Pumping Cost-Effectiveness into Design - A Necessity in Health Care Today?
Increasing efficiency by reducing waste and streamlining resources has its place on the production line, say in a car manufacturing plant, but what about in healthcare? After all, you’re dealing with people not products; more specifically, in this case, their hearts.
Accelerating efficiency was a driving force in re-designing the University of Utah’s new Cardiovascular Center, while simultaneously improving quality of care for patients. To achieve cost-effectiveness in the 21st century, healthcare must tighten its belt while avoiding carving into patient care.
“Our guiding principal in this re-design was ‘let’s get the patient seen as quickly as possible while still providing the best care possible—let’s be respectful of their time and as efficient as possible with our time,’” says Steven Tew, MHA, MBA, Director of the Cardiovascular Center.
Thus far, the results are positive. In this already busy clinic, about twenty more patients a day can be seen due to smart architectural changes ranging from reducing the steps care providers must take to reach patients to freeing up rooms by creating specialized spaces for consults and blood draws. “We spent three years examining work flow and listening to staff, providers, and patients about how we could improve our physical workspace,” says Dr. Brent Wilson, M.D., Ph.D, who is the Medical Director of the Cardiovascular Center, an 11,000-sq.-ft. space located on the hospital’s first floor. They also visited places like the South Jordan Health Center, the downtown Main Library, and Apple stores to determine the feel they wanted.
The feedback nurses, medical assistants, receptionists and others shared, unearthed details like move the air-return vents in patients’ rooms so the sound they make doesn’t interfere with listening to a patient’s heart. Place patient beds behind the door so they are not in the line-of-sight when doors open. Make doorways and hallways wider to create less congestion and more maneuverability for wheelchairs.
Along with smart efficiency modifications, a tenet of the design was to create a more personal, welcoming space for patients and easy collaboration for physicians. The Cardiovascular Center is the gateway for all cardiovascular services, where all patients begin and return to after a procedure or operation. “We are aiming for a small practice feel in a large clinical operation,” explains Wilson, whose staff sees around 125 patients a day. “We do not want patients coming in and feeling like they are just one patient among so many others.”
Perhaps the design’s most heartening feature is how it has been set up for easy collaboration among some 100 specialists that hold clinic there each week. Divided up into eight clinic pods, each accommodating a different specialty with its own nurse station and shared doctor work stations, these pods are quiet, calm islands. If a doctor needs to consult with another specialist, it may require 50 steps—a short walk away. For example, if a patient’s heart valve needs replacing, there are several treatment options—open heart surgery or a percutaneous procedure (through the femoral artery). The doctors that specialize in each of these procedures can quickly consult one another to determine what would be best for that patient. This access to immediate collaboration saves doctors’ time and provides convenience and comprehensive care for the patient. For the center’s large number of out-of-town patients, avoiding multiple appointments saves time and resources traveling to the center. “A center like this does not exist in the West,” affirms Wilson.
Below are some aspects of the design that reduced waste while maximizing value for the clinic and the patients:
The receptionist area (a.k.a., waiting room) is now multifunctional and its services are no longer duplicated elsewhere in the clinic. Located immediately off the main hallway, ensuring easier access especially helpful for older patients, this is the common check-in area for all heart patients; they will see/hear the same familiar faces/voices among the receptionists, regardless of which clinic they are in. It’s also set up to accommodate groups for educational/support classes in the evenings.
The nurses’ station used to be one central area requiring staff to walk 150-feet around it every time they checked on a patient or needed to respond to a quick question a patient, stepping out of the room, might ask. It was also the area where MAs and nurses ate their lunch, while there might be patients who were fasting in preparation for procedures. Now WHAT
Provider work areas for medical providers used to be crowded, noisy rooms with poor line-of-sight into patient rooms. Now, eight such rooms exist and it is visually apparent from the work area when the patient is ready to be seen—no need to walk around to check.
Two consult rooms now allow for patients to move out of examine rooms if procedures need to be scheduled, which can take up to an hour. They are also used to go over test results with patients. These free up examine rooms allowing each clinic to see an additional patient a day.
Two designated telemedicine rooms now provide outreach medical services via teleconference technology to some 15 locations, allowing patients in rural areas to be seen sooner, faster and without spending the time or resources to visit the center in Salt Lake City. Outreach to the prison population cuts down on transport expense for tax payers and security risks.
A Blood draw area now frees up 15-minutes that would otherwise be spent in an examine room. This opens up the possibility for another 10 patients a day.
A Radio Frequency Identification System (RFID), will provide data on where in the process time-efficiency can be improved upon. Tracking patients from the hospital entrance (signaling the center’s receptionists to greet them by name) and eventually into the exam room. The RFID will also show where the providers are in relation to patients to help improve the efficient flow in clinic. It will also ensure no patient is left unattended or without interaction for more than ten minutes; if so, iPad-like tablets outside each exam room will flash red and alert the monitor screen in the corresponding provider work area.