“We identified issues that were problematic in the old space or were unmet needs, and then worked to address those in the design,” says Randall Huss, MD, president of St. John’s Clinic-Rolla Division.
Additionally, the facility is one of the first in the country to be designed to leverage the capabilities of the electronic health record. “Up until now facilities have been typically built to accommodate the paper record and its associated workflows, which requires significant storage space and certain design features,” says Dr. Huss. “Because we had implemented Epic as our electronic health record, we didn’t have to build the same type of facility as had been done in the past.” This allowed the original facility plans to be reduced from 125,000 square feet to 107,000 square feet, which created a savings to the organization and significantly reduced its overhead costs. “Healthcare organizations have squeezed our payors for about all we’re going to be able to in a fee-for-service model, so one way we can improve margins is to be more efficient,” says Dr. Huss.
1. Smaller waiting rooms. One of the first unique characteristics you’ll notice when visiting St. John’s Clinic is that the waiting rooms are much smaller than in traditional offices. The waiting room for a six-provider office has only eight seats. “Why would you design wait into an area?” asks Dr. Huss. St. John’s “greeting area” features a greeter at a welcome desk who currently checks in the patient and takes copays, but who will eventually oversee several electronic self-check in kiosks. “Our goal is to get patients back to a room and seen by a nurse as soon as possible,” says Dr. Huss. Families and friends who accompany patients can wait outside offices in a patient-centered galleria area that features comfortable seating.
Reception is able to be so lightly staffed because all calls are handled by a dedicated on-site communication center staffed by schedulers and nurses that serves all offices in the building. “Previously, patients would have to leave a voice mail, and then frustrated nurses would spend a lot of their time listening to the messages and calling patients back for additional information,” says Dr. Huss. “Now the patient speaks with a live person, and the message is entered into our electronic health record from where it is sent to the appropriate provider or nurse pool so it can be immediately addressed.”
2. Physician lounges. Another feature of many physician practices missing at St. John’s Clinic is individual offices for physicians. Instead, the building features shared physician lounges that straddle two business units. The space features comfortable furniture, a small conference table, refrigerator, a big screen TV, bookshelves and shared computer work stations. Dr. Huss challenged the physicians to give up their private offices in return for improved shared spaces. “What have you really used your offices for? We have kept bookshelves of outdated references from medical school and hidden our stacks of paper charts with messages or lab results waiting to be addressed,” says Dr. Huss. “Now, we have access to electronic references every place you touch a computer. There’s not as much need for the space.”
Switching to shared lounges reduced the square feet dedicated to physician areas from 1,800 to 500 feet for three business units, allowing each business unit to accommodate one more physician. “This allows us to further spread out overhead and improves the bottom line,” says Dr. Huss.
3. Standardized rooms. St. John’s Clinic also features standardized rooms with smaller storage areas for supplies. “All rooms are built identically (no right and left handed mirror image rooms) and equipped in standard fashion with just-in-time inventory,” says Dr. Huss. Smaller inventory has reduced expired and wasted supplies, which in just one of the clinic’s business units amounted to $1,400.
Patients spend most of their time at the clinic in these rooms and are rarely moved around the facility as doing so would add additional steps and go against lean principles. “We wanted to stop hauling patients between a cast or procedure room,” says Dr. Huss. “Nurses are now trained to bring the care to the patient. Gear bags for casting and minor surgeries can be picked up by the nurse and brought to the room, which saves time from running around assembling the supplies from one cabinet or another.” Additionally the typical office check-out counter is eliminated as the nurses are trained in the scheduling module of the EHR, so patient check out and next appointment scheduling is done right in the exam room.
4. Encourage team-based care. St. John’s Clinic is also designed to encourage team-based care, which is a new approach toward care that has been made possible by the EHR. “The paper record could only be in one place at one time, but now we can do team-based care,” says Dr. Huss. “Physicians and multiple nurses can view patient records simultaneously.”
The new facility’s innovative approach to the traditional nursing station also encourages team-based care. Instead of the typical office nurses station, the facility features the “Care Team Module” wherein each physician office features two carousels of nursing computer work stations, surrounded by the providers’ computer work stations on each side to create an open work environment that allows nurses, physicians and mid-level providers to interact more easily.
Contact Lindsey Dunn at lindsey@beckershealthcare.com
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