ALL YOU EVER NEEDED TO KNOW ABOUT THE HEALTHCARE DESIGN

INDUSTRY

Physician

Centers

Care Facilities

These are the main types of facilities…

87%

4% 7%

2% 0%

5,724 Hospitals in the U.S.

Community Federal Nonfederal Psych Nonfederal LT Care Other

Source: American Hospital Association

58% 21%

21%

4,973 Community Hospitals in the U.S. NGO not-for-profit Investor-Owned for-profit State & local government

Source: American Hospital Association

Family Planning

8%

Mental Health/Substance

Abuse 30%

HMO Medical Centers

2%

Kidney Dialysis

14%

Freestanding Surgery, Eds

16%

Other 30%

566,000+ Outpatient Centers in the U.S.

Source: U.S. Bureau of Labor

2012: $33B Projects Completed

$37B Projects Broke Ground $54B Projects Designed

Source: Modern Healthcare

TREND: Less investment in big

projects; more in upgrades or additions to meet the

challenges of the ACA, which emphasizes accountability,

affordability, and patient access.

TRENDS: Greater focus on

infrastructure and technology, hospital-physician integration,

and outpatient facilities.

Program requirements

Healthcare clients want facilities that are…

March 2011 1

HCAHPS Survey

SURVEY INSTRUCTIONS

i You should only fill out this survey if you were the patient during the hospital stay named in the cover letter. Do not fill out this survey if you were not the patient.

i Answer all the questions by checking the box to the left of your answer. i You are sometimes told to skip over some questions in this survey. When this happens

you will see an arrow with a note that tells you what question to answer next, like this:

� Yes ; No Î If No, Go to Question 1

You may notice a number on the survey. This number is ONLY used to let us know if you returned your survey so we don't have to send you reminders. Please note: Questions 1-22 in this survey are part of a national initiative to measure the quality of care in hospitals. OMB #0938-0981

Please answer the questions in this survey about your stay at the hospital named on the cover letter. Do not include any other hospital stays in your answers.

YOUR CARE FROM NURSES

1. During this hospital stay, how often did nurses treat you with courtesy and respect? 1� Never 2� Sometimes 3� Usually 4� Always

2. During this hospital stay, how often did nurses listen carefully to you?

1� Never 2� Sometimes 3� Usually 4� Always

3. During this hospital stay, how often did nurses explain things in a way you could understand?

1� Never 2� Sometimes 3� Usually 4� Always

4. During this hospital stay, after you

pressed the call button, how often did you get help as soon as you wanted it? 1� Never 2� Sometimes 3� Usually 4� Always 9� I never pressed the call button

2 March 2011

YOUR CARE FROM DOCTORS

5. During this hospital stay, how often did doctors treat you with courtesy and respect? 1� Never 2� Sometimes 3� Usually 4� Always

6. During this hospital stay, how often did doctors listen carefully to you? 1� Never 2� Sometimes 3� Usually 4� Always

7. During this hospital stay, how

often did doctors explain things in a way you could understand? 1� Never 2� Sometimes 3� Usually 4� Always

THE HOSPITAL ENVIRONMENT

8. During this hospital stay, how often were your room and bathroom kept clean? 1� Never 2� Sometimes 3� Usually 4� Always

9. During this hospital stay, how

often was the area around your room quiet at night? 1� Never 2� Sometimes 3� Usually 4� Always

YOUR EXPERIENCES IN THIS HOSPITAL

10. During this hospital stay, did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan? 1� Yes 2� No Î If No, Go to Question 12

11. How often did you get help in

getting to the bathroom or in using a bedpan as soon as you wanted? 1� Never 2� Sometimes 3� Usually 4� Always

12. During this hospital stay, did you

need medicine for pain? 1� Yes 2� No Î If No, Go to Question 15

13. During this hospital stay, how

often was your pain well controlled? 1� Never 2� Sometimes 3� Usually 4� Always

14. During this hospital stay, how

often did the hospital staff do everything they could to help you with your pain? 1� Never 2� Sometimes 3� Usually 4� Always

Patients are being asked about their experience…

Healthcare Specialists

There are many different jobs in healthcare design…

Source: Modern Healthcare

Source: Modern Healthcare

Best Practices

Healthcare clients expect their designers to be proficient in many areas…

8

Best Practice Tools

The analysis of user experiences during design is a common practice

as well. Over half of participants also said they either usually or always

analyze patient and caregiver movements so that resulting designs

are lean and improve user workfl ows.

