How equipment planners—backed by Attainia’s powerful medical equipment planning platform—can manage change to a positive clinical and financial outcome during healthcare construction and renovation projects.
Check out the report below to find out how.
For your next facility improvement project, infrastructure planning should be a leading topic of conversation, not an afterthought.
As the information age has given way to the Fourth Industrial Revolution, the healthcare industry is positioned to reap some of the largest and most meaningful benefits these advances in technology have to offer. This recent burst in innovation, which is just now becoming mainstream, is defined by the implementation of whole-industry-revolutionizing technologies such as artificial intelligence, the Internet of Things, 3D printing, autonomous vehicles, biotechnology, energy storage and nanotechnology to name a few.
The previous wave of advancement ushered in a highly sophisticated, multi-faceted data platform to manage medical care, improve patient outcomes, and automate resource-intense workflows in the form of the electronic medical record (EMR). Some of the EMR’s promises have been fulfilled while others, such as universal access to patient information in the inpatient and outpatient environments, are not always at the same level of service and may fall short of users’ expectations.
Delivering the promises of accurate and real-time medical data to clinicians ubiquitously requires robust IT physical infrastructure woven into the provider’s business strategy and into their facilities’ “bones” regardless of setting.
The outpatient care model is rapidly expanding in more ways than can be imagined, mostly fueled by the latest technological developments. A tech-forward strategy must also be embraced and extended beyond the medical complex to community-based sites where highly mobilized care is provided to facilitate the hospital-to-home continuum of care.
This universal access model places a reliance on certain heavy fault-tolerant technologies: fast, stable network connections (both wired and wireless) as well as onto the underlying building systems which assure this reliability and maintain the same levels of stability as those found in traditional high availability facilities such as 911 call centers, energy plants and data centers. In short, IT Infrastructure is now a utility.
As the delivery of patient care moves away from the centralized hospital setting, and the patient medical record data is also distributed across multiple environments for greater reliability, the interconnection between these remote environments of care, data repositories and mobile workforce must be linked reliably, securely and be scalable.
The truth is, that’s easier said than done. Beyond the sheer scale of the effort and the high price tag that comes with such a distributed undertaking, there are several challenges that make optimizing IT physical infrastructure that much more complicated. It’s time consuming to pinpoint specific infrastructure vulnerabilities (they’re usually found in a variety of locations, systems and processes). Analyzing these into actionable priorities requires specialized skillsets and resources that most facilities don’t readily have available or are committed to other valuable efforts.
IT equipment and mobile devices are shrinking in size and increasing their computing capacity every 18 months, in accordance to the exponential curve of Moore’s Law. This evolution is accelerating the amount of devices needing network and other IT resources at an explosive rate. The growth is seen in every type of device, particularly within new miniaturized sensors enabling everything from advanced building sensors measuring indoor air quality or analyzing foot traffic patterns to body temperature checks for patients who suffer from highly infectious diseases. This new Internet of Things (IoT) will transform healthcare. Facilities must be ready for the tsunami of devices on the network and the mountains of data these will produce. Mining this data for actionable care and overall trends will place extreme stress onto the most capable IT infrastructure. In healthcare, IT infrastructure is business strategy.
So, how do healthcare providers prepare for what comes next?
In order to stay ahead of the revolutionary curve: prepare for the onslaught of data, and the resources this data will require to transport it, process it, store it, analyze it and distribute it, healthcare providers’ IT infrastructure will make best use of the following “hosting” strategies in order to be more than flexible. Providers must embrace the idea of infrastructure being elastic: resilient, able to scale and contract when and where needed.
Scenario 1: Brick and Mortar
One of the more expensive options, the brick and mortar solution requires a data center on site to house all the information, with ample square footage, power and cooling to support it. Since you aren’t depending on the functionality of the cloud, there’s a smaller risk for losing invaluable data and the existing risk is all in your control with EMR and other critical systems having to transmit information only a short way. While there are upsides, it’s not reasonable to solely rely on this strategy for data management without some level of redundancy.
