Health care planning veteran talks about change

PHOTO BY P2 PHOTOGRAPHY Don McKahan, AIA, FACHA

Health facility planner Don McKahan, AIA, FACHA, talks about how planning professionals must adjust to the profound changes that regulations, economics and patient preferences are having on health care facilities and campuses.

What are the most significant changes driving health facility planning today?

Hospitals and the health care industry in general now are engaged in a process of creative destruction. As a health care planner, I’ve spent the last 10 years of my career demolishing and rebuilding almost everything I put up in the first 10 years. Health care reform, new reimbursement schemes and evolving patient care strategies are upending traditional planning models. As hospitals move from quantity to quality, a new generation of more agile facilities is required. These buildings need the flexibility to support several generations of ever-changing hospital departments during their lifespan. This includes structural solutions that provide simple, expandable corridor systems; interstitial space for evolving mechanical and electrical systems; and the inclusion of soft space for future expansion of critical diagnostic and treatment departments.

How is the Affordable Care Act (ACA) affecting medical campus planning?

People who have insurance cards for the first time are starting to use them. In 2014, for-profit hospitals showed higher patient volumes and improved payer mixes under the ACA. As hospital systems have gained confidence in these reform measures, they are investing in new ACA-related health care facilities. Even minimal reimbursement for formerly uncompensated cases brings hospitals a newfound confidence for expanding their medical, diagnostic and surgical departments. New patient bed towers, on the other hand, are still a wait-and-see issue. ACA-related mergers between hospitals and physician groups have systems buying existing medical office buildings and relocating hospital-based specialists to new buildings on campus. Growth in primary care clinics and urgent care centers will occur somewhere down the street.

What do the new accountable care organizations (ACOs) expect from their architects and planners?

Hospitals and physician groups have merged in an effort to bundle medical services, offering single-source pricing to their payers. ACO clients want consultants who are like-minded, expecting their architects and engineers to adapt to this same packaged approach to building design and construction. The ACOs will drive more mergers among architects, engineers and construction firms who are attempting to integrate their services and attract these ACO clients.

What skills and services has your practice had to develop in response to these new health system clients?

When I started doing hospital planning in the 1980s, I knew very little about health care demographics. Since then, we’ve had to learn the methodology and market strategies behind population-based planning of health care facilities. Patient days, case mix, market share and physician recruiting underpin all of our space programs and building scenarios.

How is planning for outpatient and support services changing as hospitals move these functions off-site?

One of my clients refers to this process as decanting their medical center. In an attempt to free up space, alleviate congestion and reduce parking demands, they are moving many hospital services off campus. Only services involved in direct patient care will remain on the campus. My clients are acquiring inexpensive office-warehouse space for home care services, information technology, financial offices, purchasing, and even pharmacy and food services. Decanting is an important strategy that can free up space and extend the useful life of a hospital campus.

How can facility planning and design help to control health care costs?

Health facilities have a huge impact on staffing costs and operational efficiency. Duane Palmer, director of clinic operations for University of Utah Healthcare, wants his medical clinics to have “full parking lots and empty waiting rooms.” He is talking about building designs that improve patient throughput with minimal delays in waiting and exam rooms. Time is money for both patients and staff. As architects and planners, we should constantly look for new ways to leverage our health facility plans, allowing medical staff to multitask, reduce travel times around the department and share costly medical equipment among service lines.

What will happen with obsolete hospital buildings in the new marketplace?

It’s always tough to decide which facilities are worth renovating and which need to be replaced. Hospital buildings with adequate structure and space for new mechanical and electrical systems are being recycled into skilled nursing facilities, new diagnostic centers and patient-family support spaces. Unfortunately, many of the old hospital buildings from the ‘50s and ‘60s were single-purpose monoliths and they’ll have to go.

Which new technologies will have the greatest impact on health facility planning?

It’s all about the Internet. Medical care traditionally has been a hands-on, place-centered, human service. The arrival of telemedicine and new forms of connectivity between patients and caregivers changes all of that. Health systems and their architects need to rethink the need for facility-based services when considering the impact of remotely located physician specialists consulting with patients and their doctors online; emergency patients examined by physicians using robots equipped with medical sensors; and chronically ill patients monitored and cared for in their own bedrooms using electronic home health systems.

How are new departmental relationships changing the hospital of the future?

Hospitals are removing departmental demising walls, eliminating the silos and replacing them with integrated care platforms. Most of our hospital clients are creating new, multispecialty interventional suites (IVS), merging surgery, cath labs, interventional radiology and endoscopy. These new interventional units have a common work core and share staffing and imaging equipment. As a secondary benefit, these interventional suites are served by a single prep and recovery center, increasing flexibility and reducing staffing costs. These integrated planning strategies soon may create new imaging departments combined with diagnostic units, emergency departments with intensive care units and pharmacy services linked to central supply.

So, what is the impact of these newly merged departments on hospital operations and staffing?

In the case of the interventional suites, the consolidation of staff, space and equipment creates an economy of scale, which is very appealing to hospital leadership. Of course, physician participation is another story. The surgeons and cath lab physicians are usually accepting of the IVS concept. Interventional radiologists and gastrointestinal docs sometimes don’t appreciate the scrubbing, gowning and sterile standards required in these new procedure rooms. The project leader must work to get these diverse specialists to work in a cohesive way. 

Mike Hrickiewicz is editor of Health Facilities Management magazine.

The McKahan File

CV

• Principal of McKahan Planning Group in San Diego

• A health facility planner whose firm has created campus master plans for Sharp HealthCare, Baptist Health System, Lakeland Health and Adventist Health

Accomplishments

• Past president and founding member of the American College of Healthcare Architects

• Past president of the American Institute of Architects/Academy of Architecture for Health

• Received a Distinguished Service Award from the Kansas State University College of Architecture

• Director of the Hospital ICONs program of seminars, providing 10 years of architectural case studies on groundbreaking health care facilities

Education

• University of Colorado master of architecture

• Kansas State University bachelor of architecture