3 important trends in hospital design that Healthcare Giants are watching closely

The healthcare sector faces grave financial uncertainties, even with the June 28 Supreme Court decision upholding the Affordable Care Act. To help us sort out the factors impacting this lucrative segment, we turned to Philip Tobey, a Fellow of both the AIA and the American College of Healthcare Architects and Senior Vice President with SmithGroupJJR.

“Health industry providers legitimately expect significant efficiencies and lower costs for design and construction services, to go along with the economies that they themselves face with tighter and value-based reimbursement terms under health reform,” says Tobey, a member of Building Design+Construction’s Editorial Board.

In other words, AEC firms are going to have to share some of their healthcare clients’ pain. The drive for greater operational efficiency and lower cost in healthcare will be unrelenting, with bundled payments and shared savings models in lieu of traditional fee-for-service reimbursement forcing healthcare providers to eliminate wasteful practices.

Tobey sees three major trends emerging: 1) growing emphasis on ambulatory care, 2) medical systems integration, and 3) the “bundling/unbundling” of services.

SCROLL DOWN FOR GIANTS 300 TOP 25 AEC HEALTHCARE FIRM RANKINGS

1. PUSHING AMBULATORY CARE FACILITIES OUT

“The trend to push services out of the hospital into ambulatory settings will only intensify,” says Tobey. He notes, however, that there will be an “overwhelming need” to expand the front end of delivery—primary care, urgent care, and emergency departments—and to rationalize procedural and imaging resource capacity. At the same time, freestanding surgery and imaging centers may not be as prevalent in the future, and may need to be consolidated into larger hospital centers.

“Hospitals are not going away,” says Tobey, even though inpatient volumes are predicted to fall 5%, vs. 30% growth in outpatient volume. The sheer increased volume of patients, especially as baby boomers age, will inevitably drive up acute-care admissions. In the face of these seemingly countervailing trends, says Tobey, “The need to renovate outdated or obsolete facilities will be a strong driver in the healthcare business.”

2. INTEGRATING MEDICAL SYSTEMS MORE TIGHTLY

Tobey says the need for greater efficiency and ever-higher quality of care are not new goals for medical care or medical design, but hospital systems are being encouraged further by healthcare reform to streamline processes, with more mergers, acquisitions, and hospital-physician staff integrations on the horizon. “The industry’s even been talking about including services like long-term care and home care into this integrated approach,” he says.

Although there will always be a need for acute-care hospitals, Tobey sees a possible shift toward more community-based portals. As health systems continue to integrate, they will rely more and more on treatment venues outside the hospital to provide patients with coordinated preventive care and treatment for chronic conditions.

The IT component of hospital systems is already a natural for systems integration. “Providing the right information where it’s needed is essential for clinical care,” says Tobey, who foresees greater implementation of electronic medical records.

Are hospitals ready for lean?

“Everybody’s talking about it, but many hospital owners are wary of taking on lean,” says SmithGroupJJR’s Phil Tobey, FAIA, FACHA, whose firm is on the team for Sutter Health’s California Pacific Medical Center in San Francisco, the largest lean project in the U.S. “You have Sutter, which is totally lean, then you have clients who tell us not even to mention the word,” he says. “Others are applying the basic principles of lean construction without carrying the heavy weight of all that lean entails.”

Applying Lean/Six Sigma principles to healthcare, says Jeffrey C. Stouffer, AIA, a Principal with HKS, would result in “measurable outcomes and even risk sharing as part of the design and construction process” by eliminating unnecessary waste in construction and operations and increasing staff efficiency and safety, while reducing energy and staff costs for the hospital.

3. UNBUNDLING/BUNDLING OF HEALTHCARE SERVICES

Healthcare providers are “decanting” non-core functions—services like pharmacy, lab support, materials handling, and environmental management—from the mother ship into cheaper B-occupancy buildings. “Anything soft, anything that’s not high-tech, is being taken out,” says Tobey. “That’s the unbundling.”

