Can “Coopetition” Answer the Healthcare Challenge? 

In May, two large health systems covering large swaths of rural Wisconsin announced talks for a proposed merger. Far from unique, the announcement fell in line with similar announcements across the nation of organizations and systems exploring options to make care more viable for the residents they serve.

One month later, Jamestown Regional Medical Center in rural Tennessee was shuttered one year after its purchase by a Florida group. The hospital’s closure came after the Center for Medicare and Medicaid Services revoked its billing privileges for, among other items, a backlog of unpaid bills. Far from unique, the closure comes at a time when more than 670 critical access hospitals are in financial distress, according to the National Rural Health Association.

(Jamestown Regional Medical Center recently was recommended for CMS reinstatement.)

To say that the forces buffeting hospitals and healthcare organizations are reshaping the industry is an understatement. Changing demographics and an aging populace, especially in small and rural communities; lack of available providers and specialists; outdated facilities unable to accommodate new care models and technological advances; and payment models moving away from fee for services to quality outcomes all create a storm of challenges forcing tough decisions on care providers.

From name changes to broaden an organization’s geographic reach to mergers, acquisitions, and paring services, health practices large and small are rethinking how they define themselves. The decisions have far-reaching effects, especially in smaller communities where the hospital is intrinsically tied to the identity of the community.

The forces driving organizational changes have put many healthcare practices on the defense to ensure future vitality.

Defensive strategies may not be as foreign to healthcare organizations as thought. Such approaches as provider service agreements, co-management agreements, outsourcing and various outreach programs have been in place for years, strategies that help broaden service options for patients without necessitating higher recruitment costs or operational expenses. Additionally, organizations hoping to improve their financial standing through greater buying power have pursued mergers and acquisitions hoping to leverage the strength of a larger entity.

The struggle most are facing today is how to strategize such tactics while maintaining identity or protecting market presence. What this looks like varies greatly, from rural health organizations who want to maintain their independence while offering their residents as much as possible and be financially stable to large urban systems who compete with themselves for populations while trying to ensure economies of scale with resources. In either situation, the objective is the same: to survive and thrive.

This Maslow need to survive opens up nontraditional approaches other than ones designed to preserve and protect through their own means. A term which may be rather new in healthcare is “coopetition.” As opposing as the two words are that form it, the net gain in cooperation with those who might be thought as competition can be exponentially better for both.

Again, this has been seen through various approaches to systemize healthcare organizations, establish provider service agreements, or create co-management agreements. While not truly defined in absolute terms, the idea of coopetition is to open struggling organizations to strategies that help strike the balance between patient interests, community identity, and financial viability.

How organizations align strategies to survive in the marketplace requires rethinking and reshaping the where, when, and by whom services will be offered. More than seeking the best solution, organizations need to start by asking the right questions. From the answers will rise that appropriate strategy, whether it’s becoming part of a system, creating different venture relationships, specializing in services at which to excel, or making the harder decisions to stop doing some things and cooperate with competition.

The fact is there is no ultimate saving strategy. As recent studies have found, even the idea of leveraging the buying power of a large health system can fall short of expectations for costs control and enhancements. However, if we can see the disruptive forces in healthcare as opportunities to seize, the strategies can become less defensive and more assertive.

Throughout the United States, there are 2,300 hospitals located in rural areas, the best of which operate at only 2 percent margins and most operating at less than 1 percent or in the red. Change is going to occur. It’s imperative that however we respond to change, we avoid making communities unique in lacking access to care.

On Oct. 10, BWBR is hosting a symposium on The Future of Health Systems with Stuart Clark, managing director of the Advisory Board Company, an independent subsidiary of Optum. The live event in our Saint Paul office is free to attend and will be simulcast to attendees in our Madison and Omaha offices. 

Hennepin Healthcare’s Clinic & Specialty Center to Receive USGBC Award

Hennepin Healthcare’s Clinic and Specialty Center, a certified LEED®-Gold ambulatory care facility, will be honored with a Leadership Award of Merit by the Minnesota chapter of U.S. Green Building Council at its annual meeting in November.

The recognition follows a string of accolades for the 384,000-square foot care center, including Healthcare Award of Merit from Engineering-News Record in 2018 and being named to the 2018 Healthcare Honor Roll by Minnesota Physician as well as 2018 Top Projects by Finance and Commerce.

