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Healthcare Facility Planning Tools and Guidelines Volume 3, Number 3 |
Summer 2010
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In This Issue
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Consolidating Healthcare Facilities Requires a Unique Facility Planning Process Hospitals Rethink Spiritual Spaces and Create Meditation Rooms Smart Operating Rooms Are Coming to Community Hospitals Imaging Is Going Mobile With Smart Phones Outpatient Endoscopy Suite Capacity and Preliminary Space Need |
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Feature Print (PDF) |
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Consolidating Healthcare Facilities
Requires a Unique BACKGROUND
opportunities to improve efficiency and eliminate surplus capacity Historically, hospitals have had a reputation for being inefficient with rigid, compartmentalized organization structures and inflexible employees. Departmental turf wars for space, staff, and equipment are still common. These problems only get worse when two hospitals try to merge their operations. However, the creation of a leaner, downsized, more nimble, bottom-line oriented business is commonly cited as the rationale for the merger. Although there are many opportunities to improve efficiency and eliminate surplus capacity, the following key areas represent the most significant opportunities: Eliminating empty beds. Consolidating occupied beds into larger nursing units and closing or converting complete floors of beds to an alternate use can have some impact on operational costs. Conversion of some surplus acute care bed capacity for same-day stay patients or post-acute services may also be an option depending on the overall condition of the infrastructure and code compliance of the facility. However, the real operational cost savings occur when an entire hospital is closed or when 24-7 operation is discontinued (e.g., conversion to an outpatient facility). Integrating and restructuring clinical services. Opportunities to reduce surplus capacity through clinical service integration include:
Consolidating physician practices. As more physician practices become part of larger specialty groups, there is an opportunity to reduce operating costs by sharing resources. Some opportunities include: sharing reception/registration, waiting space, and other patient and staff amenities; sharing of support staff thus reducing the need for offices and workstations; and sharing specialized staff and expensive treatment and special procedure rooms and diagnostic facilities. The number of exam rooms can also be reduced by improved utilization through time-sharing and planning more generic, flexible space. Reducing building support space. Many of today’s hospitals were designed with a chassis to support a much larger number of inpatient beds than are currently being occupied. Space for support services is commonly located in the basement or below-grade. When two organizations merge, the surplus space increases further. Many multihospital systems have implemented the “mosaic” approach by designating specific campuses for consolidation of specific services, thus reducing the investment in duplicate and redundant resources. For example a single kitchen may be located at one site ― with the cook-chill system used to deliver food to the remaining sites ― and a single warehouse located at another site from which supplies are distributed. nature abhors a vacuum
separating major consolidation issues from non-issues Paralysis often sets in when recently merged institutions begin planning to integrate or consolidate redundant services. Assuming that market dynamics and demographics have been carefully considered, the key is to quickly separate actual facility consolidation issues from non-issues. Questions that should be initially addressed when considering the consolidation of two or more acute care hospitals at a single site include:
Less important issues that often are given more attention than warranted include outpatient services that do not involve large fixed equipment or require unique design requirements ― such as ultrasound, physical therapy, primary care clinics, and any department whose space is primarily administrative staff offices and workstations ― since these services can be readily moved into leased space on an interim or permanent basis. political, emotional, and regulatory issues Consolidating healthcare facilities may disrupt deeply entrenched economic interests and involve a number of issues including: state regulatory concerns; community opposition and public relations problems; displaced workers, unions, and the economic impact on the community; and the impact on local philanthropy when a hospital becomes part of a larger health system. Abandoning facilities with new additions or recently renovated space can create emotional, political, and legal issues. For example, there may be covenants associated with buildings funded with donated money. Physician ownership of office space and diagnostic facilities on or near a hospital site to be abandoned further complicates the equation. Conclusion Despite the difficulties in consolidating two or more healthcare facilities to eliminate surplus capacity, the opportunities for cost savings are significant. Funds used to support surplus capacity could be deployed for a long list of alternate purposes including the eventual replacement of the core physical plants and technology of the surviving institutions. back to top Cynthia Hayward, AIA, ACHA, FAAHC Principal Hayward & Associates LLC chayward@hayward-assoc.com |
