Lessons from Clinic 20XX - Medical Construction and Design

Intermountain Healthcare Kaysville Creekside
Clinic, Kaysville, Utah, connects building to
site by incorporating walk paths and outdoor
seating area — creating a sense of place.
At right: Universal rooms in the clinic allow
examination/consultation to occur around
movable exam tables and flexible furniture for
patients, family and staff.
Lessons from
Clinic 20XX
Kaysville: HKS/ Jack E. Madsen III
BY PATRICK SCHULTZ
Healthcare is at a crossroads, shifting
significantly from inpatient to outpatient care. Given this change, how do
we design outpatient facilities, not for
a faceless future, but for a dynamic
present? Researchers recently set out
to find answers to better prepare for
the healthcare industry of tomorrow.
The result is a report by the Center
for Advanced Design Research and
Evaluation, Clinic 20XX, Designing
for an Ever-Changing Present, which
delves into the drivers of change, the
trends in response and principles for
clinical design. The findings of this
report are summarized here, along
with some additional case studies and
insights on how principles outlined in
this report have been implemented in
practice.
Key drivers
As the healthcare law has increased
access to healthcare, value-driven
healthcare and payment strategies
based on quality measurements are
moving the marketplace to lower
costs by keeping patients out of the
hospital. Expanding access through
ambulatory-based health management, diagnostics, treatment and
emergency services reduces highcost, hospital-based care. Patients are
living longer, but not healthier.
More age 65 cohort patients present at least one or more chronic disease conditions. Four generations occupy the workplace and drive demand
for greater access, better quality and
immediately available care. Providers
face increased demand, surpassing
supply of physicians. Team-based care
has emerged to support physicians.
The field of medicine benefits from
medical imaging detecting diseases
earlier with advanced and miniaturized diagnostics. Precision medicine
seeks to use patients’ genetic information to tailor individual treatment to
disease. Technology, such as electronic medical records, tracks patient
information and data accurately and
effectively.
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Medical Construction & Design Magazine © 2015
HOW TO DESIGN FOR AN EVER-CHANGING PRESENT
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ISSUE FOCUS
FACILITIES OF TOMORROW
Key trends
Physicians utilizing mobile technology
employ one or more mobile devices for
patient engagement. Care coordination has
more clinics adopting the team-care model
facilitated by open offices, team spaces
and on-stage/off-stage work areas with
integrated technology. Telemedicine —
from remote patient monitoring to virtual
doctor visits — puts the care team in front
of the patient, no matter where the patient
may be located, for improved patient care.
Ambulatory and home-based telemedicine
allows providers to lower costs by reducing
hospitalizations, subsequent readmissions
and even clinic visits.
Population health focuses on the overall
community by treating the chronically ill
and addressing the social determinants
of lifestyle, health and wellness. Patients
once routinely admitted to the hospital
now receive care in outpatient primary
care and ambulatory settings. Retail health
has increased the access to care by providing patient management for people with
chronic diseases, vaccinations, screenings
and medical care focused on patient convenience in lowest cost settings.
The report identifies two key space types,
common to any outpatient clinic: consult
spaces fostering meaningful, informed
interactions and work spaces supporting
vital patient and provider connection. In
interviews with healthcare leaders and nationwide polls with patients and physicians,
the researchers found patients prioritize
consultation and meaningful engagement
as the most important aspect of a visit. Case
studies show innovative models where
exam rooms are supplemented with consult/talking rooms and, in some cases, did
not have an exam table. While physicians
report high exam table utilization, it is not
clear if more conversations, rather than
examinations, occur on these tables.
The report suggests any space where a
patient interacts with staff can be deemed
a consult space. For example, registration
performed by a medical assistant can be
recognized as the first consult. Waiting
areas with education elements are a virtual
consult. The physician examination of the
patient is the principal consult. Specific education is the final consult. This approach
allows design to occur around meaningful
interactions.
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Key characteristics
The report identifies three key space
characteristics: flexibility, connectivity and
sense of place. Flexibility allows easy expansion/contraction with changing needs,
from revised plan configurations to wall
and furniture systems. Clinics must support
connectivity, acting as a “conduit” between
the cloud and the community. The clinic’s
digital footprint supports its physical footprint at all levels, from the site, to the care
team, to the broader community and with
regional and national systems.
The open-platform model of care versus
the physician-centric model, consists of
consult rooms, shared support, staff, team
collaboration and exam rooms (not necessarily geographically assigned) to increase
overall clinic utilization by allowing flex
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Children’s Hospital of Richmond at VCU, Richmond, Virginia, provides a full-service children’s
hospital with an outpatient pediatric center. At a
larger scale, the modular approach creates a
standardized clinic module, accommodating a
variety of services and can be readily adapted to
meet specialty needs.
