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vantage CONNECTING THE HERE AND NOW WITH WHAT’S NEXT 20 twenty-one 3 Introduction 4 Topic #1 Bricks and Mortar: Building Better, Faster, Cheaper 6 Topic #2 Caring for a Community of Caregivers 8 Topic #3 The Evolution of Consumer Expectations 10 Topic #4 The Financial Aftermath: Cost-Cutting 12 Topic #5 The Threat of Disruptive Competitors 14 Topic #6 Breaking Down Barriers: Improving Access 16 Topic #7 Designing with Return on Flexibility in Mind 18 Topic #8 Focus on Infection Control: Turning Hindsight into Foresight 20 Topic #9 Making a Difference in Rural Healthcare 22 Topic #10 In Your Neighborhood: Addressing Social Determinants of Health 24 Topic #11 Right Service, Right Place: Service Rationalization 26 Topic #12 Recalibrating Telehealth Demand When the Dust Settles CONTENTS:As we navigated 2020, Kahler Slater engaged numerous health systems in a survey to gauge their perception on how healthcare delivery and the design that supports it has changed and needs to change. We interviewed 25 health systems that comprised a cross-section of the US healthcare landscape — from regional hospital systems to academic medical centers and national health systems to rural hospitals. They shared their experiences and lessons learned through the pandemic, how the pandemic is reshaping the industry, and how it will ultimately impact planning and design. Vantage is the culmination of these surveys, highlighting what your peers perceive as the top trends that will shape healthcare. Several common themes emerged from these interviews, becoming the foundation for this report. Throughout the year, Kahler Slater will continue to explore these themes in our thought leadership series. It has been an insightful journey. We are grateful for the opportunity to bring these voices to our ears. Together, we will have a greater vantage point to view the future — driving the evolution of healthcare toward healthier communities, health systems, and consumers. vantage a place or position affording a good view of something VANTAGE ©2021 Kahler Slater, Inc. 3We need to be prepared for future pandemics. We were fortunate in missing MERS and Ebola and the Swine Flu but COVID taught us that we are all susceptible. That means understanding how to control pandemics, how to treat them, and what does the control and treatment mean in terms of our physical spaces. Vice President, Facilities and Support Services, Academic Medical Center, Northeast HEALTH SYSTEM PERSPECTIVES: Overwhelmingly, our health systems indicated that the need to optimize existing space will be their top priority as they plan for 2021 and beyond. When new bricks and mortar are needed, speed to market offers an opportunity to recoup some of the financial losses from the pandemic. A key to success is engaging project teams early in design to push the boundaries of lean design and construction techniques, ultimately enabling healthcare spaces to be more sustainable. • Health systems were quick to point out that lean can have significant impacts on staff productivity and staff and patient satisfaction while lowering overall building square footage. • Leveraging a virtual health platform will reduce the size and number of exam room spaces across a system. The question is by how much? • Numerous health systems noted that, in their experience, prefabrication and modular construction offer significant speed to market advantages. • Building alternate capacity into the healthcare space and delivering appropriate care in nonacute settings will become alternate strategies to new bricks and mortar. FLEXIBLE AND ADAPTABLE. Among the many lessons learned amid COVID-19, one was about space and the cost of that space. The luxury of space and dollars to support more bricks and mortar is gone; healthcare spaces need to be more flexible and adaptable – all while reducing construction costs and accelerating speed to market. 1 BRICKS & MORTAR: BUILDING BETTER, FASTER, CHEAPER VANTAGE ©2021 Kahler Slater, Inc. 4KAHLER SLATER’S POINT OF VIEW: The key challenge to building better, faster, cheaper will be to align hospitals, health systems, and the entire design and construction team to make lean, modular and prefabrication strategic parts of a bricks and mortar delivery platform. It is critical to an organization’s short-term survival and long-term sustainability to optimize spaces and support flexibility in a care delivery process that may change dramatically – in the case of COVID-19, many processes were forced to change overnight. Leverage opportunities to rethink patient and caregiver flows and the ability to scale. Lean design enables us to reimagine how services can adapt to become more flexible and ultimately more productive. This includes the ability to flex care capacity up and down and shift care across modalities to increase surge capacity. Speed to market is