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In the News |
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Hospitals Rethink Spiritual Spaces and Create
Kaiser Permanente is constructing four meditation rooms in three hospitals in the Sacramento area. The University of California Davis Medical Center will open a new interfaith space in its new pavilion wing to open in the fall. Sutter Health's new hospital for women and children in Sacramento will have a 40-seat meditation room when it opens in 2013 and be equipped with Jewish prayer shawls as well as Muslim prayer rugs. Instead of having traditional religious symbols, such as a cross and an altar, these new spaces often have nature motifs. Instead of a traditional altar, there is space for meditation mats and prayer rugs. A bowl may be placed where worshippers can place written prayers. The intent of a meditation room is to provide a welcoming environment for people of all faiths ― and people of non-faith ― where they can sit down and reflect as they are trying to make important medical decisions. Other public spaces are now installing meditation rooms as well including airports, universities, and prisons. back to top Original article "Hospitals Rethinking Spiritual Spaces, Create Meditation Rooms " posted by Jennifer Garza on May 13, 2010 in the Sacramento Bee. |
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Trendline Print (PDF) |
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Smart Operating Rooms Are Coming to Community Hospitals BACKGROUND
Sacred Heart Hospital’s Smart Operating RoomsSacred Heart Hospital actually has two innovative surgical suites designed for both diagnostics and complex surgeries for brain, spine and trauma patients. The concept took shape in 2005 when key administrators and surgeons traveled the world conducting extensive research on available technologies from various manufacturers to best configure the surgical suite with patient comfort and outcomes in mind. The hospital’s first smart OR suite was launched in 2008 and featured an iMRI. The iMRI moves to and from the patient during procedures to offer real-time imagery during brain surgery. Conversely, in standard neurosurgeries, regular MRI scans can only be done before and after an operation. The smart OR technology combines diagnostic images with those taken during surgery to produce a high-definition, 3-D map of the brain. In addition, a high-resolution microscope operates with a GPS-like system to magnify the field of view so that surgeons can avoid sensitive areas of the brain. Sacred Heart Hospital recently launched its second smart OR suite featuring an iCT. The iCT also moves to and from the patient during procedures to offer real-time imagery. In standard spinal procedures, regular CT scans can only be done before and after an operation. The minimally-invasive technology applied in the smart OR suites offers the most sophisticated imagery and mapping technologies, equipping surgeons with the highest level of accuracy for the complete removal of tumors of the brain and precise placement of spinal screws. In addition to the iMRI and iCT, there are various other technological components that come together in the smart OR suites to create an integrated system of advanced imaging and mapping technology including:
impact on quality of careThe biggest effect of this new technology is on the quality of patient care. Navigational tools allow surgeons to make the smallest possible incisions, resulting in faster recovery time. The iMRI allows surgeons to examine a patient while he or she is still in the OR to make sure all of the tumor has been removed which also helps reduce reoperation rates. Another benefit to neurosurgery patients is that the technologies can identify unexpected situations, such as blood clots, which help surgeons manage their cases better and prevent serious complications. Plus, the images surgeons receive during surgery help them protect surrounding healthy areas of the brain and spine because they can pinpoint the area for surgery to the exact millimeter. Patient safety is another key benefit. Due to the mobility of the smart OR technologies, brain, spine and trauma patients do not need to be moved from the operating table. Keeping a patient still lessens the risk of complications. Moreover, smaller incisions are possible due to high-definition images and results in quicker healing and less risk to the patients. back to top Cynthia Hayward, AIA, ACHA, FAAHC Principal Hayward & Associates LLC chayward@hayward-assoc.com |
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Technology |
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Imaging is Going Mobile With Smart Phones
