RETHINKING THE TRADITIONAL APPROACH · 1 © 2015 – CannonDesign – Reproduction Prohibited Comprehensive Campus Planning RETHINKING THE TRADITIONAL APPROACH"

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© 2015 – CannonDesign – Reproduction Prohibited

Comprehensive Campus PlanningRETHINKING THE TRADITIONAL APPROACH"

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Across Canada Focus is Shifting Toward Value and Performance in Healthcare Delivery

§  Hospital Admission Risk Prediction

§  All-cause readmissions

§  Falls

§  Avoidable mortality

§  Patient safety

§  Patient experience

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Yes, But Campus Planning is a Structured Process That Needs to Look at the Facilities and the Campus, Not at Things Like Care Delivery

Volume Projections

Facility Analysis

Real Estate Analysis

Key Room Forecast

Space Program

Campus Plan

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Campus Scenario Development

Cost Estimating

Stakeholder Feedback

The Challenges Facing Healthcare Mandate Health Systems and Provinces Think Differently About How and What They Plan

Future Demand Assessment

Final Campus Plan

LEAN Operations

Care Model Innovation

Clinical Functionality

Facility Condition

Site Constraints

Future-State Performance Calibration

Site-of-Service Planning

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The Challenges Facing Healthcare Mandate Health Systems Think Differently About How and What They Plan on Their Campuses


LEAN Operations



Facility Condition

Site Constraints



WHAT:

WHY:

Long-term inpatient, outpatient and ambulatory demand projections

Allows for a deep exploration of predicted utilization:

§  Age cohort

§  Socioeconomic status

§  Key health indicators

§  Postal code

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WHAT:

WHY:

Assessment of existing clinical spaces for their ability to delivery contemporary and future standards of care

Spaces may be appropriate in terms of size, key rooms and infrastructure but not be organized to support optimal patient care and / or experience

LEAN Operations



Facility Condition

Site Constraints



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WHAT:

WHY:

Analysis of operational performance against industry benchmarks focused on throughput and capacity

Many health systems have numerous and considerable areas of inefficiency. Planning futures spaces to existing performance may result in over-planning, unnecessary cost and suboptimal patient and provider experiences

LEAN Operations



Facility Condition

Site Constraints



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WHAT:

WHY:

Exploration of how healthcare delivery models will evolve to support optimizing quality, performance, value and experience

Many new models of care will have an impact on demand and utilization while also having unique facility requirements not supported by existing facility layout and infrastructure

LEAN Operations



Facility Condition

Site Constraints



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WHAT:

WHY:

Detailed analysis of building infrastructure to understand current state of all aspects of the physical environment

Enables a more educated understanding of the facility’s conditions (via facility condition index) which serves as a useful guide for planning long-term investment in or replacement of existing facilities

LEAN Operations



Facility Condition

Site Constraints



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WHAT:

WHY:

Review of the overall campus(es) to determine their long-term ability to meet the healthcare needs of the community

Site constraints can prove challenging and expensive when expansion and / or replacement of facilities are required. Issues such as location, access, environmental impact and other considerations must be explored

LEAN Operations



Facility Condition

Site Constraints



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WHAT:

WHY:

Identification of what services will be provided where in a given service area

Convenient services locations can increase compliance, reduce unnecessary utilization of higher-cost services such as the ED and reduce the overall cost of healthcare delivery

LEAN Operations



Facility Condition

Site Constraints



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WHAT:

WHY:

Establishment of optimal-state performance targets across an organization focused on quality, operations, cost, service excellence and growth

Facilitate development of a master plan focused on optimally-performing organization in an effort to avoid over-planning, promote cost control and ensure long-term ability of the campus to meet demands placed upon it

LEAN Operations



Facility Condition

Site Constraints



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LEAN Operations



Facility Condition

Site Constraints



WHAT:

WHY:

Long-term inpatient, outpatient and ambulatory demand projections revisited

Allows an overlay of the impact of future-state performance calibration, care model innovation and site-of-service planning on baseline demand numbers

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Campus Scenario Development

Cost Estimating

Stakeholder Feedback



Final Campus Plan

LEAN Operations



Facility Condition

Site Constraints



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Planning for Behavioral Health Care for 26 Million Residents Across Nearly 700,000 km2

CHALLENGE Via legislative mandate, the Texas Health and Human Services commission was tasked with developed a 10-year strategic plan for the provision of care to patients in state psychiatric hospitals and state supported living centers (intellectual and development disabilities) delivering care across 26 sites and in over 200 buildings. The mandate also required translation of the plan into a facility asset plan for all buildings at all sites of care in a state with 10-year population growth projections of 24%.

