Collaborative design

Healthcare leaders in the midst of changing their business models to adapt to the Patient Protection and Affordable Care Act should consider the role that planning and designing facilities plays in addressing the challenges of a changing industry.

Creativity, innovation and “new school” thinking, especially given the growing push toward ambulatory-care facilities, can make a big difference.

Decisions made in the planning, design and building of healthcare facilities must reflect the new landscape spurred by reform and other internal and external forces. Circumstances demand substantive changes and bold ideas, not superficial window dressing sold as something different and new.

What do facilities need today and what will they need tomorrow to deliver the best possible patient and staff experience? What will the healthcare facility of the future look like?

The trend is decidedly toward “patient-centric” care, which means facilities must be where the patients need them to be. And they need to be designed with the patient experience in mind, not just the convenience of the care teams.

More choices must be made available to healthcare consumers. The most responsive facilities will garner the most and best business.

Healthcare facilities of the future need to accommodate the rising demand for primary care. They should provide outpatient care settings that achieve economies of scale, promote collaboration and offer “one-stop shopping.”

In addition to exam and treatment spaces, components should include space for patient education in prevention, fitness and health maintenance. Rooms for counseling services also need to be part of the mix.

Current clinic layouts underscore the problems with many facility designs. Physicians typically work in private offices, separated from the rest of the staff. As a result, face-to-face communication with co-workers is limited, which undermines collaborative care.

Exam rooms are also a problem. They tend to be small—typically about 90 square feet—with limited space for caregivers and staff. They are usually inflexible with little potential to vary their use when new care models come along.

Inefficient overall design is a another drawback of today's traditional outpatient clinic. Large waiting spaces contribute to patient delays. Effective patient flow and operational efficiencies are often an afterthought.

Good design can promote collaboration among clinicians, maximize cross-referrals by co-locating services and build flexibility into the facility without breaking the bank. Facility planners can start by setting three goals for the design of an ambulatory-care facility.

First, streamline front-end operations and re-imagine how care will be delivered. This means taking steps to improve the patient arrival and registration process; using technology to accelerate the patient visit process; and restructuring the patient rooming system to improve efficiency. Also, integrate electronic health records with care processes to maximize the use of caregiver time.

Second, enhance clinic design by mapping current and future workflow, optimizing value for patients and staff, creating shared workspaces that encourage staff/clinician communication, and looking at care processes from the patients' perspective. This may include removing physicians' private offices, creating more standardized workspaces and standup work areas, and examining new staffing models to leverage physician expertise.

Third, create examination rooms with sufficient size and a flexible layout to ensure high-quality care delivery and full involvement of patients, family and caregivers. Too often, spaces and exam rooms are designed to satisfy the requests of the senior physician (who might retire within a year of the project opening).

The project team can help achieve these benefits through the design process by:

• Including more of the “people doing the work” in the planning process, not just senior staff.
• Integrating “Lean” thinking into the planning process. If done correctly, this will reduce waste in care processes (and therefore improve efficiency).
• Incorporating 3D computer simulation modeling to test workflow and staff assumptions to illustrate how the new space will look and feel.
• Taking a more aggressive approach to standardization for work processes.
• Utilizing component construction and avoiding “one-off” project thinking.

To ensure that these design improvements occur, healthcare executives and planners need to hold the design and construction industry accountable. They must insist that design decisions are driven not by what has been done in the past, but by what contributes best and most efficiently to the ability to care for patients, now and in the future. This also applies to those on the owner's side who are involved in facility planning and design.

The healthcare facility of the future needs decisive leadership, not a wait-and-see approach or reliance on past practices that are quickly becoming obsolete. We need to look forward, think creatively and take a fresh approach to our facility design if we're going to continue delivering the best patient care possible.

Douglas Childs is a principal with TAYLOR, a design firm whose mission is “Promoting Wellness through Architecture.” Raymond Hino is the acting CEO of Bear Valley (Calif.) Community Healthcare District.