The Hospital of the Future: The Vision, the Journey, the Reality

IntroductionDespite the shifting landscape of healthcare delivery, the need to manage complex patient care in hospital settings will remain strong to accommodate an aging baby boomer population, but it will require the replacement of older, outmoded physical plants. Those organizations that choose to build new or replace these buildings will need to anticipate future care delivery models by embedding flexibility and sustainability into the design. How do we ensure that we make the right decisions for our communities now and yet maintain our financial viability, whether as a stand-alone organization or as part of a system?These are the questions Palomar Health attempted to address when building a new tertiary care hospital in northern San Diego County.The JourneyThe journey began in 2003 with the recognition that the facilities on our downtown tertiary campus would not meet the seismic building mandate set forth in legislation passed after the January 17, 1994 Northridge, California earthquake. Hospitals that did not already meet the standards were required to upgrade their facilities by 2008-a challenge at best for the hundreds of hospitals throughout the state that did not meet the requirements. Funds were not to be appropriated through state resources to support the modifications.At Palomar Health, funding and several other factors influenced us to develop a greenfield site for a new facility rather than upgrade our existing infrastructure. For example, the physical plant was built in the early 1960s and deteriorating. The power plant supporting the campus no longer had the capacity to meet the utility needs of the facility. Any alterations would require bringing the facilities up to the latest building fire standards and codes and reducing bed capacity to comply with new square footage standards. The campus was too small to build a new structure adjacent to the existing building without the additional purchase of land and rezoning of space. The area's population growth and shifts in demographics in our hospital district and the surrounding areas demanded a stronger and expanded response for service-both ambulatory and hospital based. Finally, the community was coming to expect private patient rooms, increased individuality and involvement in their care, and hotel amenities.Design PrinciplesNotwithstanding the organization's ability to finance a new building project and find an appropriate property, the hospital's stakeholders generally agreed on several key needs that the new hospital would have to meet, all of which needed to center on the organization's mission and vision.First, it needed to accommodate growth of any kind in the population. Second, any site needed to have the capacity for growth such that the space could be reworked or remodeled easily to meet new needs or changes in clinical care delivery. Expandability and flexibility would be the keys to the new facility's performance. Third, the building needed to be sustainable and operate efficiently and economically. In particular, we needed to be able to manage the cost of care under the capitated environment in Southern California at that time. Fourth, in accordance with evidence gleaned by the Center for Health Design (2014) through its Pebble Project, Palomar Health was encouraged to create facilities and use technologies that would markedly improve the quality of care rendered in measurable ways while creating a softer, more caring environment for patients, families, and staff. Fifth, any physical or structural changes from the older hospital's design were to transform the system's culture, which had been hierarchical and often clannish, into a more patient-centric, market-driven, and innovative climate. Sixth, the facility needed to be one that the communities could be proud of and identify with and serve as a landmark or beacon for them. Seventh, we needed to ensure that principles employed in the designs, equipment, technology, and processes could be applied to renovation and remodeling projects and be translated across all areas of the system as well as to other organizations that wished to learn from our experience. …