Health Care Facilities Changing

September 8, 2006
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GRAND RAPIDS — There is a strong possibility that the Michigan Street Development and Mid Towne Village, easily the city's two most ambitious commercial health care developments ever undertaken, will have more in common with Woodland Shopping Center and CenterPointe Mall than the two downtown hospitals. Retail will likely be included in both, and Mid Towne is now marketing residential condominiums.

Likewise, Metro Health Hospital makes no illusions about its attempts to transform 170 acres of open land in Wyoming. The new health village mimics the style of the commercial lifestyle villages slated for East Beltline Avenue, only with the hospital as its anchor instead of a D&W Fresh Market or a Nordstrom. The plan at Metro has progressed slowly; the only known tenants are the hospital, Starbucks, doctor offices and an unnamed pharmacy.

"The health care environment is rapidly becoming the healing environment, the wellness environment, the family environment, the spa environment," said Brian Bascom, principal of Velocity Partners, a Holland-based research firm specializing in the health care, furniture and technology sectors. "You can go in for a surgical procedure and also get a pedicure."

Driven by several leading architecture and design firms, the hospital is no longer just one environment, Bascom said, but 100 different environments: an emergency room in one wing with specialty surgery in another; an attached medical building with doctor offices; a medical spa with attached retail shops; maybe even high-end hairdressers, valet parking and fine dining.

"You can go to your doctor's appointment, get your prescription filled, get a manicure, pedicure and massage, and a have a gourmet lunch with your car waiting out front," Bascom said. "Driving by the hospital of tomorrow, you might not even recognize it."

Although health care is one of the few sectors in this country projecting legitimate double-digit growth, it has become a fiercely competitive industry. Whether a facility is for-profit or nonprofit, management is carefully eyeing revenue and costs.

"At the end of the day, they are competing against other facilities," Bascom said. "Creating different kinds of environments can give them an advantage, one that they can potentially charge more money for."

Twenty years ago, hospitals were universally a resource of necessity. People went there when they were sick or delivering a baby, and then left as soon as they could. Today, hospitals compete with each other and with outpatient facilities not only for patients, but also for staff and investors.

"Could you imagine seeing a television commercial for a hospital 25 years ago?" said Greg Wieland, director of design for URS Great Lakes and the firm's national health care practice. URS has designed more of the Michigan Street medical corridor than any other firm and is the designer for Michigan Street Development.

Wieland is a recent addition to the West Michigan office, having moved from the East Coast. There he was exposed to the Maria Fareri Children's Hospital at Westchester Medical Center in New York. Otherwise an average heath care system, the children's hospital has made Westchester an industry benchmark. The facility is family-centered, with parents encouraged to stay with their child and accommodations provided for them to do so. Units are divided into themed "neighborhoods." Teen rooms come equipped with computers and plasma screen TVs. There is a Ronald McDonald House on the third floor, an Au Bon Pain restaurant on the ground floor. It even has an adjacent golf course.

Wieland cited another hospital in Cleveland: Rainbow Babies & Children's Hospital. Many of its patients are inner-city children, with far fewer amenities at home than in their hospital rooms. Staff and family often have difficulty getting patients to leave.

"This kind of thing isn't unusual for high-acute hospitals around the country," Wieland said. "Hospital facilities that have the highest acuity are places that are becoming destinations for people. Not all hospitals have long stays, and those that do have a captured audience."

Because of those long stays, these hospitals have the ability to borrow from airport and transportation hub designs as facilities that provide services beyond the core use. In some cases, the hospital could evolve into a facility in which people might visit for reasons other than health care.

As a designer, Wieland sees a number of infrastructural changes he feels will be important in a competitive facility. Way-finding is a particular concern, he said. Just going to a hospital is often stressful enough without having to navigate a maze of signage to park and then weave through complicated facilities inside.

"It should be designed in a logical progression," he said. "User friendliness is a very big deal; it shouldn't have to be explained to you. Facilities should create pathways that are very easy to use."

According to Wieland, this is exceedingly difficult, as hospitals are one of the few facilities which, "If it doesn't grow, it dies." Much like a plant, a hospital must have growth vectors available, or it will create a complicated and confusing web of roots and branches.

Another area of concern is waiting room facilities. Very little thought is given to waiting room design, he said, particularly in emergency rooms. The ER is treated by many facilities as a "back door," which he finds disturbing, as more than 50 percent of an average hospital's patients come through that entrance.

These spaces should be warm and inviting, he said, but those standards are no different from decades past. Internet access and similar resources, however, are new amenities he predicts patients will come to expect.

Steelcase health care startup Nurture is keenly interested in this area.

"Maintenance people tell us that everybody rearranges the furniture in the waiting room," said Nurture President Mike Love. "That's because, traditionally, it's just rows of furniture."

If a family is waiting during a four-hour surgery, whether routine or not, odds are they aren't going to leave for that time, Love said. They will sit around, probably worried; huddle, pulling the chairs in a circle; or maybe they'll eat or play cards. Love suggests designing waiting rooms to accommodate that, as well as provide resources to occupy those waiting — computer kiosks, for instance.

This also allows for diversity of waiting, as not every family is waiting for the outcome of a surgery. The wife waiting for the husband who cut his hand slicing a bagel will have a completely different set of concerns.

Of course, emergency rooms might not play too large a role in the competitive landscape, Love said. This is the only hospital experience in which consumers will always choose the most convenient option. For almost any other procedure, the patient and visitor experience will play a significant role in the consumer's choice.    

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