Author: Tim Prince, MHA, FACHE | Senior Advisor, Strategic Project Alignment, Findorff

Threading the needle of providing high-quality care, being an exceptional place to work, managing costs, and maintaining a positive bottom line continues to be extraordinarily challenging work. Payor mix degradation, retention and recruitment challenges, and rising prices on supplies exacerbate already difficult gymnastics of keeping a hospital running.

So, should you really worry about your buildings and spaces?

Buildings, in and of themselves, are not strategies. Rather, they are tools that can be used to implement strategies. And like any tool, it needs to be the right one for the job at hand.

With all the daily operational challenges, wouldn’t it be great if your spaces worked for you and not against you?

To stay in sync with reimbursement, staffing, and procedural and technological innovations, you likely have strategies tied more and more to ambulatory services, technology enhancements, and even primary care medical home concepts. You probably also have strategies tied to efficient interventional services and an integrated continuum of care to keep patients out of the hospital.

But still, you, along with everyone, need the actual hospital.

That hospital, those spaces, need to be built well, at the greatest value cost, built to last, and built to the right purpose! We can only do that if process, efficiency, and intent of care are the core drivers of how those spaces are designed and built. We need to think about new healthcare processes and make sure our facilities support them. We need to think about advanced ways to provide care and then design the right building to support success. This kind of strategic success requires the right resources and investment — and a whole lot of preparation and planning.

The right team can help you figure out what you’re trying to accomplish with a facility investment and then make sure that investment is well managed in the process of getting the facility built.

Take the time to ensure that you know what you’re getting yourself into. Bring in experts to walk you through and manage the project process. And take time upfront to truly define what you’re trying to accomplish. Then you can launch your facility project in a way that directly aligns with your strategic and operational intent.

Findorff applies a process of Strategic Project Alignment and Target Value Delivery to help make sure you avoid the “scope of hope” and instead target a realistic project that achieves the desired operational outcome. As a starting point, ask yourself the following to help determine your project readiness:

• Do you have a project roadmap and know the key mileposts along the way?
• Do you understand the phases of project delivery and the importance of the right decisions at the beginning?
• Have you fully aligned total project costs with your budget?
• Have you considered both first-dollar and life-cycle costs?
• What is your plan to assure cost-efficient constructability of the design while also achieving flexibility for long-term adaptability?
• Is your project delivery approach compatible with your culture?
• Are you confident that you can identify the best project implementation plan for you and your project and select the best project delivery team?
• Do your leaders have the skills, experience, and time to facilitate project implementation while also staying focused on daily operations?
• Do you have a communication plan and process to coordinate, monitor, and report on progress?

A new or renovated healthcare facility project is as complicated as it is important. You know what you need the project to deliver. We know how to facilitate the process so that it can do so. Contact us with any questions — we’d love to help at any or all steps along the way.

Author: John Ford, AIA, NCARB, EDAC, LEED AP | Senior Design Architect and Associate

How can hospitals be more resilient, flexible, and efficient in unprecedented and unpredictable situations? How can they improve the patient experience, outcomes, and staff efficiency and satisfaction?

In March 2020, as the COVID-19 pandemic began, our client – a Wisconsin-based healthcare provider – faced a significant challenge. They had only 34 beds available at one of their hospitals and projected demand of up to 250 beds by early May. Instead of setting up alternative care facilities that could disrupt staff workflow and safety, our client chose to modify its existing inpatient rooms, creating more intensive and intermediate care capacities. This innovative approach allowed them to respond dynamically to the pandemic’s changing needs. The effectiveness and efficiency of this solution left no doubt about the future direction of the inpatient infill project the provider had been considering: universal care rooms.

What are Universal Care Rooms?

Universal care rooms, or acuity adaptable rooms, represent a best practice in inpatient room design. Unlike traditional inpatient rooms designed for a specific level of care – such as ICU, intermediate care, or general care – universal rooms offer more flexibility. They can adapt to any level of care, allowing patients to stay in the same room throughout their hospitalization, regardless of changes in their condition or treatment needs. This adaptability inspires a new way of thinking about patient care, where the environment adjusts to the patient’s needs, not the other way around.

