2018 Trends: Micro-Hospitals to Gain Popularity

By Alex Ciorogar

As Baby Boomers age—10,000 Americans will turn 65 every day for the next 20 years—the total demand for inpatient care will witness enormous growth. With the number of mental health patients on the rise, micro-hospitals are steadily evolving into consumer-friendly environments, taking their cue from the hospitality industry. 

In addition, architects are prone to further incorporate digital technologies into how both patients and employees interact with and within medical spaces. So what features should health-care designers watch out for in 2018? Architect Jason Carney, partner at Environments for Health Architecture, shared his views with Commercial Property Executive, highlighting the industry’s top trends for 2018.

What are the major trends impacting the health-care industry today?

Carney: The trend of health care as a commodity continues in many different markets across the country. It’s driving the tailored placement of core services at convenient locations and in the design of consumer-friendly spaces that draw from the hospitality industry to attract patients. In these cases, market competition is driving providers to focus on building the “right” styles of facilities, with the “right” services, in the “right” places to attract patients, many of whom are increasingly making health-care provider decisions based on how close a facility is to mass transit, a highway off-ramp or a shopping center. Technological innovation and medical breakthroughs are accelerating changes in the way care is delivered and spaces are configured. 

It certainly seems that industry leaders are moving away from developing inpatient structures, while micro-hospitals are growing more popular. How does your vision fit in this general framework?

Carney: Long-term success of micro-hospitals requires flexibility. As growth occurs or markets change, micro-hospitals need to be able to adapt. It is important to understand the core medical services that are needed in each market to sustain a micro-hospital and how that facility may grow and adapt over time as the market changes.

How can outdated health-care facilities be upgraded and adapted to the needs of patients and staff in 2018?

Carney: Space within an existing hospital campus comes at a premium and must be thoughtfully designed to provide an optimal experience, utilization and return on investment. In some cases, the best choice is to remove outdated buildings and provide for replacement within the existing campus structure. 

One version we are seeing is the creation of the “hospital within a hospital”—essentially, a specialty hospital sited within the existing or reconfigured shell of a larger “host” hospital. These can include maternity hospitals, heart-focused hospitals or other specialty hospitals that sit inside a larger medical center. And whether it’s expanding access to telehealth or creating spaces, where appropriate, that feel more like extended-stay hotels than inpatient hospitals, opportunities abound to reconfigure existing hospital spaces to better serve patients.

How can large-hospital services be integrated into smaller, off-campus facilities?

Carney: One leading solution we see health-care providers opting for is “micro-hospitals,” which are typically 15,000 to 50,000 square feet in size, open 24/7 and providing five to 15 inpatient beds for observation and short-stay use. Micro-hospitals are an affordable, effective way to provide a large variety of big-hospital services in the community, including surgery, radiology, emergency departments and related services.

At least 19 states now have at least one micro-hospital and many more are coming. Now that the Centers for Medicare and Medicaid Services have authorized micro-hospitals that have dedicated emergency departments as being eligible for both 340B discounted drug pricing and the Outpatient Prospective Payment System, we expect micro-hospitals will prove increasingly popular with providers and patients alike.

How can new design features offer better solutions to efficiently accommodate cognitively impaired patients as opposed to older construction types?

Carney: Between the impacts of the national opioid abuse crisis and the rising awareness of mental health conditions, we’re seeing more and more hospitals–such as Connecticut’s Waterbury Hospital and Newport Hospital in Rhode Island–reconfigure their emergency departments (ED) to accommodate cognitively impaired patients more effectively and more sensitively. A big part of this is simply creating spaces for cognitively impaired people that are thoughtfully segregated from areas serving trauma victims or cardiac arrest patients, places where they can receive a behavioral health or addiction management intervention with compassion and dignity.

Spatial arrangements and interior design elements that improve a patient’s understanding and awareness of their environment while working to reduce anxiety are important components of this design. Also, because patients with cognitive impairment and behavioral issues often require longer stays than the general ED population, a definite emerging best design practice is adding features for them such as bathroom showers, places to securely store belongings and access to decompression space.

What can the health-care industry learn from the hospitality sector in terms of design trends?

Carney: We see many hospitals embracing the trend of removing outpatient services from traditional, larger hospitals and moving them into more consumer-friendly, hospitality-influenced environments, like new medical buildings near shopping malls or transportation nodes. These aren’t just spaces that feel more hospitality than hospital—they create operational efficiencies, improve clinical outcomes and reduce readmission rates. There’s also a growing recognition that larger parts of the inpatient hospital experience can be accommodated in less hospital-like environments, which patients prefer.

Could you give us an example of such a project?

Carney: A great example is E4H’s recent work with a New York hospital to create a long-term space for immunocompromised patients going through a procedure such as a bone-marrow transplant (BMT). The first phase of a BMT—surgery and initial recuperation—obviously must take place in an inpatient hospital setting. But in later phases, when patients are recovering and need mainly to be monitored closely for infections or complications, they don’t require a standard inpatient hospital room and can enjoy a much better, less costly experience in a specially designed, hotel-like space.

For our client, we created a space for this “in-between” population that has private, suite-style rooms; specialized water filtration systems to protect immune-suppressed patients; and more of a hotel aesthetic. Patients are served by a concierge instead of a charge-desk nurse. If any of them develop complications, of course, they are quickly detected and patients can rapidly be brought back into the hospital for treatment. But if their recovery proceeds without incident, they can enjoy the equivalent of a long-term hotel stay, instead of long-term hospitalization, after their BMT.

How will telehealth affect the industry in 2018?

Carney: Numbers we’ve seen from the health-care consulting firm Sg2 project that just in the next two years, the volume of virtual health-care patients will rise 7 percent and in-home health-care services will rise 13 percent. Ever-more-sophisticated patient monitors and ever-more-robust communications platforms are allowing more and more patients to enjoy telehealth consults with physicians and care-team professionals. Increasingly, we see telehealth being used to consult with specialists like dermatologists, radiologists, psychiatrists and others without patients having to schedule a second appointment or hospital visit.

How does it impact the actual design of a facility?

Carney: Telehealth is absolutely continuing to grow, and health-care facilities need to be thinking about how to incorporate more of it in their master facility plans. That can mean everything from configuring treatment rooms to accommodate remote consultation and providing infrastructure for broadband video links to heightened attention to the lighting, aesthetics and privacy of rooms in which telehealth consultations will occur.

Telehealth technology is also transforming lobbies, common spaces and admissions areas. Increasingly, these areas are being designed to include accessible areas for kiosks or tablets from which patients can register, view their records or videoconference with a provider. As telehealth continues to expand, we will see changes to staffing models and reduction of provider support space at care locations.

What about augmented reality?

Carney: As we look even further into the future, the use of augmented reality will change the way that patients interact with providers and how providers collaborate, research and plan their delivery of care. 

What can we expect beyond 2018 in terms of trends and challenges in health care?

Carney: Pressures to manage costs, accommodate continued medical and technological breakthroughs and meet the preferences and desires of health-care consumers and practitioners will only grow. New developments in approaches such as gene therapy and bioprinting will drive a greater need for specialized laboratory functions as a component of treatment. Further miniaturization of robotic systems will mean changes in surgery and the way that operating rooms are configured, with a growing emphasis on support for technology-assisted procedures.

Image courtesy of E4H