Out of Space and Money?

Creative Ways to Improve

Space Utilization
By Cynthia Hayward
Originally printed in the
Healthcare Financial
Management
Associations Strategic
Financial Planning
Newsletter
Reprinted with
permission in the
SpaceMed Newsletter
Spring-Summer 2012
www.spacemed.com

Existing space in hospitals is a valuable resource that historically has been

overlooked as organizations focus on renovating and expanding their physical plants. With fluctuating workloads, rapidly changing technology, high
staff turnover, and limited access to capital common in todays dynamic
healthcare environment, hospital leaders are increasingly looking for ways to
better use what they already have. They are also committed to building flexible space when they do renovate or start from scratch.
Improving space utilization begins with a thorough understanding of how existing
space is allocated and used. You can then identify opportunities to improve the capacity or throughput of expensive clinical space, reassign underused space to increase its usefulness, and look for alternate and unconventional ways to accommodate programs and services both on- and off-campus.
START WITH AN INVENTORY
All space is not the same. An inventory of existing space should be organized by
major category or type of space, because each category may have distinctive
building code compliance requirements, renovation or construction costs, and
reuse potential. Inpatient nursing units, diagnostic and treatment services,
customer services, physician offices and clinics, administrative office suites, and
building support spaces are not necessarily interchangeable. For example, space
that was designed for outpatient care exclusively cannot be used for inpatients
without costly modifications such as widening corridors or providing enhanced
smoke and fire barriers.
Space can more easily be down-graded say, converting a vacated inpatient
nursing unit to an office suite or outpatient clinic than upgraded. However, due to
the modular layout of patient rooms, with contiguous patient toilet rooms,
converting that nursing unit may either result in an inefficient use of space or
require high renovation costs to reconfigure the walls and corridors.
Space occupied by one department or functional component within a category can
usually be more cost-effectively reallocated for use by another department in that
same category. Also, the grouping of departments that have similar facility
requirements often exposes new opportunities for the sharing or cross-utilization of
space between organizational entities.
MAKE MAXIMUM USE OF EACH SPACE
Now you are ready to explore a range of possibilities for making the space you
have work better for your current and future needs.
Increase the capacity of major diagnostic and treatment services. Before
committing major dollars to expand an existing department, ask yourself two key
questions:

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Out of Space and

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Would newer, state-of-the-art equipment improve throughput and thus

eliminate the need for additional procedure rooms?

Could the daily and weekly hours of operation be extended to allow more
procedures to be performed with the existing or upgraded equipment?

Note that size, ceiling height, floor-loading capacity, and power and telecommunications requirements must be considered when replacing medical equipment in
existing procedure rooms.
Improve occupancy rates with more flexible inpatient nursing units. Reconsider the use of dedicated nursing units with rigid admission criteria and low occupancy. Redesignating a boutique nursing unit for use by a broader group of patients (and cross-training staff) can potentially increase the hospitals bed capacity.
If the existing nursing unit was designed with all private rooms, these could become
acuity-adaptable or universal patient rooms that can be adapted for most levels of
acuity by altering staffing levels and monitoring equipment. This concept can provide additional beds for high-acuity patients, thus supplementing the intensive care
unit, and reduce costly patient transfers, provide improved continuity of care, and
reduce medical errors.
Identify space that is vacant or used infrequently. There may be pockets of vacant procedure rooms or administrative offices that are owned by specific departments but used infrequently. This often happens to procedure rooms as equipment
becomes obsolete. Even nursing units may have rooms that were originally designed for inpatient beds but which have been converted to offices or used for storage over time and which now offer a cost-effective way to increase bed capacity.
Likewise, staff offices may become vacant through reorganization or converted to
storage rooms.
Over time, conference and group meeting rooms located within department boundaries may have been captured for exclusive control by that department, which only
uses them infrequently. Implementing a centralized scheduling system that can
track utilization allows meeting rooms to be used by other staff in the organization
as needed, regardless of their location.
Look for opportunities for shared or multi-use space. This allows space to be
used more efficiently and balances workload peaks and valleys throughout the day
or week. You can start with the low-hanging fruit space that is not used at least
40 hours per week. The next tier includes space that is not used 24/7, which may
offer opportunities for alternating space use by shift. Here are some examples:

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Designating multi-use procedure rooms that can accommodate different

types of portable equipment as needed such as EKG and ultrasound
machines.

Alternating space use by shift such as using an adjacent occupational

medicine clinic or same-day medical procedure unit to treat emergency
department (ED) fast track patients during the evening and night shifts. ED
patients could also be held in the surgery suite recovery area during the
evening for observation or while waiting for an inpatient bed to become
available.

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Out of Space and

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Space Utilization
Continued

Co-locating selected procedure rooms (or installing multi-purpose

equipment) so they can share the same patient intake, prep, recovery, and
support space. For example, this can work with various imaging modalities,
invasive cardiology and angiography, and endoscopy and surgery.