Starting in 2021, our team had the privilege of continuing an ongoing partnership with our client to implement 28 universal care rooms. The rooms have delivered high-quality care since they went live in 2023. What makes them successful are a few critical differences from traditional inpatient rooms:

• More infrastructure like additional medical gas outlets, electrical outlets and dialysis connection capabilities
• Increased clearances for emergency response, in-room procedures and life support equipment at the head of the bed
• A full bathroom with a shower
• Family space to promote family-centered care
• Windows for direct patient observation, which is required for ICU-level care
• An advanced patient vitals monitor, which can be controlled remotely from the hallway charting station
• Negative pressure capability, allowing treatment of patients with airborne infectious conditions like COVID-19, SARS or Tuberculosis

These features contribute to a more adaptable, efficient, patient-centered healthcare environment. They enable the hospital to swiftly adjust to varying patient needs without the logistical challenges of moving patients between specialized rooms. This flexibility is crucial in emergencies or when dealing with fluctuating patient acuity levels, ensuring the hospital can maintain the highest standard of care without delay. Moreover, including family space and direct observation capabilities supports not only the patient’s physical health but also their emotional well-being, making these rooms a holistic solution to patient care.

Universal care rooms are more adaptable than standard in-patient rooms and have the infrastructure required to treat a range of patient acuity levels.

A Win-Win for Patients and a Hospital’s Bottom Line

The flexibility of universal care rooms better equips healthcare providers to deal with mass casualty events, pandemics, or natural disasters, as they can quickly adjust the number and type of beds available to meet the demand. They also have specific patient and staffing benefits.

Universal care rooms improve the patient experience by eliminating the need for transfers between different units, which can cause stress and confusion, medical and medication errors, communication gaps, or patient dropping incidents. The rooms also reduce challenges associated with transferring patients with an airborne infectious condition – instead, patients can remain in the same room for their entire hospital stay. For patients requiring dialysis, in-room connections can enhance their experience by avoiding travel to another part of the facility. Reduced traveling also puts less strain and stress on visiting family members.

Universal care rooms integrate advanced technology to expand care access and overcome staffing challenges. Rooms usually incorporate telemetry, allowing for remote monitoring of patient vitals. Care teams can monitor patients via telemetry monitors placed in the nurse stations and along hallways. Many rooms also have electronic ICU (eICU) care equipment, bringing telehealth to the patient’s bedside. eICUs include a camera and a dedicated monitor, enabling specialists to conduct exams remotely.

Despite these benefits, many hospitals have – understandingly – been slow to adopt universal care rooms because of two primary challenges: up-front construction costs and qualified staff. However, both are easy to overcome if we consider the potential costs and challenges of not implementing universal care rooms.

When completing the universal care unit with our client, the team encountered higher initial costs from more medical gas, electricity, dialysis, eICU and equipment hook-ups, as well as the mechanical systems to accommodate positive and negative pressurization capabilities. However, these are small costs compared to the renovation and downtime in converting a typical inpatient unit to an ICU. Shutting down an inpatient bed wing for a 12- to 18-month renovation has a significant financial and operational impact. Universal care rooms allow hospitals to scale up their ICU rooms immediately without compromising the quality of care or the patient experience.

While design alone cannot solve staffing challenges, architects can help hospitals implement flexible spaces that empower health systems to provide the best possible care. These flexible spaces accommodate different patient acuity levels and the appropriate responses by the care team. They might include:

• Collaboration zones and nurses’ stations, which are the primary staff work areas and have sight lines to the universal care rooms
• Office-like workspaces, which are more private than the nurses’ stations and allow team members to work individually or collaborate on a patient’s treatment plan
• Focus rooms that are unassigned and available for various uses, such as a temporary charting area, a private area for small-group meetings or a quiet space for difficult conversations with family members

Equally important, these spaces may double as respite areas for staff to recharge and connect with their colleagues, which are essential for staff well-being and retention.

