Welcome to HMC Architects’ Five in Focus blog series, where we explore the latest trends, ideas, and innovations shaping the future of architecture and design. This series asks our design professionals to tell us what’s capturing their attention and offer some insights.

Daniel Perschbacher, AIA, ACHA, Assoc. DBIA, IISE Lean Green Belt is a healthcare principal-in-charge at HMC. Here, he shares his thoughts on access to behavioral care, cost escalation, integrated design and construction, the shift to home healthcare, and staff recruitment and retention.

1. Access to behavioral healthcare

The behavioral health crisis exacerbated by the pandemic presents a formidable challenge, necessitating innovative solutions. However, the high costs associated with traditional behavioral healthcare construction pose a significant barrier, hindering organizations’ ability to provide essential care to communities. There is a pressing need to develop low-cost alternatives to make behavioral healthcare more accessible. To address this, a key focus is establishing connectivity across various project types, aiming to integrate mental healthcare into the fabric of our society. This involves initiatives such as incorporating counselors in schools, establishing community centers with access to outpatient programming, deploying mobile crisis units, and promoting workplace wellness. Exploring ways to integrate these structures within communities, reducing stigma, and rethinking episodic-driven models of care will be crucial. By breaking the mold and delivering cost-effective, preventative solutions, the architectural perspective can be pivotal in solving this complex problem by incorporating diverse programs into integrated building solutions.

2. Cost escalation

Addressing the escalating costs in healthcare construction is imperative. The current disparity between our clients’ balance sheets and construction expenses necessitates a strategic approach to design. Intelligent, thoughtful design decisions are crucial in managing costs and emphasize the need for creative programming and building planning. It is vital to scrutinize proformas early in the process, determining what and whether to build. While the inclination is often to cut costs after the big ideas have been established, meaningful cost savings lie in the initial stages—effective programming and planning. We can address the root causes of cost overruns and ensure a more efficient and cost-effective construction process by optimizing these early aspects, such as reducing the number of rooms or adjusting building size.  Cost avoidance will always be more effective than cost-cutting.

3. Integrated design and construction

The industry calls for an integrated approach to building projects in response to the escalating costs of healthcare construction and the increasing specialization of building trades. Recognizing the need for cost-effective and constructible designs, the integrated solution involves bringing specialists into the design process. Participating in integrated delivery teams requires a shift in problem-solving methods. The traditional ‘jack of all trades’ mentality needs to be updated, requiring a design approach that leverages the builders’ knowledge to avoid inefficiencies and give our clients the best possible results. The goal is to achieve a three-legged stool of better quality, faster delivery, and value. Designing with construction in mind, through design-build and integrated contracting, is a smart way forward. While integrating design and construction is essential, some drawbacks can complicate the process. It requires a special culture and skilled individuals, exemplified by firms like HMC, to execute it effectively and maintain the project’s stability. Balancing these elements is crucial to avoid building a precarious structure where complexity replaces integration.

4. The shift to home healthcare

The shift to home healthcare, accelerated by the pandemic, reflects a broader trend toward providing care in the lowest acuity setting possible. This evolution is transforming outpatient centers to integrate more procedural, surgical, and specialty spaces. Looking ahead, outpatient centers are anticipated to become more specialized, with primary care moving towards telemedicine and wearables, reducing the need for in-person routine check-ins. Conversely, larger acute care sites of care are becoming more focused on the sickest patients. To adapt to this shift towards closer-to-home care, hospitals may reinvest in existing structures more and more, prompting the need for forward-thinking planning for a higher acuity future. However, building in flexibility for this level of care can pose challenges, emphasizing the importance of cost-effective design solutions and processes. The construction landscape will change, with outpatient centers resembling diagnostic and therapy hubs while hospitals evolve from focusing on short stays for minor issues to longer stays for critical care. Building in anticipation of these site-of-care shifts is crucial for future healthcare infrastructure.

5. Staff recruitment and retention 

The healthcare industry is grappling with unprecedented challenges in staff availability, making staff recruitment and retention a pressing concern. Organizations must devise strategies to retain their workforce amidst stretched budgets for paying traveling nurses and staff augmentation firms. Recognizing the financial strain, a holistic approach to staff well-being becomes crucial. This includes initiatives such as 24/7 access to healthy foods, onsite daycare for working parents, staff-focused concierge services, and the creation of dedicated respite areas and outdoor spaces accessible from every unit. The magnitude of the challenge is underscored by the fact that 40% of doctors and nurses express a willingness to change careers, emphasizing the critical importance of addressing burnout and prioritizing staff well-being. From a design perspective, designers need to go beyond traditional staff lounges and incorporate amenities that contribute to staff health and satisfaction. Investing in staff well-being improves the quality of care and is a cost-effective strategy, as retaining and nurturing existing talent is more economical than frequent recruitment and training.

Daniel Perschbacher, AIA, ACHA, Assoc. DBIA, IISE Lean Green Belt

Principal in Charge

As principal in charge in HMC’s San Diego Healthcare studio, Daniel serves the firm’s healthcare client base and works to expand the firm’s healthcare reach in the San Diego region. He has over 19 years of experience in healthcare architecture spanning nearly every project type and delivery method. He is passionate about applying Lean principles to the architecture and construction delivery process. Daniel believes that healthcare design, more than any other project type, wraps around communities and provides space for their most joyous and difficult moments.

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