The University of Wisconsin (UW) Medical Foundation took such an approach when creating its UW Health Yahara Clinic in Monona, Wis. The foundation partnered with Kahler Slater, based in Milwaukee, to design an outpatient clinic that supports a lean and efficient operation ideal for staff collaboration and enhanced patient satisfaction.

The Vision

The UW Medical Foundation identified a need to serve the growing communities along the Yahara River near Madison, Wis. The organization desired a solution that would meet the challenges of providing quality ambulatory care and acknowledge concerns of safety, privacy and the ongoing drive for efficient care with better patient outcomes. The family medicine clinic needed to include imaging, lab and physical therapy services, as well as health education support spaces.

The UW Medical Foundation’s vision is patient-centered and quality-focused. The organization decided to adopt the patient-centered medical home model of care to improve clinical quality by optimizing an integrated care team, increasing patient engagement and offering a holistic approach to patient care.

Kahler Slater designed the ideal space arrangement to support the operational model. Key to achieving the desired results was locating Integrated Care Team (ICT) space as close as possible to the areas where care is delivered. A new space plan was developed that places offstage ICT space isolated from front-of-house patient amenity space and circulation.

When completely separating front-of-house and back-of-house in a clinic setting, the one place the two must overlap is in the exam rooms. The solution was to create double-sided exam rooms with a patient entry at the front and caregiver entry at the rear, allowing complete autonomy for both realms. Caregivers can collaborate within a fully integrated care team environment without concerns for privacy or interruptions, and patients are provided with a comfortable, hospitable environment away from the clinical environment with no overlap.

The operational model flow supports voluntary self-rooming, which incorporates technology to assist with wayfinding. This results in creating a convenient, no-wait option for those who choose to self-room and reduced wait times for all patients.

ICT Off-Stage Collaboration Space

One of the goals inherent in the ultimate design solution was to create an efficient workflow by drawing physicians out of private office environments and into integrated team environments where collaboration and face-to-face communication are encouraged. At the UW Health Yahara Clinic, the design strikes the necessary balance between integrating physicians into the care team areas and creating a private and secure environment so that patients’ cases can be discussed openly without confidentiality concerns.

By centralizing these private ICT spaces and surrounding them with exam rooms, communication remains centralized and not spread out across the facility, which greatly reduces travel distances. During post-occupancy research analysis, a footstep study showed that the clinical staff’s average walking distance from patient to support spaces was reduced by 83 percent.

Double-Sided Exam Rooms

Creating larger spaces for caregivers to interact with patients allows flexibility to provide a range of consultation environments. Rooms can be arranged as informal meeting spaces with soft furnishings, with an exam table for physical examinations, or grouped together to create larger rooms for educational group visits or group therapy.

Each exam room has double-sided access, allowing patients and caregivers to enter and exit without crossing paths. A simple switchboard at the central reception desk that turns on a series of three lights lets caregivers and staff know that either the patient is in the room waiting to be seen, the exam is finished and the room needs cleaning, or the room is clean and awaiting the next patient.

Reduced Waiting Room Size

Historically, outpatient facilities reserve two chairs in the waiting room per exam and procedure room, but more recent recommendations are for one to 1.5 chairs. At the UW Health Yahara Clinic, less than one chair per exam and procedure room was provided. Those chairs support the hospitality station for early arrivers, rather than being used by patients waiting for an available exam room. This area reduction almost entirely offsets the increase in circulation surrounding exam rooms to achieve the self-rooming and private ICT environment.

Empowering the Patient Through the Use of Technology

In addition to self-rooming for exams, patients can use a check-in kiosk integrated into the reception desk to announce their arrival for outpatient visit, diagnostic test, lab, mammography, X-ray and physical therapy appointments. Once checked in, patients proceed to the sub-wait areas or directly to their appointment. The kiosk empowers the patient by providing another option that speeds up check-in and reduces wait times. If a patient does not desire to use the kiosk, a friendly staff member is only a few feet away to provide personal assistance.

Setting the Benchmark

The UW Health Yahara Clinic aligns with the Marketing and Planning Leadership Council’s November 2010 Implications of Reform on Facility Design imperative, which proposes necessary steps to achieve true national health reform. The new proposed standards aim to improve cost of care, patient access, workflow efficiency and coordination across providers and settings.

A post-occupancy evaluation was completed one year after occupancy and revealed positive results. Improvement in scores for the UW Health Yahara Clinic show a range of 12 to 22 percentage points for general reputation, wayfinding and the environment − proof that the separation of public and private functions allows for a clarity of wayfinding and for well-crafted public space that creates the best experience for the patients and visitors. An overall 25 percent increase in patient satisfaction scores was a clear signifier that this separation allows the caregiver teams to focus on giving the quality care that the UW Medical Foundation is committed to providing.

