hospitals and nursing homes of the future: part i · 2006. 2. 10. · hospitals in the future •...

New York State Department of HealthNew York State Department of Health

Hospitals and Nursing Homes of the Future

Lisa Wickens - Deputy Director, Office of Health Systems ManagementNeil Benjamin - Assistant Director, Division of Health Facility PlanningThomas Jung - Director, Bureau of Architectural & Engineering Facility Planning

February 9, 2006

Factors Driving the Need for Factors Driving the Need for ChangeChange:

•• TechnologyTechnology•• Patient Preference and AcuityPatient Preference and Acuity•• Fiscal Pressures Fiscal Pressures –– Providers, Providers, PayorsPayors, ,

EmployersEmployers•• Reserve CapacityReserve Capacity•• Staffing Issues Staffing Issues –– Cost, Recruitment, Cost, Recruitment,

ShortagesShortages•• Difficulty Navigating the Convoluted Difficulty Navigating the Convoluted

SystemSystem•• CompetitionCompetition--unregulated and regulated unregulated and regulated

entitiesentities

Factors Specific to Factors Specific to

Acute Care:Acute Care:

•• Out Migration of ServicesOut Migration of Services

•• Relationship with PhysiciansRelationship with Physicians

•• Availability of CapitalAvailability of Capital

•• Consumer Preference for Independence, Consumer Preference for Independence, Least Restrictive SettingLeast Restrictive Setting

•• Integration with the CommunityIntegration with the Community•• Adaptability for Differing Acuity & Adaptability for Differing Acuity &

Individual NeedsIndividual Needs•• Specialty ServicesSpecialty Services

Factors Specific to Factors Specific to Long Term CareLong Term Care

Strategies for the FutureStrategies for the Future

•• Pay for Performance / Pay for Performance / Quality ImprovementQuality Improvement

•• Digital HospitalsDigital Hospitals•• Centers of ExcellenceCenters of Excellence•• FlexibilityFlexibility

–– ReimbursementReimbursement–– ProgramProgram–– ConstructionConstruction

Green TechnologyGreen Technology

Improved / Flexible Work Improved / Flexible Work EnvironmentEnvironment

Alternative Delivery Alternative Delivery ModelsModels

Adaptable ConstructionAdaptable Construction

Consumers are more Consumers are more DiscerningDiscerning

–– Patient/ResidentPatient/Resident--Centered Centered CareCare

–– Fast changing technology & Fast changing technology & expectations expectations •• accelerates obsolescence accelerates obsolescence

of Physical Plantof Physical Plant•• increases competition increases competition

among providersamong providersSt. Peter’s Hospital

Albany, NY

Acute Care HospitalsAcute Care Hospitals

Albany Medical Center, Albany NY

1920 Hospital Configuration1920 Hospital Configuration

Administration&

Main LobbySurgical Suite

M/S Bed Wards Surgical Bed Ward

Lab &Support Functions

Source: Health Technology Center - HealthTech

1950 Hospital Configuration1950 Hospital Configuration

Labs & Support Services Emergency

Surgical & Special Care Units Surgery Suite

M/S Bed Unit(s)

Maternity Unit

Polio Unit

TB Unit

Lobby/MainEntry

Administration & Records

Source: Health Technology Center - HealthTech

1975 Hospital Configuration1975 Hospital Configuration

SurgeryICU CCU

Maternity & Delivery

M/S Bed Units

M/S Bed Units

M/S Bed Units

Medical Office Building

Labs, Support &Education Lobby &

Main EntryAdministration &

Records

Source: Health Technology Center - HealthTech

2005 Hospital Configuration2005 Hospital Configuration

M/S Floor M/S Floor

M/S Floor M/S Floor

ICU/Special Care Surgical Suite

Admin/Records

Outpatient CareLobby/Main Entry

Emergency

Room

Medical Office Building

Source: Health Technology Center - HealthTech

HOSPITALS in the FUTUREHOSPITALS in the FUTURE

•• How many beds will we need?How many beds will we need?–– Population growingPopulation growing–– Outpatient modalities continue to increaseOutpatient modalities continue to increase–– Public Good ServicesPublic Good Services–– Definition of CapacityDefinition of Capacity

•• Is Decentralization the future of Is Decentralization the future of technology?technology?–– Miniaturization of diagnostics and equipmentMiniaturization of diagnostics and equipment–– Digital Technology & CommunicationsDigital Technology & Communications

•• Regulatory Landscape Regulatory Landscape –– Physicians as Physicians as CompetitorsCompetitors

Hospital of the FutureHospital of the FutureVariable Acuity Patient Rooms in Vertical Modules

Medical Office

Building

Lobby and Vertical

Circulation

Emergency

Services

Lobby and

Vertical

Circulation

Imaging, Diagnostic

and

Interventional Core

Source: Health Technology Center - HealthTech

Functional Evolution will impact Functional Evolution will impact designdesign……

•• Emergency Emergency Room is new Room is new ““front doorfront door””

