Monthly Archives: February 2018

Investing In Healthcare

The baby boom cohort has changed the world in which we live and the lens through which we view it. The aging of this cohort (roughly one third of the population) will continue to usher in dramatic changes across most business sectors and areas of our lives in the years to come. The boomer demographic in North America is also presenting unique challenges for government run social programs and presenting unprecedented opportunities for businesses with the right entrepreneurial mindsets and resources. While boomer consumptive patterns have evolved over time, there are still strong correlates between their wants/needs (and the wants/needs of their children) and the flow of capital across virtually all economic sectors. Clearly, as boomers are aging, their spending habits are evolving as well. This re-prioritization of spending has become an area of study for governments and investment organizations alike. One area that surfaces repeatedly and is becoming pre-eminent in the study of boomer consumption patterns is healthcare.

Healthcare is one of the industries that are most acutely impacted by this demographic shift. While many boomers will continue working, many are also retiring or are getting close to retirement. Most boomers are or still view themselves as reasonably young (mentally and physically) – the oldest, born in 1946 one year after the “boys came home” from WWII. For those of you without a calculator handy, the oldest boomers will be 62 years of age in 2008. This small but important factoid is lost on many bullish investors who see the present time as the “halcyon days” in healthcare investment in seniors housing options or Long-term care. Yet it will be 15 to 20 years before the leading edge of the boomers reach the age where these services will be in higher demand.

What many people, including even professional investors, forget or never learned is that much of the the current demand for healthcare is being driven by WWI babies, or what has been coined The Greatest Generation. The Greatest Generation is compromised of those who reached adulthood just before, and served in WWII. Many came from rural areas of Canada and the U.S. and settled in the larger centers after the War. This generation was entirely different than succeeding generations. While the differences are beyond the scope of this article, suffice to say that those who seriously study demographic shifts expect the baby boom generation to have an entirely different set of expectations regarding healthcare service and other services than their parents.

So, to recap thus far, there are a significant number of opportunities in the United States and Canada in healthcare investment; but these opportunities are not limitless and nor are they a sure bet. Demographic shifts are significant drivers of healthcare consumption patterns. It is important to attribute healthcare supply and demand drivers to the market and demographic to which they rightfully belong.

So, while healthcare investment opportunities abound, there is no replacement for sound judgment based on analytical inquiry. This is true of any investment decision. It is also key that current and projected changes across the following domains are reviewed in detail: demographics, finances, macro-economics, geography, consumer attitudes and behaviours, motivating factors (e.g., luxury, fear), urban/rural, SES, educational, cultural, risk orientation, and other personal and group-related factors. While this article zeros in on the effect that the baby boom will have on the healthcare investment market, there are a multiplicity of other factors and population segments that are, and will continue to exert significant pressure on healthcare economics and consumption patterns.

The following businesses related to healthcare delivery are and will continue to be worthy of consideration by individuals, private equity, and venture capital investors. Again, it should be noted that the list is only a starting point, and that investment decisions should be made on the best current and projective information possible. It will be necessary to use an array of analytical tools and methods (e.g., Porter’s Five Forces and other financial and statistical methods and models) to assess the industry/sector/business opportunity prior to making a significant investment into healthcare. Having said this, potential healthcare investment opportunities exist in the following areas:

  • Integrated Healthcare Centers, i.e., primary care (particularly where physician services, diagnostics (X-ray, CT, MRI), laboratory, and pharmacy are delivered within a short radius)
  • Providers of products & services for diabetes management, congestive heart failure, COPD, coronary artery disease, and other high incidence chronic diseases
  • Providers of mobility and other daily living assistive devices for those with a range of impaired gross or fine motor skills or other mobility limitations (e.g., caused by pain, arthritis, joint immobility)
  • Pharmaceutical and biotechology innovators and providers (care must be exercised due to patent limitations, proliferation of substitutes – generic drugs, lengthy approval processes, and other process and outcome risks such as the Vioxx controversy )
  • Health and hospitality services outsourcing (again, highly contextual and requires significant demand/supply driver analysis, political, environmental, union/non-union and other forces analysis)
  • In-home healthcare services (e.g., nursing, physical therapy, occupational therapy, care and support)
  • Medical or surgical retreats (highly specialized, significant risk)
  • Assisted Living or Long-term Care (these resources are capital intensive and targeted at the parents of the boomers, i.e., the WWI babies) – it will be 20 years before boomers will require these services in any great volume (be careful)
  • Major equipment and major/minor supplies providers (e.g., MRI, CT, ultrasound through to re-useable and disposable equipment)
  • Providers of re-furbished medical equipment to secondary markets, which include more price-sensitive purchasers (e.g. re-furbished CT scanner for a smaller rural hospital)
  • Alternative medicine centers (e.g., offering Ayurvedic Medicine, acupuncture, traditional Chinese Medicine)

