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Healthcare Facility Planning Tools and Guidelines Volume 4, Number 3 |
Fall 2011
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In This Issue
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Prioritizing Healthcare Facility Projects Use of Interactive Technology Boosts Inpatient Satisfaction |
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Feature Print (PDF) |
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Prioritizing Healthcare Facility Projects BACKGROUND
DEVELOPING A RATIONAL APPROACH Healthcare leaders may consider a number of factors to reach consensus on which projects ultimately get funded and the sequence of their funding compared to other capital expenditures. At a minimum, the rationale for each potential project should be evaluated based on the following factors:
The matrix below provides an example used by a senior leadership team to summarize their high priority projects and the corresponding rationale for each. Cells with an “X” indicate the potential rationale for a specific project on the list. It should be noted that each healthcare organization will have unique rationale relative to any given project.
Once consensus has been reached on the rational for each project, specific projects may also be grouped and sequenced based on:
Cynthia Hayward, AIA, ACHA, FAAHC Principal Hayward & Associates LLC |
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In the News |
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Use of Interactive Technology Boosts Inpatient Satisfaction
Hospitals within six healthcare systems saw dramatic increases in their patient satisfaction scores when using interactive monitors that allow patients to access information about their care and to communicate with staff. The hospitals provided patients with in-room monitors that allowed them to ask clinicians questions about their care, inquire about food menus, request help with minor tasks, read about their medical condition, and access their post-discharge instructions. Satisfaction with educational materials increased by 42 percent and overall patient satisfaction scores increased by at least 10 percent. The healthcare systems included El Paso Children's Hospital (El Paso TX), Palisades Medical Centre (North Bergen NJ), and University Hospitals Seidman Cancer Center (Cleveland OH). Source: Fierce Healthcare (www.fiercehealthcare.com) back to top |
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Trendline Print (PDF) |
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Hospital Capital Spending is Taking on New Focus BACKGROUND
CURRENT TREND Capital remains elusive as most non-profit hospitals in the U.S. find it difficult to access capital. Credit rating agencies want to see evidence of:
IMPACT ON CONSTRUCTION When it comes to construction, the focus is on fast returns. Construction projects are being scaled down with resources being directed to:
Additionally, construction projects which generate superior returns are favored ― such as surgical services and procedures. Improving access and throughput is a priority such as improving turnaround times in the emergency department or building freestanding urgent care centers to reduce hospital emergency department visits. Capital spending on information technology is becoming even more pervasive as it underpins a provider’s ability to shift to new care models ― including efforts to implement an ambulatory electronic medical record (EMR) ― assuming that an inpatient EMR and computerized physician order entry system have already been implemented along with e-scheduling, physician e-prescribing, picture archiving and communication system (PACS), and results reporting components. back to top Cynthia Hayward, AIA, ACHA, FAAHC Principal Hayward & Associates LLC |
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Technology |
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Healthcare imaging has come a long way from the days of plastic film, wet processing, and long waits for results. Digital radiography ― wired or wireless ― offers faster results and better imaging quality. Wireless devices take this convenience and efficiency one step further. According to the director of radiology at a large Midwest hospital which uses two Siemens Ysio wireless radiograph machines "We can take the imaging plate and put it on the floor, under the bed, and under the patient, or we can put it on a stool and let the patient put their leg or arm up on it." Getting rid of the wires and cords dragging across the floor not only improves safety but eliminates another source of infection. Although there are several wireless and portable radiography machines on the market, the technology is not yet widespread. Canon began touting its first wireless digital radiography system in 2010. MinXray also launched a portable system that is also designed to be used in the field such as during disaster response. These devices will probably get more traction with the advent of the fourth generation (4G) wireless network from cellular wireless companies which will enable radiologists to upload and download images much faster than they have been able to in the past ― at least for preliminary reads and sharing images with patients and family members on smart phones, iPads, and similar devices. back to top |
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Rule-of-Thumb |
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Operating Room Size Guidelines According to the American College of Surgeons, the size and location of the surgical procedure rooms should be determined by the level of care to be provided. Three levels of care are identified for operating rooms (ORs) as follows: Class A provides for minor surgical procedures performed under topical, local, or regional anesthesia without pre-operative sedation. Class B provides for minor or major surgical procedures performed in conjunction with oral, parenteral, or intravenous sedation or under analgesic or dissociative drugs. Class C provided for major surgical procedures that require general or regional block anesthesia and support of vital bodily functions. As shown below, the amount of clear floor area and minimum clear dimension also depend on the type of surgical intervention and the corresponding size and amount of equipment needed and the number of people on the surgical team. It is also to be expected that achieving the ideal operating room size may not be possible when an older facility is undergoing renovation. General guidelines for various types of operating rooms are included below: |
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Note: NSF represents the net square feet or inside wall-to-wall dimensions (or clear floor area in the above table) of an individual room. Source: Guidelines for Design and Construction of Health Care Facilities ― The Facility Guidelines Institute. Washington, DC. 2010 Edition. Rule 1311.4.3 |
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Copyright ©2011 SpaceMed. All rights reserved. |
The rationale for specific renovation, expansion, or new construction
projects undertaken by healthcare organizations may not always appear
logical or to be a prudent use of limited capital dollars. Most hospital
leaders, care providers, facility planners, and architects can cite an
example of a misguided project ― almost always by some other organization or
under the direction of someone else. Historically there was often a focus on
a “project” being on-time and on-budget without enough scrutiny as to
whether it is the right project in the first place. Today, most healthcare
organizations have many more demands for facility upgrading and expansion
than available dollars ― particularly when bricks and mortar projects
compete with investments in new medical equipment and information technology
and with lenders providing their own scrutiny. 
Hospital capital
spending was slowing down even before the financial meltdown in 2008 as
hospitals began shifting their capital funds toward shoring up
infrastructure and cutting back on capital spending, overall. The economic
downturn makes it increasingly more difficult and expensive for hospitals to
finance capital expenditures. Interest and lease rates have risen and the
availability of debt is becoming more restricted as lenders seek to avoid
risk.