1.Expect The Unexpected Neuroscience Group of Northeast WisconsinA Miron Construction Co., Inc. Healthcare Case Study

2. ContentsOur purpose is to serveIntroduction 8 with the greatest intent, Walk 10to show compassion andprovide the ultimate Talk 18healing environment.Create 42 Act66Philip A. Yazbak, M.D., F.A.C.S., President Neuroscience Group 3. Introduction To be the center ofall, working in collaboration with Miron Construction Co., Inc. and Plunkett Raysich excellence and theArchitects, LLP to create a facility unlike any recognized leader other. of comprehensive, As for why we should do this, the answer is in our purpose ~ to serve others ~ and in compassionate neurosciencethe Neuroscience Group Vision . . .To be services in Northeast the center of excellence and the recognized leader of comprehensive, compassionate Wisconsin. neuroscience services in Northeast The Neuroscience Group of Wisconsin. Northeast Wisconsin Mission Breaking new ground was our only choice. Statement Creating the unexpected, our mission. Our exploration process was under way. The Creating the unexpected is a thrillingfuture was ours to shape; the unexpected, but daunting challenge. Sustaining theto create. unexpected, even more so. Still, we considered it our privilegein fact, our responsibilityto write the most compelling What is the new way chapter in the history of neuroscienceof thinking? That which medicine and healthcare construction. created the patient Constructing a state-of-the art building was out of the question. Creating a beyond-the- experience of the past is no state-of-the-art experience was our dream.longer relevant. From the It was also our greatest challenge, one that excited everyone involved, connecting us to beginning, we must design a mission unlike any other. and construct the patient A cross-functional team of physicians,experience in a unique way... practitioners, and other key team members from Neuroscience Group agreed that the ideal way. setting the standard meant building on theSteven J. Price, M.D., Neurologist already-strong foundation . . . exploring Neuroscience Group new territory . . . innovating . . . and, aboveE x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 9 4. Walk 5. Are patients ever attachedto a building? At MironConstruction, we realize thatsimply to build is not enough.For our projects to be highlyinnovative and supremelysuccessful, they must transformhow people feel, taking theirthoughts and their emotions toan entirely new level.David G. Voss, Jr., PresidentMiron Construction Co., Inc. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 6. The transformation process beganwith three outcomes in mindeach focused on emotion, themost important aspect of the IdealPatient Experience.We asked ourselves the followingquestions: How well-cared for doour patients feel when theyre withus? How do families feel about thecare were providing for their lovedones? How does our team feel insetting and exceeding the standardfor comprehensive, compassionatecare?Our facility needed to cater to eachone of the outcomes of thosequestions, and that is why itsdesign and construction was sointegral our goals.Margie Wiess, Ph.D., CEONeuroscience Group E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 15 7. Collaborative Innovation bestdescribes the process used tobring our Creating the UnexpectedDream to life. We could not haveasked for ner, more creative,more innovative partners during thisprocess than Miron ConstructionCo., Inc. and Plunkett RaysichArchitects, LLP.Keeping the desired outcomes inmind, the rst and only choice forbuilding the Ideal Patient Experiencewas Miron Construction Co., Inc. ofNeenah, Wisconsin.E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 17 8. Talk 9. The three critical elements requiredto build this type of transformationalhealing environment were: Physical,Behavioral, and Informational. Byunderstanding the ExperienceEcology and the outcomes of allthree areas in conjunction with oneWorking together, we createdanother, sustainable change cantake place, allowing for a patient-specic experience centered on a culture of innovation. True toquality outcomes. their mission, we significantlyIt was important to align eachelement with the expectations of the improved the quality of patientpatient and Neuroscience Group.However, it was even more criticalthat each element was designed to care and, at the same time,support and complement the otherelements. One or more of these reduced costs. For example,main elements are often overlookedor executed poorly, neglectingnot only their uniqueness, but the through close scrutiny ofinterdependence of all three. function and patient interaction, each exam room was right sized six inches smaller than originally programmed. This resulted in significant construction cost savings. Mike Scherbel, Partner Plunkett Raysich Architects, LLP 10. Guided Co-Creation:A collaborative, connectedexperience during which arepresentative selection ofNeuroscience Group employeesdesigned organizationaltransformation. Stakeholders hada voice during the entire innovationprocess. This group was known asthe Innovation Team. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 23 11. