May 2020, Volume XXXIV, Number 2

  Public Health

Health care facility design

Lessons learned from the pandemic

ultiple factors, including internal dynamics and outside forces, have in recent years created a tipping point in the health care industry. The Affordable Care Act, private equity, tax reform, payer disruptions, new health care industry entrants, and skilled worker shortages have created new challenges for health organizations across the United States. COVID-19 now poses a unique challenge to the health care industry. Changes in how patients seek care, care avoidance, and the move toward a more value-based model have impacted how physical environments look and function. This in turn has caused the need for health systems, hospitals, and provider groups to quickly rethink their facilities to provide both the capacity for innovation and social distancing considerations with the flexibility to foster an uncompromised level of patient care and financial sustainability.

Recent experiences in managing the COVID-19 pandemic have emphasized the role of unified data in evaluating levels of readiness and formulating rapid response in the health care environment. The regulatory answer to the pandemic is certain to require that health care facilities adopt current and evolving best practices to ensure flexibility, adaptability, and heightened infection prevention measures in all patient care spaces. Health care leaders everywhere are learning to synthesize data from all available sources to inform decisions that literally save lives in their community. The stakes could not be higher, nor the need greater, for data-informed decisions, efficient design, and strong leadership.

Plan for the worst while hoping for the best.

How data shaped early decision-making

Minnesota is fortunate to have a strong regional system of health care organizations and influential research institutions like Mayo Clinic and the University of Minnesota, and this, along with existing data-sharing practices, has provided a solid platform for emergency response. The Governor’s office assembled a group of multidisciplinary experts from organizations across the state, including leaders representing the Minnesota Department of Health (MDH), State Health Care Coordination Center, Minnesota Hospital Association (MHA), and the University of Minnesota, to convene a statewide Minnesota COVID Ethics Collaborative. This group has worked closely and at regular intervals to research emerging state-wide data and react on behalf of the health care community across the state.

Minnesota relies on capacity modeling and infection tracking data from MDH and MHA, using testing data to evaluate what hospitals will need in terms of ventilators, PPE, beds, and staffing, forewarning systems of potential shortages in these vital resources. Health care leaders know this type of actionable data—like what can be found in MDH’s’s MNTrac application—helps project demand and identifies where resources can be effectively deployed to match that demand.

Whether it’s tracking change over time, or during a specific event like the COVID-19 pandemic, local data is your most actionable intelligence, yet it’s wise to pay attention to data trajectories from other states and regions, as we have learned it could impact the PPE and medical equipment supply chain, and it can help shed light on what to expect in different phases of the virus.

For example, population density is a known major factor in how fast a virus spreads, with rolling disparity between city, suburban, and rural communities. The comprehensive data collected allows the Centers for Disease Control and Prevention (CDC) to create patterns of spread, demographic data, and a wide swath of information that can inform health care organizations in order to prepare.

Ultimately, this situation was like many other crisis response scenarios, although much larger, using all available data to plan for the worst while hoping for the best.

Flexible design to meet a changing landscape

It will now be more important than ever to incorporate flexibility and adaptability into the design of both inpatient and outpatient care environments. We do not yet know what the future may hold, but we have begun to identify a few areas where design response must be either immediate or incorporated in the short term:

Invest in technology. As a result of the COVID-19 pandemic, a more prominent reliance on telehealth services will impact how future space is planned in care environments. In March 2020, the Centers for Medicare and Medicaid Services (CMS) broadened reimbursements for virtual care, accelerating the shift to this growing method of providing care. The change has enabled more providers to consider this in their care toolkit, and more systems have moved to implement the technology needed for its support. From a facilities perspective, the potential impact may be a decreased reliance on physical space, since many providers will be able to practice from their homes.

Rethink waiting rooms. Social distancing is here to stay, and as we are beginning to reopen clinics and ambulatory care facilities, we must rethink how and where the health care customer is waiting to be seen. Potential immediate solutions may include spacing out furniture, staggering appointment times (which likely will extend operating hours), or replacing a physical waiting room with a “virtual” one in which a patient waits in their vehicle before receiving virtual notification that their care provider is ready to see them.

Plan for surge capacity in both inpatient and outpatient facilities. Although designing hospitals to be able to accommodate a 100-year black-swan event is arguably like “designing a church for Easter Sunday” (both impractical and cost-prohibitive), the COVID-19 pandemic taught us that we must at least have a plan for surge capacity. This includes examining how existing hospital space can accommodate a significant increase in the number of patients and ensure the safe flow of supplies and materials in the face of higher equipment loads and an increased need for negatively pressured patient care areas. This may also include looking at how outpatient facilities can flex to be able to accommodate patient surges, by both utilizing existing environments and incorporating this flexibility in the design of all future spaces. Ultimately, each health care system will need to formulate and implement a comprehensive plan.

Some choices more simply come down to doing the right thing.

Leverage data to create strategy for the future. In addition to having an action plan at the ready in the event of another pandemic, health care systems and provider groups need to strategically examine their current and future investments. The health care economy that will emerge from COVID-19 will permit even less margin for underperforming sites, requiring analysis and decision-making that thoughtfully and thoroughly considers emerging future reimbursement models, trending demographics, the likely availability of staffing resources, and ultimately the urgent and evolving needs of the communities we serve.

Effective leadership during times of crisis

During crisis, leaders are often making decisions under a whole new set of priorities, particularly when changes happen quickly, and with new data being made available every day. We’ve seen, through the COVID-19 pandemic, different outcomes based on decisions made by leaders—from the government to health care organizations. Because situations and relationships are fluid and complex, there’s no one right way to lead, but some best practices can be observed.

One important consideration is to not put too much trust into your own bubble and instead, look beyond your own personal experience. Listen and learn from those around you (nations and worldwide, too) and take in as much data as you can to make the best-informed decision possible in the moment. Sometimes you must simply decide with the information you have and in which you are confident. In many situations, time is an extremely important variable.

Leaders who earn respect are the ones who transparently share data, providing valuable perspective to their teams and collaborators. There is immutable strength in saying there’s nothing to hide. Share as much and as often as you can, and share information when you feel confident about it; you’ll give others confidence and earn their confidence in your leadership.

Data is not the only factor in every leadership decision, as some choices more simply come down to doing the right thing. These can still be extremely difficult decisions, literally of life and death, but if your convictions are grounded in both data and integrity, you can own that decision—and sell it, too. Stand by informed, compassionate decisions and people will stand by you.

Finally, remember that personal connections are reliable resources; relationships nurtured in good times get leaders through tough times. Similarly, leaders who consistently engage their staff throughout less turbulent times can also be more effective leaders through times of crisis, with difficult conversations and transparency made easier from practice, open communication, and steady relationships.

Looking ahead

The next crisis may look nothing like this one, and all the data or design planning in the world may be irrelevant to certain new circumstances. It’s often said that the only constant in life is change, but it is proven that good leadership is always a strong foundation in which to help navigate that change and empower future leaders to do the same.

Mike McMahan is Senior Vice President of Healthcare at Ryan Companies US, Inc. Mike leads a team of experts on healthcare real estate and facilities and, as a part of the state’s response to the COVID-19 pandemic, served as a Healthcare Executive Liaison for the State Health Care Coordinating Center (SHCCC) within the State Emergency Operations Command Center.

Alena Sakalouski Johnson, AIA, ACHA, is a board-certified healthcare architect at Ryan A+E, working within a multi-disciplinary team to address the changing healthcare landscape. 

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Alena Sakalouski Johnson, AIA, ACHA, is a board-certified healthcare architect at Ryan A+E, working within a multi-disciplinary team to address the changing healthcare landscape.