Redesigning The Medical Home

What is more agreeable than one’s home.

Cicero (106-43 BC)

January 10, 2013 -  Three days ago, I wrote a post “Practice Redesign and Empathy for Patients.”  The gist of the post  was:  if only doctors could put themselves in patients’ shoes and empathize with them, they could redesign their practices for greater productivity and patient satisfaction.

Today I spoke Greg Kordeluk, Chairman of the International Council for Quality Care, which gives frequent conferences for intimate small groups of 20 or more senior hospital and physician executives.  The conferences are dubbed “Building Financially Sound Practices,” a popular subject in these days of health reform uncertainly and declining patient visits.

Much of Greg’s work is about practice redesign.    To illustrate what his organization does, he sent me the following article from The Pittsburgh Business Times.

Excela Health Takes Caregiver Team Approach 

What an idea: A doctor’s office without a waiting room, a welcoming place of soft lighting, stone and polished wood, and digital screens in exam rooms with educational videos tailored to the individual’s needs.

This is healing by design, Excela Health’s effort to put the “home” in the patient-centered medical home model of providing medical care. The office is a template for conversion of all the health system’s 85 or so primary care doctors to a caregiver team approach.

“We are deliriously happy with it,” says Dr. Barbara Wang, who recently joined her practice, Diagnostic Associates, in renovated offices at Excela Latrobe Hospital. “We love it, and more important, the patients love it. The reviews have been fantastic.”

It’s only coincidence that the 8,500-square-foot office replaces part of the hospital’s former emergency room — Excela’s approach is designed to accommodate emerging models of providing medical care, including the medical home model, that aims to keep patients healthy and out of the emergency room.

Excela isn’t the first in the region to adopt the medical home model — Premier Medical Associates is piloting the medical home, and it is offered by many UPMC doctor practices — but it is among the first to use office design to reach that goal.

Boca Raton, Fla.-based International Council for Quality Care Inc. has been guiding the transformation at Excela.

The cost of the office conversion, and the anticipated return on investment were not disclosed, but nothing is left to chance in office layout and design.

More important, the warm, attractive furnishings are improving efficiency in providing care. During the two months after opening in December, doctors have increased the number of patients they treat by 20 percent without working extra hours.

“It’s about creating the connection to foster communication,” said Greg Korneluk, senior partner at ICQC. “It’s an immediate comfort level for everybody.”

Increasing the time the doctor can spend with a patient begins with directing patients right into exam rooms when they arrive for an appointment. Inside, the lighting is indirect, a flat screen TV carries calming nature scenes or educational videos. To ward off a chill, patients can flip on a ceiling heat lamp.

The doctor enters through an opposing door, facing the patient. Weight, blood pressure and other vital signs are electronically recorded.

The result? The doctor or nurse doesn’t have to transcribe vital signs into the patient’s record because they’re electronically added, increasing the time doctors can spend with patients.

“Transforming primary care — that’s really our strategic direction,” said Excela Executive Vice President and COO Michael Busch. “The model is actually working the way we designed it.”

The new patient experience begins long before the appointment with preregistration, which includes insurance authorizations and verification of patient demographics. Then, patients have access to interactive videos in each of the office’s four treatment rooms.

A preventive care plan is mapped out for every patient, and educational materials are printed at the end of each visit. And there’s no need for the patient to check out – they simply leave when the exam ends.

In addition to a doctor, the core care team has a registered nurse who is a health coach; a clinical assistant, who coordinates and assists doctors and the health coach, taking vitals and conducting patient education; and a care coordinator who coordinates all incoming and outgoing messages, appointments, online services and financial arrangements.

Each of the four members of the care team is eligible for bonuses related to achieving clinical, service and performance benchmarks. Details of Latrobe’s bonus program were being finalized, Korneluk said.

Improved efficiency through design is only part of the changes going on at Excela. Patient databases are being developed to identify people with diabetes, for example, or asthma, diseases that respond well to vigilance by nurses and nurse practitioners.

Outside the exam rooms and out of patient view is the medical staff’s work area: a hallway of ergonomically designed tables, computers and printers. In the office entry is a small conference room with a long table and chairs for patient education classes.

Busch calls the development a “juiced-up physician’s office,” an idea that will be replicated at Excela’s medical office expansion at the Norwin Hills Shopping Center. Excela plans to double its presence there to 87,030 square feet and add doctor’s offices and medical imaging services.

The goal for medical facility design is to increase the time the doctor can spend with a patient by streamlining operations, said Timothy Powers, who oversees the health care and research studio at Downtown-based Astorino.

“One of the big things health care systems are burdened with right now is how to treat patients and in what setting,” Powers said. “What that’s leading to is new centers of excellence in the community.

“It’s a huge invitation to keep people healthy and well.”

Medical facility design also should foster an emotional connection with patients, said Christine Astorino, founder and CEO of Fathom, a design research company based Downtown. At UPMC Children’s Hospital, for example, colors, textiles and design are used to create a metaphor for transformation, reflecting the healing process.

Tweet: Redesigning a medical office to create a warm, welcoming, home-like environment can increase doctor productivity by as much as 20%.