Q&A talks about the design and architectural needs of outpatient healthcare facilities with Nicholas P. Michnevitz III, Robynne Orr, Beccah Eldridge, and Eric Bell of MBH Architecture LLC of West Hartford.
Q: We’ve seen many hospitals in Connecticut open outpatient and local medical care facilities in recent years. What’s driving the trend and how has it impacted architectural firms in terms of their core business focus and overall workload?
A: The trend has been driven by cutbacks in healthcare costs due to state mandates and reimbursements tied to the Affordable Care Act. The Center of Medicare and Medicaid Services implemented a “patient-experience” scoring and rating system that has resulted in improvements to facilities infrastructure and overall aesthetics. These mandates have encouraged the reinvention of the delivery care model and how we as designers meet the needs of our clients.
Additionally, the design guidelines for outpatient facilities are typically less stringent than for inpatient facilities resulting in lower construction cost per square foot. New technologies have reduced the invasive nature of procedures resulting in shorter recovery times eliminating the need for extended hospital stays. Ambulatory centers are a great way for providers and healthcare networks to expand their reach into the larger community and provide care to a wider client base.
In terms of our business and work load, the business model for an outpatient facility is different than that of a hospital. Many of these projects are built with a developer-leaseback agreement, so the hospital is not our client but rather a tenant of the building. Our workload has increased and we are proud that our clients trust us to be a part of their team as they evolve and expand to meet the needs of their patients. This is directly attributed to the relationships we have developed over the years.
Q: What are some of the unique features in the designs of the outpatient facilities?
A: The majority of programming and design is focused on branding the image of the provider and healthcare network through the built environment. Patients are empowered by their choice in healthcare providers and the design speaks to what sets a network apart from their competition — convenience, efficiency, daylighting, finishes, sustainability, etc.
The flexibility to integrate ancillary services, like imaging, pharmacy, and laboratories with non-traditional space like specialty food service, business centers, and hospitality styled environments makes the outpatient center an inviting single-point resource for patients, caregivers, and the community.
Healthcare networks are implementing “Lean” processes into their work flow and as designers we need to build in flexibility that evolves with the needs of their dynamic environment. Technology has allowed us to reduce the footprint associated with waiting rooms and patient record storage, but sophisticated building systems and medical equipment have increased the technical requirements.
Q: What’s the biggest challenge in getting these outpatient facilities designed and constructed?
A: Our biggest challenge is not knowing who the final tenant will be during design and what specialty function, services, or equipment might be needed. There is only so much flexibility that can be built-in for unknown factors while keeping the project cost viable. With respect to construction, an accelerated schedule has become the rule rather than the exception, and the traditional design-bid-build process has shown weaknesses.
Q: Your firm uses a Collaborative Project Delivery Approach to construct these facilities. What is that?
A: A collaborative approach brings the key decision makers to the table early in the process. The widely used Construction Manager (CM) project delivery method is similar because the CM is involved during the project’s feasibility phase. The difference is a collaborative approach brings select sub-contractors on board early to provide their expertise on constructability and market conditions during the design phases. These key sub-contractors (who vary from project to project) are interviewed and their fees negotiated similarly to a construction manager rather than being selected through the traditional competitive bid process.
Experience has taught us that the lowest bid does not equal the lowest overall cost or best value; and the higher upfront fees are offset by the savings resulting from their design input and reduced project schedule due to their early involvement. The ability to value engineer and track construction costs during design, and reduce the construction timeline by 25-30 percent on average is transformative.
This means that the team can control costs in a more effective way, ensuring best value the first time the project is documented, and the facility can be operating and generating income in 12-14 months rather than 18 months.
