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Behind the Healthcare Boom
By Craig Beale, FAIA, FACHA
The healthcare industry is not using words such as downsizing, restructuring and closures to describe its market climate. As a matter of fact, the healthcare industry is in the midst of a construction boom spurred by a number of factors, including aging facilities, growth in patient demand, increased competition and advancing technology.
Across the country, hospitals are enlarging emergency rooms, building heart centers, sprucing up atriums and building patient towers at a quickening pace. According to Raleigh, N.C.-based FMI, a leading construction management consulting firm, construction spending at hospitals is predicted to rise from an estimated $18.2 billion in 2003 to $21.8 billion in 2007.
In With the New
In the United States, the average plant age ranges between seven and 15 years. In general, northern states tend to have older facilities than southern states. Hospitals with older plants may need more capital in the future for routine maintenance and adapting to information technology requirements.
In Suffolk, Va., Louise Obici Memorial Hospital’s 51-year-old facility could not accommodate the changing needs for the delivery of modern healthcare. Instead of spending about 80 percent of the cost of a brand-new facility to renovate the existing hospital, management decided to build a new $84 million, three-story, 365,000-square-foot hospital providing a full range of state-of-the-art services.
These new facilities provide a blueprint for new healthcare delivery in addition to allowing administrators to focus on staff efficiencies. Because of growing staff shortages and an aging workforce, it is important to improve work flow to save time and energy. For example, nursing pods facilitate less walking time than single-loaded corridors.
Flexibility is also paramount, allowing hospitals to shrink and grow as well as reconfigure at will. At Louise Obici Memorial Hospital, careful attention was paid to making the facility more flexible than the old structure. The universal swing rooms provide the hospital with multipurpose rooms without having to add on to the structure. In addition, the medical office building, built to the same code requirements as the hospital, can be used as additional hospital space in the future.
A Healthcare Destination
Outside of Henderson, Nev., a group of businesspeople drives up a palm tree-lined entry to a hacienda-like building. They grab their luggage and walk into a spacious atrium with a skylighted, barrel-vaulted ceiling and grand staircase and head for the concierge desk. The friendly concierge informs the group that they have entered St. Rose Dominican Hospital – Siena Campus, a healthcare facility.
For more than a decade, the healthcare industry has been borrowing design concepts as well as ideas regarding amenities from the hospitality market. The idea behind it is simple — hospitality equates to relaxation, comfort and convenience. Today’s sophisticated healthcare subscriber demands all these elements. The more amenities a healthcare system provides, the better it can attract savvy healthcare consumers.
An open central atrium is the focal point of many healthcare facilities. Upon entering the facility, lush landscaping and soothing water elements create an inviting first impression. Patient registry is paralleled to hotel guest registration, and patient rooms have dramatically changed to mirror the amenities of a comfortable hotel room.
A variety of public spaces are included in today’s healthcare facility. Upscale retail shops provide a diversion for guests and staff alike. Unlike storefront pharmacies and cart-operated vendors of the past, the new merchants offer a variety of choices of essential items, as well as luxury gifts and accessories. A resource library is also offered at most facilities. Business centers, open to patients, family members and guests, host high-tech communications, including computer and intranet access, e-mail, audio- and videoconferencing, telephone, fax and copy capabilities.
The dining experience has also dramatically changed at healthcare facilities. Dining rooms, fresh food markets, cafés and coffeehouses are replacing the cafeteria of the past, traditionally tucked in the basement of the healthcare facility. Zale Lipshy University Hospital, in Dallas, Texas, has taken this theory to heart. The hospital’s food won the Ivy Award from Restaurants & Institutions magazine and the Silver Plate Award from the International Foodservice Manufacturers Association. Bayfront Medical Center in St. Petersburg, Fla., hosts Joffrey’s, a gourmet coffee and pastry shop. And a pizza oven is the focal point of the restaurant-style dining accommodations at Mercy Health Center in Laredo, Texas.
