Critical Approaches to Enhancing Healthcare Facilities 

October 31, 2024 • Ella Krygiel - BOMA International

Ensuring future flexibility in healthcare facilities is crucial as we consider evolving patient needs. With the announcement of a new surgical “megafloor” being constructed at the acute care hospital on the UCI Health – Irvine campus  and many other projects in the works, real estate professionals, designers and healthcare workers need to align their priorities. Discussion about extending the lifespan of healthcare facilities continues to be a priority given that flexibility plays a significant role in medical technology, patient preferences and changing regulatory requirements. Here to discuss all these emerging trends and more are two leading experts in the healthcare fields: Doug King, Vice President Emeritus of Healthcare at Project Management Advisors, Inc., and Shawn Janus, National Director, Healthcare Services, Colliers. Read their insights below to learn more: 

Healthcare Design identifies four key strategies for extending the lifespan of healthcare facilities: space versatility, shell space, service consolidation, and engineering upgrades. Which of these do you consider the most significant, and are there any other components you believe are also essential? 

King: To extend the lifespan of a medical facility, four key strategies are crucial. First, a universal grid (usually about 31.5 feet square) and sufficient structural loading capacity allow for easy adaptation over the building's lifespan, accommodating future equipment and layout modifications. For example, diagnostic floors at Northwestern’s Feinberg and Galter Pavilions were built with 250 pounds per square foot capacity to support various equipment, enabling flexible use of spaces like the Post Anesthesia Care Unit (PACU), which could serve different patient needs throughout the day. Standardized, modular layouts further allow departments to shift functions without needing physical alterations. Additionally, creating strategic soft spaces—initially used for office tasks—enables later conversion to medical use, particularly in Certificate of Need (CON) states where shell space is restricted. Increasing floor-to-floor heights (from 13 to over 16 feet) enhances comfort, while investing in high-quality or easily replaceable plumbing risers helps manage one of the facility’s most failure-prone components. 

Janus: The four strategies are interdependent to some degree.  While all elements are significant, space versatility rises to the top for me.  Equipment, robotics, and advances in technology are changing at a rapid pace and space versatility becomes paramount.  Engineering upgrades also plays into the versatility paradigm.  To briefly address the other two, service consolidation potentially allows for more efficient use of space for medical personnel and ease of accessibility for patients.  Shell space allows for future expansion, however the cost associated with carrying the space can be a burden. 

Recently, it was announced that a new surgical “megafloor” is being constructed at the acute care hospital on the UCI Health – Irvine campus. This development aims to streamline operations, reduce waste and errors, and accommodate more inpatient and outpatient procedures. What are your thoughts on this initiative and the steps companies are taking to enhance operational efficiencies? 

King: The concept of a “megafloor” is not a new idea, but it is definitely a useful one. In my work on Feinberg and Galter in the early to late ‘90s, we created two of them. On the 100,000-square-foot fifth floor, for example, we modularized the layout. At the time, there was a lot of forecasting in medical design and construction about the emergence of so-called “bedless hospitals,” and we weren’t sure where the market was heading. As a result, the owner asked us to design this floor so that it could be used for either inpatient or outpatient care, which has worked well in practice for almost 25 years. We also built out 50,000 square-feet on the seventh floor for specialty surgery and co-located the cardiac  and EPS functions as a precursor model to the blending of imaging and surgery into a singular treatment environment. Lastly, we located ICU space on that floor that could function either as holding or recovery space for patients. This has proven to be a model that many other large healthcare systems have adopted and used with great success in the years since. 

Janus
: The initiative makes sense for many reasons, including operational efficiencies, through-put, ease of patient access and ability to leverage staff. We’re seeing strategies to enhance operational efficiencies, particularly in the outpatient arena.  Healthcare providers continue to prioritize the delivery of higher acuity care in the outpatient sector — MOBs, ambulatory care centers, ASC’s, imaging centers, etc.  The consumer is seeking convenient locations and ease of access, and the healthcare environment has evolved to allow higher acuity procedures to be performed outside of acute care hospitals. Positive patient experiences not only increase satisfaction scores but also enhance the provider’s brand. Additionally, providers benefit financially from using less costly facilities and improved reimbursement rates. 

What other emerging trends in the healthcare industry do you think are particularly noteworthy? 

King: I see two major and intertwined emerging trends on the healthcare horizon: intelligent healthcare facilities and using data to streamline operations. As technology continues to advance at a rapid pace, there’s an opportunity for healthcare facilities to operate out of smart buildings that can streamline building performance, improve operational efficiencies and boost patient experience. These building systems can then use the data they collect during daily operations to further improve the facility’s performance. For example, these buildings can deploy autonomous robots to clean and disinfect patient space, transport materials, enact quality control initiatives and automate demand forecasting for inventory management. 

Janus: Labor shortage concerns are particularly acute in the healthcare sector. There’s been a nursing shortage in healthcare ever since I’ve been in the business.  It became more acute with the onset of the pandemic. Traveling nurses grew exponentially during this time as well, putting additional cost pressure on providers.  Perhaps more troubling is the physician shortage.  Retirements are outpacing new entrants.  In addition, the time required to train physicians doesn’t allow for a quick solution to the problem. This can affect not only the delivery of healthcare, but it also has real estate implications.  As the outpatient model has grown, physicians are needed in those locations.  Providers may know geographies where they strategically need to grow, but projects cannot get off the ground unless they can be staffed.  Inflation adds to the pressure, with rising costs for labor, supplies, and equipment squeezing already slim profit margins. Payor reimbursements have not kept up with these costs, complicated by the three-year cycle of payor contracts. Government policies also play a significant role. Medicare and Medicaid dominate, while private insurers are generally more profitable. Regulatory changes and increased congressional scrutiny introduce additional risks, particularly regarding potential shifts in for-profit and not-for-profit statuses. 

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