Buildings for Life The 8th Domain of Quality in the Healthcare Build Environment of Care

What will future Hospitals look like from the built environment perspective, and how will specific elements of healthcare Infrastructure Technology (IT), impact architectural design, commissioning support, sustainability, and operations, across the US.?

The challenge today is to develop better, faster, cheaper ways of providing healthcare in America, by promoting and supporting core processes, using technology to enable flexible, safe, high-quality care in the most cost-effective manner and environment possible. The proper planning and integration of Healthcare Infrastructure Technologies into the built environment is helping us do just that.

How do we define “Buildings for Life”?

?In today’s world, technology and the healthcare-built environment go hand-in-hand. Patient experience and sustainability, coupled with integrating the right kind of technologies and equipment in the right sized built environment,?operating at peak performance, and providing greater access to a wider level of?care via breakthrough virtual care models that enable and support greater ?“access to care” and help measurably improve people’s health before they need to go to hospital are some of our key considerations to how we define the Buildings for Life designation .

The 8th Domain of Quality: “Improved Access to Care”

Today Infrastructure (IT) effectively enables the “hospital” to serve as the center peace for acute and inpatient care, in more sustainable, efficient, and safer ways than ever before. However, proper planning and new space program benchmarks and space design standards are needed to better enable the hospital of the future to adapt and serve as part of a broader healthcare system care model, which will ultimately support improved “Access” to care regardless of physical location. Technology in the built environment is forcing architects, planners, engineers, and healthcare providers to re-think the way we design Hospital facilities and changing how the built environment will support the models of care across the health and wellness spectrum in the future.??

Interestingly, the term ‘Access” to healthcare, for architects and planners typically refers to the patients and providers physical access to all healthcare services, including acute, ambulatory, mental health and most recently wellness care (with a much greater focus on preventive care, education, nutrition, and physical therapy, etc.) within the built environment.

However, today the built environment is serving to support new fast growing virtual care models that change the way the built environment provides for “Access to Care”.

Designing Infrastructure to accommodate technologies that support this new virtual care model which includes communication technologies is changing the way we define “Access” to care and how the hospital build environment is planned and designed. ??

The traditional seven (7) domains of quality when planning / designing a hospital still include:?

1.????patient experience,

2.????effectiveness,

3.????efficiency,

4.????timeliness,

5.????safety,

6.????equity and

7.????sustainability.

An argument can be made that an “8th” domain; “Improved Access” (virtual or otherwise) of care, "quality" should be incorporated into the planning and design process.

The Importance of Planning for Early Integration of Infrastructure Technologies in the Planning and Design Process of New Healthcare Facilities. ??

Today “infrastructure Technology (IT) is a critical mainstream component of both acute inpatient, and ambulatory care. Proper??planning space programming, and new design standards for our healthcare facilities of the future are necessary to properly integrate the needs of IT both for today and into the future, in ways that will provide flexibility and allow for the future “total” integration of the built environment into a new and??broader healthcare system patient care approach which includes Acute, Ambulatory, and Virtual. Care, focuses on ?the total spectrum of health including wellness care ?provided across a wider spectrum of both accredited healthcare facilities, and virtual care models that are changing the way we will design for the “hospital built environment?of the future.

Infrastructure Technology is already an integral part of the built environment. Both the schematic design and design development phases of a new hospital development project must support all elements of IT including space, equipment, access, backbone, conductivity systems integration, security, processes, and sustainability initiatives that should be carefully planned for early in the facilities design process.

Overall, the goal is to properly integrate Infrastructure technology requirements into the built environment early to properly engineer and design the built environment to support systems technologies and medical equipment, communications including preparing for life safety monitoring, and new virtual care models of the future including medical equipment needs that will enable higher quality, more sustainable, accessible, and safer patient care.?

Some of the Most Technologically Advanced Hospitals in America.

“In today’s world, it’s important to note that technology and the healthcare-built environment go hand-in-hand”.

Patient experience, and sustainability coupled with integrating the right technologies and equipment in the built environment, operating at peak performance, and providing greater access to a wider level of care via breakthrough technologies that provide greater “access to care” and help measurably improve people’s lives overall are some of the key considerations that make up the Buildings for Life designation. An important consideration also includes how the concept of wellness is incorporated into the design of the built environment.

“Buildings for life” are healthcare facilities that do a better job caring for people. They perform better through the integration of state-of-the-art technologies that have been successfully identified planned and designed into a new kind of healthcare facility.?

“Buildings for life” are also well align with recognized WELL Building Standards. These standards encompass 108 features across 10 concepts, is a toolbox for the design and operation of buildings that care for their patients and occupants. It’s a rigorous, evidence-based, and holistic design model that can include an additonal International WELL Building Institute (IWBI) certification if healthcare systems chose to do so.

Buildings for life, unlike WELL certification, are focused on improving access to all care models through the integration of state of the art Infrastructure Technologies (IT) while also prioritizing the need for superior indoor air quality, clean drinking water, and nutrition and education programs along with designing opportunities for physical activates that promote mental health and positive social engagement by departmental adjacencies. Thermal, acoustic, and visual building comfort for occupants and patients alike is another important aspect of Buildings for Life designation.

While the concept of caring for people in the built environment is not new, measuring the successful integration of infrastructure technologies to enable health care facilities to perform better with respect to occupant and patient experience both physically and virtually is a relatively new way of thinking about how healthcare facility design can be improved.

