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— Health Care Properties Quarterly — October 2017

www.crej.com

Healthcare Construction

on

Trust.

Built

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INSPIRE • LEAD • DELIVER

Photo: Ed LaCasse

Design

A

t a recent symposium in

Denver on innovations in

ambulatory care hosted by

our firm, leaders of the major

local health delivery systems

convened to share their experiences in

planning for the delivery of services to

patients through their ambulatory care

platforms.

The catalyst for the discussion was a

recent research study on clinic design

considerations, known as: Clinic 20XX

… Planning for an Ever-Changing Pres-

ent, conducted by the Center for Design

and Research Evaluation, HKS’ knowl-

edge initiative.The study asked the

question, “How do we design, not for a

faceless future, but for an ever-chang-

ing present?” It sought to understand

the key drivers of change in health

care, prevalent trends in response with

the ambulatory care setting and facil-

ity implications of these trends. It also

identified innovations and evidential

support for new concepts, filtered by

what patients and physicians want.

The outcome was the development of

a framework for a designing a change-

ready clinic.

Why is it important? As the spec-

trum of care increasingly shifts into

the ambulatory care setting, many

new trends are emerging, but evidence

to support these trends remains thin.

What is not clear is whether patients

really want what is being provided,

if physicians are on board and if the

trends we see today are just a fleeting

idea du jour, or if they are sustainable

and here to stay. Most importantly,

what are the key components of a

change-ready clinic that can withstand

a rapidly changing health care ethos?

Insights from a literature reviewwere

filtered through case

studies and survey

findings to develop

a framework for

the key space types

and characteristics

of a change-ready

facility.The surveys

were compiled into

age-specific groups

– silent genera-

tion, Gen Xers, baby

boomers and mil-

lennials.The latter

two offered the most

significant feedback

and were given

greater focus in the

findings. Some key

findings from the

study include:

• Considering the patient to be a

“consumer”may be premature. People

visiting a clinic consider themselves

patients needing health services, not

consumers buying health services.This

was true for 87 percent of millennials

and 88 percent of boomers.

• As a patient, the overall care expe-

rience trumps having a health issue

addressed across both age groups, but

more so for millennials than boomers.

Specific environmental enhancements,

such as a spalike experience, were val-

ued much higher by millennials.

• Approximately 61 percent of millen-

nials would like to use smartphones to

access health services, while 76 percent

of boomers still consider a phone just a

means of communication.

•The facility feature that is a top-

of-mind expectation across both age

groups is cleanliness.This response

was principally focused on the facility.

•Telehealth is something physicians

are ready for, but with certain caveats.

However, they don’t think patients are

quite as ready.This is true for boom-

ers, but millennials are ready for virtual

visits.

• Physicians who currently work in

open offices are more likely to prefer

them to private offices.The study saw

a strong movement toward replace-

ment of private offices with physician

workstations more integrated into the

workplace of the entire care team.

Q

Design implications.

Change-ready

facilities were identified as having two

key types of spaces: consult space (to

foster meaningful, informed interac-

tions) and work space (to support the

key consult or patient/provider con-

nection). Each traditional space can be

thought of as one of these two kinds of

spaces. For example, registration could

be done by a medical assistant, making

it the first consult; waiting areas could

have education elements, possibly

making them a virtual consult; and

even discharge could be an opportunity

for a follow-up care, re-affirmation and

consult. In other words, imagine all

patient spaces as spaces for meaning-

ful interaction.Workspace is all space

required to support this key patient-

provider relationship in an efficient

manner, promoting well-being of the

care team.

Three key characteristics of space

were identified as flexibility, connectiv-

ity and sense of place.

Flexibility relates to the ability to

expand, contract and shape-shift based

on changing needs, all the way from

plan and configuration to selection of

wall systems and furniture.

Connectivity relates to thinking of

the clinic as a conduit between the

data cloud (systemic connectivity to

health information) and community

(regional connectivity to target popula-

tion). Connectivity also emphasizes the

need for connection to site (strategic

location liked to its health system) and

connectivity between various specialty

care teams.

Finally, sense of place relates to

developing a destination, an experience

that is clean, quiet, comfortable, con-

nected and appealing across genera-

tions (though generational specificity

can be targeted based on demographic).

Multiple potential uses of space, par-

ticularly to engage the community, are

included in this idea.

How to design for an ever-changing present

Tom Harvey,

FAIA, ACHE,

FACHA, MPH,

EDAC, LEED

AP

Principal, Denver

office director, HKS

Inc.

Considering the patient to be a ‘consumer’ may

be premature. People visiting a clinic consider

themselves patients needing health services, not

consumers buying health services. This was true for

87 percent of millennials and 88 percent of boomers.