Healthcare Facility Planning: Thinking Strategically, Second Edition
204
Healthcare Facility Planning: Thinking Strategically, Second Edition
204eBook
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Overview
Instructor Resources: PowerPoint slides of the book's exhibits.
Spending millions of dollars to renovate, reconfigure, expand, or replace a facility can be intimidating without the right direction. Healthcare Facility Planning: Thinking Strategically, Second Edition, is a practical guide that will help healthcare executives move confidently from planning to implementation by deploying an integrated facility planning process, understanding the trends that affect space utilization and configuration, and planning flexible facilities.
The book's focus is on predesign planning—a stage of the healthcare facility planning, design, and construction process that is frequently overlooked as organizations eagerly jump from strategic planning into the more glamorous phase of design. Healthcare executives have the greatest opportunity to express a vision for their organization's future during predesign planning, and decisions made during this stage have the greatest impact on long-term operational costs and future flexibility. Careful predesign planning allows an organization to rethink its current patient care delivery model, operational systems and processes, and use of technology to ensure a facility substantially benefits patients, caregivers, and payers.
This new edition addresses current issues—new financial incentives, fluctuating utilization and demand, constant pressure for technology adoption and deployment, rising turf wars among specialists, intense focus on patient safety, and aging physical plants—that affect the way facilities are used, planned, financed, and built. Detailed examples, guidelines, and case studies, many new to this edition, lead the reader step-by-step through the facility planning process. This book's planning process reveals how a new facility can improve operational efficiency, enhance customer satisfaction, and create new revenue streams, in addition to being aesthetically pleasing and well engineered.
Highlights include:
Deploying an integrated facility planning process tailored to an institution's unique needs Understanding the trends that affect space allocation and configuration Defining strategic direction and future demand Coordinating operations improvement initiatives and planned technology investments with facility planning
Product Details
| ISBN-13: | 9781567938029 |
|---|---|
| Publisher: | Health Administration Press |
| Publication date: | 04/14/2016 |
| Series: | ACHE Management |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 204 |
| File size: | 10 MB |
About the Author
Read an Excerpt
CHAPTER 1
Rethinking the Facility Planning Process
With all the dramatic changes in the healthcare industry in the past 50 years — sometimes involving 180-degree shifts in popular trends and incentives — many healthcare facilities become functionally obsolete even when their physical lives are not yet exhausted. Because of the lengthy facility planning process, new or renovated facilities that are just starting operations today may have been planned five or even ten years ago — yet these facilities are expected to endure for half a century or more. The question is, how can we ensure that the facility planning carried out this year or the next will produce facilities that are responsive to the needs of patients, caregivers, and payers in the years 2020, 2030, and beyond?
THE TRADITIONAL FACILITY PLANNING PROCESS: PART OF THE PROBLEM
Historically, facility planning was project driven and often based on the wish lists of department managers, recruiting promises to physicians, and directives from donors. Large amounts of space and new facilities were part of the "arms race" among physicians and department managers, both internally and with competing organizations. Appreciation (or recognition in budgeting) of space as an expensive resource was limited. Capital expenditures for facilities were not always coordinated with the institution's strategic planning initiatives, operations redesign efforts, and planned information technology (IT) investments. An "if you build it, they will come" approach sometimes sufficed in lieu of a sound business plan. The impact of facility investments on long-term operational costs was frequently overlooked. Design and construction professionals tended to focus on the construction or renovation "project" and had little incentive to look for creative ways to avoid building. Moreover, facility projects were seldom viewed as part of an overall capital investment strategy for the organization.
Hospitals that follow this traditional facility master planning process find that their boards deny many projects, not only because of lack of capital but also because the project's impact on operational costs is not identified. Hospital leaders must then indefinitely postpone or downsize projects, and morale suffers when they must communicate unmet expectations back to disillusioned physicians and department managers. This process often reminds me of the circus clown who opens a tin can out of which things pop out only to have to stuff the contents back into the can soon after.
When faced with a facility planning project that has taken on a life of its own, healthcare leaders must sometimes make the difficult and unpopular decision to stop or slow the planning or design process to reevaluate the need for the project and the effectiveness of the planned solution. At one critical point in the facility planning and design process, everyone involved focuses only on whether the project is "on time" and "on budget" and forgets about whether it is "on target" and is the right solution to the specific problem.
Today, successful healthcare organizations are deploying a more comprehensive, integrated, and data-driven facility planning process. This process begins with the strategic direction for the organization and integrates facility planning with market demand and service line planning, operations improvement initiatives, and anticipated investments in new technology. Major facility renovation and reconfiguration projects should be planned with a foundation of data and analyses, including business plans for key clinical service lines, a review of institution-wide operations improvement opportunities, an understanding of the project's impact on operational costs, and coordination with the organization's IT strategic plan.
THE NEW PLANNING ENVIRONMENT
The US healthcare environment is in crisis, dealing with healthcare reform and new financial incentives, fluctuating utilization and demand, constant pressure for technology adoption and deployment, rising turf wars among specialists, an intense focus on patient safety, and aging physical plants. All of these current issues affect the way facilities are used, planned, financed, and built (Hayward 2015).
