slides 007 - trends in healthcare 2015-10-27 by patrick

Holland Basham Architects

Healthcare Top 10 Trends, Challenges, Initiatives & Solutions

Healthcare Top 10 Trends, Challenges, Initiatives & Solutions The Owner’s Perspective: Jeff Prochazka,

Director of Strategic Planning, Methodist Health System

“How are we responding to Changes in Healthcare delivery & reimbursement?”

The Architect’s Perspective: Patrick Leahy, Director of Planning, Research and Innovation for Holland Basham Architects (HBA)

“Art, Science and Faith, why do Architects need to understand current HC trends?”

The Planner’s Perspective: Jim Easter, Principal, Easter Healthcare Consulting (Ehc)

“Isn’t Planning Changing to Asset Management and Dollars?”

The IT/IS/Systems Perspective: Alan Dash, Principal, The Sextant Group

“How Will IT/Medical Communications Change our Vision for The Future?”

Learning Objectivesa. Learn measurable solutions from Hospital System addressing National and

Regional Trends and market changes.

b. Creatively assess and evaluate planning and design solutions from Architect’s perspective (evidence based and programmatically grounded).

c. Apply strategic and functional planning to Future designs based on appropriate trends, design innovations and solid business objectives.

d. Measure the results and respond accordingly.

Healthcare Top 10 Trends, Challenges, Initiatives & Solutions

Future Healthcare

Top 10

Increase outpatient care

Reduce re-admissions

Reduce infections

Improve HCAHPS scores

Decrease of rural hospitals

Big getting bigger & Branding

Doing more with less

Evidence-based design

Technology tools

Population health

stop worrying about your financial future

What are you Doing now to change?

Do something Remarkable

Top 10

Increase outpatient care

Reduce re-admissions

Reduce infections

Improve HCAHPS scores

Decrease of rural hospitals

Big getting bigger & Branding

Doing more with less

Evidence-based design

Technology tools

Population health

Population Health

Education & Community Engagement

UNO Community Engagement Center

Role of Medical Center

CHI Health Bergan Mercy

Healthcare should be part of the community

Midtown Crossing

Gretna Clinic

Role of Community Based Clinics…

Proactively Keep People Healthy

Keep people out of the hospital

Population Health1

Preventative Care

Population Health1

Prescribe-a-Bike

What is the Future of the Clinic

Miller Orthopedic Specialists

Population Health1

CHI Health Immanuel – Outpatient Rehab Center

Population Health1

CHI Health Immanuel – Outpatient Rehab Center

Nurse Practitioner / Coordinating Professional

Endocrinologist

Pharmacist

Physical Therapist

Community Health Partner

Dentist

Nutritionist

Patient

Integrated Care Team1

Population Health - Broken Exam Rooms1

Steelcase Health

Population Health1

Steelcase Health

Exam Room Exam RoomConsultation room

Population Health

Mayo Clinic 2006

Mayo Clinic – Executive Health

1 Population Health

Separate Consultation Zone

Population Health1

Steelcase Health

Population Health1

Steelcase Health

Population Health1

Steelcase Health

Population Health1

Consult inside Exam Room

Population Health1

Minimize Infection – Integrate Supplies

Population Health1

How we Integrated Supplies

Population Health1

Clean Design with Integrated Supplies

Population HealthSmaller Consult Desk1

How To Design A ‘Smart’ Hospital - Healthcare Design magazine March 10, 2014

Pop. HealthSmallest Consult1

Exam Room Innovation

Distribute Care Closer to Home

Population Health1

Children’s Physicians clinics all area locationsHBA Children's Clinics in red

Population Health1

UNMC | Nebraska Medicine Main Campus and 9 Outpatient Locations

Population Health1

Methodist Health Systems Locations

Population Health1

CHI locations

Population Health1

CHI Health Clinics (ACO) NE and IA region

Population Health1

Regional Provider Network (ACO) & all NE Hospitals

Increase Outpatient Care

Understand Retail & Experience Design

Lovely Skin - retail

Think like Hospitality

Element Hotel

Increase Outpatient Care2

Methodist Physicians Clinic - Gretna

Location Location Location

Existing inpatient hospital with some outpatient

Existing: Mercy Medical Center – North Iowa

Existing inpatient hospital with some outpatient

Existing: Mercy Medical Center – North Iowa

Green field healthcare campus > % outpatient

Master Plan: Memorial Hospital, Belleville, IL

Added outpatient services & free-standing ED

Phase I

Master Plan: Memorial Hospital, Belleville, IL

Clear wayfinding

CHI Health Midlands

Strip Mall ConversionEase of Access

Retail exposure

Eye Surgeons Associates

Appeal to market

GIIK ORTHO SPECIALISTS

Reduce Re-Admits

Reduce Re-Admits3

2,225 hospitals pay fines for excess readmissions

2012 Penalties, 2013 KaiserHealthNews.org

Schedule follow-up appointment prior to discharge

Reduce Re-Admits3

Privacy

Reduce Re-Admits3

CHI Health Began Mercy

Reduce Re-Admits3Standardize Processes – Reduce ErrorsChecklists for all processes

