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SEPTEMBER 24-26, 2025
San Diego Convention Center - San Diego, California

Author: Jenabeth Ferguson

Hospitals Are Complicated. Let Digital Wayfinding Reduce Anxiety For Patients & Visitors

By: Todd J. Fisher, Founder and Chairman of Intraprise Solutions (Eyedog.US is a Division of Intraprise Solutions, Inc.)

At the end of January, a close family member of mine began to experience heart failure while we were sitting on the couch watching the news. With a jolt of adrenaline, I drove her to the ER, helped her register, and answered questions from clinical staff as they measured her vital signs, performed diagnostic tests, and provided preliminary treatment. Like it is for so many people in hospitals across the US, every single day, the experience was stressful, overwhelming, and emotionally draining.

 

And, over the next two weeks while she remained in inpatient care, having several tests and multiple procedures, I returned back to the hospital to visit, learn, and serve as an advocate. I was reminded of something I already knew, but had not felt so viscerally before: family members of patients spend a great deal of cognitive energy while supporting their loved ones, often over long periods of time, while hungry, thirsty, and sleep deprived.

 

In an already emotionally charged, stressful moment, the physical environment of a hospital can exacerbate feelings of anxiety: hospitals are, for a handful of reasons, inherently difficult to navigate. Hospitals often have hundreds of destinations that need to be accessible from any given starting point within and outside the hospital. Large hospitals, on sprawling, multi-building campuses – sometimes merging old and new structures – make navigation less than intuitive. Pedestrians navigating these spaces are often in an emotionally vulnerable state: visiting a hospital as a patient, or as a loved one of a patient, is stressful to begin, and makes navigating an unfamiliar or confusing space feel impossible.

 

 

Photo Landmark Navigation: More than Maps

 

Actually, navigating indoors is tricky even at an emotionally neutral state, especially when using digital wayfinding applications as a resource aimed at ‘simplifying’ the navigation process. We are all familiar with digital navigation systems while driving – in-dash navigation, Google Maps, and Waze have revolutionized the way we find our way while driving.  We don’t think much about how it works, we’re just grateful for the huge improvement over printing out maps, following road signs, tracking mile markers, or heaven forbid, pulling over to ask another human for directions.

 

As we consider the application of this navigation paradigm to solve a different challenge – finding our way as we move inside large complex buildings – we are quickly reminded that the real feat of Google Maps isn’t so much the tech that makes it all possible, but the simplicity and clarity with which Google communicates directions in cadence with the movement of our navigation. When we can visually match our current location with our surroundings, it becomes easy to see where to go next.

 

However, when we try to apply this GPS concept to pedestrian indoor navigation, we realize the tech that works wonderfully for navigating in open space while moving at 60mph may not serve us as well in confined spaces at low speed, where our view of the navigation landscape is obstructed by walls and ceilings. What we need is a method that converges with users’ natural way of thinking and effectively accommodates indoor navigation nuances without confusing or frustrating the user.

 

Thankfully, the scientific community has produced a stable of research regarding how humans think when it comes to matters of spatial awareness. Their key takeaway is our need for visual landmarks, as they are the most efficient way to communicate wayfinding instructions, especially in circumstances such as hospital navigation, where anxiety is high, users are distracted, and cognitive capacity is compromised.

 

Landmarks allow for fast reasoning because they align with humans’ natural cognitive navigation process. So, how do we incorporate visual landmarks into mobile wayfinding applications? Simple: we use photos!

 

A method called Photo Landmark Navigation is a more effective technique for indoor mobile wayfinding. Like GPS navigation, it leverages graphing algorithms to generate optimized pathways from one point of interest to the next – think “main entrance to NICU.” The user is presented a narrative sequence of photos showing their surrounding building hallways, rich with design features that serve as visual landmarks. As users reach each new visual landmark, they simply swipe or scroll to the next picture, revealing the next set of landmarks to walk toward.

 

Unique Hospital Design Means Better Digital Wayfinding

 

This is where the physical environment of a healthcare campus impacts digital wayfinding, and vice versa. A healthcare facility rich with visual landmarks, unique design features, and noteworthy points of interest makes a great candidate for a wayfinding solution like Photo Landmark Navigation. There are ample visual markers to help users clearly see where they are, and where they are headed. We’ve all visited healthcare facilities with the same paint color lining the multi-floor, multi-building, large campus walls – it’s hard to tell where you are or where to go. With well designed facilities, though, Photo Landmark Navigation works best, because it draws on the natural human instinct to use distinctive physical landmarks to navigate. Seeing those landmark photos on a smartphone screen signals that the user is on the right path. And, in older hospitals with updated designs, periodic additions, and tricky intersections, the same is true: Photo Landmark Navigation solves for wayfinding pain points no matter the setting, because it utilizes existing landmarks as an effective tool for navigation.

 

At Vail Health Hospital, in Vail Colorado, patients, visitors, and staff have access to a digital wayfinding solution called Eyedog, which uses Photo Landmark Navigation to deliver clear pedestrian directions to users. The solution, designed to eliminate common (and often overlooked) challenges around indoor navigation, enhances the patient experience by providing intuitive walking directions that resolve problems that often cause stress for the entire community, before they arise.

 

Great digital wayfinding meets consumers where they are, both physically and technologically. At Vail Health Hospital, the Eyedog digital wayfinding solution provides intuitive pedestrian directions that acknowledge the fact that our digital and physical environments have merged. This specific initiative provides effective and efficient digital wayfinding, because it utilizes familiar digital elements that fit seamlessly into the patient experience, ensuring that patients, visitors, and staff can focus on the task at hand, rather than the logistics of finding their way. The Eyedog solution works well at Vail Health Hospital because it eliminates concerns about the fail-points that commonly accompany other types of digital wayfinding, with third party dependencies.

 

An example of how Photo Landmark Navigation can resolve common challenges associated with digital wayfinding in the healthcare setting, Vail Health Hospital effectively utilizes unique hospital design features as the groundwork for great pedestrian directions via Eyedog Photo Landmark Navigation, merging the physical design elements with an empathetic technology solution.

