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Holland Basham Architects
Healthcare Top 10 Trends, Challenges, Initiatives & Solutions
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Healthcare Top 10 Trends, Challenges, Initiatives & Solutions The Owner’s Perspective: Jeff Prochazka,
Director of Strategic Planning, Methodist Health System
“How are we responding to Changes in Healthcare delivery & reimbursement?”
The Architect’s Perspective: Patrick Leahy, Director of Planning, Research and Innovation for Holland Basham Architects (HBA)
“Art, Science and Faith, why do Architects need to understand current HC trends?”
The Planner’s Perspective: Jim Easter, Principal, Easter Healthcare Consulting (Ehc)
“Isn’t Planning Changing to Asset Management and Dollars?”
The IT/IS/Systems Perspective: Alan Dash, Principal, The Sextant Group
“How Will IT/Medical Communications Change our Vision for The Future?”
Holland Basham Architects
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Learning Objectivesa. Learn measurable solutions from Hospital System addressing National and
Regional Trends and market changes.
b. Creatively assess and evaluate planning and design solutions from Architect’s perspective (evidence based and programmatically grounded).
c. Apply strategic and functional planning to Future designs based on appropriate trends, design innovations and solid business objectives.
d. Measure the results and respond accordingly.
Healthcare Top 10 Trends, Challenges, Initiatives & Solutions
Holland Basham Architects
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Future Healthcare
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Top 10
Increase outpatient care
Reduce re-admissions
Reduce infections
Improve HCAHPS scores
Decrease of rural hospitals
Big getting bigger & Branding
Doing more with less
Evidence-based design
Technology tools
Population health
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stop worrying about your financial future
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What are you Doing now to change?
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Do something Remarkable
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Top 10
Increase outpatient care
Reduce re-admissions
Reduce infections
Improve HCAHPS scores
Decrease of rural hospitals
Big getting bigger & Branding
Doing more with less
Evidence-based design
Technology tools
Population health
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Population Health
1
Holland Basham Architects
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Education & Community Engagement
UNO Community Engagement Center
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Role of Medical Center
CHI Health Bergan Mercy
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Healthcare should be part of the community
Midtown Crossing
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Gretna Clinic
Role of Community Based Clinics…
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Proactively Keep People Healthy
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Keep people out of the hospital
Population Health1
Holland Basham Architects
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Population Health1
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1
Preventative Care
Population Health1
Prescribe-a-Bike
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What is the Future of the Clinic
Miller Orthopedic Specialists
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Population Health1
CHI Health Immanuel – Outpatient Rehab Center
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Population Health1
CHI Health Immanuel – Outpatient Rehab Center
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Nurse Practitioner / Coordinating Professional
Endocrinologist
Pharmacist
Physical Therapist
Community Health Partner
Dentist
Nutritionist
Patient
Holland Basham Architects
Integrated Care Team1
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Population Health - Broken Exam Rooms1
Steelcase Health
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Population Health1
Steelcase Health
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Exam Room Exam RoomConsultation room
Population Health
Mayo Clinic 2006
1
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Mayo Clinic – Executive Health
1 Population Health
Separate Consultation Zone
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Population Health1
Steelcase Health
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Population Health1
Steelcase Health
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Population Health1
Steelcase Health
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Population Health1
Consult inside Exam Room
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Population Health1
Minimize Infection – Integrate Supplies
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Population Health1
How we Integrated Supplies
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Population Health1
Clean Design with Integrated Supplies
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Population HealthSmaller Consult Desk1
How To Design A ‘Smart’ Hospital - Healthcare Design magazine March 10, 2014
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Pop. HealthSmallest Consult1
