CREJ - Building Dialogue - June 2016
This, the 50th anniversary of Denver Health and Hospital Authority’s community health centers, sees the grand opening of its new Southwest Family Health Center and Urgent Care. While the community health centers have been impacting neighborhoods across the Denver area for half a century, DHHA has led the charge for innovative health care for over 150 years. Having identified a need and a passion to serve the underprivileged population long ago, Denver Health was the second health care provider in the United States to construct a community health center in 1966, in the Five Points neighborhood of Denver. Its mission, “Level One Care for ALL,” is its guiding principle, its “secret sauce” – evident in its consistent and powerful impact on patient health and economic revitalization in the communities it serves. Many at DHHA consider the work they do as bearing passionate witness to poverty and its far-reaching impact on society. Pete Gutierrez, associate chief operating officer, says, “Our staff has true empathy in their calling to serve the most underserved and overlooked in the Denver area. It’s beyond words really. It’s a rare and beautiful thing.” Lean Forward A special ingredient of DHHA’s secret sauce is its innovative use of Lean processes. According to the Lean Enterprise Institute, Lean simply means “creating more value for customers with fewer resources.” DHHA has been on its Lean journey for almost 10 years and has been using Lean processes in facility design for about six. Brown said, “In general, there are not a lot of health care organizations that have implemented a process to utilize Lean tools, and those who have are relatively new at it,” says Daniella Brown, assistant director of Lean Systems Improvement. “So we are really fortunate that our previous CEO had the foresight to bring Lean principles to our organization almost 10 years ago.” Lean is such an integrated part of the Denver Health organization that there is an overarching expectation that all staff, including providers and administrative personnel, will use Lean tools and participate in Lean events. This commitment has led Denver Health to eliminate a staggering $109 million of waste in just six years. The Newest Community Health Center Several years ago, a Community Needs Assessment revealed that an area of South Denver suffered from a severe lack of health care resources and had one of the largest populations of undocumented citizens in Denver. “The hard-working people living in this community are the ones who are building this city with their hands,” says Paul López, Denver City Councilman District 3. “These are the people for whom the American Dream just isn’t paying off. In fact, 2010 data showed that residents in our area were expected to prematurely die eight years earlier in comparison to other districts.” This assessment led Denver Health to launch the design and planning of the new Southwest Family Health Center in 2014. Located off of Federal Boulevard, this new clinic is the largest DHHA community health center and the only one with an urgent care. “One reason current Denver Health staff is enthusiastic about the new clinic is that a lot of the patients they serve at the Westside Clinic and others actually live closer to the new location,” says Tina Quintana, clinic administrator. “They are excited that patients will have a health center close to their own homes.” Similar to their other community health centers, DHHA is looking to staff 50 percent of the Southwest Clinic with people from the local community, especially those who speak Spanish and Vietnamese, to help fuel the neighborhood transformation and to better serve their patients. Like all others in the DHHA system, the Southwest Family Health Center is certified as a Patient-Centered Medical Home. The goal of the community health center system and the medical home model is to provide lifelong care for entire families, not just single patients. It is not uncommon for DHHA providers to serve several generations of the same family. “In all of the clinics with primary care, the goal is to establish a family doctor or primary care doctor to follow the patient and their extended family through their life as long as we’re here and as long as they’re here,” says Dr. Michael Russum, the new medical director of the Southwest Family Health Center and a primary care physician. “That’s the core of the medical home model.” Lean Processes, Collaborative Partnerships and Aligned Visions Because every action of Denver Health is motivated by its mission to deliver “Level One Care for ALL,” it wanted a team of designers and builders for the development of the Southwest Clinic that aligned with its commitment to supporting the communities it serves. RTA Architects was chosen as architect of record because of our client-centric principles and expertise in health care, education and community-based projects. “Denver Health clinics are woven into the fabric of the communities they serve,” says Jessica Massie, RTA interior designer, when reminiscing about recognizing Denver Health’s mission from the very beginning of the process. “Even though they are building similar community health centers throughout Denver, they want to respond specifically to the demographic of the community in which the clinic is located. They truly want to provide the best possible health care for all of their patients and thoughtful, high-quality facilities help to accomplish this.” The design portion of the process began with an immersion phase in which the RTA design team shadowed current DHHA staff at the Westside Clinic for several days in order to understand the clinic’s processes and user needs. The design team also toured three other existing clinics, including Montbello, Park Hill and Lowry. It became RTA’s goal to not only embrace the powerful impacts that these clinics have on their patients and community, but also to design a community health center that reflects and will continue to help further the Denver Health mission. The next part of the process included a weeklong Lean 3P (Production, Preparation, Process) event with RTA and a multidisciplinary Denver Health team working together to rapidly create and test potential designs. Having used Lean tools for 10 years, DHHA has developed expertise in leading Lean events. However, the events held for the Southwest Family Health Center were unique in several ways. Attendees of the events were brought into the design and planning process very early on, which is not always the case in facility design projects. All clinic departments participated concurrently, which allowed every voice to be heard and consensus to be reached more easily. Members of the design team were committed to remain open-minded and receptive to all suggestions, as were the DHHA physicians and providers. “Traditionally, we talk to user groups individually and then try to mesh together all of their needs and desires into a design,” says Megan Norris, architect at RTA. “This time, all of the departments came together and we were able to massage things to work congruently. Everyone saw what decisions were being made and why.” “I think it was a really great collaboration right from the beginning,” says Quintana. “We learned a lot about how the architects design and build buildings, and I think the architects learned a lot about how we work in the clinics. People walked away feeling like they had truly been heard.” The Result Now, nearly 30 months after the planning of the clinic began, the physical concept of the 45,000-square-foot Southwest Family Health Center is finally a reality. Denver Health’s intentionality is embodied throughout the entire building, from a large interactive children’s play zone, to expansive atriums and lobbies for large community gatherings. There is also a multipurpose community conference room, which can be used for activities such as cooking classes where community members learn about nutritional life choices. Universal signage and intuitive wayfinding allow multilingual patients to easily navigate their way through the facility. Departments that need to be most accessible to the community, like urgent care, pharmacy and dental services, are all located near the entrance of the building. The facility features high-quality finishes and design touches. With warm wood, slate tiles, expansive skylights and vaulted ceilings, the Southwest Family Health Center provides Level One care both medically and aesthetically. Denver Health continues to be a leader for innovative, patient-centered health care in Colorado. Its unwavering commitment to providing the highest quality care and service for every patient equally is truly the secret sauce that makes this organization a model to other health care networks. “I am so excited for the opening of this clinic,” says Dr. Russum. “It just feels great to be there, and the space feels absolutely joyful. It’s going to be an incredible new opportunity for Denver Health to continue to serve the Denver population.”