As a firm focused exclusively on healthcare design, we help healthcare institutions envision and realize their operations within the most appropriate setting. Never before has our job been more difficult – as the operations of healthcare are being forced to change to accommodate different patient and payment structures. But at the same time, it is also quite an honor to be in healthcare right now – as the roles that we all play, will undoubtedly have a huge impact on our communities’ future.In the past, we would sit with our clients and help to envision their future – we were used to asking questions, receiving answers and then collaborating on a solution to satisfy their needs. In most cases, we would identify a need for more Emergency Room beds, a conversion of semi-private patient rooms to private rooms, a new cancer center – or, as was the case before 2008 – brand new hospitals on a brand new campus. Array does this very well – As an architecture firm dedicated to healthcare – that came pretty easy.Nowadays though, we’re not the ones asking questions.

Our clients have been thrown into a strange new ocean, where they are treading water in a shifting tide and are wondering at which angle they should swim to get to a more secure location. Our clients are the ones with the questions. Now, it’s our job to help contemplate where to go and how to get there . . . and only then can we develop an environment that might be appropriate.Here are some of the issues we are hearing from hospital administrators – they’re looking for thoughts on:

• How to integrate and align physicians with a more standardized, controlled operational model.

• How to account for reduced Medicare reimbursement while not adversely affecting patient care.

• How to provide care to more people when they’re already experiencing a shortage of nurses and doctors.

• How to decrease re-admissions and hospital acquired infection and increase patient satisfaction to maximize reimbursement.

The overarching goal, it seems, is this: Health Providers and Health Insurers must provide complementary resources – be them financial, intellectual or physical – to provide an efficient, highly effective mechanism to ensure the health of a population.

To achieve this goal, we’re finding there to be four critical drivers that can either facilitate or inhibit the achievement of this goal. The four drivers hospitals must get right are:

1) Access:

• Who is the patient?

• What is the market?

• How do we reach these patients best, educate them, empower them to participate in their own wellness and have them come to us when they really need care?

2) Operations:

• As patients change, the business of delivering healthcare changes, the responsible party changes, the expectations change and – yes – the reimbursement changes --- How must operations adapt to support these changes?

3) Technology:

• The Electronic Medical Record should be revolutionizing the way healthcare is delivered. Implementation is costly and requires huge operational and cultural shifts. But a robust integrated IT infrastructure is the only way to effectively manage the population, standardize care, maintain compliance and participate in active, real-time, reporting (as opposed to historical reporting).

• Technology can improve Access.

• Technology can improve Operations.

• Technology can actually improve reimbursement.

4) Environment:

• The healthcare environment must change to support the new way of doing business. If you are building a hospital, expanding your emergency department, considering a new Ambulatory Surgery Center or even looking to build what was once a simple medical office building - I hope you have stopped to consider the changes that need to be occurring INSIDE these buildings and are not building the same of what you already have. The answer is not simply – we need more medical office space to house the new docs we’ve hired.

The Patient Protection and Affordable Care Act may have thrust us into this shifting ocean, but it was out of necessity – the business model was broken – so now we all need to figure out a way to be prepared. At Array, we’re working with many hospitals across the country to contemplate this change and make sure they’re making the right adjustments to their operational and building infrastructure.