Lucas: Welcome to Bridge the Gap podcast, the senior living podcast with Josh and Lucas on our special series dedicated to COVID-19. We have another thought leader on the program. I’m excited to welcome Stan Shelton. He’s the vice president organizational development health practice at HKS out of Dallas, Texas. Welcome to the program, Stan.
Stan: Thank you. Glad to be here.
Lucas: Well, we’re glad to have you on. You guys recently published a study and that made the news media about converting hotels into hospitals. We’d love to talk to you about the details of that study before we get started. Give us some background on what got your passion to the healthcare.
Stan: Yeah, so I’ve actually worked in healthcare for about 32 years. Had joined HKS late in 2019 and was actually a client of theirs before joining. So I worked at woman’s hospital in Baton Rouge for the last 30 years or so, and have done a number of different things there. But since 2005, I was responsible for their planning, development and construction that ultimately resulted in a complete change in the campus and a replacement hospital, about a $350 million project or so. And as part of that, we also got into the development of the campus as a mixed juice sort of campus. When I left there, we were about to break ground on the infrastructure for 150 or so single family homes. We had a commercial real estate section. We’re in negotiations with five or six restaurants. Just opened a freestanding birthing center on the campus and any minute now the child development center for about 200 kids will be completed on the campus.
And then 2018 we partnered with basis incorporated to open a charter school on the campus as well.
Lucas: Very interesting.
Stan: Yeah. Yeah. So my interest in joining healthcare, I started out of college working in manufacturing. And quite frankly, I said, if I’m going to work this hard, I want to do it in an organization that does more social good than just pure manufacturing. So I sought out healthcare and have really loved every minute of it. For I don’t know about 15 of the last 30 years that I was at woman’s hospital is also responsible for emergency and emergency response. So when COVID-19 happened and I met HKS at this point in time, then that experience just folded over into our HKS’s COVID response as well.
Lucas: So it sounds like, so how many authors were a study?
Stan: There were three authors. It was Jason Sharar, who is the international leader for the health practice at HKS. Jenny Evans, who is a registered nurse by original education, but she’s been with HQ, HKS for quite some time. And then myself for the primary authors. We had quite a number of collaborators, both inside and outside the firm on tackle issues.
Lucas: Okay. Now walk us through some of the main points of that study. You mentioned, I think the headline was Converting a Hotel into a Hospital in 10 Days.
Stan: Right. Yeah. So the first thing that we had to do when we well, first of all, what we would drove the study is ASHE, the American Society for Healthcare Engineers contacted us and said, Hey, can you help us kind of provide some resources for our member organizations in terms of how they could deal with the anticipated surge. We already had a number of teams within HKS that were working in or with clients to help them coordinate their surge efforts. And so we began to focus as a smaller group on, well, if we need to expand beyond the walls of the hospital proper, how can we do that? What are the facilities that are right for that, et cetera. So we looked at a handful of different kinds of buildings and facilities, and quickly a full service convention hotel popped up as a building type that has many of the same kinds of features and amenities that hospital has. So that was the first study that we used. And we used the same context really for all three of the studies that we’ve done. We’re just wrapping up a study on arenas and larger venues.
With that context and it sounds a little bit crude, but it starts out with first we understand that this is not going to be exactly a hospital. It can’t be from code compliance. Time will not allow the conversion of the facilities bringing in new air conditioning systems, rewiring et cetera. So not going to be hospital. Speed is of the essence and with speed also the availability of resources particularly construction resources and equipment.
And then I guess the final piece of context that we had is what we are studying here, will it be better than it can’t? You know, you’ve heard some field hospitals that have popped up and many hospitals were initially doing triage in their parking lots and tents and that sort of thing. And so is it better than a tent? Kind of became one of our frames of reference. So, we quickly jumped on the idea of a full service convention hotel because of its similarity with hospitals. And again, we focus on patient care. We’re not saying that we’re turning these facilities into the hospitals. And then the second thing that we had to consider as well, what are the kinds of patients that are going to be here? We’ve all heard and read about the shortage of intensive care rooms, the shortage of ventilation equipment, et cetera. But we looked at all that we looked at also, you know, this context, this time frame context that we had created for ourselves.
And our concept was that in all of the conversions that we’ve been involved in those are for low acuity patients and those low acuity patients could be people who have just recently been diagnosed with COVID-19 that don’t have any other comorbidities or they’re not sick in any other way. People that have been in hospitals being cared for and for COVID 19, but are now ready to go into a step down level of care or people who are ready to be discharged from hospital but don’t have anywhere else to go because of their family circumstances, etc. So very low acuity patients could go in some of these alternative care facilities.
Josh: This is super fascinating. Stan and there’s so much that we could just literally talk on a ton of topics here, but as a developer, as an operator, my mind takes me to how much red tape is typically involved in any kind of development project or a renovation project. And it’s very interesting to me that the type of product you guys have put together and how quickly you have put it together one has been allowed to take place and how many people have worked together to make it happen in a quick amount of time. Can you talk about that process of collaboration?