World Health Organization

McKesson’s Approach to Readmission Reduction

Risk Identification

Care Transition

Post Discharge

Measurement

Reduce Re-Admits3

Apps to Reduce Readmissions

Reduce Re-Admits3

Propeller Health

SeamlessMD

GetWellNetwork

Vocera Care Experience

Sick weather

Doctor On Demand

Reduce Medical Errors and Infections

Reduce Medical Errors and Infections4

Medicare Bonuses and Penalties 2014

Holland Basham ArchitectsKaiser Health new – 2015-01-22

Hospital Size Penalty (Avg.)1360 Hospitals

Bonus (Avg.)800 of 1700 Hospitals that qualified

> 400 Beds $1.2 Million $213,000

<200 Beds $131,000 $32,000

Centers for Disease Control & Prevention and the World Health Organization

did not exist a century ago.

Between 44,000 to 98,000 deaths/year due to medical error in U.S.

Holland Basham ArchitectsSource: Institute of Medicine (IOM) “To Err is Human”, 1999

No. 3 killer in the U.S. third only to heart disease and cancer

-Tejal Gandhi, MD, Harvard Medical School

1000 deaths per day10,000 serious complications

-Joann Disch RN, University of Minnesota

Source: Senate Subcommittee on Primary Health and Aging, July 18, 2014

4 Reduce Deaths & Complications due to Medical Error

Source: Senate Subcommittee on Primary Health and Aging, July 18, 2014

"What these numbers say is that every day, a 747, two of them are crashing. we would not tolerate that degree of preventable harm in any other forum."

4 Reduce Deaths & Complications due to Medical Error

0%10%20%30%40%50%60%70%80%90%

MedicalSurgical

Communication failure among healthcare providers is one of the

most frequently cited causes of preventable harm to patients:

Agency for Healthcare Research and Quality, June 2008

Rounding: A Time For Communication

Reduce Medical Errors and Infections 4

Communication

Alerts

Medical Reference

Barcode Scanning

Holland Basham ArchitectsVoalte

Reduce Medical Errors and Infections4EMR inclusive of all patient services

CHI Health Mercy

7,000 medication errors per year…

Source: Institute of Medicine (IOM) “To Err is Human”, 1999 & FDA 04/12/2013

Likely more, as voluntary reports

Reduce Medical Errors and Infections4Prescription Bar Code Scanning

CHI Health Bergan

Reduce hospital acquired infections

Strategies to reduce risk of infection

Target high-touch areasEmphasize hand washing among staff and visitors

Stress technique over chemicals

Follow the directions

Consider risks of using sporicidal sterilantsDetermine effects of chemicals on materials and people

Assemble multidisciplinary teamsCheck each other’s work

Biggest advancement in healthcare, improved

HyGreen

Patient Room 2020 – NXT Health

Improve HCAHPS Scores

Improve HCAHPS Scores5

Hospital design impacts patient experience

Private Rooms

Minimized Noise

Internet Access

Access to Daylight

Nature-Based Art

In-Room Family Areas

Meals On Demand

Silver Cross Hospital

IP InPatient Experience Design

Fewer Rural Critical Access Hospitals

Fewer Rural Critical Access Hospitals6

2/3 of critical access hospitals could close

Modern Healthcare August 17, 2013

6 Stop the Assault - on Critical Access Hospitals

healthleadersmedia.com 2015

Administration’s 2016 budget axe is triple whack at critical access hospitals:

eliminates critical access designation for hospitals closer than 10 miles from the nearest hospital, which would create projected savings of $770 million.

reimbursements cut from 101% to 100% of costs, which is expected to save the federal government about $1.7 billion over the next decade.

zeroed out funding for Area Health Education Centers, which provide recruiting and training for rural medical staff. Already a great workforce shortage in rural America.

Source: HealthLeaders Media , February 4, 2015

Rural Healthcare already hurting:

Sequestration, DSH, bad debt, and other types of cuts have already hit rural hospitals hard.

"Forty-seven rural hospitals have closed since 2010, and 283 more are on the verge of closure.

If this occurs, 700,000 rural patients will be without access to their closest point of emergency care.

