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  2018 Healthcare Design Conference Takeaways
Key Takeaways from the Healthcare Design Conference 2018 Facilities & Project Management Track, Sponsored by the Health Care Institute

Disaster Plan Overhaul Saves the Day: How Two Texas Hospitals Escaped Hurricane Harvey’s Fury

(Left to Right)

Greg Quinn, Principal, Affiliated Engineers Inc.

Sidney Sanders, Senior Vice President - Construction/ Facilities Design and Real Estate Management, Houston Methodist Hospital System
Lynn Crawford, Market Leader Energy and Utilities, Affiliated Engineers Inc.

Michael Shriner, Vice President - Business Operations and Facilities, University of Texas Medical Branch (UTMB), Galveston

  • Remember that natural disasters are impacting your staff and their families as well. Account for having reduced staff during a disaster. “20-25% of the people you count on to help recover won’t be able to,” Shriner said. When Hurricane Harvey hit Houston Methodist, for example, the same recovery team had to stay on site for several days, working in 12-hour shifts.

  • Ike taught UTMB “to make sure you have resources available ahead of time,” Shriner says. When Hurricane Harvey arrived, they were prepared with mobile dining, portable toilets and hand washing stations.

  • Shriner advised setting up a dedicated communications team so the operations team isn’t overwhelmed by requests for communication. In addition, consider having command center training twice a year. “Understand who is going to make decisions across a large area.”

  • Plan carefully ahead. FEMA refused to reimburse UTMB for resources purchased ad hoc after Harvey because it wasn’t part of the initial bid. But that doesn’t mean settling for recovery when there’s a chance to improve and upgrade. Crawford adds, “FEMA will pay to put it [whatever has been damaged] back where it was. Don’t do that—another storm will come and hit it again.” Upon negotiating with FEMA, they were successful in getting reimbursement to move damaged utility lines to a more secure area.

  • Review continuity plans annually. Make sure multiple departments aren’t counting on access to the same resources.

  • Today’s codes and regulations are informed by past events. They aren’t looking at the future trajectory of extreme weather events based on data from NOAA. Because these codes are broad, it’s up to individual FMs to account for their buildings’ specific vulnerabilities.

Moving the Horizon in Healthcare Design: Technology, Diagnostics, Health Policies & Population Shifts Driving Design

(Top) Ray Pentecost, Ronald L. Skaggs and Joseph G. Sprague Chair of Health Facilities Design, Director, Center for Health Systems & Design, Professor of Practice, Department of Architecture, Center for Health Systems & Design, Texas A&M University

(Bottom) Michael Wood, National Director of Construction, Medxcel; Immediate Past President HCI


Rapid advancements in technology, diagnostic intelligence, health policies and population health shifts are creating a new Environment of Care.


The speakers will share, through a research and application lens, what is happening behind the scenes in key areas such as tactics, technology, business deployment, utilization of capital assets—and how your organization can integrate into this next generational shift.

  • Evidence-based Design Forecast: Ten years ago 86% of designers were hearing requests for evidence-based design, while only 1/3 had formal training in it. Today, “We wouldn’t let you in the door without it,” Wood said. He advises designers “take evidence-based design to clients.”

  • Regulatory Uncertainty Forecast: While designers might see “uncertainty as freezing”, Wood and Pentecost argue that the M&A activity is driving greater need for design services to create more consistent branding. They predict the next wave of M&A activity to focus on rural areas.

  • Artificial Intelligence Forecast: AI is no longer limited to learning from high volumes of successes—now it learns on its own. “Tell it ‘I want you to achieve this’ and they discover how to do it,” Pentecost said. Today, “AI is no longer a novelty,” Wood said. “It’s central.” Ascension’s medical group AMG is leaning into AI, having just completed a simulation lab that can respond to atmospheric conditions. “Our buildings are going to become intelligent of themselves,” Wood said. “If you don’t have your IT consultant as your best friend, they will become your most trusted sub advisor.”

  • Technology Forecast: is changing how healthcare systems use the design community. The most important feature designers can offer is durable decisions. “Is a new facility needed? What level of trust do you engender with your client if the answer to that is no,” Wood said. Designers need to focus on operating efficiency. “Every time you [architects] drive our project costs up, you drive our delivery costs up,” Wood said. Today’s focus needs to be not on new buildings but on making existing buildings more durable.

