6/22/2016 Region IX Western Clinicians Network Conference Harvey’s Lake Tahoe, Nevada June 14, 2016 The Built Environment & Health Design Avein Saaty-T afoya, MD MBA HCM EDAC President & Chief Executive Officer Adelante Healthcare Board Member, Center for Health Design 1
6/22/2016 2
6/22/2016 Sources of Support and Revenue (in millions) 12 10 8 Federal Grant Patient Revenue 6 Other Grants Donations, Int 4 2 0 1998 2000 2002 2004 2006 2008 2010 3
6/22/2016 4
6/22/2016 2013 2013 REST ESTRUCT CTURING OF OF HEALTHCARE Blue ocean FOCUS ON PRIMARY CARE SEISMIC CHANGES 5
6/22/2016 ACA CA HEALTHCARE REFORM, LEGISLATION & THE BUILT ENVIRONMENT +3 +32M 2M Malone, E., Taylor, E., et al. PEOPLE (2015). Quality Care, Legislation and Design: An 50% 50% Issue Brief on Healthcare Reform. Concord, CA: The PAID Center for Health Design THROUGH Topics, Healthcare Reform . MEDICAID https://www.healthdesign.org EXPANSION /topics/healthcare-reform 50 50% PAID THROUGH HEAL TH INSURANCE Figure created by Ellen Taylor EXCHANGES THE HE GONE GONE INSTITUTE FOR HEALTHCARE IMPROVEMENT HO HOLY FORE FO REVE VER GRAIL GRAIL • Improve the patient experience QUADRUPLE AIM • Improve the health of populations • Reduce per capita cost • Improve provider engagement Marcus Welby, M.D. 6
6/22/2016 CAHPS Ambulatory Care Improvement Guide: patient experience in ambulatory care: CAHPS surveys Patient Experience Two CAHPS Surveys • Health Plan (1997) – experiences with health plans and their services • Clinician & Group (2007) – experiences with health care providers and practice staff https://cahps.ahrq.gov/qualit y- improvement/improvement- guide/1- about/index.html#about https://cahps.ahrq.gov/quality-improvement/improvement-guide/improvement- guide.html 7
6/22/2016 PCMH PC TARGETED PATIENT EXPERIENCE IMPROVEMENT STRATEGIES RESTRUCTURING OF PRIMARY CARE AHRQ CAHPS Strategies Safety Net Clinic Redesign Recommendations Hospital-based outpatient clinics Kaiser model PCMH Physician practices Community ….Lots more design recommendations can be found in the health centers report: Joseph, A., et al. (2009). Improving the Patient & safety net Experience: Safety Net Clinic Redesign . California clinics HealthCare Foundation. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20File https://cahps.ahrq.gov/qualityimprovement/improve s/PDF/PDF%20S/PDF%20SafetyNetDesign.pdf ment-guide/6-strategies-for improving/index.html#6a PA TIENT- RED CENTERED CARE HEALTH NURSE COACH PHARMACY PHYSICIAN PA TIENT IMPROVED OUTCOMES BEHAVIORAL NUTRITIONIST HEAL TH EFFECTIVE COLLABORA TION 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 IMPROVED Journal, 2 (2), 21-41. DECISIONMAKING MUL TIDISCIPLINARY 8
6/22/2016 Practice EBD Workshop Integrating EBD AN EVIDENCE-BASED DESIGN MODEL AMBULATORY CARE PATIENT EXPERIENCE Place (Infrastructure) People (Culture & Process (Reengineering) Leaders) Building Identify Desired End- Refine Staff Care Processes Trans- Disciplined Teamwork, State formational Execution & Leadership & Institutionalization Culture Technology Develop Readmission Engage Patients Reduction Plan Strategic Goals Improved patient, Infrastructure staff and Re-engineered Building resource outcomes Clinical Technology & Furniture/Equipment Measure and Reward Engage Loved Ones Involved in Care Furniture Administrative Progress Equipment Processes Research DESIGN DE GN DE DESIGN GN GOALS ALS GOALS ALS SAFETY-NET CLINIC CARE MODEL SAFETY-NET CLINIC CARE MODEL COLLABORA TIVE SPACES FOR CARE INCREASE VISUAL TEAM CONNECTION BETWEEN CLOSE TO EXAM WORKSP ACES ROOMS FLEXIBLE SPACES PORTABLE DIAGNOSTIC Design: NBBJ SPACE, FURNITURE, EQUIPMENT TECHNOLOGY TO SUPPORT GROUP TELEMEDICINE INTERACTION POINT-OF-CARE EASE OF TESTING COMMUNICA TION BETWEEN STAFF ELECTRONIC VISIBILITY HEALTH RECORDS MINIMIZE NOISE (USE OF CARPET) Design: Boulder Associates Design: HGA Architects 9
