ACA Impacts: Designing More Efficient Medical Facilities
It’s been more than six years since President Barack Obama signed the Affordable Care Act into law and overhauled health insurance. The ACA impacts the design of healthcare facilities across the United States as well in order to accommodate the estimated 20 million Americans that have gained health insurance coverage since 2010 (HHS.gov).
The ACA impacts have brought two major shifts to the designing of healthcare facilities:
-operational efficiencies to support healthcare as a financially viable business
With programs such as Medicare Value-Based Purchasing which reward acute-care hospitals for the quality of care they provide, the ACA is pushing patient-centeredness, patient satisfaction and patient engagement to a whole new level. Doing business as usual is no longer an option when it comes to efficiency for health systems. The ACA legislation is asking providers to do more with less to reduce costs. Health systems are challenged to achieve financial and care-delivery goals in new ways. They’re becoming more efficient while providing a better, more holistic patient experience. This explains why many systems are looking to the retail, corporate workplace, and hospitality industries to discover new approaches to operations and facility design. The ACA impacts have made it difficult for healthcare facilities to accommodate increased patient volumes — this is where we come in.
Our projects have been no exception to these ACA impacts—designing a more complete patient experience is the overarching purpose behind the facilities we design.
“We pay a lot of attention to what is happening in each space. For example, an exam room in a primary care practice could have an exam chair instead of an exam table, which could reduce building area,” said Wes Hawkins, director of our healthcare studio. “We are also unitizing the spaces to retain ultimate flexibility in the changing environment of healthcare. An exam room, a consult room, and a manager’s office are all created to be interchangeable as needs fluctuate.”
For example, research has found that 30-40% of medical office building real estate is tied up in private offices that are unoccupied 90% of the time. That is a lot of costly square footage that could be used in other ways. To curb this inefficiency and allow for better utilization rates, you can provide small hoteling stations where doctors can have private phone calls and do notations however, these areas aren’t dedicated to one specific doctor.
Whether it’s consolidating different centers into one space or minimizing private offices in medical buildings, we are all about helping our clients update their facilities to maximize flow and efficiency.
Taking cues from retail and hospitality, we’ve also been designing waiting rooms to be more engaging. “Retail environments are designed to attract customers and that’s one of the new aspects of healthcare architecture,” said Hawkins. Moving beyond a few rows of chairs and scattered magazines, waiting areas can be consolidated into a shared space that serves the whole medical office building. Patients would have the opportunity to choose seating that matches their comfort level, whether that’s a table to do something on, a comfortable couch to read on, or an intimate setting with family.
Healthcare project manager Mark Hollern adds that “in retail settings the public are expecting comfortable environments that clearly direct them to desired services or products. We choreograph our integrated finishes and wayfinding elements into a warm, calming and attractive experience that veers away from the common sterile healthcare environment and provides the consumers with a sense of healing, clarity of services and positive distractions.”
These changes aren’t easy. Some doctors and other healthcare staff can be resistant to change, but with more ACA regulations going into effect each year and patients becoming more like consumers—thoughtfully choosing their healthcare providers and services as active decision makers—healthcare systems will need to be proactive in enhancing operational efficiencies and being more patient-centric.
ADA Reform Supports Businesses and Limits Lawsuits
This year marks the 25th anniversary of the enactment of the Americans with Disabilities Act (ADA). This act was intended to make the built environment accessible to those with disabilities and be more inclusive of all people. An unintended result of this legislation is that businesses are now threatened by serial plaintiffs who serve demand letters requesting money in exchange for not filing a lawsuit – basically lining the pockets of unscrupulous attorneys. Worse yet, these demand letters never state what the violation actually is, so that businesses can correct the violations.
Property owners should be given the opportunity to fix any violations or respond to the complaint, within a reasonable time period, without a lawsuit being filed. As a member of the International Council of Shopping Centers’ (ICSC) Ohio Government Relations Committee, we have been testifying as a proponent for House Concurrent Resolution (HCR) 32 in support of federal legislation HR 3765, the ADA Education and Reform Act of 2015. These bills will provide disincentives to filing these frivolous lawsuits, requiring that the violation be identified and a 120 day notice and cure period be provided prior to the commencement of any lawsuits. This will ensure that problems get fixed, rather than paid off without consequences.