 

Changes to the Physical Environment Can Create Confusion

 

Frequent changes and updates to the physical environment of healthcare facilities are inevitable; updates are a necessary and exciting part of keeping the hospital relevant, competitive, and well-fit to serve the needs of its community. But, those design changes introduce the potential for hidden difficulties for staff and patients, particularly those who are returning patients experiencing the changes in a facility they have visited before: changes to the environment can cause unexpected obstacles in an already turbulent experience. Change is difficult, and clear communication is a key way to reduce the impact of such change. Amid changes in a healthcare facility, Photo Landmark Navigation provides clear communications that extend beyond basic walking directions. Because of the frictionless and intuitive nature of such directions, they can drastically reduce the stress and anxiety felt while navigating confusing healthcare facilities.

 

Because of the nature of hospital growth, many facilities opt to add or grow in phases. Adding to existing, often older buildings can create confusing, difficult-to-navigate building landscapes; signage is just one piece of a complex puzzle required to effectively provide directions. Staff, who are also learning to navigate a new facility, often find themselves responsible for helping patients to navigate, as well, taking their time and attention from other duties and responsibilities to provide directions. With renovation comes confusion and stress for those working to navigate unfamiliar facilities.

 

And, for brand new patients, there is an inherent feeling of stress that accompanies navigating an unfamiliar facility. Photo Landmark Navigation is so effective and efficient in all of these settings because it combines high resolution photos of the campus with directional arrows and written directions, designed to help users navigate, regardless of their familiarity with the campus. Because users see on their smartphone screen their exact, current surroundings, a building’s confusing landscape, or out-of-date signage does not negatively impact the effectiveness of the directions.

 

Attention is Valuable

Photo Landmark Navigation gives patients and visitors intuitive access to effective indoor wayfinding that does not require a lot of attention to use; there are few barriers to entry, enabling successful wayfinding that can reduce the stress and anxiety commonly associated with navigating a new (or changing) healthcare facility. With the option to view a personalized photo route ahead of an appointment, users find a sense of control within their clinical experience.

 

Enhancing existing wayfinding systems, Photo Landmark Navigation works without requiring any hardware, making it quick to deploy and affordable to maintain. Photos obviate the need for indoor positioning, thereby removing the need for beacons, which are expensive to install and maintain. Such a digital wayfinding solution allows healthcare systems to capitalize on the opportunities afforded by offering an app-less mobile wayfinding solution, dramatically increasing the likelihood of usage and adoption. Instead of only appealing to those users who have taken the time and attention to download an app (likely a tiny percentage of all visitors), you can now offer mobile wayfinding to any visitor with a smartphone. Photo Landmark Navigation technology is unique in that it is complex behind the scenes, but incredibly simple for healthcare systems and their patients, making it manageable and maintainable for everyone involved.

 

And, we can’t forget that Photo Landmark Navigation is designed to be an addition to traditional wayfinding methods. Effective indoor wayfinding is multifaceted; Photo Landmark Navigation presents directions that use digital technology, but also leans on effective signage, healthcare design, volunteer & staff participation, and community engagement to successfully improve indoor wayfinding woes.

 

Put simply, Photo Landmark Navigation alleviates the challenges often associated with indoor digital navigation, while spotlighting the unique and beautiful design of a healthcare facility, saving on costs, and improving the patient experience. A creative twist on the driving navigation we all know, love, and rely on, Photo Landmark Navigation is the simple, frictionless, intuitive solution for navigating within complex healthcare facilities. Together with signage, design, and digital wayfinding, healthcare systems can take their digital transformation and patient engagement strategies to the next level, leaning on healthcare design to promise an improved experience for the entire healthcare community.

 

About Eyedog.US

Eyedog.US offers the world’s leading indoor and campus-based pedestrian wayfinding solution. Using photo landmark navigation technologies, Eyedog.US offers a human-centered wayfinding approach that promises to reduce stress and anxiety associated with navigating a complex campus. Learn more at https://eyedog.us/

Don’t be Caught Red Handed – 2023 Healthcare Regulatory Hot Topics

By: Christina Olivarria, MSPM, PMP, LBBP, HACP, Director of Business Development and Communications, Yellow Brick Consulting Inc

I think it’s fair to say the lion’s share of us working in healthcare did not get into this field to learn about regulations, compliance, and accreditation. In fact, some of you may even cringe at the thought of developing policies, reviewing scopes of services, or verifying that staff files are up-to-date and inspection ready. Let’s face it, as much as we may dislike the headache they often bring, healthcare regulations are a necessary component to maintaining our healthcare system. As healthcare professionals, we are responsible for keeping abreast of the latest regulatory trends so that we always bring our best, most informed self to whatever setting may need that information.

As a non-clinician, I have challenged myself to become more educated about the various aspects of regulatory compliance. When activating a new healthcare facility, surveys and site inspections are often the final hurdles project teams must overcome before Day 1 Activation. Each year, as part of my regulatory education, I work with our Regulatory Specialist, ask probing questions, attend webinars, and do lots of reading. Below is a summary of prevalent regulatory hot topics across the country.

Behavioral Health Patient Risk Assessments

The CMS Hospital Condition of Participation, “Patient’s Rights” (42 C.F.R. §482.13(c)(2)) establishes the rights of all patients to receive care in a safe setting and is intended to provide protection for a patient’s emotional health and safety as well as his or her physical safety.

The Joint Commission identified patient safety risks as one of the goals listed in the 2023 National Patient Safety Goals. Specifically, reducing the risk of suicide through thorough environmental risk assessments is a top priority of the TJC and CMS, and many healthcare organizations, particularly as Behavioral Health, becomes a more prevalent topic. Evaluating ligature risks within healthcare settings where high-risk patient populations are cared for should be a top priority of healthcare leaders to mitigate the risk of self-harm. Currently, only psychiatric hospitals and hospitals psychiatric units are mandated to be designed to be ligature resistant. Those of us in healthcare understand behavioral health patients are treated in almost every type of healthcare environment, so it is important to be aware of potential risks and have the plan to minimize them.

