The Built Environment & Health Design
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6/22/2016 1 Region IX Western Clinicians Network Conference Harvey’s Lake Tahoe, Nevada June 14, 2016 The Built Environment & Health Design Avein Saaty-Tafoya, MD MBA HCM EDAC President & Chief Executive Officer Adelante Healthcare Board Member, Center for Health Design
Transcript of The Built Environment & Health Design
6/22/2016
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Region IX Western Clinicians Network Conference
Harvey’s Lake Tahoe, Nevada June 14, 2016
The Built Environment & Health Design
Avein Saaty-Tafoya, MD MBA HCM EDACPresident & Chief Executive OfficerAdelante HealthcareBoard Member, Center for Health Design
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0
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1998 2000 2002 2004 2006 2008 2010
Federal Grant
Patient Revenue
Other Grants
Donations, Int
Sources of Support and Revenue(in millions)
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Blue ocean
2013
RESTRUCTURING
OF HEALTHCARE
FOCUS ONPRIMARY
CARE
SEISMIC
CHANGES
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ACA
+32M
PEOPLE
50%
PAIDTHROUGH
MEDICAID
EXPANSION
50%
PAIDTHROUGH
HEALTH
INSURANCE
EXCHANGES
HEALTHCARE REFORM, LEGISLATION & THE BUILT ENVIRONMENT
Malone, E., Taylor, E., et al. (2015). Quality Care, Legislation and Design: An Issue Brief on Healthcare Reform. Concord, CA: The Center for Health Design Topics, Healthcare Reform. https://www.healthdesign.org/topics/healthcare-reform
Figure created by Ellen Taylor
THE
HOLY
GRAIL
INSTITUTE FOR HEALTHCARE IMPROVEMENT
• Improve the patient experience
QUADRUPLE
AIM • Improve the health of populations
• Reduce per capita cost
• Improve provider engagement
GONE
FOREVER
Marcus Welby, M.D.
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patient experience in ambulatory care: CAHPS surveys
https://cahps.ahrq.gov/qualit
y-
improvement/improvement-
guide/1-
about/index.html#about
Two CAHPS Surveys
• Health Plan (1997) –
experiences with health plans
and their services
• Clinician & Group (2007) –
experiences with health care
providers and practice staff
CAHPS Ambulatory Care Improvement Guide: Patient Experience
https://cahps.ahrq.gov/quality-improvement/improvement-guide/improvement-
guide.html
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TARGETED PATIENT EXPERIENCE IMPROVEMENT STRATEGIES
https://cahps.ahrq.gov/qualityimprovement/improve
ment-guide/6-strategies-for
improving/index.html#6a
AHRQ CAHPS Strategies Safety Net Clinic Redesign Recommendations
….Lots more design recommendations can be found in the
report: Joseph, A., et al. (2009). Improving the Patient
Experience: Safety Net Clinic Redesign. California
HealthCare Foundation.
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20File
s/PDF/PDF%20S/PDF%20SafetyNetDesign.pdf
PCMHRESTRUCTURING OF PRIMARY CARE
Hospital-based
outpatient
clinics
Kaiser model
PCMH
Physician
practices
Community
health centers
& safety net
clinics
RED
PATIENT
PATIENT-CENTERED CAREHEALTH
COACHNURSE
PHARMACY PHYSICIAN
IMPROVEDOUTCOMES
EFFECTIVE
COLLABORATION
IMPROVED
DECISIONMAKING
MULTIDISCIPLINARY
TEAMS
BEHAVIORALHEALTH
NUTRITIONIST
Gulwadi, G., Joseph, A., & Keller, A. (2009). Exploring the impact of the physical environment on patient outcomes in ambulatory care settings. Health Environments Research & Design Journal, 2(2), 21-41.