Throughout my career there have been several experiences with clients where it became clear that we can do everything right, yet the client is still exposed to lawsuits, and thus we are exposed to lawsuits. This is especially true in existing shopping centers where the requirements are vague and up for interpretation. In addition, there are federal requirements (ADAAG and FHA regulations), state requirements (ANSI) and city building code requirements regarding accessibility that can conflict and it is often difficult to determine what regulatory body governs.
For example, when working on a shopping center renovation project our client was hit with an ADA lawsuit the week we started demolition. For existing facilities, ADA and the Ohio Building Code require that 20% of the cost of the alteration be spent on reducing or eliminating barriers. To determine where to spend dollars for barrier reduction the code establishes a list of priorities in the following order:
1. Accessible entrance
2. Accessible route to the altered area
3. (1) Accessible restroom for each sex
4. Accessible telephones
5. Accessible drinking fountains
6. Lumped together accessible parking and storage
As this was an existing center, the owner had a budget of approximately $4.9 million to renovate the interior and exterior of the center. They spent in excess of 20% on upgrades that reduced barriers including modifying grades leading to accessible entrances, providing automatic door openers, leveling the interior floor to eliminate cross slopes, modifying restrooms, modifying slopes at accessible parking and the route to the entrances from the parking.
In spite of all this, they were hit with a lawsuit by a plaintiff who had 17 open cases in Central Ohio at that time (and 89 cases in the Southern District). This plaintiff did not bother to check the building plans that were on file with the city showing the scope of work to be done —including a sheet labeled “ADA Compliance Plan” that clearly clarified a vague situation. Our client had to spend tens of thousands of dollars fighting the suit to eventually have it thrown out.
To combat these lawsuits, M+A Architects has taken extraordinary steps to mitigate ADA lawsuit risk for our clients. By reviewing all the city, state and federal accessibility regulations and taking the most restrictive requirement from each, we’ve created our own standards in excess of ADAAG requirements. For example, regulations do not account for construction tolerances, so we add 1 inch to all clearances, on all sides. Not to mention, with the freeze / thaw cycle, what complies in the summer may not comply in the winter.
The goal for ADA reform is to be accessible to everyone and go beyond usual measures to make sure this is the case. HCR 32 urges Congress to pass common sense updates to the ADA. Allowing a property owner to address such minor issues is not only good for business, but it protects the true intent of the ADA.
Let’s make the world more accessible, not make unscrupulous attorneys rich.
Meet Our Newest Principals: Lori Bongiorno and Carrie Boyd
While both Lori and Carrie have been part of M+A’s broader leadership team for a number of years, this transition offers firm ownership and starts a succession planning process for current shareholders. Naming a third generation of leadership is often something very difficult for businesses, but it promises a future for M+A.
We welcome the fresh perspectives and recharged energy Bongiorno and Boyd bring with their leadership!
Founded in 1980, by Denny Meacham and Bob Apel, M+A Architects has traditionally been a production firm, focusing on solid construction documents, building code analysis, and functional building designs.
In 1994, that started to change, as M+A hired an extremely driven and enthusiastic project coordinator — Lori Bongiorno. A driving force behind some of M+A’s most challenging and complex projects—including Easton Town Center and Bob Evans Farms Headquarters—Lori has helped push M+A beyond the production of construction documents.
Largely focused on mixed use, office and retail projects, Lori is actively involved in the International Council of Shopping Centers (ICSC) at a national level and will be the incoming chair of the ICSC Ohio Government Relations Committee.
“Lori offers attention to detail, a commitment to a high level of service, and personal attention on all of her projects,” said Jim Mitchell, partner and executive vice president, “and Carrie has built a reputation of quality and forward thinking interior design services within M+A Architects.”
Joining the firm in 2007, Carrie brought a focus on design and innovation, further challenging M+A’s production background. She’s crafted an award-winning interior design team, while extending M+A’s service offerings—ultimately providing a more comprehensive experience for clients.
Always keeping an eye towards design trends, she has a contemporary, creative style that can be seen in Columbus through projects such as Turner Construction’s Columbus HQ, OSU’s Office of the Chief Information Officer and Distance Education and eLearning at Mount Hall and The Lane mixed-use development. Boyd is a licensed interior designer through the National Council for Interior Design Qualification (NCIDQ).