Since information technology is a core function in healthcare, the following is a stand alone list of technology-related opportunities related to data/information collection and transfer:

  • Devices: quick, simple to use, portable, and ease workflow in high stress healthcare environments (e.g., emergency departments, tele-health)
  • Devices whose operating systems converge with mainframe of networked systems that admit, track, audit, and generate reports with minimum input and robust rule-based error checking
  • Devices or system that integrates disparate healthcare network data and traffic
  • Devices or systems which accurately expedite services
  • Devices or systems which improve the accuracy and speed of diagnosis
  • Devices or systems which improve reduce human error and increase the probability of appropriate and targeted treatment options
  • Translational devices and applications of all sorts, i.e. translating actual “hands-on” data into useable, and interoperable information which can be used for diagnostic, treatment, recovery, and planning purposes
  • Electronic dashboard technology for strategic decision-makers
  • Providers of software applications that integrate disparate healthcare value chain and supply chain fragmentation
  • Providers of software applications that integrate in-hospital processes (e.g., admission, discharge, transfer); care-finance-payments; care-supplies-payments and other A/P and A/R alignment platforms and applications
  • Providers of software applications which refine, simplify, or facilitate the care planning of patients
  • Providers of systems integration
  • Providers of software applications for Human Resources, CRM, Finance, and other corporate functions

These are a few opportunities which currently exist in the healthcare context. As you might guess, many areas are being explored by larger firms. Healthcare IT is particularly attractive to larger, more highly capitalized companies and software developers. The competition amongst these groups is fierce due to the large volumes of funds in healthcare and the market opportunities driven by demographics and the need to constantly improve system performance. To date, there is no one firm with a strategic competitive advantage in any one area, though some healthcare sectors (e.g., diagnostics) have a high concentration of highly capitalized firms (e.g., GE and Siemens competing in the CT, MRI market).

Whatever investment decisions you decide, the amount of money you risk should be in proportion to your risk tolerance. Even “slam dunk” opportunities can turn out to be dogs if the circumstances are not right; or a context specific barrier is not weighed; or social attitudes do an about face.

If you are scanning the healthcare markets for opportunities to invest, be sure to do your due diligence and get help to investigate this complex and ever-expanding area. The due diligence you do prior to investing significant capital is essential to ensuring high double digit returns whilst minimizing your risk.

Benefits of Working For a Healthcare

Are you a healthcare professional seeking the opportunity to find great assignments in your area of expertise, but are not sure where to start? Why not consider working for a healthcare staffing agency? These are staffing firms that are geared specially towards helping healthcare professionals, like nurses, physicians, x-ray techs or medical assistants; find the kinds of assignments that are both professionally and personally rewarding. If you are a recent graduate of a medical program or are just looking for a change of pace, then a healthcare staffing agency may be perfect for you. Read on for some great benefits of working for a healthcare staffing agency.

Immediate access to the best opportunities. You know already that there are many wonderful opportunities in healthcare and that’s one of the reasons why you chose this career path. However, do you know where to look for the best opportunities for you? A healthcare staffing agency will be able to locate and find the best assignment for you. Your skills and interests will be assessed by the staffing agency and they will be able to closely match these up with assignments that will meet your needs. This is in contrast to trying to do this on your own and experiencing negative results. Many healthcare facilities are trying to keep administrative costs down so they can focus on quality of care for patients, so they turn to healthcare staffing agencies to seek out qualified candidates for their open positions. This means, many top healthcare providers are looking for you and the only way you will ever hear about their job openings is through healthcare staffing agencies. Be the first to know about great opportunities by registering with healthcare staffing agencies.

Access to career tools and support. When you register with a healthcare staffing agency, you can take advantage of all the career tools they offer. Need help with brushing up your resume or interviewing skills? Then take advantage of the help and resources available to you at a healthcare staffing agency. The recruiters there want you to be successful at getting signed on with one of their healthcare clients so they will do everything they can to help you and support you as you begin this process. You will be more successful by working closely with a staffing firm than by trying to do it on your own. After you get an assignment, the staffing agency will be there to help you with any issues you may encounter and work as a liaison between you and the healthcare administrators to make it a positive experience.

