Arbuckle: Changing models for healthcare delivery; the medical village

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Arbuckle: Changing models for healthcare delivery; the medical village

Tue, 04/04/2017 - 6:34am -- tim

by Jennifer Arbuckle, Partner, E4H Environments for Health Architecture There is a continuing trend throughout the country towards an integrated, “one-stop shop” medical village.  The objective is to modernize and improve care delivery by integrating hospital care with retail, housing, elder care and living systems. As market forces drive the need to streamline, consolidate and achieve greater efficiencies, while consumers expect greater access and convenience, and as reimbursement models favor holistic care rather than periodic treatment incidents, a more comprehensive architectural design approach is needed. The healthcare village approach is evident in the new partnerships forming among healthcare providers, government agencies and real estate companies to pursue these projects, reflecting greater collaboration and a more coordinated way of delivering care. More frequently we are seeing urgent care, elder care, preventative care, health education, and other outpatient services clustered in one-stop shopping destinations.

Medical villages feature flexible, adaptable facilities that are designed to accommodate, and anticipate, evolutions in care delivery and technology. They achieve new efficiencies in how space is used, enabling clinical and administrative services to provide multiple functions simultaneously - reducing overall costs.

Patients visiting a medical village can benefit in terms of time, convenience, and access. They can connect with multiple providers in one location, accessing both primary and urgent care, lab work, rehabilitation services, and pharmacy, while also attending educational and wellness classes, all within walking distance.

E4H Environments for Health Architecture, a nationwide architecture and design firm exclusively focused on healthcare, is at the forefront of this design trend, engaged in many such projects across the country.  E4H’s modular designs focus on creating spaces that can be multi-functional, with maximum flexibility, using the same area, for example, for a rotating specialty clinic one week, and once a month infusion therapy the next week.  Exam rooms are designed to be as uniform as possible, enabling use by any type of provider from psychiatric to cardiology. Likewise, procedure rooms are not dedicated to only one type of procedure, but designed for flexible use. There are shared reception and waiting areas, staff support areas, and bathrooms saving the cost of excess square footage and services. Private offices are minimal, staff work areas are open and collaborative, with areas for private consultation strategically located throughout.   

Some examples of E4H’s medical village projects from around the country, supported by these unique funding partnerships, include:

  • In TICONDEROGA, New York, The entire Inter-Lakes Health campus, which houses Moses Ludington Hospital, is being transformed into “a medical village”. This project entails 26,000 SF of renovations, expected to be complete in late 2018. The hospital will include an emergency department, diagnostic imaging, an outpatient clinic, PT/Rehab, Lab, and Pharmacy. and adjacent on the same campus there will be senior housing, a nursing home, adult home, dental clinic, and a primary care center, as well as hospice care and substance-abuse treatment. The $9 million project is being funded in part by New York's Department of Health. A critical part to the project's completion is the hospital's partnership with the University of Vermont Health Network, which will further enable the system to bring all new modern facilities to serve more North Country patients. This collaborative approach to design will allow the system to bring an expanded array of outpatient services to their patients, without expanding the footprint of the hospital.

This project is supported by New York State’s major grant program, the Delivery System Reform Incentive Program, aimed at a fundamental restructuring of the healthcare delivery system, and reducing avoidable hospital use by 25% over 5 years.

  • The Harker Heights Medical Pavilion, a three-story, 60,000SF medical office building located on the Seton Medical Center campus in Harker Heights, Texas.  Rendina Healthcare Real Estate, one of the largest full-service healthcare real estate firms in the country, developed the building in joint ownership with the many specialists who occupy offices there.  Patients have access to numerous medical specialties all under one roof including family practice, internal medicine, cardiology, general surgery, orthopedic surgery, neurosurgery, plastic surgery, obstetrics and gynecology, gastroenterology, otolaryngology, nephrology, neurology, oncology, rheumatology, and urology. 
  • One of the first such projects E4H Environments for Health Architecture completed was for Dartmouth Hitchcock in Nashua NH. This multi-specialty medical office/ambulatory care building accommodates both primary and specialty care patients in a collaborative environment. Diagnostic testing, endoscopy, MRI/CT, and infusion therapy are provided on site as well as a walk-in clinic for same-day care. Clinical and support programs include pediatrics, family medicine, oncology, internal medicine, gastroenterology, and space for visiting specialists. This 150,000SF space was designed with E4H’s modular approach, creating a Lean environment with extraordinary flexibility for future use. It includes collaborative off stage areas, instead of private physician offices, and saved valuable square footage for clinical space. The design supports this patient-centered Medical Home model where a primary care team, led by the physician, works collaboratively to address the acute, chronic, and preventative needs of patients.

The pace of change in healthcare delivery will only increase in the coming years, with new technologies, medical treatments, and certain economic pressures and changes to payment models. Creative public/private partnerships, integrated campus models and design innovations that can readily adapt will be critical to that future. No one can afford to let space sit idle, so increasing flexibility of usage allows healthcare providers to do more with less and improves the patient experience at the same time.

Jennifer Arbuckle, AIA, NCARB, LEED AP, Partner, E4H, Williston

Jennifer has 27 years of diverse healthcare experience. She has guided many projects from master planning through construction and is a talented planner, architect, and designer. She has worked on projects across New York State and New England, ranging from Children’s Hospitals to Community Medical Centers. She is also the Chair of the Vermont Board of Architects.