2013   JANUARY
 

1.18.2013

Designing for the     
Future of Healthcare             an article by Tompkins Architects   

With the introduction of funding made possible by the Affordable Care Act, it is an important time to consider how the allocation of these resources to medical facilities will most effectively improve our nation’s health (1). Through our experience in the architectural design of healthcare facilities across the United States, Tompkins Architects has found three growing trends that will affect the future of patient care; shift in direction for hospital care, emerging technology in residential care, and growing community based primary care. The healthcare system is evolving and we are designing facilities to accommodate this evolution. Below, we examine how effective healthcare facility design can address these trends and improve for the future of healthcare design.  
trend one: Shift in Direction for Hospital Care
The future of healthcare promises a shift in how medical professionals interact with patients. This shift will encourage hospitals to become more efficient and patient friendly as incentives are put in place to reduce duplicate services and incomplete care. We have found the separation and departmentalizing of the medical profession is the cause of nearly $25-50 billion in annual excess spending (2). The concept of “lean” design can offer hospitals a more holistic approach to healthcare architecture. Hospitals can reduce costs through reducing unnecessary and duplicate testing, more effectively using facility technologies, and improving patient diagnoses to find more effective treatments. Expansions to hospital facilities can accommodate new technology but will need to consider trends such as larger exam rooms with patient-friendly spaces (3). The future of hospital design will be found in concepts that can effectively foster a team effort in cost efficient manner. 

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trend two: Emerging Technology in Residential Care
As the “baby boomer” generation reaches the age of retirement, market impact for residential facilities is becoming a vital part of healthcare design. As people live longer, the elderly are continuing to live at home or with a relative instead of into traditional nursing homes. New technologies that were previously unavailable to the public are allowing family homes to become a more realistic option for “aging in-place” (4). New technologies will continue to become readily available at reduced costs. These technologies can track a patient’s dexterity, cognition, and movement from a remote location. This availability of these technologies is resulting in a shifted role that the traditional nursing facility plays (5). The newly developing role of nursing facilities will alter in two ways. There will be a reduced role for the accommodation of situations for senior independent living, but an expanding role in assisted care, skilled nursing, and rehabilitation. This advancement will require creative solutions to both residential and nursing home design. 
trend three: Growing Community Based Primary Care
As part of the Affordable Healthcare Act an estimated $1.5 billion will be used for community based health care construction (4).  Along with this financial boost, there are changes in the evaluation of health such as discounts in cost for integrating wellness and other whole-health programs. It is important to consider how to accommodate these changes within the built environment.
The NASBHC (National Assembly on School-Based Health Care) is an example of a healthcare program whose goals are in line with the future role of community clinics will play in a city. NASBHC is an established national program that focuses on providing all students with primary health services, including preventative care and mental health services (6).  In California, there are nearly 200 K-12 schools with campus-based health centers (7).  These centers offer students everything from check-ups to drug counseling, but they also strive to teach and provide students with facilities to implement these preventative measures. These include classes on the importance of healthy eating, reproductive health, and youth engaged exercise.  The school-based programs have several existing advantages applicable to the design of new community clinic facilities.  The relative proximity of the facility to the patient creates a community-focused approach to the care provided.  As primary care shifts to community clinics, we are advocating for the use of resources to include care for both treatment and prevention.
Summary
As the medical field adapts to serve the increase number of clients, the demand for medical care will transition to include both treatment and prevention. Current facilities that are under-equipped to handle this transition will want to update and new facilities will be required to accommodate these changes. As designers of medical facilities we are educated in the new paradigms of healthcare. As healthcare changes to accommodate the huge number of people who will now have health insurance, we ask that you act as an advocate for the design of facilities that efficiently serve and effectively treat patients.
Source(s):      

(1) The Henry J. Kaiser Family Foundation. Accessed December 19, 2012. http://healthreform.kff.org/federal-funds-tracker.aspx#.

(2) Kelly, Robert. "Where Can $700 Billion in Waste Be Cut Annually from the U.S. Healthcare System." Thomson Teuters. www.factsforhealthcare.com/whitepaper/HealthcareWaste.pdf

(3) Gawande, Atul. "How Do We Heal Medicine." TED. www.ted.com/talks/atul_gawande_how_do_we_heal_medicine.html

(4) Dash, Sarah J. The Changing Health Care Landscape. Slide program. American Institute of Architecture. December 6, 2012

(5) Dishman, Eric. "Take Health Care Off the Mainframe." TED. http://www.ted.com/talks/eric_dishman_take_health_care_off_the_mainframe.html.

(6)  NASHBC. December 16,2012. http://www.nasbhc.org/

(7) Gorman, Anna. "Taking Healthcare to Students." Los Angeles Times, November 28, 2011.

by: Jacob Coburn | Chris Richards | Adam Shuler | James Tompkins | Charles Vega
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