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AN EVIDENCE-BASED DESIGN MODEL
Strategic GoalsImproved patient,
staff and
resource outcomes
Research
Disciplined Teamwork,
Execution &
Institutionalization
InfrastructureBuilding
TechnologyFurniture
Equipment
Re-engineered Clinical
&Administrative
Processes
Trans-formational
Leadership & Culture
AMBULATORY CARE PATIENT EXPERIENCE
Place (Infrastructure) People (Culture &
Leaders)
Process (Reengineering)
Building Identify Desired End-
State
Refine Staff Care Processes
Technology Develop Readmission
Reduction Plan
Engage Patients
Furniture/Equipment Measure and Reward
Progress
Engage Loved Ones Involved in Care
Practice EBD Workshop Integrating EBD
DESIGN
GOALS
COLLABORATIVE
SPACES FOR CARE
TEAM
SAFETY-NET CLINIC CARE MODEL
CLOSE TO EXAMROOMS
FLEXIBLE SPACES
Design: NBBJSPACE, FURNITURE,
TECHNOLOGY TO
SUPPORT GROUP
INTERACTION
EASE OFCOMMUNICATION
BETWEEN STAFF
VISIBILITY
MINIMIZE NOISE(USE OF CARPET)
Design: Boulder Associates
DESIGN
GOALS
SAFETY-NET CLINIC CARE MODEL
INCREASE VISUAL
CONNECTION
BETWEEN
WORKSPACES
PORTABLE
DIAGNOSTIC
EQUIPMENT
TELEMEDICINE
POINT-OF-CARETESTING
ELECTRONICHEALTH
RECORDS
Design: HGA Architects
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DESIGN
GOALS
SAFETY-NET CLINIC CARE MODEL
DEVELOP DESIGN
CONCEPTS THAT
HONOR
CULTURES AND
ARE FAMILIAR TO
PATIENT
POPULATIONLa Maestra Community Clinic
Design: Richard Yen Associates
Anchorage Native Primary Care Clinic
Design: NBBJ
DESIGN
GOALS
CULTURAL SENSITIVITY
RESPECTFOR
TRADITION
VISUAL CUES AND
SYMBOLS TO
CREATE SENSE OF
PLACE
INVOLVEPATIENT
ADVOCATES
ENVIRONMENT IS A
SURROGATE FOR
QUALITY OF
CLINICAL CARE Anchorage Native Primary Care Center
Design: NBBJ
DESIGN
GOALS
INTUITIVE
WAYFINDING
STRATEGIES
SAFETY-NET CLINIC MODEL
EASY-TO-FINDDESTINATIONS
SENSITIVITY TOLITERACY
INTUITIVESPACE
PLANNING
LANDMARKS ASVISUAL CUES
ACCESS TO NATURAL
LIGHT THROUGHOUT
MAIN ARTERY
CORRIDORS Smiley’s Clinic
Design: HGA Architects
DESIGN
GOALS
SAFETY-NET CLINIC CARE MODEL
CARE COORDINATOR/
PATIENT NAVIGATOR:
A BRIDGE TO OTHER
RESOURCES
Red Rocks Medical Center
Design: Boulder Associates
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DESIGN
GOALS
SAFETY-NET CLINIC CARE MODEL
COLOR!
PAINT IS
CHEAP
Grace Hill Neighborhood Health Center
Design: Arcturis Grace
DESIGN
GOALS
SAFETY-NET CLINIC CARE MODEL
USE OF
COLOR
GOODLIGHTING
CULTURALLY
RELEVANT ART---
CHILDREN GIVEN
CAMERAS TO
PHOTOGRAPH
THINGS OF
INTEREST
Hill Neighborhood Health Center
Design: Arcturis
RESTRUCTURING PRIMARY CARE
Physician working for patient,
not insurance company
Holistic management of
preventative care & chronic
conditions
Integrative medicine/wellness
focus
Ease of access; longer appts.
Physician as health coach
Email consultations; remote
monitoring
Healthy Lifestyles
THE FUTURE
OF
MEDICINE?
