Hospital mergers and acquisitions continue to increase at a rapid rate with precedent-setting deals occurring in 2018. Given that this a primary business strategy for a majority of healthcare organizations, this trend is expected to continue into 2019 and beyond. One of the many challenges that newly merged healthcare systems face is eliminating redundant services and surplus capacity. Realigning services and reallocating resources among multiple campuses requires a unique strategic, operations improvement, and facility planning process. The planning team needs to understand the market and patient population, look at alternate ways of allocating resources, and evaluate the impact on operational costs, before recommending investments in bricks and mortar. This article looks at opportunities for improving efficiency and eliminating surplus capacity, separating major issues from less important issues, and other key considerations.
Existing space in hospitals is a valuable resource that historically has been overlooked as organizations focus on renovating and expanding their physical plants. With fluctuating workloads, rapidly changing technology, staff turnover, and limited access to capital in today’s dynamic healthcare environment, hospital leaders are increasingly looking for ways to better use what they already have. They are also committed to building flexible space when they do renovate or start from scratch.
Planning a surgery suite used to be fairly simple. General operating rooms were used for a wide range of procedures with dedicated operating rooms limited to cardiac surgery and orthopedics. Today, the question “How many operating rooms are needed?” is complicated by more stringent distinctions between operating rooms and procedure rooms, changing technology and increasing specialization, and the convergence of diagnostic imaging and surgical procedures. From a facility planning perspective, the number, size, and specialization of the operating rooms (ORs) is the single biggest factor contributing to the overall footprint of the surgery suite (and project cost). Moreover, the numbers and sizes of related patient care and support spaces are planned based on the number and types of ORs. And, from an operational standpoint, the number of ORs drives ongoing staffing and related operational costs.
Healthcare organizations vary significantly in the number of expensive procedure rooms and equipment units that they use to accommodate similar numbers of annual procedures. This is why it is important to look at the current capacity prior to deciding to expand the number of procedure rooms and related support space, particularly those clinical services that use expensive equipment and uniquely-designed procedure rooms.
Planning space for diagnostic services, and assessing the need for equipment, can be complicated from many perspectives. Some equipment is becoming miniaturized, portable (even handheld), and more affordable so that it can be easily used at the patient’s bedside, in the physician’s office, or even in the patient’s home. Other equipment continues to require a large footprint, unique design features, and a big investment, and is increasingly specialized. Imaging services no longer reside within the boundaries of the “radiology department” but instead are provided in many locations throughout the healthcare enterprise — often replacing other testing modalities that once occupied their own departments. The challenge is not only to determine what equipment to purchase but where to locate it.
Physician offices and outpatient clinics typically consists of a patient intake area with space for reception, check-in/check-out, and waiting; exam/treatment space with a number of identical exam rooms, several office/consultation rooms, and one or more special procedure rooms; and associated clinical and administrative support space. Physician office space may be located in a medical office building (either freestanding or connected to a hospital), co-located with diagnostic and treatment services in a comprehensive ambulatory care center, or part of an institute or center organized along a specific service line — such as a Sports Medicine Center, Heart Center, or Cancer Center. Planning space for physician offices (also referred to as physician practice space) and outpatient clinics begins with determining how many exam rooms are needed and two different approaches are commonly used.