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The Project Approach Was Iterative With Opportunity for Staff, Patient and Community Stakeholder Involvement, Input & Feedback

CARE MODEL ANALYSIS, PLANNING

& OPERATIONS FACILITIES &

INFRASTRUCTURE REAL ESTATE

PLANNING

SWIM LANE 1 SWIM LANE 2 SWIM LANE 3

Stakeholder Interviews & Facility Tours"

Data Collection & Program Inventories"

Policy, Procedure & Process Review"

"

Workforce Assessment !

Stakeholder Focus Groups

& Surveys"Site

Evaluation"

Building & Real Estate Assessment "

"

Market & Demographic

Analysis!"

Community Assessments"

SCOPE

§  Multiple swim lanes were developed to assess clinical functionality and operations, models of care, facilities and real estate at all sites over a four week time frame

§  Assessment information was used to inform visioning process intended to evolve model of care to reflect next-practices

§  Final deliverable included facilities recommendations tied to demand and care model evolution

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Lean Operational and Clinical Functionality Assessment Revealed Multiple Opportunities to Re-Envision How Care Might Be Delivered

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Infrastructure Analysis Comprehensively Assessed Assets Across 26 Sites with Buildings Over 100 Years Old, Some Historically Designated

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The Facilities Condition Assessment Answered Four Key Questions

WHAT DO YOU OWN?

WHAT CONDITION

IS IT IN?

WHAT ARE THE VALUES

AND LIABILITIES?

PLAN FOR THE FUTURE?

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The Facilities Condition Assessment Looked Across All Disciplines in Every Building

Architectural

Civil

Communications

Electrical

Fire Protection

Mechanical

Plumbing

Structural

ANALYSIS

§  Based on the 10-year value ranking of the FCI, the condition of the entire building can be organized by discipline, including the associated replacement cost

DISCIPLINES

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§  Industry Standard Scale

§  Comparison and Benchmarking

§  Strategic Investment Planning

And Yielded an Apples-to-Apples Scoring System to Promote Easier Prioritization of Investment Strategies

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ANALYSIS

While systems typically serve the entire facility, many facilities have several levels. One Level (or wing) within a facility can be isolated and analyzed for detailed review. This process identifies specific deficiencies at the selected level, and compares this to the relative value of the level based on the CRV. The results is a Level Condition Index (LCI).

Facilities Condition Assessments Reviewed Assets on the Building and Floor Levels

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DEPTH ANALYSIS

Within each level, a space or Department can be further analyzed.

Based on the percentage of the floor space allocated and the specific deficiencies occurring within the space, a relative Department Condition Index (DCI) can be ascertained.

While Also Drilling Down to Department-Level Analysis

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Facility Condition Indices Were Also Compared Across Sites

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OPERATIONAL OPTIMIZATION Clinical Quality

& Outcomes

Fiscal Stewardship

Operational Efficiency

Physician & Staff

Alignment

Service Excellence

Enterprise ««« « « «« ««

Dept. 1 ««« « « «« «« Dept. 2 ««« « « « «« Dept. 3 ««« «« «« «« ««« Dept. 4 ««« «« «« « «« Dept. 5 ««« « «« «« «« Dept. 6 ««« « « «« ««

Dept. 7 ««« « « «« «« Dept. 8 ««« « « «« ««

Dept. 9 ««« « « «« «« Dept. 10 ««« « « «« «« Dept. 111 ««« « «« «« Physical Plant

O P T I M I Z A T I O N S C A L E

««« Optimized ( Above Target Goal / Benchmark) «« Acceptable (+/- 5% of Target Goal/Benchmark)

« Modifications Recommended (Below Target Goal / Benchmark)

Operational Priority Score

Facility Priority Score

41 63 25 47 35 51 29 48 49 66 49 68 57 72 39 56 29 44 59 73 72 91 30 54 15 30

Combining Facilities and Operational Assessment Provided “The Big Picture”

FACILITY OPTIMIZATION

Structure HVAC / Plumbing

Electrical / Telecom

Crisis / Security Life Safety Energy

««« ««« «« «« «« «« ««« ««« ««« «« ««

««« « « «« ««

««« ««« « «« ««

« «« «« «« ««

««« « ««« « «

« «« «« «« ««

««« ««« « « «««

« «« « «« ««

«« ««« « « ««

« «« « «« ««

««« « ««« « «

« «« «« «« «« «« I N D E X S C A L E

100 High Priority 0 Low Priority

+ =

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Site and Real Estate Assessments Considered the Size and Appropriateness of Each Campus for Modernization, Expansion and / or Replacement

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Site Analysis Also Focused on Positioning of Real Estate Assets Against Demand Across the Service Area and Community Impact

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Baseline Demand Projections Focused on 10-Year Population Growth Estimates in a State Projected to Grow 24% in the Next Decade

Growth across the state of Texas is not projected to be uniform. The majority of population growth will occur along in three areas: Along the I-35 corridor from Dallas to San Antonio, around Houston and along the Rio Grande Valley.