Pros:
Cons
Scenario 2: Cloud Hosted
This approach takes advantage of third-party data center providers in a way that won’t require them to build a brand-new data center to run it. This has been a growing trend with many healthcare facilities or clinics. EMR providers’ ‘software as a service’ comes with a subscription fee model, with the added bonus of not requiring you to hire IT administrators, buy servers, or host your data locally.
The trade-off lies in the fact that you’re now relying on everything to be in the cloud (remote to your locale and out of direct/immediate reach), meaning that your network has to be extremely robust to ensure a seamless experience. Whether you’re a standalone clinic or big hospital system, in order for your system to completely rely on remote cloud resources, infrastructure should be designed to operate at full capacities with redundancies in the event of internet failure. In other words, you need solid backup, whether it’s a redundant copy of data and resources down the street or halfway across the country.
Pros:
Cons:
Scenario 3: The Hybrid
By far the most common-sense approach we see, the hybrid model holds critical and time sensitive information locally, and hosts other less critical information or redundant backups remotely. It’s an effective measure given that you can scale to your budget. It’s also more elastic. Distributed information is more fault tolerant (think tornadoes, earthquakes or tsunamis in your region), and locally hosted (while remotely backed up) provides low latency, and direct control of large data sets, like 3D imaging files.
Decision time: Cloud vs brick vs hybrid
Large, widespread IT infrastructure strategic changes aren’t something you need to address every year like spring cleaning; they may be best reserved for times when you’re bringing on big projects in the near future that will affect staffing and bed count, providing the rare opportunity to address potential long term goals such as preparing for the next technological advancements in healthcare.
As consultants, we walk our clients through an audit of existing physical infrastructure functionality and features, a discovery phase that helps us focus on their priorities and budget and ultimately, a recommendation to move forward.
Here’s how the conversation begins.
No matter what, count on technology to continue to change the way healthcare is delivered, enabling a highly connected workforce and an explosive growth in micro sensors and related data. The next generation of patients will expect the same level of technology integration as the experience in their homes.
All that equipment has to be supported, data must be conveyed and extracted and actionable medical decisions must be supported by a robust IT back-end. While we can’t predict the future, it goes without saying that hospitals and the technologies they depend on will evolve at an increasingly faster pace.
For your next facility improvement project, infrastructure planning should be a leading topic of conversation, not an afterthought.
Los Angeles, California, May 21 2019
It is with a heavy heart that we acknowledge the passing of Michael Woodburn, Associate Vice President and Medical Equipment Planner with One-EQ. Michael’s nuanced understanding of the back-of-house operations of healthcare facilities was second-to-none.
Mike started with CallisonRTKL in 2006 in Northern California as an equipment planner in healthcare technologies. He was instrumental to the growth and success of OneEQ in the California market. “Mike was passionate and dedicated to OneEQ and his team. He loved his work and dedicated himself to developing talent and providing the knowledge and rigor to help OneEQ to flourish in California,” notes Debbie Cameron, Senior Vice President.
His client base was a roster of preeminent institutions including Stanford University, Marin General, UCSF Precision Cancer Center, and UCSF Benioff Children’s Hospital.
In 2016, he was promoted to Associate Vice President, in part, because of his deep knowledge of medical technologies and client insights. Irene Bickell, Vice President, worked closely with Mike, “he was incredibly knowledgeable – he had a deep understanding into the work we do and never had an air about how much wisdom he possessed. He brought a meaningful and natural approach to our clients, team, and projects. He will be missed deeply.”
Mike’s work will have a legacy on the communities he served. Between the physicians, patients, administrators, and those who are reliant on hospitals for their health and wellbeing his work positively impacts all.
From his daughter Rachel, “He was kind and he was funny, and he taught me it was ok to embrace your inner nerd. He would watch horror movies with me and make fun of me when I jumped or cringed. We watched sci-fi shows and movies and he would explain how/why a certain science would or would not work in the real world. He would quiz me on rock songs in the car, and head bang with me to songs on the radio.”
Michael is survived by his wife of 35 years Lisa; his three daughters Amber, Fiona and Rachel and son Alexander.
If you would like to, the family has set up a GoFundMe campaign to offset the cost of a private autopsy and related funeral costs.
