chcf seminar whitepapers final
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Promising Practices inPromising Practices ina ety- et n c es gna ety- et n c es gn
Presented by The Center for Health DesignAmy Keller, M. Arch : Anjali Joseph, PhD : Ellen Taylor, AIA, MBA : Xiaobo Quan, PhD
April 5, 2011
Presented by The Center for Health DesignAmy Keller, M. Arch : Anjali Joseph, PhD : Ellen Taylor, AIA, MBA : Xiaobo Quan, PhD
April 5, 2011
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Safety-Net Clinics: Between Today - 2015
$10.5 Billion in facility construction, renovation, & expansion Rethink how clinics can:
Provide reater access to care
Better patient experiences
Improve organizational outcomes
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Inform and educate
Publications describe design strategies that are enabling safety-net clinics to supportbest practices as they grow and change
Designing Safety-Net Clinics for Innovative Care Delivery Models;
es gn ng a e y- e n cs or ex y; an
Designing Safety-Net Clinics for Cultural Sensitivity
Based on literature reviews, interviews, & visits to exemplary health centers & clinics
Health care experiences
Patients, providers, & communities
Facilit lannin decisions
Health care interactions, patient flow, use of new technology, & changingneeds of the community
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Designing Culturally Sensit ive Community Clinic Settings
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Key definitions
Culture Cultural sensitivity
Cultural com etence
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Culture and healthcare interactions
Models of health and disease Perception of hospitals, doctors, and other healers
Hierarchical vs. e alitarian cultures
Family and social relationships
Communication norms
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Key design recommendations
Signage, symbols and artwork tocommunicate meaning and empathy
Provide spaces to support communityactivities
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Key design recommendations
Locate clinics for easy access Integrate with public transit
Incor orate wa findin strate ies
Consider universal symbols
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Key Design Recommendations
involvement of families
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Designing for Flexibi lity and Adaptability
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The importance of flexibil ity/adaptability
Changes in:
Population
Services
Result in physical changes:
Relocation of functions
Renovation
Equipment
Technology
Care models
Expansion
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Frameworks
Learning buildings
Open/ change-ready buildings
Adapted from Stewart Brand's representation of building layers (the 6 Ss) and incorporating Soni Diamonds conditions for indeterminate change
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Universal Grids
Source Citation
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Modular Systems / Flexible Technology
Herman Miller Furniture System, Grace Hill Water Tower Health Center, Arcturis
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Visibility
Clinica Family Health Services, Boulder Associates
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Universal Rooms - Pods
Clinica/Peoples Clinic in Boulder, CO , Boulder Associates
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Incremental Growth
Buckner, Lee, and Dan Hightower. 2006. Universal Design for the Rural Environment.
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The Business case
Manewa, A, et al. 2009. A Paradigm Shift Towards Whole Life Analysis in Adaptable Buildings.
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Design for Innovative Care Delivery Models in Safety-Net Clinics
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Significance
Safety-net clinics have consistently engaged with innovative care delivery models tobetter serve target populations and reduce health care costs.
Safety-net clinic design has a substantial impact on the effectiveness of innovativecare delivery models.
However, guidelines and literature are limited.
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Purpose of Paper
To identify key features of the physical environment design for new care deliverymodels
To provide preliminary design recommendations
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Key Design Features
Innovative Care Models in Safety-Net Clinics
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La Maestra
, , ,Pediatrics, Family Medicine
Additional Services: Nutrition and obesity, Prenataland Ultrasound, Pharmacy, Optometry, HumanTrafficking, Domestic Violence, Vision, Housingassistance, Literacy training, Laboratory, Substance
Abuse, Food pantry, Economic development
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Design recommendations
Co-Location of Services
Determination of services provided based on communitys needs
collecting anecdotal information documenting existing services in the area, analyzing the special needs of targeted populations,
and formally soliciting inputs
Focus groups, community meetings, interviews, and questionnaire
Facilitating patient flow and way-finding
a cognitively comprehensible layout design
hi h visibilit of ma or destinations
perpendicular intersections
location of key facilities near the main hallway
signs
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Outreach of Services Mobile Clinics
An innovative way to reduce health care disparity by moving care settings closer tothe homeless and underserved populations
Examples:
Clinica Sierra Vista
Project HOPE (Health Outreach for People Everywhere) of Shasta Community
Health Center in Redding, CA Salud Family Health Centers in Colorado
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Design recommendations
Outreach of Services Mobile Clinics
Size and interior layout should be determined by the services to be provided
Large operable windows should be installed to reduce claustrophobia and providenatural ventilation
Proper insulation and air-conditioning for energy conservation, thermal comfort,medical equipment maintenance
Finish materials - ease of maintenance and disinfection Barrier-free environment for disabilities
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Patient-Centered Care
Patient-centered care is a key component of many innovative care delivery models
for the uninsured and underserved
A healing, empowering, and supportive physical environment is an essential part ofpatient-centered care models.
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Design recommendations
Patient-Centered Care
A welcoming environment (aesthetics)
Architectural motifs, signs, colors, and materials that are familiar to the localcommunity
emotional discomfort
Extra spaces and amenities support patients families to meet patients need for social support Improve patients physical comfort
Comfortable and adjustable furniture Efficient ventilation and air conditioning Glare reduction Partition design ensures visual and audio privacy
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Space for Team Collaboration
Effective collaboration between health care professionals is very important in
innovative care delivery models that emphasize a holistic approach and deployinterdisciplinary teams for care delivery.
Improves understanding of team members knowledge and skills,
Enhances decision-making,
Raises job satisfaction Boosts efficiency
Failures of team collaboration are not uncommon
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Use of New Technology Telemedicine
Telemedicine, a fast-growing means of health care delivery to patients in remote,
rural, and underserved areas
Depending on the needs at specific facilities, telemedicine can encompass a varietyof technologies and applications
Telephones, robotic instruments, interactive videoconferencing, biosensors,
artificial intelligence, patient information storage and transmission
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Design recommendations
Use of New Technology Telemedicine
A componentbased framework including a set of functionality components
provides a cost-effective way to construct a telemedicine system Accommodate probable future changes because of rapid technological progress
- Suitable lighting design and interior finish materials are essential to enhance the quality of
video images
Locate the telemedicine room away from noise sources and use high-quality acousticceilin tiles Convenient location of electric and Internet outlets Careful selection of telemedicine apparatus
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In SummaryPatient Experience
Welcoming, familiar, unintimidating
Patient-centered care: developing personal relationships
One-sto care
Family member presence & participation
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In SummaryProvider Experience
Interdisciplinary teams
Collaboration & group interactions
Technolo ical advances
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In SummaryCommunity Experience
Location, location, location
Way-finding
Outreach ro rams
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