FOCUS ON PATIENT ENGAGEMENT
RESTORE THE
DOCTOR/PATIENT
RELATIONSHIP OF
THE PAST
ENHANCE THEPATIENT
EXPERIENCE
REMOVETRADITIONAL
BOUNDARIES
BETWEEN PATIENT
AND PROVIDER
Design: Jain Malkin Inc.
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HOLISTIC HEALTH CARE
WELLNESSPHILOSOPHY
INTEGRATIVEMEDICINE
Design: Jain Malkin Inc.
RETAIL CARE
MODEL
HOSPITALITY AND AMENITIES
SMALL SCALE“INTIMATE”
SETTING
PATIENTS DON’TWAIT
LONGERAPPOINTMENTS
PATIENTCOMFORT
IMPORTANT
“LIVINGROOM”
AMBIENCE
Design: Jain Malkin Inc.
Exam rooms same-handedIT Rich Environment
INNOVATIONHigh visibility,
collaborative team
environment
AMBULATORYPRACTICE
OF THE FUTURE
Open access
to resources
ANSHEN + ALLEN |STANTEC
CIMITCENTER FOR INTEGRATION OF
MEDICINE AND INNOVATIVE
TECHNOLOGY
- Remote conferencing and consulting
- On-site or remote scheduling and check-in
- Virtual visits, including remote monitoring
and automatic recording of vital signs to
electronic medical records
“Off-stage”
offices
• Employee health center for Massachusetts General Hospital
• The patient as “expert” in their health needs receiving
proactive continuous healthcare and feedback
• A total redesign of the outpatient care-experience
• Model of care studied for impact on quality, cost, patient
and provider satisfaction
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INNOVATION
AMBULATORY
PRACTICE OF THE
FUTUREANSHEN + ALLEN |STANTEC
CIMITCENTER FOR INTEGRATION OF MEDICINE
AND
INNOVATIVE TECHNOLOGY
VIEWS OFBOSTON
HARBOR
A VARIETY OFSEATING
TYPES
NATURALLIGHT
INNOVATION
AMBULATORYPRACTICE
OF THE FUTURE
ANSHEN + ALLEN |STANTEC
CIMITCENTER FOR INTEGRATION OF
MEDICINE AND INNOVATIVE
TECHNOLOGY
DESIGN EXAMROOMS
TO ENHANCE
PATIENT
ENGAGEMENT
“ANY ROOM IS AN
EXAM ROOM AND
ANY ROOM IS A
TALKING ROOM”
INNOVATION
AMBULATORY
PRACTICE OF THE
FUTUREANSHEN + ALLEN |STANTEC
CIMITCENTER FOR INTEGRATION OF MEDICINE
AND
INNOVATIVE TECHNOLOGY
DESIGN EXAMROOMS
TO ENHANCE
PATIENT/PROVID
ER INTERACTION
EXAM SIZE 10’ X11’
INNOVATION
AMBULATORYPRACTICE
OF THE FUTURE
ANSHEN + ALLEN |STANTEC
CIMITCENTER FOR INTEGRATION OF
MEDICINE AND INNOVATIVE
TECHNOLOGY
TEAMCOLLABORATION
VISIBILITY
TRANSPARENCY
5 EXAM ROOMS PER
CARE TEAM
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INNOVATION
AMBULATORYPRACTICE
OF THE FUTURE
ANSHEN + ALLEN |STANTEC
CIMITCENTER FOR INTEGRATION OF
MEDICINE AND INNOVATIVE
TECHNOLOGY
CENTRALIZED
COLLABORATION
SPACE: A KEY
CONCEPT IN THE
PATIENT-
CENTERED
MEDICAL HOME
“EVERYBODY
OPERATING TO
THE LIMIT OF
HIS/HER
LICENSE”
PARTNERSHIP PROJECT MANAGEMENT
Establishing a partnership
Long-term investment
Identifying shared goals
Execute an action plan
CAPITAL PLANNING
Investor
Design/Build
Design/Bid/Build
Lease
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ADELANTE
HEALTHCARE
MESA
Design: Jain Malkin Inc.