Looking to the Future
“M+A Architects is becoming stronger. By adding two very motivated, experienced and dynamic principals to the firm, Lori and Carrie will help M+A solidify longevity in the marketplace,” said partner and president, Mark Daniels.
Bongiorno and Boyd have helped grow and sculpt the firm into its current form, building successful teams, creating lasting relationships and embodying M+A’s culture of collaboration. They both bring a unique perspective and a style of leadership that better relates to the millennial generation, helping the firm attract talent and grow from within.
“Lori and Carrie are both very dedicated individuals and firmly believe that doing the right thing for the company is in everyone’s best interest. Their management styles and how they each make important decisions are very sound and they balance out the group with their perspectives,” said partner and treasurer, John Eymann.
Advice for Emerging Leaders
While Bongiorno and Boyd will be part of the third generation of leadership at M+A, there’s room for more seats at that table, as Boyd and Bongiorno explain they’re already thinking about fourth generation leadership. So, how do you become a principal? After reflecting on their own experiences Lori and Carrie shared their advice for emerging leaders:
Carrie said, “Don’t be afraid to step up and lead. Always be thinking about what’s best for M+A and not what’s best for you personally. Look to impress and go above and beyond what is expected. Think outside the box!”
And Lori offers advice for her fellow architects, “Work hard and be passionate about architecture. Strive to be a knowledgeable, well rounded architect and take opportunities to learn leadership skills.”
SiteOhio: Making Development in Ohio Easier
Last week, the Central Ohio Chapter of NAIOP held an event focused on SiteOhio and the current development climate in the State of Ohio. SiteOhio, a program started in 2013 as a joint endeavor of JobsOhio and the seven economic development organizations across Ohio (including Columbus 2020), aims to help prospective entities find development-ready, certified land in Ohio. With other regions already certifying sites for development, this program will help Ohio compete as a prospective destination for these projects.
When initially started, the program had three main goals: identification, gap analysis, and education. However, as the program started gathering information, it was clear another benefit was emerging. SiteOhio’s database of available sites helped the organization understand inventory when a prospective business sends a Request for Information (RFI). Even though the sites may not be certified, they could very well meet the requirements of the inquiring businesses.
From there, SiteOhio established a qualification process, with the help of Insight Consulting, to identify criteria that is important to the end user and provides a more offensive approach to site certification, rather than reacting to RFIs when they are submitted.
They anticipated approximately 150 sites to be submitted for certification—but over 400 sites were submitted! Of these sites, 336 sites met the qualifications. From there, further review was necessary, so the sites were divided into three categories: Certification Ready, Pipeline, and Fatally Flawed.
Certification Ready – site is zoned properly, has a survey, has a Phase I and Phase II (if necessary) report, and is ready to be developed, including all utilities and community support
Pipeline – site does not entirely meet qualifications, but can be remedied relatively quickly.
Fatally Flawed – site requires significant improvements to receive the “Certification Ready” grade. This may include utilities being run to the site, zoning issues, and other setbacks.
No sites were deemed certification ready, but 28 were identified as being very close and with some guidance could be certification ready with minimal work. SiteOhio will work hand-in-hand with these 28 sites to get them certified and is hoping to have 20 certified sites by August 2017.
The program will continue to update the database of information when new information becomes available for each site. They will also work with each site to ensure the reports and surveys remain up-to-date so site submission becomes a smoother process. While certification streamlines the process, it can’t always be obtained. Columbus 2020 and all the other economic development organizations across Ohio will continue to submit as many sites as they can to future businesses, but having certified sites allows the prospective organization to know the preliminary work is complete and the site is ready to be developed.
SiteOhio allows Ohio to be more competitive and provides distinct advantages to Ohio from an economic growth perspective. The certified sites will allow Ohio to be better marketed to a prospective business while the database will allow the economic development organizations to know the inventory of sites in their area and what improvements they may need to make. This information will continue to help bring businesses and jobs to Ohio and for Ohio based companies find land when they grow.