Some recommendations include:

  • Evaluation of the physical environment through a standardized risk assessment tool
  • Ensure all patients are being screened for suicidal ideation
  • Develop and maintain policies and procedures should a patient be identified at risk for suicide, including continuous monitoring and staff safety
  • Develop and provide training to staff
  • Follow policies and procedures related to discharge counseling and follow-up care

Workplace Violence Prevention

The data paints a bleak picture.

  • Healthcare and Social Services workers are five times more likely to experience workplace violence
  • Workplace violence comprises 73% of all nonfatal workplace injuries
  • 80% of serious violent incidents reported in healthcare settings were caused by interactions with patients
  • The “healthcare and social assistance” sector had 7.8 cases of serious workplace violence per 10,000 full-time employees compared to other large sectors that all had fewer than two cases per 10,000 full-time employees

As a result of this problem riddling our healthcare teams, the Joint Commission issued new and revised workplace violence prevention standards on January 1, 2022. The Occupational Safety and Health Administration (OSHA) plans for a Small Business Regulatory Enforcement Fairness Act (SBREFA) review of rulemaking for workplace violence prevention in health care and social assistance to ensure all healthcare providers are compliant.

The Joint Commission’s glossary defines workplace violence as “An act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors.” Healthcare leaders are now faced with the arduous task of incorporating these new standards into existing policies and procedures.

The new prevention standards are comprised of the following components:

  • Management of safety and security risks – Conduct an annual analysis of the effectiveness of the workplace prevention program.
  • Collection of information to monitor environmental conditions – Establish a process to monitor, investigate, and report incidents, including but not limited to injuries to patients and staff, occupational illnesses, safety and security risks, hazardous materials and waste spills, and utility system problems/failures
  • Coordination of ongoing staff education and training – Establish training modules and content for various staff types, including at the time of hire and on an annual/as-needed basis. Content should include roles and responsibilities, de-escalation techniques, and reporting methods.
  • Maintenance of a culture of safety and quality – Develop policies and procedures that address workplace violence. Evaluate key performance indicators that can be established to monitor incidents. Ensure support resources are available to staff.

Although this regulatory requirement has left many organizations scrambling, there are several incentives to adopting policies and procedures addressing workplace violence, including staff-burnout prevention, minimizing workers’ compensation claims, and reducing the need to backfill staff who are out due to injury. To access the Joint Commission resource toolkit, click here.

Disaster and Emergency Preparedness

The Emergency Preparedness CoP at §482.15(d)(1) contains requirements for hospitals to train staff and to have policies and procedures aimed at protecting both their workforce and their patients.

In the wake of the Covid-19 pandemic and its impacts still reverberating through the healthcare system, it is unsurprising to see increased scrutiny on emergency preparedness. The Joint Commission has highlighted Emergency Management as key safety topic, focusing on four main areas – preparedness, response, recovery, and mitigation.

Preparedness – Conduct a hazard vulnerability analysis utilizing an all-hazards approach, considering internal and external threats to the organization. Develop an Emergency Operations Plan that addresses identified threats. Validate systems required to support critical services and develop plan to maintain in the event of an emergency.

Response – Develop policies and procedures to support an Emergency Action Plan. Conduct staff training to support outlined policies and procedures to ensure teams respond as planned. Ensure communication and roles and responsibilities are outlined.

Recovery –  Address how and when the hospital will return to full functionality after an emergency or disaster. Consider family reunification and patient identification procedures for unidentified adults and unaccompanied children.

Mitigation – Conduct exercises to test emergency response, including fire evacuation drills, active shooter exercises, mass casualty events, and technology ransomware attacks. Evaluate responses and identify areas of opportunity and gaps in planned responses.

Hospitals must ensure that emergency services will be available when the next disaster occurs while prioritizing investments that will build the healthcare delivery system of tomorrow. For more information, please click here for the Joint Commission R3 Report.

End of the COVID-19 National Emergency and Public Health Emergency (PHE)

Throughout the pandemic emergency, declarations allowed extra funding to be utilized to maintain Medicaid coverage for millions of Americans. With this funding being pulled this year, it is unclear how this unwinding will impact the healthcare system and the millions of Americans who may lose access to insurance come May 2023. Emergency declarations enacted during the Covid-19 pandemic will end, which may result in adjusting ratios, retraining staff onboarded during this period, and adjusting billing for services currently covered under the national emergency declarations.

Organizations should conduct an internal analysis of practices and procedures to prepare for this unwinding period to prioritize the next steps. Communication and coordination with community resources are recommended to ensure patients have the most up-to-date information regarding available benefits and resources.

Although not the most exciting of healthcare topics, regulatory and healthcare compliance education should be a goal of every healthcare professional. What I have found most helpful is understanding what I need to know to be successful in my role and also who my subject matter experts are in the event that I need to consult with them on a topic outside my realm of expertise. Plenty of free webinars and articles are available on the various regulatory agency websites. Should you encounter a situation in which you need consultation, reach out to a consultant that specializes in healthcare. Many are happy to point folks in the right direction. Best of luck on your regulatory educational journey, and be sure to keep these hot topics on your radar in 2023.

HEALTHCARE FACILITIES SYMPOSIUM AND EXPO RETURNS SEPTEMBER 19-21, 2023 TO THE CHARLOTTE CONVENTION CENTER

Engaging Programming, Innovative Products, Keynotes, Industry Leaders, Facility Tours, Emerging Leaders, and Networking Events

Charlotte, NC (June 14, 2023) — Healthcare Facilities Symposium and Expo, one of the country’s largest shows dedicated to healthcare design and facilities, returns for its 36th annual event to the Charlotte Convention Center, September 19-21. This must-attend symposium and expo brings together architects, designers, engineers, contractors and providers to collaborate, share research, hear fresh perspectives and participate in the ever-changing healthcare industry. Attendees will have a chance to sit in on compelling Keynote Presentations, explore 100+ Exhibitors, be inspired by industry leaders at daily Conference Sessions, explore two of Charlotte’s newest Healthcare Facilities, enjoy Networking Events and much more.

