Seattle Daily Journal of Commerce

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August 22, 2013

A Special Section of


Contractors can help with health care transition
Skanska USA

Pregnancy center offers one-stop care for new moms

Not all healing gardens deliver as advertised
By MARK EPSTEIN Hafs Epstein Landscape Architecture

Outpatient clinics multiply as big projects dry up

Workplace health clinics are making a comeback
McGranahan Architects

Integrated delivery pays off for Kirkland hospital

How buildings help with patient care

Children's addition built to be safe after an earthquake
Coughlin Porter Lundeen

August 22, 2013

How buildings help with patient care

  • Hospitals see a profitable link between well-run buildings and good patient outcomes.
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    Health care is changing. While this may not be news, the change is large scale and approaching rapidly.

    Health care legislation, the slow economic recovery and insurance reform are coming together to fundamentally shift the way hospitals are operating. In an environment where rising operating costs are colliding with declining reimbursements, many executives are reevaluating what the future of health care will look like and what steps to take to survive and thrive.

    The constant struggle to maintain revenue while managing overhead and providing quality care requires effort and imagination. This challenge impacts both public and private providers and is true across all payers.

    Health care executives are considering physician integration, hospital consolidation, strategic alignments, IT demands, risk mitigation, reimbursement model changes, a changing population and ways to improve the patient experience. For the directors of health care facilities, many of these externalities may not seem relevant as immediate concerns remain the same: The lights must stay on and the air must keep moving. So how will these industry changes affect facility operations?

    Facility managers are being asked to do more with less, and at the same time become much more integrated into the patient experience. This is a paradigm shift. The facility can no longer be considered an afterthought in the delivery of care.

    The connection to the patient, the amount of risk carried within the infrastructure and the quality of support services delivered throughout the system are now at the front of executives' minds.

    This is a perfect chance to be proactive instead of reactive. Take the time to step back, understand what the executive team is driving towards, and ask, 'How do I align my operations with these new changes, communicate better with my decision makers and get ready for reform?'

    The end goal of keeping a facility up and running will always remain. However, a new approach that aligns the facilities team with executive-level goals of delivering high-performance results will lead to meaningful, quantifiable and lasting change to an entire system.

    Getting the C-suite and facilities teams on the same page with aligned priorities and a good vision of the future can be the single most important thing you do.

    Photo courtesy of McKinstry [enlarge]
    An HVAC unit on the roof of Seattle Children’s. Hospitals require good indoor-air quality to prevent the spread of infections.

    In our experience, a few themes resonate across the facilities:

  • A drive for quality improvement and outcome-based performance

  • A push to maintain compliance standards as efficiently as possible

  • A desire to have the facilities group more ingrained in the business of the hospital

    A shift in thinking

    Facility operations are typically focused on keeping systems operating and in compliance. The only time anyone considers the support infrastructure is when something goes wrong. This is no longer the case.

    The facilities team must now be one of the points of contact for patients and part of the customer service team. The jobs performed may be the same, but the reason behind them and the weight they carry is a lot more significant since their actions can directly affect patient outcomes, patient experience and the overall performance score of the hospital.

    This subtle shift in thinking depends largely on the facilities group's attitude toward their role in a performance-based care ecosystem.

    There is a small but important difference between changing a filter because 'it's time,' and changing the same filter because it will help reduce hospital acquired infections. The same difference can be applied to hot and cold calls. Adjusting temperature because it's a work order isn't the same as adjusting temperature because it will improve the patient experience.

    Inspire facility engineers to understand the effect they have on patients through their work. Don't disconnect from the mission and strategic goals of the hospital -- integrate with them.

    Measuring performance

    The facility can really affect the performance and outcomes of the hospital. When driving for quality results, documented continuous improvement is the key.

    Since you can't improve what you can't measure, developing key performance indicators (KPIs) to track progress is a must. KPIs remove the subjectivity from the equation on performance. A KPI can't just be data on a sheet of paper, it must be used to drive change and improve outcomes. Ensure KPIs matter to the executive team and relate to business objectives.

    Questions to ask when choosing KPIs include:

  • How do resolving hot and cold calls relate to improved HCAHPS (patient satisfaction) scores?

  • How do proper filter changes relate to reduced infection rates?

  • How does system uptime relate to revenue loss avoidance?

    Identifying, tracking and improving on relevant KPIs can help obtain competitive capital dollars needed to improve areas that are important to the C-suite. Everything managed should shift toward a performance-based operation.

    If you rely on outside service providers to help maintain critical building systems, make sure to align with partners that can help drive quality outcomes. You don't want to build a reputation of quality results only to be undermined by an outside vendor who doesn't understand the importance of what you are trying to accomplish.

    The bottom line

    Cost containment is another reality that encompasses both quality outcomes and efficient compliance.

    Implementing facility best practices for daily operations and maintenance needs to be the norm, not the exception. Traditionally, the facilities department has been seen as a cost center. Now with the change in reimbursement models, and the demands being put on the facility, there is an opportunity to turn it into a profit center.

    Decisions need to be made to affect the bottom line of the hospital, and not just from a first-cost standpoint. There must be a balance between ongoing costs and the outcomes produced, and not just life-cycle costs but total cost of ownership. Find ways to tie the benefits provided to the hospital directly to clinical care and patient outcomes in quantifiable terms of dollars and cents.

    Smart planning

    At a strategic level, develop plans to maintain facility operations at maximum efficiency and prepare for emergencies. For example, Harborview Medical Center developed a utility master plan to improve emergency preparedness. The plan included an interim fire and life-safety plan that was developed to ensure patient, visitor and staff safety during all stages of new construction projects.

    Focus on quality and performance management rather than task maintenance. Be prepared to make an upfront investment for long-term gain. Don't shy away from investments that reduce risk, protect revenue and increase efficiencies -- these are the actions that will affect your hospital in the long run.

    To succeed in this dynamic and capricious industry, health care professionals need to apply a systemic perspective that includes business analysis of operations and performance management-driven decisions. When these principles converge, facilities and employees can optimize their performance, reducing operating costs and freeing up more funds for investment in patient care.

    Dan Swanson and Matt Wegworth are part of McKinstry's health care services team.


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