A staff-only area at our client’s universal care unit provides a place for connecting with colleagues, charting and respite space away from the patient’s bedside.

Design Considerations

Designing and operating universal care units is an exciting experience. Yes, there’s more to think about than when creating a traditional inpatient unit. Still, this part of the process offers opportunities to make the staff’s job easier and improve the patient’s experience. Here are a few design opportunities that require careful consideration and discussion between the design and stakeholder teams.

Visibility

Uninterrupted sightlines allow nurses to monitor patients better. Visibility becomes even more critical when the project team anticipates that the rooms will frequently treat high-acuity patients.

It is important to remember that universal care rooms are not meant to replace true ICUs, which always have high visibility into the rooms and typically have a nurses’ station across the hall for constant monitoring. Because they are designed to care for various patient acuity levels, universal care rooms may not always have this degree of visibility. Instead, they might have a centralized nurses’ station with decentralized charting stations outside the room. The design team should discuss with the hospital’s stakeholders the degree of visibility appropriate for each project.

Like ICUs, universal care rooms require clear sightlines from the corridors and nurses’ stations.

Toilet rooms

Full toilet rooms with a shower – instead of the dreaded Swivette or partitioned toilet often found in a traditional ICU – create a better patient and family experience. Generally, toilet rooms should be along the exterior wall or between every two patient rooms. Outboard or mid-board-nested-room designs provide maximum patient visibility from the corridor. They also make it easier for many team members and equipment carts to enter the room simultaneously, as is required when a patient codes or during other emergencies.

We opted for inboard toilet rooms at our client’s hospital because the infrastructure was already in place for this setup, which generated substantial cost savings. A project’s exact toilet room location will depend on the specific visibility requirements established by the care team and hospital leadership and the building’s existing conditions (if the project is a renovation).

Individuals of size

Universal care rooms can accommodate patients of different acuities, but individuals of size have different needs and challenges. They may also have higher risks of complications and need more staff assistance and monitoring. Patient lifts are typically incorporated in universal care rooms to transfer patients and reduce staff injury. Universal care units should include special rooms for individuals of size that have additional clearances for larger beds and toilet rooms. Special toilets, sinks, showers, and grab bars should be designed to accommodate these patients.

Positive-pressure rooms

Through the flexibility inherent to a universal care unit, pressurization can become negative in a bank of rooms, half the unit at one time, or through the entirety of the unit. These zones allow for better isolation and infection control of patients with airborne diseases. While negative-pressure rooms help prevent the spread of airborne diseases, positive-pressure rooms are needed for patients with weakened immune systems, such as those undergoing chemotherapy or organ transplants. Positive-pressure rooms create a higher pressure inside the room than outside. They prevent potentially contaminated air from entering the room, protecting patients from acquiring infections from the environment or other patients.

Space for staff and equipment

Universal care rooms have more staff space to accommodate intensivists, respiratory therapists, pharmacists, and other staff joining the care team as the unit flexes into high-acuity mode. Patients with higher acuity also have a greater demand for equipment, so the equipment storage rooms should have sufficient space for ventilators, dialysis, and other life support equipment.

Design Approach

Universal care rooms are a frontier for many healthcare providers. Perhaps more than any other hospital space typology, they require designers and engineers who know best practices, what works and the challenges a project team might face. These qualities come from experience and listening to and observing how hospital staff use the rooms and equipment. Our team used the strategies below at our client’s hospital to ensure a successful design.

Focus on the staff experience throughout the design process. We engaged staff because they are the primarily universal care room users. The input and feedback of the doctors, nurses, and support personnel running the rooms are invaluable in creating a functional and efficient design. We conducted surveys, interviews, workshops, and simulations with the staff to understand their needs, preferences and challenges. We incorporated their ideas and suggestions into the design.