Exam Room Innovation
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Distribute Care Closer to Home
Holland Basham Architects
Population Health1
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Holland Basham Architects
Population Health1
Children’s Physicians clinics all area locationsHBA Children's Clinics in red
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Holland Basham Architects
Population Health1
UNMC | Nebraska Medicine Main Campus and 9 Outpatient Locations
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Holland Basham Architects
Population Health1
Methodist Health Systems Locations
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Population Health1
CHI locations
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Holland Basham Architects
Population Health1
CHI Health Clinics (ACO) NE and IA region
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Holland Basham Architects
Population Health1
Regional Provider Network (ACO) & all NE Hospitals
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Increase Outpatient Care
2
Holland Basham Architects
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Understand Retail & Experience Design
Lovely Skin - retail
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Think like Hospitality
Element Hotel
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Holland Basham Architects
Increase Outpatient Care2
Methodist Physicians Clinic - Gretna
Location Location Location
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Increase Outpatient Care2
Existing inpatient hospital with some outpatient
Existing: Mercy Medical Center – North Iowa
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Existing inpatient hospital with some outpatient
Increase Outpatient Care2
Existing: Mercy Medical Center – North Iowa
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Green field healthcare campus > % outpatient
Increase Outpatient Care2
Master Plan: Memorial Hospital, Belleville, IL
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Added outpatient services & free-standing ED
Phase I
Increase Outpatient Care2
Master Plan: Memorial Hospital, Belleville, IL
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Increase Outpatient Care2
Holland Basham Architects
Clear wayfinding
CHI Health Midlands
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2
Holland Basham Architects
Strip Mall ConversionEase of Access
Increase Outpatient Care2
Miller Orthopedic Specialists
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Increase Outpatient Care2
Retail exposure
Eye Surgeons Associates
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Holland Basham Architects
Appeal to market
Increase Outpatient Care2
GIIK ORTHO SPECIALISTS
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Reduce Re-Admits
3
Holland Basham Architects
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Reduce Re-Admits3
2,225 hospitals pay fines for excess readmissions
2012 Penalties, 2013 KaiserHealthNews.org
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Schedule follow-up appointment prior to discharge
Reduce Re-Admits3
Miller Orthopedic Specialists
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Privacy
Reduce Re-Admits3
CHI Health Began Mercy
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Reduce Re-Admits3Standardize Processes – Reduce ErrorsChecklists for all processes
World Health Organization
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McKesson’s Approach to Readmission Reduction
Risk Identification
Care Transition
Post Discharge
Measurement
Reduce Re-Admits3
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Apps to Reduce Readmissions
Reduce Re-Admits3
Propeller Health
SeamlessMD
GetWellNetwork
Vocera Care Experience
Sick weather
Doctor On Demand
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Reduce Medical Errors and Infections
4
Holland Basham Architects
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Reduce Medical Errors and Infections4
Medicare Bonuses and Penalties 2014
Holland Basham ArchitectsKaiser Health new – 2015-01-22
Hospital Size Penalty (Avg.)1360 Hospitals
Bonus (Avg.)800 of 1700 Hospitals that qualified
> 400 Beds $1.2 Million $213,000
<200 Beds $131,000 $32,000
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Holland Basham Architects
Reduce Medical Errors and Infections4
Centers for Disease Control & Prevention and the World Health Organization
did not exist a century ago.
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Reduce Medical Errors and Infections4
Between 44,000 to 98,000 deaths/year due to medical error in U.S.
Holland Basham ArchitectsSource: Institute of Medicine (IOM) “To Err is Human”, 1999
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No. 3 killer in the U.S. third only to heart disease and cancer
-Tejal Gandhi, MD, Harvard Medical School
1000 deaths per day10,000 serious complications
-Joann Disch RN, University of Minnesota
Source: Senate Subcommittee on Primary Health and Aging, July 18, 2014
4 Reduce Deaths & Complications due to Medical Error
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Source: Senate Subcommittee on Primary Health and Aging, July 18, 2014
"What these numbers say is that every day, a 747, two of them are crashing. we would not tolerate that degree of preventable harm in any other forum."
