What's Next for Healthcare?

B+H ADVANCE STRATEGY

what’s next for healthcare?

“IT IS NOT THE STRONGEST OF THE SPECIES THAT SURVIVES, NOR THE MOST INTELLIGENT, BUT THE ONES MOST RESPONSIVE TO CHANGE. “ - CHARLES DARWIN

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WHAT’S NEXT FOR HEALTHCARE THERE IS A BETTER HEALTHCARE SOLUTION THAT IS SOCIALLY DESIRABLE, FINANCIALLY PROFITABLE AND EMPOWERED BY DISRUPTIVE TECHNOLOGY AND INSIGHTS INTO HUMAN BEHAVIOR. HELP US LEAD THE WAY. B+H ADVANCE STRATEGY

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executive summary Imagining a comprehensive health ecosystem that benefits society, business and the urban environment.

dealing with the dinosaurs Healthcare today is crisis-driven, infrastructure heavy, and offers a less than desirable customer experience. The traditional hierarchy is mixing with regulatory demands place pressure on providers and staff, leading to record-high levels of burnout and job dissatisfaction. Worse, across the nation, healthcare delivery is financially unsustainable for payers, employers and individuals alike.

But the healthcare dinosaurs’ era is coming to an end. A metaphoric asteroid of technological innovation and social change is disrupting the once-familiar healthcare landscape. Mobile diagnostics, self-tracking wearables, personalized medicine, retail clinics, virtual medicine and electronic record keeping are each making their impact - but to what end?

Tomorrow’s healthcare consumer will be proactive, data-driven and engaged in health decisions.

Many large hospitals fear becoming disenfranchised, disempowered by a trend towards decentralized health and wellness facilities. Is this a threat - or a tremendous opportunity?

Within this window of disruption and massive change can we seize the moment to create a healthcare delivery culture that embraces lucrative and effective new service lines, seamlessly integrates team members and technologies, and provides holistic preventative care and an appealing, engaging new user experience?

Who we are and what makes us tick Patient expectations and needs are rapidly changing. You are fighting an uphill battle against staff shortages, high turnover rates and the very real impact of provider burnout. Regulatory and reimbursement changes keep you on your toes. You’re constantly exploring, discovering and innovating to improve outcomes, reduce costs, and deliver a quality experience to your patients.

You know that rapidly-evolving technologies and medical advances will inevitably change your business, and you’re looking for a way to anticipate tomorrow’s changes while the crystal ball is

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B+H ADVANCE STRATEGY

still fuzzy. From workplace to retail to education to healthcare, experiences are changing and marketplace disruptors are adjusting consumer habits and expectations (“Hello, Amazon!”).

We believe in embracing change as an opportunity, challenging the status quo and creating vibrant experiences that bring people out of their homes and into the community. We travel the world to seek out unique experiences, we go the extra mile to take care of our health, we’re the first to try the new superfood and stick it in our office blender. We believe that taking care of ourselves has a place at home, at play AND at work. We search across diverse marketplaces to understand common goals, threats, opportunities and solutions. We see the rapidly changing landscape of health and wellness as a tremendous opportunity to offer more and do it better. We have tools that will help you envision and model a user experience – a curated model – that meets your key business objectives, sustaining your brand as a provider, an employer, and a driving force within your community.

Why design matters in a changing world We founded our global B+H Advance Strategy practice because our clients deserve better than traditional design services. Not only are we architects and designers, but we are business planners, organizational design specialists, researchers, brand specialists, and real estate professionals. We are business partners who leverage our design and architecture skills as tools, explore and develop scenarios informed by user experience and a thorough understanding of our clients’ business goals.

Data, not diva. It’s all about you! We passionately believe that when design begins with a thorough exploration of our clients’ business goals, chosen culture and user needs, expectations and desires the results will be exceptional. You know what you want – our work is to help you express it in ways that will delight, nourish and sustain you from dawn to dusk. We’re storytellers, placemakers, curious designers and human beings. We want to help you shine.