DESIGN
GOALS
FACILITATE
ONE-STOP CARE
SAFETY-NET CLINIC CARE MODEL
Family Practice
Pediatrics
Internal Medicine
Behavioral Health
Dentistry
OB-GYN
Pharmacy
Nutrition
Café
Community Room
Health Education
Podiatry
Patient Navigator
Naturopathic Medicine
Physical Therapy
Audiology
“WHOLEPERSON”
CARE
HIGH VISIBILITY
MAJOR
DESTINATIONS
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Design: Jain Malkin Inc.
KEY
DECISIONS
CHANGE IS
SCARY
LOCATION,LOCATION,
REPRESENTATION
DON’T GONATIVE…GO
RETAIL
PAINT $25 AGALLON
MIX ITUP…GIVE
MORE, GET
MORE.
A VISIONDesign: Jain Malkin Inc.
KEY
DECISIONS
ORGANIZATIONAL CULTURE CHALLENGES
NONPROFIT VS.NOT-FOR-PROFIT
TRANSITION FROM
VOLUME–BASED
REIMBURSEMENT
SYSTEM TO
QUALITY AND
COORDINATED
CARE FOR A
POPULATION
OWNING VS.RENTING
FACILITIES
PATIENT-CENTEREDNESS
Design: Jain Malkin Inc.
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DESIGN
GOALS
FQHC MODEL
TALKINGROOMS
FLOW
Design: Jain Malkin Inc.
DESIGN
GOALS
AMENITIES TO
SUPPORT
FAMILY
PRESENCE
POSITIVE
DISTRACTIONS
INCREASE
STAFF
SATISFACTION
ADELANTE HEALTHCARE
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SERVICES
PEDIATRICTALKING
ROOMS
Design: Jain Malkin Inc.
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SERVICES
Café
Community Room
Design: Jain Malkin Inc. Pharmacy
DESIGN
GOALS
CHD PEBBLE
SAFETY-NET CLINIC RESEARCH
DESIGN FOR A MULTI-CULTURAL COMMUNITY
CHD SAFETY-NET CLINICRESEARCH
EASE OF WAYFINDING
NATURAL LIGHTSKYLIGHTS
SMALL SCALE WAITINGAREAS
ENHANCE PATIENT-
PROVIDER INTERACTION
THROUGH DESIGN OF
EXAM ROOM
ALL LED LIGHTING
LEED PLATINUMCERTIFICATION
Design: Jain Malkin Inc.
PEBBLE
RESEARCH
ADELANTE
HEALTHCARE
POSITIVE DISTRACTION IN EXAM ROOMS
WILLPATIENTS
CHOOSE:
NATURE IMAGES?
MUSIC WITH
NATURE?
EDUCATIONAL
PROGRAMMING?
CHOICESAUTOMATICALLY RECORDED
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FY 2015 45+K Patients
150+K Visits
$40+M Revenue
450+ Staff
Diverse Patient Mix
45% Medicaid (AHCCCS)
10% Medicare
10% Uninsured/Sliding Fee
10% Marketplace
25% Commercial
Locations: Central Support Office and 9
Health Center sites: West Phoenix,
Mesa, Surprise, Peoria, Buckeye,
Avondale, Wickenburg, Gila Bend,
Central Phoenix
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RESOURCES
FROM CHDSAFETY-NET CLINICS WHITE PAPERS
A
•
wealth of information
Promising Practices in Safety-Net Clinic Design
(Overview)
I
• Designing Safety-Net Clinics for Flexibility
• Designing Safety-Net Clinics for Cultural Sensitivity
• Improving the Patient Experience
• Designing Safety-Net Clinics for Innovative Care
DeliveryModels
Design & Construction Process Toolkit withinteractive cost-benefit analysis feature
(healthdesign.org/clinicdesign/MySNC)
Avein Saaty-Tafoya [email protected]
602-463-5230 www.adelantehealthcare.com