Celebrating International Nurses Day
An interview with OneEQ RNs Debbie Cameron and Jennifer Patel
International Nurses Day is celebrated every May 12 to mark the birthday of Florence Nightingale and raise awareness of the vital role nurses play around the world. In 1854 Nightingale arrived at the British army hospital on the front lines of the Crimean War. The conditions were appalling. Nightingale brought regular hand washing, adequate ventilation and general hygiene to the filthy battlefield hospital and became known as the founder of modern nursing.
Then as now, today’s nurses find themselves on the front lines of COVID-19. Given our current global pandemic, this year’s International Council of Nurses’ theme, “Nurses: A Voice to Lead—Nursing the World to Health,” could not be more apropos.
To honor International Nurses Day today, OneEQ spotlights two nurses on our team, Senior Vice President Debbie Cameron RN, CLGB and Associate Jennifer Patel RN, CLGB.
What drew you to nursing initially?
DC: I always wanted to be a nurse. From the time when I was a little girl. My plan was to become a flight nurse—a specially trained registered nurse who cares for patients while they are in transport to a medical facility. I graduated from the University of St. Thomas in 1979 and went to work as a critical care nurse under the famous trauma surgeon “Red” Duke at Memorial Hermann-Texas Medical Center, a Level I trauma center.
JP: I worked in labor and delivery right out of nursing school for about four years. I was ready for a change of pace but wasn’t quite sure what I wanted to do next.
How did you go from bedside nursing to medical equipment planning?
DC: The hospital had just hired a nurse from a company that built hospitals. He told me that his position, managing equipment and construction projects, was still open. I didn’t know anything about medical equipment planning, but he assured me that the firm would be more interested in my nursing experience, that they would teach me everything else. He set up an interview for me. All I owned were scrubs! I had to go out and buy a suit. It was a lunch interview, and I was hired on the spot. I made friends quickly and had a lot of help learning all about medical equipment and planning. I really enjoyed the work. I was able to interact with fellow nurses and clinical staff and found that my nursing experience was very useful in planning a hospital. I did also find out it was a different kind of stress and put life in perspective.
JP: My boyfriend at the time, now my husband, was an architect. I joined him at a company party and met someone who had been a nurse. He told me that there was a place for nurses in the field of design, and that nurses could help with medical planning and equipment. He suggested I turn in an application to OneEQ. When I was hired, in 2005, I still wasn’t sure if I it was going to be something I wanted to do, so I stayed on with the hospital, filling in shifts as needed. At six months, I realized I liked sitting in meetings with the architects, medical directors and nursing staff, talking through flow and planning the spaces and the equipment needed. I liked being part of that process.
Can you discuss your role at the firm now and how you use your nursing background?
DC: I am the senior vice president and practice leader for OneEQ, providing medical equipment and technology planning, procurement and analytics, logistics and turnkey deployment, capital planning, budgeting and inventory and specialized consulting. I have been with the company for 31 years and am fortunate to have had the opportunity to build a dedicated, multi-talented team.
It’s essential to understand the clinical side, to have real knowledge of the inner workings of a hospital when you are building one. The people I bring on have clinical experience. And I still interface directly with clients—many of whom are nurses and I still enjoy finding solutions to their challenges.
JP: I am responsible for medical equipment planning, talking through flow, determining how to lay out equipment, helping to design a space from a clinician’s perspective. As a nurse, I find myself interpreting what clinicians and architects are saying, so that they understand each other better and can design a better space. The terminology a clinician uses has a lot more meaning to me. And having a clinical background helps me ask the right questions. That’s actually my favorite part of the process.
Jennifer, do you have a favorite project?
JP: Texas Health Frisco was one of the first joint ventures between UT Southwestern and Texas Health Resources. We’ve worked separately with UT Southwest and THR, but this was the first time working with them together. We were very involved in the process from the very beginning. Building this new hospital brought together the best of both of their worlds.
Debbie, what are you most proud of?
DC: The strong relationships we have with our clients. Our intention is to make clients for life by providing the best in consulting and service. We have worked with some clients for more than 20 years and have built our business with repeat business and by building services to meet the needs of our clients.
