Cherokee Health SystemsTogether…Enhancing Life

Facility Planning for an Integrated Care Practice

NACHC Community Health InstituteOrlando, Florida

September 11, 2012

Cherokee Health SystemsTogether…Enhancing Life

On the Jobsite Today

• Bob Franko, MBA Vice President of Marketing and National Training

Coordinator, Cherokee Health Systems (Knoxville, Tennessee)

• Jeff Howard, CPA Chief Financial Officer, Cherokee Health Systems (Knoxville, Tennessee)

• Margaret Backhurst, AIA, LEED, AP Red Chair Architects (Knoxville, Tennessee)

• Ellen Taylor, AIA, MBA, EDAC The Center for Health Design (Concord, California)

Cherokee Health SystemsTogether…Enhancing Life

Framing our DiscussionPOURING THE FOUNDATION – Primary Behavioral Health Integrated Care: Blending behaviorists into the patient centered medical home

FIRST FLOOR – Cherokee Health Systems’ first steps in facility planning

CLIMBING SKYWARD – An Architect’s perspective in planning

VIEW FROM THE PENTHOUSE – National trends, best practices

Cherokee Health SystemsTogether…Enhancing Life

Integrated Care

Integrated Care is the process and product of medical and mental health professionals

working collaboratively and coherently toward optimizing patient health through

biopsychosocial modes of prevention and intervention.

O’Donohue, Byrd, Cummings, and Henderson (2004)

Cherokee Health SystemsTogether…Enhancing Life

Cherokee’s Blended Behavioral Health and Primary Care Clinical Model

• Embedded Behavioral Health Consultant on the Primary Care Team

• Real time behavioral and psychiatric consultation available to PCP

• Focused behavioral intervention in primary care

• Behavioral medicine scope of practice

• Encourage patient responsibility for healthful living

• A behaviorally enhanced Healthcare Home

Cherokee Health SystemsTogether…Enhancing Life

• Conjoint Consultation

• On-Demand Medication Consultation

• Care Management

• Psychiatric Consultation

• PCP Consultation

• School/Agency Consultation

• Prevention

• Telephone Consultation

Typical BHC Services in Primary Care

• Triage/Liaison

• Behavioral Health Consultation

• Behavioral Health Follow-Up

• Adherence Enhancement

• Relapse Prevention

• Behavioral Medicine

• Consultative Co-Management

• Group-based interventions

Cherokee Health SystemsTogether…Enhancing Life

If Buildings Could Speak…

5th Street Confessions

Jeff Howard, CPACherokee Health Systems

Cherokee Health SystemsTogether…Enhancing Life

815 W 5th North StreetMorristown, Tennessee

• Community Mental Health Center

– Outpatient Mental Health

– Case Management

– Day Treatment (Basement)

• High Concentration of Persons with SPMI

• Original Corporate Headquarters

Cherokee Health SystemsTogether…Enhancing Life

6 Weeks Before Integration

GroupRoom

OfficeOfficeOfficeOfficeOfficeOffice

Cherokee Health SystemsTogether…Enhancing Life

Integration (Phase 1)

OfficeOfficeOfficeOfficeOffice

Cherokee Health SystemsTogether…Enhancing Life

Integration (Phase 2)

OfficeOfficeOfficeOfficeOffice

Cherokee Health SystemsTogether…Enhancing Life

Integration (Phase 3)

Office

Cherokee Health SystemsTogether…Enhancing Life

Phase ?

Promising Practices in

Safety-Net Clinic Design

Ellen Taylor, AIA, MBA, EDAC

NACHC

September 2012

Clinic Design Resources and Tools

The Patient

Journey

positive outcomes

– Access

– Waiting

– Privacy

– Communication

negative outcomes

– Anxiety

– Infection

Proximity; one-stop; transit;

parking; wayfinding

Attractive; clean; positive

distraction; information

Interaction; family

conv. computers

Educational ; positive

distractions; privacy

Services to patient;

positive distractions

Privacy;

access

Improve access to care

• Location for easy access

within community

• Co-location with other

services

• Integrate with public transit

• Incorporate wayfinding

strategies

– Universal symbols: LEP

• Space for community

programs/activities

La Clinica de la Raza at Fruitvale Transit Village

Outreach of Services – Mobile Clinics

• Size and layout for services

provided

• Large operable windows

– reduce claustrophobia

– natural ventilation

• Proper insulation and air-

conditioning

– energy conservation

– thermal comfort

– equipment maintenance

• Finish materials - cleaning

• Barrier-free environment

Patient-provider interactions

• Interaction – through design

and layout

• Design to support technology

• Space for families in exam

rooms

• Exam Room? 60-80% don’t

need the table

– Mayo Clinic - Center for

Innovation

– Southcentral Foundation

Ambulatory Practice of the Future (Mass General)

Exam Rooms?

• 60-80% don’t need the table

– Mayo Clinic - Center for

Innovation

– Southcentral Foundation

• Dual door design?

• 2 on 1 configuration?

Mayo Clinic Center for Innovation- Jack and Jill rooms

Role of the family

Family involved in decision

making; key family member

Interaction between provider

and family

• Larger exam rooms

• Adequate space for waiting

• Flexible exam rooms to

accommodate family

• Positive distractions for

waiting

Open Door Community Health Center, Eureka, CA

Integration of technology

• Telemedicine

– Layout for visual monitoring

– Lighting /finishes materials for video Quality

– Acoustics

– Convenient outlets

• Electronic records

– Computer Position

– Monitors with mobile arms

– Open layout –

– Availability of computers

Grace Hill Neighborhood Health Center-Water Tower

Improve Team Collaboration

• Visual connection of spaces

• Visual display of work info

– Display walls

– electronic displays

• collaboration spaces close to

individual spaces

– Informal meeting spaces

along hallways

• Visual/acoustic design

– information security

– minimized distractions

Ambulatory Practice of the Future (Mass General)

Culturally sensitive care

• Layout, signage, symbols and artwork

to communicate meaning and

empathy

• Spaces to support community

activities

– Gardens

– Cooking classes

– Fitness trails

Oakland Seven Directions; Native American Health Center

Designing for Flexibility

and Adaptability

• Changes in:

– Population

– Services

– Equipment

– Technology

– Care models

• Result in physical changes:

– Relocation of functions

– Renovation

– Expansion

• Grids

• Pods

• Modularity

Clinica/People’s Clinic in Boulder)

The Business Case

Cost-benefit analysis tool

Questions?

etaylor@healthdesign.org

http://www.healthdesign.org/clinic-design

Next Steps:

Clinic POE

Multiple Clinic Design Seminars

Cherokee Health SystemsTogether…Enhancing Life

THANK YOU!

Bob Franko: bob.franko@cherokeehealth.orgJeff Howard: jeff.howard@cherokeehealth.orgMargaret Backhurst:

mbackhurst@redchairarchitects.comEllen Taylor: etaylor@healthdesign.org