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change agent # 1

Care team attraction, retention and engagement PHYSICIAN AND NURSING SHORTAGES, COMBINED WITH INCREASING RATES OF PROVIDER BURNOUT ARE FORCING THE CARE TEAM TO ADJUST AND EXPAND TO INCLUDE NEW ROLES, CROSS MULTIPLE GENERATIONS, AND DRAW INDIVIDUALS FROM DIVERSE BACKGROUNDS. IT IS IMPERATIVE THAT YOU DEVELOP A CULTURE OF INCLUSION, ENGAGEMENT AND RESPECT THAT WILL ALLOW YOU TO ATTRACT AND RETAIN THE RIGHT TALENT.

change agent # 2

Consumer Expectations

GONE ARE THE “HEALTHCARE PATIENTS” OF THE PAST, REPLACED BY CONSUMERS WHO EXPECT HEALTH AND WELLNESS OFFERINGS TO COMPLEMENT THEIR UNIQUE CIRCUMSTANCES, LIFESTYLE AND GOALS. INDIVIDUALIZED SERVICES ENHANCE QUALITY OF LIFE WHILE ALLOWING CONSUMERS TO BECOME THE CENTER OF THEIR OWN WELLNESS TEAM. HEALTHCARE CONSUMERS ARE INCREASINGLY REPRESENTED BY CAREGIVERS WHO MAY SIMULTANEOUSLY JUGGLE CARE FOR THEIR PARENTS, THEIR FRIENDS, AND THEIR CHILDREN, FURTHER INTENSIFYING THE DRIVE FOR CONVENIENCE, PREDICTABILITY AND EFFICIENCY. WHILE THE VARIOUS GENERATIONS MAY HOLD DISTINCT ATTITUDES TOWARD TECHNOLOGY, CONSUMERS TEND TO VALUE EFFECTIVE AND RESPECTFUL PERSONAL COMMUNICATION AS HIGHLY AS CLINICAL OUTCOMES, WHICH ARE HARDER FOR THE AVERAGE PERSON TO EVALUATE.

CONNECTIVITY and community

Wellness and quality of life 8

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CUSTOMER SERVICE FOCUSED

Convenience AMENITY RICH ENVIRONMENT

value personal connections with patients + team

work/life balance

Team centered care

Culture of inclusion

Empowered collaboration

change agent # 3

Anticipating Exponential technological change

TECHNOLOGY’S INFLUENCE ON HEALTHCARE IS INEVITABLE. VIRTUAL HEALTHCARE PLATFORMS HAVE THE POSSIBILITY TO REDUCE COSTS, INCREASE QUALITY, AND IMPROVE COMMUNITY HEALTH, BUT TECHNOLOGY MUST BE IN SERVICE OF A SOLUTION, NOT BE THE SOLUTION ITSELF. PATIENT, PROVIDER, AND FRIEND/FAMILY INTERACTIONS WITH TECHNOLOGY WILL GREATLY INFLUENCE THE EXPERIENCE OF CARE, LEADING TO EITHER ADOPTION OR PREMATURE OBSOLESCENCE. BY FIRST DEVELOPING CLEAR TECHNOLOGY GOALS AND BOUNDARIES, THEN DESIGNING AN INTENTIONAL USER EXPERIENCE, WE CAN SUCCESSFULLY INTEGRATE TECHNOLOGY TO IMPROVE THE CULTURE OF CARE.

Artificial Intelligence INTERNET OF THINGS

AR / VR electronic health records

tele health

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Understanding the Human factors of health Life Integration

Access

Engagement

Balanced

Informed

Supported

I have a life outside of this job. With all the supposed advances in technology, why am I still putting in so many extra hours?

My schedule is overloaded. We need to get patients to the right settings to make sure we can focus on ones that really need our help.

I’m in this field to help people, not to click boxes on a computer.

How can I get the EMR out of my way so I can do my job?

I want to stay healthy, not be “fixed” after something’s wrong.

How can I avoid going to the doctor altogether?