  • Costs Forecast: Healthcare costs are close to growing so large the industry can damage the entire U.S. economy. In the U.S., 20-25% of GDP is the breaking point before the economy fragments. Healthcare now is at about 18% GDP. “Our CEO at Ascension tells us clearly it’s up to each one of us to hold that line and to be accountable for that cost,” Wood said. “We have to stop this growth.”

Follow the Money: A Discussion on Shifts Driving Financial Strategy

(Left) William Hercules, President/CEO, WJH

(Right) Michelle Mater, MBA, MHA, President of Catalyst

  • Hercules provided a history lesson on insurance that revealed we’ve seen few major changes, and are even having similar conversations today as nearly 100 years ago. In 1945, President Truman pushed for national health insurance, arguing it was “not nationalist because patients could choose the hospital and physician, and neither were employed by the government.” As Hercules said, “We’re using different language thinking we’re talking about different things but we’re not.”

  • Mater instructed architects on the primary buckets health systems used to fund construction project: discretionary fund, based on 2-5 percent profit on operating costs, covering few improvements; routine maintenance budget; strategic capital, largely from portfolio investments; tax increment financing; monetizing assets, which she sees becoming less popular today; and charitable giving, a large source of project funding.

  • Key financial metrics to know to gauge whether a project will get funded: the hurdle rate, the system’s required rate of returned on a project; and the internal rate of return, an expected rate of return on the project, which Mater indicates should be around 12% or higher. Before investing, health systems need to know: does the investment retain/grow members? Reduce long-term operating costs? Reduce borrowing rates? Fit target operating margins?

  • How does this help designers?

    1. Help contribute to lowering the bottom-line. “We need to start seeing patients in a lower cost setting,” Mater said. Hercules added, “Approach CEOs with a business plan, with a piece of architecture attached.”

    2. Learn to articulate the real value. That means moving the conversation from talk about the patient experience to focus on project ROI, supply chain integration, nursing ratios, etc. If they have problems with IT, for example, think about how you can help solve those problems. If speed to market is the primary concern, start looking more closely at modularity.

    3. Dig out the root causes of problems. Is the ED bottleneck about not having enough beds—or is it about having too small a pipeline of new nurses to manage more beds?

    4. Think about the full story.

    5. Michelle: "We’re seeing the need for storytelling. Getting community involved, funding, etc. think about the full story."

    6. Start the story asking how you can the health system them meet the hurdle rate and internal rate of return. Tell a story that shows the value of a project from operations to the CEO and community.

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From Workplace Violence to Wandering Patients: Deploy a Technology-Driven Physical Security Strategy that Won’t Impact Patient Experience

(Top) Matthew P. Jones, Vice President, H. Stephen Jones and Associates, Inc.
(Bottom) Jeffrey Kent, Managing Director Corporate Facilities, Nemours Children’s Health System, and President, Health Care Institute of IFMA

  • Kent shared that just after the Pulse Nightclub shooting in 2016, Florida-based Nemours’ CEO started talking to staff about how the world is changing. There are few areas today that aren’t at risk. Now is the time to launch a full physical security audit at your health system.

  • 45% of all workplace violence happens in the healthcare industry, Jones noted. Physical security needs to be ongoing and cyclical.

  • Kent found that cameras installed new in a 5-year-old hospital are already out of date compared to today’s rapidly progressed video technology. BriefCam, for example, is able to condense an hour of video into a single frame, and allows viewers to select the characteristics they’re searching for to pinpoint the location of offenders. Jones demonstrated how he could find eliminate “noise” to locate a person in a white shirt, walking forward, wearing a backpack, within a set timeframe.

  • AHJs won’t allow lockdowns today, because it violates NFPA 101, meaning healthcare systems have to get creative in how to secure buildings in the event of an active shooter event. “But I think it’s coming,” Kent predicts. In the meantime, Jones says, coordinated training with law enforcement is paramount.

  • Renew background checks of your vendors annually.

The Impending Disruption High-Tech Giants are Bringing to Healthcare

Oriana Beaudet, DNP, RN, PHN, Vice President of Transformation, Array Advisors, and Affiliate Faculty Member, University of Minnesota

  • “We’re going to see more AI across healthcare.” For example, MIT is spending $1 billion to promote AI. The biggest barrier is that healthcare is notorious for not having complete data sets. If healthcare could share their information with industry safely we could drive population health improvements—so consider data improvements the next step forward.

