By Roxanne Squires
MINNEAPOLIS — Designing for the patient experience in hospitals is a frequent topic of discussion in the industry, but what about designing for community clinics?
Minneapolis-based Associate Vice President and Senior Medical Planner at HGA, Nancy Doyle, has 25 years of experience directing programming and medical planning for a range of healthcare projects, from national and international academic medical centers to community clinics. She holds expertise in directing programming, medical planning, Lean design, Evidence-Based Design and sustainable strategies. She also works with healthcare systems, physician groups and other stakeholders to translate health system goals into planning strategies that improve operational effectiveness, patient satisfaction and clinical outcomes. HC+O spoke with Doyle to discuss the variances, challenges and strategies in designing for the patient experience in community clinics.
Q: What are the specific patient-centric design elements and strategies used in community clinics? How do they help improve the patient experience?
Doyle: Community Clinics are generally a highly visible and integral part of that locale. It’s a symbol of the well-being of the community and often a gathering point in the neighborhood. Anything we can do as designers to gather input from the neighborhood, family and patient advocate groups helps to strengthen the bond between the healthcare facility and the community. Simple gestures such as purposefully incorporating a hitching post in an Amish community and signage in multiple languages will go a long way in fostering community and improved patient experience.
Q: How does designing for patient experience in community clinics differ from larger hospitals?
Doyle: We find that many of these clinics want to use their facilities for community activities after-hours. We’ve seen yoga classes, adult education, farmers markets, community meetings and cooking classes in the café. One clinic we designed will be used as a food shelf for the local community. It’s important to understand the needs of the community this facility serves. For example, in Long Prairie, Minn.,, we participated in a community engagement night about the facility. After a short presentation of the project, the mock-up rooms were open to the public. Armed with post-it notes and pens, community members engaged with healthcare staff and designers in the rooms, and later left comments regarding the room design. The team addressed way-finding and privacy concerns in the design, using large graphics of local photography for wayfinding and an on-stage/off-stage clinic design for privacy.
Q: What are the challenges in designing for the patient experience in community clinics?
Doyle: Smaller clinics have a strong fiscal responsibility to the community. Community members want to know that their tax and donor dollars are being used responsibly. Balancing the budget and patient experience is often a challenge in smaller clinics. For this reason, developing a right-sized program at the beginning of the project is critical. Any resources saved by not over-building can go toward patient amenities. During our 2P Lean events, we pull clinic volumes from patient records to analyze room utilization by session and provider. We collect data by the hour on waiting room use. When possible, we shadow clinicians to understand the movement and collaboration within the clinic. We have the medical staff record patient time in the exam room and average wait times. With this information, and understanding the desired exam room utilization, we brainstorm with clinicians and staff strategies to improve utilization and reduce the overall building area. Strategies we have used include leveling the weekly load, reducing room-to-provider ratio, flexing exam rooms between specialties and reducing the tact time in clinic.
Another challenge we face is the struggle to ensure privacy in an arena where everyone knows each other. In a larger clinic setting, patients are anonymous as they travel through the system. They don’t worry about bumping into their neighbors at the check-out desk. It’s a different story in a community clinic. Smaller groupings in waiting areas and the opportunity to choose where to sit are critical. The ability to make a choice gives the patient control over their situation: choosing whether to watch television, quietly read or work on their laptop gives the patients a sense that this visit is about them. Smaller waiting areas can also mitigate noise with sound-absorbing materials.
Q: What technological or electronic systems are integrated into community clinics and how are they geared toward the patient experience?
Doyle: Some of the new technologies we are seeing such as tracking patients through the clinic process with RFID badges, or checking them in on a kiosk, help maintain patient privacy and move a patient through the system quickly. With the help of an RFID locator, medical assistants can find patients in a sub-divided waiting room without announcing their name to the entire room. There is a strong push toward greater pre-registration and the use of kiosks in both small and large clinics, making the check-in process much simpler and quicker with less information being exchanged at the desk.
Presently, self-rooming is a concept we are seeing more often with our clients on the coasts than in the Midwest, but even those who don’t choose to implement self-rooming initially want to ensure the design will allow it in the future. The next generation expects the convenience of swiping their health card, getting a visit itinerary and moving through the process on their own.
Q: What sustainable strategies are implemented when designing for community clinics and how are they beneficial?
Doyle: Smaller clinics are sometimes subject to higher fluctuations in daily patient volumes and vulnerable to provider changes. If the one OB provider leaves, it may mean the entire program has been eliminated. Clinic rooms need to be flexible and adaptable to remain viable. That means shared workspaces, universal exam rooms and clinic modules that can flex from one specialty to another throughout the day or week. It is often more of a mindset change for the healthcare staff than a physical solution. Facilities can’t afford to dedicate exam room to a provider that may not be in clinic a full 10 sessions. At Unity Point Wellness Center, the center work core supports 12 exam rooms that can be used by various medical and mid-level providers throughout the day and week.