An illustrated view of the on-stage patient pathway
and off-stage staff pathway. The pathways have
direct access into each patient exam room.
volumes among exam rooms not in use,
thereby reducing patient wait times and
increasing staff efficiency.
Finally, it is important to create a strong
sense of place — a destination. It should be
an experience that is clean, quiet, comfortable, connected and appealing across all
generations.
Medical Construction & Design Magazine © 2015
Key spaces
ISSUE FOCUS
FACILITIES OF TOMORROW
Innovation is occurring in the very heart of
clinics by separating and better organizing
the patient pathway to eliminate the bustle
of staff activity and enhance the care experience, and by organizing the staff pathway
to improve operational effectiveness.
The “on-stage” patient pathway consists
of access, registration, waiting and pause,
examination and consult, education, discharge and follow-up. The “off-stage” staff
pathway consists of scheduling, greeting
and triage, care coordination and lab work
and post-discharge care and monitoring.
The concierge station at Intermountain Healthcare
Kaysville Creekside Clinic. Space is shared with a
quiet “pause” area featuring daylight and views, with
an easy-to-access clinic module beyond.
Incorporating these trends to improve staff
efficiency and the care experience are critical to the planning and design response.
Enhancing the experience with
connected and flexible spaces
The Duke Health Primary Care Clinic prototype was developed for a 10-provider primary care clinic with urgent care, focused
on improving operational staff efficiency.
Paired with an urgent care clinic, the clinic
shares support services, including laboratory, general radiography and conference
room. Each primary care pod features nine
exam rooms, one consult room and one patient toilet, along with shared meds alcove,
point-of-care alcoves, physician dictation/
huddle areas and clinical work stations for
teaming between every three exam rooms.
Operationally, each pod supports three
physicians and a dedicated clinical support
station space for team care coordination.
The on-stage/off-stage concept allows
the public realm to be designed with a hospitality ambiance to reduce patient stress,
with the clinical staff work areas hidden
from public view. The physician pod is
a standardized module capable of being
combined into different arrangements for
different buildings throughout the system.
The 120-square-foot exam room area allows the majority of care and consults to
occur in the room. Other key aspects of
patient and staff pathways include:
>> Registration provides a touch point
for check-in to enable personal interaction, minimizing the need for paperwork.
Kiosks provide convenience for expedited
check-in to complement the face-to-face
registration and check-in.
>> Waiting rooms provide comfort and connectivity for waiting and add value through
education material directed at wellness
and informed decision-making.
>> Exam rooms are set up for meaningful
interaction between patient and provider,
with high-connectivity to information
access and the flexibility to incorporate
different needs.
>> Staff teaming work areas promote collaboration among physicians, case managers, medical assistants and digital connectivity to patient information, enabling
remote patient telehealth. Spaces are
acoustically quiet, calming and personal.
Greater staff collaboration results from
direct support and physical proximity.
Hoteling and touch-down stations accommodate variability in the number of care
team members.
Intermountain Healthcare Kaysville
Creekside Clinic in Utah provides residents cost-effective, high-quality healthcare in a clinic setting that is comfortable
and family friendly. At a smaller scale, the
13,025-square-foot clinic was designed to
support standardized care processes with
flexibility, adaptability and modular facility
expansion capability. The design encourages efficient patient flow and features onstage/off-stage room configuration within
traditional clinic area benchmarks. The use
of integrated communication systems, and
an innovative care team structure, allows
highly effective delivery of care and a positive patient experience.
Children’s Hospital of Richmond at
VCU, Richmond, Virginia, provides a fullservice children’s hospital with an outpatient pediatric center. At a larger scale, the
modular approach creates a standardized
clinic module, accommodating a variety of
pediatric services and can be readily adapted to specialty needs throughout the week.
4
The grouping of rooms can flex between
exam rooms and consult rooms, which allows physicians and patients to move from
one room type to the other — enabling
patient access to a range of care providers.
Sliding barn doors allow for easier access
and dual exam room entrances accommodate on-stage/off-stage flow.
The shift to outpatient care and a
changing regulatory environment, among
other factors, creates more questions than
answers. The expectation is the drivers and
trends will evolve every year. Responding
to these challenges requires an understanding of the key drivers, trends and
emerging principles. Ultimately, these
establish a framework for modularity
and flexibility. For more information on
CADRE’s Clinic 20XX report, visit cadreresearch.org/projects/clinic-20xx.
Patrick Schultz, AIA, EDAC, LEED AP, is vice
president and healthcare practice leader for HKS’
Mid-Atlantic region and an MCD board member. He
can be reached at [email protected].
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Intersection of patient
and staff pathways
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