“Financially, when any business or health-care provider does not know what the return on their investment is going to be, you don’t invest in your buildings,” says Ana Pinto-Alexander, RID, IIDA, EDAC, principal and senior vice president and director of health-care interior architecture at HKS, Indianapolis. “We are seeing a hesitance of the health-care provider networks to spend any money at all. Therefore, projects that are on the table sometimes approved by the board are not going forward because they don’t know how this health-care reform and the reimbursement are going to affect them, because they’re going to have scores.”
Complicating matters is the fact that many health-care providers now acknowledge the fact that facilities constructed using evidence-based design principles, such as single-patient rooms, result in measurable improvement in patient outcomes, according to Griffin. However, renovating rooms in existing hospitals to reduce the number of beds—while it may improve outcomes—may also result in a loss of market share, he explains.
“It is a real dilemma,” Griffin says. “I think there is an amount of understandable hesitation as we move forward in time here with our health-care environment.”
Health Care’s New Mindset
In spite of the uncertainty surrounding the health-care construction market, the ACA is forcing the industry to change the way it does business. As a result, new models of care and other trends are emerging that just might help make this transition to a better health-care delivery system a success. But patients and providers will need to adopt a different mindset about how, when and where health-care delivery will take place.
“What we’re seeing is that people are looking at [the questions of]: What’s the transition and where do I fit in the continuum of care?” explains Jane Rohde, AIA, FIIDA, ACHA, AAHID, principal and founder of JSR Associates, Ellicott City, Md. “That’s always my question I ask clients now. Or I ask a hospital assistant: What are you best at in the continuum of care? Because you should focus on what you’re the absolute best at, and you should partner with community- based organizations to continue along the rest of the continuum.”
As the figure illustrates, the delivery of health care is being rearranged to better address the needs of patients at different times in the process, which reflects several broader trends that are emerging in the health-care market as a whole:
REPOSITIONING Overall, expect to see more renovation projects instead of new construction (or perhaps a combination of both) as health-care providers reposition themselves in the market and subdivide the services offered to patients. Hospitals will reduce their number of beds but might also convert them to accommodate short- and long-term patients to increase market share, according to Rohde.
“I think you’re going to see a lot of people in the long-term care market wanting to do post-acute, sub-acute, short-term, long-term stays,” Rohde says. “I imagine you’re going to see community centers that have physicians’ practices within them, community centers that are senior centers that have adult daycare and physicians’ practices in them. I think you’re going to see more in-between community-based service programming.” Rohde adds the goal will be to help hospitals keep people from being readmitted with the same diagnosis.