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Health care design now favors hospitality, flexibility

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Health care facilities are being shaped by new technology, going green and starting to look a bit more like home.

The last falls under different labels: tenant improvement, 360-degree ambience and evidence-based design. But the concept is the same: Health care facilities should be warmer and more hospitable. Indeed, hospitals are starting to focus on the service-industry aspect of their business -- and to design for the five senses, which includes a focus on artwork and lighting.

"Quality design that supports a quality environment for patients is definitely something that benefits recovery," said Dan McDaniels, director of campus planning and development for Sharp Grossmont. "And there is now hard clinical evidence that supports that. You want to have an environment that is pleasant and relieves stress; that's definitely not disputed any longer."

Kaiser Permanente's Rancho San Diego Medical Office in La Mesa. Photo courtesy Kaiser Permanente

This increased focus on the interior setting of patient care facilities does require an additional investment.

Where is the drive stemming from?

Doug Childs, principal with Childs Mascari Warner Architects, attributes the shift, in large part, to consumer demand.

"The baby boomers are starting to use health care services, and they are used to nice food and nice hotels. They are also used to having a lot of choices, which the Internet has facilitated," Childs said.

One of the challenges facing the industry right now is the lead time to implement not only such design changes but also design plans in general. Currently, the approval process takes one to two years. During that period of time, the technology the space was built around may change, in turn requiring a plan modification.

Often, by the time a firm can get to the end of the approval process, the technology can be up to four years old. With the rapid advancements in technology, that can mean the whole design plan may have to be revised to accommodate the developments.

"The industry is in turmoil because technology is so unpredictable," said Eva Szots, facilities development and operations director at Kaiser Permanente. "From the consumer perspective, it provides treatment benefits. However, speaking from an architectural and design perspective, it creates turmoil. If today if I place an MRI machine that costs $2 million and then tomorrow the technology changes, I am going to have to design the area so that it is flexible in case the MRI or parts of it change. Building must be flexible now to allow for changing technology."

An interior look at Kaiser's Rancho San Diego facility. Photo courtesy Kaiser Permanente

While improvement is expected in the timeline for design plan approvals -- via a fast-tracked approach by the Office of Statewide Health Planning and Development (OSHPD) -- flexibility in design is being seen as the most viable option to handle quickly evolving technologies. McDaniels mentioned the value of having "multi-functional spaces that you can adapt."

It does tend to cost more at the upfront to account for the uncertainty of future treatment options, because it means designing for several potential outcomes. But it can save cost later. Szots also cited the adaptability that can be achieved via modular building components. These are prefabricated in factories and delivered to the building site in an 80 percent complete stage of construction.

Despite the aforementioned challenges, technology is providing great benefits as well. For example, technology now allows for decentralized nurse's stations. Nurses can now be clustered around the hallways to be closer to patients and spend more time with them. Information technology is also helping create new paperless and time-efficient options for storing electronic medical records. Developments in radio-frequency identification (RFID) can now help track patients, staff members and equipment.

When it comes to construction, health care facility needs differ substantially from office buildings. Medical buildings require more complex plumbing, a solution for containing medical gases and now require a more comforting interior. Additionally, in-patient facilities are facing more stringent seismic upgrade regulations via California State Senate Bill 1953 (SB-1953).

But the health care construction industry is similar to traditional office building development in one key way: an increased concern for the environment.

"There is a larger awareness now of the patient experience and of the global impact, because hospitals have a very big footprint on the environment. We are trying to reduce it with everything we do," said Sam Chereskin, principal with Chereskin Architecture. "There is now thinking about products and waste streams that (the industry) didn't normally think of in the past. Even in terms of what kind of insulation to use, because those particles are airborne."

Looking ahead, industry professionals expect technology to continue to create a challenge -- and a benefit -- to health care facility design and patient care. Hospitals of tomorrow will be more comfortable and less institutional.

Perhaps the most interesting consideration for the industry is the impact of virtual medicine, both in care and in facility design. With robotic surgeries and advancements that allow patients to be treated in their own homes, hospital spaces may be left to house only the most specialized and expensive equipment.

"Outpatient care, I think, has been a trend for the last eight years. I think that hospitals of the future will be for the sicker, and that home care is going to be a big thing, too," said Childs. "They have the technology now for an electronic ICU where doctors can monitor patients remotely, and telemedicine and robotic surgery are starting to happen.

"The home will be a bigger place to receive health care because of both monitoring technologies and the fact that the cost to deliver health care in a house will be a lot less."

Blackford is a San Diego-based freelance writer.

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