Specialty hospital growth and evolution

The UF Health cancer hospital in Gainesville, Fla., looks like two separate but connected buildings, while the UF Health heart and vascular and neuromedicine hospitals further down the street are housed within the same building.

Image by Kyle Walker, UF Health

The U.S. health care field includes a wide variety of specialty hospitals and centers of excellence, a trend that has gained traction over the past several decades. These hospitals have evolved to offer focused services for specific medical conditions requiring specialized skills and technology.

They have existed in various forms for decades, such as psychiatric hospitals, children’s hospitals, rehabilitation hospitals and more. However, in more recent years, specialty hospitals have focused on cardiovascular, orthopedic and general surgery. In the mid-2000s, the Centers for Medicare & Medicaid Services released a definition of specialty hospitals as those that are “primarily or exclusively engaged in the care and treatment of patients with a cardiac or orthopedic condition or those receiving a surgical procedure.”

Benefits of specialty hospitals include the enhancement of quality care and outcomes focused on a specialty; the delivery of more efficient and cost-effective care; staff trained in the specifics of the condition; services and technology related to the condition housed in one location; brandable and identifiable recognition and rankings; and the ability to attract and retain the best staff. They also often are affiliated or partnered with academic institutions or other health care providers, allowing patients to receive specialized care within a facility with which they are already familiar. Specialty hospitals excel in patient-centered care by offering personalized treatment plans customized to the patient’s individual needs, resulting in better outcomes and positive patient satisfaction rates.

Some of the challenges that specialty hospitals face include the conflict between physician ownership and physician referral; the potential for higher levels of cost inefficiency compared to general hospitals; the siphoning of patients and services away from full-service hospitals; a focus on specialty care at the cost of comprehensive holistic patient health; and that the advertisement of specialized services and treatment may elicit a level of quality of care that may or may not exist.

Whether referred to as specialty hospitals, centers of excellence, institutes or other names, these hospitals play a crucial role in the delivery of medical care for patients with specific medical conditions and needs. It is difficult to determine the number of specialty hospitals in the U.S., and there is no accepted definition of what makes a specialty hospital. Specialty hospitals comprise between 4% and 11% of the more than 400 health care systems and 6,100 hospitals in the U.S.

Models of care

The following includes three case studies of specialty hospitals, each of which represents a different model of care. These were selected not to compare but to provide a background and overview of their inception and identify trends emerging from the planning, design and subsequent evolution of the facilities’ operations.

University of Florida (UF) Health’s heart, vascular and neuromedicine hospitals in Gainesville: specialty hospitals as a campus transformational strategy. The last 25 years of planning and expansion at the UF Health campus is a model of how a 1,000-bed academic medical center leveraged specialty hospitals as a mechanism to expand, enhance its reputation and provide an improved patient experience.

Initially conceived in the 1940s, the University of Florida Teaching Hospital became Shands and eventually a not-for-profit organization with a reputation for high-quality care. The acute care medical center had evolved into an aggregated model of additions to the campus with no good way to traverse from one end to the other, plagued by limited floor-to-floor heights and, finally, hemmed in by other university structures and major roads.

By the turn of the 21st century, it was clear that there had to be a new path forward. With a master plan effort that began in the early 2000s, Flad Architects worked with the owner to determine which major programs and services could be located south of Archer Road and take advantage of an underutilized 30-acre site. The decision was made to design and build a new cancer hospital on the south campus with a long-range vision for additional specialty hospitals to follow, all arrayed around a new pond and “garden of hope” in the center of the site.

The cancer hospital includes the new adult emergency department (ED), trauma beds, oncology beds and 13 operating rooms (ORs), and is connected back to the original campus with a pair of tunnels, one for patients and service and the other for the public.

In 2017, the heart, vascular and neuromedicine hospitals opened. The new hospitals were designed as an almost matching pair of bed towers constructed over a shared entrance and lobby and diagnostics and treatment plinth. They connect directly to the cancer hospital and share access to surgical services.

