From bottlenecks in emergency departments to communication breakdowns between departments to lengthy walks down corridors, hospitals face daily inefficiencies that can affect patient care, staff performance and their own bottom line.
But many hospitals are headed down the right path as they work to streamline the processes that can make or break a facility, according to the 2016 Hospital Construction Survey, conducted by Health Facilities Management magazine in cooperation with the American Society for Healthcare Engineering. HFM, like Trustee, is published by American Hospital Association’s Health Forum. ASHE is a personal membership group of the AHA.
The survey comprised more than 240 hospitals nationwide, about evenly split among rural, urban and suburban facilities.
In terms of improving workflow, the survey shows that 60 percent of facilities are using evidence-based design, while another 57 percent have adopted mock-ups and staff interviews to improve their facility planning processes.
Hospitals are beginning to explore high-tech solutions including rapid prototyping/mock-up testing events and simulation software, which have been adopted by 6 percent and 17 percent, respectively.
They also are going to greater lengths to seek input from clinical and nonclinical stakeholders to shape new designs and processes from inception.
Survey respondents named long throughput times, breakdowns in staff communication and delays in patient care (37 percent, 37 percent and 35 percent, respectively) as top barriers to efficiency.
And as hospitals make necessary changes, new efficiency issues may develop. For example, hospitals that have added on to their existing buildings over the years may have created longer walking distances for staff members and hindered communication, among other problems. The move to single-patient rooms also increases walking distances.
Adaptability, flexibility and standardization are key to every area of design during the ongoing changes in health care, says Joan L. Suchomel, principal at Eckenhoff Saunders Architects in Chicago, a founding member of the American College of Healthcare Architects and 2016 president of the American Institute of Architects Academy of Architecture for Health. “New facilities need to be able to expand or contract instead of just adding on.”
The survey shows that hospitals are embracing such design features as flexible, adaptable patient rooms (38 percent) and furniture (27 percent). Even larger numbers are adopting standardization throughout the facility (65 percent).
Using modular designs to create identical spaces can actually facilitate the ability to adapt a space to the facility’s changing needs, says Joseph Sprague, principal and senior vice president of HKS, an architectural firm headquartered in Dallas. “When you have a standardized layout throughout the hospital and a flexible modular approach that allows you to change out the furniture, to move the medical equipment, etc., it really gives the hospital more freedom — especially if more change is coming down the road,” he says.
Hospitals also are adopting features designed to improve communication and decrease interruptions, including zoned rooms and departments (adopted by 16 percent and 20 percent of respondents, respectively).
For example, a medication room might be zoned to include a separate, well-lit and quiet space for staff who dispense medicine. An emergency department might include a separate section to treat minor emergencies only, reducing long waits and improving patient flow.
Another up-and-coming strategy is zoned paging, where technology allows hospitals to define specific areas in which only targeted departments and certain staff receive pages. Technology solutions like radio-frequency identification badges that track staff movement and real-time tracking devices that track supplies and equipment also are effective efficiency tools.
Just as central to implementing design efficiencies is gauging their progress. Comprehensive staff surveys and focus groups — cited by 48 percent and 57 percent of respondents, respectively — are guiding facilities through every phase of the design process and beyond.
Overall, funding for construction remained relatively flat, dipping slightly from last year, which experts say could be related to the focus on consolidation and purchasing new facilities. Respondents said that 23 percent of their facility’s capital budget is allocated for new construction, 24 percent for renovation and 16 percent for facility infrastructure.
Instead of focusing on new facilities, hospitals planning construction in the next three years are putting their money into renovation projects, continuing a trend from last year.
Acute care numbers may continue to rise as hospitals that have long focused on building outpatient facilities begin to shift resources to the central hospitals that may have been on the back burner under the Affordable Care Act, says Randy Keiser, vice president and national health care director of Turner Construction Co. in Nashville, Tenn.
“In my opinion, we may be peaking out on building outpatient facilities and medical office buildings and starting to spend money on existing hospitals,” says Keiser, who has seen requests for proposals for acute care additions rise recently. “The need is so great among baby boomers.”
Nearly one-third of the survey’s respondents are undertaking specialty hospital construction projects, and 50 percent of those say they are building or planning to build behavioral health centers/psychiatric hospitals in the next three years. Children’s hospitals (21 percent) and cancer treatment hospitals (19 percent) were the next highest in this category.
Community-based initiatives remain a priority, with hospitals focusing on ambulatory surgery centers, health system-branded facilities in the community, immediate care facilities and fitness/wellness.
Overall, the survey shows some encouraging trends as well as some areas for improvement.
More than 62 percent of hospitals completed projects under budget and on or ahead of schedule — a healthy percentage roughly in line with last year’s numbers.
Just 26 percent are using building information modeling for facilities operations, which Sprague says is largely a wasted opportunity — especially in terms of improving efficiency. “BIM makes us better problem solvers and designers on the construction site and integrates construction documents between design teams and buildings,” he says.
Suchomel stresses the importance of having a site and facilities master plan and updating it on a regular basis. The survey shows that 36 percent of respondents have updated their facility’s master plan in the last year while 11 percent said they do not have a master plan.
“Even an existing facility should update its master plan at least every five years,” Suchomel says. “It will save enormous amounts of time and money down the road.”
Beth Burmahl is a freelance health care writer based in Lisle, Ill.; Suzanna Hoppszallern is senior editor of data and research for Health Forum; and Jamie Morgan is associate editor for Health Facilities Management.
About the survey
Health Facilities Management and the American Society for Healthcare Engineering of the American Hospital Association surveyed a random sample of 2,336 hospital and health system executives to learn about trends in hospital construction. The response rate was 10.5 percent. HFM and ASHE thank the sponsors of the survey: Gordian, Messer Construction and Modular Services Co.