03/01/2013

Accommodating the ACA

A look at how the Patient Protection and Affordable Care Act has the potential to influence the future of healthcare design.

By Kylie Wroblaski

 
  • /Portals/3/images/magazine/2013/0313/I_0313_Web_Focus_1.jpg

    Because of the ACA, healthcare designs moving forward will have to be more adaptable and accommodating. Corgan and HDR’s design for the New Parkland Hospital in Dallas provides separate circulation paths for patients and staff to reduce noise and congestion.
    rendering courtesy of HDR+Corgan View larger

  • /Portals/3/images/magazine/2013/0313/I_0313_Web_Focus_2.jpg

    Because of the ACA, healthcare designs moving forward will have to be more adaptable and accommodating. The above nurse’s station, designed by Inner Design Studio, is modular, so it can be reconfigured as the facility’s needs change.
    Photo courtesy of inner design studio View larger

  • /Portals/3/images/magazine/2013/0313/I_0313_Web_Focus_3.jpg

    The patient rooms at the New Parkland Hospital have been designed to be acuity-adaptable, reducing intra-hospital transfers, while nursing stations have been decentralized to increase staff time spent on direct care.
    rendering courtesy of HDR+Corgan View larger

Widely regarded as the most significant regulatory overhaul of the U.S. healthcare system since the creation of Medicare and Medicaid in 1965, the Patient Protection and Affordable Care Act (more popularly referred to as the ACA or Obamacare) was signed into law three years ago, on March 23, 2010. And while we know the intended goals of the law—to reduce the number of uninsured Americans, decrease the overall cost of healthcare, improve healthcare outcomes and streamline its delivery—there are still plenty of questions about the specific impact it will have on the design community.

Considering how complex and varied our healthcare system is, it is hard to come up with firm answers, but there are two generally accepted assumptions that can help designerss prepare for the future:

  1. With greater access to insurance, it’s speculated that there will be a greater demand for healthcare services.
  2. Healthcare providers and facilities are expected to accommodate the rising number of patients while raising the quality and efficiency of healthcare, preventing chronic disease and improving public health.

To assist hospitals and clinics in meeting these requirements, the healthcare industry is depending on designers’ help and expertise. Let’s examine how each of these points has the potential to change healthcare design.

influx of the insured
Effective January 1, 2014, nearly all individuals in the country will be required to obtain and maintain at least minimum coverage or pay a fine. With a greater number of individuals carrying insurance, there is bound to be a rise in individuals seeking healthcare, as studies have found that the lack of insurance is what currently keeps many from doing so.

To accommodate the influx of new patients and hopefully reduce already overcrowded emergency rooms, hospital systems are rapidly expanding into off-campus outpatient facilities.

READ: Get more resources for the coming changes in healthcare design at the Inside Sources blog.

“We’re seeing more outpatient services,” says Rebecca Donner, principal of Nashville’s Inner Design Studio. “We have a client that’s building these free-standing EDs [emergency departments] and it’s like we can’t build them fast enough. I would say that this past year and going into 2013, there are a lot more services being offered outside the hospital.”

These facilities can offer anything from primary care and surgery to emergency care, be located closer to patient neighborhoods, and built free-standing or in a retail setting. Designers will be expected to provide solutions for caring for more people in an efficient way, all in a variety of environments that may not have previously been considered for healthcare use. Consider having a range of efficient concepts and ideas ready for fast deployment.

paying for positivity
Pay-for-performance requirements in the ACA now tie portions of Medicare payments to hospitals to a range of quality metrics, including “patient experience measures.” That puts the onus on hospital administrators and designers to find ways to create safer and more pleasing patient environments.

“We are seeing an increase in the attention being given to upgrades for hospitals that would improve patient satisfaction,” says Tina Larsen, vice president and healthcare design studio leader with Corgan. “There is compelling research available that shows that patients who perceive the healthcare environment as less stressful and more visually appealing associate the facility with higher levels of care. Upgrades include art and other positive distractions, better acoustics and clear wayfinding.”

Donner provides a recent cancer center as an example of positive distractions in action. The design team chose to create an outdoor healing garden with a waterfall, giving patients a place to sit quietly and relax in-between the rigors of cancer treatment—and hopefully improving the overall perception of care.

In short, good design has a significant and quantifiable effect on the bottom line. Be ready to discuss the benefits of evidence-based design—and bring the numbers to back it up. 

reduction of re-admittance
In addition to patient satisfaction scores, hospital payments are also being tied to better quality outcomes. One of the prime aims of the ACA is to reduce re-admittance due to a hospital-acquired infection—something that affects an estimated 5 to 10 percent of all patients staying in an acute care hospital, according to estimates from the Centers for Disease Control. For this reason, fabric and finish choices have come under greater scrutiny.

“Furniture and finish choices have expanded in terms of options that are appropriate for healthcare settings,” Larsen says. “Fabrics that are manufactured with antimicrobial properties and furniture finishes that are cleanable and resistant to cracks where microbes can survive all provide additional ways to prevent the spread of infection.”

Thanks to the growing number of cases of antibiotic-resistant strains of bacteria and other incredibly nasty bugs, for a lack of a better term, fabrics and furnishings also must be able to experience an increasingly aggressive cleaning routine and escape unscathed.

“All of our furnishings and the fabrics and vinyls now have to take a 10 percent bleach solution,” Donner says. “It can’t be any old fabric—it has to be able to stand up to that bleach solution. It started as an infectious disease thing, but it’s now more of a standard practice.”

As the fabrics and surfaces that make up our healthcare spaces become increasingly sophisticated, it is essential to keep up to date on the various options on the market. Be ready to discuss how a proposed product can impact both quantifiable metrics, such as infection rates and durability, and more abstract goals like sustainability and aesthetics.


building in flexibility
Flexibility and the ability to adapt a space to new needs may not be explicitly required by the ACA, but as the demands on our healthcare system continue to increase, it will become more and more critical.

“In order to design a facility that will serve patients and staff today as well as in the future, it is important to incorporate as much flexibility into the design as possible,” Larsen says. “Demographics, technology, and disease management may all change how hospitals will treat patients in the future. For example, in designing the New Parkland Hospital, a county hospital for the city of Dallas, we don’t know what imaging technology will look like in 50 years. As a way to anticipate the need for change, we recessed the floor on the imaging department. As equipment changes, the hospital has the flexibility to expand by removing the topping slab as required to install shielding.”

Not all flexibility enhancements need to be so drastic; Donner cites a recent project in which they created modular nursing stations, so that as the hospital’s situation changes, the stations can be easily (and inexpensively) reconfigured to meet its new needs.

READ: Get more resources for the coming changes in healthcare design at the Inside Sources blog.

Of course, while hospitals and clinics want flexibility for the future, they also want solutions to be efficient for their current needs. The trick for designers will be finding the middle ground between those two desires.

“We are being asked to put more in less, if you will, making everything so much more efficient,” explains Donner. “The steps that a nurse takes from the nurse’s station to the patient room to the nutrition room—everything is so much more efficient for their staff and way more efficient in terms of square footage.”

 

Kylie Wroblaski is a former editor for BUILDINGS magazine, and has written previously about architecture and facilities management.

 


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