Albany Medical Center, Albany NY

St. Peter’s Hospital, Albany NY

Increased emphasis on Increased emphasis on flexibilityflexibility……

•• Universal Universal Interventional Interventional RoomsRooms–– SurgerySurgery–– Minor ProceduresMinor Procedures–– CatheterizationCatheterization–– Minimally Invasive

GE CT Scanner

Minimally Invasive

TodayToday’’s Surgical Suites Surgical Suite

Operating Rooms

Sterile Core

Post Anesthesia Care Unit

Staff

Support Services

Pre-Op & Stage 2 Recovery

Endoscopy and

Minor Procedures

Radiology & Imaging

Cardiac Catheterization

Labs

Source: Health Technology Center - HealthTech

Facilitate operational Facilitate operational efficienciesefficiencies……

–– Combining PreCombining Pre-- and Postand Post--OpOp……–– Combine Radiology and SurgeryCombine Radiology and Surgery……–– Patient Care Patient Care ““podspods”” should be adjacentshould be adjacent

•• InterchangeableInterchangeable•• Allow Allow ““flexingflexing”” to accommodate fluctuations in to accommodate fluctuations in

demanddemand

–– Centralize interventional suites vs scattered Centralize interventional suites vs scattered approachapproach

TomorrowTomorrow’’s Surgical Suites Surgical Suite

Catheterization & Vascular Intervention Module

Staff & Support

Image-Guided Surgical Module

Minor Procedure ModulePost Anesthesia Care Unit and Recovery

Intake and Pre-Op

Source: Health Technology Center - HealthTech

Also structural designAlso structural design……

•• Separate Separate ““StructureStructure”” from from ““UtilitiesUtilities””–– “…“…capital investment needs to be capital investment needs to be

focused on flexibility, interoperability focused on flexibility, interoperability and technology as opposed to and technology as opposed to ‘‘bricks bricks and mortarand mortar’…”’…”

–– Source: Healthcare Reform Working Group Source: Healthcare Reform Working Group –– 11/18/0411/18/04

•• ““DemountableDemountable”” partitions?partitions?

…….and equipment.and equipment……..

•• Medical EquipmentMedical Equipment

•• Lights and partitionsLights and partitions–– Hospitals want to use themHospitals want to use them……but but

perhaps not perhaps not ownown them (Lease?)them (Lease?)

19201920’’s Hospital Wards Hospital Ward

16 Bed Ward

Gang Toilet

19501950’’s Hospital Roomss Hospital Rooms

2-Bedded Room160 SF (80/bed)

Toilet

Room

4-Bedded Room320 SF (80/bed)

Source: Health Technology Center - HealthTech

19701970’’s Hospital Roomss Hospital RoomsHeadwall Utilities

Toilet Room w/ShowerToilet Room

w/Shower

2-Bedded Room200 SF (100/bed)

1-Bedded Room120 SF

Source: Health Technology Center - HealthTech

Hospital Room of the FutureHospital Room of the FutureVariable Acuity Rooms

Patient Bed

Patient Toilet

& Shower

Patient Toilet

& Shower

Patient Bed

Family Space Family Space

Nurse Work Station

Patient Support

Patient Support

Source: Health Technology Center - HealthTech

Digital IntegrationDigital Integration

•• Digital Systems and Digital Systems and Information Information TechnologyTechnology–– Integrate across Integrate across

continuum of carecontinuum of care–– ClinicalClinical--AdministrativeAdministrative--

FinancialFinancial–– Interoperability with Interoperability with

PhysiciansRaytheon Company EPTS

Physicians

AntiAnti--””silosilo”” TechnologyTechnology……..

•• The Digital HospitalThe Digital Hospital……–– Point of Care: Lab Work & Point of Care: Lab Work &

VitalsVitals

•• Clinical ProgramsClinical Programs and and Functional SystemsFunctional Systems will will likely replace Department likely replace Department OrganizationOrganization……....

•• Capital Access is Critical to Capital Access is Critical to Success

Thermo Electron Corporation

PocketChem UA

Success

Implant TechnologyImplant Technology

•• Ventricular assist Ventricular assist devices for heartsdevices for hearts

•• Artificial lungs Artificial lungs (short(short--term term pulmonary pulmonary support)support)

•• Bioactive bone Bioactive bone cementscements

Ventracor Cardiac Assist System

Source: National Tissue Engineering Center

New Hospital ModelsNew Hospital Models……..

•• Critical AccessCritical Access

•• LTACHLTACH

•• Freestanding Freestanding Emergency RoomsEmergency Rooms

•• Mobile Services

Mobile Cardiac Catheterization

Mobile Services

Mobile Medical International Corporation

Reserve Capacity: Care CapabilityReserve Capacity: Care Capability

0102030405060708090

100

Care Capability

Dem

and

Sufficient >>>> Ultimate Standard

•• Planning for CarePlanning for Care

•• Flexibility in bed Flexibility in bed capacity.capacity.

Source: Texas A&M University College of Architecture, Texas A&M University System Health Science Center, Office of Homeland Security