First, do no harm…
First, do no harm…
With A Nod To Hotel Amenities And Technology, Hospitals Are Changing — A Firsthand Account Offers Insight
I recently had the unexpected delight of spending some significant time in a new local hospital, just down the street from my home. It wasn’t a planned vacation, and I hadn’t been in such accommodations in 20 years, and then once 30 years before that. So the encounter was somewhat unfamiliar.
But one thing I noticed right away was that THIS particular experience was different from both my earlier stays, and different from my visiting many friends and relatives in the intervening years. How so, you ask…
First, the building looked like a modern, stylish office building – somewhat Silicon-Valley-ish. Glass and shining steel. A giant curve. Almost ultra-modern industrial. All set in an immense field that used to be a golf course and driving range where I used to bring our parish’s altar servers for putt-putt. The construction was new enough that there was as yet little in the way of landscaping mingled among the hardscaping. Gave the impression from the main road of some sort of secret operation, some kind of military structure.
I assume because I was a VIP (or maybe because my heart “paused” in the adjacent rainy parking lot and I was bleeding profusely from a gash in the back of my head!), I was wheeled into an enormous emergency wing. Slid into one of the (I was told) over 50 ER cubicles, right in full view of the nurses station. Over the ensuing 6+ hours of my visit (with me asking a lot of questions as I was having trouble seeing the TV with a concussion, one flatscreen of which was set up in each ER cubicle), I realized that every bed was in the full and very watchful gaze of medical staff at central hubs that resembled a NASA control room. If I moved to adjust my position, some sensor sent a signal to that station – and a head popped up or someone stepped in. I watched and listened over that afternoon and early Friday evening as people came and went, and divisions/sections/sets of cubicles (I think they used to be called “wards”) of the ER closed and reopened to accommodate the ebb and flow of patients. It was like watching a well-choreographed dance.
Having begun my adventure about Noon, somewhere close to 7PM I was taken up to the top floor, the cardiac floor. My room was filled with very adjustable and pleasant lighting, a private room with a full private bath (as was every room in the hospital), a couch which opened into a double bed, and various chairs and occasional tables. There was a second sink in the room. My room was twice the size of my home bedroom – between my bed and the window, there was room for a medium-sized dance floor! I had a nurse who was responsible for me and only one other patient. And a charge nurse who checked on my care. And a floor supervisor nurse who checked on my nurses. And a “concierge nurse” who checked in a few times a day to see if there was anything I needed. And a maintenance supervisor who came by daily to see if “everything is working alright”. Everyone was on a 12-hour shift, so all tasks seemed performed at a more leisurely pace than the old 7-3, 3-11, 11-7 shift change routine. Meals were chosen from a restaurant-style menu, and most everything was available 24-hours-a-day. Double window shades were electronically raised and lowered. And everything was immaculately spotless. Hardwood floors! Over the next few days (and two return visits over the following two weeks), I got to see a lot more of the complex. When I finally went home, no one seemed hurried, everyone smiled and was deliberately cheerful … I was lacking for nothing. Plus, when all was said and done, I had a transmitting recorder implanted in my chest – a little bonus!
Why am I telling you my tale of woe and wonder? Well, hospitals are changing. That’s not a new concept – rarely does one visit a hospital where some wing is not being added or renovated or repurposed. But at least some hospitals, as newly built, are different than those extant in your hometown or city. They are becoming aligned and designed similar to a hotel or an apartment complex. Folks often now have choices as to where they will spend time when they are sick or need care. Sudden emergencies aside (I collapsed 11 feet from the curb of the hospital where I was taken, so my ride was mercifully short and my destination predetermined by the obvious!), people now think about where they want to go for care for some of the most vulnerable and difficult times in their lives. And hospitals, just like multi-family and hospitality and assisted-living/skilled nursing assets, compete for occupancy. Hospitals get paid for specialty (near miraculous) services, but the basic value metric remains heads-in-beds (for a few hours to a longer stay). Or do they/will they?
Today’s hospital designs are beginning to mimic hotels and other similar “sleep-in” asset classes in that they are taking some of their cues from the preferences of the Millennial Generation. I am a Baby Boomer, and fully expected to see the easily-repainted eggshell white or light beige of decades of hospital design. Tiny shared rooms with awkward florescent lighting, hallways too crowded for the constant traffic, long waits in the insufficiently-chaired lobby, food clearly awaiting complaints, staff barely available (and whenso, irritable or hurried). Machinery and procedures seeming huge and ham-handedly maneuvered/performed. The whole experience designed to make you look forward to getting the heck out of there. These days, the beds are comfortable, staff delightful, and food/amenities resort-like. You feel safe and cared-for. The wall colors were close to the Sherwin-Williams “poised taupe” color-of-the-year, a marriage between a light brown and a light gray. It was downright cozy! Were it not for the ridiculous rules of my insurance which required me to go home, I would have stayed for a far longer stay!
