In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and to share some ideas on the subject.

Here, Mark Herstein, design manager at Tocci Building Companies (Woburn, Mass.), discusses the effects of the Patient Protection and Affordable Care Act on healthcare design and constructing healthier facilities for the future.

1. The Patient Protection and Affordable Care Act

As early as December 2010, the Patient Protection and Affordable Care Act (PPACA) was considered a wake-up call for facility managers, urging them to  become leaders with more responsibility for patient advocacy. The PPACA contains initiatives to expand healthcare coverage, reduce cost growth, improve patient safety and quality of care, and expand community-based primary care.  Emergency departments anticipate an impact with an increased demand for services in lieu of patient access to local ambulatory clinics. We have to ask ourselves: Are staff members sufficiently trained to identify issues with diverse populations, particularly seniors, who may be unable to accurately communicate their conditions? Hospitals are also facing challenges in implementing new technological initiatives, such as advanced information technology, electronic medical records, tele-health and interactive electronic way-finding and messaging.

2. Hospital construction and renovation 

The U.S. Department of Health and Human Services is making available $730 million in PPACA grants to assist community health centers in the provision of high-quality care.  These grants will facilitate the expansion and modernization of local hospitals, clinics, and other medical facilities in the nation’s most vulnerable communities. A large component of the PPACA relates to information technology and the need for greater efficiency in existing and future facilities. Smaller ambulatory facilities under the umbrella of a healthcare system may be a solution to creating greater efficiency and lower costs in the provision of services, and could also enable expansion of the insured population.

3. Making sustainability a priority

Energy-efficiency initiatives, reduction in water usage, sources of alternative transportation, reduced site disturbance, and preservation of open space are some of the actions being taken to reduce the amount of waste generated at medical facilities. But what else can we do? The fabrication of recyclable supplies (such as patient receptacles) through 3D printing technologies, relying on polymers and ABS filaments, could be a feasible option. This process could facilitate a localized cradle-to-grave-to-cradle approach with the added benefit of reducing and managing the bottom line.

4. Reducing HAIs and pollutants

Are we constructing healthier environments that utilize physical solutions to reduce bacterial growth and minimize or eliminate pollutants? Facility standards should be developed to include initiatives that provide easily cleanable environments, reducing dependency on chemicals that build resistant-strain of bacteria. In addition, the application of low-emitting VOCs in finishes and furniture along with the provision of fresh air to minimize entry of chemical odors and pollutants into the facility should be considered. Right now, too many facilities expand and remodel without established criteria for construction or finishes.

5. Lean implementation

A great deal of Lean implementation and process is driven by organizational culture and involves a shift in thinking to change conventional and existing habits, an appreciation of quality over quantity, and the design of spaces that increase patient throughput and staff efficiency. Areas need to be provided that permit flexible use, enhance development of effective means of communication and collaboration, and foster uniform and consistent practices. Additionally, Lean’s operational philosophies and methods focus on creating value for a facility through elimination of waste and errors in its development and growth. Our approach embraces Lean practices to eliminate labor and material waste along with achieving cost containment through value target design for our projects. The core mindset of “do better today than yesterday” focuses efforts on continuous improvement with the owner, construction team, and trade experts as an integrated part of the process from start to end.

Mark Herstein