Shown (from left) are: Mary Jo Olenick, JP Bonin, Martha Boyd, Jake Horak and David Neal

Glastonbury, CT Recently at the New England Real Estate Journal Health Care Facilities Summit in Boston, David Neal, AIA, ACHA, and Mary Jo Olenick, AIA served as moderator and panelist respectively, alongside Jacob Horak of Kurt Salmon Associates, Martha Boyd of UMass Memorial Medical Center, and JP Bonin of The Sextant Group. The panel’s topic focused how hospitals and universities are forging stronger real estate partnerships, based on the panel’s experience from working with some of the country’s best known academic medical centers on both the clinical and academic side. Traditionally, these two entities, although united by name, have separate facility groups and goals. Lately however, the focus has shifted to establishing greater partnerships, particularly in joint facility development. A prime example is the Simulation Center, which has become a prime focus and cross-over platform for both medical education and staff training.

Horak initiated the panel discussing the national trends for academic medical centers and facility implications associated with those trends. “Lately, academic medical centers have been forced to do more with less, creating the strategic response of forming a clinically integrated value-based network. There has been a broad recognition of a need for better integration between academic medical centers and other entities along the continuum of care as well as a recognized need to reduce costs despite the decline in patient utilization over the last several years,” said Horak. “As the demand for tertiary and quaternary services continues to grow, academic medical centers are at inpatient capacity creating common trends which emerge across these facilities.” One of these trends according to Horak, is the increased focus on higher complexity of care.

“Within the costly infrastructure, many basic services are being performed, which has created a targeted effort to transfer wholesales and basic programs off campus. By doing so, you can battle with higher margins, tertiary and quaternary services, and you can defer capital and not have to build infrastructure to support basic services,” said Horak. “If you shift care to lower cost platforms, you can improve your margins on basic care services assuming that those platforms are within your network. Hand in hand with that, you’re seeing academic medical centers start to partner more with outlying facilities and push their capabilities out to keep patients closer to home.”

“A lot of academic medical centers are recognizing that over half of their revenue comes from half of the ambulatory services, as well as half of their margin. Traditionally, most of their planning efforts and most of their capital spending has been on the inpatient side, but now they’re recognizing the need to shift their thinking and start investing more in ambulatory care.” The focus on ambulatory care has presented a trend of flexibility and universal design in health care environments. “By building flexible, universal rooms, be it an OR, clinic, or patient room, you can adapt readily to changes over the next, 30 or 50 years, because care will certainly be delivered differently.” In addition, a major trend has been designing shared touch-down space for physicians rather than large private physician offices, in order to effectively utilize more space.

Boyd echoed the trend of universal design in response to changing care models. As the models of care have changed in health care environment, where nurses are now giving an increasing amount of the daily care to the patient and much more of the information back to the physicians, one of the things UMass is taking part in is the collaboration of nursing interns, residents, and students across the system in order to receive and deliver the same type of care. “One of the things we’re working on at UMass right now is having all of our private patient rooms designed as flexible rooms,” said Boyd. “We’re not building a PA room, orthopedic room, or isolation room, but rather rooms that can be used at any given time for any type of patient, and in turn, allowing for staff to be run accordingly.”

Mary Jo Olenick, AIA, principal of The S/L/A/M Collaborative with an expertise in programming and planning academic medical centers across the country, rounded out the panel discussion with a more educational perspective in terms of what medical schools are trying to achieve and what the trends are in academic medical centers. Olenick commented on the trends in simulation centers stating that, “When simulation became the trend, it was really viewed as a profit center. Simulation facilities have a real appeal to medical students, where many medical students, when making decisions about medical schools, will look at simulation facilities as one of their determining factors, despite the fact that they will spend very little of their time in those centers.” She explained that the major challenge of these centers has been operational cost because the large number of staff required and the fairly low level of utilization that can be achieved.

Olenick remarked on Johns Hopkins Hospital’s current repurposing of their former 13-story, 370,000 s/f Children’s Medical and Surgical Center (CMSC) originally constructed in 1963, to include a new Simulation Center on two floors for the Johns Hopkins School of Medicine students and hospital staff in addition to a host of other new spaces. “Because it’s a hospital, there’s a lot of fidelity already built into that, which is an excellent use of the facility,” said Olenick. “So now they’re investing a lot of money into this building, and they’re not dealing with the issues of tearing it down in the middle of their campus but rather, are recouping their investment in a premier location, and enhancing collaborations between the Hospital and the School of Medicine.”

Bonin focused on emerging trends from a technology perspective in relation to both hospitals and education facilities, as well as current and future technologies within the Simulation Center. “Facilities have adopted and understood what technology needs to be in order to get recordings, to have different angles and views, and how the cameras need to be positioned…that really starts with strong planning on HVAC and riser runs and the ideas of positioning cables in order to mitigate any particular challenges for that recording, because you could dump $3 million into a really nice suite and end up with a bad recording.” Bonin also discussed the evolving technology of data visualization built into walls of rooms allowing for natural language processing for physicians to understand different aspects of patients’ history from backend artificial intelligence. This enables the advancement of medical operations to be executed more safely and efficiently. “Hospitals realize that having a medical simulation facility within a hospital is not just about patient safety, it’s really about getting better at procedures to cut down the cost; so in the end, the efficiencies easily pay for these facilities to be built out,” said Bonin.

Olenick later discussed the idea that many cities are looking to medical schools as economic development engines. She explained SLAM’s design efforts at Indiana University’s new medical school to be completed in 2017, which is a multi-institutional facility comprising three different universities and four different hospitals. “The city really wanted the School of Medicine in downtown Evansville, and in the process, the University probably got an $80 million facility for $60 million because the city invested in the project,” said Olenick. “We also designed one in Kalamazoo, Michigan and that school is actually a partnership with Western Michigan University and two hospitals in a renovated former pharmaceutical building. These three entities developed this medical school as part of their desire to reinvigorate their downtown area.” She explains the challenge in multi-institutional facilities is that there are various medical and health professions programs being shared belonging to various universities while all sharing facilities and a simulation center, “but now we get to this technology question which is, ‘what kind of platform are we using for technology’ because everyone has a different platform; they all want to use their own technology in their classrooms but they also want to share classrooms,” said Olenick. “So the technology issue becomes really important in shared facilities, and it’s an exciting aspect that I think we are going to see more and more of.”

SLAM’s David Neal summarized the rapidly changing healthcare and medical education arenas with a brief history lesson: “Years ago people couldn’t imagine riding an elevator without an operator. Now we can’t imagine the need for one.” He continued, “times change, technology changes, and relationships change. The joining forces of hospitals and their academic medical partners, centered around facilities and technology, is just the beginning of what the future holds.”