Facility planning presentation nachc chi2012 orl
Transcript of Facility planning presentation nachc chi2012 orl
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?
http://www.healthdesign.org/clinic-design
Next Steps:
Clinic POE
Multiple Clinic Design Seminars
Cherokee Health SystemsTogether…Enhancing Life
THANK YOU!
Bob Franko: [email protected] Howard: [email protected] Backhurst:
[email protected] Taylor: [email protected]