In addition to the positive patient feedback received, caregivers overwhelmingly commented on the improved working environment, improved patient privacy, reduction in interruptions to nurses, improved efficiency with close proximity to exam rooms, and an appreciation for the natural light and views out to nature from the working environment.

The success of this operational model has elevated the UW Health Yahara Clinic to become a recognized benchmark facility for the delivery of ambulatory care.

An internationally registered, award-winning architect with 14 years of design experience, Eric Mayne, AIA, RIBA (emayne@kahlerslater.com) is a health care architect and project designer with Kahler Slater.

Also contributing to this article were Theresa Soik, director of facilities and materials management, and Lori Hauschild, director of clinic operations, with the University of Wisconsin Medical Foundation.

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The Wisconsin chapter of the ASID presented the awards, which recognize outstanding interior design in categories such as corporate or office space, health care retail and hospitality.

The firm received the Gold Award for its design of the LEED-certified UW Health Yahara Clinic in Monona, Wis. The sustainable design included the use of wood throughout the facility, creating a warmer environment than most medical clinics. The front desk and a cabinet in the lobby were made entirely from walnut trees. The daylighting elements also added to the overall interior design, especially with views of Wisconsin wildlife, such as deer, turkey, cranes and possums, in the distance.

Earning Silver Awards were the firm’s designs of the LEED-built Meriter DeForest-Windsor Clinic in Deforest, Wis., and the LEED-certified Monroe Clinic in Monroe, Wis. The Meriter health clinic was designed for maximum flexibility to accommodate busy times for the clinic and it also has views of the area’s native meadowlands. Technology, such as an electronic medical record system, interactive website and automated kiosks upon arrival, also help maximize efficiency at the clinic. The Monroe Clinic’s four-story expansion was designed using evidence-based design. Healing gardens, a rooftop meditation area and an outdoor dining terrace all work towards helping the patient, as well as adding a sustainability factor.

A jury of ASID members from outside of Wisconsin chose the award winners. Projects were evaluated for the appropriateness of the design solution; functional use of space; innovative and creative use of space, scale and proportion; color composition; design elements; and commitment to sustainability.

In late 2012, Kahler Slater also won the nationwide 2012 Patient Empowered Room Design competition, presented by the Atlanta-headquartered Institute for Patient-Centered Design Inc.
 

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It is one in only 438 LEED-certified health care-type facilities to earn the designation, representing a mere 3.1 percent of LEED-certified projects nationwide. But it is also one of a handful of health care facilities within the University of Wisconsin Medical Foundation’s system that already received the designation.

“UW strives to be sustainable and they make that a priority throughout the entire university,” said Deb Lovik-Kuhlemeir, BS, RN, TNS, clinic operations manager at the facility. “UW likes to be the leader in making positive solutions in our community, and I think they are taking the lead in this case.”

The UW Health Yahara Clinic serves the greater Madison area, offering family medicine, laboratory, X-ray, mammography and physical therapy services, as well as health and nutrition classes. Built with LEED certification in mind from the beginning, it officially opened in September 2011 and has been in the LEED mindset ever since.

“[Working towards LEED certification] has to be on the forefront of preconstruction. Every piece of construction and every design that you make or create has to have that LEED certification in mind,” Lovik-Kuhlemeir said. “Then, the clinic staff has to sustain whatever [the architects] created in the project and take it to the next step. The LEED application process is something that starts after construction is completed.”

Among the LEED standards that the construction team focused on were some of the more typical requirements: energy-efficient lighting, low-flow water systems, recycled construction materials and the use of low-VOC-emitting materials, to name a few. They also employed an HVAC system to help create good air quality.

As far as sustainable design goes, one of the highlights was the use of wood throughout the facility, creating an environment that appears less sterile than most medical clinics. For example, the front desk is made entirely of wood, and a cabinet in the lobby is made from walnut trees. The new clinic, which combined two area facilities, took the cabinet built by a wood smith in the McFarland community (where one of them was located) to display old medical instruments from the former Monona clinic, representing the joining of the two communities at the new facility.

Windows and the use of natural light also played a big role in accomplishing a LEED-worthy design. Offices and other spaces primarily used by the staff and public were placed close to the windows on the outside of the building, while more private areas such as exam and procedure rooms were located on the interior. However, even the lab facilities have windows located at the top of the walls — which make a more positive environment for the patients and staff alike.

“Our staff is able to sit by windows and look out at deer, turkey, cranes and possums, even though we’re in the middle of the city,” Lovik-Kuhlemeir said. “It’s so calming to have that nature around you.”

The 32,600-square-foot facility was designed by Milwaukee-based Kahler Slater and developed by J.H. Findorff & Son and Livesey Co., both located in Madison.

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