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.
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.
The Facility Guidelines Institute (FGI) is a nonprofit organization that works to develop guidelines for designing and building hospitals and other healthcare facilities in the U.S. Through a consensus process that includes public input the FGI Guidelines documents are updated every four years. The SpaceMed Guide complements the FGI Guidelines by helping healthcare architects, planners, and providers to develop the functional program, required prior to application of the FGI Guidelines, and the room-by-room space requirements necessary to begin the design process. Although the 2018 FGI Guidelines documents provide indispensable guidance for the designer on risk assessment, infection prevention, architectural detail, surface, and built-in furnishing requirements, this article identifies changes that specifically impact space planning — including the types, numbers, and minimum sizes of spaces.
Laboratory testing has grown from a manual, “hands-on” process providing a simple test menu — with staff organized by testing methodology or discipline in multiple small rooms — to an automated, multidisciplinary, high-volume instrument-centric clinical enterprise. A visit to a hospital laboratory today reveals a varying array and number of instruments, often operating with little human intervention. While test volume and staffing were once used to determine the amount of space in a laboratory, today, the instruments and degree of automation dictate the test volume capacity. The number of staff required to support the instrumentation is then determined.