Outpatient volumes are projected to grow 20% over the next decade, compared with 7% growth in inpatient discharges. That shift is changing how health systems plan their facilities including where to invest, how to connect outpatient sites and how to design spaces that can adapt as care needs change.
Becker’s Healthcare spoke with Rob Hennes, vice president of health strategy and consulting at Gresham Smith, about what rising outpatient demand means for facility design.
Outpatient care as network strategy
Historically, many health systems developed ambulatory and outpatient locations incrementally, one opportunity at a time. Those facilities were often viewed as one-off extensions of the hospital.
Today, the strategic challenge and needs are different. “The question is no longer how many outpatient buildings we need,” Mr. Hennes said. “It’s more about what network we need to serve this market over the next 10 to 20 years.”
Operationally, organizations want consistency across outpatient locations. This can be accomplished through common scheduling, a standardized layout for clinics and rooms, shared support functions, coordinated staffing and clear patient referral pathways. The goal is a cohesive network that is easier for health systems to operate and easier for patients to navigate.
Managing outpatient locations as an integrated network starts with understanding market characteristics, such as where patients live, where they travel for care, which regions are growing and how demand differs across service lines.
Data-driven insights can be used to influence network design. For example, primary care may benefit from a broadly distributed model, while oncology, orthopedics or even ambulatory surgery may work better in large regional hubs or centers of excellence.
Facility design and the consumerization of healthcare
Patient expectations are also a key consideration for network design decisions. Today’s patients want healthcare to be as easy to access, schedule and navigate as other consumer experiences. Convenience isn’t simply having a physician near where a patient lives. It’s defined by factors like ample parking, shorter wait times and easy access to diagnostic testing on-site.
“Patients don’t experience healthcare as individual departments, but as a journey. A system’s operating model and its facilities need to support that journey,” Mr. Hennes said.
Instead of locating physician offices, imaging, labs and procedure rooms across different facilities, many systems are now bringing those spaces together by designing multidisciplinary, multi-service outpatient centers.
Integrated capital decisions
Before committing to new construction, health systems must understand their future clinical model. From a design perspective, not all outpatient facilities have the same needs. Imaging centers and surgical facilities have very different structural infrastructure, as well as mechanical, electrical and plumbing requirements.
Rather than predicting exactly what a facility will look like in the future, it’s more useful to identify any decisions that will be difficult or expensive to change later. Elements like floor height, structural capacity, MEP capacity, parking and utility infrastructure are largely fixed.
“The goal is to avoid making today’s capital decisions that limit what your strategy could be tomorrow,” Mr. Hennes said. “One way to do that is by separating durable decisions from investments that can be phased as demand becomes clearer.”
A strategy for success
Instead of first designing an outpatient facility and then deciding how to operate it, a better strategy is to gather the key decision-makers, develop the operating model and then design the building to support that vision.
“A simple sequence for the front end of a project is market demand, services, operations, capital and finally design. If you follow that process, it produces better decisions,” Mr. Hennes said.
For systems currently reassessing their outpatient strategies, another best practice is assembling a multidisciplinary group that’s small enough to make informed decisions. This type of team works best when it includes service line and clinical leaders who own patient volume, ambulatory operations, scheduling, finance, workforce and staffing and IT.
Portfolio discipline is also important when identifying growth opportunities. This means starting with a baseline, not a building plan. Mr. Hennes recommends plotting every outpatient location on one map and creating a scorecard that evaluates volume utilization, service mix, patient origin, market growth and strategic importance. Market dynamics like projected demand, physician supply and competition must also be considered.
“This approach shows what services should be broadly distributed and which should remain on the acute care campus,” Mr. Hennes said. “Then you can make good real estate and capital decisions.”