“After a hugely successful event in Long Beach, CA, we’re thrilled to bring the 36th annual Healthcare Facilities Symposium and Expo to Charlotte, NC, one of the top three markets in the country for healthcare construction,” said Jenabeth Ferguson, Vice President, Symposium Director. “Each year, we look forward to bringing together healthcare design’s industry leaders for powerful keynotes, informative sessions, the latest product innovations and new this year, we will be welcoming Emerging Leaders.”

Robust Conference

The Symposium features three jam-packed days of educational and insightful sessions, case-studies and keynotes meant to inspire and improve current and future healthcare facilities. The sessions will span multiple topics including Pediatrics, Behavioral Health, and Community Health, among others that are making an impact on the healthcare design industry. This year’s closing keynote titled, “What is This Thing Called Heart and How is it Relevant to Care | Design | Impact?”, features Susan Black, Principal and Director, Perkins Eastman Black Architects Inc. Black will challenge and inspire attendees with provocative questions, probing an examination into: how can our shared professions and related industries be more impactful; how can an investment in heartfelt determination be not only scalable, one project at a time, but be parlayed into a global phenomenon; and how can these disciplines of ours shake the world?

Exhibit Hall

The Exhibit Hall features the most Innovative products and services in the healthcare facilities industry from some of the country’s top manufacturers and providers. Many exhibitors will launch new products at HFSE, getting in front of important decision makers from healthcare facilities, architecture and design firms. Experience the latest furnishings, technology, flooring, modular and healthcare consulting from WIELAND Healthcare, eVideon, Tarkett, Modular Services Company, ECG Management Consultants, a Siemens Healthineers Company and many more. Don’t miss mini sessions on the Exhibit Floor at the Design Solutions Theaters where the design team galleries come alive in these 15 minute presentations. Back by Popular Demand – there will be two design solutions theaters so double the chance to hear about the latest projects in this exciting format.

Symposium Distinction Awards

The annual program recognizes design teams, projects and individuals who have made a profound contribution to the healthcare design industry. The program accepts submissions of all types and sizes of patient care-related facilities. In addition, it recognizes the best and most innovative new products within the healthcare design & construction industry. All entries are due July 28 and submissions can be made here: https://hcarefacilities.com/awards/

Networking Events

Mix and mingle with new and old friends at daily events including the Grand Opening of Exhibit Floor and Symposium Party, the Ice Cream Social, the Happy Hour and many more fun and engaging events.

Emerging Leaders Welcome

The Healthcare Facilities Symposium and Expo’s NEW Symposium Emerging Leaders Scholarship Program in 2023 gives recognition to those individuals with less than 10 years (non-consecutive) of experience in healthcare design and construction including research and/or education. The recognition includes attending the 2023 HFSE in Charlotte, North Carolina September 19-21 and participating in all activities surrounding the event.

RECIPIENTS RECEIVE

  • A Full Access registration to the 2023 Healthcare Facilities Symposium & Expo (travel expenses are not included)
  • Welcome breakfast for all emerging leaders to meet each other at the beginning of the event
  • Recognition at the Opening Keynote at the 2023 HFSE
  • Recognition on a display board at the 2023 HFSE
  • Invitation to the VIP Reception at the 2023 HFSE with a chance to network with the HFSE Advisory Board
  • Featured in the October 2023 Leaflet issue

For more information and to apply, visit https://hcarefacilities.com/elp/

Facility Tours

The 2023 event will bring back Facility Tours throughout Charlotte, a beloved tradition that is returning after its hiatus since COVID.

The Atrium Health Union West Campus is a greenfield, 37-acre full-service hospital campus in Stallings, North Carolina, just east of downtown Charlotte. Phase one included 160,000 SF hospital providing approximately 40 beds in two care wings, along with a bridge connected 69,000 SF Medical Office Building (MOB) that includes a satellite Levine Cancer Institute care facility. The hospital design adopts Atrium’s systemwide use of same-handed, acuity adaptable patient rooms that are supported by a 16’ wide double-loaded care corridor approach.

Novant Health’s Ballytyne Medical Center is designed to meet today’s community health care demands and tomorrow’s projected growth needs. The 185,000 SF hospital and 52,000 SF MOB were designed together to complement each other in scale, materiality, wayfinding and programming, as well as, to relate to the surrounding upscale Ballantyne area in Charlotte, NC. Planned as 4 stories plus penthouse, the hospital is initially 48 beds and includes horizontal growth zones for the diagnostic and treatment departments like emergency, surgery, and imaging. The attached Medical Office Building (also designed as Type 1A, Institutional Occupancy) is initially 3 stories for outpatient clinics but planned to expand both vertically and horizontally to allow campus growth up to 150 beds with minimal disruption to the operation of the hospital. Opened in June 2023, this campus was designed by HDR Architecture with engineering services provided by consultants. Attendees will be able to tour the newly opened hospital and MOB and better learn about expansion strategies, built-in flexibility, and lessons learned.

Both tours will take place Monday, September 18, 1-5pm.

For more information or to register, please visit www.hcarefacilities.com

ABOUT

The mission of the Healthcare Facilities Symposium & Expo is to create a multi-disciplinary environment that inspires you to evoke change and the advancement of a better delivery of healthcare through the physical space. Competitors, clients, and colleagues come together as friends to collaborate, share research, hear fresh perspectives and participate in the ever-changing conversation of your industry.

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The Conference Program is here!

By Jenabeth Ferguson

Our 2023 conference program was unveiled earlier this week.  Have you had a chance to look it over yet?  I am really looking forward to this year’s program and hope you take some time to check out the compelling sessions we have put together.

We have folks from Penn Medicine, Seattle Children’s Hospital, Memorial Hermann, Rush University Medical Center, University of California Irvine, Boston Children’s Hospital and Mercy Health coming to share their stories and expertise with us in September.  Some of our “fan favorites” are back like Frank Pitts with architecture+, Lynn Aguilera with Stanford Medicine Children’s Health, Bob Gesing with Trinity:NAC and Victoria Navarro with Milwaukee County Department of Administrative Services.

