ZGF
Firm's role on the project: Planning, Programming, Architecture, Design, Interiors
EBD Goal
To combine lean, sustainability, and evidence-based design (EBD) to create a patient-centered facility designed to eliminate waste, improve workplace efficiencies, and minimize environmental impact. Systems were implemented because they were found to improve patient comfort. This was a LEED-Silver registered project as well.
Overview
The 78,600 square-foot Cottonwood Clinic was designed to reflect Intermountain Healthcare’s values and streamline processes to enhance the patient experience. The facility includes seven clinics: internal and family medicine, endocrinology, rheumatology, podiatry, pain services, and Murray InstaCare and Cottonwood Pharmacy in a single accessible location. The inspiration for the interior design was the diverse colors and textures of the natural Utah landscapes: aqua blue, desert gold, forest green, and sky blue.
Challenge
The team used an integrated Lean design approach to the facility’s program and design. This process involved developing an interdisciplinary, crossfunctional team comprised of physicians, nurses, medical assistants, laboratory and radiology technicians, pharmacists, social workers, dieticians, and facility staff and management. Collaborating with ZGF, the contractor, and clinic leadership, the team focused on Intermountain Healthcare’s number one core value: do what is right for the patient. Using five multiday Integrated Design Events over five months, the team made decisions to target operational and facility outcomes in support of the project goals. Key outcomes that were targeted include: increased efficiency, reduction of non-patient care space, maximized building square footage on-site to incorporate growth, improved patient satisfaction scores, improved current call abandonment rates, reduced number of days for an appointment, and improved wait times. Full-scale mockups were assembled and tested by caregivers who would actually use the spaces.
Solution
Designing this new multispecialty clinic for an established healthcare provider afforded an opportunity to rethink the clinical care model by implementing significant operational, workflow, and cultural changes within a patient-centered environment. The design provides distinct care team and patient zones. The concept utilizes distinct partitions to separate patient and visitor paths of travel to minimize interruptions and help ensure patient privacy. Improvements targeted key metrics such as reducing lead cycle time to shorten patient visits, grouping common patient flows to overlap support, and designing performance specifications for common patient flow.
Sustainability features included:
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Pedestrian and bicycle access by providing a bicycle storage area and tree-lined walkways that assure a safe and secure path
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Pervious (landscape) areas to reduce storm water
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Permanent shading devices and automatically actuated shades to reduce solar gains
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Use of natural light and daylighting controls to reduce energy use
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Occupancy sensors and overrides to turn off lights when there is adequate natural light
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Use of finishes to reduce VOCs
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Low-flow fixtures to reduce water use
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Reflective roofing to reduce heat gain
Results
The project produced positive results within the clinic’s first few months of operation. Patient wait times have been reduced; patients now check in at a centralized station on each floor. Staff at check-in desks are not required to answer phone calls (which are being routed to the Patient Service Center). Standard rooming activities and Intake are performed in exam rooms. Services such as blood draws are performed during the patient exam by staff and taken by runners to the laboratory; results are sometimes reported before the patient exam is completed. Separating staff and patient circulation also contributes to faster and more efficient appointments. Intermountain Healthcare hopes to use this clinic as a standard for future projects throughout the organization. Achievement of this clinic’s goals has been so successful that Gemba walks (personal observations of work of the clinic) are underway to illustrate how integrated design using Lean and EBD can improve target outcomes. Interim post-occupancy evaluations (POEs) are being conducted to track patient satisfaction, with plans for a comprehensive one-year post-occupancy survey.