The politics of planning has been a topic of interest to many, particularly those of us involved in the rapidly evolving healthcare industry. At a minimum, persons considering a new healthcare construction or modernization project must consider how certificate of need(CON) laws have evolved, the impact a Community Health Needs Assessments (CHNA) might have on the project, and the political implications of lobbying efforts and how the enactment of new laws could impact facility design or the way health care services are rendered. Health care facility planners must also consider, from the onset of a project, how the project’s scope might evolve from the first stage of demonstrating project need, through the CON and licensure application stages, and ultimately the final stage — the operation of the new health care facility. When healthcare-related buildings are constructed or modernized without completing an adequate CHNA, they are often placed in the wrong location, developed without an adequate vision and mission, and typically not packaged with a solid business plan in mind. An adequate CHNA must contemplate the needs of communities with unmet healthcare needs and under-served population groups and consider how a project will affect people living within the project’s service area. A project can change the dynamics of the community for generations. Ultimately, planners must consider the current trend toward population-based service delivery, a method which is timely and complementary to improving business practices in the healthcare sector.

Understand the Healthcare Needs of the Community to be Served and Design Accordingly

Before a planner begins any healthcare construction or modernization project, he or she should ensure that they have a complete understanding of the community in which the healthcare facility will be located and the healthcare needs of the people it will serve. The community in question may be a small rural area or an inner city location with similar concerns relating to access to healthcare, but without the means to improve the situation that is presently existing. Access, quality of service, cost of care, and image are key factors to measure along with the type and style of care that will be rendered. At the same time, the architecture of change will result in neighborhood and community transformation through urban or rural renewal, new construction and/or building upgrades, and environmental improvements.  Gentrification is truly the vision for change that embodies both improved access to health-care and the economic development we believe can be realized within many communities around the country.

Build a Project Team That Understands the Project, the Law, and the Community

Every successful project is rooted with a strong project planning team. From the very beginning the planning team should include, at a minimum, attorneys, consultants, and professionals with extensive experience in the scope of work that they will be responsible for and government relations experts who can address local, state,and federal matters as they arise. The consultants and professionals should be able to provide guidance on project design, financing, reimbursements from government and commercial payors, facility operations, and human resources. Throughout every stage of the project, each member of the team should focus on their given tasks and report to one person identified as the project leader.

It is imperative to have experts on the team who thoroughly understand the project and the community it will serve.  An informed policy expert can clarify the legislative agenda, evaluate the national, state, and local situation, and share insights on policies that might enhance the project or clarify how one might draft bills that help fill service and image gaps.

Community Health Needs Analysis

The current federal guidelines require that providers of public healthcare services prepare a Community Health Needs Assessment (CHNA) which defines both service needs and methods for filling healthcare service gaps. If there are service needs that have been discontinued or gaps within an under served population, effective plans will define a path toward filling those gaps. In a recent HFR project, the planning, legal, and design team embarked on a total re-definition of the service plan from inpatient acute care to outpatient, episodic care,and full-service emergency care. The resulting product should equate to improved access to care, better facility design, and happier consumers within a presently under served community.  The completion of the CHNA will typically answer the questions required to meet the needs of the healthcare provider and suggest direction for area-wide affiliations that further enhance the overall project plan. Any partnerships must ensure that they clearly address how the facility’s programs may evolve over time, how services may be adapted to the needs of the local population,and how decision-makers can determine the best course of action for each situation.The CHNA is a thorough report that closely examines the health care needs of people living within a defined service area. The CHNA report will:

  • Provide an evaluation of the community service area being assessed;
  • Determine the health needs of the population (compare to other providers);
  • Administer community survey and capture input/feedback and comment;
  • Describe the current health facilities and other resources within the community;
  • Develop a comprehensive report including the process, analysis, findings, and recommendations for future program expansion;
  • Clarify ongoing strategies that may link to other providers; and
  • Define resource limitations and potential roadblocks to effective results.

The ability to staff, license, and operate an innovative program is determined by the planning team members and their leader, as well as their ability to structure the operational response to the plan. Staffing is a primary factor as well as the understanding of project’s licensure needs, economic feasibility, and overall program implementation for the market. The ability to adjust to the local situation, establish operational and partnership linkages, and determine the best fit of resource needs to services rendered are critical skills that each team member must possess.




by James G. Easter, FAAMA, MArch, Development Consultant and

Joseph J. Hylak-Reinholtz, JD, Attorney

This article originally appeared in HFR Perspectives on Health Healthforward Report Newsletter Vol. 8, #1

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