As you know, this year we are heading to Charlotte, North Carolina which is experiencing a population boom which the major health-care systems are matching by investing more than $1 billion into new hospitals.  We’ll be hearing from some of those providers such as Duke Health, Atrium Health, FirstHealth of the Carolinas and Novant Health.  In addition, we’re also going to hear about international projects with lessons from African Hospitals as well as Cairo and Mexico.

With almost 200 speaker that is thousands upon thousands of years of expertise that you can learn from when you attend our conference program. Speakers who will be in the room with you and you can chat with after the session or on the exhibit floor or before our keynotes.

These are just a few examples of the education you will receive by attending this year’s event.  You can see the entire program at a glance by clicking here.  Keep in mind we have yet to announce our keynotes or facility tours  . . . so stay tuned!

The Opportunity for Continuous Improvement in Activation and Transition Planning

BY: Rich Clough and Stefan LaBere, ECG Management Consultants

In Brief: When the excitement of moving into a new facility fades, will your organization fall back on old processes or continue to pursue new efficiencies?

Transitioning to a new and upgraded space presents an opportunity for healthcare organizations to reset and “reinvent” operations to realize new efficiencies. But a new facility alone won’t improve a department’s processes or change its culture. The excitement and optimism that accompany a move to a new space are fleeting; leaders need to promote a culture of continuous improvement to ensure that the advantages of a new space aren’t squandered by a gradual return to the old way of doing things.

The seeds for that culture are planted at the beginning of an activation and transition planning (ATP) project by defining the vision and setting guiding principles for operational excellence. These elements serve as the North Star for all planning activities—they are integrated into project materials, reviewed at key meetings, and championed by executives.

Creating the new facility’s vision and guiding principles demonstrates the organization’s willingness to embrace change and support frontline staff, which in turn encourages department leaders to adopt a continuous improvement mindset during operations planning activities. When done successfully, this enables departmental staff involved in operations planning activities to get creative and reevaluate how their processes can and should change.

Maintaining Momentum

As the opening date of the new facility comes to pass, it is always accompanied by a flurry of excitement and various activities to welcome patients to the new care setting. It can be easy for staff to return to their old habits and processes once operations in the new space reach the new steady state, and the activities completed and ideas shared during operations planning can be at risk of being forgotten.

Often, workarounds and other deviations from the agreed-upon plans prior to opening can become permanent fixtures, which is less than ideal. It is crucial that new or refined processes developed during operations planning, as well as the defined vision and guiding principles, are continually reinforced through training—not only prior to the first patient, but routinely and consistently. This can be achieved through a combination of simulation exercises or in-person training activities to maintain standard workflows and protocols; perhaps more importantly, this can enable the continuous improvement mindset to persist.

Organizational leadership must encourage and enable departmental leaders and frontline staff to utilize existing forums (e.g., daily huddles, regular staff meetings) to reinforce these principles and best practices. Additionally, maintaining select committees established during operations planning (e.g., Opening Readiness Committee) for three to six months after opening day—the stabilization period—can further supplement these efforts.

Sustaining the Mindset

ATP projects typically involve the transition or expansion of existing departments into new spaces. It can often be difficult to capture and sustain process improvements in legacy spaces, so transitioning into a new facility presents a significant opportunity for service lines to “do things the right way.” Reinforcing the new facility’s guiding principles through training and maintaining forums established during operations planning are effective means of sustaining a mindset of continuous improvement. However, it is crucial that these elements are not targeted at one or a few select services in the new facility—these must be broadly applicable to all services and ingrained in the fabric of the entire building. All stakeholders must not only have the ability to contribute, but also feel empowered to do so.

As such, it is incumbent upon organizational and service line leadership to adapt to change and identify new methods for encouraging the adoption of a continuous improvement mindset. How this can be achieved will vary between organizations, but establishing some ongoing structure or process to sustain this cultural change (e.g., creating formal committees comprised of facility service line leaders, conducting facility town hall events) is essential to realize long-term results. Ultimately, organizational leadership must want staff to adopt this mindset, and identify and capitalize on the opportunities available to do so.

Accelerating Innovation in Healthcare Design…

by Dr. Wayne Ruga

Innovation is integral with healthcare – throughout the history of healthcare, it has continuously evolved in its effectiveness through progressive innovation.  What is the source of this innovation, who does it, where does it come from, and – perhaps you find yourself wondering, at times – what can I do to contribute my own innovation to healthcare?  If you do wonder this, please keep reading.

The Symposium has been the leading vanguard for innovation in healthcare design since its very beginning.  In fact, Sara Marberry edited a book called Innovations in Healthcare Design that draws from the most innovative presentations during the first five Symposia.  If you read the ‘Table of Contents’ (posted on Amazon), you will appreciate that many of these select presentations are as innovative today – and impactful in their design influence – as they were more than three decades ago.

Now, thirty-six years after the First Symposium, healthcare design innovation is no less important, now, than it was then.  With the current challenges in our world, for example – shifting and aging populations, environmental concerns, new strains and variants of resistant pathogens, rising energy costs, supply chain breakdowns, and shortages of qualified available labor – the urgent need for accelerated healthcare design innovation is probably even more important, today, than it ever was before.

What – precisely – is ‘innovation’, and how can it be distinguished from other types of advances in healthcare?  From my own personal point of view – being a serial innovator – an innovation must fulfil two requirements.  First, it must make a systemic improvement – this means that it introduces something new, something that never existed before, something that changes the status quo and introduces a new way.

The second requirement is that it must be sustainable – by this, I mean that the improvement is not a flash-in-the-pan, flavor-of-the-month trend, fad, or fashion.  Rather, by sustainable, I mean that the improvement continues to improve over time.

The Symposium is an ideal example of an innovation – nothing like it ever existed before – it changed the pattern.  And, it has sustained the test of time, with tens of thousands of attendees participating in it from across the US and every corner of the globe – carrying its pattern-changing messages back into their own communities in support of making their own local improvements.