How to Design a Business Incubator
Leveraging design to create purposeful use of space is extremely important for a business incubator, as these spaces have become synonymous with innovation. While these spaces require heightened collaboration and idea-generating areas, at the same time, they need private spaces for individual work. So, how can the design of a business incubator help cultivate all of these things? I interviewed M+A’s Director of Design, Dan Pease, and Interior Designer, Kelly Heitkamp, to find out.
By Entrepreneur magazine’s definition, a business incubator is an organization designed to accelerate the growth and success of entrepreneurial companies through an array of business support resources and services that could include physical space, capital, coaching, common services, and networking connections.
Traditionally seen with technology startups, business incubators are spreading into other arenas. Cardinal Health recently launched Fuse Innovation Lab to develop innovative products for use in healthcare. Additionally many municipalities in the Central Ohio area are creating entrepreneurial centers to get small business owners out of their basement offices and into a space with infrastructure, collaboration, and most importantly, a network of support.
Q: Microsoft recently described its business accelerator, Microsoft Garage (pictured below), as “a protected habitat for Microsoft employees and their wild ideas.” How can you leverage design to promote a nonbiased, creative space conducive for an incubator?
Pease: Creative synergy can be initiated and promoted by considering each user’s requirements to conduct business. Having open creative areas with centrally-located amenities, promotes a relaxing environment – allowing better and more honest participation in discussions/workshops. People need to feel a level of acceptance to let their guard down and offer, in some cases, ideas that are a little out of the box.
Heitkamp: The design process should mirror the innovation of the start-up companies —and Microsoft Garage is a perfect example of this. Because the purpose of these spaces is to promote out of the box thinking, you have to approach the design in a similar way. Part of the design challenge is to determine exactly how this is done. To help foster innovative thinking, the environment should change your frame of mind as soon as you walk in the door. It could be through using materials in unexpected ways, incorporating amenities that allow the users to feel comfortable, or incorporating cutting edge technology.
Q: What are specific design elements/techniques that you would integrate into creative spaces?
Pease: The creative area should have a combination of casual seating and flex space with chairs positioned in a circle or u-shape to promote idea sharing. The lighting level should be designed to reduce glare and stress. And bold colors/materials should be used to invigorate the casual, yet fun environment. I’d also integrate a tabletop smart-screen to help efficiently capture creative sessions and a marker wall or pin-up area. Ideas left pinned-up for display helps engage stakeholders who may not have been in the discussion.
Heitkamp: From a space planning standpoint, it’s all about an open environment promoting connection and interaction between the users.
Another component—one that can be hard for us, as architects and designers—is taking a step back from the design and avoiding the urge to make things look “too perfect.” Not only does a space with some raw edges communicate authenticity, it is a reality for most start-up companies. A space designed for a startup company shouldn’t look or feel the same as a corporate headquarters. I think harnessing the charm and excitement of a start-up space through the building design is important.
Q: On one hand, you need to foster cutting-edge ideas that challenge normal business practices, but on the other hand these ideas should serve the business and its market. Are there any traditional office elements you would incorporate?
Pease: Sometimes an individual user or small group will want to take time to work on their own. There needs to be intimate break-out rooms, in close proximity to the creative space, that are enclosed to control sound. The size should accommodate four to six people and should include similar amenities as the creative space. Locating both types of spaces near a kitchenette aids in creating a non-stress setting. Again, we want the users to be comfortable and relaxed, making conversations honest and personable. This attitude promotes teamwork and makes the process fun, resulting in more efficient productivity.
Heitkamp: In an open office environment, it’s important to incorporate quiet, private spaces for respite and contemplation. Striking a balance between private and public spaces, while maximizing flexibility, is the sweet spot. A lot of this has to do with boundaries in the space. Is a stud and gypsum board wall really better suited to be a glazed modular wall or a visual division of space created by high backed seating piece? This is an example of the kind of questions that you should be prepared to ask when designing the space.
With millennial entrepreneurs launching about twice as many businesses as boomers, business incubators could have a huge impact. The “millennipreneurs,” as they’re called, are taking the entrepreneurial leap at a younger age and have higher targets in mind. Business incubator design that can offer an innovative, collaborative, technology-integrated space, business coaching and opportunities for networking could be a huge asset.
Share your thoughts! Do you think business incubators can lead to startup success and/or idea generation? What would you want to see designed into an incubator space?