Costs and travel related to job placement. If you are a healthcare professional who is trying to land a job with a healthcare facility that is out of town, or you are a traveling nurse – you can benefit substantially by signing on with a healthcare staffing agency. If you work for them, they will be assisting you with the costs of travel and hotels for job assignments. The staffing agency will make your hotel arrangements, pay you for mileage, meals and other costs associated with your goal of getting on with a great healthcare provider. In many cases, the staffing agency also has opportunities for you to have some or all of your training or educational needs paid for as well.

Online Degrees in Healthcare

Candidates aspiring to enter the healthcare industry need to go for a degree that kick starts their chosen career or the job position they want to achieve. Today, people not only go for campus degrees in healthcare, but they prefer obtaining online degrees as well. Online degrees not only save time, but they save people thousands of dollars as well. To become eligible to enter the healthcare industry, the basic education requirement is an online associate’s degree in healthcare. There are a number of online degree programs available to get trained in healthcare education. Most of these healthcare degree programs need candidates to complete 60 credits of coursework from an accredited academic institution.

Popular Universities & Colleges providing Healthcare Degrees Online

Today, candidates can find multiple options for being trained in healthcare. To cater to the increasing demand of professionals in the healthcare industry, more and more colleges and universities are providing accredited online healthcare degrees. Whether you are looking for an associate degree, a bachelor’s degree, master’s degree or a doctoral degree in healthcare, you can get a number of options to obtain your online degree. Given below are some popular universities and colleges that offer healthcare degree programs online.

University of Phoenix
Everest University
Ashford University
Walden University
Kaplan University
Ohio University
Regis University
Grand Canyon University

For most the jobs in the healthcare industry, candidates would require a four year college program. Whether you want to become a physical therapist, a registered nurse, a dentist or a physician, an online bachelor’s degree is necessary to kick start your career in healthcare. Most of these online degree programs need students to complete 160 credits. While being trained online, students will receive education health related topics, business management, strategy planning and public relations. Depending on your healthcare career goals, you can further decide to obtain online masters or doctoral degree in healthcare.

Job Prospects for Online Healthcare Degree Holders

An online healthcare degree can land candidates a number of entry level job positions. An online associate degree can prepare candidates for the following healthcare industry job positions.

Dental Assistant
Medical Assistant
Nursing Aide
Office Manager
Home Health Aide
Veterinary Technician

If you want to advance your career in healthcare even more and earn a higher salary, you and get enrolled in an online healthcare bachelor’s degree and be ready to land the following jobs.

Nursing Home Director
Medical Office Manager
Health Services Administrator
Hospital Administrator
Clinical Services Representative

Job Outlook & Earning

The healthcare industry is expected to add 3 million more jobs for professionals through to the year 2016. Looking at this employment growth rate, it is obvious that the job market for healthcare professionals is quite strong. Though an online associate’s degree in healthcare is the basic requirement, an online bachelor’s degree can help you earn even more. Professionals who land jobs in the healthcare administration can earn an annual salary ranging between $60,000 and $100,000. As you grow in experience and skill, you can look forward to earning even more salary.

Careers in Healthcare Administration

The thought of a career in healthcare may conjure up images of doctors, nurses, and other direct healthcare providers rushing in their scrubs from one emergency situation to another.

While there is little doubt that these direct patient care providers are the key to healthcare delivery, many others are working behind the scenes to ensure the entire process is smooth and seamless throughout the system.

Among these healthcare professionals are health services managers, also known as healthcare executives or administrators.

Healthcare Administration: The Profession

According to the U.S. Department of Labor, the primary job of a healthcare administrator is to plan, direct, coordinate, and supervise the delivery of health services in a healthcare facility. A healthcare administrator may manage:

    • An entire healthcare facility

    • A specific clinical department

    • The medical practice of a group of physicians

    • Typically, a healthcare administration degree is required for the job. Depending on the level and type of degree they have, health services managers can find career opportunities in any of the following positions.

    • Hospital administration: The job of a hospital administrator is to make sure the hospital they manage runs smoothly and healthcare is efficiently delivered to those who need it. They coordinate day-to-day administrative activities such as creating work schedules, handling finances, maintaining records, managing inventory, etc. to ensure the business of healthcare continues uninterrupted.