  • Other focus: How to use AI to make high value services less expensive? Today, for example, IBM’s Watson is able to provide 20-50 ranked diagnoses.

  • The rising costs of healthcare are fighting today’s focus on wellness and prevention. “We are seeing patients refusing healthcare because of the high deductible, so they’re getting care at home then coming in sicker.”

  • “The prediction is hospitals will be for high-end procedures only… this is where you’ll go to get your 3D printed organs.” Companies like Dispatch Health, which does ICU level care in your home, will be driving everything else into the community.

  • Disruptive innovation is not sustained by traditional business solutions.

Deep Dive into the Subsectors of Ambulatory Care

(Left to Right)

Craig Mulford, Partner, Boulder Associates

Alicia Wachtel, Executive Director, Facilities Planning, Design and Construction, Cedars Sinai
Steve Howard, Managing Principal, Cumming Corp.
Bill Foulkes, National Vice President, Cumming

(Not Pictured) Sam Sears, Principal, Percival Health Advisors

  • “The demand for MOBs is really strong right now but I think we’ll reach a plateau on there in the next few years if not a decrease,” Mulford said. He sees six types of ambulatory care:

  1. On-demand care—the patient is sick, this is where they get help. This ranges from the ED to urgent care to even an e-visit.

  2. Whole person care—this coordinated, continuous care might include the patient centered medical home model, primary care, and now even the insurance company in some cases driving long-term care.

  3. Diagnostic and treatment—imaging, rehab, ambulatory surgery.

  4. Wellness centers—focused on healthy living and medical-based fitness. “Traditional healthcare providers are really interested in this but don’t know how to do it.” The payment model is different here, often subscription based, and so joint ventures are becoming popular as a way to understand the model.

  5. Senior care/adult daycare. This is a big market but, again, health systems don’t understand the business model.

  6. Behavioral health—this is slowly becoming integrated with other types of care, but healthcare providers are looking for help

  • A lot of systems haven’t figured out how the spaces work together, Foulkes noted. It’s important to take these pieces and create a roadmap.

  • Wachtel explained Cedar Sinai’s business development is about targeting specific address, and that drives buy/lease/build decisions as they make the shift from medical center to health system. Surprisingly, she added: “A lot of our location decisions are driven by parking.”

  • “One of the most important things was transforming to team-based care, and that drove what clinics look like,” Wachtel said Cedar Sinai eliminated all doctor offices and moved work to centralized hubs. Now 70% of their physicians don’t need to leave the patient room to find what they need.

  • Despite tariffs, labor shortage, and other factors, Howard said escalation hasn’t increased as much as expected. He budgets 4-4.5% for escalation. “Rather than using one number, we have to look at individual markets…to set the number,” Howard said. The labor shortage are driving some new strategies. Wachtel said Cedar Sinai has found they have to explore “how do we as owners become more desirable to contractors to secure those resources.” Paying fast and lowering liability are key. “The market is shaping us as owners,” Wachtel said.

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Branding: The Powerful Secret Health Systems are Adopting to Win Consumer Hearts and Minds

Gina Bleedorn, CXO, Adrenaline

  • “In talking about branding, digital disruption has altered consumer expectations—and they’re driving all changes,” Bleedorn said.

  • Coming from a focus on finance and retail, Bleedorn said, “You might feel digitally disrupted but a lot of industries have it worse.” Today healthcare is still at the “early adopter” stage, and the stage is set for major changes to come.

  • As soon as things become automated, that becomes the norm, and “that’s the new standard of consumer expectations.”

  • Branding isn’t a logo on a building—it’s the gut feeling patients are left with after your services. “Satisfaction is not advocacy and does not drive brand loyalty. It means you’re ‘ok.’” To gain customer loyalty, you need to create meaningful experiences.

  • Of course, the logo on the building does matter. Remember, “your facilities are your owned media.” Use your façade is branding and think about how it attracts and speaks to the community. Your brand should be visible 24/7, so consider lighting.

  • Consumers want choice: there’s DIY (think retail health, telemedicine) and DIFM (“do it for me”—think urgent care). Are you branding your facilities to reflect these specific experiences? Most consumer don’t know the difference between urgent and quick care, so it’s up to you to make it clear. And all of these formats need consistent branding, so make sure elements are scalable and repeatable.