As the stories about innovation are told – including even many of the presentations we hear at the Symposium – they tell us about the ‘what’.  Most often, these stories describe ‘what’ the innovation is, or ‘what’ it does.  Rarely, if ever, does the story tell us about the ‘how’ – what was the source of this new idea, and how did it come into the awareness of the innovator?

In keeping with the original inspiration that led to the creation of the Symposium – that is, to initiate an intervention that is an ongoing and ever-expanding quest into the inquiry of ‘how can we design the environment to improve lives?’ – this year’s Pre-Conference Workshop is a candid, truth-telling exploration into the sources of innovation from acclaimed pioneers of innovation – each having made recognized improvements to the healthcare status quo that are both systemic and sustainable.

The ‘what’ story that each one of these innovators will present is breath-taking…but – even more importantly – each innovator will also explain ‘how’ their innovation came into their awareness, and how they each gave their innovation the breath of life, to live on in the world and make a sustainable improvement.  The purpose of this unconcealing of the ‘how’ is to provide workshop attendees with the opportunity to look at the wide range range of these ‘how’ stories, to demystify them, and to introduce ways of knowing that attendees can use to make their own discoveries with.

Every innovator goes on a unique journey of exploration and discovery.  Sometimes much of this journey is extremely unproductive – sometimes it might even take years to arrive at a clear discovery – other times, this journey can occur in a fraction of a nanosecond, with vivid and compelling clarity.  It’s impossible to predict, in advance, what the journey will be like – or, even whether or not it will be a productive journey.

The good news, though, is that there are some common characteristics of how we can prepare ourselves to make innovative new discoveries.  The purpose of the Pre-Conference Workshop, at this year’s Symposium, is to enable ourselves to become acquainted with these characteristics, and to clearly articulate them, with the goal of priming the pump and accelerating a new generation of Symposium inspired innovators.  Appropriately, then, this year’s Pre-Conference Workshop has the title of Breakthrough Innovation: Exploring and Learning ‘HOW I CAN DO IT, TOO’.

The structure of the Pre-Conference Workshop has been designed to cultivate the conditions for learning ‘how’ to innovate.  These conditions include:

  1. Specific presentations by accomplished innovators that focus on explaining their ‘how’;
  2. Breakout sessions that enable small discussion groups with attendee-selected presenters;
  3. A ‘speed-dating’ format of the breakout sessions to provide opportunities to have small group discussions with more than one presenter; and
  4. A closing Networking Reception to enable informal one-on-one conversations.

Registration is currently open for this unique Symposium event. This one-time event is a special opportunity for you to have a direct learning experience from those leading pioneers who have already achieved acclaim for their contributions to healthcare, and put your foot on the path that begins your own personal journey of discovery.  Seats are limited, and are available on a first-come, first-served basis.  I encourage you to register quickly – and – I am looking forward to our time together, then.

If you have questions or concerns about this workshop, please feel welcome to be in touch.  I can be reached at:  [email protected] .

 

Check in on others!

Around New Year’s, someone sent me a link to psychologist Naomi Holdt’s Facebook Post about why we are all feeing so utterly exhausted.  It resonated with me and as I shared it with several different friend and family group texts the response was overwhelmingly “oh that is why I feel this way”.  Her primary point was that we all were on high alert and in crisis mode for 2 years, and then leapt back into life in 2022 trying to make up for lost time in every single area of our lives without having properly processed the trauma of what we’d been through.

In Massachusetts, where I live, since New Year’s there have been quite a few high-profile tragedies that involved people killing their own family members and in some cases children.  When these happen so close to your home it’s very hard not to be impacted.  All of the cases have of course in one way or another involved someone with mental health issues that either were not treated or treated incorrectly and lead to unimaginable results. In every instance, the law enforcement officers reporting on what happened have ended by saying something to the effect of if you need help there are resources and if you are worried about someone, please check in.

Over the years at the Symposium, we have shined a light on mental health with sessions about design and construction of behavioral health facilities, keynote speeches from individuals who have survived tragedy and the battle they faced mentally as well as physically and by naming non-profit organizations who bolster awareness surrounding mental health as our charitable organization. We will continue to do our part in bringing these discussions to our annual event.  We will continue to drive the conversation within the industry on creating better behavioral health environments.

Today, however, though I’m focusing more on all of you as individuals. It’s been a long few years.  All of you who work in healthcare supporting the front-line workers;  who had your kids at home for months on end and now back in the classroom and maybe still feeling the effects; whose parents are aging and their care is now falling on you; who have so much work but not enough resources to do it whether that be people or supplies; or countless other stress points.  Be kind to yourself.  Check in on others.  Especially those that are seemingly strong and always in control.

Be well,
Jenabeth

Jenabeth Ferguson
Vice President, Symposium Director
Healthcare Facilities Symposium & Expo

P.S. Have a thought about the Symposium? Please feel free to contact me at any time at [email protected].

Improving the Micro-Hospital Model

Renee Kubesh, AIA, EDAC | Senior Project Manager and Principal | EUA

Healthcare providers increasingly turn to micro-hospitals to deliver quality care to their communities. These fully licensed, 24/7 facilities can help patients with myriad medical issues – including critical care – within a fraction of the space of their full-sized counterparts, typically less than 20,000 square feet.

After more than a decade of operational micro-hospitals, we’ve seen recurring themes in how providers adapt them to meet their evolving needs. We also had the privilege of recently conducting post-occupancy evaluations for two buildings. We offer these top findings as lessons and recommendations for sustaining the success of this healthcare delivery model.

Finding the Right Location

Micro-hospitals can offer convenient and accessible community care when strategically positioned relative to a greater healthcare system’s network. Many existing micro-hospitals are in relatively urban areas. Still, a micro-hospital could be located to reach underserved areas or to enter new markets, even if other providers are already present.

Despite a robust network of hospitals and clinics in the United States, many communities – especially economically disadvantaged and rural areas – lack adequate access to healthcare. Some healthcare systems see micro-hospitals as a solution and a mutually beneficial arrangement: the community gets access to nearby care, and the provider introduces new patients to their system with a relatively small investment. Also, higher-risk patients benefit from connecting to a specialty care network while receiving local, stabilizing, pre-treatment care.

