Kahler Slater
Firm's Role on the Project: Reduce staff footsteps, increasing collaboration, broadening exposure to expertise, increasing patient access to caregivers, maintaining privacy, and operationalizing self-rooming, while serving a rural population with primary and specialty care services.
EBD Goal
The goals were to promote staff connection and collaboration using an Integrated Care Team (ICT) model, to increase efficiency, and to simultaneously enhance the patient and staff experience.
Overview
Essentia Health Spooner Clinic is a 15,000 square-foot rural clinic attached to Spooner Health System Hospital in northwestern Wisconsin. Opened in fall of 2016, Spooner Clinic has 20 exam rooms providing primary care and family practice clinics. Specialty care outreach clinics, such as orthopedics, are also available, with clinicians rotating in from Duluth. The footprint also includes imaging and lab services.
Challenge
In 2014, Kahler Slater conducted a nationwide survey of ambulatory care models to identify trends and select a model for their upcoming Essentia Health project. After a comprehensive review, the ICT model was chosen as it fosters efficient collaboration among caregivers working at the top of their license and prioritizes physician and staff time.
The clinic design needed to address multiple priorities: reducing staff footsteps, increasing collaboration, broadening exposure to expertise, increasing patient access to caregivers, maintaining privacy, and operationalizing self-rooming, while serving a rural population with primary and specialty care services.
Solution
The team worked together to break down the silos of private physician offices, replacing them with flexible work areas adjacent to exam rooms where providers, nurses, and medical assistants could work side by side. The design has allowed staff members more time for patient care, documentation, and follow-up, with fewer interruptions.
Offering a choice of work areas, including huddle zones, private discussion zones, and sit-stand workstations, keeps the team within a collaborative zone. Additionally, floor-to-ceiling windows provide staff with views of nature and generous natural light, resulting in a restorative working environment.
The ICT model promotes flexibility by accommodating various operational models and associated staffing needs for both primary and specialty care clinics. Leveraging opportunities for collaboration, providers conduct consultations on the fly between scheduled appointments, reducing both the length of patient visits and the need for additional appointments. The clinic also supports Telehealth, which further increases the breadth and depth of clinical expertise available to patients and staff.
The double-sided exam room allows for increased utilization when flexed between primary care and specialty clinics, maintaining front-of-house and back-of-house circulation with minimal additional square footage. Acoustics are controlled by high-performance door sweeps and seals, allowing providers the efficiency of dictation at their workstations following an appointment.
Results
A post-occupancy shadowing study demonstrated that the most frequent trips made by a medical assistant (37%) were between the exam rooms and the workstation. Further analysis showed that staff footsteps between exam rooms and the workstation were reduced by an average of 75% compared with the old facility. This, combined with the elimination of medical assistants’ roundtrips between the workstation and the physician’s office (an average of 120 feet), has resulted in a dramatic decrease in overall staff footsteps compared with their previous building.