    • Nursing home administration: Nursing homes are residential facilities for people who require constant nursing care. The challenges of managing a nursing home are quite different from those of managing a hospital. Part of a nursing home administrator’s duties is also to take care of the resident patients in addition to managing staff, finances, admissions, and the property itself.

    • Clinical administration: The responsibilities of a clinical administrator depend on the specific medical specialty department he or she manages. They are responsible for formulating and implementing policies for their clinical department, monitoring the quality of care provided to patients in that department, creating budgets, and preparing reports.

  • Health information management: Health information managers have the important task of maintaining and safeguarding patient information from unauthorized access. They work with the latest technologies in information management and security to handle hospital databases. It is, therefore, vital for health services managers in this field to keep themselves updated on evolving technologies.

Healthcare Administration: Training

Individuals interested in this profession are typically required to have a Bachelor’s in Healthcare Administration degree for entry-level assistant roles. Bachelor’s degree programs in health information management are also available for individuals interested in managing this aspect of healthcare.

Some employers, however, may insist on a graduate healthcare administration degree for the role of health services manager. A Master’s in Healthcare Administration degree may also be required for advancement from assistant roles to positions with more responsibility and a higher salary.

For healthcare administrators seeking advancement without having to take a sabbatical from work, an online Master’s in Health Care Administration program may be an ideal fit. An online healthcare administration degree can provide them the flexibility to continue their education and while still working full time.

Planning and Design of Behavioral Healthcare

Behavioral Healthcare Facilities: The Current State of Design

In keeping with most districts of healthcare, the marketplace has seen a boom in the construction of Behavioral Healthcare facilities. Contributing to this increase is the paradigm shift in the way society views mental illness. Society is placing a heavier value on the need to treat people with serious addictions such as alcohol, prescription and elicit drugs. A large percentage of people suffering from behavioral disorders are afflicted with both mental and addictive behaviors, and most will re-enter communities and either become contributors or violators.

These very specialized facilities do not typically yield the attention from today’s top healthcare designers and their quantity accounts for a small fraction of healthcare construction. However, Behavioral Healthcare projects are increasing in number and are being designed by some very prominent architectural firms such as Cannon Design and Architecture Plus. Many are creating state-of-the-art, award-winning contemporary facilities that defy what most of us believe Behavioral Healthcare design to be.

Changing the Way We Design Behavioral Healthcare Facilities

As with all good planners and designers, A+D (along with facility experts) are reviewing the direct needs of patient and staff while reflecting on how new medicine and modern design can foster patient healing rates, reduce environmental stress, and increase safety. This is changing the face of treatment and outcome by giving the practitioner more time to treat because they require less time and resources to “manage” disruptive patient populations.

The face of Behavioral Healthcare is quickly changing. No longer are these facilities designed to warehouse patients indefinitely. And society’s expectations have changed. Patients are often treated with the belief that they can return to their community and be a contributor to society. According to the National Association of Psychiatric Health Systems (NAPHS), depending on the severity of illness, the average length of stay in a Behavioral Healthcare facility is only 9.6 days.

What has changed?

Jaques Laurence Black, AIA, president and principal of New York City-based daSILVA Architects, states that there are two primary reasons for the shortened admission period:

1. Introduction of modern psychotropic drugs that greatly speed recovery

2. Pressures from insurance companies to get patients out of expensive modes of care

To meet these challenges, healthcare professionals are finding it very difficult to effectively treat patients within the walls of antiquated, rapidly deteriorating mental facilities. A great percentage of these facilities were built between 1908 and 1928 and were designed for psychiatric needs that were principled in the belief to “store” not to “rehabilitate.”

Also impacting the need for Behavioral Healthcare construction is the reluctance of acute-care facilities to provide mental health level services for psychiatric or addiction patients. They recognize that patient groups suffering from behavioral disorders have unique health needs, all of which need to be handled and treated only by very experienced healthcare professionals. This patient population also requires a heightened level of security. Self-harm and injuring staff and other patients are major concerns.

The Report of the Surgeon General: “Epidemiology of Mental Illness” also reports that within a given year about 20% of Americans suffer from a diagnosable mental disorder and 5.4% suffer from a serious mental illness (SMI ) – defined as bipolar, panic, obsessive-compulsive, personality, and depression disorders and schizophrenia. It is also believed 6% of Americans suffer from addiction disorders, a statistic that is separate from individuals who suffer from both mental and addiction disorders. Within a given year it is believed that over one-quarter of America’s population warrants levels of mental clinical care. Even if these statistics were cut in half, it cannot be denied as a serious societal issue.

