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July 2018 — Health Care Properties Quarterly — Page 3 www.crej.com ment requires staff buy-in and training for efficiency. • Building a strategic business case. At North Kansas City Hospital, a 1,280-square-foot endovascular hybrid suite was integral to the hospital’s stra- tegic renovations and growth strategy. “We couldn’t justify building a hybrid room for either vascular or cardiology, but by combining them, we could make the case,” said Jody Abbott, senior vice president and chief operating officer at NKCH. “The potential for growing the combined services, adding structural heart procedures, along with growth in each specialization, made the invest- ment possible.” Since its implementation in 2016, the hospital doubled its use projections. Its vascular surgery team has grown from four to eight surgeons, and its new structural heart procedures now num- ber 40 per year, driving the need for a second facility. • From hybrid to “tri-brid.” To increase use, hospitals are catering to secondary markets, using hybrid spaces for joint replacement, radiology, spinal surgery and procedures requiring advanced imaging. “Most people don’t realize what can be done in a hybrid room,” says Jason Wojciechowski, senior director of peri- operative services at St. Joseph Hos- pital, a teaching hospital with one of Colorado’s largest cardiology programs. “It’s expensive, because it contains a lot of infrastructure to support, so you need to ask how that room can be used for other procedures.” To maximize use, St. Joseph moved to a “tri-brid” model. The room, com- plete with a convertible surgical bed, also handles ear, nose and throat pro- cedures; hernia surgeries; emergent cases; and more. “Using an expensive room 60 percent of the time is still 40 percent wasted revenue,” he said. “It lines up now – the numbers, staffing, case management and physician satisfaction.We have been able to justify the need.” • Designing for variable uses. To ensure usability, the design must be flex- ible, yet tailored for the hospital and patients it serves. Understanding what will happen inside that room is critical for a layout that enables mixed use. “Optimize the design for how it’s used 95 percent of the time and then cover for the outliers,” said Anderson. “For instance, if you could only have two pans in the kitchen, what would they be? It’s similar with a hybrid OR. What are the hospital’s most essential needs?” NKCH’s hybrid room is outfitted for head-to-toe imaging, which is impor- tant for structural heart procedures, but also for radiology. At St. Joseph, moving to the “tri-brid” model was a game changer. “I can now come in and adjust as needed, and we are able to clear the room for quick-response situ- ations,” saidWojciechowski. Once imaging and surgical bed needs are identified, the layout is built around the patient, identifying placement of equipment booms, lighting, monitors and critical infrastructure. A typical hybrid OR procedure could involve as many as 16 to 20 people, which makes layout critical. For NKCH and St. Joseph, design mock-ups, site visits and collaborative design meetings were crucial to achiev- ing an efficient and flexible hybrid. To achieve buy-in from the start, con- sider bringing in all professionals who use the space. However, know that undirected, it may lead to competing visions, according to Jerry Husman, NKCH vice president, facilities and sup- port services. “The owner needs someone to make clear decisions. If you allow clinicians to work directly with manufacturers, you can easily increase costs by 50 percent.” Instead, NKCH developed a transparent process, solicited requests from clinical staff and weighed options together. The result: Clinical staff truth- tested sales claims, and clear priorities prevented unreasonable requests – and an inflated budget. • Future-proofing your OR. Hybrid operating suites will continue to evolve with technology and current practice, so designing for wide use can protect your investment long term. “Unless you design for multiple uses and for your particular hospital, it may not be used the way you intended,” noted Anderson. “You don’t just build it; you have to also build the business for it.” ▲ Continued from Page 1 Hospitals Before you commit Designing and building a successful hybrid – or “tri-brid”OR startswith asking the right questions. Here’s where to start: Building your business case • What is your goal? Which uses, proce- dures, functionality and growth opportuni- ties are driving your decision making? •What is your patientmix andhowwill this investment meet their needs? What does it enable? • From a market perspective, is this the area you want to compete in? Can you compete? Is there sufficient demand in your com- munity? •What are your strategic goals as an organi- zation?Where does a hybrid roomfit inwith your other OR service lines? • Would it make sense to build a shared hybrid ORwith another institution? Expanding usage • Who are the key stakeholders, front- line staff and key leadership that must be involved in the planning process? • Which equipment choices will allow you to maximize the utilization of the room? • How might different disciplines use this room? • Which functions and equipment choices will you prioritize when you can’t have everything? Design priorities •For each of the primaryplanneduses, how does the process work? What’s required? What’s nice to have? • How are you bringing the patient into the room? Where are you standing? Where are your people working? • What’s happening 95 percent of the time? What about the other 5 percent? Are major changes needed for the one time per month when you do a certain procedure? • Do you need to have external physicians or medical staff participating in the surgery? • What are your IT, conferencing, robotics and/or telemedicine needs? • How will you plan for future uses of the space? Operations • How will you operationalize the OR once it’s brought online? •What have you done to ensure the highest possible utilization? • How will you handle staff education and onboarding? QUESTIONS TO ASK