How to design a health care facility—when health care keeps changing

Health care moves fast. From delivery reform to new technologies, there's no shortage of market forces transforming how providers do business. To succeed, hospitals need to reinvent their model for delivering care. But they must also adapt their facility design, experts say.

To explore the important role of design in the evolving health care system, the Daily Briefing sat down with Dr. Upali Nanda, director of research for HKS, executive director of the Center for Advanced Design Research and Evaluation (CADRE), and the lead author of Clinic 20XX: Designing for an Ever-Changing Present, a study funded by J.E. Dunn Construction that explored the major trends affecting design needs.

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Here's a condensed version of that conversation.

Question: Hospitals are dealing with more external competitors than ever—retail clinics, concierge services, and so on—and many of those services are conventionally focused on serving consumers. What does the rise of retail mean for how hospitals are designing facilities for patients?

Nanda: Facilities have to be more nimble and flexible than ever. And adaptability in design will be essential to keep up with the demands of a retail market. But that's not necessarily new.

Here's what is new—we learned from our research that retail doesn't just mean giving consumers a variety of choices, it means giving them a patient-centered experience. It's about having empathy in understanding what the patient really wants in their health care experience.

The retail revolution also means understanding and respecting intergenerational differences. For example, co-location of diagnostics is more important for baby boomers, while proximity to home and work is more important for millennials.

Q: Going beyond patients, how should health systems think about physician space?

Nanda: For clinicians, good design can break down walls and foster greater collaboration among the care team. Our research shows that physicians who work with care teams, especially case managers, also report higher overall satisfaction, and physicians who currently have shared offices are more open to collaborative and open work spaces than those who have private offices.

Physicians also see the potential of telehealth to impact follow-up care, mental health, and disease management. So thinking of open physician offices to foster collaboration, and tech-ready spaces to foster remote connectivity, will be important for health systems.

Q: Do you think that the growth in telehealth will result in fewer brick-and-mortar assets?

Nanda: Telehealth won't replace bricks-and-mortar facilities, but it will fundamentally change them. We will have to think about digital and physical space for each activity in the clinic—for every "foot-print" to think of the corresponding "cloud-print."

At the same time, face-to-face interactions will not go away. Many physicians we surveyed indicated a portion of their in-person visits could be done remotely, but also felt that many of their patients weren't ready to transition to virtual care. The patient surveys on the other hand showed that while this held true for boomers, millennials were quite open to virtual care.

The biggest barriers we identified were the issue of "trust" in technology, and (for physicians) the issue of reimbursement. Regardless, as telehealth options grow in the future, they'll represent an important touchpoint in the delivery system.

Q: What was the most surprising result from your study?

Nanda: I think one of the biggest surprises for us was that a majority of patients we surveyed didn't consider themselves to be "consumers" buying health services, but rather "patients" needing health services. This made us think—are we, as an industry, making a mistake when we call patients consumers? Patients certainly don't think of themselves as such.

Health care is unique—it is not like any other kind of retail—it is not necessarily a choice a person wants to make. Having choices, and having the incentive to exercise them, are two fundamentally different things. Ultimately, whether they are boomers or millennials, patients want to feel taken care of and to have meaningful interactions with care teams in a clean, accessible, and affordable environment.

It comes back to the idea of a human-centered/patient-centered experience. In the end, it comes down to whether the facility can be flexible, connected, and support a sense of place that simply says, hey, don't worry, we got you covered. You're safe, we'll make you better, and we will continue to be good stewards of your health after you leave this facility.  

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