Health economics, care delivery, and buildings of the future were each top of mind to the more than 40 CEOs, owners, designers, and management consultants who offered a take on the future of healthcare in a recent industry survey.

DPR Construction conducted the year-long study through in-person interviews and online surveys to gather the insight and filter the results into its “Future of Healthcare” report, including 10 areas of change projected to impact what’s on the healthcare horizon, from reimbursement changes and electronic medical records to patient-centered care and evidence-based medicine.

They include:

  1. Hospitals will be smaller and more integrated at many levels.
  2. Systems will be changing.
  3. Outpatient systems will be the focal point for growth.
  4. Specialty areas will focus on those that are most profitable.
  5. Technology/data intensity will be crucial.
  6. The economy and availability of capital will be limiting.
  7. Renovation and adaptive reuse will increase.
  8. Sustainability expectations are changing.
  9. New delivery methodologies and best practices are being embraced.
  10. Demographics are a top concern, aging staff and patient populations .

Hamilton Espinosa, DPR’s national healthcare group leader, describes how the trends that emerged from the data will shape how future building projects unfold, starting with the ramifications of healthcare reform’s accountable care organizations and changing reimbursement models.

Hamilton Espinosa, DPR


Reform realities
To start, a pay-for-performance system will mean hospitals and health systems will be held more accountable than ever. “Each organization is going to have to do a better job of tracking their performance and how they provide certain services,” Espinosa says. “They need their facilities to be better tools to allow them to deliver that care in a more cost-effective manner.”

Some examples can be found in smart patient room design to prevent falls, materials specified to support infection control, and infrastructure created to power electronic medical records.

And depending on the outcome of November’s presidential election and the subsequent future of reform, the study indicates that lean operations will also be an important component of absorbing the additional costs associated with potentially 32 million newly insured Americans.


IT upgrades
Improving the delivery of care goes hand in hand with offering patients technology that supports that care. Beginning with electronic medical records and on to hybrid ORs, “Technology is growing at such a huge rate, the last thing we want to do is build a new hospital and have it not sized right from an infrastructure standpoint to accommodate future technology,” Espinosa says.

Also on the technology front is personalized medicine—for example, offering patients the ability to track their heart rate on their smart phone and send the data right to their doctor’s own mobile device. But all of that digital information is going to need a home of its own.

“Some hospitals need to build data centers because they have all this information, but where are they storing it? You have HIPAA patient privacy rules and regulations, so how is this information being tracked and monitored? Does a hospital need to build its own data center?” Espinosa says. For large healthcare systems, the answer will likely be yes. However, for one-off hospitals or small community-based systems, a better option may be a collocation facility, he adds.


Focused care
Technology also plays an important role in the overall trend to treat patients at the lowest acuity level possible. “Care is not always at a hospital, or at the MOB or outpatient facility; often it’s being delivered at your house,” Espinosa says.

But that doesn’t mean he expects the design and construction industry to see even large-scale projects disappear.

“We are seeing some of these megahospitals still being built, but I think they’re being built in strategic locations, and they’re being built with intent,” Espinosa says, adding that that intent is often to serve as a tertiary facility that outlying outpatient centers and home-based care feed into.

“You’re going to see more renovations to the central hospital and upgrades to put in hybrid ORs or intraoperative MRIs. Or maybe those hospitals were built in the ‘70s with semi-private rooms, so you’ll see them add a bed tower. They’re not adding bed capacity, but they’re adding a bed tower that has acuity-adaptable private rooms,” he says.

And as a preventive care model continues to emerge in health systems across the country, Espinosa says he expects to continue to see facility projects supporting that movement by creating education spaces for outreach or outdoor spaces to promote physical well-being.

In terms of design interventions, Espinosa says the survey results showed a growing recognition of evidence-based design and having a “why” behind the way things are built—for example, placing patient bathrooms a certain distance from beds to reduce falls or improving the efficacy of staff by creating decentralized nurses’ stations.


Teaming up
For DPR, Espinosa says the survey results help the firm not only recognize what’s on the minds of healthcare industry professionals but how to respond to those concerns through a collaborative approach to projects.

“Being able to train our folks to watch out for these things and being able to add specific items during the design and construction process is better. We have to be smarter on regulations and design criteria to provide better information to clients,” he says. “I think long past are the days when an architect would design something, bid it out, and we would just build.”

Instead, the builder is more commonly being asked to be part of an integrated team and to offer the foresight necessary to construct a building that anticipates the direction healthcare is taking.

“We’re seeing trends, and we need to adapt to what the hospital systems want to build,” he says.

Hamilton Espinosa will be joined by Kip Edwards, system vice president, development and construction, Banner Health, and Mark Patterson, vice president, SmithGroup JJR, to present more details on the survey results at the HEALTHCARE DESIGN Conference. Their session, “New Survey Enlightens on 10 Areas of Change Coming in Healthcare,” will be held from 1:15 to 2:15 p.m. on Nov. 4. For more information, please visit