imperative. Innovation in project delivery has pushed the boundaries of traditional design and construction techniques to promote modular and prefabrication strategies. These strategies can deliver exponential improvement over traditional field construction, when entire project teams design to prefabrication or modular construction, not making it fit the design. We were not prepared for the magnitude of the pandemic, and the need for more storage, more PPE, more storage for the PPE, security needs and barriers. And we recognized that some of what we had done from a customer service and flow perspective could hamper our need to control patient and staff flow. Those open, inviting spaces and the welcoming reception space may no longer function. Vice President Facilities and Construction, Six Hospital Regional Health System, South Atlantic Users reporting increased schedule performance. 87% 82% Forecasted increase in use of prefabrication/modular over next three years. 90% PREFAB MODULAR Users reporting greater cost certainty. 81% 88% PREFAB MODULAR $ Source: Prefabrication and Modular Construction 2020. 2020. The Dodge Data & Analytics. VANTAGE ©2021 Kahler Slater, Inc. 52CARING FOR A COMMUNITY OF CAREGIVERS BURNOUT. Recent events focused a powerful spotlight on provider burnout and caring for caregivers. As scenes of tired, bewildered, and tearful healthcare providers have flashed across media screens during the COVID-19 pandemic, a renewed focus on caring for the caregivers has emerged. Provider burnout and dissatisfaction correlate with increases in adverse medical events, lower levels of patient satisfaction, and higher healthcare costs, among other negative impacts. We have devoted space for our caregivers in cancer for a long time; we need to do the same for other caregivers. They experience the same emotional and physical toll and we need to recognize it and respect it. We have to give them spaces to be together or alone, and we need to make the caregiver work space more comfortable. Vice President, Facilities and Support Services, Academic Medical Center, Northeast HEALTH SYSTEM PERSPECTIVES: In a crisis, workers will often ignore their own care. But it is never more important to support caregivers with the resources they need to pause, reflect and recharge. • Many health systems stated that as hospital finances suffered, prime real estate was devoted to revenue- generating spaces. Spaces for staff were often cut in the interest of revenue. • Overwhelmingly, health systems spoke of their gratitude for the tireless and selfless work of both their caregivers and caregivers across the country. Hospital executives spoke of the need to support the well-being of staff. • Health systems also noted the need to provide caregiver amenities in a safe, efficient work environment, expecting it to pay off in staff satisfaction and retention. VANTAGE ©2021 Kahler Slater, Inc. 6COST to U.S. healthcare system associated with physician burnout & associated turnover Source: National Taskforce for Humanity in Healthcare. Position Paper: The Business Case for Humanity in Healthcare April 2018. We have to keep our staff healthy and give them the ability to recharge and manage stress. They are under enormous strain with no end in sight. We need to make sure we don’t make bad choices or bad decisions. We need to give them all the information and support them any way we can. We are wired to be “on” all the time. But COVID is overwhelming. Executive Director Facility Services, Academic Medical Center, Midwest KAHLER SLATER’S POINT OF VIEW: There are now four generations of caregivers in the workforce, each with their own culture, a world view of healthcare, and their role in it. Each generation is looking for different things out of their relationship with their employer, and younger generations are much more willing to switch employers if they perceive a benefit. To cultivate a high-performing workforce, health systems need to begin approaching care providers as consumers, who have a choice about where to deliver their craft. Competing for caregivers on pay alone will not work. It is important to offer a market-rate compensation model tied to other benefits and incentives that demonstrate your appreciation and respect for your caregivers and their contribution to organizational success. $17B 2X 3X the risk of patient SAFETY INCIDENTS in connection to physician burnout Source: Jaime Rosenberg. Physician Burnout Associated with Poorer Patient Outcomes. 