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Customized Volume Projections Overlaid Specific Demographics As Well as Unmet Needs Common to Behavioral Health Services in the U.S.

§  Gender

§  Age

§  Socioeconomic status

§  Substance abuse

§  Education level

§  Comorbid medical conditions

§  Unmet need

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The Care Model Vision Focused on Needs of All Constituents and All Aspects of the Care Delivery Process

Co

st R

ea

ch

Q

ua

lity & Se

rvice

State & Providers Consumers

Low total costs Low out-of-pocket costs

Large geographic area Access to preferred providers

High quality outcomes Great care experience

Standardization

On-demand services

Comprehensive scope of services

High satisfaction

On-demand services

Convenient access points close by

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Summarized, The Overall Model of Care and Planning Vision Focused on Four Key Themes

Right Care

Right Place

Right Time

Right Resources

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The Right Care: Person-Centered Model of Care

Spiritual

Substance Abuse

Medical Care

Medications

Research

Behavioral Therapy / Psychiatry Services

Safety Net Services / Support

Coping Strategies

Wellness

Nutrition

The person-centered model of care understands that the condition of

behavioral health consumers cannot be optimized without attention to all

aspects of their health and well-being.

At the center of this mode is the assumption of a proactive model to

address behavioral, wellness, medical, substance use, psychosocial and basic survival needs, all in an integrated and

coordinated manner.

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The Right Care: Behavioral Health Services Must Be Seamlessly Coordinated with Medical Care and Substance Abuse Services

Substance Abuse Services

Medical Care


The coordination of these services is about more than simply making sure different services providers

are talking to one another. It’s about:

§  Identifying opportunities to co-locate services

§  Simultaneous service delivery

§  Integrated service delivery plans

§  Funding to support all needed services

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The Right Place: Optimizing the Continuum of Care Means Not Everything Belongs on the Main Clinical Campus

Home

Long-Term Care

Inpatient Care

Acute Stabilization Services

Virtual

Community

Acute Assessment Services

The future of behavioral health consumer services will be focused on shifting from an institutional

model of care to one that is focused on leveraging all resources along the continuum of care to promote consumers receiving services and

support in their communities and as close to their home as possible with the state psychiatric

hospitals transitioning to provide care for only most complex and / or severe civil patients as well as caring for specialty populations not cared for in

community settings as well as the forensic population.

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The Right Place: Integrated Care Models Will Vary Across the State

Approach #1

Local MHA sponsored clinic embeds primary care physician or

nurse practitioner

Approach #3

Integrated clinic with in-house primary care and licensed mental health providers services provided

to consumers

Approach #2 – Limited MH Providers

Tele-Psychiatric services provided

by host clinic with linkage to behavioral health center of

excellence

Approaches implemented should include, where possible,

substance abuse services and be tailored to the available resources

in the community.

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The Right Place: Demand Varies Across the State and Set the Tone for How and Where Resources Will be Distributed Across Texas

Geriatric

Child & Adolescent

Forensic

All Ages Pediatric (<18) Adult (18 – 64) Geriatric (65+)

County Legal Status Total MH Substance Abuse

Medically Complex Total MH Substance Abuse



Medically Complex

Total Region Civil 160 80 156 18 12 18 136 66 131 7 1 7

Forensic 34 25 34 7 6 7 25 19 25 2 0 2 Bailey Civil 3 3 1 0 0 0 3 3 1 0 0 0

Forensic 0 0 0 0 0 0 0 0 0 0 0 0 Carson Civil 1 0 1 0 0 0 1 0 1 0 0 0

Forensic 1 1 1 0 0 0 1 1 1 0 0 0 Castro Civil 3 1 3 0 0 0 3 1 3 0 0 0

Forensic 0 0 0 0 0 0 0 0 0 0 0 0

DSHS Patients Receiving Care*, 2024 Projection "

