Magazine article Health Facilities Management

Expanding Challenges: Facilities Professionals Are Key to Moving Care into Communities

Magazine article Health Facilities Management

Expanding Challenges: Facilities Professionals Are Key to Moving Care into Communities

Article excerpt

When the University of Arkansas for Medical Sciences (UAMS) underwent a major, rapid expansion, acquiring eight satellite facilities over a two-year period, Jonathan Flannery, MHSA, CHFM, FASHE, experienced the growing pains firsthand.

As then-executive director of engineering and operations at the 332-bed academic medical center based in Little Rock, Flannery and his staff encountered challenges on every front--from information technology (IT) and building systems that weren't integrated to a lack of manpower and equipment to an endless series of cost and logistical issues. Then there was the added "windshield time" driving between the central hospital and satellite facilities spread across Arkansas.

"It was quite the struggle," says Flannery, who was responsible for facility assessments for the UAMS expansion from 2010 to 2012 and now serves as senior associate director of advocacy for the American Society for Healthcare Engineering (ASHE). "We were put in the position of making a major transition without having a blueprint in place. We were making plans as we went along."

Sign of the times

Driven by mandates of the Affordable Care Act (ACA), health care has been moving toward a similar model--a central hospital serving as a hub for a network of satellite facilities--for a number of years. Hospitals working toward ACA goals to expand health coverage, reduce cost growth, improve patient safety and quality of care and expand community-based primary care have been moving quickly to embrace some form of the satellite model since the law passed in 2010.

The transition to a wellness-focused vs. an acute care model is critical as health care moves toward 2014, when coverage begins to extend to an estimated 30 million to 40 million more Americans.

"Hospitals are charged with managing health now as opposed to just caring for the sick; risk has transferred from the payer to the provider's side," says Joseph G. Sprague, FAIA, FACHA, FHFI, senior vice president and director of health facilities for architectural firm HKS Inc., Dallas. "Moving toward an outpatient model is a big part of that culture shift."

Because planning and multidepartment coordination is critical to a smooth transition, department leaders need to be involved in the process from the very first discussion, says Patti Costello, executive director of the Association for the Healthcare Environment (AHE). That involvement is key to helping facilities comply with new Medicare laws that reduce reimbursements for hospitals with high levels of preventable 30-day readmissions.

"Environmental services leaders need to engage in high-level, strategic discussions with their peers and within their own organizations about how the wellness focus will shift inpatient care to the sickest patients and how that shift will impact the operation in terms of measuring outcomes, preventing readmissions and improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores," Costello says.

Adds Flannery: "Hospital systems tend to look on this type of a transition from the clinical aspects and the support side as almost an afterthought. Facilities managers need to be in on these discussions from the very beginning; that is critical to a smooth and successful transition."

Surmounting setbacks

Experts point to the many advantages hospitals stand to reap from the transition--from sharing expertise among buildings to cost savings tied to bundling services--but say getting to that point is fraught with challenges, especially considering the looming reform law deadlines.

One common difficulty is restructuring of staff, which can present a difficult adjustment for some managers. "Facility managers tend to function autonomously, so it's a big change when they are asked to expand their focus from one building to multiple facilities," Flannery says.

And because most hospitals are adapting existing buildings, those facilities also come with existing problems. …

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