Design with an integrated and Lean approach. These design approaches involve collaborating with the owner, contractor and consultants from the early stages of the project. We used Lean principles and tools to optimize the project’s value, quality, and efficiency, including Gemba walks, process mapping, and mockups to eliminate waste, reduce cost, improve safety and enhance performance. We also used 3D modeling and virtual reality to visualize and test the design and to communicate and coordinate with the entire project team and the staff.

Complete post-occupancy evaluations (POEs) to learn for the next project. Learning is continuous; every project is an opportunity to improve and innovate. After serving patients and staff for nearly a year, our client’s universal care rooms are undergoing a systematic assessment. We collect data and feedback from the staff, patients, and project team and analyze it to identify the design’s strengths and weaknesses and areas for improvement and enhancement. The results from these assessments will be available soon.

The lessons we learn from each project inform and guide the next one. For example, based on our experience, we helped our client move the charting stations—usually at the head of the patient’s bed—to the foot of the bed. This shift provides more space for other critical equipment to treat higher acuity patients.

The project’s design and construction team mocked up the headwall of a universal care room to help stakeholders test the room’s layout and equipment placements.

A Future-Ready Solution

Universal care rooms are vital to the future of healthcare, representing a move towards resilient and adaptable facilities. They also underscore the role of collaborative design in solving complex challenges, blending flexibility, technology, and a solid understanding of both patient and staff needs.

Implementing these rooms at our client’s hospital demonstrates their significant benefits: enhanced patient experiences, streamlined care delivery, and an improved capacity for the provider to manage emergencies and varying demands. This project sets a benchmark, showing the impactful role of architecture in health outcomes and operational efficiency.

Our team is prepared to offer insights and work alongside those looking to advance their healthcare facilities. This collaboration aims to address current challenges while preparing for what lies ahead. To learn more or to discuss potential projects, please reach out. Let’s work together to create better healthcare environments through strategic design and innovation.

Alexandra Urrutia-Comas, MHSA, FACHE, is a distinguished healthcare leader serving as the Vice President of Operations at Aurora St. Luke’s Medical Center, a prominent healthcare institution within Aurora Health Care, now part of Advocate Aurora Health. With a Master of Health Services Administration from the University of Michigan and a Bachelor of Arts in Health Administration and Policy from the University of Maryland Baltimore County, Alexandra possesses a robust educational background complemented by over a decade of hands-on experience in healthcare administration. Her career journey includes progressively challenging roles, from her tenure as an Administrative Fellow at the Clement J. Zablocki VA Medical Center to her leadership positions at Wheaton Franciscan Healthcare and Aurora Health Care. Notably, Alexandra’s expertise extends to operations improvement, strategic planning, and executive leadership, underscored by her Lean Certified status and active engagement as a Wisconsin Regent for the American College of Healthcare Executives. Alexandra’s commitment to diversity, inclusion, and professional development is evident through her involvement in various organizations, including her current role as President of NALHE WI (National Association of Latino Healthcare Executives, Wisconsin Chapter). Her dedication to advancing healthcare leadership and fostering a culture of excellence makes her an invaluable asset to the healthcare community and beyond.

ACHE-WI 2023-2024 Leadership Development Program (LDP) Cohort XIV kicked off their 2023 Site Visits in Green Bay, spending the morning at BayCare Clinic and then traveling to Prevea Health for the afternoon on June 21^st. Our early careerists met with senior leaders and learned about unique aspects of each organization. The group was privileged to participate in engaging discussions with key executives about leadership strategies and gained valuable insights and career advice along with some unexpected swag to remember the inaugural visit as a cohort.

Key takeaways included: Surround yourself with people who are smarter than you. Get to know people and build relationships; take time to understand politics at work and impact on others in the industry. Honor your moral code. Get rid of stupid stuff – “GROSS” (waste). Be curious, not judgmental (leadership tips from Ted Lasso). Advance through Availability – Competency – Behavior. Network and commit to continuing education and mentorship. Don’t be afraid to fail.

