Future of Healthcare: Patient Experience

A driving force in healthcare facility design and construction right now is shaping the patient experience. Our panelists at Bisnow's San Francisco Healthcare event yesterday told the roughly 250 attendees about the shift from serving providers' needs to focusing on the needs of patients.

In the 1950s, hospitals were cold and institutional, done in greens and metal, said Kaiser Permanente VP Hollis Harris (right with Carla Collins Mixon of Signet Testing Labs). Then came the transition to everything white, which she said was in some ways even less inviting. In Kaiser's new facilities, for both inpatient and outpatient treatment, the focus is on creating a warm, inviting environment that takes away some of the fear of going to the doctor, she said.

That applies to the physical environment, but also to the way the practice is set up, with details such as a roving greeter who helps patients entering the building get registered and in the right location, she said. In Kaiser's next generation of medical office buildings, Hollis notes that patient exam rooms will be bigger than the physician offices, rather than the other way around.

Pankow SVP Scott Anderson, who moderated the first panel, called this "one of the most dynamic times in one of the most dynamic markets for healthcare." That's Scott on the right with panelists Taylor Design director Kevin Hinrichs and Ratcliff associate principal Gary Jereczek.

Kevin said patient expectations are changing, and with varied populations of patients, there's a difference in how those patients wish to interact with their healthcare providers. Many younger, healthy patients want to have a relationship with their provider, but don't necessarily want to step into an office for an appointment, he said. But patients with chronic illnesses want a close relationship with their providers that includes regular office visits, he said. The trick is designing facilities that can handle both kinds of patients.

Gary said he's worked on projects ranging from student health centers serving Millennials to facilities serving cancer patients. The goals of those differ significantly, as do the expectations, he said. He added that the staff experience has to be a part of the equation along with patient expectations. It is important to find operational efficiencies as well as meet patient expectations, he said. By using open office, reception and pharmacy areas delineated by furniture, a plan can be left open for future growth, he said.

Allen Matkins partner Fernando Villa talked about the projected cost of healthcare in the United States reaching $4.6T by 2020. In San Francisco, there is the tug in both directions as well-off workers move into a desirable market while high poverty rates remain in the city, he said. That presents another challenge when it comes to the patient experience.

Executive director of USCF Benioff Children's Hospital San Francisco Kim Scurr (here with Jack Poindexter of DPR Construction) sees the challenge firsthand, as about a third of California's population is kids, of which about 25% live at or below the federal poverty level, Kim said. Her hospital deals with the sickest kids (about half of the hospital's beds are ICU). About half of the country's children are on government insurance, and they often have a hard time getting the follow-up care they need once they leave the hospital, because providers near home may not take government insurance, such as Medi-Cal, she said. That means they have to make a long drive for care or don't receive the care at all, she said.

XL Construction SVP Alan Laurlund (here with Kevin) said all the focus on patient experience, access and convenience still comes with working to drag down cost. That's leading to more smaller outpatient facilities within communities, particularly the repurposing of existing buildings to bring those clinics and services to communities faster. It also is leading to clinics in novel locations, such as within a Target, CVS or Walmart—or on-site at a large employer's offices, he said.

Meridian COO John Pollock (center with colleague Joseph Crist and Kristi Pearce-Percy of Cuschieri Horton Architects) said though strip mall medical offices work in some cases, they do have their challenges. John sees more demand for stand-alone medical office buildings (both ground-up construction and repositioning existing buildings), which are more easily branded and adapted to provider needs. Providers are trying to create outpatient care that is convenient for both patients and providers, he said, such as a clinic Meridian built on an outparcel in front of a Home Depot in Pomona.

Pacific Medical Buildings SVP Jake Rohe said one approach to creating a positive patient experience mirrors what Kaiser does in bringing all services under one roof, but with independent providers. Bringing together specialized service providers in partnership with health centers or academic medical centers in a single location creates a one-stop shop for healthcare. The patient experience can be the little things, too, he said. Like the move at St. Jude Heritage Medical Plaza to install comfortable, custom chairs for exams rather than the rarely needed exam tables. The next challenge, he told the laughing crowd, is finding a better solution to the paper barrier on exam tables.