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Trends in Healthcare Design impacting Austin
1. Shift to outpatient and retail services from hospitals and major medical
2. Adoption of technological advancements
3. Growing understanding by practitioners and patients that personal, soothing, and holistic designed spaces impact the patient’s experience and healing process
Healthcare design is being impacted by 3 major dynamics:
“The median age in Austin’s metro area is 35, three years younger than the national figure, and millennials—who are known for being dissatisfied with traditional healthcare services nationwide—made up 22% of the city’s population in 2017.” – Jessical Kim Cohen from Modern Healthcare “Tradition-bound healthcare is learning a few things in Austin’s innovation-focused atmosphere”
Dynamic #1:
Shift to outpatient and retail servicesLeaving Hospitals behind
Between 2006 & 2016 outpatient visits increased nearly 3 times while inpatient visits decreased
• More types of treatments are being administered in outpatient facilities
• Healthcare is moving to meet the people where they live
Retail principles are influencing and being incorporated into healthcare site selection and delivery methods
Retail Influences:• Training and fitness centers• Spas • Retail “therapies” (i.e. massage, acupuncture, Cryotherapy)• Health food delivery services
• Health and Fitness Center in Illinois
• Cryotherapy marketing material included in Medical News Today
• Blue Apron Advertisement
The Retail Model impact:• Multiple functions in one space
• Procedure suites + rehabilitation facilities• Podiatry + Pedicure spas• Surgery centers + clinics
• Supplemental Spaces• Pharmacies• Orthopedics• Rehabilitation• Onsite Laboratories• Medical Billing• Records keeping• Casting• Imaging• Procedure Suites• Real “outpatient” services
• ASCs are required to be licensed in the State of Texas• In addition to a City of Austin plan review for permit, the
Department of State Health Services provides a review for a license. Both a permit and license are required in order to begin construction.
• The Department of State Health Services also regulates the operation and use of ASCs.
• ASCs can exist within Medical Office Buildings • The Architectural Review Unit also provides a
comprehensive inspection upon completion of the project to ensure the operation of the facility meets or exceeds the minimum requirements set forth by Texas Administrative Code.
Deep Dive: Ambulatory Surgical Centers (ASCs)
ASC Requirements:
• Waiting room• Secure corridor• Secure patient
records/administration area• Department of Nursing Office• Administrator’s Office• Consult office• Staff Lounge• Centralized Nurse Station• Pre-operative bays/rooms• Post operative (Recovery)
bays/rooms• Sterile Corridor
• Sterile Work Room• Soiled Work Room• Locker Rooms (per sex)• Janitor’s closet• Operating/Procedure Room• Pharmacy• Equipment Storage• Medical Gas Storage• Ambulatory Access• Covered Patient loading zone• Emergency Department Access• Receiving Room• Staff & Patient toilets
Example of a Surgical Facility:
ASC Infrastructure Requirements:• 1 hour minimum rated separation wall is required in NFPA 101 compliant
multi-tenant, multi-story buildings
• 2 hour minimum rated separation wall is required in NFPA 101 non-compliant buildings. The rating requirement can go up depending on the construction and layout of the existing building and surgery center.
• All mechanical systems must be ducted and isolated from the rest of the building.
• The entire building must adhere to the minimum requirements of the surgery center for electrical and plumbing minimum requirements.
ASC Life Safety Requirements:• Emergency Generator on-site
• Electrical configuration must include separate “life/safety branch”
• Fire alarm provided throughout.
• Plumbing systems must be pressurized and temperature controlled to provide infection control (120°F minimum)
• Elevators, corridors, and elevator lobbies must all adhere to the requirements of an ASC, including:
• Elevators must be accessible, sized to accommodate a full sized gurney, and protected insure fire department rescue access (RE: IBC and NFPA)
• Areas of rescue assistance provided within egress stairwells
Dynamic #2:
Adoption of technological advancements
Less file storage = more space for provider care more space patient amenitiesmore interactive space between patients and providers
Digital medical records have changed everything
Patient records are more readily accessible and can travel with them
• Supports the growing “continuum of care” model• Allows for a new healthcare network
Medical equipment is getting smaller and smarter
Smaller equipment
footprint = more space for provider care more space for patient amenitiesmore interactive space for patients and providers
• EKG machines• Cows (Computers
on Wheels)• Diagnostic imaging
equipment• Vitals measurement
equipment
Telehealth is bringing healthcare closer to home and away from the exam room.• Developments in communications technology are allowing patients to
see a doctor from anywhere, including their living room.
Greater use of Telehealth = More need for private, technology
supported spaces Less need for traditional exam rooms
Data Gathering Technology
• Clinical pathway mining• Evidence Based Design data• Interactive Design Diagrams• Real time staff and patient tracking services
Dynamic #3:
Growing understanding by practitioners and patients that personal, soothing, and holistic designed spaces impact the patient’s experience and healing process
• “Clinical” is out personal, comfortable and modern is in.• Medical clinics becoming more “boutique-like,” dynamic and
fun!
More personal, comfortable and modernLess personal and modern
Offices and clinics are becoming more personal in their design
Waiting Rooms of the past
The new direction for healthcare space design:
The new healthcare space incorporates art and nature
Even small changes can improve patient wellness• Thoughtful and impactful design doesn’t have to be expensive. Simple
finishes and dynamic patterns can create a more appealing space, increase a patient’s mood, and contribute to more comfortable wait times.
How are modern clinics and medical offices configured?Traditional configurations still found in modern offices:• Centralized nursing stations and storage• Perimeter offices• Secluded procedure
facilities• Two access points
(one staff and one patient)
Nurse Stations are the heart of the clinic:
The exam room is where healthcare happensThoughtful design allows for: • Patients and providers to
interact face to face• Connection to nature• Technology enabled
workspaces • Efficient connection to
nurse stations and other support spaces
Steelcase Exam Room Typical
3 typical work flows in medical spaces:
• Racetrack pattern
• Linear pattern
• Onstage/offstage models
Racetrack Pattern
Linear pattern
Onstage/offstage models
Somethings don’t change, but they can be improved.What’s true, is still true, and will always be true…
• Finishes must be cleanable. Select antimicrobial or microbicidal finishes where possible
• Air systems should be filtered and isolated
• Handwashing/hand sanitizing facilities should be easily and quickly accessible. Touchless fixtures are preferred
• Select furniture that has cleanout spaces
Infection control is 1st priority in clinical spaces
• HIPAA laws regulate how patient information is stored and shared.
• Design for acoustical privacy to allow for private conversations between provider and patient
• All exam rooms to have acoustical ceilings
• All walls to have acoustical sound batt insulation
• Walls surrounding exam rooms and doctor’s offices are to extend above the ceiling grid, and ideally to deck
• Walls at Procedure spaces and Restrooms are to extend to deck
• Restrooms to have exhaust fans
• Exam room layout is to provide optimum privacy for patient visibility when the door is opened
Patient Privacy is a very close 2nd priority
What does this all mean for designers, leasing agents and building managers?
• As practices incorporate elevated design into their individual spaces, they expect the building and common area spaces to be equally updated and to reflect a similar standard.
• strategically leasing complimentary services and practices within the same building or complex encourages tenant permanence, and provides leverage.
• Include higher design fees in project budgets to allow for specialized medical design and technology coordination
• Building owners can be strategic when marketing their vacancies to prospective tenants by partnering with a design firm that specializes in medical design. A design specialist will ask the right questions, understand the dynamics more quickly and provide a test fit that reflects the practice’s needs, which will bring that prospective tenant to the table faster.
