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Fall 2008

Volume 1, Number 4

Planning Flexible Healthcare Facilities Is No Longer Optional

BACKGROUND

The term flexibility has become somewhat overused today. It is repeated as a mantra among healthcare planners and design architects. By definition it means “adaptable” or “adjustable to change.” In reality, achieving flexibility often requires that physicians and department managers and staff relinquish absolute control over their space and equipment for the greater good of the organization. However, with fluctuating workloads, rapidly changing technology, staff shortages and high turnover, and limited access to capital in today’s dynamic healthcare environment, planning flexible space is no longer an option.

WHY IS FLEXIBILITY IMPORTANT

There are many reasons why healthcare organizations need to provide flexible and adaptable facilities such as:

• The unpredictable healthcare environment with fluctuating demand driven by changing reimbursement, new regulations, and media attention.

• The blending and melding of many diagnostic and treatment modalities with advances in technology.

• Staffing shortages in many specialties that necessitate cross-training and the creation of new job descriptions.

• Electronic information management that eliminates the need for physical proximity.

• Limited access to capital that requires ever more efficient utilization of all resources including staff, equipment, and space.

DIFFERENT WAYS OF ACHIEVING FLEXIBILITY

Facilities should be planned to optimize current utilization as well as provide flexible space that can be adapted over time. Some ways to achieve flexibility include:

Planning multi-use or shared facility components enables a healthcare organization to use their space efficiently and balance workload peaks and valleys. Examples of multi-use spaces include:

• Acuity-adaptable or “universal” patient rooms that can be adapted for most levels of acuity by altering staffing levels and equipment; this concept can reduce costly patient transfers during an increasingly short length of stay, provide improved continuity of care, and reduce medical errors.

• Time-share clinic space where physicians lease space ― patient reception/intake area, exam rooms, offices, and support space ― by the day of week as needed thus reducing their fixed costs.

• Multi-use procedure rooms that can accommodate various procedures as needed using different types of portable equipment such as EKG and ultrasound.

• Alternating space use by shift such as using an adjacent occupational medicine clinic or same-day medical procedure unit for treating emergency department (ED) “fast track” patients during the evening and night shift, or holding ED patients in the surgery suite recovery area during the evening (or overnight) for observation, or while waiting for an inpatient bed to become available.

• Co-locating selected procedure rooms so that they can share the same patient reception/intake, prep, recovery, and support space ― for example, various imaging modalities, invasive cardiology and angiography, and endoscopy and surgery.

Planning flexible space that can be adapted over time to accommodate shifts in program focus and fluctuating utilization can reduce long-tern renovation costs. This includes space that can be easily adapted for a different functional use by switching out equipment, adding a second bed, or reassigning offices and workstations to another department. In addition to the acuity-adaptable patient room mentioned above, other examples of adaptable spaces include:

• Planning a flexible diagnostic and treatment center with a central patient reception/intake, prep, and recovery area, shared staff facilities, and a mix of large and small procedure rooms where equipment can be changed and upgraded as needed; this is in contrast to the traditional approach of planning dispersed and fragmented “departments” (e.g., radiology, CT, nuclear medicine, cardiology, ultrasound).

• Providing flexible customer service space using a “one-stop shopping” concept to accommodate admitting/registration, financial counseling, cashiering, scheduling, and other similar services that require face-to-face customer interaction; with flexible offices/cubicles (and cross-trained staff), services can be adapted to the customers’ needs over time.

• Planning a generic administrative office suite to be used by various administrative and support staff who do not require face-to-face customer contact. Space can be reassigned in response to organizational changes, thus eliminating department “turf” issues and improving overall space utilization.

Unbundling selected services ― rather than embedding everything into the hospital structure ― can not only reduce an organization’s initial capital investment, but can facilitate future space reallocation, contraction, and expansion, as workloads, staffing, and operational processes change over time. Some examples include:

• Relocating routine, high-volume outpatient services in separate facilities (on-campus or off-campus) with dedicated parking and convenient access. Examples include primary care clinics, selected high-volume outpatient services, or recurring or chronic outpatient services such as rehabilitation, chemotherapy, and dialysis. 

• Consolidating building support services into a separate service building ― creating space for supply, processing, and distribution functions that is less expensive to construct and renovate as operational systems, technology, and work processes change.

• Relocating administrative offices for staff who are not involved in direct patient care outside the hospital (on-site or off-site) in less expensive and adaptable “office building” space.

Leasing space (versus buying or building) when appropriate allows an organization to limit its capital investment and long-term risk. This may include leasing space off-site for administrative offices and new or expanding outpatient programs. Some healthcare organization may choose to lease space such as hotel conference facilities or a school auditorium for periodic inservice or community education in lieu of constructing an education center on the hospital campus. Interior systems furniture and other building elements may also be leased by making an arrangement with a manufacturer to take stewardship over the product’s life, and putting it together, refreshing it, and recycling it for a reasonable fee. Some healthcare organizations also keep up with changes in technology by leasing imaging equipment or paying based on its use rather than buying the equipment outright.

Building a flexible infrastructure with long-span joists and interstitial space provides a cost-effective way to adapt to ongoing changes over the life of a building. Embedding everything in the building so the pipes and wires are inside the walls, floors, and ceiling, makes it almost impossible to reconfigure any space without major construction. In the future, hospitals may be built more like shopping centers, with a huge superstructure and interiors that can come and go at will, resulting in an adaptable tool for delivering health care.  back to top

Cynthia Hayward

chayward@hayward-assoc.com

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