As has been the case for many other kinds of services, rapid and substantial technical advances in healthcare have shrunk the need for physical space to accommodate the delivery of patient care. This comes as surgery and other procedures have become increasingly “micro,” making medicine much less invasive, resulting in lower risks of complications and infection with corresponding improvements healing and recovery.
Meanwhile, the digital and wireless revolutions have downsized the medical enterprise in terms of its “physical plant” as electronic records replace space-devouring paper and as new kinds of equipment and new techniques evolve to include remote imaging and robotic surgery. The net effect has been a radical change in the demand for space and especially for beds and longer patient stays on premises. In short, acute care has become much less acute, as more of what patients require can be accomplished conveniently and quickly on an out-patient basis.
In terms of the physical practice of medicine, there’s less need for large centralized facilities and significantly more demand for process-driven specialty centers: clinics, outpatient surgical centers, and a species of micro-hospitals have begun to emerge that scale better to distributed communities and that better suit the requirements of healthcare providers who find themselves becoming more like retailers who thrive by proliferating more targeted, specialty outlets.
On the organizational side, healthcare networks have become more centrifugal as they acquire or build satellite facilities that offer less residential care in favor of more ambulatory, treatment-driven models in which the facilities are better able to accommodate patients where they live in suburban and rural communities often at considerable distance from city centers.
Among complicating factors, however, is the problem of attracting first-class medical talent in rural or even suburban communities. In many rural areas it’s nearly impossible to recruit trained specialists with the result that patients needing specialty care in disciplines like obstetrics, cardiology or orthopedics have to travel to city centers to find the care they need.
All of which has encouraged competition and new organizational models along with the emergence of new more flexible facilities’ design concepts. Modular buildings, designed around function and outfitted with advanced video and digital imaging equipment, intelligent exam-rooms and outpatient treatment suites that have increasingly replaced “old-school” residential care.
Some networks whose mission has always involved community outreach have embraced advanced telemedicine in support of local partners in need of the scarce skills of specialists. Armed with technology such as remote ultrasound and real-time digital-video uplinks, network specialists are able to perform highly effective, remote physical examinations and advanced diagnostics and even certain procedures with the in-office assistance of trained partner nurse-practitioners.
Here in the Midwest, both Mercy Health and SSM Health have been offering pediatric subspecialty care and women’s-health services via telemedicine to their satellites and rural healthcare partners throughout the region. The technology required is robust and increasingly affordable, involving high-speed fiber-optic connectivity with advanced imaging and staffers trained in the team-medicine practices needed to participate. Additional advances in robotics have further enhanced the capabilities of the latest in well-equipped satellite facilities. The models for this approach of increasingly minimalist healthcare intervention vary, with stand-alone clinics designed around exactly this kind of remote medicine capability, as well as more traditional full service rural satellites that are investing in the upgrade of their electrical and communications resources needed to support the imaging and diagnostic services that are offered through this kind of cooperative medicine.
Making these changes happen has meant that specialty contractors like Guarantee Electrical Company (GECO) have adapted and retooled to meet the demand created by this extra-urban medical revolution, as they supply the infrastructure that’s enabling the micro-hospital concept to develop and mature throughout the greater Missouri region. Frequently this involves comparable forms of team-building with skilled local contractors eager to expand their electrical and communications construction capabilities. The upshot has been a renaissance of full-service rural health centers like Phelps County Reginal Medical Center in central Missouri, as well as specialty hospitals like Mercy’s Orthopedic Hospital and Surgery Center in Springfield MO, which have made advanced medicine and orthopedics fully accessible in rural Missouri.
One of the most sophisticated of this type of development was the Siteman Cancer Center located in South St. Louis County where the concept of specialty care in a micro-center was fully realized through GECO’s design-assist on behalf of Paric, delivering a “best-of” technology combination of suitably calibrated power and high-speed network bandwidth. Offering radiation therapy through its new linear accelerator together with infusion chemotherapy, the Siteman South County Cancer Center—owned and operated in a joint venture of BJC and the Washington University School of Medicine—brings outpatient cancer care to levels previously only seen in large urban medical centers. Compact and convenient, the Siteman Center’s modular design and advanced equipment offer patients life-saving treatment near to home without having to resort to expensive in-patient residential care.