Designing for a Health System Versus a Hospital

What’s the difference between designing for a health system and designing for a hospital? My experience working with both health systems and singular hospital facilities has enabled me to recognize the marked differences between these two forms of healthcare structures in terms of how I interact with them as a healthcare designer. The fundamental difference between the two can be traced back to the emergence of the health system of today. 

The Evolution

Prior to the 1980s, most U.S. hospitals operated independently and functioned under a singular operational or leadership structure. Hospitals also operated within a community and were linked to other hospitals by a unifying vision or goal. In addition to these community hospitals offering a wide-range of comprehensive inpatient and outpatient services, they also provided the community with an opportunity to be personally engaged participants in the environment of care (think: candy striper). As the 1980s rolled in, a series of government-enacted, health-related ordinances, along with the rising costs of healthcare and competition, significantly impacted the way community hospitals operated and provided care.

In order to continue to serve their local communities, and perhaps most importantly to alleviate their rising financial burdens, the vast majority of single, community-based hospitals began to merge, which resulted in larger health systems. These newly formed health systems were corporate entities that owned and operated multiple hospitals and service lines, while also managing multiple provider groups and networks. Since the health systems varied in size, geographical location and the types of services provided, their multifaceted and integrated structure allowed them to provide and deliver patient-care services within a community or region through a diverse blend of healthcare facilities (primary care through tertiary care) as well as provider mixes—something that can be difficult for an independent hospital facility.

This strategy afforded the newly formed health systems an opportunity to offer integrated service lines across multiple facilities, which led to a consolidation and strengthening of their market position and reach. It also allowed the health systems to service a larger patient population while simultaneously reducing costs due to their ability to share resources.

The Health System Client Today: Systematic Thinking Versus Facility Thinking

Through an extensive analysis and understanding of population health needs, health systems can focus on the big picture of what is required across their network, and how the hospital(s), service line(s) and provider group mix(es) can effectively service those needs. The identified strategies that address the needs can sometimes challenge the environment of care as well as its delivery. These strategies can also involve the reallocation, relocation, consolidation and maybe even elimination of service lines outside of a region or community in response to burgeoning trends in population health and reimbursement models.

Where we predominantly supported our clients in decision-making efforts directly related to a singular facility—how they might add to or renovate their hospital or campus, for example—we’re now helping our health system clients with wide-ranging issues through strategic planning that explores the impact of key decisions on multiple entities from a holistic point of view, representing a shift from facility thinking to systematic thinking. Some of these decisions, which can be tough, ultimately ensure that health systems are continuously striving to improve patient outcomes in the communities they serve.

This approach requires that designers working with health systems step back and understand a health system as a diverse mix of components that’s not only made up of its brick-and-mortar elements. A strong knowledge of population health trends, resource availability, payer-mix strategies and other opportunities available across a health system will enable designers to employ our unique expertise in terms of effective approaches that transcend constructable solutions.

Health Systems: The Future of Thought Leadership

It’s important to note that this shift from facility thinking to systematic thinking is necessary when working with health systems. It ensures that designers are actively helping health systems leverage their available resources in the exploration of innovative and transformative solutions that focus on improving the overall care continuum while reducing costs—for both the patient and caregiver population. This approach affords health systems the opportunity to act as thought leaders and advocates for issues of great importance to the fields of health and medicine, while safeguarding the delivery and cost of care provided across their system.

Emerging uncertainties in the healthcare market associated with the advent of new technologies, the development of new treatment protocols, the appearance of newer diseases, and changes to compensation structures will all continue to impact the healthcare landscape and play an important role in the advancement and delivery of healthcare across the U.S. Since health systems manage an entire network of facilities and providers, they can influence industry practices and define the minimum standard of care for clinical and quality program performance across a larger swath of a region and population.

Regardless, a health system or individual hospital’s ability to effectively navigate and manage these issues—while expanding service offerings and providing specialty physicians and clinics that safeguard proper treatment, patient satisfaction and a safe environment of care—will always be a priority.

The Author

Motunrayo Badru, AIA, ACHA, LEED AP BD + C, is a Healthcare Project Executive leading business development initiatives for Gresham Smith in both North Carolina and Virginia. As a healthcare architect, she lends her expertise to the advancement of innovative and resourceful design solutions in healthcare.

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