Stan: Well, I mean, I can talk about the collaboration of the concept studies that we did, which is one thing, but I’m not sure that’s exactly where you’re headed. We are still finding out how much red tape there is in this kind of conversion and how to overcome that. And as you might imagine as a developer or as just a thinking person the first piece of that red tape really involves who’s going to pay for this. If it’s a hotel who’s going to pay the hotel for it’s lost revenue during this period of time, the actual conversion and then rehabilitating the hotel after the fact into a state that it can be used as a hotel again.
And we’re finding our way through that one project. We at HKS are involved in one conversion right now of a convention center that will ultimately accommodate 1100 beds in Michigan. And it’s a complicated operation because of where the money comes from, who makes the decisions, the partnerships that are involved, et cetera. We’re involved in about four or five other opportunities that are in various stages of negotiation and an agreement. So, the complication of red tape starts with funding and then it goes to the healthcare entity or the entity in each state that’s responsible for regulating healthcare the department of health and hospitals or whatever it’s called in that particular state.
Now what we have seen in the work that we’ve done with clients and in preparing their internal organizations for surge as well as the conversions that we’re talking about, is that we have seen those state departments of health and hospitals and be very flexible in terms of the reasonableness of what they’re requiring. They just like we figured out, they figured out you can’t turn a stadium into a hospital quickly and abide by, you know, everything. So, that red tape has been relatively easy to navigate and they are also very motivated based on the mission of their organization and their dedication to the citizens of their particular state. So that’s helpful.
One of the challenges that we have here, and I’ll try not to get on a soap box about this that really goes to this red tape issue is we are not really very well coordinated across the country and across municipalities and across states to manage this sort of an event. I don’t know if that makes sense to your, you’ve had some of those experiences yourself. And that’s one of the things that we hope to learn from through this COVID-19 experience is how do we do a better job of coordinating not just the resources but the decision making across as different tiers of government so that we can move faster in this sort of circumstance.
And to the corps of engineers, yesterday we got a call yesterday of about 300 people, mix of hotel operators, some representatives of the corps of engineers, some healthcare executives, construction industry folks, et cetera, just to talk about this hotel conversion and hopefully find some answers to some of the questions. And one of the representatives of the course said that they had evaluated 800 facilities, about 820 facilities so far and they’ve got 17 deals done.
Josh: It’s fascinating. So one of the things I want to interject here, and you’re hitting some of the, some of the nail on the head here of what I was trying to get to, because you brought up a lot of interesting things.
One of the things we’ve been focusing on on our podcast special COVID series is what are some of the lessons we are learning as we are being pushed out of our comfort zones in a response to this that will not only be applicable for other, you know, God forbid, similar situations that may come, but also to the existing challenges that our industry has already faced. You know, and I’ll use a parallel example. It’s not necessarily as an emergency as a pandemic, but prior, even three months ago, what everybody’s talking about at every conference and every industry event is this tsunami of people that are coming that need quality care and how do you make it more affordable? And some of what you know, I firmly believe in what I think a lot of people do is one of the reasons that, that a big challenge we have is being creative is red tape, being all the red tape and working it through the different bureaucratic systems. And it’s been very interesting. I think the way you phrased it is when people’s mission, the mission of multiple people across the industries are aligned around a central mission. It’s amazing what we can accomplish in a very short amount of time, right?
Stan: Yeah. So, the interesting thing about this about the COVID-19 circumstance in which we all find ourselves is that it is for a period of time, probably a relatively brief period of time, but it is going to create for us the opportunity to learn how to do better. Not just for next time, but going forward on everything that we do. So this, this event has softened all of our resistance. We’re all living in a virtual world now. The physicians and healthcare organizations that had resisted telemedicine for whatever reason, you’re doing it full time. They’re finding it’s not so bad, et cetera, so that our resistance is softening and we’ve got a window of opportunity as a society, as an entity, a as a company to understand what we can learn from this COVID event and to make changes and do things differently going forward before that resistance phrases back to where it normally resides and what we need in order to do that again, as a country, as an industry, as a firm is leadership to do that.
HKS has really a handful of efforts right now where we are trying not very comprehensively to understand what we can learn as a firm from this COVID event that we can carry forward into the healthcare, hospitality, commercial education center designs that we do so that those facilities are better prepared to withstand this kind of event, but also they’re more flexible in order to be adaptable for this kind of event.
At the same time, we’re trying to understand all that’s possible for us to learn about how we work together going forward. I mean, we’re doing really amazing things on, I think it was March the 16th or so, we went completely virtual at HKS. Architecture is a visual endeavor and for us at HKS, it’s a very participative kind of thing. We are used to working with large user groups in person, drawing on paper, observing their operations and learning from that. And we’ve been almost completely virtual since March 16.