Building Information Modeling / Virtual Design and

Construction (BIM/VDC)...

When your organization executes major healthcare facilities

projects, how prevalent are the following practices?

Utilizing BIM/VDC

Patients/caregivers sharing experiences during design

Analyzing movement to design lean workfl ows

Using Evidence-Based Design (EBD)

Attaining LEED for healthcare certifi cation

Attaining Net Zero and/or energy independence

*Provider and architect responses were similar

Always Usually Sometimes

BIM/VDC was identifi ed more than any other design and

construction practice as a tool that is always utilized in major

projects. Both healthcare providers and architects see many

strong benefi ts of BIM/VDC (see lower right-hand chart).

All Respondents*

Almost Never Never

Evidence-Based Design (EBD) was utilized somewhat less on major

projects than other practices. However, 50% of healthcare providers

said that interest in EBD is growing signifi cantly at this time, which was

more than what was reported for either BIM/VDC (20%) or LEED (32%).

As found in last year’s study, some architects struggle with the

practical utilization of EBD. For example, 47% do not feel there is a

suffi cient base of quality evidence available to utilize EBD broadly on

projects, and 60% agree that in too many cases EBD is simply used as a

persuasive tool to help market a predetermined design.

Although energy effi ciency was mentioned as an important goal by

many participants, LEED certifi cation, Net Zero operations, and other

similar goals were pursued the least on major projects among the

practices evaluated.

Enhances team collaboration and

integration

Provides a value- added tool for future facility management

Improves construction process effi ciency

Results in a better design

Improves design process effi ciency

Strongly Agree Agree Disagree

41% 26% 24%

22%46%28%

26%

13% 33% 44%

33%37%

43%26%

13% 36% 25% 23%

20%

4%

4%

9%

6%

6%

6%

4%

4%

32% 58% 10%

30% 58% 10%

30% 64% 6%

28% 58% 14%

27% 61% 12%

Source: Mortenson Construction 2012 Survey

9

Delivery Method Trends

Comments from Healthcare Providers

“We’re looking at IPD to get more stakeholders involved earlier.”

“IPD offers better collaboration, budget, and schedule efficiencies.”

Comments from Architects

“IPD offers more partnering and teaming opportunities and brings the whole team on board early in the process.”

“Clients believe they have greater control over cost and schedule with DB, but as more see the successful results of

IPD projects, they are considering this option.”

When your organization executes major healthcare facilities

projects, how prevalent are the following practices?

2011 Survey

Providers

Architects

Integrated Project Delivery (IPD)

Architects

Design Build (DB)

Providers

2012 Survey

2011 Survey

2012 Survey

2011 Survey

2012 Survey

2011 Survey

2012 Survey

There was a large increase from our survey a year ago in the

portion of healthcare providers who said interest for IPD was

growing within their institution.Alternative delivery methods such as Design Build and the more

recent emergence of Integrated Project Delivery (IPD) aim to enhance

project collaboration and outcomes by aligning the goals of project

participants and involving parties early in the process.

Of respondents who have never entered into a formal IPD

contract, 18% nonetheless said they use behaviors / functions

affi liated with IPD. This “behavioral IPD” approach may offer a

straightforward option to achieving integrated project goals.

At the same time, fewer architects now perceive growing interest in

Design Build. Interest in IPD was thought by some architects to come

at the expense of DB. Like healthcare providers, many architects are

attracted to the early teaming opportunities IPD aff ords.

It remains unclear how well the actual practice of IPD will be received.

Only half of architects who have used IPD would recommend it for a

future project, and while just seven healthcare providers in our survey

have used IPD, none would recommend it for a future project.

68%

54%

83%80%

44% 46%

72%

55%

Source: Mortenson Construction 2012 Survey

Influencing Facility Design

Top trends shaping how healthcare is delivered are…

Home

Ambulatory Procedure Center

Urgent Care Center

Retail Pharmacy/Clinic

Diagnostic Imaging Center

Physician Clinics

Wellness/Fitness Center

Hospital

Health Reform = More Clinic Based Care

1/3 of people in the U.S. between the ages of 65-70 are still working.

