Med­i­cal home model in­flu­ences how de­sign­ers build new of­fices

Modern Healthcare - - CONSTRUCTION & DESIGN - By An­dis Robeznieks

The pa­tient-cen­tered med­i­cal home is a health­care de­liv­ery model, not a brick-and-mor­tar fa­cil­ity. But the mem­bers of a med­i­cal home’s multi-dis­ci­plinary, co­or­di­nated-care team need a phys­i­cal place to hang their white coats.

So the health­care con­struc­tion in­dus­try is work­ing on med­i­cal of­fice de­signs that fa­cil­i­tate med­i­cal home goals. Clin­ics and med­i­cal of­fice build­ings are be­ing de­signed with more con­fer­ence ar­eas where mul­ti­dis­ci­plinary care teams can share ideas or meet with pa­tients’ fam­i­lies. In­di­vid­ual of­fices and closed doors are be­ing re­placed by open work ar­eas that fos­ter col­lab­o­ra­tion. And us­ing Lean ef­fi­ciency con­cepts, ar­chi­tects and de­sign­ers are work­ing closely with providers to cre­ate more seam­less, pa­tient-cen­tered work­flows that im­prove qual­ity of care and re­duce costs.

A ma­jor ben­e­fit of an ef­fi­ciency-en­hanc­ing de­sign is that it can de­crease pa­tient-wait­ing times. That al­lows prac­tices to de­crease wait­ing-room size and free up that space for other uses.

But ex­perts pre­dict that more of these pa­tient-cen­tered med­i­cal fa­cil­i­ties soon will be lo­cated in re­tail mall-type set­tings rather than in med­i­cal of­fice build­ings in or near hospi­tal cam­puses.

The ef­fect of the med­i­cal home move­ment on con­struc­tion vol­umes is not yet clear, how­ever. The 151 com­pa­nies that par­tic­i­pated in Mod­ern Health­care’s 35th an­nual Con­struc­tion & De­sign Sur­vey re­ported that 2013 was a busy year on the med­i­cal of­fice build­ing front. But the num­bers of MOBs built, ex­panded and ren­o­vated were not all that dif­fer­ent from the num­bers gen­er­ated in 2012.

Sur­vey par­tic­i­pants re­ported com­plet­ing 104 new MOBs, ex­pand­ing 28 and ren­o­vat­ing 218 in 2013. By com­par­i­son, the 169 com­pa­nies that par­tic­i­pated in last year’s sur­vey re­ported com­plet­ing 110 new MOBs, ex­pand­ing 25 and ren­o­vat­ing 313 in 2012. For 2013, this year’s par­tic­i­pants re­ported start­ing con­struc­tion on 63 new MOBs, 18 ex­pan­sions and 92 ren­o­va­tions. That com­pares with 98, 18 and 92, re­spec­tively, in 2012. Also, 92 new MOBs were de­signed in 2013, as

were 35 ex­pan­sions and 167 ren­o­va­tions. In 2012, the num­bers were 121, 21 and 158, re­spec­tively.

“We see things this year be­ing pretty level with 2013,” said Deeni Tay­lor, ex­ec­u­tive vice pres­i­dent of In­di­anapo­lis-based MOB de­vel­oper Duke Realty Corp.

Tay­lor sees two big de­sign and con­struc­tion changes re­sult­ing from the growth of the med­i­cal home con­cept. More meet­ing space is be­ing added, as well as more wiring and ma­te­ri­als to fa­cil­i­tate In­ter­net, Wi-Fi and cell­phone use.

He added that con­fer­ence rooms are now in­cluded in the space that mul­ti­spe­cialty groups al­lo­cate for their pri­mary care doc­tors.

The trend is to get pri­mary-care doc­tors and their med­i­cal home prac­tices away from hospi­tal cam­pus-based MOBs and closer to their pa­tients, said Scot La­timer, man­ag­ing di­rec­tor at Jones Lang LaSalle’s Health­care So­lu­tions Group in Ever­green, Colo. In­te­grated sys­tems seek to cre­ate brand loy­alty among mem­bers by pro­vid­ing con­ve­nient ac­cess and short travel times, he said.

He sees pri­mary care mov­ing into re­tail store­fronts. “I think we’re go­ing to see much less (MOB) de­vel­op­ment,” La­timer said. “The de­velop-

ment will be off cam­pus and look and feel very dif­fer­ent.”

Andrew Quirk, se­nior vice pres­i­dent for Skan­ska USA Build­ing in Nashville, agreed. “Phys­i­cal lo­ca­tion is be­ing turned upside down,” he said. “The con­cept of a med­i­cal home is re­ally where health­care is headed.”

Pa­tients also want one-stop shop­ping, Quirk said. A pro­to­type is Van­der­bilt Health’s One Hun­dred Oaks med­i­cal mall in Nashville. The out­pa­tient fa­cil­ity is housed in a re­pur­posed shop­ping cen­ter that now fea­tures 22 spe­cialty clin­ics. “It’s bril­liant mar­ket­ing,” he said. “You can see it from the high­way.”

