As the CEO of Adelante Healthcare, a federally qualified community health center with seven sites, Avein Saaty-Tafoya has overseen the delivery of comprehensive primary care services to 40,000 patients in Phoenix and surrounding communities in Maricopa County, Ariz., since 2006.

The mission of Adelante Healthcare is “reaching across our communities to provide comprehensive primary healthcare that is accessible, sustainable, and of high quality, resulting in the vision of healthy people, healthy communities.” For her work in achieving that vision, The Center for Health Design named Saaty-Tafoya the winner of its 2014 Changemaker Award. She will accept this award and serve as a keynote speaker at the 2014 Healthcare Design Conference, to be held Nov. 15-18 in San Diego.

The Center sat down with Saaty-Tafoya to discuss her organization’s growing mission, its challenges, and lessons for the future.

The Center for Health Design: How have your life experiences shaped your approach to serving as CEO of Adelante, and to your organization’s mission?
Avein Saaty-Tafoya:
My education and career experiences have a common thread in satisfying my curiosity about the people and communities around me. My orientation toward service was inspired by my teacher parents and growing up an immigrant in rural southeastern Ohio. There was always a sense of being a survivor where others had not been so lucky. It was important to me to have something to show for that second chance at life. Success has been defined for me by where and how I could make a meaningful difference.

 

Adelante’s roots have inspired its progress over the years, too, particularly in creating a sustainable healthcare system. How has the past shaped what the organization is today?
As we recalled our beginnings in the late 1970s as an agricultural clinic, staffed by volunteers and serving rural communities and farm workers, it became clear that we still believed in those values, but we needed to reinstate and refine some of our core business policies and procedures. That process has translated to more thoughtful and long-term decision-making, better stewardship of our limited resources, less waste, reduced environmental impact, focused support for nutrition and lifestyle changes, and more. So in 2009, Clinica Adelante grew up to become Adelante Healthcare, and our small-town roots evolved into the way we deliver healthcare services in a modern system of personalized care.

 

What challenges have you faced as a federally qualified health center?
A few years ago, we faced a huge financial loss in the aftermath of health policy changes at the state level that reduced Medicaid eligibility for childless adults and kidsover 100 percent of the federal poverty level—that is to say, households with incomes greater than 100 percent of the federal poverty level. To qualify for Medicaid benefits, this translates to a family of four making just under $24,000 per year. Even $1 over this amount would exclude thousands of families from approval. It was at the same time that the housing and economic crisis was hitting Arizonans hard. The need in our communities far surpassed our capacity, and there were times when it seemed a turnaround was impossible. For the first time in my career, I had to cut positions for which there was no funding.At the same time, we were working on strategies like sustainability, evidence-based design, the patient experience, and other such “luxuries.” As a team, we persevered and slowly made our way out of that tough time. What it taught me was resiliency and patience. What it solidified was my belief around strong business principles and the importance of strategy. We were positioning our organization for the future, while the present posed challenges. We were determined not to allow the crisis of the day to block the path toward stability and success.

 

What design and vision strategies did you implement for your facilities?
My development partner Bryan Mar from Axis/One World coined a phrase, about how we needed to avoid creating a “new ‘old’ building.” What he meant by it is a capital project that is brand new and full of pretty finishes but lacks design integrity that correlates with improved function and user satisfaction. This is a risk when we use outdated planning and design/construction methods to manage costs and the development process. The business case is critical in achieving a vision for a building that evolves out of evidence-based design and is built to produce the intended functional outcomes.For example, we spent more than double on an LED lighting package for our Mesa, Ariz., facility; that would normally be value-engineered out of the budget. When we analyzed the return on investment, though, it was clear that supporting that line item made sense for more than LEED certification points. We would recoup the extra dollars spent on the lighting fixtures in lower utility bills and maintenance costs. Of course, we had to raise and allocate the extra funds on the front end. The lesson for me and my team was to commit to being present and involved enough in the process to complete the analysis and make a strategic decision that would prevent us from building a new “old” building.

  

You established the first LEED Platinum-certified health center in the nation at the Mesa site. What are some design innovations you were able to implement, and what are the benefits realized?
Well, to name a few: skylights, transom windows, interior doors inset with glass, a continuous exterior walking path, and meditation garden.
Individually, each design element can improve one or more aspect of the patient experience or influence employee/patient satisfaction, but collectively the effect is exponentially greater than any one decision. It simply feels different whether you are an employee or patient; you’re empowered as you enter the building, move from one area or service to the next, and finally exit and find your way home.

 

What current projects are in the works, what are the design goals, and how have these goals evolved?
We are completing the tenant improvements on an existing 10,000-square-foot building in Peoria, Ariz., to expand into that community to provide sliding-fee primary care services.  Adelante Healthcare Peoria is designed as a patient-centered medical home with all of the relevant cross-functional primary care team functions and services embedded into a small footprint. We have some limitations within the existing building footprint and other considerations that may affect the scope. Interestingly, though, we’ve been able to include many features like natural light, distributed nurses’ stations, care team conference space in each wing, and an on-stage and off-stage circulation track that connects the entire building. The building will be complete and open to patients Sept. 2.

 

How have your past projects informed this one?
Surveys of staff and patients pre- and post-implementation about various design elements, along with data and outcomes around business metrics, made it clear, for example, that ensuring natural light to most of the
building was consistent with the best outcomes for both patients and staff. There’s a national shortage in the healthcare workforce, from physicians to support and technical staff.  The working environment we’ve developed has helped us become an employer of choice. We may not be able to pay the highest salaries, but we are attracting top talent in a very competitive market.

 

What guiding principles keep you inspired?
Patient empowerment and patient-directed care are key guiding principles. The building should further this because of the myriad ways that patients can choose where to go, how to engage, and customize an experience of services based on what they feel they need or are ready and willing to achieve. This is very different from the historic model of Western medicine where the “doctor knows best.”

 

You have a background in fine art, medicine, public health, and business administration. How has your education influenced your design choices?
We are resetting patient and employee expectations, and their psychological experience in healthcare ambulatory environments. We’ve learned to engage the public the way museums, libraries, hospitality, and retail industries have. Patients have many choices; just because we build it doesn't mean they will come. In order to attract public attention, keep it, and implement a comprehensive set of services, we had to cultivate trust and brand loyalty.

 

How do you want to provide healthcare to the community in the future?
My team and I want to continue to push the boundaries of retail psychology, the incorporation of technology and media, and employee engagement, as well as utilizing affordable and sustainable materials from manufacturers. We also want to develop destinations for health and community healthcare parks by collocating with partners who are like-minded, to better leverage limited resources, reduce cost, and increase access and quality for patients. Finally, we want to inspire others by sharing lessons learned. Last year we hosted more than 80 tours with hundreds of attendees. We imagine a ripple effect with each new healthcare project taking things to the next level across the country.

 

Linda Plunkett Franklin is the senior marketing and communications manager for The Center for Health Design. She can be reached at lfranklin@healthdesign.org.