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by Michael Schelper
Published on October 13, 2016

The healthcare industry is reaching another tipping point with the change from a volume-based towards a value-based care. This is on the one hand challenging existing business models, and on the other imposing the need on healthcare providers to adjust to a changing environment, new ways of care delivery, and innovative services in a more rapid manner.

Rising healthcare costs, chronic & lifestyle diseases, aging populations, as well as the blurring of lines of healthcare towards a more integrated wellbeing, which means actively engaging the citizens into their own health, is a reality healthcare providers are faced with and need to adjust to, even in the most traditional venues. More care is taking place in ambulatory than inpatient settings. It is even evolving further to be taking place in the natural home environment of the patient.

Particularly in the Middle East advancements towards establishing smart countries that consist of smart cities with smart buildings, will impact healthcare facilities and provide at the same time the opportunity for innovative technologies and approaches to be incorporated into the daily practices. Consequently, there is no better time to take these dynamics into consideration than already during the planning stage of a new healthcare facility. Especially given the over $90bn worth of Middle East healthcare facility construction projects in the coming years.

A large number of healthcare design consultancy firms are operating in the markets around the globe. The focus for most is to provide an iconic design that draws patients towards the healthcare facility and at the same time ensures that its morph-ability is prevalent to adapt to the ever evolving demands. Country and cultural specific elements are incorporated to create a welcoming environment that in many instances even feels like a home, in contrast to the historically scientific sterile approach. The technological symbiosis is brought to the inpatient settings, though this represents only a piece in the big picture. Increasingly more care is taking place outside of the hospital setting, supported by healthcare consultants. The seamless integration of technology beyond high level infrastructure requirements is very rarely being considered. In countries with a high Future Health Index (FHI) the thoughts of what technological innovation should already be considered right from the get-go will be of importance and most likely impact the design profoundly. Whereas it might only be a secondary or tertiary priority for construction projects in countries with a low index. Combining the architectural requirements with innovative technologies is a challenging task to accomplish and can be split into 5 areas:

  1. Outsourcing
  2. Workflows
  3. Technology
  4. Aesthetics
  5. Morph-ability

Outsourcing of services is a topic that should be defined early on in the process as it will substantially impact all other considerations. Enabling a healthcare facility to focus on value and outcomes in their care delivery, instead of imposing unnecessary distractions upon the staff members and processes, can positively impact the financial side of operating and maintaining the facility, as well as provide higher flexibility in design and layout. It is essential to find the right partner for the outsourced services to align those with the organization’s strategy in utmost efficiency. Typical services that are prone for outsourcing include non-clinical work such as facility services, landscaping, laundry, catering, IT, revenue cycle management, and others. Though clinical services are becoming more prominent in the outsourcing discussions such as lab, genetic testing, dialysis, and clinical staffing.

Having defined the work areas that will be outsourced enables a more precise planning and execution throughout the design, structural build, internal fit out, staffing, pre-opening, and post-opening phases. All these considerations will result higher quality input for the design process.

Workflows and their appropriate value oriented design with a clear focus on outcomes is the next logical step to be taken and linked very closely to the technological feasibility of realizing them. The personalization of healthcare and along with it the increased consumer engagement will only intensify in the coming decade. Consumers are utilizing more and more wearables, whose captured data needs to fuel evidence based medicine and thus impact the workflows of the clinical staff. There are two dimensions of patient engagement, internal (Kiosk self-check-in, infotainment, education, recovery) and external (Patient Portal, SMS, Telemedicine, Population Health Management) the healthcare facility, whereas the latter will grow in importance as patients are becoming more health aware and require a different service or interaction with their caregiver. In addition, the desire paths within a healthcare facility need to be designed keeping the most optimal efficiency in mind, be it short distances from closely cooperating departments, unit-dose medication dispensing to increase patient safety and lower waste, seamless integration of technology to support the clinical staff in the patient interaction, or the transparency on patient, staff, and equipment location to ensure a just-in-time coordination of required resources. There are also regional or country related dynamics that will impact the workflows design. In the Middle East for example, over 90% of Emergency Department visits do not necessarily qualify for care provision in this rather expensive setting, but more a primary healthcare one. Consequently, having a high level ‘triaging’ conducted to route patients to the appropriate facility as well as co-locating them will help in improving the care outcomes as well as patient satisfaction. In terms of design it could even be beneficial to have patients pass the primary healthcare clinic on their way to the ED, as well as having outpatient specialist practices close by to reduce transition times for the patients.

Technology will be the enabler for the defined workflows to establish a paperless digital healthcare facility. Some organizations argue that it is not possible to go entirely digital as some data needs to be entered manually. Though, having in mind during the planning phase the

  • usability of devices (mobile, wall-mounted, cart, table),
  • required medical devices ecosystem,
  • infrastructure requirements (Strong and reliable WiFi coverage where it is required, real-time location tracking, remote consultation and tele-medicine requirements, etc),
  • electronic medical record system (The backbone for the workflows, including interoperability, patient portal, medical devices connectivity, wearables, reporting, monitoring, etc),
  • technology innovation demands (Virtual reality, augmented reality, workflow based facility management like A/C or lighting)

will be the foundation for realizing a Smart Healthcare facility that is supporting the clinical staff and workflows in a seamless way, ensuring the elimination of oversizing costs, as well as eliminating the potential of ‘human error’ in data capture by ensuring the constant connectivity, communication, and access to information. Thus, making technology and integral part of the daily routines of the staff members.

Aesthetics is the next consequent step in creating a welcoming environment that is positively impacting the recovery. The goal is to provide a setting in which the patient feels as comfortable as possible. This clearly has a different definition for each of the departments. Consultation rooms should be like a living room where the information is directly shared by the caregiver with the patient on a screen, the relaxation spaces and rehabilitation ward should foster the recovery with wall gardens, greenery (indoor and outdoor), and maximize the use of natural light sources. Dynamic lighting in general has proven to positively impact a person’s wellbeing, concentration, relaxation, and is an integral part for resetting its circadian system naturally. Despite the fact that we are focusing on consumer-driven healthcare more and more, it is also important to cater the needs of the healthcare facility staff members at the same time. For example, the separation of patient and staff areas and connecting those via treatment rooms has in multiple instances, particularly clinic settings, drastically improve the satisfaction for both, the patient as well as the caregiver.

Morph-ability is the last and most difficult consideration in a very dynamic healthcare environment. Healthcare facilities have to have the ability to grow, evolve, and convert. This requires a flexible design that is able to adapt to the changing dynamics in the healthcare space and to incorporate technological advancements seamlessly. Micro-level morph-ability within specific care settings to dynamically serve the changing demands, as well as macro-level morph-ability to cater to changes in delivery models and service strategies are driving the considerations. The advancements in Nano-robotics might drastically impact the need for surgery rooms, when various operations will be conducted by swallowing a pill with a Nano-robot that will conduct the procedure without the need of external intervention.

As in all construction endeavors the above requirements have to be realized in a cost-effective way encompassing construction, operation, and maintenance of the healthcare facility, without compromising on quality and safety. In the end, we are provided with the unique opportunity to create a digital environment that will make smart healthcare a reality. The only constant in healthcare is evolution and change.

** This was originally published in the Arab Health magazine. **