4 Reduce Deaths & Complications due to Medical Error
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0%10%20%30%40%50%60%70%80%90%
100%
MedicalSurgical
Communication failure among healthcare providers is one of the
most frequently cited causes of preventable harm to patients:
Agency for Healthcare Research and Quality, June 2008
Rounding: A Time For Communication
Reduce Medical Errors and Infections4
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Reduce Medical Errors and Infections 4
Communication
Voice
Alerts
Text
EMR
Medical Reference
Barcode Scanning
Holland Basham ArchitectsVoalte
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Holland Basham Architects
Reduce Medical Errors and Infections4EMR inclusive of all patient services
CHI Health Mercy
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Holland Basham Architects
Reduce Medical Errors and Infections4
7,000 medication errors per year…
Source: Institute of Medicine (IOM) “To Err is Human”, 1999 & FDA 04/12/2013
Likely more, as voluntary reports
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Holland Basham Architects
Reduce Medical Errors and Infections4Prescription Bar Code Scanning
CHI Health Bergan
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Reduce Medical Errors and Infections4
Holland Basham Architects
Reduce hospital acquired infections
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Reduce Medical Errors and Infections4
Holland Basham Architects
Strategies to reduce risk of infection
Target high-touch areasEmphasize hand washing among staff and visitors
Stress technique over chemicals
Follow the directions
Consider risks of using sporicidal sterilantsDetermine effects of chemicals on materials and people
Assemble multidisciplinary teamsCheck each other’s work
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Reduce Medical Errors and Infections4
Holland Basham Architects
Biggest advancement in healthcare, improved
HyGreen
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Reduce Medical Errors and Infections4
Patient Room 2020 – NXT Health
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Reduce Medical Errors and Infections4
Patient Room 2020 – NXT Health
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Improve HCAHPS Scores
5
Holland Basham Architects
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Improve HCAHPS Scores5
Holland Basham Architects
Hospital design impacts patient experience
Private Rooms
Minimized Noise
Internet Access
Access to Daylight
Nature-Based Art
In-Room Family Areas
Meals On Demand
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Improve HCAHPS Scores5
Holland Basham Architects
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Improve HCAHPS Scores5
Holland Basham Architects
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Improve HCAHPS Scores5
Holland Basham Architects
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Silver Cross Hospital
IP InPatient Experience Design
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Fewer Rural Critical Access Hospitals
6
Holland Basham Architects
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Fewer Rural Critical Access Hospitals6
2/3 of critical access hospitals could close
Modern Healthcare August 17, 2013
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6 Stop the Assault - on Critical Access Hospitals
healthleadersmedia.com 2015
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Fewer Rural Critical Access Hospitals6
Administration’s 2016 budget axe is triple whack at critical access hospitals:
eliminates critical access designation for hospitals closer than 10 miles from the nearest hospital, which would create projected savings of $770 million.
reimbursements cut from 101% to 100% of costs, which is expected to save the federal government about $1.7 billion over the next decade.
zeroed out funding for Area Health Education Centers, which provide recruiting and training for rural medical staff. Already a great workforce shortage in rural America.
Source: HealthLeaders Media , February 4, 2015
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Fewer Rural Critical Access Hospitals6
Rural Healthcare already hurting:
Sequestration, DSH, bad debt, and other types of cuts have already hit rural hospitals hard.
"Forty-seven rural hospitals have closed since 2010, and 283 more are on the verge of closure.
If this occurs, 700,000 rural patients will be without access to their closest point of emergency care.
Source: HealthLeaders Media , February 4, 2015
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6 Critical Access Hospitals
Centers for Medicare and Medicaid Services 2013
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6 Critical Access Hospitals – Midwest Distribution
Centers for Medicare and Medicaid Services 2013
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Holland Basham ArchitectsAll Nebraska Hospitals
Fewer Rural Critical Access Hospitals6
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Holland Basham ArchitectsAll Nebraska Hospitals
Fewer Rural Critical Access Hospitals6
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Fewer Rural Critical Access Hospitals6
“They would either go to more expensive urban hospitals ordelay care until more expensive”
Republican Sen Chuck Grassley, IA
Modern Healthcare August 17, 2013
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Critical Access Hospital – Other Trends9
Holland Basham Architects
Becoming Large Clinics with <10 Beds + ED/UC
Exam Rooms that Flex to Impatient Rooms
Inpatient Rooms that Flex to Exam Rooms
Early Adopters of new Imaging & Treatment Equipment In Example: 3D Color Ultrasound, CT and MRI.Or do the simple things that work with Care and Empathy
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Big Getting Bigger& Branding
7
Holland Basham Architects
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Big Getting Bigger and Sharing of Best Practices7
Clinically integrated networks
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Holland Basham Architects
Big Getting Bigger – partnerships, working agreements or ACO’s7
Regional Provider Network (ACO’s) & Regional Partnerships
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Big Getting Bigger Branding7
Branding
Holland Basham Architects
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Branding7
Branding
Holland Basham Architects
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Branding7
Branding
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Branding7
Old Brand: Basic & Sameness
New Brand: Distinction & Quality
