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