Healthcare facilities are about as complex a building type as you can get, making a career in the healthcare planning and design field far from a cakewalk. And market conditions are only complicating matters. Hospitals and health systems are responding to the financial realities of reform (and remaining unknowns tied to the Affordable Care Act), implementing measures to support population health, and trying to figure out what to do with an aging building stock—each priority shaping expectations for new building projects and, more importantly, the project team members delivering them.

Healthcare A/E/C firms are responding to the new climate that’s been created, one where shorter schedules are the norm, collaboration is key, and expertise is a must. Healthcare Design asked healthcare design leaders to shed light on the business side of the industry today—specifically, what challenges are top of mind, from talent acquisition to streamlining project delivery to answering evolving client expectations.

In this special report, we profile not just those challenges identified, but the drivers behind them and the solutions being implemented. Here, Scott Garand, principal at EwingCole, discusses his firm’s efforts to tackle eliminating waste in construction and operations.

Name: Scott Garand
Title: Principal
Firm: EwingCole (Charlotte, N.C.)
Number of employees: 350
Healthcare revenue in 2016: $28.5 million

Business challenge: Eliminating waste in facility construction and operation
Healthcare organizations must do more with less—less time, less staff, and less money—and they’re looking for ways to continuously improve efficiency. As a result, these organizations are seeking assurances that planning and design solutions can lead to proven capital and operational cost savings. The challenge for A/E firms is to add value and demonstrate a return on innovation in the planning and design of facilities. Offering nontraditional services like design research is one way firms can partner in the effort to meet today’s challenge of less is more.

What’s behind it
Two major factors that are driving healthcare systems to demand cost savings are the continuous reduction in reimbursements and an increase in market competition. Gone are the days of reliable revenue growth. Since the initiation of the Affordable Care Act, many health systems have seen lower Medicare and private payer reimbursements along with an increase in Medicaid patients. This has been partially responsible for the increase in the merging of health systems so that smaller hospitals, which may be financially struggling, can now access more capital, advanced technology, expanded service lines, and increased market share.

Additionally, many larger systems are seizing the opportunity to expand their footprints by either affiliating with or acquiring smaller health systems. As these “mega” systems begin to encroach on each other, it’s creating more financial competition in areas that were once controlled by individual systems. However, many hospitals have realized that there’s only so much market share they can acquire and are looking at their assets to identify creative ways that planning and design can help alleviate the pressure of tighter budgets.

The solution
 At EwingCole, design research is the basis for design decision-making and envisioning innovative design solutions. The research team is a combination of PhD researchers, clinicians, healthcare architects and designers, and sustainability experts who use empirical data to understand the relationship between building design, user behavior, and user experience. The team identifies trends in overall efficiency, measures the performance of specific models of care, and helps to quantify the effectiveness of physical environments on user needs. Informed design decisions equal savings and a better understanding and appreciation of the value of design by all stakeholders. In a time when every healthcare dollar spent is scrutinized, it’s important to consider a means to validate design choices.

To do so, we ask a multitude of questions to identify specific areas of concern. Organizations looking to improve patient satisfaction scores or determine if current design standards meet the needs of changing care models can turn to the research to ask, “Is design a contributor to our success? If it is, how do we maximize its return?”

Our approach uses multiple methods, and our toolkit is made up of three complementary research domains: secondary research, original or field research, and calibrated simulation. At the beginning of the design process, secondary research synthesizes existing scientific research and qualitative data, helping the organization identify what matters most to their unique staff and patients. Secondary research can also set a benchmark for further investigation.

Organizations have found the most value from original or field research. Detailed behavioral observation, quasi experiments (involving full-scale and virtual architectural models), and layout analysis are just a few of the ways we collect data. The findings and converging evidence are sometimes expected, but more often point to staggering statistics about the correlations between design and behavior. For example, one experiment revealed that patients were more likely to recommend a facility based on the artwork there. We often find that valuable design improvements don’t require major renovation or redesign. Paint and furnishing color choice can have a big effect on the bottom line and overall savings, if the research data collected demonstrates a correlation to the patient’s perception of care.

Additionally, when organizations look to operations for savings, data collected through work sampling and behavioral observation can provide real-time information for calibrated simulations. Virtual design options can be evaluated for efficiency and utilization based on how the organization was observed to operate and behave, in addition to historical data on volumes and throughput. This can result in a more accurate picture of the impact of design on operations that spreadsheets can’t always reveal.

Words of wisdom
Healthcare facilities can create measurable and sustained value by practicing and implementing research to determine appropriate built environment solutions. Not only can research-informed design identify potential construction and operational costs, but, when used effectively, it can create team consensus that streamlines project delivery and expedites speed to market, reducing those costs.