The theme for 2020, chosen last year and long before our current global pandemic, yet eerily prescient, is “Nurses: A Voice to Lead—Nursing the World to Health.” Debbie, has the work that you do changed in the last few months since the rise of COVID-19?
DC: Our goal is to help our clients navigate through this difficult situation. Every day seems to provide different challenges for them. There is so much unknown about this virus. And as a result, so much uncertainty as to what will happen next. Where will it hit? How hard will it hit? The rules keep changing for everyone. We partner with our clients and are as proactive as possible to address current issues and help them move forward.
What would you say to nurses just starting out in their careers?
DC: Nurses just starting out and students considering nursing should be aware of the many, many things you can do with a nursing background. You can choose to work at a hospital or medical center. You can become a bedside nurse or go into healthcare administration. Or you can work for a private company like mine, that serves patients and the medical community.
JP: I would encourage them to always ask questions and never stop learning. Many of the skills that you learn in patient care can be applied in a wider range of settings than you would ever imagine. One great thing about nursing—all the different opportunities that are out there.
DC: I honestly believe, “once a nurse, always a nurse.” We have empathy and passion and the stamina to get the job done. I am grateful to the nurses on the front lines. It takes a special kind of person.
Debbie combines clinical experience with an operator’s perspective, giving her a practical budget-savvy knowledge base that only comes from decades of experience. More than anything Debbie gets stuff done. She’s also not afraid to bust heads, especially when heads need to be busted.
Jennifer is a registered nurse and well versed in all phases of project design. She oversees teams to develop projects from schematic design through installation. Her attention to detail is paramount in ensuring quality documentation and medical equipment coordination while acting as a liaison between clients, architects, contractors, and vendors.
LOS ANGELES–April 2, 2020 – OneEQ, the full-service technology, medical planning and operational consultancy, announces that Mario Sanchez, RCDD has joined the firm as an Associate Vice President based in Los Angeles. A Registered Communications Distribution Designer, Mario’s background includes technology systems for complex, architecturally significant structures, associated physical infrastructure and supporting facilities; facility planning, design and construction; and furniture, fixtures and equipment fit-up with embedded technology implementation. His technical and management expertise will integrate into the robust service lines of OneEQ.
“OneEQ places the client, connectivity and efficiency at the center of our process,” says OneEQ Senior Vice President Debbie Cameron, RN, CLGB. “Mario understands that today’s healthcare facilities must balance operational efficiency, financial performance and ever-changing technology with patients and end-users. It’s rare to find this depth of expertise in a single professional, but we have, and we couldn’t be more pleased that Mario is now a part of our team.”
With more than 20 years of diverse experience in all aspects of IT systems construction, architectural integration and MEP infrastructure, Mario has delivered strategic solutions for some of the most recognized names in the industry, including Stanford Healthcare, Google, CHOC Children’s Hospital, UCLA, California Institute of Technology and Chapman University.
“Mario is the exact professional we need to advance our IT service line offering,” says Irene Bickell, Vice President, OneEQ. “With his diverse background and arsenal of expertise, we are excited about our ability to offer our clients a deeper reach of services across the nation.”
Mario’s experience providing integrated medical and IT solutions uniquely positions OneEQ as the healthcare industry moves towards an all-digital environment. By leveraging IT infrastructure such as Wi-Fi and mobile EMR charting, for example, hospitals are capable of extending their services to the exterior of their facilities and are better prepared to respond to the growing needs of hospital emergency departments.
“Clients come to OneEQ for their formidable expertise and deep market insights,” says Mario. “I look forward to working with the team to broaden the firm’s reach and provide an expanded array of solutions to the healthcare industry’s most pressing challenges.”
OneEQ’s Rick Leonard and Nik Fincher talk about getting the biggest bang for your healthcare organization’s bucks when buying equipment
Did you know that 45-50% of the total cost of a piece of healthcare equipment is its software? Or that the world’s top healthcare and health research organizations are increasingly considering purchasing refurbished or gently used equipment, something that would have been virtually unthinkable ten years ago? How about that the trade-in offer you just received on a piece of equipment can be 60% to 80% less than the market value of the item if you sold it outright? These are just three examples of ways that the healthcare capital cycle has gotten increasingly complex and why hospitals and other healthcare organizations are rethinking how they do business, especially when it comes to technology and medical equipment.