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 25 12. To create the unexpected and bringthe outside in, the architecturalfeatures of the building needed tocomplement the natural landscapeelements. The goal to haveunique design elements thatcaptured the minds of each visitor.We started with the outcomes how we wanted our patients tofeel and moved backward fromthere. A very non-traditionalapproach.Margie Weiss, Ph.D., CEO & Community Health Care AdvocateNeuroscience GroupE x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 27 13. Design elements and patientoutcomes were identied, illustratedand examined to ensure they werebrought to life. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 29 14. Neuromarketing:The connection of the brainsynapses to the positive patientexperience are directly related andoften overlooked.Reaction - Physical reactions to objects and spaces Example: Employees stand on toes to reach something.Adaptation - When an object serves a purpose for which it was not intended Example: A box elevates a computer higher on a desk.Exploitation - Using existing conditions to accommodate needs Example: The space beneath a desk becomes a storage space.Conformity - Social norms and their patterns Example: Patients sit ve seats apart and star at each other.Signaling - Communicating with patients Example: Post-it notes transform a refrigerator into a bulletin board.Stewardship - Caring for the environment Example: An organization relies excessively on paper for collecting information that could be transmitted electronically.E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 15. As advocates for communityhealth, NSG recognized that thenew facility presented both achallenge and an opportunity tointegrate sustainable design intothe construction and operationalstrategies. A healing environment ispredicated upon the premise thatthe land, people and building mustall work together in holistic harmony.The design process was stimulatedby patterns found in nature andbrought to life through Mirons C5Process. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 33 16. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 35 17. Neuroscience Group leaderswere aware of the economic andenvironmental benets of designingand building Green. Sustainablebuildings lower operating costs,improve employee retention,enhance occupant comfort andhealth, increase building valuation,decrease strain on communityinfrastructure systems and helpto create patient-centered high-performance healing environments. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 37 18. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 39 19. All factors were considered beforeimmersing the team in any decisionmaking. Much like a fashion runway,preferences in colors, fabrics,and style are unique for everyone.However, we do know that ifdesigned with patient-experienceoutcomes as the primary focus,sensations come to life, enablingpatients to feel completely specialand in control of their healingprocess. 20. Create 21. Taking ownership of thisproject has been deeplygratifying for our team. Thebuilding process, in particular,was carefully planned,integrated and executed, verymuch in the spirit of how wehandle patient care. Miron wascommitted, from the beginning,to build an environment of trustfor all involved.Susan G. Hibbs, M.D., NeurologistNeuroscience GroupE x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 22. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 47 23. Bringing the building to life wouldnot have been possible withoutthe use of Building InformationModeling (BIM) and Dan Bayer,Mirons BIM specialist. The Mironteam was equipped to forward planand visualize the outcome, allowingfor the NSG team to analyzethe results. Real BIM successwas driven by living the virtualenvironment experience. Mironsuse of BIM tools helped to deneand visualize the outcomes beforethe rst shovel entered the ground.E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 49 24. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 51 25. The Innovation Team was ableto assist Neuroscience Groupin reducing patient registrationwaiting time from 13 minutes to35 seconds. This savings notonly lowered the initial time spentin the reception room by thepatient, but also allowed for a moreconsistent scheduling workow.Because patients rarely arrive 30minutes early for their appointment,additional slots were available toaugment the schedule. With thechange in design and caregiverbehaviors, two to three slots perprovider per day were opened fordirect patient care. This changeadded 6% additional revenue tothe top line each year, resulting ina 1.4% increase to the bottom line.Outcome-based design changesdo make a difference in patientfeelings, in caregiver connectionsand in bottom line protability. