Earl Wilson: Master Planning in an Era of Change

Architectural planning

The Master Planning Paradigm

I am often asked, “What the heck is a Master Plan, and why do I need one; and if I have one, how often do I need to update it?”

Your Master Plan is your road map to getting where your facility needs to go, and of successfully navigating through this era of change. The more up-to-date your map, the better you will be able to plan your journey around hazards and avoid unnecessary road blocks.

The old rule of thumb regarding how often healthcare providers need to update their master plans was about every three to five years. That time frame was a convenient place holder. The real answer is any time there is a change in your organization’s internal or external circumstances, such as new regulations, changes in the marketplace, mergers and realignments, or shifting census conditions. The current healthcare environment is undergoing a seismic shift like in no time in recent memory. Any organization that is not prepared can face extinction, or at the very least can lose out on opportunities for improvement and growth.

The pressures and obstacles are coming from all directions:

– Rising operational costs — compounded with changes in reimbursement;

– Tight access to capital that still hands on from the credit restructuring of 2008;

– Aging staff – coupled with on-going staff shortages all across the board;

– And the emergence of disruptive technologies and the “e-patient.”

Any one of these issues will cause any healthcare facility manager, and his or her CEO, many a sleepless night. Compound these with the shift from the current episodic model of care to preventative care, and you have the perfect storm that only those that are well prepared will survive.

Healthcare’s Seismic Shift

So what should healthcare provider organizations be planning to meet in this new era? The following are the top 10 trends for the future of healthcare.

1. Increasing Volume. The “Silver Tsunami” is already upon us. Ten years from now, patients will be living longer. Added to the increasing number of patients over 65, expect more patients of all ages. Setting political and regional differences aside, the ACA, coupled with the numbers of Baby Boomers reaching retirement age, has had profound impact on the numbers patients seeking care.

2. Increasing Complexity. Acuity levels will rise. It is no secret that seniors have more chronic illnesses than youth, thereby requiring more intensive treatment. Until population health becomes the norm, this trend will not abate.

3. More uninsured. Employers are already shifting costs to their employees. Providers must be prepared to expect reduced insurance coverage and more cost sharing. Some health systems have set goals to reduce costs of upwards of 30% in order to meet reductions in coverage.

4. More and More Information. The amount of information available to the clinician will increase exponentially. This will bring increased data demands, but also the potential of better decisions and outcomes. The challenge for healthcare organizations is in managing the sheer volume of data and putting it to practical use through improved analytics, while keeping patients’ information safe. The promise is that information will be available to the clinician on best practices, instantly.

5. Better Outcomes. 1.3 million fewer patients were harmed in hospitals between 2010 and 2013. DNA chip technology and genetic fingerprinting are beginning to see promise in the design of patient-specific drugs in the treatment of certain cancers and other diseases.

6. Technology Reigns Supreme. Technology holding the promise of driving more efficiency. 70 million people in the U.S. are using wearable tracking devices, and the use of mobile health apps doubled in the past two years, with no signs of slow-down. [1] This means that patients will be able to monitor their own statistics and communicate with caregivers off-site.

Mobile Health App Adoption

7. The Risk Is Shifting. As the total healthcare costs in the U.S. have grown by over a Trillion dollars to 3.5 Trillion in the past five years alone, health plans are taking steps to limit their risk by paying increases to those that they must pay, and reducing payments to the rest. Providers will be given what is left, unless they develop strategies to demonstrate value. The challenge for healthcare providers will be in balancing cost savings versus the quality of care. [2]

National Health Expenditures

8. The Patient Will Be the Ultimate Consumer. Hospitals are now rewarded (or punished, depending on your point of view) based on patient satisfaction scores. Patient scorecards will only assume increasing importance. This places renewed emphasis on improving patient satisfaction scores. But the real measure of patient-centered care will be how patients become engaged in managing their own health.

Patient Satisfaction

9. The New Front Door to Healthcare is Here…and People Like It. The Emergency Department is rapidly fading away as the second front door to the hospital. The new front door will be retail healthcare. While a majority of patients still prefer a doctor’s office of the hospital for treatment of minor episodes or managing chronic conditions, 79% of people who have used retail and urgent healthcare rate the experience as equal or better than traditional sites of care.[3]

Urgent Care Options

10. A Different Definition of Success. In order to reduce readmissions, many health systems have formed alliances with post-acute care (PAC/CCN) organizations to provide a more comprehensive continuum of care. With the move to value-based healthcare, providers will need to seek partnerships with companies outside of traditional healthcare. Provider differentiation will not be based in outcome statistics alone, but in how patients perceive the care they receive. The definition of success will be based less on who has the best outcomes, and more on the ability to innovate.

The Future of Medicine

The Take Away

Healthcare is in the process to rapidly migrating to new models of care that will embody new staff roles and truly collaborative planning to achieve the best outcomes. Ambulatory care entities, post-acute home care and retail clinics are just the beginning of the changes we are seeing in response to these disruptive pressures.

Success in this new era will require new levels of strategic thinking. Healthcare providers will need to build teams across aligned entities and focus on optimization of care, rather that worry about who will take care of whom.

As the core operational & design attributes of a “hospital” have shifted from stand-alone buildings to integrated healthcare systems, your master plan needs to be your “road map” for navigating towards implementation of your strategic vision. If you have not visited it in a while, perhaps it is time to reexamine its relevance in this new era.

Article Written By: Earl Wilson, NCARB, EDAC, LEED AP

Earl Wilson is the Senior Medical Planner for HMN Architects, Inc.

He can be reached at: ewilson@HMNarchitects.com


[1] Price Waterhouse Cooper, HRI Consumer Survey, 2013, 2015.

[2] Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Expenditures, September 2014.

[3] Oliver Wyman, Consumer Survey, 2015.

Posted on July 12, 2016
Category: HMN News & Updates

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