With a growing population, effectively designing in accordance with such measures is at the heart of public health.

Understanding the Complexity of Behavioral Healthcare Design

Therefore, like Corrections, leading planners and designers specializing in Behavioral Healthcare are delving deeper to better understand the complexity of issues and to be the activist to design facilities that promote treatment and healing – and a safer community.

The following is a list of key design variables that are being studied and implemented:

1. Right Sizing

2. Humanizing Materials and Color

3. Staff-Focused Amneties and Happiness

4. Security and Safety

5. Therapeutic Design Tenants

Right-sizing

Today’s Behavioral Healthcare facilities are often one-story single buildings within a campus size. Often debated by Clients due to costs, this design preference is driven by the demand for natural light, window views to nature for all patient areas, and outdoor open-air gardens “wrapped” within. All of this provides soothing qualities to the patient, reduces their anxieties, counteracts disruptive conduct and helps to reduce staff stress.

“When you look at the program mix in these buildings, there’s a high demand for perimeter because there are a lot of rooms that need natural light. Offices, classrooms, dining areas, community rooms, and patient rooms all demand natural light, so you end up with a tremendous amount of exterior wall, and it forces the building to have a very large footprint.” – James Kent Muirhead, AIA, associate principal at Cannon Design in Baltimore

These design principles are also believed to improve staff work conditions. Unlike a multi-story complex, at any moment staff can walk outdoors and access nature, free from visual barriers, and within a building that more accurately reflects building types that both patients and staff would encounter in their communities.

In addition to right-sizing for the overall building footprint, is right-sizing for internal patient and staff support area. Similar to the move we have seen in Corrections to de-centralize support spaces, Behavioral Healthcare is moving to decentralized nursing/patient units called “neighborhoods.” With mental health facilities there is a large concern with distances and space adjacencies in relation to the patient room and patient support areas such as treatment and social spaces. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, Troy, NY, advocates neighborhoods that average 24-30 beds arranged in sub-clusters, called “houses”, of 8-10 beds. Thus, each neighborhood consists of three houses. Often these layouts will include a common area where patients congregate and socialize, with a separate quiet room so patients can elect to avoid active, crowded areas. In addition Pitts states, “There’s a move away from central dining facilities. So, while facilities will still have a central kitchen, it’s a whole lot easier moving food than it is patients.” However, it is important for the facility to mimic normal outside daily life routines, so patients are encouraged to frequently leave their neighborhoods to attend treatment sessions, and outdoor courtyards.

Humanizing Materials & Color

In all facilities that play a role in rehabilitation, design strives to create spaces that humanize, calm, and relax. Behavioral Healthcare patients need to feel that they are in familiar surroundings; therefore, the architectural vocabulary should feel comfortable and normal. Since these facilities are about rehabilitation (when possible) and encouraging patients to merge back into society, the facility should feel like an extension of the community. Their spaces should reflect the nature and architecture of the surrounding region and thus so, no two facilities should look too much alike.

“Our approach to designing these facilities is to view the facility as an extension of the community where patients will end up when they’re released. Interior finishes also depend on geography because you want to replicate the environment patients are used to. You want to de-stigmatize the facility as much as possible.” – Tim Rommel, AIA, ACHA, OAA, principal with Cannon Design in Buffalo, NY.

Therefore, materials and colors within these spaces want to feel familiar to one’s region and everyday life. To soothe the psyche and rehabilitate, they want to feel soft and comfortable, yet visually stimulating. An interior that is overly neutral or hard in appearance is not appropriate. Materials should reduce noise, and colors should lift the spirit. This can help to create an environment in which the patient can learn, socialize, and be productive while easing anxieties, delivering dignity, and modifying behavior. As stated previously, behavioral studies advise the use of softer interior materials-like carpeting, wood doors and tile. Doing so translates directly to both patient and staff well-being, particularly staff safety, and makes for a nicer place to work. In addition, staff have more resources to “treat” instead of manage heated situations. When staff experiences are eased and satisfied, morale is boosted and life-saving rules and policies are more likely to be enforced.

Staff-Focused Amenities & Happiness

While reducing staff stress and fatigue through a healing supportive environment seems like an obvious goal, there are relatively few studies that have dealt with this issue in any detail. More attention has been given to patient outcomes. However, many leading hospitals that have adopted therapeutic tenants into their newly built environments have seen vast improvement through their “business matrixes” and financial reporting.

