Identifying forward-thinking practices that will contribute to making healthcare more affordable and accessible, and that will ultimately improve the quality of patient care, is absolutely critical in the evolving landscape of healthcare delivery in the United States. With that as its core focus, the American College of Healthcare Architects (ACHA) Next Practices Committee is in the midst of refining a set of “next practices” for healthcare design and healthcare delivery.
The genesis of the committee came from a challenge to the audience from a regional healthcare system during a panel discussion at the 2009 California Health Facilities Forum. The system’s leaders contended that California hospital building and licensing codes were so rigid that the clinical and operational improvements occurring in the other 49 states were often difficult or impossible to implement in California. As a result, healthcare architecture in California was perceived to be in a remedial mode, rather than at the leading edge of clinical and operational practices. The healthcare system challenged the audience of architects to seek innovation in healthcare and to work with regulatory agencies to ensure that code requirements—now and in the future—better support best practices.
National focus based on California lessons
Because the ACHA has a national perspective, the committee quickly evolved to focus beyond California, identifying future “next practices” that should be adopted by architects throughout the United States. It also focused on an awareness of future trends that will affect healthcare design.
The committee’s methodology is a scholarly approach that marries the best architectural and clinical practices. An important part of the effort is considering how the trends and forces influencing the future of healthcare will affect the design of healthcare settings and spaces. The advantage of having a diverse group of healthcare architects from across the country was gaining access to a range of perspectives to aid the flow of creative thinking.
Focusing on the common themes of driving down costs, making care more accessible and improving outcomes, the committee identified and vetted key concepts that resulted in a list of ideas.
The ACHA Next Practices Committee’s presentation at the 2011 California Health Facilities Forum in Oakland revolved around three concepts:
1. Improve patient flow, patient services, and throughput
2. New configurations to respond to new thinking
3. Incorporation of new sciences and technologies
For each concept, the committee developed several supporting ideas, or “next practices.” Examples of next practices include:
Team-Based Medicine. One of the first next practices resulting from Healthcare Reform is the idea of Team-Based Medicine. Improvements in quality, access, and cost control will occur through collaboration by providers emphasizing prevention, wellness, and continuity of care to at-risk populations. Design plans for physician practices must include space that enables communications among multidisciplinary team members with the physician as team leader.
Care Processes and BIM. As labor is the most expensive part of healthcare delivery, the design process must evolve to become more integrated at strategic, logistical, and tactical levels. Patient care processes need to be designed first using tools such as value stream mapping to meet established benchmarks. As the building is being designed to support the efficient delivery of patient care and the effective use of care teams, architects will use such tools as simulation modeling and plan optimization software to assure targets are being met. With these elements incorporated into the Building Information Model (BIM), opportunities for improvement can be explored with real time feedback on operational and construction costs, as well as an evaluation of their relative efficiency and effectiveness.
Physician Home Visits. A former emergency department (ED) physician on the committee has re-imagined the traditional physician home visit. His medical group puts the doctor on the doorstep—when necessary within 60 minutes and without any advance appointment. The physician is dispatched to the patient’s home, equipped with every diagnostic tool necessary to assess the patient’s symptoms and a full supply of standard emergency-care drugs to treat them. Using portable lab, x-ray, and EKG instruments, the physician can make any emergency decision and provide any treatment available at the time of the house call.
Nanotechnology. Nanotechnology has become a buzzword in the energy, computing, and fabrication fields. The potential use of nanotechnology in cancer therapy is also rapidly advancing. Nanoparticles are being tested as vehicles for drugs, as packages for gene therapy, and as anticancer weapons themselves, activated at just the right time using radio waves or near-infrared light. And it’s projected that within the next year or two, several of these therapies will be available to patients in clinical trials. This type of technology has the potential to make linear accelerators—a device commonly used for external beam radiation treatments for cancer patients—obsolete.
The Next Practices committee continues to seek those practices that are on the horizon, refine concepts, and promote solutions that will drive down costs and improve care. The discussion continues at the California Health Facilities Forum on October 24 in San Francisco. The full-day forum, “Certainty in an Uncertain Age,” will address questions such as: How will facilities support these evolving changes in healthcare delivery? Will there be major hospital-led, full-service campuses or will healthcare service be decentralized? Will the impact of large new patient populations drive non-hospital construction in the short term with discreet high-tech hospitals following in the future? Will the family doctor become the family clinic? Will freestanding emergency departments be a viable care delivery in the future?
The committee is also hosting a roundtable discussion at the Healthcare Design Conference on November 3 in Phoenix to explore a number of topics with national experts including simulation, data, and hospital acquired infections.
Learn more about this and other programs of the ACHA at healtharchitects.org.
Douglas Childs, AIA, FACHA, based in San Francisco, is a principal with TAYLOR, a healthcare consulting firm whose mission is “Promoting Wellness through Architecture.” A member of the ACHA Board of Regents, Childs is chair of the ACHA Next Practices Committee.