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Attendee Comments

  • The level of diverse information

  • Good

  • Interesting content

  • Great mix of attendees.

  • Speakers & presentation. Ben Riestra presentation was very good

  • The information provided was relevant and current in today’s market

  • I particularly appreciated the population growth information as it related to the amount of sq. ft. that would be needed to support that growth

  • Networking

  • UM Health Presentation and Leo A Daly

  • The venue

  • Good variety of speakers

  • All the talks were interesting. I particularly learned the most from the Prefab Components Case Study

  • Reuniting with healthcare community

  • It was my first healthcare conference. It was overwhelming, but most interesting

  • Lots of great, useful information I would like to reference in an upcoming meeting

  • I have a huge presentation coming up and would love to include some of the amazing insights you provided

    Miami - Post Summit Recap


Takeaway Messages

March 06, 2019 - Miami, FL

  Reported by Richard Westlund, a freelance writer based in Miami. Westlund specializes in business, medicine, real estate, human resources, corporate leadership, law, finance, education, aviation, technology, and other topics. He also founded the South Florida Medical Review, the nation's first regional medical-business newspaper.
  Future of Ambulatory Healthcare Delivery

Ben Riestra, Chief Ambulatory Operations Executive and Chief Administrative Officer of The Lennar Foundation Medical Center at UHealth, the University of Miami Health System

  • Don’t do your planning in the conference room — go out and talk to people on the floors.

  • Improve the patient experience through strategies such as reducing check-in and wait times and making parking convenient.

  • Be flexible. Plan with a 5- to 7-year time horizon.

  • Adopt the principle of continuous improvement. Daily huddles can help your team deliver better care.

  • With design and construction, nothing should say “ugly and sterile.” Make it pleasing, convenient and fun.

  • Keeping physicians and staffers happy translates into a better patient experience.

  • Improving clinical workflows, so patients can move in and out more quickly, is a great strategy for reducing wait time in the examination room.

  What’s Driving Demand for Healthcare Facilities
  • Healthcare is very regionally driven.

  • Emergency department (ED) visits are rising while inpatient admissions are flattening. 64% of admissions start in the ED.

  • Since 1990, the U.S. has 500 fewer hospitals and 100,000 fewer beds.

  • Outpatient visits are skyrocketing.

  • About 16% of a doctor’s patients are new and 84% are recurring.

  • More physicians are employees and fewer are independent.

  • Physicians drive the patient experience and healthcare revenues, while hospitals are integrators of services. The average net revenue generated by a physician is $2.378 million.

  • As the U.S. population gets older, physician visits will increase. The U.S. average is 282 annual visits per 100 people, but in Florida it is 341.2 visits. A University of Florida population forecast projects a 31.6% increase in doctor visits from 2020 to 2045.

  • An estimated 1.4 to 2.6 million square feet of additional outpatient facilities will be needed to accommodate the volume.

  • Most patients over 65 don’t come alone on visits, and this is influencing facility design, transportation and other factors.

  • About 30% of hospital space will be functionally obsolete in the future.

B. Alan Whitson, RPA, President, Corporate Realty Design & Management Institute
  FGI 2018 Guidelines and Beyond
  • The 2014 edition of the FGI guidelines are now in use in most states, while the 2018 edition is being referenced in seven states. The 2022 guidelines will focus on going beyond the fundamentals. Visit fgiguidelines.org for the latest information.

  • FGI does interpretations, such as on the minimum square-footage requirements of a low-acuity patient pod in the ED. The Institute also is looking at palliative care facility standards and behavioral health units in the ED.

  • It’s important to take resiliency and business continuity into account in design, particularly in relation to tornadoes, hurricanes and long-term climate change. Be prepared for community residents who plan to shelter in place.

  • When clinical telemedicine services are provided, it’s important to consider the environment as well as the facility space.