THINK OUT OF THE BOX (LITERALLY)

The traditional hospital was designed with everything embedded in the main facility. Unbundling
services that dont need to be within that hospital
box can provide additional capacity for patient
care services. For instance:
Relocate routine, high-volume outpatient
services in separate facilities. These can be oncampus or off, but should feature dedicated parking
and convenient access. Examples include primary
care clinics, selected high-volume outpatient
services, or recurring or chronic outpatient services
such as rehabilitation, chemotherapy, and dialysis.

You may need to get

even more creative in
rethinking the
conventional use of
space, even if only as
a temporary
measure.

Consolidate building support services into a separate service building. This

creates space for supply, processing, and distribution functions that is less expensive to construct, renovate, and maintain as operational systems, technology, and
work processes change.
Consolidate services so they can be shared among multiple hospital sites.
Multi-hospital health systems can develop off-site warehouses, kitchens, reference
laboratories, compounding pharmacies, and other support services.
Relocate administrative offices for staff who are not involved in direct patient
care. Again, these can be on- or off-site in less expensive and more adaptable office building space. Creating a generic administrative office suite allows the space
to be reassigned in response to organizational changes, thus eliminating department turf issues and improving overall space utilization.
Lease space instead of buying or building. This alternative allows you to limit
capital investment and long-term risk by leasing space off-site for administrative
offices and new or expanding outpatient programs. Some healthcare organizations
may choose to lease hotel conference facilities or a school auditorium for periodic
in-service or community education in lieu of constructing an education center on the
hospital campus.
THINK WAY OUT OF THE BOX
You may need to get even more creative in rethinking the conventional use of
space, even if only as a temporary measure. Consider the possibility of:
Virtual staff offices. Most healthcare facilities have large blocks of space
dedicated to administrative offices where staff hang their diplomas and display
family photos. Many organizations have successfully weaned staff from these
dedicated offices to multi-use or virtual workstations. Depending on the nature
of their work, and the time they are present, some staff could be assigned a
mobile storage cart, which can be secured in their absence and wheeled to an
available office or workstation when they are on duty.

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Out of Space and

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Ways to Improve
Space Utilization
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Time-share clinic space. Creating clinics where physicians lease space for patient reception/intake, exam rooms, offices, and support staff the day of week as
needed reduces fixed costs and increases overall utilization of the space.
Hall beds for ED patients who have been admitted. Even though hospitals have
been trying for decades to eliminate the practice of temporarily parking patients on
stretchers in corridors, a recent study at Stony Brook University Medical Center
found that no harm was caused by moving emergency patients to upper-floor hallways when they were ready for admission. The study concluded that the common
practice of boarding patients who have been
admitted in the ED creates an out of sight, out of
In reality, achieving
mind situation. Once the patients are moved to
flexibility often requires
the nursing unit corridors, nursing staff get a lot
more creative and aggressive with workflow practhat physicians, departtices.
ment managers and
Other non-traditional ways of delivering
staff relinquish absolute
patient care. The media are full of stories about
the use of non-traditional settings, from drivecontrol over their space
through flu shot clinics to walk-in clinics at retail
and equipment for the
stores and shopping malls. However, the use of
telemedicine allows even more patient care
greater good of the orpossibilities.
ganization.
One of these is a remote presence robot, which
incorporates a zoom camera and sensors that
allow a doctor to conduct patient exams from his or her office using a specialized
joystick and interface. The wireless, mobile robot has a TV screen for a face that
shows the doctors head and shoulders. It can move untethered, allowing the
physician to freely interact with patients, family members, and hospital staff from
anywhere, anytime to provide a long-distance consult.
Another possibility is remote management of critically-ill patients, which is being
successfully implemented in a number of U.S. hospitals that want to improve quality
of care and patient outcomes despite shortages of nurses and intensivists. Virtual
intensive care unit (ICU) monitoring centers can monitor multiple ICUs at once from
a remote location with real-time tele-presence, including the review of clinical
documentation and medical images, the monitoring of vital signs, and the use of
digital stethoscopes and high-quality video cameras. Use of this type of remote patient management system allows scarce clinical staff to be more effectively leveraged 24-7 and also gives rural hospitals improved access to intensive care resources.
Of course, sharing space and using non-traditional settings to deliver patient care
requires flexibility. By definition the term flexibility means adaptable or adjustable
to change. In reality, achieving flexibility often requires that physicians, department
managers and staff relinquish absolute control over their space and equipment for
the greater good of the organization. However difficult this may be to achieve, it
must be compared to the cost, time, and energy required for a major renovation or
new construction project.

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Out of Space and

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Ways to Improve
Space Utilization
Continued

2012.5.2

Many healthcare organizations may find that scrutinizing the utilization of their existing space to improve its efficiency and flexibility provides increased capacity or,
at a minimum, allows them to temporarily postpone a major capital project while
they assess market conditions and utilization trends.
Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC.

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