The Clinic & Specialty Center opened in spring 2018 to wide acclaim for its attention to its urban location and neighborhood surroundings, both contributors to its LEED® certification. The site is a brownfield redevelopment that incorporated the residential neighbors to the south in both design and amenities, including open space and a pocket park that exceeded city requirements as well as underground parking and stormwater retention system to improve land use, reduce run-off, and avoid surface parking.

Plant selections and more efficient irrigation methods around the facility reduce water use by more than 50 percent compared to traditional landscaped sites.

Inside, the use of low VOC materials and a building flush-out before occupancy helped create a healthy indoor environment. Walk-off mats at entrances control contaminants entering the facility, and Hennepin Healthcare also incorporated policies to minimize waste and optimize pest management.

In addition to its healthy design elements, energy efficiency strategies for the ambulatory center reduced the estimated energy use by more than 21 percent compared to a LEED® baseline building.

Hennepin Healthcare’s Clinic & Specialty Center consolidated 26 primary and specialty clinics spread across nine building into the six-story facility. It houses primary and specialty care clinics, a dental clinic with 26 operatories, physical and occupational therapy programs, and a same day surgery center with seven operating rooms and four GI/endoscopy rooms. The clinic is also home to a comprehensive cancer center with radiation therapy, an outpatient imaging center, women’s imaging, and skyway and tunnel connections to the rest of the campus.

Marking the biggest expansion in the history of Minneapolis/Saint Paul’s largest teaching hospital – Hennepin County Medical Center – the Clinic & Specialty Center is the first phase of a master campus plan that reorganizes the care it offers to make it more accessible and centralized for the thousands of patients it serves from across the region.

BWBR Supports Students in Global Climate Strike

Tomorrow, headlines across the world will document a massive movement designed to grab the world’s attention to the global climate crisis. With events in Omaha, Madison, Saint Paul and around the world, the Global Climate Strike is galvanizing youth to bring attention to the crisis climate change is causing and challenge political leaders to take action.

As designers of facilities that have a direct impact on our planet’s resources, we would be abdicating our leadership if we did not take a stand to show our support for this movement.

Friday, our website will go green for 24 hours as a show of solidarity with the students participating in the marches. Consider it a “digital strike.” Deservedly, the students should have the spotlight on this historic day. By using our digital platform to show support for student movement and joining in on the movement’s registration page, we are both raising the issue as a topic of conversation with building owners and designers while allowing the students to have their platform and find their voices in this cause.

We know that, collectively with our engineering consultants and building owners, we could be doing more to improve the performance of the spaces we design. We also know, working upstream on the creation of these spaces, we have a role as designers to be leaders and advocate for a better and more responsible built environment.

As Jesse and Sara wrote recently, this is more than an environmental issue. It is an equity issue, because communities that can least afford the effects brought by climate change will bear some of the greatest impacts, whether that’s in rural areas whose economies will be transformed through climate change or in urban areas where higher energy and food costs will disproportionately impact communities already struggling financially.

When we signed the 2030 Commitment, it was more than a cursory act. It was a commitment to be leaders on the issues of energy and climate. It was also a commitment to act in the interests of everyone who will come after us. This important action the students are taking should be recognized and we’re proud to support them in raising the issue of climate change and action to combat it now.

Using Climate Activism to Design Better Buildings and a Better Future

“The time for incremental change is over. The urgency for change is upon us.”

When Minnesota Gov. Tim Walz made this announcement at the recent Climate Reality Leadership Corps training in Minneapolis, the words swept through the arena, more like a tailwind than a headwind. On an August weekend in a summer that has been filled with stories of record breaking wet Midwestern weather, heat in Alaska and Europe, drought-driven wildfires in Siberia, sunlit floods in Miami, and accelerated deforestation in the Amazon, event-goers readily supported the need for urgency.

We, too, are firsthand witnesses turned activists. Supported by our coworkers, families, and communities, our attendance at the Climate Reality Project training gave us the tools to ask the right questions, take the right actions, and ultimately help change the world.

Founded by Nobel Laureate and former Vice President, Al Gore, the Climate Reality Project is a non-profit organization dedicated to spreading information about and solutions to the Climate Crisis.  Currently there are over 20,000 Climate Reality Leaders in over 170 countries.