6/22/2016 DE DESIGN GN DESIGN DE GN CULTURAL SENSITIVITY GOALS ALS SAFETY-NET CLINIC CARE MODEL GOALS ALS RESPECT FOR DEVELOP DESIGN TRADITION CONCEPTS THAT HONOR VISUAL CUES AND CULTURES AND SYMBOLS TO ARE FAMILIAR TO CREA TE SENSE OF PA TIENT La Maestra Community Clinic PLACE POPULA TION Design: Richard Yen Associates INVOLVE PA TIENT ADVOCA TES ENVIRONMENT IS A SURROGA TE FOR QUALITYOF CLINICAL CARE Anchorage Native Primary Care Center Design: NBBJ Anchorage Native Primary Care Clinic Design: NBBJ DE DESIGN GN DESIGN DE GN GOALS ALS GOALS ALS SAFETY-NET CLINIC CARE MODEL SAFETY-NET CLINIC MODEL INTUITIVE WA YFINDING CARE COORDINA TOR/ STRA TEGIES PA TIENT NA VIGA TOR: A BRIDGE TO OTHER EASY-TO-FIND DESTINA TIONS RESOURCES SENSITIVITY TO LITERACY INTUITIVE SPACE PLANNING LANDMARKS AS VISUAL CUES ACCESS TO NA TURAL LIGHT THROUGHOUT Red Rocks Medical Center MAIN ARTERY Design: Boulder Associates Smiley ’s Clinic CORRIDORS Design: HGA Architects 10
6/22/2016 DE DESIGN GN DE DESIGN GN GOALS ALS SAFETY-NET CLINIC CARE MODEL GOALS ALS SAFETY-NET CLINIC CARE MODEL COLOR! USE OF PAINT IS COLOR CHEAP GOOD LIGHTING CULTURALLY RELEV ANT ART--- CHILDREN GIVEN CAMERAS TO PHOTOGRAPH THINGS OF INTEREST Grace Hill Neighborhood Health Center Design: Arcturis Grace Hill Neighborhood Health Center Design: Arcturis THE FUTURE FOCUS ON PA TIENT ENGAGEMENT RESTRUCTURING PRIMARY CARE OF OF MEDICIN DICINE? Physician working for patient, not insurance company RESTORE THE Holistic management of DOCTOR/PA TIENT preventative care & chronic RELA TIONSHIP OF conditions THE PAST ENHANCE THE Integrative medicine/wellness PA TIENT focus EXPERIENCE Ease of access; longer appts. REMOVE TRADITIONAL BOUNDARIES Physician as health coach BETWEEN PA TIENT AND PROVIDER Email consultations; remote Design: Jain Malkin Inc. monitoring Healthy Lifestyles 11
6/22/2016 RETAIL RE AIL CARE CARE HOLISTIC HEALTH CARE HOSPITALITY AND AMENITIES MODEL SMALL SCALE WELLNESS “ INTIMA TE” PHILOSOPHY SETTING TIENTS DO N’T PA INTEGRA TIVE WAIT MEDICINE LONGER APPOINTMENTS PA TIENT COMFORT IMPORTANT “ LIVING Design: Jain Malkin Inc. ROO M” AMBIENCE Design: Jain Malkin Inc. Exam rooms same-handed IT Rich Environment INN INNOVATION ON High visibility , collaborative team environment AMBULA TORY Open access PRACTICE to resources OF THE FUTURE ANSHEN + ALLEN | STANTEC CIMIT CENTER FOR INTEGRATION OF MEDICINE AND INNOVATIVE TECHNOLOGY - Remote conferencing and consulting - On-site or remote scheduling and check-in “ Off-stag e” - Virtual visits, including remote monitoring offices and automatic recording of vital signs to electronic medical records • Employee health center for Massachusetts General Hospital • The patient as “ exper t” 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 12
6/22/2016 INN INNOVATION ON INN INNOVATION ON AMBULA TORY AMBULA TORY PRACTICE OF THE PRACTICE FUTURE OF THE FUTURE ANSHEN + ALLEN | ANSHEN + ALLEN | STANTEC STANTEC CIMIT CIMIT CENTER FOR INTEGRATION OF MEDICINE AND CENTER FOR INTEGRATION OF INNOVATIVE TECHNOLOGY MEDICINE AND INNOVATIVE TECHNOLOGY VIEWS OF DESIGN EXAM BOSTON ROOMS HARBOR TO ENHANCE A V ARIETY OF PA TIENT SEA TING ENGAGEMENT TYPES NA TURAL “ ANYROOM IS AN LIGHT EXAM ROOM AND ANY ROOM IS A TALKING ROO M” INN INNOVATION ON INNOVATION ON AMBULA TORY AMBULA TORY PRACTICE OF THE PRACTICE FUTURE OF THE FUTURE ANSHEN + ALLEN | ANSHEN + ALLEN | STANTEC STANTEC CIMIT CIMIT CENTER FOR INTEGRATION OF MEDICINE AND CENTER FOR INTEGRATION OF INNOVATIVE TECHNOLOGY MEDICINE AND INNOVATIVE TECHNOLOGY TEAM DESIGN EXAM COLLABORA TION ROOMS VISIBILITY TO ENHANCE TRANSPARENCY PA TIENT/PROVID ER INTERACTION EXAM SIZE 1 0’ X 5 EXAM ROOMS 1 1’ PER CARE TEAM 13
6/22/2016 INN INNOVATION ON PARTNE TNERSHIP IP PROJECT MANAGEMENT AMBULA TORY Establishing a partnership PRACTICE OF THE FUTURE Long-term investment ANSHEN + ALLEN | STANTEC Identifying shared goals CIMIT CENTER FOR INTEGRATION OF MEDICINE AND INNOVATIVE TECHNOLOGY Execute an action plan CENTRALIZED COLLABORA TION SPACE: A KEY CONCEPT IN THE CAPITAL PLANNING PA TIENT- Investor CENTERED MEDICAL HOME “EVE RYBODY Design/Build OPERA TING TO THE LIMIT OF Design/Bid/Build HIS/HER LI CENSE” Lease 14
6/22/2016 DE DESIGN GN ADEL ELANTE TE SAFETY-NET CLINIC CARE MODEL GOALS ALS HEALTHCARE Family Practice MESA Pediatrics FACILITA TE Internal Medicine ONE-STOP CARE Behavioral Health “ WHOLE Dentistry PER SON” CARE OB-GYN Pharmacy HIGH VISIBILITY Nutrition MAJOR DESTINA TIONS Café Community Room Health Education Podiatry Design: Jain Malkin Inc. Patient Navigator Naturopathic Medicine Physical Therapy Audiology 15
Recommend
More recommend
