2TEXAS CHILDREN’S HOSPITAL

TCH Conversion

$6.6M – Initial Construction Budget (10% Contingency Included)$6.6M – Actual Construction Budget

$13 M – Overall Approved Project Budget$12.6M – Actual Total Commitment To Project

Building Relationships with Community – Metro, Local Council

Managing non-TCH tenants (Dental) – infrastructure heavy & delayed opening timing

Computer Simulation

Overview Of Simulation Modeling

ARRIVAL AT MEDICAL HOME

PT TO SUB WAITING FOR NAVIGATOR

GATHERS ANY SIGNITURES AND

REVIEWS NECESSARY DOCUMENTS

CHECK-IN KIOSKS FOR ESTABLISHED

PATIENTS? 3-5 MINS

SICK CHILDWELL VISITNEW VISIT

%$ WELL VS. SICK

SICK VISIT

WELL VISIT

NEW VISIT

PT TAKEN TO EXAM ROOM

VITALS TAKEN ON WAY LAB

DRAW AR VITALS IF REQ

3-5 MINS

PT TAKEN TO EXAM ROOM

VITALS TAKEN ON WAY 3-5 MINS

PT TAKEN TO EXAM ROOM

VITALS TAKEN ON WAY 3-5 MINS

EXAM VISIT HISTORY & PHYSICAL

TIME BASED ON ESTABLISHED PT

HISTORICAL DISTRIBUTION

5-40 MINS

EXAM VISIT HISTORY & PHYSICAL

TIME BASED ON ESTABLISHED PT

HISTORICAL DISTRIBUTION

5-40 MINS

EXAM VISIT HISTORY & PHYSICAL

TIME BASED ON ESTABLISHED PT

HISTORICAL DISTRIBUTION

10-60 MINS

DISCOVERY OF ISSUE

DISCOVERY OF ISSUE

DISCHARGE IN EXAM ROOM

UNLESS COMPLEX DISCHARD NEEDED 3-10 MINS

TO COMPLEX DISCHARGE AREA FOR

SCHEDULING DIAG OR

TREATMENT10-20 MINS

DISCHARGE IN EXAM ROOM

UNLESS COMPLEX DISCHARD NEEDED 3-10 MINS

TO COMPLEX DISCHARGE AREA FOR

SCHEDULING DIAG OR

TREATMENT10-20 MINS

TO TREATMENT ROOM

20-90 MINS

PATIENT LEAVE MEDICAL HOME

PATIENT LEAVE MEDICAL HOME

THIS SIMPLIFIED FLOW DIAGRAM IS USEFUL TO LOOK AT THE NUMBER OF EXAM ROOMS IN A STANDARD CARE TRACK. HOW WITH THIS FLOW DIFFER FOR PED PATIENTS IN A CENTERING

CONCEPT? WHAT % OF PATIENTS COULD THIS BE?

DID WE WANT TO MODEL PATIENTS HAVING THEIR PERSCRIPTIONS BROUGHT TO THEM IN THE EXAM ROOM, OR

WAITING IN A SUB-WAITING AREA?

TCH MEDICAL HOME PEDI PATIENT PROCESSMODEL - 01/30/2012

Medical Home – Space Program SummaryTotal Area

50,458 sf Quantity of Rooms

Public Area 3,528 sfPediatric Service Module 8,338 sf 25 Exam Rooms, 2 Consult RoomsOB Service Module 4,726 sf 11 Exam Rooms, 4 Consult RoomsCentering Module 2,030 sf 2 Centering RoomsService Module Support 1,972 sfDiagnostics 5,340 sf 1 Gen Rad, 2 UltrasoundPharmacy 3,074 sfEye Clinic 5,733 sf 4 Exam RoomsDental Clinic 3,560 sf 9 OperatoriesSpecialty Clinic 2,160 sf 4 Observation RoomsMember Education 2,849 sfAdministration 4,874 sfSupport 2,273 sf

Site Selection

Reflects Pilot Program Preferred Area

-Membership Density-Proximity To Potential Partner Hospitals-Near Major Freeways

site

TMC

CBD

Vehicular Access- Site Along Beltway Feeder Road- Can Be Approached From Multiple Directions

N

I 45

B 8

Existing BuildingTCH Medical Home

Site OrganizationParking1.1=Patient & Public Parking

2.Staff Parking3.Patient Flow from Bus Stop

4.Main Entry5.Public Retail Entry

6.Staff Entry

4

3

65

6

N

1

2

1 2

Public Areas

1.Main Entry/Drop-Off

2.Public Retail Entry- North/East Natural Light

3.Waiting/Circulation

4.Retail Corridor

3

1a

a

42

3

Program Plan

3 1a

a

2

Public/Retail/EDU/Admin1.Main Entry/Drop-Off2.Public Retail Entry3.Waiting/Circulation4.Retail Corridor5.Pharmacy6.Dental7.Optometry8.Education9.AdministrationStaff10.Staff Work AreaOB Program Space11.OB Clinic12.CenteringPeds Program Space13.Primary Care Clinic14.Specialty Clinic15.Diagnostics

13

14

15

10

12

1111

89106

57

4

ReceptionTCH Medical Home

WaitingTCH Medical Home

Team WorkstationsTCH Medical Home

ReceptionTCH Medical Home

3Lessons Learned

POE Methodology

(to be provided at learning session)

POE Results

(to be provided at learning session)

Common Takeaways – Conversion “Pros”

- Large, open footplate- Opportunity for various ceiling heights / high ceilings- Potential for second floor / mezzanine- Opportunity for skylights- Potential for separate front-of-house and back-of-house - Good visibility from major thoroughfares- Ample parking- Economical investment- Places care directly in the target community - Create a feeder system to or away from hospital campus

Common Takeaways - Conversion “Cons”

- Inappropriate column spacing - Undersized / shared utilities with adjoining tenants- Usually no emergency generators- Inappropriate / unusable mechanical systems- Low-budget original construction- Poorly documented building alterations over time- Undocumented / undiscoverable existing conditions- Potential limitations to exterior façade changes- Significant saw-cutting for under-floor plumbing- High roof: ceiling-mounted equipment challenging- Security

Dianna Prachyl DPrachyl@jpshealth.orgJPS

Allison Muth ABMuth@texaschildrens.orgTCH

Diane Osan DOsan@fkp.comFKP

Lance Winn LWinn@fkp.com