  • Future proofing is important. Remember how airlines’ mobile kiosks were made obsolete by mobile check-in? Today financial firms are ripping out teller lines to replace them with teller pods. Talk to designers about how to future proof facilities for future technology.

A Session Audience at Healthcare Design 2018

Comprehensive Enterprise Care Models: Leveraging a Multi-Campus Strategic Master Plan for Scripps Health

Chaithanya Jayachandran, Healthcare Studio Leader, SmithGroupJJR
Bruce Rainey, Corporate VP Construction & Facilities, Scripps Health
Issam Khalaf, Vice President Western Region Manager, Program and Construction Management, Jacobs Engineering Group, Inc.

  • “Scripps built one hospital and acquired four, and the result of that is variation,” Rainey said. “Variation is not value. Standardization is value.” That also means putting an end to custom designing every building. If the goal is to provide same healthcare from site to site, it’s important to focus on program, not project; consistent processes as well as consistent rooms.

  • In complying with California’s requirement to upgrade all acute care buildings to meet seismic standards by 2030, Scripps has taken on more of a master-planning role, taking on more risk but gaining more consistency across the system. The result was a $2.6 billion system-wide capital program.

  • Engineering was driven by open architecture: systems are manufacturer-agnostic so they can have a variety of service providers across the buildings’ 50 years, with a range of cost and quality options. However, the goal is also to limit variation in equipment.

  • “We drew the OR and patient rooms before handing to architect. We wanted to get clinical buy-in, and get opinion out of the way,” Rainey said.

  • In the case of this construction, Khalaf said, “It’s a program, not a project,” It’s important to look at system solutions, not solutions at one particular site. This makes collaboration crucial. Scripps collocated program core teams in one center, then crated multiple site teams to handle site-specific issues.

  • The biggest unexpected challenge on this project was staff burnout. “This is drawing their attention in addition to normal projects,” Rainey pointed out. On average, they might have 150 smaller projects going on at the same time. It became very important to organize efforts and keep digital knowledge on the project.

  • Digital design tools also allowed the team to use their best practice model as a basis for Revit designs that helped achieve incredible levels of detail, like identifying locations for the soap and paper towels in exams rooms, to ensure consistency across the system.

  • Speed to market isn’t as crucial an issue in this case. Starting now to meet the 2030 deadlines makes it possible to in some cases slow the schedule to lower monthly costs. But because all state systems have the same 2030 deadline, they must account for the constrained market.


Achieving a “Designed” Population Management Approach


(Left to Right)

Douglas King, Senior Associate, Stantec Architecture Inc.
Jingfen Guo, Assistant Professor, Interior Design Department, University of Central Oklahoma
Alex Tsaparis, Architect, Stantec Architecture Inc.

  • Considering 5% of our population uses 52% of healthcare spending dollars, it’s important to keep people out of this category. Population health is a system approach to health aiming to prevent the illness/keep people healthy. King has identified 16 areas where systems and facilities can support population health management. How are you meeting these:

  1. Housing. It’s more expensive to treat a homeless person than buy them a house. Promedica became a developer specifically to address this.

  2. Healthy foods. “Urban farming can become a healthcare strategy,” as Homestead Hospital found with Grow2Heal.

  3. Promote agriculture.

  4. Education and training. More organizations are doing health classes, cooking class, community organizations in conference space at the hospital.

  5. Transportation. Some health systems are finding it’s cheaper to pay for the Lyft or Uber ride than the cost of people missing an appointment.

  6. Therapeutic outdoor spaces. “We need to explore facades that reach to the community.”

  7. Embracing the arts

  8. Child friendly. Guo points out that population health is about understanding the needs of users, including non-primary users: kids tagging along with parents. Her recent research found 70% of parents’ doctor visits include their kids, and more frequently with scheduled appointments rather than ER visits. Kids, eager to engage with the environment and people, soon distracted parents and care providers. Integrating lessons from pediatric hospitals (think playrooms, low whiteboards for drawing, YMCA-style babysitters) can lead to more effective primary care.