In one example, the Mayo Clinic, a national leader in implementing healing design in its facilities, has reported a reduction of nursing turnover from a national annual average of 20% to an annual 3%-4%. In another example, when Bronson Methodist Hospital incorporated evidence-based design into its new 343-bed hospital, they cited their 19%-20% nurse turnover rate dramatically dropped to 5%.

Now, both the Mayo Clinic and Bronson Methodist Hospital have had to initiate a waiting list for nursing staff seeking positions. This converts to better-trained and qualified staff, and a reduced error rate. Therefore, more health facilities are investing in staff support areas such as lounges, changing rooms, and temporary sleep rooms. Within these staff spaces and in the hospital throughout, facilities are also recognizing the need for upgrade materials, better day lighting, and an interesting use of color: One soon realizes that the need of patients and staff are interwoven, each impacting positively or negatively the other.

Security & Safety

Without debate, self harm and harm to staff is one of the biggest concerns mental health facilities manage. Often the biggest safety and security concern is the damage patients can do to themselves. “There are three rules I had drummed in me,” says Mark Hanchar; Director of Preconstruction Services for Gilbane Building Company, Providence, R.I. “First, there can’t be any way for people to hang themselves. Second, there can be no way for them to create weapons. Third, you must eliminate things that can be thrown.” Hanchar says that the typical facility is, “a hospital with medium-security prison construction.” This means shatter proof glass, solid surface countertops (laminate can be peeled apart), stainless steel toilets and sinks (porcelain can shatter), push pull door latches and furniture that cannot be pulled apart and used as a weapon. These are just to name a few.

Additionally, removing barriers between patients and nursing staff is a safety consideration. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, says what may be counter-intuitive for safety precautions, “Glass walls around nursing stations just aggravate the patients.” Removing glass or lowering it at nursing stations so patients can feel a more human connection to nurses often calms patients. There is also discussion of removing nursing stations altogether; decentralizing and placing these care needs directly into the clinical neighborhoods and community spaces. Pitt says, “The view is that [nursing staff] need to be out there treating their patients.”

Therapeutic Design Tenants

As medicine is increasingly moving towards “evidence-based” medicine, where clinical choices are informed by research, healthcare design is increasingly guided by research linking the physical environment directly to patient and staff outcomes. Research teams from Texas A&M and Georgia Tech sifted through thousands of scientific articles and identified more than 600 – most from top peer-reviewed journals – to quantify how hospital design can play a direct role in clinical outcomes.

The research teams uncovered a large body of evidence that demonstrates design features such as increased day-lighting, access to nature, reduced noise and increased patient control helped reduce stress, improve sleep, and increase staff effectiveness – all of which promote healing rates and save facilities cost. Therefore, improving physical settings can be a critical tool in making hospitals more safe, more healing, and better places to work.

Today’s therapeutic spaces have been defined to excel in 3 categories:

1. Provide clinical excellence in the treatment of the body

2. Meet the psycho-social needs of patients, families, and staff

3. Produce measurable positive patient outcomes and staff effectiveness

Considering the cost of treating mental illness, which is exceedingly high, and wanting facilities to have effective outcomes, a further practice of incorporating therapeutic design is increasing. The National Institute of Mental Health (NIM H) approximated in 2008 that serious mental illnesses (SMI ), costs the nation $193 billion annually in lost wages. The indirect costs are impossible to estimate.

The estimated direct cost to clinically treat is approximately $70 billion annually and another $12 billion spent towards substance abuse disorders. In addition to the increased need of care and the boom in Behavioral Healthcare construction, it becomes an obligation to make certain that we as facility managers, architects, designers and manufacturers therapeutically plan and design these facilities.

Notably, in 2004, “The Role of the Physical Environment in the Hospital for the 21st Century: A Once-in-a-Lifetime Opportunity,” published by Roger Ulrich P.H.D., of Texas A&M University, was released. In a culmination of evidence-based research, research teams found five design principles that contributed significantly to achieving therapeutic design goals.

The report indicates five key factors that are essential for the psychological well-being of patients, families and staff, including:

1. Access to Nature

2. Provide Positive Distractions

3. Provide Social Support Spaces

4. Give a Sense of Control

5. Reduce or eliminate environmental stress

Access to Nature

Studies indicate that nature might have the most powerful impact to help patient outcomes and staff effectiveness. Nature can be literal or figurative – natural light, water walls, views to nature, large prints of botanicals and geography, materials that indicate nature and most importantly, stimulating color that evokes nature. Several studies strongly support that access to nature such as day-lighting and appropriate colorations can improve health outcomes such as depression, agitation, sleep, circadian rest-activity rhythms, as well as length of stay in demented patients and persons with seasonal affective disorders (SAD).

