Renovating or Considering a New Build? Design for Health Care Success

The physical environment is critical to work effectiveness, satisfaction, and physical and psychological well-being. This has direct effects on staff and patients. For those of us who work each day in a stressful environment, the design of the physical space is critical to safety, motivation, attitude, and efficiency. While comfort may not be a top priority when it comes to the correctional environment, sometimes, so little attention is paid to design concerns that the effectiveness and safety of the operation can be compromised.

NCCHC Resources has had the opportunity to consult on renovations and design of the health care services areas in correctional facilities. Often, we see spaces originally designed for custody retrofitted to provide health services. Renovations are a necessary part of the evolution of a facility, and they require careful thought and planning to ensure quality of care is maintained and enhanced.

Because health services operations extend throughout a facility, a comprehensive master plan is critical even when the area requiring modification may be modest. Additionally, many forward-thinking custody leaders want to add services to better care for the population. And for good reason: incarcerated patients need services such as imaging, dialysis, or basic trauma care, and transportation outside of the jail or prison is a high-risk activity.

Driving Good Decision-Making in Facility Design

Let’s explore some factors or variables that can drive good decision making. Every program is unique, but one or more of these considerations can tip the balance toward success and better outcomes.

First, consider the demand for services. Too often, decisions are driven by anecdotal and personal experience, rather than evidence-based principles. Let’s use the example of the idea to provide care for patients who require dialysis. The first step the leadership team should undertake is exploration of demand. How many patients in our population need this services? How are we currently meeting this need and what would change by offering it in-house? Is there space in the current facility that is located and sized appropriately for the necessary equipment, and what are the capital and operational costs involved? Could the space allocated for dialysis better serve another need, particularly when planning future operations? Finally, who will provide clinical services? This includes not only the physician or provider staff, but also nursing and other support personnel. This is not a conclusive exploration, but some initial considerations.

Another common ask is for a treatment room or area that can provide care for minor trauma, disease exacerbations, or the initial stages of a serious need while awaiting transport. The first consideration is obvious: what is reasonable to treat in-house? What types of medical emergencies are appropriate to treat? Then, what equipment is needed? Will the team want to manage laceration repair, cardiac arrest, intubation, etc.? Will you need any diagnostic capabilities such as lab and imaging to compliment these services? Can you acquire and maintain any needed supplies or certifications (staff and equipment)? Very importantly, where will this space be and how accessible is it to all patients who need it? A central location, close to staff and accessible to outside medical and transport crews is beneficial, but in an existing facility, centrally located spaces are often in high demand. Again, the need for a comprehensive master plan is critical when planning additional services.

Let’s look at another common services area that jails and prisons seek to provide: long-term care. LTC is where we can house patients who are not acutely ill but are not well enough to be in general population. These patients frequently have nursing needs and often special equipment as well. Before even talking about design, leaders should carefully review requirements for licensure and accreditation that may be well beyond the capability of many programs and facilities.

Unique Correctional Health Care Considerations

There are some general considerations specific to the correctional environment. The first of these is the role of the health services vendor. Although there is variability, the vendor will usually be called upon to provide new services. Consider whether the new services are within the scope of the current contract, and/or if the vendor has appropriate resources for them. If leadership has to seek another contract for added services, it adds another layer of expense and complexity.

Again, the real need and benefit of providing these services must be carefully assessed. When planning for additional services, the health services vendor’s input is valuable but often needs to be supplemented by health care planning expertise that is not burdened by existing contracts or limitations with regards to staffing and can instead focus on the overall treatment mission of the facility.

The potential for mission creep or space misuse is important. Everyone knows that beds, units. and pods belong foremost to custody. Sometimes, the design characteristics of a health care space make it attractive or suitable for custody purposes. This may be just fine, but all leaders should be alert to any risks of compromise of the health care mission.

There may be direct financial impacts on treating some patients in-house versus outside. In some facilities, there are outside reimbursement mechanisms that would not be applicable to in-house treatment. Ironically, in some cases, it might be more expensive to treat in-house rather than on the outside.

When planning modifications to an existing facility, or when considering a new facility, it is important to understand the impact on health services. The organization of spaces within a clinic, the location of the clinic within a larger facility, and the proximity of staff to patients affect efficiency and safety. Developing circulation diagrams that indicate the movement patterns of staff, patients, and medications is essential to the planning process. Individual spaces must be designed to promote safety as well as healing, and the importance of communication between staff and patients should be considered.

Suicide prevention is a profound concern in correctional facilities. Designs that reduce risk through careful selection of fixtures and furnishings can be supplemented by the creation of a therapeutic environment that reduces stress. Most importantly, building consensus among health care and custody staff on the treatment mission of the facility requires a clear plan.

To conclude, robust planning and consensus building are required to avoid good and well-intended ideas that don’t come to fruition in application. Sometimes that realization comes too late, after a serious investment in resources has been made. These costly and unnecessary mistakes can be avoided by methodically approaching any project involving a shift in health services, clearly identifying goals and a shared vision, and developing a comprehensive master plan the incorporates the entire health services operation.

Where NCCHC Resources Can Help

If you are planning any renovations, expansion, or a new facility, NCCHC Resources assist in guiding the process and appropriately factor in the complexities of correctional health care.

Specific services can include:

• Defining and analyzing the appropriate level of care to be provided, and serving as a client representative to ensure health care needs are met
• Developing and reviewing relationship diagrams that describe how spaces relate to each other, what critical adjacencies will need to be maintained, where secure access points are located, and where direct visibility is required into a space
• Developing and reviewing movement diagrams that describe how staff, patients, and supplies move through a proposed space
• Space planning, which describes what an individual room, for instance an exam room, needs to accommodate
• Staffing plans to understand what physical changes to the facility will have on health care operation
• Selection of appropriate furnishings and finishes for a treatment space
• Peer review of completed or in progress architectural designs

By

Brent Gibson, MD, MPH, CCHP-P
Managing Director, NCCHC Resources

Gregory Cook, AIA, CCHP
Principal, PendulumARC Consulting, LLC