Why is the healthcare system so hard to navigate? I want to know who to see, where to go, how much it will cost, and how fast I can get in.

I don’t want to be here. Are they actually listening to me? Do they understand me as a person, not just a patient or a record?

How can I maximize connection to my family and caommunity while I support my loved one’s health?

Don’t put me on hold!

Just tell me who to see, when I can get in, and how much it will cost.

Bonus points for taking less time out of my schedule.

Do they understand who I am and why I’m here? Why are they talking to me, and not their actual patient?

Provider

Patient

caregiver

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Communication

Continuity

empowered

Confident

I can’t keep up with the research. I need a way to narrow the possibilities so I can recommend the best possible options.

What will make my patients actually do what’s needed to keep themselves healthy?

I‘m overwhelmed and I don’t understand what they’re talking about.

Why can’t they tell me in simple words and pictures so it makes sense to me?

What are my next steps? Will they remember me after this visit? Can I look at what spent all that time putting into the computer?

How in the world am I going to help my loved one when we get home if I can’t understand what they’re telling me to do?

I’m not a doctor. What are they going to do to help me care for my loved one and watch for signs we need to come back in?

911 Shortage of providers and nurses THE UNITED STATES IS FACING A POTENTIAL SHORTAGE OF

105,000 & 800,000 physicians

BY THE YEAR 2030 -- Association of American Medical Colleges, 2017 -- U.S. Department of Health and Human services, 2014

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Nurses

More than 50% of US Physicians and 25% of nurses are experiencing professional

burnout which can result in lower patient satisfaction, reduced health outcomes, and an increased cost of care.

-- Annals of Family Medicine, 2014 & Mayo Clinic, 2015

Each disengaged nurse can cost an organization more than $20,000 in lost revenue due to reduced productivity.

THE GLOBAL DIGITAL HEALTH MARKET IS EXPECTED TO EXCEED $200 BILLION BY 2020.

-- Statista, 2015 - 2020

Fully engaged physicians give hospitals more than 50% more inpatient referrals than those who are not engaged.

-- Kamins, Gallup, 2015

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THE opportunity disruptors Shift to outpatient settings

Collaborative Care Teams

virtual care

Near immediate access

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Personalized medicine

Whole-person health

culture of hospitality

Scale and integration

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The global healthcare industry is facing a series of disruptive changes. Rapid policy and reimbursement shifts, ubiquitous mergers and acquisitions, skyrocketing costs, technological advancements, demographic shifts and the rise of the consumer economy are all converging to challenge the status quo. We believe that we can lean into these disruptors by exploring the possibilities, discovering what will work best for your organization, and defining lowest-cost interventions that can be leveraged to make the biggest impact where it matters to you and your community.

B+H Advance Strategy is about achieving a deeper understanding of the healthcare delivery context our clients face today. With the right guidance, today’s healthcare infrastructure can be reimagined, re-designed and re-deployed to facilitate an efficient new healthcare delivery for the modern era and create an environment more adaptable and responsive to change – futureproofing investments for years to come.

Our process focuses on people, culture and experiences, not on buildings. This means the scenarios we develop in partnership with our clients reflect a unique combination of qualitative and quantitative factors. Together, we challenge assumptions, set bold criteria for success, develop daring new visions, define comprehensive road maps, and measure our success along the way.

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our process 1 RESEARCH establish vision collect data identify participants study best practices

2 analysis Synthesize data determine parameters frame opportunities set success criteria

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scenarios identify possibilities determine options confirm assumptions build & test models

Solutions

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Define solutions Create a road map Plan communications Define and apply metrics 16 B+H ADVANCE STRATEGY

tools & matrix Portfolio Optimization

Development Solutions

Workplace Strategy

Pre-visioning checklist performance systems map visioning questions set visioning deck competitive set matrix organizational cultural assessment enterprise vision time utilization study user surveys Day in the life day in the life (workplace) planning game camera ethnography probability of success matrix Proadmap

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Advance strategy

3303 SW BOND AVE. PORTLAND, OREGON 97239

knight cancer research center

ohsu.edu/xd/

COLLABORATION

Associates/Lab Tech.

