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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A Model for the Future
Health care facility designs are evolving to support the changing landscape and are increasingly resulting in the repurposing of existing facilities. Environetics, an architecture, interior design and engineering firm founded in New York, experienced this investment in the repurposing of existing facilities firsthand through a recent project with one of Southern New Jersey’s leading health care providers, Lourdes Health System.

In March 2013, Environetics completed a $14 million, 55,000-square-foot ambulatory care center in the heart of Lourdes’ service area in Cherry Hill, N.J. The facility is an adaptive reuse of a vacant supermarket. LourdesCare was designed with the knowledge that to stay ahead of the accountable care paradigm, health care organizations must improve access and promote greater seamlessness in the continuum of care — one-stop shopping.

The facility is home to Lourdes Cardiology Services and other nationally recognized physician specialists, including cardiac surgeons, orthopedic surgeons, physical medicine rehabilitation specialists, podiatrists, rheumatologists, sports medicine specialists and vascular surgeons. Other services include cardiac testing, cardiac rehabilitation, heart failure care, lab services, physical therapy, wellness services and general diagnostic imaging.

Designing a Facility to Meet Tomorrow’s Challenges
Lourdes Health System wanted a facility that could evolve with the changes in health care delivery and be able to facilitate the management of patients’ wellness at all stages of life. Every design detail is meant to support Lourdes Health System’s goals.

In selecting the existing property to repurpose, the vacant supermarket was an ideal choice. For many of the same reasons that the space is suitable for a supermarket, it lends itself well to health care — expansive structural bays, high floor-to-structure clearances and ample parking. It also allows for flexibility and, given the nature of change in the health care industry, flexibility is critical. The new facility is designed to allow for growth and contraction of departments over time via interchangeability of rooms, standardized planning modules and unifying circulation systems.

The project’s architects strived to design a space that was easily understood by first-time visitors to the facility. This was accomplished by orienting all of the major waiting rooms along a single concourse that faces the street and main entry drive. Each practice is identified with a diagonal marker wall (or marquee wall) along the curve to further enhance wayfinding. Additionally, all check-in and checkout spaces are purposely treated the same so patients can quickly become orientated to the process when they arrive.

One of the major reasons for selecting the property was that the building is located at a high-visibility intersection. This very attribute, however, presented a challenge to the design team because the building sits at a lower elevation than the roads, so passersby look down at the building. The Environetics team embraced this as a design opportunity and created a gently arching fin wall that brought attention to the main entry and became a brand identity element for Lourdes Health System while screening the mechanical units on the roof.

The expansive glass storefront allows drivers and pedestrians on Brace Road to window-shop for health care services. Just through the front doors, the fin wall from the exterior leads the visitor into the main entry and transitions to a gently curving soffit that defines the circulation and the waiting spaces. The concourse is designed to be full of light, with continuous glazing and a simulated wood canopy that creates cover outside while continuing to the inside, helping to create a visual transition from outside to in.

Inside, the interior design team aimed to enhance the feeling of warmth and hospitality with natural materials and lively lighting design. Finishes conform to a strategy of on-stage and off-stage areas, resulting in a disciplined allocation of cost. Areas frequented by patients promote a sense of comfort and hospitality, while staff work areas and other off-stage support spaces are more utilitarian.

This project is exemplary of a growing trend in health care financing. The LourdesCare project was financed and led by Rosewood Real Estate Enterprises and completed with a design-build approach with services from Environetics, consulting architects Alberto & Associates and contractors The Norwood Company. The design/build model allowed for an efficient and effective cost-management process that involved daily collaboration between all parties over the course of a remarkable 11 months from the start of planning through the completion of construction.

Fletcher H. MacNeill, AIA, NCARB, LEED AP is the principal in the health care practice at Environetics, founded in New York.

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