The heart, vascular and neuromedicine hospitals are designed to optimize dedicated specialty services while also utilizing standardized key rooms for both (i.e., inpatient rooms, exam rooms and post-anesthesia care unit/prep/recovery) and sharing support services. Inpatient beds are virtually identical for both service lines, and their design is largely based on the inpatient nursing units in the older cancer hospital, though physicians and others had opportunities to make adjustments. Rather than being allocated vertically as the two bed towers suggest, both acute and critical care units are currently assigned horizontally in a more efficient arrangement for care providers.

Relocating specialty services to the new southern campus has allowed those programs remaining within the original campus to expand in place. The old adult ED was renovated to become a pediatric ED. The children’s hospital has made artful use of new brightly colored steel panels on the exterior that announce its location and entry.

The UF Health campus is now “a collection of specialized hospitals all linked together,” according to Brad Pollitt, AIA, the former vice president of facilities at UF Health who oversaw the development. Space remains on the new campus for expansion and a future specialty hospital should the need arise. This is an example of the placement of specialty hospitals over time on a campus based on a master plan that came out of a long-term business and financial plan.

The University of Texas MD Anderson Cancer Center in Houston: a successful giant among specialty hospitals. As one of the oldest and most successful specialty hospitals, MD Anderson serves as a model of what specialty care can offer. Established in 1941, it was the result of the Texas Legislature and University of Texas looking to establish a hospital for cancer treatment and research while the trustees of the MD Anderson Foundation were searching for a worthy cause.

The main MD Anderson Cancer Center campus is located within the Texas Medical Center in Houston.

Image by F. Carter Smith and courtesy of MD Anderson

It’s unclear if benefactor Monroe Dunaway Anderson was personally interested in health care, but the foundation trustees were. When the Texas Legislature appropriated $500,000 to establish a hospital for cancer research and treatment, the MD Anderson Foundation matched the sum when the hospital was built in Houston and named for its benefactor.

The main MD Anderson campus is located within the Texas Medical Center. With 16.5 million square feet dedicated to clinical care, research, prevention and education, the hospital houses 760 inpatient beds and saw nearly 180,000 patients in the last fiscal year. Given this scale, MD Anderson makes the case that its clinical teams and other top-ranked cancer centers have the advantage of “volume, sub-specialization and mastery,” according to a YouTube video by the hospital, and that “rare cancers are not rare at MD Anderson.”

The question of holistic patient care is an interesting one for a specialty hospital, and there may be different responses for treating the whole person. In Houston, one of MD Anderson’s 10 clinical divisions is internal medicine — something of the inverse of a general academic medical center in which oncology might be one of the clinical divisions.

Despite its strong reputation and long-standing top ranking, not all patients with cancer in Houston visit MD Anderson. Some potential reasons for this might be patient perception that treatment and outcomes are similar at many cancer centers, the inconvenience of navigating the density of the Texas Medical Center, or denial and fear regarding cancer and going to a cancer hospital. Patients diagnosed with late-stage cancer may not appreciate the options that may be available at an institution like MD Anderson, opting instead to stay with a local facility for their care.

The Christ Hospital Joint & Spine Center in Cincinnati: specialty orthopedics as a branding opportunity. The Christ Hospital has a rich history that dates to 1889, when James Norris Gamble, a founding partner of Proctor & Gamble, donated a house for a 10-bed hospital. It quickly outgrew its initial location and moved to its current Mount Auburn site in 1893.

TThe Joint & Spine Center in Cincinnati has served The Christ Hospital well through changing needs and was put to the test during the COVID-19 pandemic.

Image © Tom Rossiter and courtesy of SOM

The hospital has a significant place in medical history and innovation, performing notable milestones such as the first use of dialysis, introducing the first intensive care unit (ICU) in Cincinnati, and conducting the first ceramic hip replacement in the U.S., among other pioneering advancements.

While the hospital system specializes in more than orthopedics, with 555 beds and over 100 locations throughout Greater Cincinnati, design began on a 381,000-square-foot, eight-story, 87-bed joint and spine hospital in 2012 in response to an enterprise strategic plan, which fed into a master plan of the Cincinnati campus developed by the firm SOM.

