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Antibiotic-resistant infections have become a major public health issue in the United States. In other countries, however, the problem doesn’t appear as severe or as widespread. It’s worth taking a look at what they’re doing differently to see what we can learn from their efforts.

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Promising Practices Seminar Video

 

The Promising Practices Seminar, held in Sacramento California on April 5, 2011 brought community health centers together to learn about the latest research around clinic design, network, and learn from their peers. View the video recording of the plenary sessions:  

 

Part 1: Introduction, Key Note, White Paper Panel Discussion

Part 2: Afternoon Session: New Tools and the Clinic Design Website

Ambulatory Practice of the Future (APF)

The Ambulatory Practice of the Future (APF) at Massachusetts General Hospital is an innovative new approach to primary care delivered by highly collaborative teams, with the patient as an active participant. This proactive partnership between patients and caregivers focuses on prevention and controlling the cost of care through prevention of chronic disease. The practice also seeks to improve the work life of primary caregivers and support their professional development.
 


The APF’s care model involves a complete paradigm shift in ambulatory care:


 


Current Paradigms                            APF Paradigms
                                   


Focus on sickness              --->           Focus on health & life balance
                                 


Event-based healthcare       --->           Continuous healthcare
                          


Static experiences             --->            Interative experiences
                                        


Directive communication     --->            Collaboration
                                


Individual experiences         --->           Team-based experiences
                                     


Patient goes to treatment    --->           Treatment goes to patient
                                     


One size fits all                  --->           Mass customization
                                                   


Obscurity                          --->           Transparency


 


The Ambulatory Practice of the Future opened in May of 2010. Currently, the clinic is serving only MGH employees and their spouses or partners. This practice will gather data over its first three years of operation that will inform how the model will be applied to other MGH primary care practices.
 


                                                           

Anshen+Allen, now a part of Stantec Architecture, worked with MGH and the APF project team in a highly collaborative series of workshops that included all stakeholders. Lean principles were applied to enhance operational efficiency, eliminate waste and optimize caregiver/patient interaction. The intense involvement of the APF team ensured that the design met its goals for promoting collaboration, experimentation, and continuous improvement. In addition to the Medical Director and Project Manager, the design team included staff and patient representatives.

The design encourages a proactive focus on health and life balance, dissolves the traditional barriers between doctor and patient, and provides open access to resources and education for both patients and caregivers. Some of the design features include:


 



  • Comfortable spaces for health planning, record updating and personal reflection;

  • Light filled exam rooms with a separate zone for caregivers and patient conferences;

  • Teaching and learning spaces that flex in size to accommodate patients and staff learning;

  • A robust and intuitive IT interface enables on-site or remote scheduling and check in. Virtual visits are possible from any exam room or private location;

  • The care team work area occupies the center of the clinical core, supporting interaction among care teams; 

  • Shared “off stage” offices and staff interaction spaces offer places of respite and pro¬mote a collaborative culture of care;

  • An innovation lab will pioneer and test new processes and products;

  • Sustainable, non-toxic materials and finishes maintain a healthy care environment.

 


This new model of care will be studied for its impact on quality, cost and satisfaction for patients and providers. The lessons learned will be translated to the MGH primary care community and beyond, transforming the practice of primary care in the future.

Location
Boston, MA
Architect
Stantec Architecture, formerly Anshen + Allen
Opening Date
May 3, 2010
Setting
Urban
Type of Facility
Renovation/Re-Design
< 10,000 sq ft.
Size
7200 sq ft.
Services Offered
Medical
Safety Net Facility
0
Number of Exam Rooms
16 rooms
Number of Floors
1 floor
Number of Floors Occupied
1 floor
Average Daily Patient Encounters
12 encounters
Number of Care Providers
3 physicians
Encounters per Provider
8 encounters
Encounters per Clinic Hour
2 encounters
Number of Staff
4 staff members
Average Patient Cycle Time
1 hour

Council Connections - Group Purchasing

Council Connections is the leading group purchasing organization for California's clinics. All non-profit clinics are eligible to participate in this free program which provides access to hundreds of contracts at discounted rates. Almost everything an organization needs to build, renovate or maintain a facility can be found on contract and at substantially lower prices than obtainable on one's own. Everything from equipment and supplies to furniture and paint can be found within the 1,600 contracts available.

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Capital Project Business Planning and Owner Decision Making

 

 

 

 

Anita Addison of La Clinica de la Raza hosted the knowledge exchange table on Business Planning at the Promising Practices Seminar.  During her session she provided a checklist/description of items to be included in a business plan as well a a chart to owner decision making.  Download the handouts here.

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Strategic Facility Development: Suggested Pre-Planning Internal Assessment Activities

 

 

Preparing for Strategic Facility Development?  Download this checklist of information and data to gather during pre-planning for a facility development project.