  • For instance, are you achieving accurate skin tone and facial features on display monitors; avoiding glare; protecting patient privacy; or accounting for acoustics, lighting and even the color of walls (not yellow!)?


Doug Erickson, CEO, Facility Guidelines Institute
  • Portable lifts for individuals of size need 7-foot clearance, while overhead lifts only need 5 feet.

  • Pre-and post-procedure patient care areas can be combined; however, they should be visually separated to avoid emotional reactions.

  • Outpatient guidelines have been moved into a new 17-chapter book. There are provisions for flexibility for small projects.

  • New chapters were added to the residential guidelines in 2018, including guidelines on facilities for individuals with disabilities and long-term residential substance abuse treatment facilities.

  • FGI does not cover hospitality areas – just the clinical space.

  Healthcare Security – Guns, Guards, Gates & Technology

(Left) Jose Acuna, Director of Security for GSOC and Baptist Health Enterprises
(Right) Steve Nibbelink, Healthcare Segment Manager, Vector Security Network

  • Security challenges have changed and putting more bodies on the ground may not be the solution. Training is crucial as the pool of security guards becomes smaller and more expensive.

  • The design of a facility should include security considerations, as they are much easier to incorporate in the plans than in a retrofit.

  • Security people need to trained to serve as ambassadors for the organization, and technology should reinforce a positive patient experience.

  • Nibbelink advises adopting a visitor management program that makes people who come into a building aware of security.

  • Culture is one of the keys to securing data and medical equipment. People need to understand what happens if they don’t take precautions.

  • Security personnel should not have guns, Acuna says. Instead, they should be trained to de-escalate situations, rather than using deadly force.

  • In an active shooter situation, the best strategy is for staff to be trained to run and tell someone. Also, have lockdowns in place for critical areas like the operating rooms.

  • Train staffers to notify others about potential domestic violence situations. Then be on the lookout for that person until the situation is resolved.

  Avoiding Compliance Pitfalls in Clinics and MOBs

(Left) Jeff Butler, Project Executive, Robins & Morton
(Right) Jim Peterkin, Senior Life Safety Consultant, TLC Engineering, and Past President of the Florida Chapter of the Society of Fire Protection Engineers.

  • Avoiding violations is crucial because healthcare providers that receive federal monies must comply with CMS Conditions of Participation or be subject to damages and fines under the federal False Claims Act of 1875.

  • Compliance in leased buildings can pose issues for healthcare tenants, as responsibilities may involve the owner and even other tenants. For example, Peterkin shared how one co-tenant shut a building’s electrical system down over the weekend, resulting in the medical tenant losing $100,000 in refridgerated drugs.

  • If you hire a contractor, service provider or have “guests/invitees,” be sure to understand the applicable provisions in the lease document.

  • In new construction, spell out responsibilities for the shell contractor, and try to reduce logistical issues if another contractor is doing the interior build-outs.

  • Be aware that change orders can have many ramifications for other areas of the building, including utilities, storage areas and medical gases.

  • If there is any chance of a new facility providing ambulatory healthcare, plan ahead. For instance, a two-story building might require dual elevators that are large enough to accommodate patient beds.

  • Let strategic planning drive construction, rather than the other way.

  • Construction costs are escalating, so take that into account when planning ahead.

  Case Study: A Systems Approach to Healthcare Redesign
  • Don’t accept a napkin sketch as the starting point for a healthcare design. Instead, expect your designer to dig into the situation, look beyond the distractions and solve the right problem.

  • A good starting point is workload volumes and forecasts for future population growth and usage. That can determine how many rooms will be needed.

  • Identify wasteful processes before designing. For instance, a bottleneck in the ER might be a sign that more inpatient beds are needed rather than a larger ER.

  • Get input from physicians, nurses, equipment managers and other staffers before laying out the spaces. Strive for consensus.

  • Consider prefab construction techniques.

  • Explore a configurable family care system to meet the needs of patients of different generations. For instance, a room might have a pull-down bed or a panel that turns into a desk of a table for dining.