The Joint & Spine Center at The Christ Hospital offers a comprehensive range of services, including 14 ORs, advanced imaging facilities and a variety of therapy services. Goals for the project included constructing a building that would be versatile for changes in health care and the needs of the community and planning a building with infrastructure that will last long into the future.

The building has served the facility well through changing needs and was put to the test during the COVID-19 pandemic, when entire bed floors were converted to negative pressure to treat COVID-19 patients. With the reduction of average lengths of stay for joint and spine patients from two days when the building opened in 2015 to less than one day today, the building currently houses complex and multi-specialty patients. The beds were designed to be ICU “capable” and were upgraded post-COVID-19, which allowed the facility to move all its neuro and surgical ICU patients under one roof.

The Joint & Spine Center building was developed based on a strategic and campus master plan, but the guiding principles developed for the project have been employed on subsequent projects. The planning and design approach has continued to be used and has resulted in a cohesive language and vocabulary for services that are more distributed over many locations.

Evolving role

The evolving role of specialty hospitals is enhanced by their integration into or being part of a larger health care system. This integration allows for better coordination of care and more efficient use of resources. All three case studies do this to some extent, providing access to both specialized and general medical services.

Specialty hospitals are most successful when they leverage their concentrated expertise, advanced technology and patient-centered care models. All three hospitals highlighted in the case studies also do this, but each does it differently.

• UF Health’s heart and vascular hospitals are expanding their services to include comprehensive heart health programs that emphasize prevention and early detection of heart disease, signifying a growing focus on preventive care for which specialty hospitals are well-positioned due to their expertise and resources.
• MD Anderson is renowned for comprehensive cancer care, research, prevention and education. Its multidisciplinary approach ensures that patients receive personalized treatment plans developed by teams of specialists, leading to superior outcomes.
• The Christ Hospital excels in cardiac and orthopedic care, offering advanced surgical techniques and state-of-the-art facilities. Its Joint & Spine Center is a prime example of how focused expertise and advanced technology can lead to exceptional patient care and recovery.

Specialty hospitals will continue to be major players in the delivery of care in the U.S. When implemented in a thoughtful and meaningful way, they can play a crucial role in improving patient outcomes, advancing medical science and setting new standards in health care excellence. 

RELATED ARTICLE: Recommendations for planning and designing specialty hospitals

From a planning and design perspective, successful specialty hospitals have several elements common to each other. While there is no silver bullet that ensures a successful project, there are important planning factors that play into whether a specialty hospital building reinforces and enhances an existing campus fabric.

• A specialty hospital must evolve out of a robust strategic plan that builds a business case — a financial and operational model combined with a campus master plan that includes a real-estate assessment.
• Location and access are critical when considering the site and placement of a specialty hospital.
• Connection to existing buildings on campus, patient transport and staff convenience are all significant considerations that factor in a decision as to where a building should be placed.
• The importance of wayfinding, parking and connectivity cannot be underestimated. Adding more entrances to an already complex campus can have major implications ranging from staffing and security to patient satisfaction.
• Proximity to and impact on support services, including utilities, loading area, deliveries, central sterile, dietary, pharmacy and imaging, need to be considered and resolved.
• Future opportunities and expansion need to be included in the master plan assessment. Not owning a parcel of land or an inappropriately placed building can be a deal breaker (e.g., disruptions, replacement and cost) when considering the next logical move.
• A designated facility that is strategically located and visible can prove effective in brand ability, driving market share and physician recruitment. It can also attract donors and naming opportunities.
• Sensitivity to existing campus flows, vocabulary and expression is essential to long-term campus cohesiveness and functionality.
• Planning for flexibility, anticipated advancements in technology and changes in care delivery will extend the life of the building. 

About this article

This feature is one of a series of articles published by Health Facilities Management (HFMmagazine.com) in partnership with the American College of Healthcare Architects (healtharchitects.org).

Jennifer Aliber, FAIA, FACHA, LEED AP, is principal at Shepley Bulfinch in Boston; and Bryan Langlands, FAIA, FACHA, is principal and Kaitlin Laustsen, AIA, is associate at NBBJ’s New York City office. Their emails are jaliber@shepleybulfinch.com, blanglands@nbbj.com and klaustsen@nbbj.com.