These and related studies continue to affirm the powerful impact of natural elements on patient recovery and stress reduction. Thus, it is clear that interior designs which integrate natural elements can create a more relaxing, therapeutic environment that benefits both patients and staff.

Positive Distractions

These are a small set of environmental features that provide the patient and family a positive diversion from “the difficult” and, in doing so, also negate an institutional feel. These can be views to nature, water walls, artwork, super imposed graphics, sculpture, music – and ideally all of these want to be focused on nature and, when applicable, an interesting use of color. Therapeutic environments that provide such patient-centered features can empower patients and families, but also increase their confidence in the facility and staff. This helps with open lines of communication between patient and caregiver.

Social Support Spaces

These are spaces designed partially for the patient but mainly for the comfort and socialization of family members and friends of the patient; therefore, family lounges, resource libraries, chapels, sleep rooms and consult rooms all play a role. When family and friends play a key role in a patient’s healing, these spaces encourage families to play an active role in the rehabilitation process.

Sense of Control

In times when patients and family feel out of control, it is very healing for the facility design and staff to provide it back when appropriate. Although, this cannot always be done suitably in mental healthcare facilities. However, when applicable, these design features include optional lighting choices, architectural way-finding, resource libraries, enhanced food menus, private patient rooms and

optional areas to reside in. A few well-appointed studies in psychiatric wards and nursing homes have found that optional choices of moveable seating in dining areas enhanced social interaction and improved eating disorders. When patients feel partially in control of their healing program and that the building features are focused to them, an increased confidence of the quality of care enters and tensions lower.

As with all therapeutic design, this allows the caregiver to use their resources healing in lieu of “managing” patient populations.

Reduce or Eliminate Environmental Stress

Noise level measurements show that hospital wards can be excessively noisy places resulting in negative effects on patient outcomes. The continuous background noise produced by medical equipment and staff voices often exceeds the level of a busy restaurant. Peak noise periods (shift changes, equipment alarms, paging systems, telephones, bedrails, trolleys, and certain medical equipment like portable xray machines are comparable to walking next to a busy highway when a motorcycle or large truck passes.

Several studies have focused on infants in NIC Us, finding that higher noise levels, for example, decrease oxygen saturation (increasing need for oxygen support therapy), elevate blood pressure, increase heart and respiration rate, and worsen sleep. Research on adults and children show that noise is a major cause of awakening and sleep loss.

In addition to worsening sleep, there is strong evidence that noise increases stress in adult patients, for example, heightening blood pressure and heart rate. Environmental surfaces in hospitals are usually hard and sound-reflecting, not sound-absorbing causing noise to travel down corridors and into patient rooms. Sounds tend to echo, overlap and linger longer.

Interventions that reduce noise have been found to improve sleep and reduce patient stress. Of these, the environmental or design interventions such as changing to sound-absorbing ceiling tiles, are more successful than organizational interventions like establishing “quiet hours.”

Conclusion and Additional Information

The information contained in this excerpted report is intended as a guide for architects, specifiers, designers, facility planners, medical directors, procurers, psychologists and social workers which have a stake in providing improved facilities for behavioral healthcare patients. It is a portion of a report entitled “The Contributions of Color” authored by Tara Hill, of Little Fish Think Tank. Ms. Hill was commissioned by Norix Group Inc., in 2010 to research the role color plays in the safe operation of correctional facilities and behavioral health centers. More in-depth information specifically about the psychological influence of color and behavioral healthcare facility design can be found by reading the full report.

About the Author
Tara Hill is a full-scope, state registered interior designer, and the founder and principle of Little Fish Think Tank. Before founding Little Fish, Ms. Hill was an Associate + Senior Designer at HOK, and the Director of Interiors at Stanley, Beaman & Sears. She has implemented award-winning, innovative design solutions for commercial and institutional interiors.

Ms. Hill also has significant experience regarding the science and theory of color, both as a design tool and a promoter of healing. She has conducted extensive research in evidence-based design regarding color and its profound impact on the human spirit.

Healthcare Revenue Cycle Outsourcing

Historically, the drivers of change in healthcare have been focused on clinical advancements. Applying innovative strategies in healthcare finance and revenue cycle management have lagged significantly behind clinical progressiveness.

