As we peer into healthcare’s future, it’s clear that we’ve reached the end of “one facility master plan to rule them all.” The old way is too expensive and cumbersome for the value it provides.
A nimbler model uses data and design thinking to set broad, enterprise-wide targets in a strategic plan composed of service line master plans. These focused plans ask important questions such as “How can we deliver diagnostic imaging services in a way that optimizes staffing, yet still reaches all patients?” Or “How can we deliver all our surgical services and maximize real estate assets?”
This approach gives healthcare systems a more flexible way forward. The strategic plan is the compass pointing toward the future, while service line master plans are the turn-by-turn GPS directions to get there. If you make a wrong turn on Microhospital Street, it’s easier to reroute on to Ambulatory Service Center Drive without invalidating the entire plan.
- Diagnostic Imaging plans. A top-tier quaternary care institution wanted to use their electronic medical record data to forecast the demand in 10 years for diagnostic imaging equipment throughout their network of nearly 400 imaging suites across 37 different sites. The transition to EMR systems like Epic and Cerner has created an unprecedented opportunity to match the distribution of facility resources to not only current patients, but also to the forecasted future trends.
We compared the geographic distribution of patients to the regional demographics, and then overlaid those maps with 20-minute drive-time polygons. We saw quickly that the client had great coverage within their traditional territory, but a large percentage of their patients were in areas beyond the 20-minute drive time and located in areas with strong forecasts for growth.
Additionally, many patients were driving past multiple facilities before arriving at the imaging center where they had appointments. With a new understanding of the market, the institution shifted the focus of its service line master plan from expanding existing facilities to finding new real estate assets closer to their underserved patients.
- Interventional Platform plans. Surgical services are changing how interventional services are delivered in both inpatient and outpatient settings. Many formerly inpatient procedures requiring lengthy recovery times are shifting to an outpatient setting, leaving hospitals with a higher proportion of complex cases and more invasive diagnostic modalities.
The line is also blurring among what can be accomplished in a catheter lab versus an interventional radiology lab versus an electrophysiology lab. This leads many facilities to designate them as “image-guided labs” and place them in the interventional platform as well. This consolidation helps maximize real estate assets because these services share in the benefits of having a semi-restricted “red line,” with one-way-flow, pass-through, staff-changing procedures and access to full post-anesthesia care units (PACUs).
Again, EMR data analysis unlocks additional flexibility for the SLMP. A larger interventional platform needs to be served by a larger post-anesthesia care unit, but data shows how to share excess capacity between service lines to balance surges. We fed historical trends for PACU patient arrival rates into a queueing theory model to create a more accurate forecast for how many PACU bays were needed without clogging the ORs.
- Integrated Pre-op and PACU bays. Similarly, preoperative bays typically experience a spike in demand early in the day when all the ORs are starting up, then see a drop of 30% to the steady-state demand for pre-op bays. Data informs us that the pre-op and PACU bays can be blended into an integrated department, eliminating the need to build enough pre-op bays to meet the morning surge. If all the bays are PACU capable, and the nursing staff is cross-trained, the morning pre-op patient spike can be absorbed by empty bays used later for PACU patients. As the day progresses, surges in PACU demand can be absorbed by empty pre-op bays.
By using service line master plans to deliver a service throughout the enterprise, we can think systemically and separate our planning from focusing on a single campus or major building. If external factors derail a particular project, the plan can endure and adapt by shifting to other parts of the system. The narrower scope of these plans also enhances the value of data analytics in uncovering new insights and future trends.
One caveat: while it is often surprising how far clinician perception varies from actual data, and focusing on service lines leads to more objective decisions, we should always temper the reliance on data with the clinician’s business acumen. They are the front-line heroes who will steer us toward a future mapped by the strategic plan.
Eric Peabody is an architect and principal medical planner for Taylor Design, an architecture, strategic planning and interior design firm with five offices throughout California.