?We’ve spent the past few years identifying healthcare facilities that where designed to prioritize patient experience, and sustainability coupled with integrating the right technologies and equipment in their design in ways that best support operating at peak performance, and providing greater access to care.

?In addition to the 8 domains of quality, we also measure an additional 6 occupant determinants that together support our Buildings for Life designation for new healthcare facilities in America. The six occupant determinants that we measure include:

1.???Benefits to Patients by Support Care Teams

Enhanced care benefits to patients through facility designs that successfully integrated Infrastructure Technologies that do a better job supporting care teams in their built environment. In the case of healthcare buildings, occupants include the nurses, doctors, technicians, custodians, and administrators—who spend much of their lives in hospital buildings. In an era of staffing shortages, and unprecedented burnout among care teams, improving the occupant experience through technology enabled design supports a healthier, happier healthcare workforce which in turn also benefits the patient and enhances the overall care model. ?

2.???Designs that Help Support Operational Improvement

Unlike the LEED rating system for new construction projects—where one achieves certification for design and construction measures only— the “Buildings for Life”, designation we used also assesses how the final design of the facility addressed sustainable improvement to operational and maintenance policies and practices. Our review encompasses nutrition and food services, cleaning and maintenance, human resources (HR), infection prevention and control (IPAC), and senior executives—in addition to how the engineering and architecture design teams engaged department heads, Users, administration and the patient population during their discovery and planning process through Schematic design.?

Healthcare providers may also discover that the Buildings for life design approach can help push teams to update HR and operating policies during the programing and design phases healthcare project. This could benefit staff across the organization. Other examples include incorporating stress management planning, and design considerations during shift changes for shift-workers.

3.???Building System Specifications ?

Buildings for life designation evaluates integration of quality specifications for lighting systems, air quality, and water quality building system specifications including Smart BAS and other building controls and communication systems that help measurably improve the building environment (Air, water , sound , temperature, security, communications and Life safety monitoring and telemetry systems .) for its occupant’s overall experience, along with patient safety and overall quality of care.

Buildings for life designation also addresses sustainability, including energy efficiencies and capital and operating costs compared to more standard healthcare facility designs. Although healthcare building systems are?already?upgraded compared to non-healthcare buildings, with a focus on increased infection controls as required by code, there are other additional features considered upgrades like 100% fresh air capabilities UV controls, Acoustical controls and glare control lighting design, travel distances, and Max permittable VOC in indoor air quality. ?We also examine overall building resilience measures when evaluating building system specifications.

4.???Adequate Lighting.

The need to meet critical departmental adjacencies drives deep floorplates, in hospitals in particular resulting in work areas located away from the perimeter. Larger floor plates often end up without a exterior windows. Buildings for life reviews how interior space designs with respect to how lighting and workspaces are designed. Spaces without natural daylight can decrease productivity and promote fatigue. Daylight on the other hand increases productivity. Therefore, how access to daylight is managed to help maintain a healthy work environment is an important part of our review. Accommodating this requirement in the overall design strategy at the start forces design teams to rethink a project’s program and building plan.

5.???Acoustical - Occupant and Patient Care Design Criteria

Design focus on improved acoustics and light and glare levels has become more important than ever as computer screen glare and med equipment noise elves continue to increase. Consideration of sound control strategy reviewed with department leaders early in design is something that we look for when speaking with the Design team and users.

Healthcare designers are expected to involve an acoustic consultant in developing alternative compliance pathways based on industry best practices that meet or exceed occupant expectations as documented at the beginning of the design process. The same process should be followed with the lighting design. Adjacencies and distance of travel measurements vs expectations with respect to Operational improvement metrics should be documented and measured for performance.?

6.???Getting Started with a Well-Documented Operational Process Improvement and Patient Experience Strategy

Finally, although operations are reviewed and improved upon regularly. Getting off to a good start by aligning the design process with the client’s operational improvement expectations is important.?Operational improvement often involves 3rd party Process specialties in areas like material management, food services, Pharmacy and Lab to name a few. We recommend consultants who specialize in process improvement be engaged early in the design phase to work closely with the architect and department heads to identify the most efficient flows, processes and procedures early enough to be tested and incorporated successfully in facilities design. This type of process engineering and testing of operational flow does introduce additional consulting and design costs but it more than pays for itself year one of operations if done correctly should be thought of as a small investment in maximizing the value and efficiency related to ROI.?

?Our Top Ten examples of sustainable, most technologically advanced hospitals in America that we believe meet the definition of “Buildings for Life” include:

·?????Mayo Clinic.

·?????Johns Hopkins Hospital.

·?????Cleveland Clinic.

·?????MD Anderson.

·?????Massachusetts General Hospital.

·?????Stanford Health.

·??? University of Chicago Medical Center.

·??? New Your Presbyterian Hospital.

·?????UCLA Health.

·?????Boston Children's Hospital.

About the Author: Chris Kay ([email protected]) is a healthcare facility planning and design professional with over 33 years of experience in integrated healthcare master planning and facilities design and construction management. Chris is an internationally accredited healthcare architect, (IAIA) urban planner, and experienced real-estate development professional. He serves as National Healthcare Practice leader for JLL Americas and is the Executive Director of Healthcare infrastructure Institute located in Washington DC. He is an active member of National Institute of Building Sciences, and the American College of Healthcare Executives while continuing to serve as a trusted advisor on major healthcare capital development programs across the US. For more information on how to integrate Infrastructure Technologies into the build environment or how to plan and manage your next healthcare capital facilities program contact Chris at [email protected]