The medical home model of delivery is gaining ground among healthcare providers as a cost-effective way to provide primary and specialty care while at the same time lowering costs and improving patient outcomes.

The collaborative, team-based model focuses on reducing hospitalization, emergency room visits, and readmissions, with primary care providers serving as team leaders who coordinate care with specialists, nurses, and other professionals. Essentially, the right care is provided by the right provider at the right time in the right location.

This model offers patients better access to healthcare resources, specialty care, educational services, home-based care, family support, and public and private services.

The core of the medical home model is preventive care—providing the educational tools and resources to enable patients to better manage their healthcare. It’s also about patients partnering with their providers to take charge of their long-term health.

Since the greatest cost is always at the beginning and end of life, the medical home model also helps reduce cost by focusing on wellness—better prenatal care that leads to healthier babies and better life-long care that leads to healthier senior living.

There are many challenges affecting the design of healthcare facilities to accommodate this evolving collaborative care model. Designers must consider how to design flexible spaces for team-based, patient-driven programs that incorporate new technology and new ways of approaching the traditional brick-and-mortar outpatient clinic, and three specific trends are influencing design approaches. 

 

Collaboration
The spaces in a medical home model are organized around the care team. Previously, nurses’ stations were often remote from physician work/office areas. In this model, spaces are adjacent to each other, often to promote collaboration and shared information.

An individual exam room should be designed to have fewer fixed elements to allow the rooms to easily accommodate different specialists and equipment. Group exams in flexibly deigned spaces often supplement private exams with educational programming and group support as preventive measures.

Through this combination of individual and group exams, patients can better understand their conditions and learn how to control—and potentially prevent—problems.

 

New technology
Emerging technology continues to change the way patients approach healthcare and communicate with their care providers. Mobile devices, tablets, videoconferencing, and electronic medical records offer options for alternative approaches to traditional patient clinic visits.

In addition to patient interaction, communicating via technology also expands the professional network by connecting physicians with specialists remotely—allowing for collaboration and care solutions that were unimaginable 25 years ago.

Some clinics are already testing remote exams or consultations via videoconferencing or Internet-based communication options, such as Skype. A patient can be with his or her primary care provider while videoconferencing with a specialist to discuss the diagnosis and care options. This is particularly beneficial in rural communities where patients may have to travel long distances to meet with a specialist.

Other evolving remote technologies enable patients to access their records online, conduct self-tests, and transmit data back to their caregiver.

In designing clinic spaces, consider, for instance, that some exam rooms may be replaced by consultation rooms with videoconferencing stations or computers equipped with a camera and microphone for Internet-based video communication.

Mobile and remote communications can reduce the amount of square footage needed if fewer office visits are required, which helps lower a clinic’s operational budget. Just as technology is transforming the workplace, technology will continue to transform the clinic environment.

 

Flexibility
The medical home model may have the greatest impact on space planning.

For instance, HGA is currently developing a strategic plan to assess efficient space allocation and utilization for a national healthcare provider. Focusing on collaborative care models, the strategic plan is assessing the healthcare provider’s entire multi-campus system to determine the best use of space for care teams, group exams, wellness programs, education, and support.

For many healthcare organizations, strategically planning flexible spaces will be essential to future success and the ability to deliver quality care. Ever-evolving technologies, changing demographics, and new care delivery models all impact where and how healthcare will be available.

Already, shifts in space allocation outside of healthcare systems are taking place, as providers and retailers team up to offer micro-clinics within local Walmart or Target stores. For routine visits, patients are looking for convenience with their medical services; they’re becoming more interested in a quick diagnosis while running errands.

Many progressive businesses are also introducing wellness programs into their benefits package by having full-time, on-site wellness coaches plan programming and conduct consultations. Local fitness centers, community centers, schools, and other civic organizations are ramping up their wellness programs and forming partnerships with businesses to promote community health awareness.

These geographic shifts in clinic spaces—from a campus or clinic to a retail environment or business—are critical parts of the space allocation analysis. The healthcare “marketplace” is playing into how owners and designers approach a traditional clinic because patients have more options—all impacting space planning.

 

Conclusions
As national healthcare legislation puts greater pressure on lowering costs, the medical home model will gain momentum. By focusing on preventive care, wellness, and team-based care, healthcare providers need to look for ways to do more with less.

Efficiently designed clinics must focus on improved planning to accommodate evolving care delivery.  

Gary Nyberg, AIA, is Vice President and Principal for the Healthcare Practice Group at HGA Architects and Engineers. Christine Guzzo Vickery, CID, EDAC, is Vice President and lead healthcare interior designer for the Healthcare Practice Group at HGA. For more information, please visit www.hga.com.