Josh: So impressive.
Stan: Yeah. Yeah. And so what this tells us is we can work virtually and we can work effectively virtually. And what it might mean for us is that we travel less, which makes us more efficient, and costs the client less money because I don’t have to reimburse them travel. It might mean that we can meet more frequently in a participative way then if we had to bring six architects to meet with 20 people that are in a department at a hospital. We could call them up on a Tuesday afternoon and nobody has to go anywhere except for in front of their computer.
And we’re also understanding as a firm that some of the practices that we have adapted to during this virtual COVID-19 event are really very effective. Our teams are actually meeting virtually more frequently than they were when they were face to face. Because when you’re face to face, you have a sense that, well, I don’t really need that. You know, Josh is always there. I’ll just go chat with him, et cetera. Sure, he understands what I want him to do in the virtual world. We’re not taking any of that for granted. And so the teams are actually getting closer now than they were when they were sitting in the same room in many respects. So it’s been a really interesting process. But the key for us and for the industry is how do we learn from that. You can see from the studies that we’ve done that, you know, HKS, we produce those things not to get work out of that, but we thought we had some ideas that might be worth sharing to other people and we will continue that process related to both how design reps should change going forward and how work processes can change going forward as well.
Josh: Well, I think you’re really onto something there. And I think every organization with the self inflection, self reflection that people are doing, and I think we’re going to come out stronger for this. You know, even from a regulatory standpoint, I sit on a regulatory board here in the state of Tennessee and I’m certainly not speaking on behalf of that, but what we have seen is even the way that that board functions and typically a lot of the red tape that is there for creativity for developments, for construction, for renovation by one stroke of the pen and one meeting has been eliminated to allow for groups to come together to do something in a tough and difficult time. And I think there’s some lessons that everyone can learn from this that we’re going to be better for it as we come out on the other side.
Stan: Yeah. I have a really tiny regulatory issue with in health care. For some time now, it’s not been compliant for us to have a patient room that can be with a flip a switch or a valve or whatever can be either a positively pressured room or a negatively pressured room. So the code right now says it has to be one or the other. And the rationale for that code is, well a human error could turn a, which should be negatively pressured room to contain a virus. It could turn it into a positive, positively pressured room and spread that, that virus throughout the unit. Well with this COVID-19 thing, the need for us to really adapt rooms from one use to another, I suspect that that, that guideline code, regulation, et cetera is going to at least be talked about. And our hope is that we’re able to change it and we’ll just have to be creative to figure out how to overcome the potential for human error. And there are dozens of those kind of things. I think that will be a beneficial thing that’ll come out of this COVID-19.
Josh: Stan, I think me and you could geek out for a long time.
Stan: I’m sorry about that.
Josh: No, seriously. I really do. And I think this will hopefully what we hope through this COVID series and talking to thought leaders like yourself, again, keep this conversation going. It keeps creativity. It keeps people thinking positively about, yeah, while we’re in the weeds, while we’re dealing with this, while we’re finding solutions and beating this COVID, that what we’re learning through the process is going to make us better on the back end of this thing. And so Lucas and I really appreciate the time that you’ve taken out of your busy day, away from HKS, to spend a little bit of time with us.
Stan: Yeah. Yeah. Anything else I can share with you, you know any questions? One of the things that is kind of in the back of my mind about this and it goes to some of those regulation issues and it goes to how we work, et cetera. And what I think I’ll personally take out of this is anytime I’m tempted to quickly say no, just something that’s, that should be an inspiration to me to dig in a little harder to understand the why’s or the why not about it. And really to try to be more creative and finding a solution.
Josh:I love that. That’s great, that’s a great thought for every one of our listeners and those that are watching today.
Lucas: Sure. Stan, thank you so much. We may ping you again another time and maybe we could go into the MEP discussion.
Stan: Well, I’ll need to bring some support for that, but yeah, be happy to.
Lucas: Sure, sure. Well, thank you again. I know our listeners are going to want to know more information. Where can they find the study?
Stan: They can get it at our website, HKSinc.com. And I can send you guys a link too if you, if that’d be helpful then you can post that if that’s possible. Everything that we’ve put out is available on HKSinc.com.
Lucas: Okay. Stan Shelton, thank you so much for being on the program today. Thank you for y’alls commitment and to solving these challenging problems and challenging times. Thank you to our listeners right now that are tuning in. Many of them operators that are on the front lines of caring for older adults right now and we hope that they are encouraged and, and if and if they have any questions, comments, or ideas, please contact firstname.lastname@example.org and we’ll make sure that we connect to HKS in the show notes. We hope everybody has a wonderful day. We’re thinking of you, we’re praying for you, we believe in you and thanks for listening to Bridge the Gap.
For more information about the podcast and Coronavirus resources, visit BTGvoice.com