Af­ter sign­ing a long-term lease in 2007, Van­der­bilt be­gan mov­ing in clin­ics, start­ing with women’s health, then der­ma­tol­ogy. “Pri­mary care was rel­a­tively late in the mi­gra­tion process,” said Dr. Rob Hood, med­i­cal di­rec­tor for One Hun­dred Oaks. “This is not ex­actly the same as a med­i­cal home.”

De­spite the dif­fer­ences, Hood noted that One Hun­dred Oaks of­fers pa­tients the chance to see mul­ti­ple physi­cians in one place, and have imag­ing and other tests done on the same day as their doc­tor visit. Other con­ve­niences in­clude park­ing spa­ces no more than 25 to 50 yards from each spe­cialty area.

Mul­ti­dis­ci­plinary col­lab­o­ra­tion— an­other prin­ci­pal el­e­ment of med­i­cal homes—was a cor­ner­stone of the One Hun­dred Oaks project, both in the de­sign and con­struc­tion process and in the fi­nal prod­uct. Early on, Hood said, reg­u­lar meet­ings brought to­gether physi­cians and ad­min­is­tra­tors from each clin­i­cal sec­tion. Com­plaints were aired, sug­ges­tions were of­fered and an­nounce­ments were made.

The fa­cil­ity has plenty of meet­ing spa­ces, in­clud­ing sev­eral 10-seat con­fer­ence rooms that can be used by com­mu­nity groups and a con­fer­ence room that can be con­fig­ured to seat 85 people for ma­jor pre­sen­ta­tions. The rooms are equipped for tele­con­fer­enc­ing with the main Van­der­bilt cam­pus.

But other providers are go­ing for a purer form of the med­i­cal home model, said Dr. Andy Ell­ner, co-di­rec­tor of the Har­vard Med­i­cal School Cen­ter for Pri­mary Care. Many new med­i­cal home of­fices in­clude quiet ar­eas for pri­vate phone calls and “touch­down spa­ces” which serve as a hub for the mul­ti­dis­ci­plinary care team to have short con­sul­ta­tions with each other.

At the Cen­ter for Pri­mary Care, Ell­ner works with physi­cians, res­i­dents and med­i­cal stu­dents to fos­ter in­no­va­tion at 19 physi­cian prac­tices that see some 275,000 pa­tients. He said a key bar­rier to med­i­cal home trans­for­ma­tion is a re­luc­tance to give up in­di­vid­ual of­fice spa­ces. Still, ideas about what con­sti­tutes the ideal phys­i­cal space for the med­i­cal home model are evolv­ing. “We are not at the point of stan­dard­iz­ing—we have 19 prac­tices and ev­ery one is dif­fer­ent,” Ell­ner said.

One of the 19 of­fices is the Di­mock Cen­ter in Bos­ton, where Dr. Julie Tish­ler prac­tices in­ter­nal medicine. Tish­ler said work at the Di­mock Cen­ter is or­ga­nized so the mul­ti­dis­ci­plinary team comes to the pa­tient rather than hav­ing the pa­tient travel from room to room to see each type of pro­fes­sional.

The Di­mock Cen­ter will al­most dou­ble its foot­print, with an of­fice ren­o­va­tion planned that will ex­pand the space from 4,700 to 7,000 square feet. In the mean­time, Tish­ler said pa­tients have been sur­veyed to gauge their at­ti­tudes to­ward dif­fer­ent chair con­fig­u­ra­tions in the wait­ing room and small touches like us­ing a white board to list de­lays in­di­vid­ual doc­tors may be ex­pe­ri­enc­ing that day.

A lot of at­ten­tion was given to is­sues such as exam room lay­outs that help clin­i­cians main­tain eye con­tact with pa­tients.

Ar­chi­tect Ken Dun­can, in the Tulsa of­fice of the Dew­berry ar­chi­tec­tural, en­gi­neer­ing and con­sult­ing firm, said small el­e­ments that cre­ate waste in a med­i­cal of­fice can add up to a lot of time and money. Dun­can ad­vo­cates us­ing Lean meth­ods to de­sign pa­tient­cen­tered care fa­cil­i­ties that elim­i­nate waste­ful and in­ef­fi­cient pro­cesses.

Ef­fi­cient fa­cil­ity de­sign can stream­line care de­liv­ery. Dun­can used Lean meth­ods—both in the de­sign process it­self and in the fi­nal plan—to cre­ate physi­cian of­fices for St. Louis Park, Minn.-based Park Ni­col­let Health Ser­vices.

That process led to build­ing a sim­ple phys­i­cal lay­out that al­lows pa­tients to find their own way to their exam room with­out hav­ing a med­i­cal as­sis­tant or nurse es­cort them. While ac­com­pa­ny­ing pa­tients to a room may only take two min­utes, if mul­ti­plied by 25 pa­tients per doc­tor and eight doc­tors, that can eat up a full-time staffer’s en­tire work day.

Chart­ing the pa­tient’s ex­pe­ri­ence, from the pa­tient’s point of view, is a good way to work on the de­sign, Dun­can said.

Van­der­bilt Health’s One Hun­dred Oaks med­i­cal mall in Nashville is housed in a re­pur­posed shop­ping cen­ter.

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