Nurses in their 50s are expected to become the

largest segment of the nursing workforce.

Exhibitors at HCD

Furniture, fixtures, etc. usually costs between 2-4% of the construction budget…

TRENDS: Modularity, connectivity,

comfort, cleanability

Nurture by Steelcase’s Regard

www.transparency.perkinswill.com

Which products are safe to use?

Industry Associations/Organizations

Some of the industry influencers…

www.healthdesign.org

This is a great

resource.

www.fgiguidelines.org

Another great

resource.

Licensure Government-issued,

mandatory, entry level, generally but not always by

state.

Licensed architect, interior

designer

Certification Voluntary, non-government

assessment of a level of compliance or specialized

knowledge. Usually given by an association for a specific

profession.

AAHID, ACHA, IFMA, EDAC,

LEED

Accreditation Voluntary, formal evaluation to

provide recognition or credentials. Generally given to

an organization, not an individual.

Joint Commission,

LEED

What credentials do you need? Depends on who you are and what you want to do.

BUILT ENVIRONMENT RESEARCH

DOES EXIST MORE THAN 1200 STUDIES

And what about Evidence-based Design?

EBD Definition

Source: Center for Health Design

It’s a Process, Not a Prescription

�HDR ArchitectureCentral Washington Hospital:HQDWFKHH��:DVKLQJWRQ EBD Goal:

7R� LQFUHDVH� FDUHJLYHU� HIÀFLHQF\�through the implementation of evidence-based design strategies in the design of a new patient bed tower at Central Washington Hospital.

Challenge:

(%'�67(36�$33/,('�

Solution:

To achieve this goal, HDR was challenged to integrate the latest research findings, EMR technologies, evidence-based design strategies and Lean operational efficiencies into the patient tower design. Specifically, the design team hypothesized that building a standardized and same-handed patient room would decrease errors and increase caregiver efficiency.

Lean studies were performed during programming through construction as staff transitioned into the new facility. A workflow analysis was completed as part of a comprehensive process improvement study of travel patterns for nurses and doctors using handheld PDA devices that track staff travel times. This same study was repeated one year post-occupancy in the new bed tower. Data collection for the PDA study was done with “Time Study RN”, a PDA handheld used by the nursing staff. The PDA alerts them at random intervals to indicate their location, what task they just completed, and what task they are currently completing. This was used to track clinical behaviors and to identify opportunities for improvement for the newly designed space.

Three units were analyzed including Critical Care, Medical Oncology and Obstetrics. The care delivery time results were then compared against “Time Study RN” benchmarking data and were stratified into value-added, value-enabling, and non-value-added time categories. Travel densities were also vetted indicating over 49% of nursing travel was spent between patient room and nurse station or document server. This provided clear direction for designers that decentralized workstations could decrease travel distances for clinicians. Layout optimization was then used to map processes in the new design layout. Travel distances were calculated and new workflow processes were identified. The travel study indicated for all units measured, that the time spent on value added care, the time spent on direct care, and the aisle effectiveness all increased from current to future state workflow and generally outperformed the national benchmarks for their corresponding unit types.

Additionally, HDR conducted a post-occupancy evaluation, (POE), one year after occupancy. User focus groups were held to gather feedback from the staff on how well the design of the building supports their work processes. A survey was also distributed to supplement the findings of the focus groups. The POE revealed that overall the staff is very satisfied with the design of the new facility. The surveys also revealed areas in communication and technology that were not functioning properly and have since been addressed.

� �2 � 73 6 8

�

Source: Center for Health Design

Who’s Following the Process?

Better design

solutions

EBD: Design decisions to

improve outcomes

Lean: Design decisions that create more value using

fewer resources

How are EBD and Lean Related?

FINALLY What do you need to do to

pursue a career in healthcare design?

1. Get EDAC certified 2. Create a killer resume 3. Join LinkedIn, Google+ 4. Read Healthcare Design 5. Talk to people 6. Explore all opportunities

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