In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

Catherine Gow is the principal of health facilities planning for Francis Cauffman Architects (New York and Philadelphia). Here, she shares her thoughts on the changing paradigm of ambulatory care and how it’s affecting the planning and design of new ambulatory health and wellness facilities.

  1. Rise in interdisciplinary care

Health centers are changing: Individual practice models are being replaced with multispecialty care spaces designed for interdisciplinary use. This collocation of practice groups is convenient for patients by enabling them to see multiple physicians in a single visit. It also encourages synergistic communication among the medical staff, including primary care physicians, specialists, nurses, case managers, educators, nutritionists, phlebotomists, concierge team members, medical assistants and the clerical team, who can all work together to eliminate steps and streamline patient visits. This improved efficiency allows clinicians to significantly grow the number of patients they’re able to see. For example, one model we created for a client in Brooklyn, N.Y., increased annual patient volume by up to 3,000 patients per physician. This increase in throughput was achieved not only through the operational care model and facility design, but also by leveraging technology that eliminated wasteful steps to provide a simplified patient experience.

  1. New ambulatory care delivery models

A new trend in ambulatory care is the organization of treatment delivery around disease type. This model puts patients’ health issues front and center for the care team, focusing resources on disease types such as musculoskeletal, diabetes and endocrine, cardiovascular, women’s, pediatrics/family care, and more. The facility that accommodates this care must be modular, with flexibility to handle the ebb and flow of patient volume per day. For example, key elements such as a radiographic machine might be added to complement and provide additional needed information for the musculoskeletal pod. The exam room design should take full advantage of the most recent technology to share patient scans, take notes in EMR, and print or digitally send prescriptions and care instructions for patients.

  1. Connecting with the community

Ambulatory centers are most successful when they embrace their community. Getting input from residents and patients on what they want to have in a new health center helps to create a community vision for the project. Providing open spaces for wellness fairs, educational sessions, and exercise classes and support groups isn’t just good design, but a way to build trust between the care center and the people it serves. These spaces should be able to flex up for larger engagements or be divided into smaller settings to accommodate meetings, education, and training sessions. Having a retail component can also engage the community and help draw them to an institution more frequently.

  1. Making room for telemedicine

Once thought of as a futuristic luxury, telemedicine is now a typical added benefit to many insurance plans, with adoption of telemedicine services growing from roughly 54 percent in 2014 to 71 percent in 2017 according to HIMSS Analytics’ “2017 Inpatient Telemedicine Study.” The Facility Guidelines Institute’s 2018 FGI Guidelines set size standards for these spaces, which should be designed to accommodate a range of exam types, including one-on-one interactions, consultations with a patient and family members (e.g., pediatric or elderly patients), examinations supported by a telemedicine presenter located with the patient, or specialty services such as dermatology or orthopedics. Within a telemedicine space, the exam table should be situated so that the camera can have full view of the patient and finish selections should take care not to conflict with patients’ natural skin tones, so that conditions such as jaundice can easily be observed. Additionally, site identification signage is sometimes a required element for reimbursement.

  1. Don’t forget employee wellness

Staff wellness has come to the forefront in this busy and competitive market. As experienced staff age out, younger employees will replace them. This new generation has a different vision of what they expect in their work environment. Gone are the days when a windowless lounge space for staff in the basement was sufficient. Instead, employees today are looking for staff spaces designed to support and improve their health and well-being, reduce stress, and provide access to nature and light. Amenity and cultural requirements should be considered, as well. For example, staff that are nursing need private, comfortable places to pump, and those that need to pray should have thoughtfully designed areas to do so. Taking care to provide employee wellness spaces will improve employee satisfaction and retention.

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