Many healthcare buildings are being designed as public-use facilities, as well as healthcare facilities. Atrium spaces can host a variety of events from art shows and children's concerts to health fairs and screenings. Outdoors areas of respite are also a popular feature. A three-quarter-acre healing garden grows in the center of St. Rose Dominican Hospital – Siena Campus. The garden creates a peaceful environment where patients and their families, staff and community can visit and enjoy the natural beauty of nature. The space has hosted a mother’s day tea, mini concerts and community events, such as the Nevada Rose Society gardening classes.
Customer Conveniences
Today’s healthcare consumers want to know more about their healthcare concerns and take more control of their therapies and where they go for treatment. Hospitals are responding to the growth in demand for knowledge. In the United States, the decision-making process regarding an individual’s healthcare is moving much closer to the patient.
The growth in information and knowledge is being fueled by the dramatic rise in the use of the Internet and associated technologies and the increase in direct-to-consumer advertising. Healthcare consumers are able to go online and compare the amenities of each hospital. Given the competition between hospitals — in particular specialty, urban and academic medical centers — a few extra amenities might be the difference between feast and famine.
Patient participation in the treatment and healing process is key. A sense of control and comfort with the environment will promote the healing process. Within the patient room, patient and family empowerment is provided with control over noise and distractions, television, lighting, thermal comfort and social interaction.
At Utah Valley Regional Medical Center in Provo, Utah, the individual patient rooms are designed from the patient’s perspective. All lighting, music, television and communication controls are ergonomically located within reach of the patient bed. Concealed storage is provided for clothing and personal supplies. Display space for cards, flowers and personal items allows personalization that empowers. A residential atmosphere is created through the use of natural woods, scaled furniture, a full spectrum of color and soothing artwork. Views of nature are visible from the patient’s bed and family spaces. A clear distinction is created between the patient, caregiver and family zones. Caregiver supplies and work areas are separated from the patient and family spaces.
Places of retreat provide positive distractions and a sense of choice, especially for inpatients requiring longer stays. The designated indoor and outdoor spaces are easily accessible and secure, and they promote choice without confusion. Social interaction and privacy, music, entertainment, retail and educational choices also create a positive environment.
Aging Baby Boomers
The aging of the population is one factor contributing to an increase in hospital services and will play an even greater role as baby boomers begin to reach retirement age in this decade. Hospitals are already experiencing a dramatic increase in the numbers of critically ill patients, which has spurred a shortage of critical care beds in certain areas.
It is important for hospitals to consider growth in the over-65 demographic because this group is the heaviest user of hospital services, according to Healthcare Financial Management Association. Americans between the ages of 65 and 74 average 1.3 inpatient days annually compared to less than half a day for Americans under the age of 65.
Four states — Nevada, Arizona, Colorado and Florida — are projected to lead the nation in growth rate of both overall population and population over age 65 between 2002 and 2007. In absolute numbers, the states that will see the largest swells in population are California, Texas, Florida and Georgia.
Today’s consumers are more educated, are accustomed to immediate services and have the financial means and access to seek care. These factors have led to the development of a number of centers of excellence. Since two of the nation’s leading causes of death are heart disease and cancer, according to the Centers for Disease Control and Prevention (CDC), you can bet that a number of these centers focus on treating these two illnesses.
At Indiana Heart Hospital, in Indianapolis, Ind., patients are treated with the latest in cardiac care and amenities. The heart hospital offers a number of unexpected services to its patients, from escorts to bellhops carrying their bags. Employees are also being taken care of through an on-site concierge offering oil and lube services, flower and grocery delivery, film developing, dry cleaning and postal services.