Staffing is vital to this approach. As these facilities are introduced in underserved areas, the municipality and health system have a joint responsibility to foster strong relationships among their constituents and improve local amenities, making the region desirable to medical practitioners as a place to not only work but also live and be part of the community.

Other providers leverage their micro-hospitals to support a “spoke and hub” model of care. Staff triages incoming patients to determine the best care location based on patient needs, staffing and bed availability. This approach works well when assets like a robust network of physicians and access to ambulatory and acute care are already in place. It is also a valuable model for municipalities seeking to revitalize their city centers, as proximity to healthcare is critical in driving downtown living and business development.

Both approaches to locating micro-hospitals have typically assumed the facility will operate as a stand-alone service. But we’ve noticed a trend of using micro-hospitals as anchors for medical office buildings or specialty care services. Patient-centered care and patient satisfaction are enhanced through convenient access to pharmacies, laboratories, radiology departments, ambulatory surgery or specialty care. This allows the micro-hospital to remain true to its core model – lean and efficient – while being able to plug into other services.

Some healthcare systems integrate their micro-hospitals to support a “spoke and hub” delivery model, allowing them to transfer patients, if necessary, to main-hub hospitals or other in-network facilities that offer specialized services.

Integrating Specialty Care

Our healthcare clients increasingly ask for micro-hospitals with more integration and flexibility. They are rightfully concerned about licensing requirements, local patient population needs, and incorporating appropriate demographic specialty care components.

The challenge is meeting those requirements without forfeiting the efficiencies of the micro-hospital model. We often caution our clients from over-engineering or over-programming; the micro-hospitals do not need to meet every patient’s needs all the time. They will still be effective, as staff will attend to patients that require immediate care while stabilizing and transferring others as needed. Over-engineering these facilities can increase the break-even point, slow patient throughput, and hurt patient satisfaction and employee engagement.

If done strategically, it is possible to integrate specialty care while still realizing a micro-hospital’s benefits. For example, one client considered pairing cancer care with the traditional emergency department and inpatient model. With cancer care as a top revenue draw – and considering the distance from the main hospital – this made sense for the provider.

To integrate specialty care effectively and preserve the micro-hospital’s efficiency, healthcare systems should identify the specific components of care early in the building’s design process and review them with the local authority having jurisdiction over the project. The facility may require separate entries, clear identification of dedicated versus shared support areas and code-delineated smoke zones.

In our post-occupancy evaluation, we found it is better to offer radiology as both an inpatient and outpatient service. Radiology for inpatient service is required for licensing, but offering it for outpatient services will increase patient access and lead to a greater return on the high-investment imaging equipment. Future micro-hospital designs should maintain separate access pathways for each type of service to maintain efficiency and reassure patients that they are receiving the care they registered for in the appropriate location.

Supporting Staff and Cross-Training

Micro-hospitals are intended to operate on a lean and efficient staffing model where doctors, nurses, and aides cross-train to provide care to the maximum ability of their licenses. This is a functional approach as long as the staff still find value in their work. Often, burnout is not the result of staff doing too much work but rather from losing touch with the job they once loved.

We’ve heard from staff that they want more time at a patient’s bedside, which allows them to own the patient’s care from arrival to discharge. While it might seem counterintuitive, in a micro-hospital setting, one nurse should provide services ranging from meals to breathing treatments, all at the patient’s bedside. The variety of work counteracts nurse burnout and increases patient satisfaction by developing a deeper relationship with one caregiver.

The hospital’s design should support staff cross-training. A centrally located nurses’ station adjacent to the medication room, lab and storage areas allows staff to help the emergency and inpatient departments during low census counts. At busier times, when both departments may have dedicated teams, the station encourages communication between them so that staff can assist each other.

A centralized nurses’ station allows staff to see what’s happening around them and ultimately deliver better care. We learned from our post-occupancy evaluation that inpatient waiting rooms must be within view of, and ideally adjacent to, the station so nurses can oversee and communicate easily with family members.

Placing the nurses’ station and other support spaces in the center of the micro-hospital makes it easier for staff to respond to patients in all departments.

Incubators for New Ideas and Systems

There is little doubt that micro-hospitals will continue to adopt more technology, and the patient experience will become more virtual. Many providers are leaning into their micro-hospitals as technology incubators because it is easier and more cost-effective to test new technology and workflows in a 10-bed rather than a 100-bed facility.

For example, consider how micro-hospitals might embrace a new registration and check-in experience. Today, patients walk into an emergency department, and the first person they see is likely a receptionist. In the future, this position will be handled by an automated kiosk that scans the patient’s identification and directs them to the appropriate waiting area. Or they may bypass the kiosk altogether; instead, there might be an automated secure door system with advanced wayfinding to support patient self-rooming. The point is that providers are much more likely to try this technology on the micro-hospital scale – with minimal investment – before implementing it in their larger facilities.

Micro-hospitals are also apt testing grounds for improved mechanical systems. We learned from our post-occupancy evaluation that more rooms should have systems that can flex to negative pressure, allowing maintenance staff to respond to potential future pandemics without re-tooling mechanical equipment.

Looking Ahead

Micro-hospitals have a bright future. The model has become increasingly attractive to healthcare systems and patients due to rising construction and healthcare costs. As we continuously look to improve the state of healthcare in our country – whether through enhanced access to care, better support for staff, or new technology – micro-hospitals are fertile ground to test and implement ideas in an already innovative and efficient model.

About the Author: Renee Kubesh believes that architecture makes a difference in people’s lives and is excited to be a part of that dynamic in healthcare. Her healthcare environments empower staff to realize their potential, welcome family and visitors in a relaxing atmosphere, and help patients take control of their treatment and wellness. Over her 30-year-plus career, she has led the creation of spaces that can flex to future needs. She values an evidence-based design approach of understanding and respecting what has worked in the past while making the design and construction process engaging and fun for everyone involved.

