The Impact of the ACA on Interior Design

Oct. 3, 2014

Designers are well-equipped to help in the strategic planning and repositioning of the healthcare system as a result of the Affordable Care Act.

Throughout 2014—during presentations, conferences, and conversations with colleagues and friends—a common theme continues to enter the discussion that runs deeper than the term “healthcare trends,” which indicates an ever-changing, temporary condition. The Affordable Care Act (ACA) has been the subject of much debate and is not a trend, but an entirely new direction for the whole continuum of care requiring key stakeholders to rethink and reset long-held assumptions about the healthcare delivery system.

Case in point: in a presentation by HGA for a recent client, the following chart from the team’s Advisory Board was used to illustrate the emerging continuum of care from “home” to “home” that reflects this new direction in healthcare. Along this continuum, there are many access points that require coordination and transitional management between the different types and levels of care.  

In addition to multiple access points, there is a focus on overall health and wellness of individuals, where oftentimes related care for the “whole person” is referred to as “wrap around” services (interestingly, this is also the premise for person-centered or patient-centered care.) Outcome based evaluation, coordination between services, and management of chronic diseases equals population health management. 

So what does this mean to the healthcare interior designer, and what opportunities are available to the design professional?

Designers are well equipped to assist clients to be strategic in the planning and re-positioning process of healthcare system, many of which are consolidating physicians’ practices, believing this will increase their revenue share simply by increasing the size of the pool. However, from a strategic perspective, it is recommended that all healthcare providers analyze their strengths within the continuum of care and then identify what other areas complement their current strengths. This may mean partnering with other care providers, reducing the number of inpatient beds, re-alignment of types of beds and licenses, and phased re-positioning of campuses and communities over time.

Because interior designers are alternative thinkers and multitask oriented, they can utilize this skillset to assist with the programming and planning discussions with their healthcare and long-term care clients to be strategic instead of reactionary. Those health systems and long-term care providers that are strategic will set themselves apart as experts and collaborators instead of continuing to build silos that are not integrated, further separating care types versus coordinating transitions between care services.  This includes assisting a community or campus in their evaluation of a decentralized approach to care and services versus a centralized approach.

Often, medical staff needs to be coached and educated on the changes that may occur that can lead to positive outcomes. The mantra of “we’ve always done it this way” is a real issue as healthcare providers are trying to reposition themselves in the market. The design professional can assist with the educational process to help medical staff see that there are different ways to evaluate the care and services provided. I have found that completing “learning journeys” can be very beneficial for staff and administration to better understand opportunities for change and to see firsthand the potential outcomes.  This also encourages buy-in by the staff, as their ideas can be incorporated into the process.   

Another opportunity for interior designers is to discuss with clients the connections between positive outcomes/satisfaction and the physical environment, as health and wellness includes healthy design and construction practices. Based upon the recent SmartMarket Report from McGraw Hill Construction conducted in collaboration with the AIA, ASID, and several other design-related entities, “in order to fully educate the public and convince owners to make investments (in building projects), medical professionals need to fold recommendations about their patients’ environments into their care policies.” However, the report found that doctors currently are not connecting public health to the advantages of healthy design, construction, and operations. (Read the full report here.)  

This discussion about the importance of the environment based upon medical outcomes is the reason The Center for Health Design was originally established by Wayne Ruga many years ago. This organization has evolved over time under Debra Levin’s leadership and includes the searchable Knowledge Repository (research, articles, and related information helpful for those focusing on evidence based design). This resource has proven to be helpful with different educational opportunities and fulfilling client needs.

Collaboration comes naturally to most interior designers, and I encourage partnerships with not only other design professionals, but also with organizations that specialize in management consulting and financial modeling. Healthcare and long-term care providers are focusing on reimbursement, but more importantly need to focus on operational efficiencies. This can be completed through utilizing LEAN principles, strategic functional programming, evaluation of efficiencies, gap analysis of existing operations and through-put, and utilizing evidence-based design principles for benchmarking outcomes.

Two examples of collaborative partnership in healthcare include ECG Management Consultants located in Arlington, Virg.,that helps develop strategies for healthcare provider teams, and MHS Alliance in Goshen, Ind. that provides strategic and operational, marketing, and financial consulting for senior living settings. Connecting and partnering with consultants outside of the design profession provides opportunities for the interior designer to grow, as well as being placed at the strategic planning table.

The future of healthcare and the implementation of the ACA create an opportunity for the interior design professional to become an expert in their field—through collaboration and progressive thinking. It is time for interior designers to sharpen their already strong skillset and strategically re-position themselves into a growing market that needs creative thinkers in a team based process for lasting client solutions!

Jane Rohde is the founding Principal of JSR Associates, Inc. located in Ellicott City, Maryland.  She champions a global cultural shift toward de-institutionalizing senior living and healthcare facilities through person-centered principles, research and advocacy, and design of the built environment.  Clientele includes non-profit and for-profit developers, government agencies, senior living and health care providers, and design firms.  Jane speaks internationally on senior living, aging, healthcare, evidence based design and sustainability.  For more information or comments, please contact Jane Rohde at [email protected].  

About the Author


Jane Rohde, AIA, FIIDA, ASID, ACHA, CHID LEED AP BD+C & GGA – EB: Jane Rohde is the founding principal of JSR Associates Inc. in Catonsville, MD. JSR Associates Inc. celebrates 23 years of consulting services in 2019. Jane is the recipient of the 2015 Environments for Aging Changemaker Award and in 2018 she received the ASID Design for Humanity Award, was recognized as an Honorary Alumni of Clemson University’s Architecture + Health program, and has been honored as one of 10 notable Women in Design. For more information or comments, please contact Jane Rohde at [email protected] or “Chat with Jane” at www.jsrassociates.net.

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