Optimizing value in health facility planning

Since its inception, the U.S. health care system has continued to evolve. One of the most substantial shifts in modern health care practice is the move from fee-for-service, volume-based care to value-based care. 

This moves the mechanisms of health care from paying for the number of patients that are diagnosed and treated to value, a more complex equation of quality (e.g., clinical outcome, patient perceptions and safety). 

The perception of care is captured through Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. In simple terms, moving from a Lean model of counting people and diagnosis to a multidimensional rating system that includes experience and outcomes. 

This value-based model has challenged old paradigms of operation. In previous models of operation, the primary mechanism to increase capacity would be to add space. In value-based care, volume no longer serves as the measure of success. 

Think of a hospital’s operations like an Ikea store. A person presents an issue or ailment. To move forward, they must follow a prescribed route with various stops. The patient doesn’t move forward in a straight line; therefore, they will not immediately arrive at the desired outcome. To buy a rug, they must pass housewares and bedroom furniture first. 

How do we know we are successful in the continuum? In this model, the fact that an item was purchased is a success. It did not matter that it took several stops and more time to reach success. Where is the value? 

In a value-based approach, the organization values the entire person, including their safety, time, outcomes and experience. Patients arrive and are met with a multidiscipline assessment. 

Think this time of a pit crew on a racetrack. The driver goes to one location, and the crew addresses all of their needs. The patient doesn’t have to travel service-to-service to gather care along the way. Instead, they are surrounded and supported by a team of experts who look at the whole system of care, maximizing the resources of the health care system to provide the highest level of care so all systems can work at their optimal
levels of performance.

There are three primary influences that will lead the shift toward operational success in this environment: 

• Collaboration. Creating models for staff to work together or implementing systems to share information with the primary goal of improving communication and overall health and wellness across the continuum. This reduces duplication and excessive use of services. An example is team-based care spaces for multiple disciplines to work and treat patients, providing rapid diagnosis and treatment all in one location and visit.
• Consolidation/integration. The backbone of the value-driven system’s success is to have a system that connects services, technology and practices with an eye to a fully efficient and optimized system. An example is the ability to integrate telemedicine into clinical practices where the provider flows from in person to remote and works at their optimum. 
• Customization. The patient at the center is not enough. It needs to be easy to access and meet the needs of the patient and be fully coordinated with their network of care. With the implementation of patient portals, the move to self-rooming and instant-satisfaction responses while at the visit, how can the environment continuously measure how the experience is meeting their needs?  

Our planning tools and systems of evaluation and improvement need to shift toward value. More space or Leaning the space is not what the hospital system needs. Instead, it’s a new, holistic model ­— one that has clear ways of measuring a successful engagement, wherever it occurs. 

The health care field needs a disrupter that can see the possibility for encircling the patient with the services that evaluate the success of that encounter from the safety, experience, efficiency and overall health outcome of the patient. 

Now, services and payments are moving out of the acute care facility environment. We need to ensure that health care staff is working and functioning at its optimum as it is the most costly function of a health care system. 

As hospitals are a huge contributor to employment and therefore local economies, ensuring their environments are properly utilized actually has a large effect on the financial success of the entire country. 

The health care worker shortage will continue, and we need to support integration and optimization of staff use to get there. Space cannot be a barrier. Until we recognize that building more space without considering value is an inefficient use of resources, we will never achieve the ideal patient experience. 

In a hospital model that is trying to bring value to its patients and staff, patient experience is one of the biggest components.

Lorissa MacAllister, Ph.D., AIA, LEED AP, Founder and President, Enviah, Grand Rapids, Mich.