Medical centers and nursing care around the world have shifted from acute and post-acute intervention to crisis responsiveness. The U.S. Department of Health and Human Services (HHS), the Corp of Engineers, the American Hospital Association, architects, engineers, and building planners have responded to COVID-19 service demands by developing new, mass response centers for testing, triage, diagnosis, isolation and nursing care.

The places where this traditional care was provided have moved to a variety of retrofitted locations. For example, converted parking structures, athletic stadiums, convention centers and older facilities previously closed have been re-opened or restructured to respond to this emergency need.

The type of rooms required for a highly contagious disease are not readily available to meet increased demand. In a typical planning environment, one could trendline the needs, project what the number of beds/rooms might be, and then design a facility to meet those projections based on the appropriate number of observation stations, isolation rooms, nursing support and recovery areas. The pre-planning, under normal circumstances, could also determine the infection control measures, staffing requirements and code-complying environmental features required to meet the safety needs of the patient, family, physicians and nursing care.

Process & Responsiveness

Before COVID-19, listing hospital risk concerns was straight forward. However, this pandemic has created an infection and space management challenge. In today's healthcare environment, the networking and merging of healthcare programs compounds all risk factors and makes them more complex. For example, additional consideration must be given to:

• Multiple hospitals with numerous access points,
• Extensive information management challenges,
• Regional clinical and nursing service challenges,
• Asset management and life/safety considerations,
• Accessibility, safety and wayfinding challenges, and
• Infection control and risk assessment (ICRA).

The proactive responses of facility managers and engineers working in partnership with infection control has been effective pre-COVID-19. The current status is not manageable. Collaboration with the regional and statewide agencies having jurisdiction over healthcare providers have helped with crisis intervention by providing variances to rules and regulations. Another source of leadership support and guidance has come from professional associations including the American Hospital Association/American Society of Healthcare Engineers and the American Institute of Architects (AHA/ASHE/AIA).

Regulatory Compliance and CHNA Value

It is timely for providers to begin a focused "community planning effort" to address pandemic responses in a collaborative manner. This could be conducted as a part of the Community Health Needs Assessment (CHNA), which is currently required for 501(c)(3) public providers. Investor-owned providers have also joined in since they do receive federal funding and CMS support.

This law requires the CHNA master plan be developed and be updated every three years. The regulations that were effective at the program's implementation in 2014 should be slated for update in 2021, considering:

• The community served by the provider or system, the geographic area and the target populations being served, including the medically underserved, low-income and minority populations (which also would certainly apply to high-risk populations as noted in COVID-19).
• Prioritization of the significant health needs of that community and target population.
• Soliciting community input to the healthcare provider, or system, within the service area and seeking out persons with specific healthcare expertise in public health, disease awareness and prevention and defining proactive measures for emergency responsiveness.
• Providing individual or group documentation in the report, such as: definition of the community served, process and methods used to conduct the CHNA, community input received or ongoing feedback, significant health needs of the community that are prioritized by cycle, and a description of resources available to address the significant health needs identified

Ideally, every hospital facility or system would document its CHNA for public awareness and make the information available via a website, which has been and should continue to be updated every three years following the 2014 program implementation.

Master Plan & Future Action

From this planner's point of view, the CHNA efforts in tandem with an appropriate facility and environmental response would be the preferred approach. The primary objective should be a virtual road map or master plan for the future. This would be based on current events, lessons learned and "regionally collaborative" responses to service gaps, new trends and crisis intervention. The approach would include the following:

1. Assemble a Regional Team. The team should include the agency-In-charge, healthcare architect(s) and engineer(s), epidemiologist, systems representative (telehealth), product representative (biomedical and technology), provider representation (facility/risk management), scientist (from a specialty deemed appropriate), psychologist (behavioral health authority), government (CMS, HHS, other local, state or national agency representation) and financial/insurance representative.
2. Assess the Situation, Goals and Objectives. Determine the facts associated with COVID-19, including current CHNA status, size of acute care facility, trend analysis on cases, attributes of community, statistical projections, staffing, functionality, environmental/infection rates and preparedness of building. Benchmark issues and outcomes, including trendlines, staffing implications, qualified A/E/C direction, funding and continuity, leadership, vision, risk assessment measures and continuity of CHNA findings. Determine responsiveness measures for the next crisis or threat, develop a workplan and assemble a team. Activate the work plan within the CHNA context for operations and staffing, policy and process, patient care implications, transition and transformational strategies (particularly in rural areas), budget and schedule, approval authority, supportive resources, assessment of progress within a three year window, and sustainability. Finally, take remediation efforts where required and look at environmental and operational changes from the standpoint of assignments, staffing outcomes, statistical progress and priority, capital access by phase, human resource and budgetary requirements, and the approvals process.
3. Integrate Crisis Intervention with the Master Plan. Assess status of the facility or system master plan (MP), gather electronic data for all sites and buildings, assess available space and inpatient/ED/holding areas, assess staging/phasing and patient handling and movement options, seek state and AHJ regulatory variances and ST/LT intervention measures, quantify impact factors and associated data, outline ICRA compliance plan and pandemic guidelines at all government levels, and benchmark similar programs for a quick, comparative check.

Putting processes in place will help mitigate risk and accelerate action in the face of the current pandemic and in preparation to address future threats.

Jim Easter, March, ACHE is principal and founder of Nashville-based Easter Healthcare Consulting (Ehc), which specializes in facility planning within the healthcare continuum. Easter has more than 2,000 healthcare master plans and functional programs to his credit. For more information, go online to easterhealthcare.com.

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