Healthcare construction spending could double in 2017. Where will those dollars be targeted as healthcare consumers become more sophisticated and demanding?
Healthcare is in the midst of another construction boom.
The American Institute of Architects this summer forecast that healthcare sector construction in 2017 is expected to double from the $19.6 billion spent in 2016, a year that also saw robust growth.
"The demographics are incredibly favorable on the long run for healthcare," AIA Chief Economist Kermit Baker said in an August conference call. "Seniors consume a lot of healthcare services, and as baby boomers are moving into their late 60s and 70s, we expect to see a lot of construction in the healthcare sector."
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It will be fascinating to observe the speculating and strategizing—and guessing—on where the industry is headed as hospital boards and C-suites float bonds, pour slab, and grid rebar in a $1.7 trillion sector that could change healthcare delivery models before the concrete dries.
Partners at E4H, the architectural firm that specializes in healthcare projects, have identified five design trends that they believe will grow in the coming year. E4H Partner Rod Booze says the trends are aligned with what increasingly sophisticated and demanding consumers say they want and have come to expect.
1. Microhospitals
These mini hospitals are 24/7, small-scale inpatient facilities, anywhere from 15,000 to 50,000 square feet, with five-to-15 inpatient beds for observation and short stays.
They offer services similar to larger hospitals, including ER, pharmacy, lab, radiology and surgery. They also provide easy access for patients and cost-effective market growth opportunities for providers.
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There are about 50 of these hospitals in the United States, mostly in mid-western and southern states, but Booze expects their numbers to grow, rapidly.
Booze says microhospitals haven't caught on in rural areas because there's no money in it. "They can go into urban areas and get select ZIP codes where the payer mix is strong and where the insurance contracts are plentiful," he says.
"If they go out in the middle of nowhere where it's an underserved medical community, the projected caseloads are not as appetizing and the return on investment is a little riskier. They wouldn't be doing this if it didn't offer them a market share advantage or a chance for profitability."
2. ED Modernization
Many EDs have yet to adapt to higher volumes, and thus risk bottlenecks. To fix this, EDs will be configured to provide more immediate access to alternative settings, such as "rapid treatment" areas where patients are seen and often diagnosed, treated, and discharged without entering the main ED.
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There will also more partnerships with nearby primary care settings for non-acute patients. EDs will also be better equipped for a wider range of medical problems, including universal, acuity-adaptable, same-handed treatment rooms.
3. Infection Control
Design innovations will become more ubiquitous, such as adapting single patient rooms' bathroom showers to include offset drains and sloping sides to minimize the spread of infection and contamination, as well as accommodation for new plumbing fixtures such as specialty sinks for hand-washing, shaped to reduce splash and the spread of dirty water.
Additional innovations will include specialized light fixtures that spin high-intensity, visible, indigo-colored light, which kill bacteria but do not harm human cells, and infection-resistant materials such as copper alloy surfaces.
4. The Medical Village
This next generation treatment model has a central family medicine practice surrounded by selected specialists that offer one-of-a-kind patient access and share improved processes, outcomes, and data for quality.
This model offers more outpatient services, including some surgical and invasive procedures that require only an overnight stay. E4H says this will lead to the design of more elaborate outpatient facilities, with observation beds and partial hospital stays.
5. Behavioral Health
Facility upgrades will balance safety and regulatory concerns with therapeutic environments.
Safety systems being advanced include: top of door alarm systems; interior, high-impact, polycarbonate security windows; wearable fob-type staff alarm systems; and securing furniture to walls and floors.
The upgrades will improve therapeutic environments by incorporating open nursing stations resembling hotel reception areas, more family involvement in daily care which requires furniture and program space, and more patient control of their immediate environment with dimmable lighting systems and patient-adjustable environmental controls.
The Common Theme?
"All of these pieces drive themselves towards consumers," Booze says. "Big or small, fancy or not, the boutique hospitals, the micros, the traditional models in healthcare, the public is getting more sophisticated in terms of how they execute their healthcare, where they go to get it, how they spend their healthcare dollar, and who is healthy and who is not."
For example, five years ago conversations about hospital-acquired infections were reserved for healthcare policy wonks. "Now, people external to the industry are using healthcare and they are starting to pay attention to those trends," Booze says.
These trends also underscore the notion that traditional healthcare is no longer calling the shots.
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"If it were up to traditional healthcare, they'd still be trying to force everyone into their behemoth 200-, 400-, 500-bed facilities," Booze says.
"We are looking for convenience. Who is serving me? How do I get access to my healthcare? I don't care if it's fragmented. I want to go to my community hospital or my cardiologist, and I don't want to go to the mothership if I don't have to."
"More of the major hospitals will become a haven for critical care and critical disease," Booze says, "whereas the balance of it that is more consumer driven will be on an outpatient basis and in smaller microhospitals."
John Commins is the news editor for HealthLeaders.