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INSPIRE • LEAD • DELIVER
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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 presentTom 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.