Contract - October 2013 - (Page 84)
practice
The Impact of the Affordable Care Act
on Healthcare Design
Experts affiliated with The Center for Health Design describe strategies
and interventions for improved outcomes through design
By Upali Nanda, Ph.D.,
Eileen Malone, RN, MSN,
and Anjali Joseph, Ph.D.
The impact of the 2010 Patient Protection and Affordable Care
Act on healthcare delivery has been widely discussed and
debated. But what does it mean for the design industry? In this
era of big data, cloud computing, and sophisticated analytical
tools, the ability to manage and measure has increased, and
healthcare models are changing based on these abilities. With
the Affordable Care Act, the onus to manage and measure will
be even greater because it will be linked to reimbursement
models with strong fiscal implications.
The Affordable Care Act and evidence-based design
Politics aside, the enactment of the Affordable Care Act will
transform just about every aspect of healthcare delivery.
Sweeping reform legislation targets nine essential
components, ranging from access to affordable care to the
improvement of patient safety and care quality. One of the
fundamental components of the law is the transformation of
the reimbursement system. Instead of only paying hospitals
based on the volume of care provided, the Affordable Care Act
shifts the reimbursement model to one based on care quality.
Hospitals are now financially rewarded for improving
the patient experience as measured through the Hospital
Consumer Assessment of Healthcare Providers and Systems
(HCAHPS). Beginning in Fiscal Year 2015, through the
Hospital Value-Based Purchasing Program of the Centers for
Medicare & Medicaid Services (CMS), hospitals will also be
reimbursed based on their ability to reduce patient harm as
a result of hospital-acquired conditions. Through the use of
evidence-based design findings, designers create important
solutions that can help to address these pernicious problems.
So, what solutions can designers provide as part of an
integrated approach to improve the patient experience,
reduce patient harm, and—as a consequence—potentially
realize increased CMS reimbursement? There are two items
on the HCAHPS’s inpatient survey that pertain to the built
environment—noise and cleanliness—both of which can be
improved with good design, as noted in the table on the next
page. Key patient safety targets, typically tracked by hospitals,
84
and simple interior design solutions that can help to achieve
these targets based on robust evidence and best practice
precedents are also listed in the table.
In fact, a large body of evidence indicates that the
physical environment impacts many essential healthcare
outcomes including patient and staff safety, patient stress
and satisfaction, staff effectiveness, the quality of care,
sustainability, and healthcare cost. Just as medicine has
increasingly moved toward “evidence-based medicine,”
where clinical decisions are informed by research, healthcare
design is increasingly guided by rigorous research linking the
physical environment to healthcare outcomes, and is moving
toward evidence-based design. The underlying assumption
is that the built environment provides the stage for all care
delivery, and consequently impacts care delivery outcomes.
Accountability in design
The evidence-based design process relies on using credible
research to inform design decisions and then clearly
articulating the potential impacts of these design decisions
on a broad range of healthcare outcomes. By measuring
healthcare outcomes pre- and post-occupancy, and then
sharing the results, not only is the team held accountable,
but it also contributes to the growing body of knowledge.
Accepted by designers and facilities alike, this
accountability is evident in the growing number of hospitals
that are part of The Center for Health Design’s Pebble Project,
which is committed to measuring, tracking, and sharing
outcomes. Design firms with in-house research departments
focused on human and organizational outcomes and design
and health professionals who are getting their credentialing
via Evidence-based Design and Accreditation (EDAC) and
Lean Six Sigma training also contribute to accountability.
The EDAC and Lean Six Sigma training allows professionals
to become well-aware of the methods to integrate research
into design and to then undertake systemic approaches to
improve processes based on reduced waste, increased
efficiencies, and enhanced collaboration of caregivers.
contractdesign.com
october 2013
http://www.contractdesign.com
Table of Contents for the Digital Edition of Contract - October 2013
Contract - October 2013
Contents
Editorial
Industry News
Columnist: Winning Work at the Interview: It’s All About Chemistry—Part II
Product Focus: New Classics
Product Briefs: Health and Wellness
Cedars-Sinai Medical Center Advanced Health Sciences Pavilion
Banaji Pediatric Dental Specialists
Seattle Kids Dentistry
Healthcare Environment Awards
Spaulding Rehabilitation Hospital
Olivia Newton-John Cancer and Wellness Centre at Austin Hospital
Seattle Children’s Building Hope: Cancer, Critical and Emergency Care Expansion
Dale & Frances Hughes Cancer Center
Kent Campus Expansion, Phase 2 Pavilion
Horizon Blue Cross Blue Shield of New Jersey
Camp Southern Ground
Poetic Living
FOUND: An Adolescent and Young Adult Cultural and Wellness Center
The Impact of the Affordable Care Act on Healthcare Design
Book Review: Sustainable Healthcare Architecture, Second Edition
Designers Select: Healthcare
Sources
Ad Index
Perspectives
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