Millennials would like the place I stayed. Generally speaking, responding to the clearly different expectations of the Millennials will give hospitals, other healthcare providers, and medical practices a competitive edge over locations and businesses that fail to manage these differences. The M’s have been raised online and connected – with the ability to touch a screen, receive instant gratification, and then move on. Knowing that if they need a service again down the line, they need only approach that same gratifying screen. We seniors have grown accustomed to waiting, especially for healthcare. Somehow, it became acceptable to our generation to think of the medical profession and the places in which they work as so important that they could keep us waiting, give us the minimum in the way of comfort and privacy, and baffle us with the intricacies of the insurance maze. We would stay with our doctor for life (his life … because it was usually a male – or ours). It would rarely occur to us to use one of those new-fangled retail or urgent care facilities along the highway. We would never “shop around” to find a better/cheaper doctor or hospital. We went to where we went … well, because we ALWAYS went there.
In a similar fashion to how M’s will switch apartments yearly if the place down the street throws a concession or some first-level meeting/networking areas their way – or change jobs WAY faster than the almost biblically-mandated-two-year stay in any job, M’s will travel to find a researched doctor or facility. Even though very few doctors make house calls anymore, we Baby Boomers still like to think of our doctors as neighborhood available/locals. And although few of us walk to the doctor’s office anymore, we like to think of our doctor (who is probably now part of a massive professional partnership) as Marcus Welby, MD. Millennials, you can look up that reference! Yes, you had to get up to change the channel. And there were only 12 of them.
Have you been a part of a “virtual examination” where you “visit” your doctor by iPad or smartphone? Using the camera to show the doc “where it hurts”? Have you experienced any part of a consultation or robotic procedure performed by a practitioner who is located far from where you are lying on a gurney, who talks to you over a video link? Do you receive email updates on specifics about your condition, or lab tests, or followups? Are you comfortable with making your appointments with a voiced robot, who calls the day before your assigned day to confirm? I am almost old as dirt, and I have had each experience in the past 45 days. Each time and event a bit discomforting at first, but eventually OK-ish.
So are doctors and hospitals and medical offices going the way of Star Trek’s Tricorder? No, probably not. OK, maybe a strong “not yet”! The changes that are definitely coming (and are already here in many cases) involve learning how services will be offered going forward. We Baby Boomers are going to continue to like one-stop shopping – where we can get our exam performed, our bloodwork drawn, and our results reported from a single faithful source. A source we know by name and have trusted since we were way younger. Our Millennial offspring like to have home and work and services all in a tight geographic circle, but will be willing to travel for better prices or when research shows better potential outcomes. They will ask for discounts. They will comparison shop. And all services will have to have remote connectivity. And same-day appointments and whatever other instant-or-at-least-fast gratification services will become normative.
Interestingly, trust remains in the forefront of the relationship between doctor and patient – same as for every generation. Will virtual appointments become more normal? Probably (I had my first one this past week). Will these totally supplant the personal office visit with the doctor you have trusted since you were 12 or 23 or 40? Probably not. Although there is a new “hospital” in Missouri that has 350 doctors and staff and NO in-house patients – a totally virtual hospital. The professionals sitting in their nodes in front of monitor screens are caring for patients at home or in beds in 38 hospitals in 7 states. They are informed about their patients by cameras, sensor-monitors, smart devices, and other adaptive techno apparatus. All driven by remote technology — telehealth! All aimed at incorporating the centrality of the patient while incorporating both physical and virtual support spaces. Augmenting people with technology.
Everybody wants to feel cared for and safe and meaningfully-connected to their healthcare professional. Each person in pain or distress wants to believe in these highly-trained professionals, whether hugging you in person when bad news comes your way, or easing your concerns over a tele-link so you can get back to your day – one way or the other, you trust that they will make things better. And that you can count on them to watch over you in the following days and weeks and years.
How do you value THAT? Well, that’s the topic of another blog. Separating out business value from bricks-and-sticks-and-land, applying approaches to value … you know the drill. But for THIS blog, I’m just pulling back the curtain a bit on the world into which we are all heading. There will be intergenerational accommodations for both the new kids on the block AND for us revered elders(!); but with healthcare expenses becoming such a growing percentage of our disposable income, there will be increasing efforts to introduce new efficiencies and gadgets and methods and even buildings. It will still be recognizable: neat, organized, clean, professional, accessible, connected, and (hopefully) affordable. And trusted. A somewhat braver, newer, magical, miracle-working world. But still recognizable as a place and/or a person who will help us feel better.
“Calling Doctor Bombay”. Look it up. He just passed away this past December.