Small Scale, Big Impact

Improving Healthcare Outcomes with Micro-hospitals and Economies of Scale
Written by Jessica Ferlaino

In many rural and underserviced communities, demand for healthcare continues to put pressure on the already strained resources that are available. There are fewer doctors and more patients, and much of the infrastructure, equipment and resources are insufficient, old and degrading. All the while, healthcare funding continues to be depleted.
Micro-hospitals or micro-clinics could be the solution to this problem, providing economies of scale that rein in the operational costs of healthcare by mitigating the strain on resources. They make the system more efficient, accessible and affordable operationally and for patients, without having to compromise patient care or healthcare outcomes.

As the name implies, micro-hospitals are smaller scale medical facilities that address a gap in healthcare provision where one exists. These smaller clinics can provide specialized care tailored to the needs of the community or can be general in nature, and in both forms serve a significant function in the hierarchy of care in the network of healthcare providers.

Micro-hospitals deliver the same regulated standard of care as larger facilities, but do so with a smaller footprint, using fewer resources. They are designed to be efficient, cost-effective and tailored to ensure an optimized workflow and an exceptional patient experience. These smaller clinics can range in size from 30 000 to 60 000 square feet and support eight to fifteen beds. They are often designed with flexible rooms that can be adjusted to meet the needs of the patient and treatment as needed.

Micro-hospitals, because they can serve nearly every patient that walks through their door, be it through direct treatment or preparation and stabilization for transfer to a larger facility, serve as effective hubs and spoke feeder systems for larger healthcare facilities, while urgent care facilities cannot do the same. Micro-hospitals serve pre-acute patients, with emergency and low to medium acuity care, while high acuity cases are referred to larger facilities. They are higher acuity than urgent care but lower acuity than trauma centers.

Micro-clinics consolidate primary and urgent care into one facility in a way that better addresses the needs of patients while taking some of the strain off of emergency departments and dedicated urgent care facilities by addressing and filtering out less-serious or treatable cases. Offering 24/7 care, they serve as a middle ground between emergency departments and major hospitals. From both a cost and regulatory standpoint, they are far easier to build and license than larger facilities. Though they are subject to standards and regulations, they require less time, labour and materials to get off the ground.

The greatest costs in health care are derived from recovery and lengthy stays and micro-hospitals are designed to keep those costs down while getting patients up and running in no time. As micro-hospitals are designed with short-term care and routine procedures in mind, discharge times are faster, the length of stays are shorter and wait times are significantly reduced.

Micro-hospitals, while smaller in scale, still boast fully equipped labs, diagnostic tools and imaging devices but patients tend to receive more personalized levels of care by doctors who suffer lower rates of burnout in micro-clinic settings. The smaller setting, the lower patient count and the atmosphere of these micro-clinics, by design, have not only had a positive impact on workflow and patient care, they can improve the physician experience as well. Doctors in micro-settings report feeling less burnout in micro-settings.

These hospitals are ideally structured to be able to provide personalized treatment and care as well as preventative care. Not only can they diagnose and treat, they can help prevent illness and improve health and wellness through the administration of nutrition programs, fitness promotion, stress reduction and other similar programs.

Micro-hospitals are a place where patients can develop a relationship based on trust with a practitioner and where practitioners can reconnect with patients. Even though shifts are long and days can be stressful, with 30 to 60 patients being seen on an average day, they feel like they can provide better care. The only disadvantage that could possibly result from a move from larger to smaller patient-care centers like micro-hospitals is that with fewer procedures, physicians will have less practice and will need to undertake other efforts to remain proficient in their fields.

The smaller setting does, however, allow for more camaraderie and collaboration amongst physicians, nurses and administrators, which allows for better delivery of care. They work in close proximity with one another and when silos between professionals are broken down, new ways of looking at old problems lead to the discovery of new solutions and treatments.

While micro-hospitals can play a role in rural, suburban and urban areas, the greatest benefit is often seen in rural and underserviced areas with lower and middle class neighbourhoods that face the greatest financial and geographic barriers to healthcare.

Larger healthcare facilities are seeing a decrease in demand, which is highly attributable to their design. Hospitals have traditionally been designed with an 85 percent occupancy rate in mind, while the reality is now closer to 60 to 70 percent. The additional 15 percent was meant to satisfy spikes in demand caused by natural disasters or crisis situations but much of that capacity goes unused. Larger hospital systems can turn to the micro-hospital model in order to expand their geographic footprints to improve access to care and address gaps that exist in various communities.

When larger health systems align with micro-hospitals and integrate, it serves as an effective use of resources and can amplify the level of service and care being offered without the need for significant capital investments or substantial construction projects. If a partnership with a large facility doesn’t exist, micro-hospitals can establish contracts with transportation, communications and information technology partners that can deliver large scale resources to back their small scale setting.

Pennsylvania-based Highmark Health recently made an investment of $700 million in Pittsburgh that demonstrates that larger health care systems understand the value of smaller care facilities. Highmark’s plans include a larger facility with 160 beds and four micro-hospitals with ten to twelve beds each. The smaller facilities will provide emergency and primary care, as well as specialty medical services to filter out and address the needs of patients that are well within the scope of their capacities to reduce strain on the hospital’s resources.

As a result of their size, efficiency and patient-centric approach to healthcare, the scale of these facilities can also take the fear out of healthcare for many patients. Hospitals can be stress-inducing for many, and their designs often exacerbate the situation. Unclear wayfinding, old infrastructure, crowded waiting rooms, lack of privacy – all of these issues can be eliminated in smaller settings.

Scale is one of the greatest advantages derived from employing micro-hospitals. While scale might also be seen as a disadvantage given the limited size of these facilities, if viewed in the spectrum of care, they serve a very important purpose. Micro-hospitals offer efficiency, lower-operational costs, improved workflow and ultimately, greater patient and physician satisfaction, making it good for business, the community and the bottom line, and could be the solution that is needed to address gaps in service and strained resources in healthcare provision.

Micro-hospitals provide convenience to the healthcare system, the administrators and healthcare professionals charged with operating healthcare facilities, and the patients; bigger is better no longer holds true. What does hold true is the emphasis on the customer experience in retail and this is no different for retail clinic settings. Micro-hospitals offer convenience, which is considered an important element of the success of brick-and-mortar operations, and in the era of instant gratification and public accountability in which we live, patient satisfaction is everything. If the goal is improved patient care and service then micro-hospitals might be the thing the industry needs to provide an improved level of patient-centric care.



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