  9. Entertainment

  10. Gathering spaces

  11. Access to affordable care. This needs to include mental and dental care as well.

  12. Respite for staff and families.

  13. Developing symbiotic partnerships with the community.

  14. Community-based emergency response.

  15. Embracing elder care

  16. Aging in place. Coming together with home healthcare

  17. Socially sustainable


Optimal Facility Planning and Design for Innovation through Stakeholder Alignment


(Left to Right)

Stephanie Statz, Senior Project Interior Designer, RSP Architects
Karla Koons, Associate, Senior Project Interior Designer and Medical Planner, RSP Architects

Mary Haugen, Director Professional Nursing Practice and Ambulatory Surgery Center, TRIA Orthopaedic Center

  • “With facilities merging, aligning stakeholders can be a challenge,” Statz said. When three Minnesota orthopedics practices merged, and needed to align their diverse specialty service lines, models and workflows into the new TRIA Orthopedics Center, the team began with informal visioning. The first team meeting was social to bring together three groups who didn’t know each other. Over round tables, the groups talked about brand experience, team culture and innovation, and identified commonalities.

  • Designers used Lean to understand how the space was being used. Early research involved representatives from all areas of the center. Although meetings ran long, it was helpful in getting early agreement, Koons said. “Dive deep in the beginning of the project. This is where you need clarity,” Statz said. She added, “You don’t have to be a designer to have great design ideas. Get out of the way and let end-users ideate.”

  • “For nurses plans aren’t really intuitive…mockups were invaluable,” Haugen said.

  Making Decisions at the Crucial Time: When and Why Projects Go Astray
  Tim Cole, VP/Marketing, nora systems, Inc.
Val Williams, Client Manager, Adolfson & Peterson Construction
  • Create a more diverse building committee at the start of the project. Then, empower your team members by encouraging them to speak about their experiences and expertise. Read-in new members as they join the team to ensure everyone is comfortable speaking up about issues.

  • Plan to hold more face-to-face meetings to improve accountability and ensure the entire team gets the message. An added bonus: you get better communication from these meetings where you’re able to watch body language and show proper empathy. Communication is key to a successful project. Ensure the architect has thoroughly explained the design to end users and they understand what is planned so as to limit surprises along the way.

  • Be proactive. Don’t assume someone else is thinking of the issue.

Deep Dive into Next Wave of Healthcare Real Estate Development  

Crossing the Chasm – Where Construction Stops and Operations Start


(Left) Julie Johnson, Principal/Healthcare and National Co-Leader, Healthcare Affinity Group, Avison Young

(Right) Josh Teague, President of Development & Investments, Real Estate Strategies


(Left) B. Alan Whitson, RPA, President, Corporate Realty, Design, & Management Institute

(Right) Dave Arnold, President, Arnold Interim Management Services and former Hospital Chief Operating Officer


Three Boldest Trends in Flooring, Surfaces and Furnishings Every Designer and Owner Should Know

(Left to Right)

Flooring: Cynthia Hubbell, VP/Healthcare & Senior Living , The Mohawk Group

Surfaces: Mark Krejchi, Ph.D., Healthcare Manager, Wilsonart

Furnishings: Lisa Teman-Rosenburg, Western Specialist Manager, Haworth Health Environments

(not pictured) Moderator: Mike Wood, National Construction Director, Medxcel

  Most Stunning Trends to Watch For in 5 Major U.S. Regions
  (Left to Right)
Moderator: Eileen McMorrow, Editor/Publisher of McMorrow Reports/Healthcare
Chicago: Jennifer Patton, Vice President, Krusinski Construction and President of HCI Chicago
Central & SW Florida: Rania Sadrack, Principal/Director of National Healthcare Strategy, TLC Engineering, and President of HCI Orlando
Texas: Rod Armstrong, RVP, The Mohawk Group and President of HCI North Texas
Upper Midwest: Troy Stutz, Vice President, RJM Construction and President of HCI Upper Midwest
(Not Pictured) California: Bill Foulkes, National VP/Healthcare, Cumming and President of HCI Southern California
  Latest Research: Comparative Study of Seven California Hospital Projects Reveal 9 Indicators for a Successful Healthcare Project

(Left to Right)

Lynn Welch, SitePlus
Michelle Malone, Executive Director of Facilities & Construction, Chinese Hospital
Laurel Harrison, Vice President & Chair, Health Sector, Stantec
George Hurley, Healthcare Core Market Leader, DPR Construction

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