The COVID-19 pandemic and broader recognition of structural racism over the past several years put a spotlight on health disparities and contributed to the increasing prioritization of health inequity and its root causes.

Though these disparities are far from new, health inequities currently cost the U.S. health system approximately $320 billion annually and could balloon up to over $1 trillion in the next 15 years if left unaddressed. At the very root of health care spending is health inequity, and in the larger context of cost-cutting and cash conservation, making health care more accessible and equitable has become both a moral—and economic—imperative.

There are several interpretations of the term, but in its broadest sense, health inequity refers to systematic differences in health status and outcomes of different population groups. Ongoing efforts to reduce these disparities—in the form of cultural competency training, community outreach, decreased bias, and population health initiatives—have largely failed to yield the aspirational outcomes partially because these approaches tend towards a one-size fits all model, categorizing people into common disease states but not their individual experiences with the disease. A far more personalized, proactive, precise, and predictive approach is required.

Enter Techquity, one of the key themes of the ViVE 2023 Conference and defined as the intentional design and deployment of technology both to advance health equity, and to avoid deepening existing systemic inequities and health disparities.

For many projects, digital and IT investment has typically been ad hoc and add-on to the capital project. However, we are now seeing that digital initiatives can and will increasingly alter how providers can close gaps in access, quality and affordability of care in conjunction with the physical build. Capital projects need an accompanying digital strategy and a clear, shared vision for scaling and extending reach to the most disenfranchised populations. Working alongside the designers and builders must be a team that will translate the impact of digital adoption to increased healthcare access and improved health outcomes and how these factors, in turn, will change clinical operations, the space program, and built environment needs.

• The foundation begins with data. Much the same way that a capital project is incepted by understanding the epidemiology of the patient population and their service utilization needs, digital projects should collect and track data that is representative of the concerns and needs of populations facing health inequities.
• The digital and built environments in tandem should aim to create a bespoke experience, analogous to personalized medicine, tailoring healthcare delivery to individual preferences, environment, and lifestyle, thereby allowing for more effective treatment.
• If data is at the heart of this capability, AI will be the mechanism that processes the data and produces insights that generate the tailored care experience of the future. However, the insights gleaned from the data analyzed by AI must be designed, developed, and implemented with an emphasis on equity to prevent further exacerbation of existing health- and technology-driven disparities.

Understanding the cultural fabric and composition of the health system is crucial to defining Techquity in terms that resonate within the organization. Systemic level transformation happens only when alignment on the challenge and commitment to breaking down barriers that inhibit progress are addressed through collaboration, transparency and inclusivity.

Healthcare construction projects are often the catalysts that drive innovation in care models, clinical workflows and the technology necessary to support them. Success is achieved through the work of multi-disciplinary collaboration between project team members, departments, clinical and administrative staff, as well as patients and families. Establishing dialogue and communication channels that provide transparency fosters inclusive decision-making that benefits all.

The benefits of unifying these diverse groups of people are immeasurable and can lead to incredible solutions and outcomes. For instance, working within a collaborative unit that fosters diversity and invites perspectives from the entire community encourages a sense of ownership and interaction amongst thought leaders who typically do not collaborate on similar initiatives. A good example is the patient arrival scenario, where not everyone arrives the same way (e.g. car vs public transit). When Architects, Patient Experience, Patient Registration, Digital Innovation, Technology Infrastructure, Parking, Valet and Volunteer Services come together with a unified strategy and tactical plan to execute, the resulting arrival process is intuitive and efficient.

We can attribute many elements of project success to close-quarters collaboration amongst multidisciplinary teams. While the stakeholders of the built environment are mostly obvious to design and construction firms, the stakeholders of the digital environment are not as obvious. Digital technology is a thread that is woven throughout the organization, uniting all departments and caregivers, administrators and support staff. New roles for digital, innovation and experience leaders are popping up in health systems across the country. Each of these leaders has initiatives, insights and funding.

The built/digital environment can no longer treat these as standalone, unrelated initiatives, processes and investments. Without intentional design and deployment of technology—both to advance health equity and to avoid deepening existing systemic inequities and health disparities—we put ourselves at risk of creating more disparities in care and outcomes within the four walls and beyond. To further complicate the matter, the roadmap to a hybrid environment includes blending the built with the digital.

Planning a built/digital environment requires decision-making groups to collaborate even earlier in the process than ever before. Being deliberate with our inclusion of contributors, both internal and external, to the project is vital to the collaborative process. Particular attention should be given to leaders who are guiding initiatives that focus on underserved populations. Additionally, the inclusion of technology vendors and incubators led by minority and underserved visionaries provide often overlooked insights for solutions that truly enhance the care experience while lessening systematic differences in health status and outcomes.

When considering how these capital projects will be funded, too often we do not fully explore other potentially intersecting initiatives. This is notably true with regards to facilities construction, patient experience, and digital transformation. Each represents a significant allocation of capital expenditure and collectively, have the opportunity to drive equitable organizational transformation.

It’s highly probable that any health system planning a new facility will have multiple teams with defined initiatives focused on creating the optimal patient experience. Architects will focus on arrival and public amenities, patient/consumer experience (CX) leaders will focus on consumer interests and expectations while digital/innovation leaders will focus on creative technology solutions. However, it’s just as probable that each of these groups is planning the optimal patient experience irrespective of the other. Too often these types of planning efforts are conducted in silos, ignoring opportunities to align project goals/objectives, schedule and budget. Separately, these initiatives make incremental change. Without inclusivity and collaboration, this change could further widen the gap in health status and outcomes for marginalized patients. However, when aggregated, these initiatives have the potential to create a more personalized, proactive, precise and predictive approach to patient care. Resulting in meeting patients where they are, in the channel that best suits their needs.

As stewards of the hospital’s resources, the Architecture, Engineering and Construction community must condition ourselves to ask about initiatives that are complementary to our own projects. Embracing the uniqueness of cross-pollination with external initiatives is prudent to ensure a comprehensive delivery of high-priority projects that meet and exceed the health system’s expectations. In doing so, we can promote improved health outcomes and create long-term enterprise value. Ultimately, we will find that enabling collaboration, transparency and inclusivity is not only the right thing to do, but it also makes sound business sense.

Authors: Carl Fleming, Supina Mapon

Photos: Ground Picture/shutterstock.com, fizkes/shutterstock.com, Hryshchyshen Serhii/shutterstock.com