By Miguel Burbano de Lara

Today’s health care buildings must enable and support a sustainable health care enterprise’s response to the Affordable Care Act (ACA) mandates for safety, superior quality and lower costs. Modern buildings play a critical role in addressing the ACA emphasis on population health, which is grounded in coordinated and integrated care. In order to support these objectives, the nation’s aging plant requires accelerated intervention for modernization, repurposing, or replacement using a radically different approach to planning, architecture and construction.

The interior of the Coquille Valley Hospital in Coquille, Ore., shows how health care design has been transformed by guidelines set up by the Affordable Care Act.
Photo Credit: LaCasse Photography

In addition to the physical building response, health care organizations are also transforming services delivery. They are shifting from episodic treatment to preventive protocols, and from high-cost inpatient programs to lower-cost, more accessible outpatient delivery. To support these shifts, today’s health care organizations seek facilities that are designed to support higher efficiency, lower costs, integration of players, consolidation and accountability, which produce different demands for facility development.

The ACA Imperative Shift

The ACA introduced an imperative shift from inpatient to outpatient care, as well as a move toward population and community-based health care creating significant facility challenges for health care leaders. Space must be allocated in ambulatory care facilities to support the population wellness and behavioral health programs, which are driven by primary care and outpatient services.

Electronic Health Records

Electronic Health Record (EHR)-enabled care is a significant driver for coordinated, integrated care in the new patient-centered medical home (PCMH) delivery model. For example, the Sutter Gould Medical Foundation’s Turlock Care Center in Turlock, Calif., which opened in August 2014, consolidated several clinics in order to provide better services distribution and better access, as well as new services and new technology. Operating on the principles of a PCMH, the ambulatory center offers urgent care, primary care and specialty care, supplemented by behavioral health, nutritional and social services. The center optimizes EHR technology, Lean workflow processes and architectural solutions that nurture the care team philosophy.

Cost Containment & Speed to Market

Architectural solutions that are driven by EHR technology and sustain Lean workflow processes have proven cost-effective. Specifically, effective results can be achieved through careful allocation and arrangement of space to sustain care team delivery models. For example, when a facility is designed to increase the number of universal examining rooms by decreasing non-productive space, the organization is able to increase productivity, often without increasing the number of staff. At the same time, the care team’s model eliminates redundant positions, as when medical assistants who are also capable of scheduling appointments eliminate the need for redundant scheduling staff.

St. Charles Prineville is a case in point. The hospital selected a dramatically different, innovative medical care team module for its new campus in Prineville, Ore., which opened in fall of 2015.  St. Charles Prineville offers comprehensive patient, family and visitor services, including primary care and specialty care clinics, emergency department, lab, radiology and rehab. The health system has an ambitious goal of co-locating the functions of the nurse’s station to serve and support surgery, the emergency department and the walk-in clinic, thus leveraging nursing staff with a broad skill set to perform multiple tasks.

As the ACA directives make their way into the market, facilities must evolve. Key drivers include EHR technology, Lean workflow processes and architectural forms that foster the care team approach. As budgets tighten and operations must become more efficient, tactics that save time and money are valued more than ever.

Tune in for Part II on this topic.

Miguel Burbano de Lara, AIA, NCARB, architect at Fort Collins, Colo.-based Neenan Archistruction can be reached at miguel.burbano@neenan.com.