Our fellow Climate Reality Leaders at the Minneapolis training included approximately 1,200 people from 46 states and 30 different countries, representing a cross-section of industries, businesses, and demographics. The people donating one of their summer weekends to attend this training had already demonstrated their interest in the effects of climate change. However, the training’s overarching energy went one step further, galvanizing action rather than merely discussions about solutions.

What does it take to get stakeholders to envision something different?

Local, regional, and global conversations on climate can vary greatly, often muddied by misinformation and polarized political views. The daunting size and nature (pun intended) of the problem can paralyze many as they move to action. The data and science of climatology is staggering. Watching a live version of An Inconvenient Truth given by Al Gore himself is overwhelming.

One fact is clear, though: climate change doesn’t care about politics or international borders. Those most affected — minority and poor communities — will be the least able to adapt. Climate change is a social justice and equity issue as much as it is an environmental issue.

As professionals working in the A/E/C sector, we are astutely aware of the impact our designs have on climate. According to the U.S. Energy Information Administration, residential and commercial buildings account for 40 percent of all domestic energy consumption and greenhouse gas emissions. The International Energy Agency notes that as access to energy improves for developing countries and, subsequently, building square footage grows, global building energy consumption is predicted to increase 3 percent annually.

What if we had the knowledge, power, and resources to create more efficient buildings?

The good news for building owners and designers is that the knowledge exists, even if it’s not completely perfect. Solutions exist, even if they are evolving. And the power exists, even if not in the global or systemic sense that we often associate with power.

Energy efficiency is one of the best tools we have to reach cleaner energy goals, a key imperative in the solutions for the climate crisis. As signatories to the Architecture 2030 Challenge, we’ve committed to designing buildings that are carbon neutral by 2030. This can be met through innovative sustainable design strategies, generating on-site renewable energy, and/or purchasing up to 20 percent of energy from off-site renewable resources.

As building designers and advocates for our clients’ resources, we strive to understand the day-to-day business challenges and issues that are very real to stakeholders and connect them to the larger issue of the climate crisis. With building owners, we can flex our power and re-shape our thinking of near-term and long-term solutions for building design.

The Climate Reality Leadership Corps training also encouraged discussions around the influence of a technology revolution and the culture of immediacy on climate change. Both impair our ability to see and evaluate the short- and long-term impacts of our actions. However, we can change the narrative, a point driven home by Climate Generation: A Will Steger Legacy. Instead of finding ourselves waiting for the ultimate solutions, we can put together seemingly unrelated concepts into something new — connecting the analytical and logical thought processes with the complementary emotional and creative approaches.

As Dr. Henry Pollack noted, by enlarging the conversation, we see better results. Big and small voices have made tremendous progress.

Climate change forces us to face the challenge of choosing one of two potential futures: one in which we accept the path we are on with tremendous forthcoming destruction (increased extreme weather events, food and water scarcity, population displacement, aging and undersized infrastructure for climate related events, etc.) or the path where we work together to make the necessary changes and create a better future for all.

Building owners, architects, engineers, designers, energy producers, contractors, product manufacturers; we all have voices to raise in the effort to find solutions to climate change. Individually, the voices can be lost in the dissonance of the discussion, whereas together, we can create a chorus of change, even if that change seems to be a trickle on a local level. Al Gore’s words are ones to keep in mind as we face our choices:

“The trickle of change becomes a flood.”

Sara Goenner Curlee, AIA, LEED AP is a Project Architect and Jesse Turck, AIA, LEED AP is a Project Manager, both champions for BWBR’s sustainability efforts and Climate Reality Project Leaders. If you, your organization, or someone you know, would like to learn more about climate change or how to make your building more efficient, please contact and

Healing Learning Environment Supports Student Self-Regulation

Karner Blue Education Center started with a clean slate and an aim to design a school unlike traditional elementary schools. Karner Blue provides education for students with autism, emotional and behavioral disorders, and cognitive disabilities. A “typical” elementary school would not support the success of Karner Blue’s students and staff. Design elements both big and small were thoughtfully considered to best serve the school’s population, reducing distractions, minimizing common sources of anxiety, increasing safety, and promoting tranquility.

In partnership with the University of Minnesota’s School of Architecture Consortium for Research Practices, BWBR investigated the ways in which the design of this education center impacts the unique student population. The research focused on studying how the physical environment and features aid students in the process of self-regulation and de-escalation when they are experiencing moments of emotional and behavioral distress.