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34 Medical Construction & Design | J U LY/AUGUST 2017 | MCDM AG.COM Healthcare leaders can eff ectively navigate today's changing forces in healthcare by matching forecasts to hospital building plans. Flexibility must be vertical, as well as horizontal. With the demand for increased fl oor- to-fl oor height for changing mechanical, electrical and plumbing systems, hospital leaders gain more interstitial space, which allows easier, faster and safer servicing, as well as modifi cation of mechanical and electrical systems. In hospitals that are older than 50 years, designers can't incorporate infrastructure in minimal fl oor-to-fl oor heights and compact densely fi lled ceiling space. As a result, it is increasingly common to specify fl oor-to-fl oor heights of 16-18 feet for optimal long- term fl exibility with the ability to adapt to change. One-stop evolved care shapes facility needs As medical technology and care delivery methods evolve, some departments will simply need to be reintroduced. Take, for example, oncology. In the past, classic-style oncology was either radiation (cobalt) or medical (chemo drip). Medical oncology is moving to self- administered pills. For healthcare leaders, this means new oncology units may become smarter with do-it-yourself technology. On the radiation side, healthcare is evolving with more eff ec- tive cobalt treatments, such as gamma knife and cyberknife radiosurgery that deliver more highly focused, high-dose radiation, avoiding the inevi- table adjacent tissue damage and other side eff ects and, with photon therapy, protons have little lateral side scatter in the tissue, providing a more accurately focused but very expensive alternative. Consider another example: Imaging that was once limited to invasive radiology has pro- gressed to non-invasive MRI. Computer-aided technology permits doctors to see tissues in diff erent colors depicting diff erent densities, so they can derive more information than previously with 2-D X-rays. Ultrasound imaging, another non-invasive technology, is similarly being interpreted in new ways as that technology improves. On the surgical side, advancements in minimally invasive procedures, robotics technology and interventional radiology permit surgeons to treat or remove diseased tissue percutaneously for a procedure that requires minimal heal- ing time and is fundamentally outpatient care. Rather than eight-day re- covery, the patient goes home on the same day, dramatically reshaping the facility needs of imaging and surgery. Resources + benchmarking Large facilities can explore and research what other institutions are doing to break ground with the latest concepts. Many healthcare providers are doing away with central fl oor nurse stations and replacing them with distributed charting stations. As central cores and private patient rooms emerge in new and renovated inpatient units, the dispersed sub-charting areas are closer to the patients, typically with one nurse for every six patients in acute care and one to three patients in critical care. The design change substantially reduces nurse walking distances. It optimizes care delivery as nurses can be with patients instead of walking to retrieve supplies, which also needs to be redistributed with the sub- charting areas. The only way to get ac- curate results is to take the clinical engineering approach of data gathering to develop the optimum solution. Using this approach eliminates many subjective measures prevalent in the discussions that typically take place. This illustrates the importance of using an outside professional resource to help evaluate existing operations and develop new processes. Savvy + precision Healthcare leaders can ef- fectively navigate today's many changing forces in healthcare by matching forecasts to hospi- tal building plans. While this requires savvy, by evaluating appropriate met- rics and conducting in-depth analytics, developing custom- ized fl exible solutions — such as modular design — and decisively allocating resources, leaders can develop increasing- ly precise forecasts and plan- ning, fundamentally improving the delivery of healthcare and optimizing outcomes. Phil L'Esperance is vice president of the Process Group at Ghafari Associates. Thomas Gunn is a senior healthcare planner at Ghafari Associates. INTEGRATED SPACES ISSUE FOCUS Ribbons of smaller seating areas linked to each specialty check-in window provide intimacy in physician group practice models.