Kaiser Seeks Big Ideas for Small Hospitals

If you have a notion about what the hospital of the future should look like, Kaiser Permanente wants to hear from you.

The nation’s largest not-for-profit health care system is launching an open hospital design competition looking for new ways to deliver care in a small hospital. The contest, which includes “compensation of up to $750,000” for finalists, invites students, architects, engineers, designers and multidisciplinary teams to combine facility design with innovative use of technology to visualize how a small hospital should be built in Southern California.

“In many ways we are at the cusp of a totally different model of delivering in-patient care,” said John Kouletsis, executive director of strategy, planning and design for Kaiser Permanente.

“Technology is now starting to show us there are whole new ways of doing things. We’re hoping to capitalize on some of the promise of that brave new world. I don’t know if we’re ready to move to the Star Trek vision of health care, but we’re hoping this competition will encourage people to start thinking like that,” Kouletsis said.

Although architects who specialize in health care design may have an inside track, the juried contest hopes to attract a wide array of competitors — international and inter-disciplinary.

“We are not just looking for dynamic building designs,” said Benjamin Chu, president of Kaiser Permanente Southern California, where the need for a new hospital sparked the competition.

“It’s probably time to look at the state of the art in building construction for hospitals,” Chu said, adding, “We want a partner with fresh ideas on how technology and medicine can reshape our current medical delivery infrastructure.”

The prospect of millions of newly insured patients in California also played a part in the decision to launch the competition.

“Because of the possibility that we’re going to grow quite a lot in our delivery system because of health care reform, we thought we needed a lot more flexibility,” Chu said.

The competition, which is free to enter, comes with a rapid timeline. The contest starts today. Entrants must register online by March 21, and submissions are due by April 18. Stage 1 winners, who will be announced May 6, will present their plans to a jury May 16 to May 17. Finalists, who will be announced May 20, move to Stage 2 and have until Oct. 28 to deliver a final submission. The winner will be announced Nov. 4.

This is the first hospital design competition for Kaiser, which operates 36 hospitals and nearly 500 medical office buildings in nine states and the District of Columbia. The seven-member jury, to be named next month, will have four Kaiser representatives and three industry representatives. Finalists will receive compensation of up to $750,000 to develop their concepts further. The winner will earn the right to contract with Kaiser Permanente for the small hospital project.

Kaiser officials hope some of the ideas from the competition can help all health care providers, not just Kaiser.

“We’re interested in raising the level of design in health care,” Kouletsis said. “We tend to be pretty open in sharing what we do, and I would expect that we’ll follow that trend with this contest.”

Getting Small Could Help Keep Costs Down

New York architect Robin Guenther, considered one of the country’s most influential people in health care design, said going small could help keep health care costs down.

“The concept of a micro-hospital is powerful as an important step in driving down the cost of health care while providing relevant, convenient, community-based care,” Guenther said.

Guenther quoted Clayton Christensen, author of “The Innovator’s Prescription: A Disruptive Solution for Health Care,” who said, “Hoping that our hospitals and doctors will become cheap won’t make health care more affordable and accessible, but a move toward lower-cost venues and lower-cost caregivers will.”

Guenther, co-author of “Sustainable Healthcare Architecture,” said Kaiser’s competition ultimately could have an effect on all health care consumers.

“Can the micro-hospital answer the need for more affordable and accessible care? It is a question worth asking,” Guenther said. “The results of this inquiry can have important ramifications for not just Kaiser members, but for all U.S. health care consumers.”

New Directions for Kaiser

Embracing technology is not new for Kaiser. After a four-year, $4 billion design project, Kaiser in 2008 rolled out an electronic health record system connecting its 8.6 million members to doctors, nurses, lab results and scheduling. It was billed as the world’s largest privately funded EHR system.

The “Small Hospital, Big Idea” competition marks two new directions for Kaiser — going small and looking outside.

Kaiser’s integrated model of care has so far revolved around a large medical campus with big hospitals and supporting outpatient medical office buildings. But as the organization grows and demographics change, Kaiser officials see the possibility that smaller hospitals, using new technology differently, may provide better, more accessible care.

“The marketplace is sort of shifting,” Kouletsis said. “Now, when we talk about opening new hospitals, we see that they don’t need to be the large facility serving a large geographic area. In areas like Southern California where you have a large suburban and rural fringe, you’re talking about having to drive two hours to get to a hospital. Depending on what’s going on with you — you still may need to drive two hours. If you have a brain tumor, you understand that you may have to go a long way to get the best treatment. But for many other things — if you have a broken leg or a chronic condition or some other problems — there might not be a need to go so far.”

Kaiser officials expect some of the ideas they see over the next few weeks will challenge the way they’ve always done things in its self-contained integrated system.

“What comes out of this will challenge us to think about our own rolls and how we do things,” Kouletsis said. “Some of these ideas may actually ask Kaiser to rethink some of our processes and procedures — and we’re open to that. We might find some really interesting wild ideas that may make sense. We have to be willing to look at everything in a new way, including ourselves,” Kouletisis said.

Chu agreed.

“In many cases there are more efficient ways to do things now than there used to be. The use of electronic capabilities opens a lot of possibilities. We are, after all, in the age of Skype,” Chu said.

‘Small is Beautiful’ … Again

In some ways the contest marks the cyclical nature of all kinds of endeavors and marketplaces. Just as small, community-based hospitals of the early part of the previous century gave way to larger, more efficient urban hospitals, new technologies may allow the cycle to move back more toward close-to-home delivery of health care.

In another cyclical interpretation, the first time Gov. Jerry Brown (D) was governor, he publicly and repeatedly embraced the concepts preached in British economist E. F. Schumacher’s book “Small is Beautiful: Economics As If People Mattered.”

In Kaiser’s new health care model, small may be beautiful again.

“We’ve done a lot of research about what the patient experience is like,” Kouletsis said, adding, “We want to make sure that we move toward technologically advanced hospitals, but they also should be a good experience for patients. We strive of a high level of dignity. We have to work for a good balance of high tech and high touch and we’re hoping this competition can help us find good ways to get there.”

Kaiser officials hope to get “maybe 50 to 100 serious people to at least express an interest in this,” Chu said.

“There are a lot of brilliant people out there with a lot of good ideas. I think it’s time to bring the hospital world into the 21st century,” Chu said.

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