Large medical centers benefit from economies of scale

Although outpatient centers have become an integral part of health care’s Triple Aim, large medical centers are not and most likely never will become obsolete. As seen in our recent cover story, many patients still require a single site where they can access a wide range of medical services and specialists. Growing urban centers are responding with facilities that not only meet these needs, but also meet them in the most efficient way possible with thoughtful designs that ease some of the stress of hospital staff and patients.

Four health care CEOs and directors from McGill University Health Centre in Montreal, Quebec, Canada; Grandview Medical Center, Birmingham, Ala.; Parkland Health & Hospital System, Dallas; and Orlando (Fla.) VA Medical Center tell us how their systems made sure these new facilities weren’t just designed to be bigger, but better, too.

Why are you bucking the trend toward smaller, off-site facilities?

Imma Franco, director, technical services, planning and real estate management, McGill University Health Centre: Given the nature of the McGill University Health Centre’s tertiary and quaternary care mandate, it requires a large facility to effectively integrate its comprehensive programs, as well as its academic and research components.

Keith Granger, president and CEO, Grandview Medical Center: The new facility replaced an aging hospital that was being outgrown quickly. The decision was made to place our comprehensive medical center in a high growth and well-connected area that allows better access for providers and patients. Offering comprehensive specialty capabilities requires breadth and depth of service line offerings that can be offered collectively under a common structure.

Fred Cerise, M.D., M.P.H., president and CEO, Parkland Health & Hospital System: As the public safety net hospital serving densely populated Dallas County, the new Parkland Memorial Hospital is the hub of our health system, which includes 12 large Community Oriented Primary Care health centers dispersed in neighborhoods throughout the county. The 2.1-million-square-foot hospital provides acute care inpatient services in a state-of-the-art facility to maximize quality of care, efficiency and access.  

Timothy W. Liezert, director, Orlando VA Medical Center: The new medical center, located at Lake Nona, serves as the primary referral site for acute care, complex specialty care, advanced diagnostic services and advanced technologies.  The majority of our veterans’ needs are met through the outpatient clinics and community-based outpatient clinics located near their home, while the medical center provides more complex services like emergency and inpatient care, which we expect will open in 2016.

How are you reaching out into your communities?

TL: We’re looking forward to completing the full activation of our Lake Nona campus by opening our inpatient services and emergency department (ED) in early 2016, and from there, we can bring the full impact of this facility to bear for our veterans and the Lake Nona community. We anticipate opening a Fisher House on campus in the near future, and participating in some unique national and international veterans events, such as the National Veterans Creative Arts Festival, and the 2016 Invictus Games.

FC: Parkland provides extensive outreach and educational programs, including mobile medical vans that offer primary care services to homeless adults and children. The health system averages more than 1 million outpatient visits annually.

KG: we are growing our primary care network into neighborhoods and rotating specialists in these clinics. We also have established multispecialty clinics where outpatient ambulatory services, such as imaging and physical therapy, can be offered to complement the primary care physicians and specialists.

IF: The location of the Glen site was chosen to seamlessly integrate within an urban setting that is closer to our patient provenance. It also allows for a greater accessibility to major highways and public transit, which, in turn, facilitates easier access for our users.

Do these facilities have more ambulatory space than previous large hospitals?

KG: Yes, like many new facilities, there is a large percentage of square footage devoted to ambulatory services. Facility design and flow were built around acute, disease-specific services and easy ambulatory access. Creating easy access from parking entry and aligning similar services resulted in ambulatory care being a priority to meet patient expectations.

FC: In addition to the new Parkland Memorial Hospital, the new 2.8-million-acre Parkland medical campus includes the adjacent WISH (Womens and Infants Specialty Health) Clinic, a large Urgent Care Center averaging more than 60,000 visits per year and a multispecialty outpatient clinic building scheduled to open in 2017.

TL: Much like other large VA facilities we incorporate outpatient care into our Lake Nona medical center. The design of the building incorporates three distinct spaces: outpatient clinic space; diagnostic and treatment space; and inpatient bed tower and ED space. The outpatient clinic space works in concert with the inpatient bed tower and ED, providing a continuum of care for our veterans.

Is there a telehealth strategy aligned with your facility?

FC: Advanced technologies in the new Parkland Memorial Hospital enable teleconferencing in each patient’s room utilizing digital footwalls with TVs that can be used for real-time consultations, accessing language services and providing educational videos and instructions, among other uses.

IF: In 2010, the MUHC was given a mandate from the Quebec government to operate a virtual health center to better serve the patient population in rural areas. Today, telehealth is fully integrated in the operations of the MUHC. Our telehealth strategy brings specialists and patients together in virtual space at the local and provincial level.

TL: Our strategy is to deliver the right care at the right time and in the right place, while providing veterans with options that reduce or eliminate travel challenges. We offer virtual care at all of our sites of care.