simply reduce the costs.
Cost Cuts Increase Costs in the Long Run
Scaled back plans can cost more in the long term. Moreover, outdated plans and designs will increase the operational cost of the facility. For instance, eliminating frequency drives for large motors (soft start) could minimize the initial costs, but increase long-term operating and maintenance expenses. Another common example: design engineers can eliminate shut-off valves on water lines. Doing so may lessen plumbing costs, but it will ultimately inconvenience facility operations when the entire plumbing system has to be shut down to repair broken pipes. Therefore, it is important to keep in mind that cost-cutting suggestions that may save money in a standard office building do not necessarily have the same positive effect on a modern hospital.
When funds for capital improvements are limited, budgetary realities impact the design stages of construction projects. The challenge for hospital administrative staff is to maintain operations according to budgetary restraints while keeping up with the latest technology. Having up-to-date technology not only helps attract more patients, but also gives the community access to essential services closer to home. Therefore, these types of purchases are often prioritized over structural needs of the facility and delay the implantation of the master plan even further. As the healthcare market changes, hospitals may purchase medical practices and joint venture projects with other physician practices, digging deeper into funds earmarked for a strategic master plan.
Planning Ahead
As another misjudgement, hospitals will wait until all available space has been consumed before implementing the master plan for further construction. This is not a wise move because this is the point where problems generally occur. Instead, hospitals should plan ahead. Healthcare facilities should have a five- or seven-year vision and strategic plan—one that is implemented and updated on a regular basis. This would prevent construction plans from getting tied to an old budget and producing “budget-driven” construction. With this type of construction, architects may rush through the project without securing vital input from hospital staff. Architects also may focus on reducing costs rather than increasing functionality. As a result, greater importance may be granted to revenue-producing areas than for staff, utility and storage.
Senior management must provide guidelines for the planning process. For example, if budget is the driving force, then everything will evolve around money. Consequently, architects will be advised to satisfy the minimum requirements to design healthcare facilities. Facility directors are often caught in the middle. They must support the senior management staff by negotiating with the architects to stay within the budget. Yet at the same time, they may be vexed when the right equipment is not installed.
Clinical and facility staff must work together cohesively from the beginning of the design process to identify what is best for patient care. They should not resort to value engineering to trim costs. When a hospital cuts costs, it ultimately pays in subsequent additional expenses or the patients pay by not receiving optimal care. Each hospital must determine its own best course of action.
Pursuit of Optimal Care Paramount
With money being the driving force in healthcare construction, patients are rarely asked for their opinion regarding the design of the facilities being build to accommodate their needs. Patients are often polled about their medical care in surveys, but are rarely asked about the facility. Even if they were asked, most hospitals are reluctant to apply them to the design process. Perhaps it is time we invite patients’ ideas into the discussions before designing new facilities.
There was a time when healthcare focused only on patient care and not environment issues. However, this has changed because of patients’ increasing expectations and preferences for private and home-like healing settings. These expectations are not unreasonable, as research shows that an aesthetically-pleasing environment promotes healing and well being. Hospitals must make everyone who visits as comfortable as possible. After all, their facility setting may be the final destination of that person’s life. Therefore, hospitals—regardless of size or profit status—must not allow budgets to drive decisions that prevent them from providing the best healing environment for their patients.
This article was reproduced for educational purposes from the November-December 2006 Inside ASHE article entitled “Healthcare Design Flaws” by Skanda V. Skandaverl, MBA, CHFM.
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