The boom in outpatient facility construction shows no signs of slowing. But these projects are becoming increasingly complex as medical groups and hospital systems demand spaces that can keep up with their rapidly changing strategic and organizational requirements.
Outpatient facilities have become the darlings of the healthcare construction sector in recent years. By even the most conservative measure, spending on outpatient construction is expected to grow anywhere from 20-30% in the next decade.
“In the early 1990s, outpatient care accounted for only 10 to 15% of hospital revenue; today, it’s closer to 60%,” says Patrick Duke, Senior Vice President with KLMK Group, Richmond, Va. “It’s a shift that’s been happening across the board, sweeping along academic medical centers, community hospitals, for-profit chains, and not-for-profit providers alike,” says Duke, a Building Design+Construction “40 Under 40” honoree. “And it’s showing no sign of slowing, especially with advancements in care and changing reimbursement patterns.”
This shift in service modes should not be surprising. Outpatient facilities typically allow healthcare organizations and physician groups to deliver care at lower cost than can be done in inpatient environments. They are generally less expensive to design, build, operate, and maintain, which translates to higher profits for their owners. And with the Affordable Care Act on the horizon, demand for outpatient care facilities is likely to accelerate.
What healthcare clients are demanding from Building Teams
1. EXPECT DEMAND for easily reconfigurable spaces in outpatient facilities to be on the rise.
2. BE PREPARED to rethink the conventional wisdom about underfloor air systems in healthcare facilities.
3. LOOK FORWARD to heightened scrutiny of facility quality and operational performance.
4. ANTICIPATE greater pressure from clients for you to deliver ‘affordable elegance.’
5. WATCH FOR healthcare providers to put you on a ‘Lean’ diet.
However, these kinds of projects are becoming increasingly difficult to execute, as healthcare clients see outpatient environments as a means not only to deliver better patient outcomes and experiences, but also as a way to provide flexibility to meet their own rapidly changing organizational needs and strategies.
Building Design+Construction combed the healthcare design and construction sector to evaluate the latest developments in outpatient facility designs. Here are five radical trends to watch.
1. Expect demand for easily reconfigurable spaces in outpatient facilities to be on the rise.
At the Spectrum Health ambulatory center, exam and procedure rooms are located at the center of the plan, rather than at the perimeter, to create a more reconfigurable environment. Interior exam rooms receive daylight through clerestory windows. Designers from Integrated Architecture used mockups to test room configurations. Photo: Justin Maconochie
Like most large healthcare providers, Spectrum Health System. a seven-hospital nonprofit system in Grand Rapids, Mich., is constantly struggling to stay ahead of changing conditions in the healthcare field. With more than two-dozen inpatient and outpatient locations throughout Michigan, having to deal with this moving target puts a huge burden on Spectrum’s facilities.
On average, Spectrum makes a major renovation to its spaces every four years. “In some cases, they’re touching spaces every two years,” says Michael Corby, FAIA, LEED AP, Executive Vice President with Integrated Architecture, Grand Rapids, who has worked on multiple projects for Spectrum. “It is extremely costly, as you can imagine.”
To reduce both costs and the noise, dust, and disruption associated with renovation work, while simultaneously enhancing operational efficiency, work environments, and patient experience, Spectrum Health commissioned Integrated Architecture to develop a highly flexible, reconfigurable outpatient facility model.
The designers tested a number of physical mockups to get the optimal configuration, which turned out to be a 9x12-foot patient exam room. “Once we got the exam room piece resolved, we started to build on that,” says Corby.
All other spaces became increments of the exam room module: a procedure room becomes one-and-a-half times the size of an exam room; a utility room becomes half the size of an exam room—“so they can replace an exam room with, let’s say, two utility room modules,” says Corby.
Corby says the team put the design scheme to the test halfway into the construction documentation process, when Spectrum decided to shift its care groups around. “Imagine that, halfway into the planning, the client says to you, ‘We’re going to move primary care up here and subspecialists over there,’ it would have been disastrous under a traditional planning process,” he says. “But because of the modularity, it took us all of 60 minutes to redo the floor plan.”
The resulting design scheme was first applied at Spectrum Health Medical Group’s new ambulatory center in Holland, Mich., and is currently being replicated at several other outpatient centers in Spectrum’s network. The 58,000-sf facility follows a consolidated delivery model, where both primary-care providers and subspecialists are housed under a single roof. “This has been done before, but what is unusual is the fact that they wanted the mix to not be limited by the facility,” says Corby.
To achieve the kind of flexibility of spatial use that the client wanted, Integrated Architecture had to depart from more traditional outpatient facility plans. For instance, the exam rooms are located in the central core of the facility instead of at the perimeter. With its open-plan configuration, the facility incorporates underlying modularity that allows patient rooms, workspaces, conference rooms, and other spaces to change in function, location, and dimension as needed, without the need for intense renovation.
The floor plan for Spectrum’s Holland, Mich., facility was organized around the dimensions of the exam rooms (green), which were optimized at 9X12 feet using physical mockups. The resulting 30-foot-wide bays responded to the unit size of the exam rooms. All other rooms, including procedure rooms (large green) and utility spaces (blue), became multiples of the exam room module.