The day started at BayCare Clinic Corporate Headquarters with networking and breakfast, prior to interactive sessions with Ashwani Bhatia, MD, FACP, CPE, Chief Executive Officer & Chief Medical Officer; Tony Violetta, MPA, Chief Operating Officer; Karen Miller, MSN, RN, CHPN, Chief Quality Officer; Mike Schmidt, MBA, Director of Marketing & Business Development. LDP cohort member Sherrie Dorow, MBA, CMPE co-planned and hosted the high impact site visit.

The cohort then traveled to the Prevea Health Executive Office for a welcome lunch, followed by insightful and enlightening sessions with key executives including Ashok Rai, MD, President & CEO; Jason Helgeson, MS, Senior Vice President and Chief Operating Officer; Paul Prichard, MD, Senior Vice President and Chief Quality Officer; Larry Gille, JD, Senior Vice President and General Counsel Prevea, Vice President Legal Affairs HSHS WI Division. The cohort capped off the day with a staff tour of the new Ambulatory Surgery Center, led by Luke Mitchell, MBA, Director of ASC, Prevea Health. LDP cohort member Milan Patel, MHA co-hosted the site visit, and welcomed his LDP student mentee Ryan Leitzinger to share in the experience.

ACHE-WI LDP Cohort XIV members include: Aly Capp, John Davis, Sherrie Dorow, Kiefer Jundt, Nora Kopping, Ben Meyer, Kaila Mitchell, Samuel Meyers, Milan Patel, Kalli VandenHeuvel. The cohort was joined by LDP co-chairs Aaron Kinney, FACHE and Kathleen Olewinski, FACHE, and LDP committee member Jessica Vogen who shared photos from the eventful day.

LDP Cohort XIV Site Visit at BayCare Clinic in Green Bay

Pictured (left to right): Dr. Ashwani Bhatia, Mike Schmidt, Aly Capp, Ben Meyer, Sam Meyers, Kiefer Jundt, Sherrie Dorow, John Davis, Kaila Mitchell, Tony Violetta.

LDP Cohort XIV Site Visit at Prevea Health in Green Bay

Pictured (left to right): Kathleen Olewinski, Ryan Leitzinger, Milan Patel, Ben Meyer, Aly Capp, John Davis, Kaila Mitchell, Kiefer Jundt, Sherrie Dorow, Aaron Kinney, Sam Meyers, Jess Vogen.

LDP Cohort XIV Tour of Prevea Health Ambulatory Surgery Center in Green Bay

Pictured (left to right): Kiefer Jundt, Sam Meyers, John Davis, Kaila Mitchell,
Ben Meyer, Sherrie Dorow, Ryan Leitzinger, Milan Patel.

Meet the Author

We can’t think our way out of stress or forget that we are biological beings. Resilience’s ground zero involves controlling our sleep patterns before anything else. Without this, we are more stress sensitive during the day, our hunger hormones spike, we overeat, and we are less prone to exercise. It’s a downward spiral, and the starting point is bedtime.

At its core, well-being is driven by brain chemicals. The good and bad news is that our behavior directly shifts the neurotransmitters in our heads. When dopamine is higher, we feel motivated. If we want to feel more driven, we can exercise for 30 minutes, take a two-minute cold shower, laugh, dive into the early morning, drink coffee, or get sunlight in our eyes first thing. All these activities raise dopamine and make hard things easier.

When we are pressured, our brains direct us in the wrong way and lie to us about what will make us feel better. Stress-caused spikes in cortisol are aimed at getting us moving forward. Instead of trying to eradicate the feeling, it is helpful to reframe it as a prompt to do something physical. Walking briskly (even for three minutes between meetings) calms the amygdala and diffuses cortisol.

Dr. Dan Gilbert’s research shows that we are terrible at predicting what makes us happy. We prioritize quick rewards and sell short the things that work. I’ve heard from clients lately that their drinking and overeating are up, and people feel stuck. One executive I work with tracked (but didn’t change) how he felt after drinking two glasses of wine with dinner each night. This was his “unwind” time, and he was sure it helped his stress. He found that after drinking, he slept less well and skipped his workout in the morning. In turn, the day was launched on a tense note and set him up to repeat the cycle at bedtime. These observations led to an experiment to limit drinking to weekend nights and substitute walking with his wife following weeknight dinners. The change allowed him to manage his bedtime and the morning exercise shifted the day’s energy. From here, he prioritized mentally taxing projects first thing (when dopamine is high), and the momentum affected the rest of the day.

