As the healthcare market continues to consolidate, smaller hospitals are joining forces with larger healthcare systems to maintain their competitive edge. Throughout Texas and the Southern states, mergers between providers have allowed companies to accumulate market share, streamline business operations, and drive profits. But how are these mergers manifesting in new facility builds, and what are healthcare systems doing to get out of the box quickly?
Through 15 years of architecture design and planning work for client United Surgical Partners International, we’ve helped them expand into new markets, share their branding model, and renovate facilities to meet the growing demand for outpatient services. During this tenure, we’ve gleaned some key learnings that have become a working road map that other health entities could apply to expedite new projects and renovations. Over the course of our partnership we’ve identified specific efficiencies and design workflows that have evolved into a formal construction and development manual for facilities. These standards dictate the project evolution, based on years of trial and error and decisions.
Below are some planning pillars that healthcare facility planners can use as starting points when renovating or building a new facility.
Mission and vision first: Fundamental to an organization’s decision making, it’s important to first outline goals for the team to accomplish relative to customers and outcomes. It is not simply a repetition of the health system’s overall mission and vision, rather a deeper dive into how those values translate into the built environment. For example, when designing ambulatory service centers, E4H and USPI identified “just in time delivery” to enable patients to receive timely care, get up and moving, and return home as quickly as possible.
Make it flow with diagrams: Use diagrams to map how patients move from the entryway to reception to sterile zones into the operating rooms; how carts and materials are brought in from the back of the ORs; how the efficient sterile processing from behind the OR is laid out–every movement within the facility. These orientations get extremely detailed, showing where the patient’s head is, where gases are, where anesthesia machines are located, and where staff is positioned for different kinds of treatments. For USPI, we designed a racetrack-like model that minimizes cross traffic between patients and materials and goods, allowing surgical and processing technicians to have an improved line of flow delivering materials to treatment areas.
Know special requirements: State law dictates square footage of facilities based on the number of operating rooms. This document outlines those requirements on a state-by-state basis–and includes best practices on how to make the most out of the minimum space needed.
Design to Heal: Patients want a good-looking facility–it’s part of their overall care experience. As health systems expand into new markets, declaring their brand aesthetic right from the front door can have a big impact on repeat visits and the company’s overall reputation. The interior design standards, from the basic color palette to flooring choices to finishes and textiles, are described and visualized in detail.
Have vendors and manufacturers in place: Purchasing programs with manufacturers are revised annually. Before starting the project, it’s critical to know who they are and ensure they have received all specifications relevant to the health facility’s brand. New project managers then approach these pre-approved companies for their tile or VCT, where the price has already been negotiated and they’re getting the right value for the material.
Know your specs: Each state has a different set of codes that regulate the placement and outfitting of critical building systems. State and local governments regulate structural, plumbing, mechanical, electrical, fire, life safety, accessibility, energy, and elevator codes. These requirements are based on the size of the facility, its use, and program spaces. Thus, the development standards should be as detailed as possible, while allowing flexibility for specific restrictions according to the jurisdiction.
Laying out these considerations in detail prior to project initiation enables the healthcare entity to enter a new market quickly. Coming into the first development meeting with these pre-established standards makes each decision more streamlined as it answers around 75 percent of the questions right out of the gate with specific reasoning and evidence embedded.
Once construction and development standards are established, it ideally should be updated yearly by a small committee along with the architectural team. Incorporate additional lessons learned, new vendor and manufacturer agreements, and new interior finishes keep standards up to date. The end goal is to have living standards that are continuously evolving and reflecting best practices based on past design and construction experiences. We have found that this saves both time and money.
David Tooley is a partner at E4H Environments for Health, a nationwide architecture and design firm exclusively focused on healthcare, located in Arlington.