  • Be innovative. If Amazon can deliver a salad from Whole Foods to a patient room, perhaps a drone port would be a nice feature for improving the patient experience.

Eduardo Egea, Managing Principal, LEO A DALY
  Future of South Florida’s Healthcare Real Estate Market

Left to Right:
Carol Ellis-Cutler, First Vice President, Advisory and Transaction Services, CBRE
Kathleen Moorman, Corporate Vice President, Corporate Real Estate, Baptist Health Enterprises
Richard M. Rendina, Chairman and CEO, Rendina Healthcare Real Estate

  • A CBRE survey of healthcare investors and developers found demand for wellness centers at the top of the list. Demand was lower for long-term acute healthcare facilities.South Florida has seen an increase in care closer to neighborhoods. Outpatient services is where the growth is occurring, including imaging centers and standalone emergency rooms.

  • Rendina is focusing at redevelopment projects. A lot of retail malls want to incorporate a medical office use.

  • Health system tax status is not a big concern for many communities that want to bring in healthcare uses.

  • Investors like the medical office market, even with lower cap rates and higher purchase prices. There is more money chasing quality assets than there is supply.

  • If Florida repeals its Certificate of Need requirements, the state could see a number of “micro hospitals.”

  • However, demand for multifamily and condo projects in South Florida has driven up land prices, making it difficult to develop new medical office facilities.

  • Care on demand, including telehealth, may be a cost-effective solution for serving patients in high-priced real estate markets like Miami’s urban core.

  Case Study: Real Time Savings with Prefabricated Components on Two South Florida Bed Tower Expansions
  • Because prefabrication work is done in a controlled environment, it typically results in time savings, higher quality environments and safer job sites.

  • Prefab components may include bathroom PODS, exam room PODS, headwalls, modular casework, and overhead MEP racks, to name a few examples.

  • Prefab addresses labor shortage problems in local markets.

  • Prefab components can be produced in advance and shipped to the job site ready for installation.

  • On one tight South Florida job site, prefab components were installed in 3.5 weeks, versus the four months it would have taken using a traditional approach.

  • DPR is now working on prefab underground electrical modules and prefab central energy plants as a way to eliminate on-the-job labor and save time.


(Left) Daniel Berger, Superintendent, DPR Construction

(Right) Kevin Dean, Project Executive, DPR Construction

  Tips, Tricks of the Trade & Traps to Avoid – In the Field Experts
  (Left to Right) Dave Blackwell, Chayla Brown, Paul Swan
  Dave Blackwell, Camfil:
  • For every $1 a hospital spends on air filtration, $7 is spent on fan energy to push air through that filter. Buying energy-efficient air filters may be more expensive upfront, but that price becomes a wash as they reduce that energy cost.

  • Check your filters’ MIRV ratings and purchase MIRV 8 filters that maintain efficiency that won’t decline over time.

  • Don’t change air filters based on the calendar year. ASHRAE recommends filters be changed based on pressure rather than frequency. That means you will buy fewer filters, install them less frequently and have fewer to throw away.

  Chayla Brown, nora systems Inc.:
  • Flooring installers may not take enough time on the details and corners, so have the general contractor ask the flooring contractor to provide a mockup to show you how the floor will look once installed in a space.

  • Be sure you understand the type and compound of subflooring, and ask your flooring contractor to disclose the amount and type of patching done to ensure you have a good substrate.

  • When wheel marks or other indentations appear, it is more likely to be a displacement of underlayment rather than of the adhesive. Be sure the patch has enough compressive strength.

  Paul Swan, ASSA ABLOY:
  • Put the door design into the construction documents. When value engineering occurs, the end result is not the same, and you don’t want to scramble to see how things function at the end.

  • Think of economies of scale when selecting door security products. When we price a project as a total package, you get a more competitive price and TCO, so think of a total door opening, not just the frame, hinges and doorstop.