Building Design Supports New Ambulatory Care Delivery Models
The era of accountable care brings with it significant challenges for health systems and their ambulatory care facilities – the anticipated influx of newly insured patients, a demand for greater efficiency and leaner operations, the ongoing drive to achieve better patient outcomes and higher levels of patient and staff satisfaction, and the need to ensure patient safety and privacy. A new approach to ambulatory facility design can help health systems meet these challenges.
The University of Wisconsin (UW) Medical Foundation took such an approach when creating its UW Health Yahara Clinic in Monona, Wis. The foundation partnered with Kahler Slater, based in Milwaukee, to design an outpatient clinic that supports a lean and efficient operation ideal for staff collaboration and enhanced patient satisfaction.
The Vision
The UW Medical Foundation identified a need to serve the growing communities along the Yahara River near Madison, Wis. The organization desired a solution that would meet the challenges of providing quality ambulatory care and acknowledge concerns of safety, privacy and the ongoing drive for efficient care with better patient outcomes. The family medicine clinic needed to include imaging, lab and physical therapy services, as well as health education support spaces.
The UW Medical Foundation’s vision is patient-centered and quality-focused. The organization decided to adopt the patient-centered medical home model of care to improve clinical quality by optimizing an integrated care team, increasing patient engagement and offering a holistic approach to patient care.
Kahler Slater designed the ideal space arrangement to support the operational model. Key to achieving the desired results was locating Integrated Care Team (ICT) space as close as possible to the areas where care is delivered. A new space plan was developed that places offstage ICT space isolated from front-of-house patient amenity space and circulation.
When completely separating front-of-house and back-of-house in a clinic setting, the one place the two must overlap is in the exam rooms. The solution was to create double-sided exam rooms with a patient entry at the front and caregiver entry at the rear, allowing complete autonomy for both realms. Caregivers can collaborate within a fully integrated care team environment without concerns for privacy or interruptions, and patients are provided with a comfortable, hospitable environment away from the clinical environment with no overlap.
The operational model flow supports voluntary self-rooming, which incorporates technology to assist with wayfinding. This results in creating a convenient, no-wait option for those who choose to self-room and reduced wait times for all patients.
ICT Off-Stage Collaboration Space
One of the goals inherent in the ultimate design solution was to create an efficient workflow by drawing physicians out of private office environments and into integrated team environments where collaboration and face-to-face communication are encouraged. At the UW Health Yahara Clinic, the design strikes the necessary balance between integrating physicians into the care team areas and creating a private and secure environment so that patients’ cases can be discussed openly without confidentiality concerns.
By centralizing these private ICT spaces and surrounding them with exam rooms, communication remains centralized and not spread out across the facility, which greatly reduces travel distances. During post-occupancy research analysis, a footstep study showed that the clinical staff’s average walking distance from patient to support spaces was reduced by 83 percent.
Double-Sided Exam Rooms
Creating larger spaces for caregivers to interact with patients allows flexibility to provide a range of consultation environments. Rooms can be arranged as informal meeting spaces with soft furnishings, with an exam table for physical examinations, or grouped together to create larger rooms for educational group visits or group therapy.
Each exam room has double-sided access, allowing patients and caregivers to enter and exit without crossing paths. A simple switchboard at the central reception desk that turns on a series of three lights lets caregivers and staff know that either the patient is in the room waiting to be seen, the exam is finished and the room needs cleaning, or the room is clean and awaiting the next patient.
Reduced Waiting Room Size
Historically, outpatient facilities reserve two chairs in the waiting room per exam and procedure room, but more recent recommendations are for one to 1.5 chairs. At the UW Health Yahara Clinic, less than one chair per exam and procedure room was provided. Those chairs support the hospitality station for early arrivers, rather than being used by patients waiting for an available exam room. This area reduction almost entirely offsets the increase in circulation surrounding exam rooms to achieve the self-rooming and private ICT environment.
Empowering the Patient Through the Use of Technology
In addition to self-rooming for exams, patients can use a check-in kiosk integrated into the reception desk to announce their arrival for outpatient visit, diagnostic test, lab, mammography, X-ray and physical therapy appointments. Once checked in, patients proceed to the sub-wait areas or directly to their appointment. The kiosk empowers the patient by providing another option that speeds up check-in and reduces wait times. If a patient does not desire to use the kiosk, a friendly staff member is only a few feet away to provide personal assistance.
Setting the Benchmark
The UW Health Yahara Clinic aligns with the Marketing and Planning Leadership Council’s November 2010 Implications of Reform on Facility Design imperative, which proposes necessary steps to achieve true national health reform. The new proposed standards aim to improve cost of care, patient access, workflow efficiency and coordination across providers and settings.
A post-occupancy evaluation was completed one year after occupancy and revealed positive results. Improvement in scores for the UW Health Yahara Clinic show a range of 12 to 22 percentage points for general reputation, wayfinding and the environment − proof that the separation of public and private functions allows for a clarity of wayfinding and for well-crafted public space that creates the best experience for the patients and visitors. An overall 25 percent increase in patient satisfaction scores was a clear signifier that this separation allows the caregiver teams to focus on giving the quality care that the UW Medical Foundation is committed to providing.
In addition to the positive patient feedback received, caregivers overwhelmingly commented on the improved working environment, improved patient privacy, reduction in interruptions to nurses, improved efficiency with close proximity to exam rooms, and an appreciation for the natural light and views out to nature from the working environment.
The success of this operational model has elevated the UW Health Yahara Clinic to become a recognized benchmark facility for the delivery of ambulatory care.
An internationally registered, award-winning architect with 14 years of design experience, Eric Mayne, AIA, RIBA (emayne@kahlerslater.com) is a health care architect and project designer with Kahler Slater.
Founded in 1908, Kahler Slater more than 95 professionals and three offices in the United States and Singapore. Its mission is to partner with clients around the world to bring their visions to life through total experience design. The firm maintains an international specialty in planning and designing health care facilities, providing a comprehensive array of services including strategic master planning, architecture, interior design, research and graphic design.
Also contributing to this article were Theresa Soik, director of facilities and materials management, and Lori Hauschild, director of clinic operations, with the University of Wisconsin Medical Foundation.