All patients are treated like VIPs at Cleveland Clinic in Weston, Fla. The facility uses a grand entrance as a gathering space. All rooms are private and have many bedside amenities, including patient and guest storage, a work area, a desk and a refrigerator. These provisions promote a family-centered care environment that makes guests and families feel welcome. The rooms are 15 feet wide, compared to the typical 13-foot patient room. Extensive wood millwork throughout the patient room, including concealed headwalls, creates a warm atmosphere. Full drapes, a tailored bedspread and lounge seating are part of each patient room.
Harris Methodist Heart Center in Fort Worth, Texas, also under construction, has created a patient room designed to offer a unique healing environment. Many of the patient rooms take advantage of dramatic downtown views. A television/cable system, in addition to a patient/family reference library, will provide educational programming as well as Internet and e-mail access to patients.
M.D. Anderson Cancer Center in Houston, Texas, ranked the nation’s top cancer hospital by U.S. News & World Report’s “America’s Best Hospitals” survey, offers patients an environment that is comfortable and familiar. An enclosed park area resembles a mall with retail shops, restaurants, a newspaper stand and a gourmet coffee shop. It also provides an extensive library for patients, families and staff.
The High-Tech Hospital
Healthcare’s ultratech revolution is propelling the field into a new era. According to hospital chief financial officers, the three most commonly cited future capital projects all focus on technology, including digital radiology systems, computerized physician order entry systems and other major information technology.
Advances in medical and information technology are affecting every area of the hospital, including emergency departments, operating rooms, patient rooms, nursing stations and administrative support services. Healthcare administrators are struggling to keep pace with the rapid evolution of medical and information technology systems. In turn, they are spending major dollars to renovate, expand and build new facilities while hoping their new facility will not be outdated before it is built.
When built back in 1948, The George Washington University Hospital, located in Washington, D.C., was the most modern hospital in the nation’s capital. Over the years, doctors there have treated numerous national figures, including Ronald Reagan, Dick Cheney and Alan Greenspan. Today, a replacement 371-bed, $96 million hospital carries on the tradition of quality healthcare with an expanded emphasis on technology and wireless communication.
The facility houses millions of dollars in high-tech equipment. Diagnostic capabilities have been drastically improved with the addition of state-of-the-art technology for cardiac catheterization, angiography, magnetic resonance imaging (MRI), computed tomography (CT) and nuclear medicine. A fully integrated, picture archiving communication system (PACS) enables all radiology scans to be stored digitally for easy retrieval. The filmless, paperless department offers special X-ray equipment, cutting-edge MRI scanners, and upgraded nuclear medicine and ultrasound equipment.
The PACS system stores data electronically on a secure Web server. This means doctors can view images and reports from computers anywhere and anytime. Because the images are readily available, physicians are able to make clinical decisions more quickly. The hospital is also adding voice recognition into its dictation system, allowing radiologists to dictate reports more efficiently.
In addition to wireless capabilities, The George Washington University Hospital is one of the first facilities in the country to integrate virtual reality, computer-controlled mannequins and other interactive teaching tools into a hospital setting. This technology benefits the patient and provides risk-free tools for training future healthcare providers.
More often than not, physicians are carrying palm-held personal data assistants (PDAs). Through the hospital’s pilot PDA program, physicians have online, real-time mobile access to patient data. Via a secure system, doctors can access hospital records to retrieve up-to-the-minute information on their patients’ care. In addition, PDAs and laptop computers will soon allow doctors to key in patient orders for laboratory tests and X-rays and, eventually, order medicines directly from a patient’s bedside. Plans for other technological advancements include a new generation of remote access allowing doctors to view medical information safely and confidentially from remote locations.
Conclusion
As in many other industries, healthcare is constantly changing. The Health Insurance Portability and Accountability Act (HIPAA) will continue to allow the industry to grow and share information with its consumers, allowing patients to play a greater role in their treatment. Simultaneously, a new generation of healthcare facilities, different from the familiar institutional model, also continues to evolve. Yesterday’s hospitals were designed solely to house the sick. The hospital of the future will be a welcome part of the community providing a healing, hospitable environment to serve not only the sick, but also the healthy.
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