Unlike corporate America’s general financial sectors like credit card processing and accounts receivable collections, healthcare finance and business office operations have been slower to adopt the cost-effective improvements offered by the outsourcing of billing and collection accounts.

Recently, due to economic factors and the shifting of patient financial responsibility, healthcare executives have become more accepting of revenue cycle outsourcing initiatives. In spite of a looming paradox, which pits opposing goals against each other, maintaining fiscal health versus the political pressure of keeping jobs in the local community offers a continual balancing act for healthcare executives.

Gartner Research Inc. estimates healthcare executives spend about twenty percent of their budget on all categories of external sourcing options, compared to the general mainstream industries, which typically invest about a third of their budget on external sourcing.

Gartner also estimates that seventy percent of healthcare organizations who do choose to outsource meet or exceed their cost-savings expectations, and most see an improvement in services as they shift their non-core functions to outside experts.

Healthcare outsourcing in general has begun to see a significant rise in acceptance. During the next five to ten years, it is estimated healthcare will see an increase in the outsourcing of many financial, clinical and business processes.

The American Recovery and Reinvestment Act of 2009 (economic stimulus package for the U.S. economy), healthcare reform, and the Health Information Technology for Economic and Clinical Health Act (HITECH), will create significant opportunities for all outsourcing companies to aid healthcare organizations in meeting the requirements for the new set of regulations and requirements mandated by legislative action.

These industry changes will increase outsourcing demand because healthcare providers cannot efficiently implement these changes on their own and certainly not at the speed they want.

Historically, physicians, hospitals and insurance payers with larger footprints and decentralized organizations were the first to initiate outsourcing partnerships. Smaller organizations typically relied on internal resources or in limited cases, local outsourcers.

This trend is changing. All sized healthcare organizations are jumping on the outsourcing bandwagon and are moving toward leveraging IT, clinical and revenue cycle business processing outsourcing to improve the financial viability of their operations.

The motivators for the shift in strategy for smaller healthcare operations are due in part by the margin pressure they are under and the need to cut costs. The key ancillary benefits to an outsourcing strategy are operational efficiencies, cost reductions and delivering superior patient satisfaction.

Healthcare executives have numerous sourcing strategies from which to choose. Utilizing a US based local, regional or national outsourcing company has been the typical choice for healthcare executives who outsource.

With today’s technology, especially in the services’ sector, it is less important to contract with a local provider than to choose the best-in-class provider regardless where their business operation is located.

In the US, outsourcing, in general, has become a polarizing political issue driven by poor economic times and localized job losses. Even with local and national pressure to curtail outsourcing activities by consumer advocates, the return on investment (ROI) from cost reductions and improvements in quality have influenced healthcare executives to pursue offshore and onshore outsourcers as an alternative to maintaining an internal workforce.

Over the past ten years, the providers who have chosen their outsourcing partner wisely, and partnered with qualified process oriented firms, have experienced reduced operating costs and ultimately, higher patient satisfaction encounters.

Americans value the financial opportunities offered by our free-market economy. In every region of the country, community leaders attempt to support and protect local labor forces, which serve nearby businesses. The goal of this action is to keep jobs in the community and surrounding area.

Unfortunately, with budget cuts and margin pressure becoming greater than it’s ever been, healthcare executives cannot meet the demands of managing various clinical and revenue cycle functions, which typically demand a lower cost, more qualified and educated workforce.

The healthcare executives who have avoided non-localized outsourcing have succumbed to the local pressure of keeping jobs within their community regardless of the impact on the financial performance of the health system.

An interesting paradox exists as those same executives and community influencers do not think twice about purchasing clothes, food products, electronics, cars, toys, furniture, and household goods produced globally.

Regardless of the task, business segment or location of the potential outsourcing firm chosen to provide services, the ultimate goal of pursuing any outsourcing strategy is to support the goals of the healthcare organization, which are ultimately to serve the community with the highest level of patient care. That cannot be accomplished if the organization is under financial duress.

Many top healthcare thought leaders are now accepting outsourcing as a cost reduction and operational improvement strategy designed to combat legislative reform and the economic squeeze the healthcare industry is experiencing.

In general, outsourcing saves time, effort, demands on infrastructure, manpower, and money. By leveraging the best of breed solution providers, healthcare organizations gain a competitive edge guaranteeing endless benefits for the enterprise and the patients they serve.