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The Right Place: Future Service Delivery Focused on Enhancing Access Closer to Patients’ Homes, Particularly for Rural Areas Civil Psychiatric Bed Capacity by County"State of Texas, 2014"

200+

100 to 199

25 to 99

1 to 24

0

Civil Psychiatric Bed Need by County"State of Texas, 2024 Projection"

50 to 799

25 to 49

10 to 24

2 to 9

0 to 1

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The Right Time: On-Demand Access for Services Was Planned to Reduce the Demand for Higher Cost, Higher Acuity Services

Crisis Intervention

Acute Assessment

Behavioral Health

Medical Care

Peer Support

Community Services

Substance Abuse

Acceleration of access to services provides numerous benefits that elevate quality, increase satisfaction and lower

the overall cost of care, including:

§  Reduced use of ED services

§  Earlier detection and management of acute decompensation

§  Increased compliance with post-discharge plan of care

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The Right Resources: The Campus Plan Also Focused on the Role of Providers in Access, Care Delivery and Care Coordination

Spiritual

Substance Abuse

Medical Care

Medications

Research


Safety Net Services / Support

Coping Strategies

Wellness Many patients struggle with coordinating and accessing services across different agencies and sites. Care & Resource

Navigators offer consumers the opportunity to liaise with a single person who’s sole

responsibility is to ensure the consumer is receiving the right care in the right place at

the right time with the right resources regardless of what the patient needs or

where along the continuum it is needed.

Patient Care & Resource Navigator

Nutrition

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The Right Resources: Campus Plans are Great, But What if There is No One to Staff the Facilities? The Plan Also Considered Future Staffing Models

Increase Number of Training Programs

Loan Forgiveness Programs for Service

Commitments

Partnerships with Texas Healthcare

Agencies

Out-of-State Recruitment H1B Visa Program

✔ ✔ ✔ ✔ ✔

✔ ✔ ✔ ✔ ✔

✔ ✔ ✔ ✔

Psychiatrists

Psychologists

Psychiatric Nurse Practitioners

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The Customized Demand Forecast, Future-State Performance Calibration and Care Model Innovation Drove Key Room and Space Programs Across All Sites

§  Projected length-of-stay

§  Admission-avoidance strategies

§  Enhanced ambulatory model

§  Care coordination

§  Tele-medicine services

§  Integrated care delivery models

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The Campus Plans Blended All Aspects of the Project Into Unique Campus-by-Campus Plans

Across 26 campuses recommendations included modernization without expansion, expansion/ partial replacement, wholesale replacement and even relocation of the entire campus to a greenfield site.

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Campus Plans Focused on Wellness, Accessibility, Efficiency, Expansion, Cost Control

All campuses were envisioned to engage the communities in which they exist with green spaces to promote wellness, activity and engagement for patients, families, staff and community alike.

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New Facility Recommendations Were Created with Lean Operations and Optimal Experience in Mind

The development of replacement facilities focused on optimizing all aspects of the planning engagement into viable solutions that reflected next-practices in healthcare delivery.

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Optimized Staffing Models and Work Flows Were Also Considered

Care model evolution considered new staffing models, how work will be performed and how clinical areas need to be re-envisioned to support a cost-effective model that also allowed for segregation of staff, patients and logistics while providing safe clinical environments.

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Renderings Offered An Opportunity to Tell the Story to the Community and Other Stakeholders

Many communities were concerned about the impact of new or modernized facilities. Renderings were provided to articulate the scale of new facilities and now users might engage the campuses and how the facilities might look in the community.

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Main Report (334 pages) §  Executive Summary §  Current and Future Demand Summary §  Key Global Themes §  Key Recommendations §  Global Assessment of Infrastructure Summary – Facility Planning §  Best Practices and Benchmarking in Behavioral Health Care Design §  Global Assessment of Infrastructure Summary – Facility Infrastructure Global

Assessment of Real Estate Summary §  Global Assessment of Care Model Summary §  Global Assessment of Community Summary

Supporting Appendices (1,150 pages) §  Focus Group Summary §  E-Survey Summary §  Global Assessment Detail §  Facility Planning Best Practices §  Facility Infrastructure and Real Estate Reports §  Literature Review

The Final DSHS Report Contains Nearly 1,500 Pages of Content

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Documents

RETHINKING THE TRADITIONAL APPROACH · 1 © 2015 – CannonDesign – Reproduction Prohibited Comprehensive Campus Planning RETHINKING THE TRADITIONAL APPROACH"