Grad Students/Post Docs

communication between teams and across departments.

We approached this project by identifying core attributes of a desired research culture that could be advanced through the physical environment. Working with scientists, experimentalists as well as computationalists, we studied current culture, job-shadowed, hosted social gatherings and got to understand individual’s preferred and desired ways of working. These varied by generation. Insights from our qualitative analysis revealed points of tension and opportunities that quantitative analysis alone could not discover. Our integrated method established the foundation for a creative, meaningful, and effective design solution that encourages collaboration and advances the Team Science culture.

Missy Principal Investigator Missy Wong Principal Lab - RJH 5 Investigator

Existing Intra-Lab Collaboration

DURATION

FREQUENCY 1 Trip

Wong Lab - RJH 5

DURATION

FREQUENCY

5 Trips 1 Trip 5 Trips

8:00 - 17:00

1.5 Hours

45 minutes

1.5 Hours

10 minutes

15 Trips

18:00 18:00

17:00 17:00

16:00

16:00

15:00

15:00

14:00

14:00

13:00

12:00 13:00

12:00

11:00

11:00

10:00

10:00

9:00

9:00

PLANNED COLLABORATION

8:00

8:00

Wednesday, April 1, 2015 Wednesday, April 1, 2015

45 minutes

8:00 - 17:00

10 minutes

10 Trips

P.I.

Grad Students/Post Docs

MEETING

IMPLEMENTED TOP DOWN

Existing Inter-Lab Collaboration

MEETING

Associates/Lab Tech.

75%

So

Associates/Lab Tech.

ci

al

In

iz

te

in ra

g ct

in

g

Grad Students/Post Docs GRASS ROOTS IMPLEMENTATION

New connections via Ad-Hoc Collaboration

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19%

TRAVEL

P.I.

19% TRAVEL

AD HOC COLLABORATION

INDIVIVUAL

75%

INDIVIVUAL

science at the ng, facilitating design team’s throughout the s, it was found ation was well c collaboration t seems to be ng connections “grass roots” nnections to be

The leadership recognized the need for a workplace strategy to support the necessary cultural shift.

They needed a new way of working collaboratively to unleash insights and discoveries that was fundamentally different from the traditional academic research culture, defined by individual achievement, status and hierarchy. To unleash its full potential Team Science needs a flat organization where status and hierarchy give way to increased

Top Driven

P.I.

each lab is led s in a top down

meetings where ngst leadership eam members very structured , where most he discretion of

Nike founder, Phil knight, donated $500 million to the Oregon Health and Sciences University (OHSU) to advance team science in pursuit of early cancer detection. Matched by the state, $1 billion dollars is enabling the Knight Cancer Institute to recruit new scientists, fund groundbreaking research, and construct a new building for this effort.

The academic research sector and the technology sector are converging. Silos are dissolving.

6% Prepared By: B+H Architects Page 31

Nick B+H ARCHITECTS 6%

Post Doc Wong Lab - RJH 5

DURATION

FREQUENCY 1 Trip 5 Trips 10 Trips

10 Trips 15 Trips

Advance strategy

1100 FAIRVIEW AVE N SEATTLE, WA 98109 fredhutch.org

fred hutch Studies to align the interiors of this research leader’s 13 building campus with their culture and mission.

Project size 1.5M ft2

Overview Fred Hutch is a world leader in cancer research, and their facilities are top notch. While highly functional, over time the design of their interior spaces became misaligned with their growing organizational culture. Recognizing the key role that the built environment plays in the productivity, well being, attraction, and retention of faculty

and staff, Fred Hutch engaged us to embark on a study of their culture, values, and functions. Focus groups, visioning exercises, staff shadowing, demographic, and industry research and benchmarking informed subsequent design studies aimed at bringing the spirit of their culture and mission to their facilities, while giving them options for future densification and growth within their existing real estate.

