Operations and Facility Management

The U.S. healthcare system has been profoundly affected by the pandemic, accelerating the pace of moving people out of the hospital and into outpatient settings. Moving the treatment of less critical or severe conditions off the hospital campus can help reduce exposure and transmission and enables the hospital to focus on long-term and highly specific care. Within hospital environments, healthcare clients are rethinking how to plan spaces for flexibility while ensuring patient and staff safety.

These efforts are driving new approaches to healthcare facilities, including the design of patient rooms and location of core services.

Rethinking patient room design

Within hospitals today, the patient care unit has seen some of the most significant pressure to become more resilient and flexible post pandemic. Specifically, there’s demand to be able to ramp up and down the number of active beds while still supporting patient and staff safety. This has accelerated the need for all patient rooms to be private and isolation-capable at a moment’s notice.

Renovating patient rooms to be bigger can address the need for acuity-adaptable rooms that can handle varying functions or bed counts. Larger rooms accommodate more changes in equipment and bed numbers by virtue of having more available space.

Other efforts include adding moveable furnishings and building utilities and connections into adaptable wall units for less-stationary equipment, which also support flexible space needs. The ability to accommodate more beds or equipment isn’t useful if casework and equipment are bolted into the floor, which can limit movement, or power cannot be easily accessed when equipment is moved.

Planning core services

Outside of the patient room, core services such as emergency, surgery, and imaging must continue to function when crises arise. Many hospitals that provide emergent and short-term care as well as long-term, chronic care in the same facility were caught off guard during the pandemic with mixed inpatient and outpatient care platforms. In some cases, this situation resulted in the reduction in non-emergent services or non-pandemic patients prevented from entering the hospital to avoid risk of exposure.

Additionally, hospitals with these core services in the center of the facility had to juggle entry, exit, and flowthrough and were more challenged by limited routes to and from these departments.

Going forward, placing these services in perimeter areas rather than the facility core and will make inpatient and outpatient care more feasible in a pandemic and post-pandemic environment. For example, in an ideal situation, a hospital would have essential services such as emergency in an ancillary area so that emergency patients and pandemic patients (and their care providers) would not be meeting in the halls or overlapping.

Lean lessons

Providing ambulatory services off campus continues to be one of the biggest growth areas in healthcare. As pace on these projects continues to increase, it’s imperative that project teams deliver design strategies that address how to keep these services running during future crises.

The use of Lean strategies can help with these approaches, including focusing on analyzing workflows to optimize space for each service/care modality as well as the movement of people and materials while reducing waste in the built environment.

For example, large waiting areas take up space that can be used to route patients through an ambulatory environment without contacting others. Creating more space to develop alternative circulation routes increases efficiency and limits odds of transmission in a pandemic environment.

Going forward

There’s no silver-bullet approach to resolve the complex challenges that have resulted from the pandemic. Working collaboratively with care providers, facilities, and designers, project teams need to deliver solutions that address resiliency, increased safety, and improved operations to help inform design decisions and solve current and future healthcare industry issues.

David Jaeger is principal and healthcare sector leader with national architecture and engineering firm HED (Detroit). He can be reached at djaeger@hed.design.