The Changing, Increasingly Complex Playing Field
For those who need a refresher, before the Affordable Care Act, hospitals made money based on a payment-per-procedure basis. If a patient got an MRI, for example, the hospital was reimbursed a pre-determined amount based on that procedure. The ACA changed that model with a Medicare program called the Value-Based Purchasing Program (VBPP). Now, providers are paid based on the diagnosis and outcomes and not on individual tests. That means an MRI is no longer a stand-alone service—it’s an expense bundled into the calculus of a comprehensive treatment plan. So, for instance, if a patient comes in with kidney pain, the clinicians will determine what’s causing the pain. If they determine that the cause is kidney stones, the hospital will be reimbursed for the entire treatment plan for kidney stones, not for each test that led them to the diagnosis.
Certainly, part of that bundle payment will offset the cost of the equipment and technology used and there is a return on those assets, but it’s much more complex than the old formula of ROI (return on investment), or “This MRI machine costs X, and I will perform Y number of scans per year and get reimbursed Z amount, so it will pay for itself in 3 years.” Today it’s about ROA (return on assets), meaning all of a provider’s assets must work together to produce the desired outcomes. It’s a much more sophisticated way of thinking about the capital cycle of a single piece of equipment, let alone an entire health system. Couple that with the fact that every healthcare provider in the world is trying to cut costs and add value, and you can see how much this new model has affected the healthcare capital cycle.
It’s New to You
Speaking of adding value, refurbished and/or gently used equipment is a hot topic in the industry right now and for good reason. A decade ago, top facilities wouldn’t have even considered buying refurbished or slightly used equipment, but market dynamics are making it more appealing. Here, too, the calculus is complex.
It’s crucial to know when it makes the most sense to go used—today’s refurbished equipment is an entirely new generation with the latest technology making some gently used equipment nearly as good as new. Hospital beds are a great example—bed frames have changed very little over the years, it’s all the bells and whistles that attach to it that have grown in complexity. If we can reuse the frame, it can reduce the cost by up to 40% compared to the cost of a new bed. Multiply that over hundreds or even thousands of beds across a health system, and it’s clear why more hospitals are moving in this direction. We’ve also worked with top-tier clients who consider gently used equipment for temporary facilities when moving from one building to another; this can often save millions of dollars and has no detrimental effect on patient care.
Of course, good equipment planners must think about refurbished assets from every angle—you have to make sure it’s a reputable firm, that the refurbisher offers a warranty on the equipment, and that the acquisitions and logistics team know all the players, inside and out.
Trade or Sell on the Open Market?
On the other end of the acquisitions spectrum you have healthcare organizations trying to offload their existing assets when upgrading to new equipment. Should they try to sell it on the open market or trade it into the manufacturer? Trade-ins are certainly less complicated than trying to sell, but let us illustrate the situation with some cold, hard numbers: Manufacturers typically offer 18% of the true value of a piece of equipment. Across the healthcare industry, meaning there are billions of dollars at stake.
In one recent example, we worked as an “owner’s representative” for a client to replace six catherization labs. The vendor who was awarded the business for the new labs offered $10,000 per lab as a trade-in on the equipment being replaced. The actual market value for the equipment was closer to $50,000 per lab, meaning our client was leaving a lot of money on the table, money that could be used in many ways.
Of course, it takes real expertise to broker a deal like this, and not everyone will have these dramatic consequences. In some cases, a trade-in may make more sense if a number of clinics or hospitals are closing their doors and flooding the market with similar equipment. Or, on the other hand, some equipment, such as a particular mobile x-ray machine that was popular in the 1990’s, is still one of the most popular models in 2019 and providers are willing to pay top dollar for it. It’s crucial to have a team that understands the equipment and its functionality so that it’s presented to the market in top condition (e.g., don’t let a contractor cut electrical or communication connections). It’s also important to plan effectively so equipment doesn’t get damaged when moving it from place to place. These are the nuances that make working with a tried and true equipment planning, logistics and acquisition team worth every penny.