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E XTE R IOR B+H ARCHITECTS

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Advance strategy

725 BRONTE STREET S. MILTON, ONTARIO, CANADA haltonhealthcare.on.ca

Milton district hospital Anticipating technological innovation and ever-changing community needs

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Catalyzed by the rapidly growing and increasingly diverse population in this Greater Toronto Area town the Milton District Hospital redevelopment and expansion envisions the highest quality patient-centered care model for changing community.

Technological innovation and the ability to flex and adapt in the face of exponential change are critical planning considerations. Our team designed flexible spaces and systems that can expand, contract or be reprogrammed to meet new demands. Modular/template rooms and standard dimensions in experience and operations remove constraints without disrupting the planning geometry. Reserve systems capacity in base systems enables soft

B+H ARCHITECTS

space conversions that are rapid and cost-effective.

The entire spectrum of experience is safe, convenient, sensitive and dignified. It promotes a healthy and collaborative work environment with easy sightlines, seamless movement of people and materials, comfortable places to gather, adequate storage space, transportation, and reduced risk of workplace injury. Technology is integrated into the built environment to support operational objectives by making it more accessible and less intimidating to users. The Milton District Hospital blends evidence-based healthcare design strategies with a hospitality approach to create healing and empowering environments.

Advance strategy

30 BOND STREET TORONTO, ONTARIO, CANADA stmichaelshospital.com

St. Mike’s Nicu Stakeholder visioning to promote true collaboration in service to patients

The redesign of St. Mike’s NICU provided the opportunity to create a true people-centered experience to meet the needs and expectations of patients and staff. St Mike’s wanted their new NICU to serve the needs of a diverse urban population in an innovative way, setting a new model for space to facilitate collaboration in other medical organizations. The Advance Strategy team facilitated a work session to uncover a shared vision to guide both the client and the design team in creating a high performance space. The critical insight revealed

during the session was the need to unify the NICU team with the OB team located in another part of the building. All parties recognized that collaboration within and between the care teams was essential if they were to provide integrated patient experience for momsto-be and new moms. With this understanding the design team paid particular attention to the “backof-house” experience, ensuring that care teams felt supported and empowered to collaborate in the best interests of all their patients.

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Advance strategy

2 SIMEI STREET 3 SINGAPORE cgh.com

Changi general hospital Embracing the importance of family and community on the healing journey

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An early step in the Government of Singapore’s plan to address a growing and increasingly aging population, Changi General Hospital’s Integrated Building recognizes the central role that community plays in the healing process. The design is the result of close collaboration with the client and a thorough understanding of both community and staffing needs and expectations. The Integrated Building reimagines the campus as a hub for wellness and healing, creating an environment that encourages patients’ smooth transition back home to their community.

B+H ARCHITECTS

Advance strategy

KENT RIDGE ROAD SINGAPORE

national university center for oral health singapore integrated Teaching and healing spaces together in a collaborative team environment

Scheduled to open in 2019 and targeting BCA Green Mark Platinum award, the NUCOHS will be able to accommodate about 500 patients per day when it is fully operational.

This 34,000 sqm GFA integrated healthcare centre would consolidate multi-disciplinary clinical dental services, education and research facilities under one roof.

The design of the building activates a Campus Green with landscaped civic spaces linking NUCOHS to the National University Hospital, Singapore (NUHS) campus.

It is connected to the public transportation network through a network of bridges and covered walkways.

nuhs.edu

The treatment floors allow close cooperation between teaching and treating with a mix of tutorial rooms, open-office concept low partition dental chairs aggregated into pods, closed operatory and flexible waiting areas. Interior spaces combine high ceiling with extensive high-performance curtain walls that maximize natural light penetration and allow a better connection to the nature. The education, administration and research wings share a landscaped courtyard at the upper levels of the building with naturallyventilated circulation, pre-function zones and student common spaces.