Certain research findings crop up over and over. Increasing resilience begins by getting serious about our biological bodies and understanding that immediate rewards have a rebound effect.

Here are a few places to start:

• Identify the bedtime that allows you 7-8 hours of sleep and stick to it for a month.
• Move your body (even 15 minutes) before you start the workday.
• Use the early day for the most demanding work when dopamine is naturally highest.
• Get five minutes of outside light into your eyes soon after waking.
• Do a mood tracker for a week and correlate your activities with your emotions.
• Stand up between meetings and walk for a few minutes, even in your house.
• Note the “treats” you offer yourself for stress management and how you feel after them (binging Netflix, drinking, dessert, social media, or other things).
• Create a substitute list of pleasant actions that increase well-being. Conduct a “me-search” and find the ones that work for you.
• Intentionally notice the positive moments in the day and savor them.
• Focus on things you look forward to. Surveys show that Fridays are preferred to Sundays (even though the latter are days off) due to anticipating the weekend.
• Emphasize choice and control in your life. Depression is linked to the perception of helplessness over life’s outcomes. Even minor changes to what you can affect can shift this bias.
  

  

Where were you at in your career when you joined ACHE?
I was a student at Carroll University starting my senior year when I first joined ACHE. I was a mentee in the Leadership Development
Program learning alongside students from UW-M and CUW. I saw all of the opportunities that ACHE provided, and knew that it was a
step in the right direction to furthering my career goals in healthcare.

Where are you now in your career?
I am currently a Data Scientist for BSG Analytics/Alliant in Pewaukee, WI.

How have you been involved with ACHE-WI?
Leadership Development Program

How has ACHE been valuable to your career progression?
ACHE has been valuable in my career progression by allowing me to meet other healthcare students when I was still a student as a
part of the LDP. ACHE also introduced me to various healthcare executives that have given me valuable insight on how to navigate the
healthcare field and start my own professional career. I attended my first ACHE-WI conference this year and gained valuable insight
into different areas of healthcare leadership on how to be an effective leader in an ever changing landscape which is valuable in my
current career as well as in my future plans. I am looking forward to attending future ACHE events and learning even more valuable
information.

Who has been the most influential person in your career?
As an early careerist still learning about the administrative side of healthcare during my 4 years at Carroll University, Benjamin
Layman, MBA (COO, AdventHealth Hinsdale and La Grange), was very influential in my decision to learn more about analytics in
healthcare, explaining how important they are to gain insights within a hospital/hospital system.

What is something that you are working on recently that you are excited about?
As a data scientist I have been challenging myself to learn more analytical skills. I have been teaching myself how to code in the
Python programming language so I can translate those newly learned skills into bigger projects within the BSG Analytics/Alliant team,
and further excel my career.

Tell me about your dream vacation.
My dream vacation is to go to Ireland and Italy to see exactly where both sides of my family came from and immerse myself in those cultures.

The Annual Leadership Summit, held in Milwaukee from September 28-30th, was a huge success. The sessions were engaging and timely and the attendees had the opportunity to connect through volunteer efforts, social events, and general networking. NALHE National also recognized several outstanding leaders within the organization for their contributions to NALHE and the Latino and Hispanic communities at large. We are already excited about next year’s summit, which will take place in Seattle, Washington in the fall of 2023.

This week we bring you a short teaser segment we couldn’t fit into next week’s podcast release.  This month’s topic is Breaking Down Silos, and our guest is Mike Grubich, President and Chief Talent Officer at the LAK Group.  In this five-minute conversation, Mike responds to a real-world example of siloed leadership experienced by one of the co-hosts, Brian.  We hope you enjoy and tune in for the full episode next week.