2017. American Journal of Managed Care. INCREASED RISK OF ERRORS associated with nurses working more than 12½ hours in a row Source: Rogers AE, et al: The working hours of hospital staff nurses and patient safety. Health Affairs, 2004; 23(4):202-212. The Cost of Provider Burnout VANTAGE ©2021 Kahler Slater, Inc. 73THE EVOLUTION OF CONSUMER EXPECTATIONS HEALTH SYSTEM PERSPECTIVES: Patients have choices – and are increasingly willing to exercise those choices. A strong brand is extremely important in healthcare. However, for all but the most specific of care, patient loyalty is tied to personalized care accessible from anywhere. • Many health systems noted their consumers want help from health systems to stay out of the hospital, leading them to explore community and business partnerships to help consumers focus on a wellness journey. • Patients and providers have adapted to the flexibility and convenience of virtual care. But consumer demands go beyond just virtual care. Health systems said that they are being forced to rethink the entire customer experience, shifting from a provider-centered mindset of scheduling appointments based on provider convenience to a consumer-centered mindset of anticipating rapidly changing consumer needs. • Streamlining the patient experience benefits more than the bottom line. It creates meaningful interactions with consumers. • Building alternate capacity into the healthcare space and delivering appropriate care in nonacute settings will become alternate strategies to new bricks and mortar. ENGAGED. Healthcare consumer expectations are evolving quickly, and health systems are struggling to keep pace with the changes. There was a time when patients went to the doctor, received a recommendation, and did as was suggested. Those days are over. Today, patients have become healthcare consumers, who expect to be actively engaged in their healthcare — and in every decision along the way. They value and expect high-quality, convenient, low-price care, delivered in a culturally-competent manner. They do their own research and share their feedback on social media — especially if it’s bad. VANTAGE ©2021 Kahler Slater, Inc. 8KAHLER SLATER’S POINT OF VIEW: Healthcare and retail are different. Most retailers target a specific consumer segment. Whether by age, gender, location, income level, ethnicity, or some other metric, retailers focus their energies on meeting the needs of a specific consumer persona. Healthcare does not have this luxury. Patient-consumers come from every demographic and every walk of life. Health systems not only give them the services they need, but they also address the myriad of things that stand in the way of receiving those services. Exceptional patient consumer experience is not just about ensuring that patients walk away satisfied and plan to return the next time they need care. Exceptional patient-consumer experiences result in patient engagement that increases compliance with treatment recommendations and on-going care. Consumer experiences have evolved to become omni-channel and health systems need to keep up. Many patients have decided they want virtual and contactless experiences driven by digital tools, but there are just as many who place considerable value on personalized, high-touch engagement. You have to offer both, knowing who wants what, when, and where. Only about 10% of the consumer experience happens at the point-of-care. Much emphasis is placed on what happens at the point-of-care, and that’s important. What’s often overlooked is the other 90% — leading up to and after the point of care. A quality end-to-end experience is what establishes and reinforces a brand’s credibility, driving loyalty, reputation, and word-of-mouth referrals. Simply having attractive buildings with comfortable interiors is not enough; if you can’t back up best-in-class environments with best-in-class processes and experiences, you may wind up with a reputation for having aesthetic buildings but little more. Generations of Americans alive today and accessing healthcare service HIGHER NET MARGINS for hospitals with “excellent” HCAHPS ratings compared to hospitals with “low” ratings. 2.9% AVERAGE INCREASE IN PATIENT REVENUE per adjusted patient day for hospitals with better experience scores. $444 6 70 + You know, providers think that their patients are devoted to them, but they aren’t. For some diseases they may be, but not for routine care. Patients want to be able to get the care they need when they need and at a place that is convenient to them. Chief Executive Officer, Rural Hospital, Midwest It’s interesting in healthcare because we aren’t a Target or a Nordstrom that is trying to appeal to a specific demographic. We have to appeal to multiple demographics with multiple generations. We are on a learning curve. We don’t have all the answers yet. Director, Facility Planning, Twelve Hospital Regional Health System, Midwest Distinct consumer segments with significantly different healthcare utilization patterns and individual demographics Source: The Deloitte Center for Health Solutions. The value of patient experience Hospitals with better patient-reported experience perform better financially. 2016. Source: Experian Mosaic® USA Consumer Segmentation methodology VANTAGE ©2021 Kahler Slater, Inc. 9Next >