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WE know healthcare HEALTHCARE EXPERTISE HIGHLIGHTS

90+ PROJECTS WORLDWIDE

65% of our work is with repeat clients

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DESIGN FOR OVER

10m ft

2

OF HEALTHCARE SPACE IN THE LAST 10 YEARS ALONE

“

We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten.

Don’t let yourself be lulled into inaction.

- BILL GATES

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50+

Years of healthcare design experience B+H ADVANCE STRATEGY

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OUR CLIENT LIST + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

AGILENT TECHNOLOGIES ALASKA AIRLINES ALLERGAN AMAZON APPLE APPLIED BIOSYSTEMS AT&T ASTRAZENECA BANK OF AMERICA BANNER MD ANDERSON CANCER CENTER BARCLAY CAPITAL BEHUNE DEVELOPMENTS BENSON, A COAST HOTEL BEST WESTERN INTERNATIONAL BJC HEALTHCARE BLACKROCK BOEING BROOKS CHANGI HOSPITAL CHILDREN’S HOSPITAL CISCO CITY OF SEATTLE COLLIERS INTERNATIONAL COLUMBIA AISA GROUP COTERIE WORKLOUNGE COMMONWEALTH PARTNERS CHI / CREIGHTON UNIVERSITY DENDREON DIGNITY HEALTH DISNEY DOUBLE TREE HOTELS EMBASSY SUITES HOTELS EVERGREEN HEALTH EXPEDIA

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+ EXXON MOBIL + FACEBOOK + FORTRESS DEVELOPMENT GROUP + FRED HUTCH + GATEHOUSE CAPITAL + GE CAPITAL + GOOGLE + HAWAIIAN AIRLINES + HILTON HOTELS & RESORTS + HILTON GARDEN INN + HOTEL CONCEPTS + HP + HSBC + IBM + INTERCONTINENTAL HOTEL + IU HEALTH + KETTERING HEALTH NETWORK + KIDDER MATTHEWS + KILROY REALTY + MARKHAM STOUFFVILLE HOSPITAL + MERCK + MICROSOFT + MILTON DISTRICT HOSPITAL + MORGUARD + MOTOROLA + MT SINAI MEDICAL CENTER + MU HEALTH CENTER + NATIONAL UNIVERSITY HEALTH

SYSTEM + NEXT HOTELS + NIKE + NOBLE HOUSE + NOVA DEVELOPMENT + NOVEL

+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +

OHSU OXFORD PROPERTIES PIERRE FAMILY INVESTMENTS PORT OF SEATTLE PRECOR PROVIDENCE ST JOSEPH HEALTH QUEEN ANNE ELEMENTARY SCHOOL ROCK BRIDGE CAPITAL SCHNITZER WEST SEATTLE CHILDERN’S HOSPITAL SIERRA DEVELOPMENT STANFORD STARBUCKS ST. CATHERINE’S HOSPITAL ST. MICHAEL’S HOSPITAL SUN MICROSYSTEMS SWEDISH CANCER INSTITUTE SWEDISH MEDICAL CENTER TABLEAU TALON T-MOBILE TRULIA UNIVERSITY OF BRITISH COLUMIBA UNIVERSITY OF KANSAS HOSPITAL UNIVERSITY OF MINNESOTA UNIVERSITY OF TEXAS UNIVERSITY OF WASHINGTON VULCAN REAL ESTATE WASHINGTON HOLDINGS WASHINGTON UNIVERSITY IN ST LOUIS WEYERHAEUSER

THE FUTURE IS NOW. JOIN US.

B+H ADVANCE STRATEGY

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B+H less risk

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optimized performance

=

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greater return on investment

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your competitive advantage

LET’S TALK +1 206 582 2875

Lori Epler

Doug Demers, Managing Principal: doug.demers@bhadvancestrategy.com Bryan Croeni, Director: bryan.croeni@bhadvancestrategy.com Hout, Director of Healthcare, Senior Strategist: lori.eplerhout@bhadvancestrategy.com Jill Jago, Strategist: jill.jago@bhadvancestrategy.com