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 26. NSGs green vision is a unifyingtheme, encompassing of allaspects of the project. MironConstruction Co., Inc. was selectedto assist in the implementationof this vision. Rather than hiringa sustainability expert, Miron hadthe talent, tools and knowledge tobring the dream to life. Without apartner who understands and livessustainable excellence, NSGsLEED initiative would not havebeen possible.E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 55 27. New ideas for the patient examroom transformed into the wayNeuroscience Group is perceivedboth internally and externally. Tocreate the ideal outcome in theexam room setting, the experience-design team used the revolutionaryRapid-Access Prototyping toolthat challenges traditional thoughtprocesses. Healthcare patientexam room design has changedvery little since it was created 30years ago commented Philip A.Yazbak, M.D., In fact, if you readperiodicals from years past, examroom design today is substantiallythe same. The challenge is thatour health care delivery system haschanged quite dramatically.E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 57 28. Physicians, healthcare architects,clinical assistants and associatepractitioners from the group co-created the ideal exam room,Dr. Steven Price said. First, wecleared out one of our 10 x 10exam rooms and began designingthe experience from there. Therevolutionary change we werelooking for would not have comefrom simply rearranging theenvironment that already existed.And so, Price continued, wechallenged traditional thinking bystarting with an open palette.What was once a sacred spacewas up for discussion. Anythingwas possible. commentedWeiss. Soon, everything becamepossible. Foam items were putin place, illustrated, identied, andthe creativity began. We startedwith the expected emotionaloutcomes connected with patientow and physician expectations,added Steve Tyink, VP of BusinessInnovation at Miron. Then we tookthese expectations to the realm ofthe unexpected, our ultimate goal.The results? No more frighteningmodels of half brains, no moreposters of the human body greetingpatients as they entered the examroom. Together, we created theultimate in patient privacy and anexam-room environment that waswarm, welcoming, and reassuring.E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 59 29. Three realities and levels ofexpectation can be formed within aclinical setting: Patients receive less thanwhat they expect. Example:They would like to enjoy somecoffee, however, it is nowhereto be found. Patients receive what theyexpect. Example: Coffee isavailable through a confusingcountertop serve dispenserwith styrofoam cups. Patients receive more thanwhat they expect. Example: ACoffee Barista stands ready toexceed all patient expectations.Each outcome brings decidedlydifferent feelings and emotions. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 65 30. Act 31. Just as evidence-basedmedicine is revolutionizinghealth care, evidence-baseddesign is transforming thehealth care environment. Wenow have at our disposal provenmethods for improving patientoutcomes, safety, attachmentlevels, as well as staff retentionand service efficiency. Ourevidence-based design alsoresults in improvements toclinical outcomes, economicperformance, productivity,Press-Ganey patient satisfactionand community measures.Steven J. Price, M.D., NeurologistNeuroscience Group 32. Members of the NeuroscienceGroup Innovation Team touredother rms where alternativemethodologies are currently in use.These trips provided discoveryand insight into the specic areasneeded. Best practices wereidentied at Cabelas, REI Outtters,Lush Cosmetics, Whole Foods, toname a few. Direct observation andanalysis challenged perceptionsand changed outcomes.E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 71 33. By simply altering processes,modeling impression areas and attachpoints, understanding outcomes and shifting behaviors, the experience at the Neuroscience Centernow closely reflects the organizations mission andcommitment to its patients.The result? An experience that is unforgettable. The ultimate healing environment and ideal patient experience have beencreated and are well underway.Gizell R. Larson, M.D., NeurologistNeuroscience Group 34. AcknowledgmentsWe would like to thank the following people and rms who shared their passionand dedicated their expertise to the successful creation of the NeuroscienceCenter:Miron Construction Co., Inc.President/Principal: David G. Voss, Jr.Vice President/Principal: Tim Kippenhan, LEED APProject Manager: Andy DerksenProject Superintendent: Jim ZeiglerVP, Business Development: Corey BrumbaughVP, Health Care Services: Dennis LynchConceptual Estimator: David SchaetzProject Coordination: Jodette Friedrich & Kelly McCarthyVP, Business Innovation: Steve TyinkPlunkett Raysich Architects, LLPArchitectural Design and RenderingsPartner: Michael H. Scherbel, AIA, NCARBProject Architect: Mary Spriggs, AIA, CSI, CDTSenior Planner: Daniel J. Becker, AIA, LEED APInterior Design: Dan EffenheimEngineering Concepts, Inc.HVAC & Plumbing EngineerGEI ConsultantsElectrical EngineerSTS/AECOM AssociatesCivil EngineerPierce Engineers, Inc.Structural EngineerAll Content 2008 Miron Construction Co., Inc.Professional PhotographyArk Media Group, LLCMargie Weiss, Ph.D.Weston Imaging Group, LLCGraphic DesignSarah Parker 35. Corporate Ofce Regional OfcesUS $16.991471 McMahon DriveWausau, WINeenah, WI 54956Madison, WIwww.miron-construction.comp. 920.969.7000 Cedar Rapids, IAf. 920.969.7393 This book contains recycled material.