Hospital reimbursement rates are increasingly based on outcomes and the patient experience, as measured by the HCAHPS survey. OneEQ’s Jeff Davis explains how the right equipment planning and design can make all the difference.
Ever since the Affordable Care Act made hospitals dependent on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for full reimbursement, healthcare organizations have started thinking about new ways to enhance the patient experience.
Not everyone has been happy about this shift, but, regardless, patient experience has always been a core part of clinical philosophy. As new research and evidence comes out, and HCAHPS scores provide insight into how patients are experiencing the healthcare environment, the best design and planning strategies that can improve that experience are rising to the top. In fact, U.S. News recently updated their method for scoring the best specialty hospitals, incorporating HCAHPS scores and putting a stronger emphasis on the patient experience.
And lest you think that higher survey scores are only meaningful on paper, the truth is that increasing HCAHPS scores can have a two-fold financial benefit. First, with hospital scores now in the public domain, patients can be savvy healthcare consumers and choose healthcare institutions with the best patient experience. Clearly, more patients means higher revenue. Second, the scores translate directly into dollars, with a portion of Medicare and Medicaid reimbursements tied to the HCAHPS survey; hospitals that perform better than the median in their region are rewarded with higher reimbursement rates and lower performing hospitals are penalized. In turn, private payers typically base their reimbursements or contracted rates on Medicare reimbursements, so it’s easy to see that improving HCAHPS scores is becoming a financial imperative to most institutions.
The survey itself only takes a few minutes for patients to complete and the questions fall into three categories—staff communication and responsiveness; cleanliness and quiet; and overall patient experience. The right equipment planning and design can make a big difference in moving the needle from a mediocre patient experience to an excellent one.
Staff Communication and Responsiveness
More than half of the questions on the 32-question survey fall into this category and they’re all about how patients feel that they’re treated by nurses, physicians and other staff—were they respectful? Did they explain medications and instructions in a clear way? Did they listen carefully? And did the patient understand everything? Clearly, these questions can depend a lot on the personalities involved, but that doesn’t mean that design can’t play a role in improving scores to these questions.
The physical environment can certainly affect staff and how engaged they are with patients and designers can use a number of strategies to enhance well-being.
Specific material selections can reduce noise and absorb the impact of a 12+ hour shift. Then there’s the design program for the hospital, which should include space for staff and outdoor areas for both patients and staff, which has been shown to help with healing. The quality of staff “off stage” areas can make a major difference, giving nurses and physicians social spaces to interact, but also quiet, private areas to process some of the inevitably overwhelming emotions that come with the job.
Including staff in hospital initiatives, the hospital planning process and addressing their feedback early on can help ensure that staff are getting the resources they need to exceed patient expectations.
The HCAHPS survey also asks if staff explained medication and recovery instructions properly with the goal of shortening healing time and reducing errors in combining medications and other complications. Good communication is part of the culture of a health organization—doctors used to sit behind a desk and tell you what you needed to know; these days, they’re more likely to have a laptop and show you a screen with your medications on it, asking you to make sure everything looks right. By including staff in the planning process and addressing their feedback early-on, designers and equipment planners can create the best physical environment to help hospital staff communicate with their patients on an equal level, encouraging patients to feel more involved in their own healing process.
Cleanliness and Quiet
It may be easiest to see how design and equipment planning can improve scores on survey questions about quiet and cleanliness, since they relate directly to the built environment. Indeed, if a designer has a proven strategy to make a facility cleaner and quieter, hospitals are likely to listen, especially because the biggest complaint on the HCAHPS survey is about noise in the hospital.
There are plenty of materials that can help, like special floors, soft-close doors and drawers, and ceiling panels that can reduce noise. There are engineering solutions like triple demising walls and double-layered flooring. Designers and planners can even change the layout of a hospital unit to carry less noise. Hospitals can encourage quiet by using lights that are programmed to dim during quiet hours in the afternoon, and equipment with lights that change color as noise levels increase so that staff and visitors get a visual cue that they’re being too loud.
