2. Healthcare Top 10 Trends,
Challenges, Initiatives & Solutions
The Owner’s Perspective: Jeff Prochazka,
Director of Strategic Planning, Methodist Health System
“How are we responding to Changes in Healthcare delivery & reimbursement?”
The Architect’s Perspective: Patrick Leahy,
Director of Planning, Research and Innovation for Holland Basham Architects (HBA)
“Art, Science and Faith, why do Architects need to understand current HC trends?”
The Planner’s Perspective: Jim Easter,
Principal, Easter Healthcare Consulting (Ehc)
“Isn’t Planning Changing to Asset Management and Dollars?”
The IT/IS/Systems Perspective: Alan Dash,
Principal, The Sextant Group
“How Will IT/Medical Communications Change our Vision for The Future?”
Holland Basham Architects
3. Learning Objectives
a. Learn measurable solutions from Hospital System addressing National and
Regional Trends and market changes.
b. Creatively assess and evaluate planning and design solutions from
Architect’s perspective (evidence based and programmatically grounded).
c. Apply strategic and functional planning to Future designs based on
appropriate trends, design innovations and solid business objectives.
d. Measure the results and respond accordingly.
Healthcare Top 10 Trends,
Challenges, Initiatives & Solutions
Holland Basham Architects
5. Top 10
Increase outpatient care
Reduce re-admissions
Reduce infections
Improve HCAHPS scores
Decrease of rural hospitals
Big getting bigger & Branding
Doing more with less
Evidence-based design
Technology tools
Population health
9. Top 10
Increase outpatient care
Reduce re-admissions
Reduce infections
Improve HCAHPS scores
Decrease of rural hospitals
Big getting bigger & Branding
Doing more with less
Evidence-based design
Technology tools
Population health
22. Nurse Practitioner / Coordinating
Professional
Endocrinologist
Pharmacist
Physical
Therapist
Community Health
Partner
Dentist
Nutritionist
Patient
Holland Basham Architects
Integrated Care Team1
63. Reduce Medical Errors and Infections4
Medicare Bonuses and Penalties 2014
Holland Basham ArchitectsKaiser Health new – 2015-01-22
Hospital Size Penalty (Avg.)
1360 Hospitals
Bonus (Avg.)
800 of 1700
Hospitals that
qualified
> 400 Beds $1.2 Million $213,000
<200 Beds $131,000 $32,000
64. Holland Basham Architects
Reduce Medical Errors and Infections4
Centers for Disease Control & Prevention and
the World Health Organization
did not exist a century ago.
65. Reduce Medical Errors and Infections4
Between 44,000 to 98,000 deaths/year due to
medical error in U.S.
Holland Basham ArchitectsSource: Institute of Medicine (IOM) “To Err is Human”, 1999
66. No. 3 killer in the U.S.
third only to heart disease and cancer
-Tejal Gandhi, MD, Harvard Medical School
1000 deaths per day
10,000 serious complications
-Joann Disch RN, University of Minnesota
Source: Senate Subcommittee on Primary Health and Aging, July 18, 2014
4 Reduce Deaths & Complications due to Medical Error
67. Source: Senate Subcommittee on Primary Health and Aging, July 18, 2014
"What these numbers say is that
every day, a 747, two of them are crashing.
we would not tolerate that degree of
preventable harm in any other forum."
4 Reduce Deaths & Complications due to Medical Error
71. Holland Basham Architects
Reduce Medical Errors and Infections4
7,000 medication errors per year…
Source: Institute of Medicine (IOM) “To Err is Human”, 1999 & FDA 04/12/2013
Likely more, as voluntary reports
73. Reduce Medical Errors and Infections4
Holland Basham Architects
Reduce hospital acquired infections
74. Reduce Medical Errors and Infections4
Holland Basham Architects
Strategies to reduce risk of infection
Target high-touch areas
Emphasize hand washing among staff and visitors
Stress technique over chemicals
Follow the directions
Consider risks of using sporicidal sterilants
Determine effects of chemicals on materials and people
Assemble multidisciplinary teams
Check each other’s work
75. Reduce Medical Errors and Infections4
Holland Basham Architects
Biggest advancement in healthcare, improved
HyGreen
79. Improve HCAHPS Scores5
Holland Basham Architects
Hospital design impacts patient experience
Private
Rooms
Minimized
Noise
Internet
Access
Access to
Daylight
Nature-
Based Art
In-Room
Family
Areas
Meals On
Demand
85. Fewer Rural Critical Access Hospitals6
2/3 of critical access hospitals could close
Modern Healthcare August 17, 2013
86. 6 Stop the Assault - on Critical Access Hospitals
healthleadersmedia.com 2015
87. Fewer Rural Critical Access Hospitals6
Administration’s 2016 budget axe is triple whack at critical access hospitals:
eliminates critical access designation for hospitals closer than 10 miles
from the nearest hospital, which would create projected savings of
$770 million.
reimbursements cut from 101% to 100% of costs, which is expected to
save the federal government about $1.7 billion over the next decade.
zeroed out funding for Area Health Education Centers, which provide
recruiting and training for rural medical staff. Already a great workforce
shortage in rural America.
