Planning in Health Care Facilities - Five Planning Dynamics to Consider
When planning a new health care facility, in today’s changing health care environment, there are five dynamic factors that can potentially make or break a project. In the ‘new normal’, created by the current reform and economy, Providers are expected to deliver and provide greater patient quality outcomes for less financial reimbursement. This creates major challenges for Providers; however well executed planning can mitigate these challenges. Proper planning, executed at the earliest stages of facility consideration, will provide the least expensive solutions while offering the most profound impact on facility development.
Return to the Time Honored Design/Build Approach
When the citizens of classical Greece envisioned their great temples, public buildings and civil works, Master Builders were engaged to both design and construct these monumental structures. Master Builders accepted full responsibility for integrating conceptual designs with functional performance. To assume anything less than complete accountability for delivering a project was unthinkable. Enduring structures such as the Parthenon and the Theatre of Dionysus are testimony to an age and a process that are greatly admired, though the process has been virtually abandoned by modern designers and constructors. Today, however, there is a resurgence of the master builder’s approach in project delivery that centers responsibility with one entity and offers Owner’s better control of design content and corresponding cost.
Sensory Design 5 – Unlocking a Memory
SD5©, or Sensory Design 5, is a user-focused, design philosophy meant to stimulate and engage all five senses; sight, smell, sound, taste and touch, specifically within the health and senior care markets. By integrating SD5 throughout a senior care campus or other health care solution facility the user’s senses are stimulated which creates an understanding of the environment around them. Depending upon previous perceptions of certain stimuli, mental representations are formed providing the user with an extraordinary opportunity of unlocking or enhancing a memory. From the core of the building to the landscape surround, the proper application of SD5 has the ability to enrich the environment giving the user an enhanced sensory experience while creating emotional pleasure.
The components that make up a Memory Care or Senior Care Campus which offer the opportunity of infusing the SD5 design philosophy include a vestibule, living room, a resident café, resident gallery, covered garden, community club room, a country kitchen, spa, discovery courtyard, and backyard courtyard.
The Resident Café, where resident involvement and family participation are encouraged, is one of the most significant spaces that have the potential to unlock or enhance a memory weather it’s baking cookies with your daughter or preparing and smelling a special meal the resident use to prepare for their own family. The Living Room offers back ground music of varying musical style and form inviting the resident to indulge in an enjoyable recollection of past events. Further SD5 components can be applied in the Multifunctional Club Room. These rooms provide space for not only new activity experiences, but to aid in the recall of past experiences or previous hobbies. The Discovery Courtyard can enliven the senses as well and offers residents the opportunity to plant and enjoy sensory gardens. Often times plants and other design elements are selected with intentions of providing a fragrance garden while others may focus on several senses.
There are hundreds of elements to take into consideration when designing a comfortable and effective senior living community or other health care solution facility. To speak with an SD5 expert, please contact Nancy Mooney, Allied ASID at nmooney@pdcmidwest.com or Amy Schoenemann, AIA at aschoenemann@pdcmidwest.com.
“LEAN” PLANNING IS THE KEY
FOR HEALTH CARE DEVELOPMENT EFFICIENCY & COST SAVINGS
5 Strategies for Health Care Providers
Every healthcare provider is faced with the challenges of a health care system in turmoil. There are physician shortages, reduced reimbursement and funding, increased regulatory challenges, demands for higher patient care quality and a general uneasiness about healthcare reform. If higher quality care is going to be required, but reimbursement for the services is going to be reduced: then new sources of efficiency and cost savings will need to be identified and implemented.
A significant key to higher efficiencies and cost savings is the process of Planning in the early stages of a project. This is a comprehensive Planning of all aspects of development prior to any design activities. Strong planning efforts establish the road map to guide future design and avoid inefficient redesign. By establishing “Lean” planning efforts it sets the stage for a Lean delivery process though out the life of the project.
The following chart illustrates the facility development process and the declining opportunity to influence costs as the process unfolds. Even the best of teams have to be wary of impatience and the desire to design the facility too soon; resulting in a stifling of the crucial planning process.
A new awareness and appreciation for the value of “Planning and Programming” is emerging during this recent paradigm shift in healthcare delivery. This activity should include the following five essential components:
1 Conduct a strategic evaluation of the anticipated development.
Sometimes an organization’s mission, philosophy and vision evolve and morph without interim redirection or planning. Should they be analyzed and realigned with new market forces and delivery expectations? Are your Board and Senior Management responding to current operations in a coordinated and cooperative manner that supports success? Will the anticipated development fit your organizational goals and build upon its strengths?
2 Develop a detailed development program.
Programming is a planning tool that studies a future facility’s use and quantifies its potential contents based upon that use. It is more than a list of spaces and areas. Programming is an analytical process that matches health care services strategy with functional uses that support that strategy. The methodology should remove personal opinions and replace them with logical, business based analyses. Any programming discussions that contain the phrase “I like…” indicates a personalization of the efforts and lack of strategic focus.
3 Develop a functional relationships study based upon strategy.
The physical relationship of one space to another has a major impact on the functionality and efficiency of a new development. For example, if part of a health care provider’s strategy is patient-centered delivery; should a physician’s personal preference for arranging examination rooms around their personal office prevail at the expense of patient convenience?
