The 2020 Hospital^®

Over the coming 20 years, hospital redevelopment in North America will be driven by a tightening reimbursement environment, technology advances, and growing consumerism. While unique to North America in many ways, the resulting facility planning concepts will nonetheless have broad applicability to any worldwide market characterized by the needs for more high-technology applications in a consumer-friendly and healing environment.

KSA expects hospitals to evolve along five key dimensions.

1. Enhanced focus on absolute core competencies. Most hospitals will focus on the provision of care and little else. While U.S. hospitals have traditionally maintained control over all functions, tight margins, coupled with increased service expectations, will lead to outsourcing of many hospitality, logistics and information services.
2. Increasingly bimodal clinical operations. The future hospital must accommodate more high-acuity critical care beds and more sophisticated ambulatory capabilities. The middle band of inpatient acuity and the simpler ambulatory cases will move to alternative and lower-cost settings.
3. Acute care beds and complex diagnostic and treatment (D&T). These technologies will consolidate as the primary purview of hospitals. Well-financed physician groups will continue ownership of selective ambulatory D&T along a moving boundary line defined by shifting reimbursement incentives.
4. Greater integration with retail distribution channels. Enhanced ambulatory technologies and growth in consumerism will lead to new distribution channels through the retail sector. Large pharmacies, fitness chains, etc. - with national brand and consumer infrastructure - will enter the health care service arena.
5. Change in capitalization and asset ownership. Hospitals will seek more and different sources of capital to sustain redevelopment. Building ownership will become less essential to the provider’s core competency of delivering health care.

Factors to consider for future planning today:

• Shorter, faster building replacement/replenishment cycle. The idea of the 50-year-hospital physical plant is dead, as the most flexible new designs will not sustain 50 years of modification at today’s rate of change. Health care should anticipate a building cycle of 25 years or less.
• Use of less-costly construction techniques. Instead more sustainable and re-usable building materials and more “lighter weight” ambulatory and office-occupancy buildings to offset the high cost of inpatient and diagnostic/treatment spaces will be used. Construction delivery models will also change.
• More adaptable building infrastructure. In high-technology buildings, providers will invest in more robust infrastructure to allow more flexibility. Also, repetitive room types will be more generic to adapt over time to changing clinical applications.
• Organisation around a unifying circulation core. Such as a mall or spine to permit separate growth paths for different functions (beds, D&T, offices, logistics and ambulatory care).
• Greater levels of amenities. The drive toward more patient-centered and consumer-friendly environments will demand increased amenities both in ambulatory and inpatient settings.
• Healing environments. The convergence of consumer demand and greater evidence of improved outcomes will result in a host of environmental design concepts for health care facilities, including natural light, gardens, and water effects.
• Increased security. The impact of such events as 11 September will increase demand for building security systems.

On the front, we foresee:

• "Intelligent" buildings with "pervasive" computing will wirelessly link all provider information system components, at all locations, through a central self-organising network.
• Remote monitoring will allow more critically ill patients to live at home, changing the locus of care and caregivers.
• Miniaturisation and robotics will make D&T equipment increasingly portable, permitting more diagnosis, treatment, and surgery within the patient room.
• Electronic medical records will support rule-based clinical decision-making systems enhancing patient safety and care effectiveness.

Kurt Salmon Associates specialises in providing management advisory services in strategy, facility planning, and information technology to hospitals and physician groups.

Contact Information:
Tom DeChant
Principal
Kurt Salmon Associates
2870 University Avenue, Suite 108
Madison, WI 53705

Tel: +1 608.238.2999
Fax: +1 608.238.2482
tadechant@kurtsalmonassociates.com
www.kurtsalmon.com

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