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Responding to Change: Understanding the Challenges in Outpatient Facility Expansion

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“It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” – Charles Darwin (paraphrased by Leon Megginson)

I recently gave a presentation with one of our clients on strategies for outpatient facility expansion at the Illinois Hospital Association (IHA) Leadership Summit and the American College of Healthcare Executives (ACHE) - Wisconsin Chapter’s Annual Conference. We kicked off our presentation with the quote above. 

Today’s healthcare organizations exist in a rapidly changing landscape. Patient consumerism, demographic shifts, healthcare reform, and private payers are all putting tremendous pressure on organizations to evolve in order to survive. Collectively, these forces are pushing more and more services to the outpatient setting.

The Advisory Board recently presented a webinar entitled ‘The Ambulatory Constellation: Facility Investments for Tomorrow’s Network'. Their research identified four archetypes that systems fall into when approaching outpatient expansion: The Campus Maximizer, The Expansionist, The Reactionary, and The Opportunist. 

Whatever their specific “constellation” of strategies, every system is adding outpatient gateways to their portfolio.

The Challenges: Expanding facility reach may seem like a “no-brainer”, but there are a few challenges to overcome along the way. I see these challenges fitting into eight general buckets, as outlined below. With advance planning, there is also a solution right around the corner. 

  • Speed to Market: If adding an outpatient facility is a strategy to capture market share, then speed to market is critical. Long decision timelines can significantly delay projects, affecting the ability to introduce services to the market prior to competitors. This ultimately results in lower long-term facility usage and higher organizational costs. Executive steering committees can streamline the decision-making process and ensure timely project delivery.
  • Messaging: Many times, projects are of a confidential nature, but extreme limitations in messaging and lack of communications can actually hurt a brand’s introduction to the marketplace. Working closely with corporate communication staff and agreeing on a strategy early can prevent potential pitfalls.
  • Provider Engagement: Lack of physician buy-in during the design is a “dead in the water” moment that can immobilize an entire project. Physicians often respond better when they can “diagnose” a plan in progress, rather than being faced with a blank sheet of paper, so engaging them at the appropriate time is essential.
  • Staff Time Commitment: Everyone is busy in today’s world, but late or no input from knowledgeable staff can be detrimental to the final project outcome. Plan the time needed for key stakeholders to be integrally involved in the design process.
  • Brand Standards: Your hospitals are probably the cornerstone of your brand, but ensuring that your outpatient facilities offer the same patient experience and clinical quality can be a challenge. Facility design standards and a Clinical Quality Officer can help in this regard.
  • Infrastructure: Desired service line offerings need to drive infrastructure, not the other way around. Ensure that you are not limited by insufficient floor-to-floor height, lack of emergency power, or life safety code issues by engaging an architect early, especially when considering converting existing buildings to health care uses.
  • Supply Chain: Hospital settings today are structured for optimal logistical and operational flow. Adding regional facilities can strain this process; understanding best practices and providing appropriate space allowances prior to finalizing design can optimize flow.
  • Medical Equipment Planning: We are all familiar with the specialized nature of medical equipment planning in our hospitals, but this aspect is often overlooked in outpatient facility design. Depending on service lines, this can be just as necessary in the ambulatory setting, particularly for Cancer Care, Freestanding EDs, and ASCs.

This is just the tip of the iceberg, and I understand these challenges are a lot to digest, but acknowledging them before you get started can lead to more effective planning. I challenge you to take a step back and honestly ask yourself: what approach is your organization currently taking? And within this approach, are outpatient facilities becoming a cornerstone of your offering? If you’ve added new facilities, what challenges did you undergo in getting those to market?  I’d love to hear from you.

Paul Stefanski, AIA, EDAC, LEED AP
Healthcare Studio Director : Principal

Paul Stefanski, AIA, EDAC, LEED AP, is the Healthcare Studio Director at Eppstein Uhen Architects (EUA) and is based in Milwaukee. In his free time, Paul enjoys watching films and hanging out with his two cats.

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