4 Establish evidence based best practices that match health care outcomes to design responses.
Part of a health care provider’s strategic planning should be the determination of the quality of health care outcomes expected from the new development. Reduction of patient falls, increased staff efficiency, reduction of infections, increased revenue, etc. are all strategic health care outcomes that should be identified and paired with programmatic design responses to support the intended outcomes.
5 Test the anticipated costs and financial impact of the projected development.
As the planning process takes form, realistic preliminary budgeting of the development should be created based upon prior experience and empirical data rather than ill-defined or uncategorized “safe” amounts that might be padded to satisfy personal agendas. Budgeting should include a comprehensive consideration of all hard and soft development costs that the project will incur from start to finish. A preliminary pro forma model should then be developed as a viability tool to measure the financial impact of the project as it progresses though the design process.
The assistance of an experienced health care facility developer during the planning phase is an invaluable asset to an organization’s success in determining the best cost-controlled solution to meet intended strategic goals. Please feel free to contact me to discuss how strategic facility planning can contribute to your organization’s success. I can be reached at Wtaylor@pdcmidwest.com.
A REPOSITIONING STRATEGY FOR SENIOR COMMUNITIES
The current business climate for today’s senor care providers is complex and contains increasing risks. More stringent regulatory controls, increasing operating costs, staff retainage, and a seemingly unpredictable senior market are among the daily challenges facing senior management.
Attracting an emerging or shifting senior market with static, inflexible community facilities is often a source of declining occupancies and eroding revenue. A building developed 10, 20, or 30 years ago was designed to serve market expectations of that time – not today. Senior demands are constantly changing and often move away from the premises which created an older community. How can a community adapt to meet new and future senior expectations?
A successful strategy for repositioning an existing senior community is composed of seven basic phases in an integrated, market centered process.
1 Develop a Strategic Plan that answers the questions of:
- Who we are?
- What is our mission?
- What are we doing and how?
- What must change?
- How do we get there?
2 If change is needed, select an Experienced Development Team and incorporate an integrated project delivery with representatives for:
- Market Research, Operations, Financing, Physical Improvements
3 Market Analysis should begin the study process for executing the Strategic Plan and include:
- Demographic Study, Competition Evaluations, Senior Market Attitudes
- Quantification of Emerging Senior Market Demands
4 Community Planning based upon the market analysis findings would incorporate:
- Experienced Design with Evidence Based Criteria
- Facility Improvements to Meet Market Expectations
- Enhanced Building and Site Design
- Furniture and Equipment Planning
- Alternatives and Future Steps
5 Determine Investment Viability with the synthesis of:
- Improvement Budgets
- Projected Financial Performance
- Lender Search
- Loan Capacity
6 Test the Market Assumptions
- Present Improvement Plans to Focus Groups
- Develop Select Groups for Feedback
- Acquire Perceptions and Attitudes to Fine Tune Approach
7 Capture the Market Quickly
- Execute Before the Competition
- Finalized Design Modifications
- Logical Competitive Bidding Experienced Construction
- Marketing During Construction
PDC has assisted dozens of senior communities across the country with developments to protect and acquire market positions. If you would like to discuss how PDC might assist your planning efforts, please feel free to contact me directly at 262-367-7772 or email RGummer@PDCmidwest.com
Economic Recovery Repositioning for Senior Care Providers
Every business is dealing with challenges from the Great Recession and senior care providers are no exception. Add the uncertainty from health care reform, declining home sales with inaccessible equity, a sluggish senior market, and most providers find themselves searching for a clearer crystal ball. Experts say that the worst is behind us and better days are ahead. While this view can be argued, it is clear that a different paradigm for senior care is emerging and planning for the future should include five key issues:
1 Conduct a strategic re-evaluation of your business.
Sometimes an organization’s mission, philosophy and vision evolve without interim redirection or planning. Should they be analyzed and aligned with new market forces and delivery expectations? Are your Board and Senior Management responding to current operations in a coordinated and cooperative manner that supports success?
2 Consider the impact of generational market shift.
The Baby Boomer’s impact to senior care during the last few years has been primarily to influence decisions of their parents. Generational shift is a dynamic, constantly changing market force that has an acute affect to providers. When will Baby Boomers become senior care users and Generation Y begin to impact decision making in your service area? Does your market’s future generational alignment match your service and facility offerings?
3 Determine if aging-In-place has emerged as a critical planning challenge.
Health acuity needs naturally increase for senior residents and an entrenched reluctance for relocation emerges gradually over time. Can your operations accommodate those needs and will your facilities comply with building codes and other regulatory requirements for higher levels of health care services?
4 Evaluate operation cost efficiencies and market competitiveness.
Operational cost efficiency is more than a temporary survival technique during recessionary times – it has become a market expectation. Are you prepared for the “less for more” expectations arising from the economic recovery? Does your business model reflect the expectations of your senior care market and are your facilities helping or hindering your efforts?
5Innovate to increase market access and revenue opportunities.
Think out-of-the-box regarding new business acquisition. Do your discharges or resident requests suggest a new business opportunity? Are you now providing free additional services that could be formally structured to enhance income? Are there diversification or expansion strategies that could both mitigate risk and offer new revenue streams?
Consulting with an experienced senior care facility developer may be of assistance at this crucial time in your organization’s planning. Please feel free to contact me, Bob Gummer at rgummer@pdcmidwest.com, to discuss how strategic facility planning can contribute to your organization’s success.