The other component of this section of the survey, cleanliness, is really asking about the patient’s perception of how clean their room and bathroom were, but hospitals have other reasons to focus on cleanliness; under ACA rules, if a patient contracts a secondary infection while in the hospital, the hospital isn’t reimbursed for the patient’s stay while they recover from that infection.
We all tend to think of cleanliness as a housekeeping issue—things like easily cleanable, antimicrobial materials and finishes. But cleanliness is also a clutter issue; if there isn’t adequate storage for equipment and supplies, it makes people think it’s messy, even if it might be germ-free, which speaks directly to equipment planning, layout and overall design.
As equipment planners, our OneEQ team works with designers to create room mock-ups and prototypes. We have clinical staff go through these prototypes and provide feedback as they go along. Added to that, we combine our own research, industry trends and our 30 years of experience to buy the best possible equipment for a given situation and place it to reduce clutter, increase hygiene and, consequently, enhance the patient experience and increase HCAHPS scores.
Overall Experience and Recommendations
There are only two questions under this category: 1) Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay? And 2) Would you recommend this hospital to your friends and family?
These two overview questions give the most substantial insight into the patient experience. It’s really about what we remember. If any of us walk away from a hospital with a good feeling, even if we can’t necessarily pinpoint an aspect of the design strategy that made us feel good, we’re more likely to give a positive review of the institution.
Clearly, if a patient feels that they were well cared for by nurses and doctors, and that the hospital was clean and quiet, they’re going to have a pretty positive impression. But there are other things that can help push them into a positive mindset. Some hospitals are creating special toolkits for patients that are having trouble sleeping with an eye mask, ear plugs and calming essential oils—these amenities may help with insomnia to be sure, but it’s also just one more opportunity for nurses and doctors to show patients that they care and understand what the patient is dealing with.
The Final Score
As the political winds shift and the Affordable Care Act goes through changes, the HCAHPS survey continues to have a great deal of influence on how hospitals operate and how they are reimbursed by both public and private payers. By using equipment planning and design strategies to increase HCAHPS scores, healthcare organizations and clinicians will necessarily improve patient experiences and enhance health outcomes, increasing their reimbursement rates in the process.
Jeff Davis takes a pragmatic, no nonsense approach to everything he does—from project planning through equipment selection and purchasing as well as project activation and clinical analysis. Whether new construction or renovation, a 1.2MSF replacement hospital or a cardiac cath unit, Jeff brings it home.
OneEQ Vice President Irene Bickell explains why IPD is becoming an essential part of hospital construction
When people think about the future of healthcare, they typically think about new technologies, procedures and tests that will speed healing times, cure complex illnesses, and enhance the overall patient experience. Certainly, those advancements will change how physicians work and how patients are treated, but I would argue that healthcare is being revolutionized by a process put in place long before a hospital’s first MRI machine is purchased: Integrated Project Delivery, also known as IPD. To be clear, IPD isn’t a new concept, but as hospitals and healthcare facilities become more and more complex, IPD is becoming the way forward for any value-conscious organization.
What is IPD?
Just as it sounds, in healthcare, IPD is a process for designing and constructing hospitals that integrates the entire team from the very beginning, including the owner, architect, engineer, general contractor, equipment planners, interior designers, practitioners, and even the BIM and Revit teams. The financial structure is integrated as well, with every “trade partner” (i.e., the architect, engineer, equipment planners, etc.) taking on risk.
In practical terms, that means everyone on the team is working toward a common goal and, together, almost operating as their own company, although they remain employed by their respective organizations. As anyone in construction can tell you, the relationship between these entities isn’t always amicable on a non-IPD project. Once the team makes the shift from an adversarial relationship to a cooperative one, true innovation, cost savings and excellence become the new goals.
Benefits of IPD
At OneEQ, we are strong proponents of IPD and we truly think it’s the way most future hospitals will (or should) be built. IPD is not ideal for every project, but it has some very clear benefits for most healthcare organizations.
Value and cost savings. Our experience backs up the research that shows when trade partners are treated as one team from the beginning, we head off potential problems before they become expensive change orders that affect the construction schedule, all of which can affect the bottom line of a project. Each trade partner’s profit is at risk, which is a powerful motivator to make sure everyone is bringing their best, value-driven ideas to the table.
