During the opening keynote session for the Healthcare Design Virtual Conference, Nov. 9-12, panelist David Grandy, vice president of delivery system design and innovation at Kaiser Permanente, reminded attendees that it was the 291st day since the first COVID-19 case was diagnosed in the U.S. Furthermore, he reflected on all that’s changed since then. In the early months of the pandemic, he said Kaiser Permanente, like many other organizations, focused their efforts on expanding capacity in anticipation of patient surge. As the pandemic progressed, and demand didn’t meet those expectations, Kaiser Permanente turned its efforts to learning more about COVID-19, its transmission, and how it could be prevented. “We know much more now,” including about early treatment and when it’s best to put a patient on a ventilator, he said.

That perspective, some of the lessons learned over the last nine months, and the best practices that could be used going forward were shared with attendees during the HCD Virtual keynote panel, moderated by Healthcare Design Editor-in-Chief Jennifer Kovacs Silvis with panelists Grady; Carolyn BaRoss, principal, health, at Perkins & Will; Walter Jones, senior vice president of campus transformation at The MetroHealth System; Jeff Stouffer, global director, principal, and executive vice president at HKS Inc.; and Barbara Wagner, executive vice president at Clark Construction.

Grady explained that Kaiser Permanente used the summer months, when cases were in decline, to “get upstream,” including getting all clinical environments and clinicians up to speed on the pandemic. Additionally, the nonprofit healthcare organization developed a program to help members handle the pandemic from home, including developing a kit of supplies, sharing tips/data on COVID-19, developing a 14-day isolation plan for members with positive diagnoses, and sending out pulse oximeters to high-risk patients to help monitor when a person might need to be brought into the hospital. Looking ahead, Grady says testing, including increasing capacity and expediting results, will be the key to “breaking the chain of cases.”

Panelist Jones said MetroHealth had a similar experience, moving through a spring of unknowns and learning how to plan for the anticipated case influx from a medical angle and a logistics one. In his organization’s case, MetroHealth decided to relocate patients from a skilled nursing facility to other locations in the community and convert the building to a surge facility, which ultimately wasn’t used. “This next wave now is very different,” as the industry has more experience on how to handle cases, he said.

One solution the panelists, including Jones and Grandy, agreed is here to stay is telehealth, with Jones noting that it came to the forefront very rapidly. Grady added that Kaiser Permanente’s primary care visits delivered through telehealth has risen from 15 percent pre-COVID-19 to more than 80 percent. “The longer this [pandemic] goes on, the more people will accept it,” he said, adding that in the past telehealth was thought of as a convenience, but going forward it should be looked at through the lenses of affordability and accessibility.

BaRoss said Perkins&Will spent the spring working collaboratively with industry partners through the Greater New York Hospital Association to develop surge capacity plans for the region. “The stats from New York Governor Andrew Cuomo were very motivating,” she said. Among the work was reviewing 29 sites for potential to become temporary care sites and developing a rapid assessment tool to help clients in their decision-making. Among the lessons learned this spring were that surge facilities associated with an existing facility or hospital were the best options, as one of the biggest challenges was figuring out staffing and supplies for facilities. Going forward, she said the industry needs to figure out how the fit out of these spaces can support caregivers.

Sharing her perspective from the construction side, Clark Construction’s Wagner said speed became paramount this spring with solutions such as prefab and modular construction becoming a big part of the conversation. “Material availability was another big factor,” she said. In response, the construction firm created an assessment tool to use with clients and is focusing on learning what’s worked to inform future situations.

HKS’ Stouffer said another issue that needs rethinking in light of COVID-19 is resiliency. “Most emergency planning in hospitals and facilities were of a brief duration,” such as a weather disaster or chemical spill, while the current pandemic has lasted months, he said. That extended duration means the industry needs to “rethink how we plan for future surges.”

And while a big focus of discussion has been the need for flexibility in design, he says the term can mean lots of things to different organizations. To help guide that conversation, HKS has broken down the idea into four areas: versatility, modifiability, convertibility, and scalability. For example, he said future facility design may need to consider enhanced screening or testing capabilities near entrances, which could be addressed with a double chamber entrance. Material selection, updated HVAC systems that support compartmentalization and negative pressure rooms, and touchless technology are other strategies that could be used to help facilities address infection control and reduce the spread of pathogens. “As we move forward, these are considerations we’ll be looking at with clients,” Stouffer said.

Discussing what factors are influencing design and construction in the industry, Wagner said, “I think we’re still figuring out the balance.” For example, she said many clients are rethinking their real estate needs in light of the work from home movement and rising telehealth services. She said she’s also anticipates more focus on infection control, including discussions about the use of privacy curtains in clinical spaces, utilizing windows with integral shades, and material choices.

When asked where they’d like to see the industry head, Stouffer said he’s optimistic that the experiences of the last several months will accelerate innovation in the industry. “I think it’s a call to action for all of us,” he said. Wagner said in the past healthcare has been designed to be lean, not flexible. With COVID-19, she’s seeing clients start to rethink their investments and how best to serve patients while being more adaptable.

One issue that BaRoss would like to see addressed going forward is access to care and the role of healthcare in the community. “What’s really rising to the surface is the need to focus on health locally and globally,” she said. Jones added “speed of market” to the list of opportunities for improvement going forward, noting that one of the challenges will be compressing timelines while being as responsive as possible to get needed facilities up and running “both for current needs and ones not thought of yet.”

During a time in history when people are more aware of connecting and how we come together, Grandy says he sees promise in the idea of “technology-powered humanity.” “We have to find ways to use technology in service of advancing humanity,” he said. But he cautioned against implementing technology for technology’s sake. Rather, he said, think of it as an “enabler” or an “on-ramp for human connection.”

Missed HCD Virtual? Don’t worry. Registration is still open, and all sessions will be available on demand through the end of the year. Visit HCDvirtual.com for more information.

Anne DiNardo is executive editor of Healthcare Design. She can be reached at anne.dinardo@emeraldx.com.