About EUA: EUA is best known for designing environments that elevate people’s potential. The respected 115-year-old firm specializes in several markets, including education, workplace, healthcare, senior living, student housing, mixed-use, entertainment, and science and technology. More than 250+ employees in Milwaukee, Madison, Green Bay, Denver and Atlanta demonstrate an unparalleled commitment to the markets, communities and clients they serve. For additional information, please visit the firm’s website at eua.com.

Lasagna Love

Writing this column is sometimes a challenge in December when there is so much going on. Wrapping up year end projects, trying to clear the inbox before time off for the holidays and getting ready for the holidays of course. I often come up with inspiration from what is going on in my life and tie it back to the Symposium. Instead, this month, I’m going to share my story about a grassroots project I got involved with almost two years ago. If you think back to January 2021, it was a pretty dark time for a lot of reasons. One of the ways I survived COVID lockdown and the many, many months of when it was safer at home, was cooking.

I love to cook. It is often how I relax, and it is how take care of the people I care about. Like a lot of you I cooked a lot during COVID, but I really dove into learning new recipes and getting a lot better at techniques I had only dabbled in previously. I was special ordering food online from all sorts of sources to recreate meals I’d had in restaurants or trying recipes I had wanted to attempt for years. It really was a lot of fun and saved my sanity. And then one day I saw a social media post about Lasagna Love.

Lasagna Love is a global nonprofit and grassroots movement that aims to positively impact communities by connecting neighbors with neighbors through homemade meal delivery. They also seek to eliminate stigmas associated with asking for help when it is needed most. Such a simple concept and talk about a way to directly give back to someone in your own community.

I signed up immediately and before I knew it, my Fridays were filled with cooking lasagnas and driving to strangers homes and leaving a hot meal on their steps. It was such a meaningful way to do something for others. In the past 8 months as life has gotten back to a more pre-pandemic pace, I haven’t been able to make as many lasagnas as I’d like. In fact, at one point, I spoke to my regional leader about everything that was going on in my life, including the increased level of care of mother was needing at the time, she suggested that I needed a lasagna made for me. It seemed weird to accept. My instinct was to refuse. And then I remembered the advice I had given to people in my life time and time again . . it is ok to ask for help. I’m terrible at taking it myself but this time I did. And so one Friday afternoon a Lasagna Love volunteer showed up at my house with a lasagna.

The good news is that in recent weeks I’ve been back to delivering lasagnas myself. Last week I delivered to a woman who texted me later she shared it with an elderly neighbor. It truly warmed my heart. Tomorrow I’ll be dropping off a hot lasagna to a mother of 3 whose husband has been picking up extra shifts to support their family.

Every year at the Symposium through our raffle we make a donation to charitable organization supporting worthy causes. Like most of you, as the year end approaches I make sure I’ve supported the organizations that are near and dear to my heart. All of this is important but what I truly value about Lasagna Love is the direct impact it has on someone who for whatever reason needs a little help.

As you are rushing around this time of year, make sure you are also stopping and thinking about what you can do to give back in one way or another to someone who needs a little help.

Wishing you and yours the best this holiday season!
Jenabeth

Jenabeth Ferguson
Vice President, Symposium Director
Healthcare Facilities Symposium & Expo

Thank You!

Last month we gathered in Long Beach for the 35th Annual Healthcare Facilities Symposium & Expo and what a tremendous success it was – with incredible buzz and high energy, compelling keynotes, conference sessions, networking and much more! I kicked off our event sharing some of my personal history with the Symposium and also how it has impacted my family. I thought I would use this space this month to share what I told the audience, with our entire Symposium community as I know not all of you were there in Long Beach.

1998 was the first time I became aware of the Symposium on Healthcare Design (our former name), and I was early in my career producing events, so I wasn’t always focused on the purpose of each event, but the Symposium was different. As the daughter of an engineer, I certainly could appreciate the impact of design on the experiences in spaces.

One year later the Symposium was to take place in Boca Raton, Florida in September but Hurricane Floyd had other ideas. We rescheduled the event three months later in Orlando and for the very first time I learned how to cancel and relaunch an event; skills I didn’t really need again until 2020. Back in 1999, I went to the Symposium and was asked to lead one of the tours and we went to Celebration Health.  Like all of you know, it’s great to talk about healing environments and how design impacts them but there is nothing like seeing it in person. Meanwhile, back home my family was moving my grandmother with Alzheimer’s to a nursing home so when I got home and first visited her, I saw the good and bad about where she was now living. My family thought I was crazy when I said the nursing station was in the wrong location.

Jumping ahead to this past winter, I was once again faced with a family member with Alzheimer’s needing to be placed in a facility.  This time it was my mother and I have been her primary caregiver so the responsibility of picking the right place was on my shoulders. I armed myself with everything I knew about Alzheimer’s and almost 20 years of my career solely focused on the Symposium.  All the hospitals and healthcare facilities across this country I have spent time in, all the sessions I have programmed, all the conversations I have had with all of you.  I felt bad for the folks I was meeting with because they were fully prepared to talk to a daughter looking for some place for their mother, which was a situation they had seen far too many times, but a daughter whose work focuses on healthcare design that was a whole other level of critique.

I visited five facilities and narrowed it down the best two. I will just tell you about one that didn’t make the cut. I met with the woman for over an hour and was really impressed with their programs and philosophies.  We walk into the memory care area, and I notice the residents’ apartments are all down a hallway with zero line of sight to the common areas.  As we walk down this endless hall where all the doors look the same there are handwritten signs on the walls telling ‘John Smith your room is this way’.  And I thought bad design negates all the best intentions in the world. In the end we were fortunate enough to select a facility super close to my home with some very good design aspects.

What I wanted to say to all of you is thank you for the pushing and questioning and changing you’ve done in the past 20 years to make the place I put my Mom so much better than the one my grandmother was in, which was really my Mom’s biggest fear.

Be well,
Jenabeth

Jenabeth Ferguson
Vice President, Symposium Director
Healthcare Facilities Symposium & Expo