May 24, 2019

It is no secret that the demand for healthcare is changing the way hospital systems think, design and plan for the future. To take a deeper dive into the subject, SMPS Nashville recently hosted a panel discussion on the future of healthcare. I was invited to be a part of the diverse healthcare panel, which also included Fahad Tahir, president and CEO of Saint Thomas Midtown and West hospitals, and Ryan Doyle, vice president and general manager of Nashville’s ONEC1TY—an urban community dedicated to healthy living. Each of us brought our respective experience, knowledge and expertise to the table, offering our perspectives as an architect, an owner and a developer. In this post, I share some of my thoughts from the event, based on questions from SMPS.


How are changes in healthcare delivery changing the demands on healthcare architecture and engineering?

We are currently witnessing a shift toward a more robust outpatient care model and more on-demand services such as urgent care, retail health and telemedicine. Healthcare systems seem to be most interested in providing multiple access points for a consumer-minded population. In today’s healthcare climate, we are master planning so the acute care hospital is less about a campus trying to be all the things to all people, and more about providing the best possible environment for the most acute patients.

To that end, the concept of extending care so it’s closer to the patient via a diverse and broad care network is helping us to improve outcomes and better serve the needs of the communities in which we live, work and play. Distributed care hubs—ranging from small retail centers to multispecialty office buildings and ambulatory surgery centers—are all helping patients stay connected to their care teams in an easy and convenient manner. I truly see it as the future of healthcare.


WellStar’s new Cherokee Health Park at Holly Springs is a multispecialty MOB that includes Urgent Care, Primary Care, Specialty Care, and an array of support functions.


Urban hospitals like the ones in Nashville cannot build enough space to keep up with demand. How are some of these hospitals creating much-needed space?

While acute care facilities continue to offload and disperse services to more nimble facilities like ambulatory surgery centers and multispecialty medical office buildings, there are still a lot of questions about what to do on those acute care campuses. As design professionals, we are always looking toward the horizon.

At Gresham Smith, we have conceived some interesting strategies for maximizing the utilization of space for the maximum amount of time possible during a 24-hour period. For example, we have located a clinical-decision unit in between the emergency room and the surgical prep/recovery suite in many of our designs. This permits a great deal of flexibility, allowing the emergency department to shift and temporarily grow during nights and weekends, while also allowing the surgical prep/recovery suite to utilize the same space during early morning weekday hours when large volumes of surgical cases are being prepped. It’s a win-win situation that didn’t require any additional space—just a little thought and creative thinking!


Patients are now paying more for their healthcare out-of-pocket and therefore have increased demands for the services and spaces provided to them. Millennials, for example, are doing more research around convenience and cost before they seek treatment. How is this factoring into the location and design of new facilities?

Millennials are a savvy group of consumers who are more likely to research cost, convenience and outcomes, and to read online reviews when considering a physician. As the newest generation of healthcare consumers, they have unquestionably changed the paradigm. Because of this shift, we have a broad swath of the overall population demanding care that is faster, better and cheaper—the holy grail of any service industry.

As a result, many healthcare providers are more interested in creating convenient access to their network through additional “pins on the map” versus expanding services at existing facilities. Providers are also striving to streamline the process for every patient interaction by introducing self-check-in kiosks, on-site retail pharmacies, and an array of healthy-living amenities.


Many new outpatient facilities are tailored to a more retail environment where self-check-in, on-site pharmacies and education functions provide a simplified patient experience.


UF Health’s North campus features many exterior amenity areas that allow patients, visitors, and staff a place of respite and access to the healing power of nature.


Are generational shifts changing design?

As architects and engineers, we have enjoyed the boom in medical office real estate. Even when you consider the aging population, there is still concern within the industry that real estate supply might be far outstripping demand. With technology advances such as telemedicine, we are setting ourselves up for a more virtual care model in which healthcare real estate inventory can be reduced, or in some cases eliminated altogether. In 2018, Kaiser Permanente reported that over 50 percent of their patient encounters were virtual. We are preparing to meet the needs of our clients by asking ourselves: What kind of space will it take to support this new care model?


In the next 5 to 10 years, what do you see as the biggest opportunity in the healthcare architecture/engineering/construction space?

BH: I believe the biggest opportunity is in China. Gresham Smith opened an office in Shanghai more than 10 years ago, and it has been an amazing experience to witness some of the things that culture is committed to doing. The sheer pace at which they are designing and constructing facilities in so many underdeveloped parts of the country is truly astounding.

For years, I was excited about applying U.S. knowledge and experience to healthcare design in China. But now I am excited to see the knowledge stream reverse course and start informing how we deliver care. The Chinese are able to blend traditional eastern medicines and practices from what they have learned from the west, and are creating a unique care model that will be well-equipped to treat the mind, body and spirit.


Preparing for the Only Thing Constant

When I think about the future of healthcare and evolving healthcare delivery models, I am reminded of the old expression “The only thing constant is change.” Currently, the future of healthcare appears to be built on outpatient migration, with urgent care facilities and multispecialty MOBs across the country placing their focus on a more consumer-minded patient. No matter the trend, it is important that designers plan for flexibility that allows a space to change and adapt to different demands over time, and to help our clients prepare for the next evolution of care.