Collaborative Attitude. IPD means more teamwork and a better work environment where innovative ideas can thrive. When a challenge comes up, rather than having one organization blame another or avoiding litigation as the main goal, we come together as a team to figure out the best person or sub-team to solve the issue. Finally, healthcare is data and operationally focused and IPD brings us closer to a data-driven, performance-based compensation model for the entire design, planning and construction team.
A Cutting-Edge Structure for Cutting-Edge Hospitals. Most of the organizations we work with are already known as leading research institutions and they want it to stay that way, which necessitates innovation and vision. Through the IPD process, the team can put the best people to work on the toughest challenges, using their expertise to implement new ideas and technologies. In a typical construction project, different teams and experts are brought on at different points of the process, making it more challenging to implement new ideas along the way.
Coordination is a Breeze. This may sound like an exaggeration, but as equipment planners, the value of coordinating hundreds of thousands of moving parts with a cooperative team is incalculable when compared to coming into a project in the final year and dealing with a multitude of contractors, vendors and project team members; if we’re all working toward a common goal, that process naturally goes much more smoothly.
Limitations of IPD
Although IPD is an excellent way to build a hospital, everything has drawbacks.
Every member of the team is involved from the very beginning. This is a major advantage for the most part, but from our perspective as equipment planners, it can be a double-edged sword; we can prevent issues by offering our expertise from the beginning, but because these projects can last for 5-10 years, it can be challenging if not impossible to predict what technology will be available when the hospital opens for patients. We typically solve this issue by including time in the project schedule to re-evaluate planned equipment and technology and assess what new technology would benefit the hospital.
Some owners are reluctant to adopt IPD. The risk structure isn’t as familiar and it can be challenging to explain. Legally, it can be difficult for state owners to adopt this structure.
Your profit is at risk. The nature of IPD means that every trade partner’s profit is at risk. By being efficient, thoughtful and coordinated, everyone stands to make a healthy profit, but there’s always the possibility that the opposite could happen.
The Proof is in the IPD Pudding
OneEQ has completed a number of hospital projects using the IPD model. For us, as equipment planners, the value is significant; for our clients, the value in the tens of millions of dollars, if not higher.
One of OneEQ’s most recent examples is CPMC Van Ness in San Francisco. The hospital takes up an entire city block in the Tenderloin and had a budget of $2 billion. Their were a number of challenges from the beginning, including a very constrained site surrounded by extremely busy roads. As the equipment planning team, our responsibilities included the logistic and deployment of all the medical equipment. We had to figure out how to deliver equipment in large semi-trucks, in heavy traffic, with a very small loading dock. By coordinating with the rest of the IPD team through the process, we created a number of unusual solutions—we utilized an off-site warehouse and broke down everything and disposed of trash and packaging outside of the city to save significant costs. We then brought everything in on smaller trucks and implemented a complex RTLS (Real Time Location System) system for the 35,000 pieces of equipment.
Our team worked with the owner and other vendors to tag everything from the warehouse, where it could then be tracked and pinged as it went from the warehouse to the dock and from the dock to its location within the hospital. This streamlined process omitted the typical manual process, saving about 15-20 minutes per piece. With 35,000 pieces, the client estimates it reduced the project cost by about $150 million.
Now that the hospital has opened its doors, the system continues to save the hospital money by eliminating the time it takes to find moveable equipment—for carts and other equipment on wheels, staff can simply look up an item’s location on the RTLS system instead of walking the halls to find it.
The RTLS process put in place is just one very specific example of how the IPD process saved the project money and continues to make CPMC Van Ness a technologically advanced hospital for a diverse urban community. Each time OneEQ participates in an IPD process, we have seen several of these types of incremental changes that have had a huge impact on the final project—it’s the reason IPD leads to innovation and why more owners and construction teams will fight for IPD in the coming years.
Irene Bickell is a consummate planner and organizer, fluent in management transitions and logistics as well as California’s OSHPD requirements and innovative delivery methods. Don’t be fooled; Irene’s a no-nonsense professional who drives results. She has become an IPD convert and loves to tell people about its benefits; just ask her.
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