CREJ - Healthcare Properties - October 2017
At 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 Present, conducted by the Center for Design and Research Evaluation, HKS’ knowledge initiative. The study asked the question, “How do we design, not for a faceless future, but for an ever-changing present?” It sought to understand the key drivers of change in health care, prevalent trends in response with the ambulatory care setting and facility 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 changeready clinic. Why is it important? As the spectrum 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 review were 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 generation, Gen Xers, baby boomers and millennials. 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 experience 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 valued much higher by millennials. • Approximately 61 percent of millennials 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 boomers, 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 replacement of private offices with physician workstations more integrated into the workplace of the entire care team. •Design implications. Change-ready facilities were identified as having two key types of spaces: consult space (to foster meaningful, informed interactions) and work space (to support the key consult or patient/provider connection). 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 meaningful 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, connectivity 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 population). 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, connected and appealing across generations (though generational specificity can be targeted based on demographic). Multiple potential uses of space, particularly to engage the community, are included in this idea.