Source: HealthLeaders Media , February 4, 2015
88. Fewer Rural Critical Access Hospitals6
Rural Healthcare already hurting:
Sequestration, DSH, bad debt, and other types of cuts have already hit
rural hospitals hard.
"Forty-seven rural hospitals have closed since 2010, and 283 more are
on the verge of closure.
If this occurs, 700,000 rural patients will be without access to their
closest point of emergency care.
Source: HealthLeaders Media , February 4, 2015
89. 6 Critical Access Hospitals
Centers for Medicare and Medicaid Services 2013
90. 6 Critical Access Hospitals – Midwest Distribution
Centers for Medicare and Medicaid Services 2013
93. Fewer Rural Critical Access Hospitals6
“They would either go to more expensive urban hospitals or
delay care until more expensive”
Republican Sen Chuck Grassley, IA
Modern Healthcare August 17, 2013
94. Critical Access Hospital – Other Trends9
Holland Basham Architects
Becoming Large Clinics with <10 Beds + ED/UC
Exam Rooms that Flex to Impatient Rooms
Inpatient Rooms that Flex to Exam Rooms
Early Adopters of new Imaging & Treatment Equipment
In Example: 3D Color Ultrasound, CT and MRI.
Or do the simple things that work with Care and Empathy
96. Big Getting Bigger and Sharing of Best Practices7
Clinically integrated networks
97. Holland Basham Architects
Big Getting Bigger – partnerships, working agreements or ACO’s7
Regional Provider Network (ACO’s) & Regional Partnerships
118. Evidence Based Design9
Holland Basham Architects
evidence-based design - research conclusions
View of Nature Shortens length of Stay
Natural Light Shortens length of Stay
Flooring best for Infection Control
Quiet for patient sleep
119. Evidence Based Design9
Holland Basham Architects
Benefits of Evidenced Based Design
Better Outcomes / reduce HAI’s
Develop Best Practices
Design that works better for patients
While also being Innovative & Inspire
120. Evidence Based Design9
Holland Basham Architects
Benefits EDAC Advocate firm.
Credentials and Knowledge recognized
Center of Health Design partner.
Access to EDAC Knowledge Repository
Knowledge of process.
126. Reduce Re-Admits3 Design Strategy – Nurse View
Oklahoma Heart Institute
Hillcrest Heart Pavilion, Tulsa OK Project by Mark Vaughan, Research by (Zadeh & Kadse, 2009)
127. Reduce Re-Admits3 Visibility New Layout
Visibility, Existing Layout
Visibility, New Layout
The new design layout has
significantly improved the visibility of
the patients from nurse stations by
25%
128. Reduce Re-Admits3 Walking Distance
As the color changes
from orange to blue,
the walking distance
of the space to the
nurse station
increases.
Existing Layout
Nurse location
Distance level 1
Distance level 2
Distance level 3
Distance level 4
New Layout
There is sufficient evidence that
the new design layout has
decreased the walking distances
from the patient rooms to nurse
stations by 33%
138. Wearables - Encouraged healthy lifestyles
Technology & Tools10
Fitbit Surge & dashboard - wearables will soon be able to connect to your healthcare provider.
139. Technology & Tools10
Smartphone + wearable integration + Physician Connected
Holland Basham ArchitectsApple Watch, 100 of new Apps in development
140. Primary Care Office Visit for Existing Patients Holland Basham Architects
Yelp type Price Comparison for Patients
141.
142. Holland Basham Architects
CONTACTS
Jeff Prochazka
Methodist Health System
jeff.prochazka@nmhs.org
Patrick Leahy
Holland Basham Architects (HBA)
pleahy@hba1.com
Jim Easter
Easter Healthcare Consulting (Ehc)
JimEaster518@Comcast.net
• Alan Dash
Sexton Group
www.TheSextantGroup.com
Thank
You
