Insights From Physicians, Patients Help Shape Future Clinic Design
It’s long been recognized that the delivery of healthcare in the U.S. doesn’t quite stack up against that of other peer countries across the world, ranking low comparatively on effectiveness, quality, and even healthy living, said Jim Miller, executive vice president of JE Dunn Construction—“We should not be proud of this.”
Miller spoke at the ASHE PDC Summit this week in the session “Designing for an Ever-changing Present: Insights from Patients and Physicians on Designing Change-ready Facilities.”
To address these needs of the modern healthcare landscape, providers are making a dramatic shift toward outpatient care and increasing access points—a trend that prompted JE Dunn to partner with architectural firm HKS Inc.’s research arm CADRE to uncover the clinic of the future.
Joining Miller to discuss the research results were Upali Nanda, vice president and director of research for HKS, Tom Harvey, principal and senior vice president for HKS, and Philip Macey, national director of collaborative project delivery at JE Dunn.
Nanda outlined the research initiatives that unfolded as part of what was dubbed Clinic 20XX, a project that eventually sought to not define a faceless future but instead prepare for what’s an ever-changing present and how clinics in 2016 or 2040 will need to work. The effort included a large literature review, case studies, surveys, and drawing conclusions for design.
The drivers for change were first identified: healthcare reform, an evolving patient population and provider base, a changing field for care delivery, and technology.
The trends that emerged from those drivers started with mHealth, including care delivery supported via mobile devices to online patient portals, and telehealth, which captures other types of remote care access. Coordinated health was another trend, or larger teams of caregivers working collaboratively alongside more informed patients, as well as population health that expands the continuum of care. Finally, retail health beyond the corner drugstore and including demand-focused, choice-based care was also identified as pushing the solutions being brought to the table.
The desire to see what organizations are or aren’t getting it right next inspired the case studies as well as polling of patients and physicians.
Some of the significant results included a perception by respondents (results from millennials and baby boomers, specifically, were reported) of seeing themselves as patients needing care far more than as consumers buying services, despite trends toward retail delivery. “Our industry is different, is unique. We need to respect that,” Nanda said.
Additionally, both generations agreed that a good experience is more important than just having their health addressed, with influences for selecting clinics based on insurance coverage and cleanliness.
For physicians, they reported more time with patients as the number one thing that would make them more satisfied with their jobs, and the patient relationship as most important to them. Fifty-five percent were open to the idea of virtual visits, and the availability of exam rooms was the primary facility feature they seek.
With a better understanding of what both patients and physicians find important, the team next identified some change-ready features that can be designed into clinics, including a streamlined check-in process through kiosks and quick entry to exam rooms (also calling for much smaller waiting areas), exam rooms evolving to rather be consult rooms, moving the discharge process to the exam room to eliminate that physical space, and creating a work core to support a team-based approach to care.
Macey then tied those design possibilities to how they might influence construction, starting with the need for more space. For example, clients may seek larger sites to provide associated services like nutrition of physical therapy alongside clinic space or dedicating more square footage than a janitor’s closet to best support demands for cleanliness. “Cleanliness isn’t just a shrug,” he said.
Technology will have a large influence on buildings, as well, with Macey projecting that clinics will need to be just as technology enabled as hospitals and that clash detection used for building systems today will be necessary to streamline the complex wired and wireless systems that will be needed.