How the ACA is effecting construction of Medical Office Buildings
Written by Shane Williams
The delivery of healthcare is evolving due to healthcare reform initiatives
based on the Affordable Care Act (ACA). Nowhere is that more apparent than
in the design of Medical Office Buildings (MOBs).
Traditionally, MOBs have been comprised of practice suites housing private
physician groups occupying as little as 1,000 SF to as much as an entire
floor, +/- 25,000 SF. These spaces were designed to support routine
physical examinations, checkups, lab work and minor outpatient procedures.
However, due to changing reimbursement rates as a result of the ACA, an
increasing number of physicians are choosing to be employed by hospital
systems. As a result, today's MOBs are designed with new configurations to
support increased efficiency, collaboration and revenue generation. One
benefit of hospital-managed physicians is the ability to leverage shared
support spaces across multiple physician practices. As a result, the
individual components of the physician suite are being reconfigured.
How many exam rooms do you need?
While different service lines require unique equipment (i.e. dermatology
versus podiatry), the basic exam room component exists for nearly all
service lines. The question has always been - how many exam rooms are
required for each physician's work day?
In 2009, the Mayo Clinic engaged a research study developed in conjunction
with Steelcase to understand the potential impact of utilizing a
consultation room for patient visits that do not require a physical
examination and if this configuration would result in improved outcomes for
both patients and clinicians. In the study, both conventional exam rooms
and experimental 'conversation rooms' were utilized in a random assignment
for 63 pairs of patients and doctors. While the researchers found that both
patients and clinicians were very satisfied with the conventional exam room,
they observed that in the reconfigured conversation room "patients felt they
had more and better access to information, including their own records, test
results, images and online patient education material."1
While this particular study focused on the experience of the room
comparisons, a follow-up study took a deeper dive in looking at the overall
process. SPARC (See, Plan, Act, Refine, Communicate) is "much more than
redesigning exam rooms and equipping them with new furniture; it is also
about the process and flow of patient care. How and where patient caregiver
interactions occur and how to most effectively integrate technology into the
patient care experience are essential to informing the space design."2 This
study described the benefits of shared support spaces and combination of
exam rooms and consultation rooms. Further, in a recent two-day study
conducted by Kaiser Permanente3 that focused on MOB exam room
configurations, these benefits were noted:
"Improved provider flow and patient care. More available workspace has the
potential to enhance workflow and improve provider-patient communication, as
well as patient safety and satisfaction."
"Design efficiencies. Flexible exam rooms that could accommodate many
specialties would reduce the number of exam rooms needed within the medical
"The Multi-Purpose Exam Room could accommodate a larger variety of patient
needs, allowing clinics to more easily accommodate the increasing diversity
of member populations over time."
What all these studies point to, and what Array's simulation software and
Lean analysis indicates - is that through more efficient use of space, MOBs
can feature fewer traditional exam rooms and a mix of interview/conversation
With health systems continuing to recruit physicians and establish new
service lines, designing an MOB with flexible exam/conversation spaces
supports additional physicians to utilize the same space. This allows
hospitals to construct less space and maintain projected throughput volumes.
For patient visits that do not require a physical examination, the
conversation room configuration can result in overall less square footage
required and improved throughput resulting in greater patient satisfaction.
When paired appropriately with exam room modules, this can also lead to
greater efficiency in the physician's workflow.
Designing to Support Flexibility
Flexibility is essential to the financial success of MOBs. Service lines
evolve and change, medical equipment is continually updated and procedures
become less invasive, allowing a shift from an inpatient environment to an
outpatient setting. Utilizing universal sizes for exam rooms,
incorporating conversation rooms and right sizing procedure rooms to
accommodate multiple modalities are all design tools to support flexibility.
Perhaps the most efficient design tool to support future flexibility is to
incorporate modularity in MOB design. Modularity can be seen in a variety
* Traditional planning - by utilizing an established arrangement of
rooms that are repeatable across scale, there can be a range of space from a
very small exam/conversation configuration to a large, multi-practice
configuration through the traditional construction methodologies.
* Pre-fabricated rooms -construction methodologies are increasingly
looking into pre-fabricated spaces to improve construction quality and
reduce the amount of time to completion. A modular, repeatable
configuration of interior spaces facilitates this construction approach.
* Complete building components - taking prefabrication a step further,
it is possible to construct entire building components remotely, deliver to
a prepared site pad and assemble a building configuration.
MOB as "Front Door"
Ultimately, the goal of the MOB is to become the primary location for
education, preventative care, wellness, outpatient procedures and outpatient
surgeries - becoming in essence, the hospital's "Front Door." A successful
MOB will provide a consistent stream of referrals for the inpatient
hospital. This makes brand recognition across your outpatient and inpatient
facilities critical - and architectural design can be a powerful tool to
create brand loyalty and awareness. Developing consistent signage and
wayfinding programs is important, so that a patient and their family knows
they are in YOUR hospital. Incorporating modular layouts for physician
offices, utilizing similar materials, finishes and furniture can help your
patients navigate different locations and make them feel comfortable and
At the epicenter of the Affordable Care Act (ACA) is the philosophy that
healthcare should be focused on the wellness of the patient rather than
narrowly focused on the symptom/diagnosis of a singular event. Creating the
experience of having everything a patient and their family needs under one
roof, conveniently organized and accessible, designed to promote a
conversational and simplified sharing of information will result in a
patient-centered experience and enhanced brand recognition. The future of
Medical Office Building design will be closely tied to how it supports
patient-centered care. The ability of MOBs to adapt and respond quickly to
developing market conditions as healthcare delivery adapts to the nuances of
the ACA make it the ideal candidate for development of new best practices
founded in Lean design.
How healthcare can safeguard itself against cyberthreats
One of the most fundamental lessons from the COVID crisis is that health should always be a priority. In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.
The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics.
From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world.
The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years.
This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate.
Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.
To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care.
Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change.
It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device.
These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.
Despite this, there are fundamentals that any organisation should implement:
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.
In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.
Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents.
Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.
This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents.
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.
Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.
As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.
Fighting future threats
With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.
To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced.
This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.