The Impact of Healthcare Reform
The Affordable Care Act (ACA) was signed into law in 2010 with the intent of reforming the US healthcare industry. This law puts in place comprehensive health insurance reforms that roll out over several years. Some of the key provisions of this law that affect facility planning include the following:
* Encouraging integrated healthcare. The new law provides financial incentives for physicians to join together to form accountable care organizations (ACOs). In an ACO, physicians and various other healthcare providers take responsibility, in a collaborative and formally integrated arrangement, for coordinating the care — from prevention to acute care to chronic care and disease management — of a specific patient population.
* Reducing paperwork and administrative costs. Healthcare is one of the few remaining sectors that rely on paper records. The new law institutes a series of changes designed to standardize billing and requires health plans to adopt and implement rules for the secure, confidential, electronic exchange of health information. Using electronic health records (EHRs) lessens paperwork, reduces medical errors, improves the quality of care, and changes how and where many healthcare professionals do their work.
* Bundling payments. The law establishes a national pilot program to encourage hospitals, physicians, and other healthcare providers to work together to improve the coordination and quality of patient care. Hospitals and physicians receive a flat rate for an episode of care rather than billing each service or test separately, as in a fragmented system. The payer compensates the entire team with a "bundled" payment, which provides incentives to deliver healthcare services more efficiently while maintaining or improving quality of care.
* Paying physicians based on value rather than volume. A new provision ties physician payments to the quality of care they provide. Physicians see their payments modified so that those who provide higher-quality care receive higher payments than those who provide lower-quality care.
* Improving preventive health coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.
All of these changes have caused healthcare organizations to rethink the amount, type, and location of the space that is needed to deliver patient care.
Fluctuating Demand and Utilization
Starting in the 1980s, healthcare strategists and policy experts encouraged hospitals to reduce their surplus inpatient bed capacity in response to declining admissions, use rates, and lengths of stay. These shifts had, in turn, resulted from the advent of Medicare's diagnosis-related group (or DRG) payment methodology in the public sector and managed care in the private sector. Hospitals responded to changes in demand by shifting their resources. Between 1980 and 2003, community hospitals in the United States took 175,000 inpatient beds out of service — an 18 percent reduction — through downsizing, consolidation, and closure. At the same time, skilled nursing and subacute care facilities were developed to provide a less expensive and less resource-intensive alternative for patients requiring a lengthy recuperation. Home health agencies also proliferated. After 2003, the number of hospital beds declined less dramatically. Although, nationally, inpatient admissions rose between 1992 and 2012, both the rate of inpatient admissions per 1,000 people and the average length of stay have declined to an all-time low — resulting in an overall decline in the demand for inpatient beds.
Hospitals today are at a crossroads that few had anticipated in the past. In addition to reducing the number of uninsured Americans, the ACA aims to manage a population's health across the care continuum, keeping patients healthy through preventive and primary care services and out of acute care facilities whenever possible. As healthcare transforms from a hospital-centric model to a population-centric model, and supported by sophisticated diagnostics and minimally invasive treatment, inpatient utilization may continue to decline despite the needs of aging baby boomers and the newly insured.
At the same time, ambulatory visits to community hospitals have grown dramatically over the past several decades. From 1992 to 2012, annual visits almost doubled, and the rate of growth increased as well. As the newly insured population seeks healthcare services, experts predict that ambulatory care visits will continue to grow (American Hospital Association and Avalere Health 2014), so ambulatory facilities will have to keep pace.
The Rapid Adoption of Electronic Health Records
In the wake of new financial incentives, physician practices and hospitals may finally become paperless. The drive for EHRs in the United States started with the Health Insurance Portability and Accountability Act of 1996, which mandated the creation of a standardized method for exchanging financial and administrative healthcare information electronically. The ACA carried these initiatives even further, and the American Recovery and Reinvestment Act authorized the Centers for Medicare & Medicaid Services to provide financial incentives to encourage the adoption of EHR technology. The law required all public and private healthcare providers and other eligible professionals to have adopted and demonstrated "meaningful use" of EHRs by 2014 in order to maintain their Medicaid and Medicare reimbursement levels.
Enterprise imaging — in which all imaging data from disparate systems throughout the hospital are available in one place via the patient's EHR — is likely the next development in EHR storage and management. This shift will take the responsibility for imaging management from radiology and make it an enterprisewide IT function. With this evolution, all clinical data are available, easily accessible, and usable, allowing organizations to provide coordinated patient care that is not confined to department silos.
Advances in Information Technology
The healthcare environment will increasingly rely on data, whether in the form of EHRs, financial and management information, imaging studies, sensor and device readings, voice communications, or telemedicine. Continued advances in IT are creating new staff positions and job descriptions and altering historical perceptions regarding necessary functional relationships. Hospital leaders are consolidating traditional health and financial data management functions (e.g., medical records, quality assurance, risk management, infection control, finance, data processing, telecommunications) as data become increasingly computerized and common databases generate data more quickly and effectively. At the same time, new interdisciplinary fields are evolving — such as health informatics — that will require healthcare professionals to have the skills and knowledge necessary to develop, implement, and manage IT software and applications in a medical environment.