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Capital Link Capital Financing Options

 

 

Tony Skapinsky of Capital Link hosted the Knowledge Exchange table on Captial Financing at the Promising Practices Seminar in 2011.  Download his handout from Capital link on financing options.

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Promising Practices Seminar: Clinic Design Website and Upcoming Tools Presentation

 

 

Learn about the new features of the upgraded Clinic Design website and the upcoming tools you should be on the look out for.  The audio/visual version of the presentation will be coming soon!

Promising Practices in Community Clinic Design: White Paper Overview Presentation

 

Safety-net clinics will need to invest an estimated 10.5 billion in facility construction, renovation, and expansion between now and 2015. A series of whitepapers on safety-net clinic design, published in March 2011, suggest a range of design strategies for building and renovating the built environment. During this panel presentation, the authors of these papers will discuss the variety of issues that impact healthcare experiences and highlight exemplary health centers and clinics.

Environment of Care/Facilities Inspection Checklist

 

 

Doug Moore, facilities manager at Clinica Sierra Vista shared one of their checklists that they use as they finish their clinics and prepare to open and move in.

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Developing a Health Center

 

Developing a Health Center: A Guide for Health Center Staff and Boards on Managing the Design and Construction Process Facility development is a complex endeavor that relies on many different professions: architects, lawyers, contractors, and a host of others that you can learn about in this manual.

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Wayfinding: Free Resources

 

This handout is a compilation of free resourcres that are available on wayfinding.  The handout was first distributed at the Promising Practices Seminar on April 5, 2011.

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Promising Practices Seminar: Opening Keynote Presentation

 

Ian Morrison, PhD is an internationally known author, consultant, and futurist specializing in long-term forecasting and planning with particular emphasis on health care and the changing business environment. He combines research and consulting skills with an incisive Scottish wit to help public and private organizations plan their longer-term future.

 

Ian kicked off the April 5, 2011 Promising Practices Seminar in Saramento, California with his presentation titled, "The Future of California Healthcare: Life in the Gap, Life in the Game."

 

Sustainability Toolkit

Developed by a team of represtatives from Perkins + Will, Integral, Bognet and Capital Link the Sustainability Toolkit was designed specifically for Community Health Centers who were anticipating facility renovation projects and have no experience incorporating sustainability interventions in their previous facility projects. The goal was a “toe in the water” rather than the “deep dive” most of the literature/resources offer. 

EBD Parent Phase
Organizational Readiness
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Words of Advice 700

"Medical facility design should include preoccupancy studies and physical measurements, building performance standards, consulting specialists in building performance, performance commissioning and post occupancy studies. Most medical projects do not have access to these research tools." -Steven Orfield, Orfield Laboratories, Inc.

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Architectural Research Consortium (ARC)

The Architectural Research Consortium is a collaboration of architects interested in evidence and research based design. This group provides seminars and design assistance on projects. It is administered by Orfield Laboratories, a well known architectural and building performance research lab. There are currently 17 architectural firm members with offices in half the 50 states.

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Clinic Design Recommendations

Recommendation
Ensure furniture is easy to fit into most parts of the building, is easy to adapt to technical installations (modular systems), and is easy to move around.

Clinic Design Recommendations 774

Recommendation
Use simple (as opposed to medical) terms to indicate locations and provide information in multiple languages (depending on key patient populations served) and use universal symbols supplemented with text and numbers when designing signs in a multicultural setting.
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Clinic Design Recommendations 768

Recommendation
Use zoning to separate public, treatment, and staff functions to improve internal circulation and privacy.
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Clinic Design Recommendations 767

Recommendation
Use televisions and/or monitors as a positive distraction outlet.
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Clinic Design Recommendations 766

Recommendation
Use state-of-the-art technologies to improve infrastructure for telemedicine, and improve visual and audio quality of video conferencing by using proper lighting, finish materials, and equipment.

Clinic Design Recommendations 765

Recommendation
Standardize technology and equipment to allow movement into different areas for flexible functionality.

Clinic Design Recommendations 764

Recommendation
Standardize placement of equipment and supplies within treatment and exam rooms.

Clinic Design Recommendations 763

Recommendation
Reinforce community commitment through the selection of interior aesthetics, such as artwork and color preferences relevant to multiple patient populations represented in the clinic.
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Clinic Design Recommendations 762

Recommendation
Provide secure access for staff-only areas.

Clinic Design Recommendations 761

Recommendation
Provide positive distractions for patients and families in waiting areas including culturally relevant art work, reading materials in different languages, television, and information kiosks.

Clinic Design Recommendations 760

Recommendation
Create patient spaces that also accommodate accompanying family members.