However, once the unbundling of less-intense services has been accomplished, says Tobey, some hospital systems are opting to bundle the remaining hospital space, by placing beds back on top of the structure’s base diagnostic and support block, instead of having the traditional diagnostic/support chassis with attached nursing wings.

“You unbundle and decant the support services, then take the remaining high-intensity hospital base and put the beds on top,” says Tobey. A recent study for a 100-bed community hospital found that following such a scheme would result in 39% savings in construction costs per bed. +

TOP 25 HEALTHCARE SECTOR ARCHITECTURE FIRMS

Rank	Company	2011 Healthcare Revenue ($)
1	HDR Architecture	205,200,000
2	HKS	124,736,964
3	Perkins+Will	122,895,589
4	Cannon Design	121,000,000
5	NBBJ	116,401,000
6	HOK	102,695,248
7	SmithGroupJJR	74,600,000
8	RTKL Associates	68,421,405
9	Perkins Eastman	63,700,000
10	Hammel, Green and Abrahamson	61,900,000
11	ZGF Architects	54,338,355
12	Heery International	48,583,000
13	HMC Architects	42,715,899
14	PageSoutherlandPage	38,670,000
15	IBI Group	37,349,554
16	Skidmore, Owings & Merrill	33,950,000
17	FKP Architects	33,947,200
18	Gresham, Smith and Partners	32,876,981
19	FreemanWhite	28,500,000
20	RBB Architects	28,500,000
21	LEO A DALY	26,900,325
22	BSA LifeStructures	26,323,759
23	EwingCole	24,000,000
24	KMD Architects	20,161,678
25	Ennead Architects	19,875,000

TOP 25 HEALTHCARE SECTOR ENGINEERING FIRMS

Rank	Company	2011 Healthcare Revenue ($)
1	AECOM Technology Corp.	314,000,000
2	Stantec	109,980,000
3	URS Corp.	41,298,918
4	Smith Seckman Reid	38,300,000
5	Jacobs	32,950,000
6	Parsons Brinckerhoff	30,600,000
7	KPFF Consulting Engineers	28,000,000
8	TTG\|TMAD TAYLOR & GAINES	27,677,900
9	Mazzetti Nash Lipsey Burch	24,988,296
10	Degenkolb Engineers	22,454,591
11	Allen & Shariff	21,577,769
12	Bard, Rao + Athanas Consulting Engineers	18,000,000
13	ccrd partners	17,100,000
14	Atkins North America	16,173,240
15	AKF Group	15,200,000
16	KJWW Engineering Consultants	14,607,369
17	Syska Hennessy Group	14,462,238
18	Zak Companies	13,882,705
19	TLC Engineering for Architecture	13,874,283
20	Dewberry	10,613,564
21	Thornton Tomasetti	9,860,000
22	Sparling	9,658,825
23	Walter P Moore	7,718,326
24	M/E Engineering	7,700,000
25	Rutherford & Chekene	7,650,000

TOP 25 HEALTHCARE SECTOR CONSTRUCTION FIRMS

Rank	Company	2011 Healthcare Revenue ($)
1	Turner Corporation, The	1,807,050,000
2	McCarthy Holdings	1,231,000,000
3	Gilbane Building Co.	1,091,777,000
4	Clark Group	1,067,411,678
5	PCL Construction Enterprises	869,130,091
6	Brasfield & Gorrie	833,522,003
7	Skanska USA	724,418,042
8	JE Dunn Construction	636,206,095
9	Robins & Morton	599,073,000
10	DPR Construction	588,199,172
11	Whiting-Turner Contracting Co., The	464,779,240
12	Mortenson	455,620,000
13	Lend Lease	434,626,482
14	Hensel Phelps Construction	425,760,000
15	Suffolk Construction	420,343,563
16	Pepper Construction Group	415,064,000
17	Tutor Perini Corp.	409,583,000
18	Balfour Beatty US	389,253,907
19	Hunt Construction Group	369,500,000
20	Hoar Construction	313,937,000
21	Flintco	291,400,000
22	Layton Construction	287,300,000
23	HBE Corp.	279,200,000
24	Power Construction	275,000,000
25	Swinerton	274,627,440