We all know that delivery of healthcare in the United States is undergoing a massive shift, driven primarily by the Patient Protection and Affordable Care Act and the desire to improve access to care across the spectrum of the country. This is not a new phenomenon. Since the middle of the 19th Century the systems that deliver healthcare have evolved significantly, and for the past 50 years this evolution has been driven by the rapidly increasing speed of delivery.
Besides the regulatory drivers, our system of care delivery is struggling to cope with an aging population that is living longer with chronic conditions; health systems that need to consolidate in order to survive financially; and continuing technological advances that perpetually change and improve care delivery.
We know that the care delivery system is moving from its traditional focus on episodic, sick care to an increased focus on wellness and chronic care. This is requiring facilities and organizations to become much more flexible both operationally and physically. Based on these influences here’s where I believe healthcare is heading:
- The primary focus of healthcare will continue to transition from acute care to wellness, population health management, and primary care.
- Integrated delivery systems and distributed networks will bring healthcare to local communities when and where patients want it to be available.
- Traditional and remote locations will see expanded access to diagnostic technologies to treat and monitor patients.
- Heightened controls will be put in place to better manage the growing families of antibiotic-resistant strains of viruses and bacteria which threaten to destroy nearly a century of health improvement.
- The physician/patient relationship will continue to change with patients taking a more active role in their care decisions.
- The shortage of skilled caregivers desiring appropriate work environments, job satisfaction, and rewards must be resolved to ensure continuing delivery of care.
- A larger percentage of fixed assets will move into less expensive investments like medical office buildings, ambulatory care centers, specialty care centers, and home health delivery.
- A shift from a volume-based, financial model of care toward a value-based system with rewards for high-quality care and penalties for failures will provide transparency for consumers.
As our knowledge and understanding of the human body has increased exponentially during the past 50 years, the shift from acute (inpatient) care to primary (outpatient) care has been in play. For healthcare organizations to survive financially, the relocation of non-essential services out of the traditional hospital facility will also increase, leaving only those services necessary to care for the sickest patients. In many cases, the disparity between healthcare in urban centers versus rural communities is widening.
This shift in healthcare impacts the design and construction professions as seen in the rapidly declining numbers of new acute-care facilities, and the move to smaller, less-expensive ambulatory and primary care facilities. There is a need for higher levels of design and construction flexibility in all types of healthcare facilities. This is challenging designers to develop facilities that can change rapidly as care modalities and technologies change, while still responding to a need for attractive spaces that increase patient comfort and satisfaction. In other words, the delivery of quality care and the built environments within which care is provided are co-dependent.
Regardless of the shift in healthcare delivery, one constant remains: The need to engage the four groups most impacted: the patient, the caregiver, the family, and the community. The successful engagement of each of these groups will be measured by their involvement and satisfaction in the healthcare process, which is an immutable reality across the world.