It is an interesting time to be working in the healthcare field. We face so many open-ended questions: What will be the impact of the Affordable Care Act? How are reimbursables going to impact operations? What are the system impacts of a shifting focus toward diagnostic treatments and preventative care?
Although these questions remain unanswered, the pressure of the consumer need for hospitals, outpatient facilities and long-term care settings has superseded the fear of the unknown. Fortunately, demographic analysis, research and benchmarking are creating new opportunities for the design community. Savvy healthcare providers can apply these tools before completing new spaces and facilities, but with such a wealth of resources and data, sifting through it all can be an equally daunting challenge.
enter: team healthcare
For firms to become multi-disciplinary—which includes expertise in design, sustainability, technology, healthcare licensing, building codes, care models and product development—a collaborative "studio" environment (real, virtual or otherwise) where everyone contributes is essential. Design firms frequently team with marketing and demographics experts, real estate advisers, healthcare providers, financial modelers, potential community partners, residents of the community, and civic and business leadership. Instead of charrettes held for design professionals and their clients, workshops and focus groups help define the problem from a global perspective, identifying and engaging stakeholders, and recognizing natural partnerships that support positive development of community.
Depending upon the healthcare need, different parties that can positively impact the process may be added as needed. For example, if a hospital is working on a new unit that impacts a certain population, strategically bringing all of the stakeholders together from the beginning of the project, including the community at-large is the place to start.
integration generation
Another consideration in building an effective healthcare team is allowing younger designers and those of us with years of experience to function as equals. Youth brings not only the technological savvy needed in today's world, but a fresh perspective to the new set of circumstances facing the healthcare industry. One of my newly hired designers
mentioned that in her previous position, there wasn't any sharing of ideas, no request for input and no dialogue for creating the best solution for the client. But through team creation and connectivity, partnerships are the future for all ages, as healthcare solutions are complex and require thoughtful discussion to create a synthesis process that results in successful spatial solutions.
I've learned from collaborating with younger clients, starting a social cause gallery in our community, and providing consulting for firms such as MASS Design in Boston, it's clear that the younger generation is looking for meaningful work that positively supports social needs and issues. They are willing to seek change where some might dread it.
This focus on forging new and sometimes unorthodox partnerships is already creating new opportunities for business, growing relationships that support healthcare initiatives and strengthening our communities. Governments are beginning to look differently at public/private relationships, regulators are sitting at the decision making table and design firms are reaching out for additional expertise to build a better solution-based team.
decentralization
as the new center
Our industry now recognizes that old "silos"
must also break down within healthcare institutions themselves. Care provisions no longer have clear boundaries, as different types of settings are now providing care and services for higher acuity
conditions. The right-sizing of hospitals is a critical
part of the equation for meeting the needs of the future, and the natural next step is providing decentralized, long-term care and services within our communities—in outpatient settings, retail settings, libraries, senior centers and in the home instead of within large, institutional settings.
These developments are already reducing the silo effect. As care in the United States is being increasingly driven by reimbursement rates and quality-of-care outcomes, it is "forcing the hand" for collaboration and pushing institutions and communities to evaluate the gaps between different types of care. Within these gaps, designers may find additional opportunities to provide solutions. Some may result in new built environments, but others may result in a care and service model shift, or a technology solution that supports coordination and connection to needed services. Savvy hospital boards and C-suite executives are looking at opportunities that provide management of chronic diseases at the source (or close to the source), and utilizing infrastructure dollars to create acute care environments that support diagnostic treatments in an effort to avoid acute episodes resulting from unmanaged chronic disease.
For example, emergency rooms present a huge financial cost for hospitals and healthcare systems, but some systems have found that by placing services for managing chronic diseases within the community, there has been a correlating reduction in ER visits. Most healthcare clients are now more strategic in their evaluations prior to approving monies for building projects. Stakeholders at all levels are evaluating the strategic process for alternative thinking and increased community involvement, whether it is for a hospital system, a long-term care and senior living facility, or a medical office building for outpatient care services.
There is a place for the design community at the strategic planning table where alternative and creative thinking is required, and it is time to pull up a chair! This is an exciting time, and as difficult as change can be, it is the only constant. The evolution of delivery of healthcare and services is an opportunity for designers to contribute to the creation of a healthier, vibrant future.
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. Rohde speaks internationally on senior living, aging, healthcare, evidence based design and sustainability.