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Branding – Clean Modern7
Chicago Lincoln Park Upper West Side NYC
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BrandingContext or Region Character7
Mason City ASC
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BrandingInside compliment the outside7
Mason City ASC
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BrandingMaterial Consistency and Exception7
Mason City ASC
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Branding7
Brand Architecture, Signage and accessory structures
Holland Basham ArchitectsMemorial Hospital, Belleville, IL
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Doing More With Less
8
Holland Basham Architects
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Doing More With Less8
Less revenue per patient
Holland Basham Architects
$Increase in patient population
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Doing More With Less8
More patients
Holland Basham Architects
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Doing More With Less8
More patients, older, & sicker patients
Holland Basham Architects
older, & sicker patients
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Doing More With Less8
Remote eICU monitoring
CHI Health Mercy
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Doing More With Less8
Holland Basham Architects
Comprehensive Planning=Strategy + Operations + Facilitates + I.T. + Finance +
Real Estate Evaluation + Physician Integration
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Charrette – 4 day Iterative design eventDoing More With Less8
Memorial Hospital, Belleville, IL
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Holland Basham Architects
Charrette – 4 day Iterative design event
Doing More With Less8
Client Workshop Client Workshop
Client Workshop
Kick-Off Presentation
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Doing More With Less8
Lean design & planning
Mercy Medical Center – North Iowa
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Evidence Based Design
9
Holland Basham Architects
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Evidence Based Design9
Holland Basham Architects
evidence-based design - research conclusions
View of Nature Shortens length of Stay
Natural Light Shortens length of Stay
Flooring best for Infection Control
Quiet for patient sleep
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Evidence Based Design9
Holland Basham Architects
Benefits of Evidenced Based Design
Better Outcomes / reduce HAI’s
Develop Best Practices
Design that works better for patients
While also being Innovative & Inspire
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Evidence Based Design9
Holland Basham Architects
Benefits EDAC Advocate firm.
Credentials and Knowledge recognized
Center of Health Design partner.
Access to EDAC Knowledge Repository
Knowledge of process.
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Technology & Tools
10
Holland Basham Architects
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Technology & Tools10
Smart Strategy®
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Technology & Tools10
Data Analysis & real-time Predictive Forecasting
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Reduce Re-Admits3Standard Processes - Optimize Work FlowsMeasure, Compare, Adjust, Publish
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Reduce Re-Admits3Heat Mapping TrafficMeasure, Compare, Adjust, Publish
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Reduce Re-Admits3 Design Strategy – Nurse View
Oklahoma Heart InstituteHillcrest Heart Pavilion, Tulsa OK Project by Mark Vaughan, Research by (Zadeh & Kadse, 2009)
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Reduce Re-Admits3 Visibility New Layout
Visibility, Existing Layout
Visibility, New Layout
The new design layout has
significantly improved the visibility of
the patients from nurse stations by
25%
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Reduce Re-Admits3 Walking Distance
As the color changes from orange to blue, the walking distance of the space to the
nurse station increases.
Existing Layout
Nurse location
Distance level 1
Distance level 2
Distance level 3
Distance level 4
New Layout
There is sufficient evidence that
the new design layout has
decreased the walking distances
from the patient rooms to nurse
stations by 33%
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Technology & Tools10 Better Patient Experience
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Technology & Tools10
Easy to Clean & Integrated Technology
Patient Room 2020 - NXT Healthcare
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Technology & Tools10
Caregiver Hub – Sealed Keyboard
Holland Basham ArchitectsPatient Room 2020 - NXT Healthcare
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Technology & Tools10
Caregiver Hub – Closed
Holland Basham ArchitectsPatient Room 2020 - NXT Healthcare
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Technology & Tools10
Improvement on tradition devices
Holland Basham ArchitectsPatient Companion - NXT Healthcare
Better Patient Experience
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Technology & Tools10
Holland Basham ArchitectsPatient Room 2020 - NXT Healthcare
Design for assistance
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Technology & Tools10
Design for assistance
Holland Basham ArchitectsPatient Room 2020 - NXT Healthcare
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Technology & Tools10 Patient Lift
Holland Basham ArchitectsHill-Rom HCD 2013
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Technology & Tools10 Concealed Patient Lift
Hill-Rom HCD 2013 Holland Basham Architects
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Wearables - Encouraged healthy lifestyles
Technology & Tools10
Fitbit Surge & dashboard - wearables will soon be able to connect to your healthcare provider.
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Technology & Tools10
Smartphone + wearable integration + Physician Connected
Holland Basham ArchitectsApple Watch, 100 of new Apps in development
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Primary Care Office Visit for Existing Patients Holland Basham Architects
Yelp type Price Comparison for Patients
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Holland Basham Architects
CONTACTS Jeff Prochazka
Methodist Health System
Patrick Leahy
Holland Basham Architects (HBA)
Jim Easter
Easter Healthcare Consulting (Ehc)
• Alan Dash
Sexton Groupwww.TheSextantGroup.com
Thank You