Northern Health Authority delivers healthcare to the residents of 20 different communities that are a mix of settlements, towns, and villages. With many of the existing remote health centers in need of replacement, Northern Health decided to develop a prototype community health center that could be replicated to serve communities of less than 1,500 people — some of which are accessible only by air.
Case Study: Planning an Ambulatory Care Facility
Prudent Health System planned to construct a new ambulatory care facility on its main hospital campus to provide space for urgent care, ambulatory surgery, and various hospital-sponsored clinics. The organization needed space to accommodate the following ten-year workload projections and corresponding clinical services:
- Urgent care center with 32,000 annual visits
- Ambulatory surgery center with 4,200 annual surgical cases
- Hospital-sponsored clinics: medicine (23,000 annual visits), surgery (15,000 annual visits), neurosciences (6,000 annual visits), orthopedics (16,000 annual visits)
In addition, Prudent Health planned a small express testing area to consolidate routine, quick-turnaround outpatient testing in a single area — including X-ray, electrocardiogram, and specimen collection — along with a small satellite laboratory.
Case Study: Evaluating Emergency Expansion
Midwest Hospital planned to expand and potentially replace its ED in response to increased crowding and congestion. Although the current number of annual visits (40,000) was not expected to grow significantly in the near future, the patient and visitor waiting room was frequently overflowing during the evening hours. ED staff also began creating “hall beds” by labeling and assigning defined stretcher bays in the hallways to gain additional treatment space during peak periods. The relocation of an adjacent occupational medicine clinic was viewed as an option for ED expansion in lieu of total ED replacement.
Specific facility expansion goals included expanding the patient and visitor waiting space with enhanced amenities; providing adequate exam and treatment space; triaging nonurgent patients in a separate, fast-track area; and developing a holding area for patients to be admitted who are waiting for an available inpatient bed. Although facility expansion and operations improvement were deemed necessary by all members of the planning team, the CFO was concerned about spending significant capital dollars when ED revenues were relatively flat. ED staff were also not in agreement regarding the extent of required expansion; some wanted to almost double the size of the current ED, while others were concerned that significant expansion would require additional staff at a time when budgets were tight and recruiting was difficult. Others were concerned about the long ED length of stay and its impact on customer satisfaction. However, all members of the planning team agreed that a detailed analysis of the relationship between improvements in exam and treatment room turnaround time and resulting space need and construction cost was warranted prior to initiating the detailed operational and space programming process.
Case Study: Consolidating Two Acute Care Hospitals
Ocean Health System includes three acute care hospitals with a total capacity for 670 beds although each hospital staffs significantly less beds:
- Valley Hospital with 245 beds
- Coast Hospital with 360 beds
- Rural Hospital with 65 beds
Valley Hospital and Coast Hospital are located six miles apart in a scenic northeast region. Acute care beds are currently located at both sites along with duplicative emergency departments, surgical suites, and various diagnostic and support services. Both of these facilities share essentially the same market along with a competitor hospital to the northeast.
Rural Hospital, although only eight miles away from Valley Hospital, requires travel via a congested and winding road with the travel time averaging between 20 and 30 minutes. Rural Hospital also has a distinctly different patient catchment area than Valley and Coast Hospitals. Most of Rural Hospital’s patients come from the west where it competes with hospitals bordering a large urban area.
Centers of Excellence: A Hub and Spoke Approach
For several decades, healthcare organizations have been developing Centers of Excellence to better compete for market share, research dollars, philanthropy, and scarce subspecialists. Promoting a specific program within the healthcare organization’s broader portfolio of services helps to attract the critical mass and resources required to make it successful. Centers of Excellence are commonly developed for cardiac care, cancer treatment, neurosciences, orthopedics, pediatrics, and women’s health, although various other clinical programs and specialties may also be candidates. Historically, these centers were envisioned as freestanding facilities with the name prominently displayed on the building’s facade. Before high-speed internet and intranet connections, this concept was promoted to improve collaboration and communication among the healthcare providers as well as to provide one-stop-shopping for the customer.
The Functionally Obsolete Hospital
Hospital buildings and wings have a tendency to become functionally obsolete for specific services before they become physically obsolete — often resulting in inefficient space utilization, high labor costs, and staff and patient dissatisfaction. The cost of renovation may exceed the cost of new construction and may even take longer if multiple construction phases are required to maintain existing operations. However, this depends on the services to be accommodated, the age and general characteristics of the space, building codes, replacement alternatives, and the reuse potential of the vacated space.