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Rule-of-Thumb Print (PDF) |
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Outpatient Endoscopy Suite Capacity and Preliminary Space Need Endoscopy procedures ― using a rigid or flexible scope to examine the interior of a hollow organ or cavity in the body ― may involve the upper gastrointestinal tract (GI endoscopies), large intestine (colonoscopies and sigmoidoscopies), lower respiratory tract (bronchoscopies) and the urinary tract (cystoscopies) along with a variety of other specialized procedures. Endoscopy procedures generally take 30 to 45 minutes. Patients are usually given intravenous sedation and may recover for up to an hour after the procedure. Recovery time has been reduced significantly in recent years due to the use of shorter-acting sedatives. An endoscopy suite will have a minimum of two procedures rooms. Suites with six or more endoscopy rooms are rare. Utilization of the suite can vary dramatically depending on whether it is a hospital-based service used by various independent physicians (lower utilization) or whether the suite is owned and operated by an entrepreneurial physician group (higher utilization). The guidelines below can be used to estimate the preliminary space need for a distinct endoscopy suite. Endoscopy rooms are sometimes located within or contiguous with an outpatient surgery suite or incorporated into another type of medical procedure unit which allows the sharing of patient intake, prep, recovery and other support space. If endoscopy rooms are part of an outpatient surgery suite, a range of 800 to 1,200 DGSF of incremental space per procedure room is generally required. |
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Note: DGSF represents the "footprint" of a department or functional area and includes the net square feet of the individual rooms as well as the space occupied by internal circulation corridors, walls/partition, and minor utility shafts; DGSF excludes common areas such as shared public corridors and lobbies, elevator banks, stairwells, major mechanical spaces, and the space occupied by the building's exterior wall. Source: SpaceMed Guide (Second Edition). |
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Copyright ©2010 SpaceMed. All rights reserved. |
In the ten-year
period from 1998 to 2008, 28 percent of the hospitals in the United States
were involved in mergers and acquisitions according to the American Hospital
Association’s Trend Watch Chartbook 2010. One of the many challenges
that newly merged healthcare systems face is eliminating redundant services
and surplus capacity. Realigning services and reallocating resources among
multiple campuses requires a unique strategic, operations improvement, and
facility planning process. Alternate ways of allocating resources need to
be thoroughly evaluated and the impact on operational costs fully
understood, before a healthcare system spends money on bricks and mortar.
It also needs to understand the market and patient population served at
each of the individual hospital campuses. A different facility planning
approach is required when two or more campuses (sites) share the same market
versus when they have distinctly separate markets. Planning at the clinical
service line level ― such as for obstetrics, pediatrics, cardiology, and
cancer care ― is also required because some service lines may share the same
market and others may not. For example, consolidating two obstetrics
programs at a single location could negatively impact the health system’s
market share for this service line if the new location is deemed
inconvenient for the referring physicians and patients. 
When there is
ample surplus space, hospital departments tend to metastasize into the space
available whether or not all the space is needed. This may result in an
exaggerated space allocation when the department is relocated to leased
space or an alternate facility. For example, the new space may
be oversized if it is based on the incremental need beyond the existing
(already too large) space allocation.
At least three
Northern California hospitals have plans to open meditation rooms ― or to
expand and update what were once known as chapels ― for nondenominational
observance. This is in response to the changing needs of hospital staff and
the evolving view that the body and soul can heal together.
These new meditation rooms do not have pews or religious symbols. Instead
they are sanctuaries where families can pray for patients, space for prayer
rugs and windows facing east, or a quiet area where doctors can pause for
spiritual refreshing. According to a chaplain who manages spiritual care for
Kaiser North Valley hospitals "When people are facing the ultimate spiritual
and existential crisis, such as illness, they need a quiet place to go.
These rooms should meet the needs of all faiths." Some hospitals do not call
the rooms chapels because that label invokes the Judeo-Christian tradition.
Hospitals have staff from a wide variety of faith backgrounds including
Muslims who need a place to pray five times a day. 
BrainSUITE®
― a surgical mapping system in which all imagery is managed and registered
for immediate access