The creation of a paperless healthcare environment that exploits Internet, mobile, and wireless technologies is having a revolutionary impact on the need for physical proximity between departments and functional areas. Many of the traditional facility planning principles that were based on the need for departments to share paper, equipment, and patients are no longer relevant.
The Convergence of Diagnostic and Interventional Imaging and Surgical Procedures
While imaging procedures are becoming more interventional and no longer limited to diagnostic procedures, surgery is becoming less invasive. For many years, real-time imaging, using a mobile ultrasound or endoscopy unit (also called a C-arm, a name derived from its shape), has been a standard part of the surgical operating room. Today, the hybrid operating room has permanently installed equipment such as intraoperative computed tomography (CT), magnetic resonance imaging (MRI), and fixed C-arms. Physicians typically use these machines in conjunction with cardiovascular, thoracic, neurosurgery, spinal, and orthopedic procedures to enable diagnostic imaging before, during, and after a surgical procedure. This insight allows the surgeon to assess the effectiveness of the surgery and perform further resections or additional interventions in a single encounter. Many equipment vendors now offer highly specialized, proprietary imaging systems that are integrated with the operating room, while others offer designs that position the CT or MRI with dual access so that the equipment can be used independently for diagnostic procedures when surgery is not in progress.
Turf Wars
Interventional radiologists — using their expertise in angioplasty and catheter-delivered stents to treat peripheral arterial disease — were the first minimally invasive specialists. As cardiologists and vascular surgeons increased their use of interventional techniques, territorial disputes emerged. The specialties of interventional radiology, interventional cardiology, and endovascular surgical neuroradiology are all perfecting the use of stents and other procedures to keep diseased arteries open, and they are evaluating new applications. The rapid development of new imaging technologies, mechanical devices, and different treatment options, while certainly beneficial to the patient, can also lead to ambiguity regarding specific specialty claims on certain techniques and devices. These practitioners are often in competition with each other, creating "turf" wars. As a consequence, workloads — and the need for space — may fluctuate depending on how, by whom, and where a specific procedure is performed.
The Reengineering of Operations and Ongoing Process Improvement
With continued pressures to reduce the cost of labor as well as other expensive resources, healthcare organizations are expanding manager and supervisor responsibilities and merging departments to share staff, equipment, and space. Human resources departments are revising narrowly defined job descriptions to reflect opportunities for cross-training and increased responsibilities. The resulting new organizational charts are becoming compressed and flatter.
Improving patient throughput allows healthcare organizations to optimize their resources, often using Lean process improvement. Lean is a customer-centric methodology used to continually improve any process through the elimination of waste. The approach involves establishing a baseline by defining the current state of operations and then using industry trends, best practices, benchmarks, and other metrics to define the desired future state. When applied to facility planning, an organization typically focuses first on improving operations, apart from making any physical improvements. Once Lean processes are established, planners can begin looking at how physical improvements might further enable operational improvements. An iterative approach is necessary to reaching consensus on the appropriate balance between improving operational processes and investing capital in facilities.
Consolidation
The US healthcare delivery system has been undergoing consolidation for many years. Healthcare reform may propel this trend by providing financial incentives for developing ACOs and implementing EHRs and by encouraging providers to share risk with bundled payments. In 2013, the number of hospitals and hospital beds involved in mergers reached a five-year high (American Hospital Association and Avalere Health 2014). In addition, healthcare systems are acquiring physician practices, outpatient surgery centers, and imaging centers at a record pace. The remaining independent physicians are joining forces and assembling into large, multispecialty group practices. Radiology "supergroups" are also evolving to compete locally, as well as nationally, which is made possible by teleradiology technology that allows 24/7 instant access to images from any location. Healthcare systems are also reorganizing physically and operationally by specific diseases or service lines — frequently with a center-of- excellence orientation — to optimize capital investments in expensive technologies, attract leading-edge physicians, and better market their services.
(Continues…)
Excerpted from "Healthcare Facility Planning"
by .
Copyright © 2016 Foundation of the American College of Healthcare Executives.
Excerpted by permission of Health Administration Press.
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Table of Contents
Preface,
1. Rethinking the Facility Planning Process,
2. Understanding Your Current Facility,
3, Defining Strategic Direction and Future Demand,
4. Coordinating Operations Improvement Initiatives and Planned Technology Investments with Facility Planning,
5. Identifying Facility Needs and Establishing Priorities,
6. Reaching Consensus on a Long-Range Facility Investment Strategy,
7. Identifying Specific Projects and Preparing a Phasing and Implementation Plan,
8. Beginning Detailed Operational and Space Programming,
9. Case Study: Developing a Ten-Year Capital Investment Strategy for a Multihospital System,
10. Case Study: Planning an Ambulatory Care Facility,
11. Case Study: Evaluating Emergency Expansion,
12. Case Study: Developing a Bed Expansion Plan,
13. Case Study: Consolidating Two Acute Care Hospitals,
14. Case Study: Planning a Prototype Community Health Center,
15. Optimizing Current and Future Flexibility,
16. Ensuring Success: Optimizing Your Capital Investments,
Index,
About the Author,