Source: HealthLeaders Media , February 4, 2015

6 Critical Access Hospitals

Centers for Medicare and Medicaid Services 2013

6 Critical Access Hospitals – Midwest Distribution

Centers for Medicare and Medicaid Services 2013

Holland Basham ArchitectsAll Nebraska Hospitals

“They would either go to more expensive urban hospitals ordelay care until more expensive”

Republican Sen Chuck Grassley, IA

Modern Healthcare August 17, 2013

Critical Access Hospital – Other Trends9

Becoming Large Clinics with <10 Beds + ED/UC

Exam Rooms that Flex to Impatient Rooms

Inpatient Rooms that Flex to Exam Rooms

Early Adopters of new Imaging & Treatment Equipment In Example: 3D Color Ultrasound, CT and MRI.Or do the simple things that work with Care and Empathy

Big Getting Bigger& Branding

Big Getting Bigger and Sharing of Best Practices7

Clinically integrated networks

Big Getting Bigger – partnerships, working agreements or ACO’s7

Regional Provider Network (ACO’s) & Regional Partnerships

Big Getting Bigger Branding7

Branding

Branding7

Branding

Branding7

Branding

Branding7

Old Brand: Basic & Sameness

New Brand: Distinction & Quality

Branding – Clean Modern7

Chicago Lincoln Park Upper West Side NYC

BrandingContext or Region Character7

Mason City ASC

BrandingInside compliment the outside7

Mason City ASC

BrandingMaterial Consistency and Exception7

Mason City ASC

Branding7

Brand Architecture, Signage and accessory structures

Holland Basham ArchitectsMemorial Hospital, Belleville, IL

Doing More With Less

Doing More With Less8

Less revenue per patient

$Increase in patient population

More patients

More patients, older, & sicker patients

older, & sicker patients

Remote eICU monitoring

CHI Health Mercy

Comprehensive Planning=Strategy + Operations + Facilitates + I.T. + Finance +

Real Estate Evaluation + Physician Integration

Charrette – 4 day Iterative design eventDoing More With Less8

Memorial Hospital, Belleville, IL

Charrette – 4 day Iterative design event

Client Workshop Client Workshop

Client Workshop

Kick-Off Presentation

Lean design & planning

Mercy Medical Center – North Iowa

Evidence Based Design

Evidence Based Design9

evidence-based design - research conclusions

View of Nature Shortens length of Stay

Natural Light Shortens length of Stay

Flooring best for Infection Control

Quiet for patient sleep

Benefits of Evidenced Based Design

Better Outcomes / reduce HAI’s

Develop Best Practices

Design that works better for patients

While also being Innovative & Inspire

Benefits EDAC Advocate firm.

Credentials and Knowledge recognized

Center of Health Design partner.

Access to EDAC Knowledge Repository

Knowledge of process.

Technology & Tools

Technology & Tools10

Smart Strategy®

Data Analysis & real-time Predictive Forecasting

Reduce Re-Admits3Standard Processes - Optimize Work FlowsMeasure, Compare, Adjust, Publish

Reduce Re-Admits3Heat Mapping TrafficMeasure, Compare, Adjust, Publish

Reduce Re-Admits3 Design Strategy – Nurse View

Oklahoma Heart InstituteHillcrest Heart Pavilion, Tulsa OK Project by Mark Vaughan, Research by (Zadeh & Kadse, 2009)

Reduce Re-Admits3 Visibility New Layout

Visibility, Existing Layout

Visibility, New Layout

The new design layout has

significantly improved the visibility of

the patients from nurse stations by

Reduce Re-Admits3 Walking Distance

As the color changes from orange to blue, the walking distance of the space to the

nurse station increases.

Existing Layout

Nurse location

Distance level 1

Distance level 2

Distance level 3

Distance level 4

New Layout

There is sufficient evidence that

the new design layout has

decreased the walking distances

from the patient rooms to nurse

stations by 33%

Technology & Tools10 Better Patient Experience

Easy to Clean & Integrated Technology

Patient Room 2020 - NXT Healthcare

Caregiver Hub – Sealed Keyboard

Holland Basham ArchitectsPatient Room 2020 - NXT Healthcare

Caregiver Hub – Closed

Improvement on tradition devices

Holland Basham ArchitectsPatient Companion - NXT Healthcare

Better Patient Experience

Design for assistance

Technology & Tools10 Patient Lift

Holland Basham ArchitectsHill-Rom HCD 2013

Technology & Tools10 Concealed Patient Lift

Hill-Rom HCD 2013 Holland Basham Architects

Wearables - Encouraged healthy lifestyles

Fitbit Surge & dashboard - wearables will soon be able to connect to your healthcare provider.

Smartphone + wearable integration + Physician Connected

Holland Basham ArchitectsApple Watch, 100 of new Apps in development

Primary Care Office Visit for Existing Patients Holland Basham Architects

Yelp type Price Comparison for Patients

CONTACTS Jeff Prochazka

Methodist Health System

jeff.prochazka@nmhs.org

Patrick Leahy

Holland Basham Architects (HBA)

pleahy@hba1.com

Jim Easter

Easter Healthcare Consulting (Ehc)

JimEaster518@Comcast.net

• Alan Dash

Sexton Groupwww.TheSextantGroup.com

Thank You

slides 007 - trends in healthcare 2015-10-27 by patrick

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