Using Stakeholder Input to Design Healthcare Facilities

August 10, 2017 10:08 am

More than 80 people had input on a new surgery and rehabilitation facility space that has a retail feel.

When Lee Health, a six-hospital system based in Fort Myers, Fla., opens its new Lee Health at Coconut Point outpatient campus next year, it will reflect the input of dozens of clinicians, staff members, and community members.

The 164,000-square-foot facility is designed to support three important trends in healthcare: a focus on wellness; the need to deliver care in an outpatient setting whenever possible; and the support and navigation needed to help patients make high-value healthcare decisions.

The southern part of Lee County is one of the fastest-growing areas of the country, and community residents have been clamoring for healthcare services close to home. Even though the area is just 15 miles from Lee Health’s flagship hospital, Lee Memorial, heavy traffic during the winter tourism season makes it seem much farther. In particular, some residents worry that it takes too long to reach the emergency department for patients with life-threatening conditions.

While residents originally sought a hospital—and the site plan allows for one to be built in the future, if needed—Lee Health leaders worked with community leaders to come up with a different idea. More than 80 staff and providers gave input on the entire facility design to incorporate a wellness and retail feel into the healthcare setting.

“It was through that collaborative process that the project that we are pursuing really emerged,” says Dave Cato, chief administrative officer for outpatient services. “We feel that 85 to 90 percent of patients’ needs can be taken care of without having an acute care bed onsite.”

Cato and Kevin Newingham, Lee Health’s chief strategy officer, used demographic data to verify the feasibility of the new outpatient complex, then turned to a broad group of stakeholders to determine the specifics.

“We really tried to design the care model differently by getting different points of view from the very beginning of this project,” Cato says.

Because of the significant population growth in the region, which is expected to continue for the next decade, Lee Health anticipates that the project will generate a positive ROI on its own, without counting referrals that will be made to Lee Health’s hospitals.

Rethinking Outpatient Care

The $140 million Lee Health at Coconut Point, expected to open in autumn 2018, will include the following services:

  • 24/7 emergency department
  • Observation/clinical decision unit
  • Outpatient surgery
  • Outpatient radiology and cardiovascular diagnostics
  • Breast health center
  • Outpatient rehabilitation and cardiac rehabilitation
  • Primary care and specialty care physicians
  • Outpatient laboratory
  • Pharmacy

A key component of the project will be the Healthy Life Center, which will be relocated from its current site in an upscale shopping mall nearby. The center offers programming and services, including a teaching kitchen to demonstrate healthy cooking and an exercise area, to promote healthy lifestyles, early detection of disease, and chronic disease management. Beyond that, it seeks to remedy what Newingham refers to as “fend-for-self medicine.”

Many healthcare consumers in south Florida live there only during the winter months and, thus, do not have a primary care physician to advise them. “Many seniors are trying to deal with multiple chronic disease states, and they are left to their own devices to determine what is the appropriate specialty and what might be the best place to access care and the most appropriate service to seek,” Newingham says.

To help patients make appropriate choices, The Healthy Life Center is staffed by personal health advocates, health service coordinators, and schedulers. “Even though this is in a retail setting, we have schedulers onsite to actually help people gain access to care, versus leaving it to them to navigate it themselves,” Newingham says.

Staying Focused Through Guiding Principles

The outpatient complex development effort started by convening a group of Lee Health staff members, physicians from various specialties, and community representatives to discuss what services and programs should be included in the new center and how it might function differently than traditional inpatient or outpatient facilities.

“We used that to develop a series of guiding principles that we deployed as we were planning the facility,” Newingham says.

See related tool: Guiding Principles for Facility Design

The guiding principles keep everyone focused on creating a facility that, by design, overcomes some of the vexing challenges that many traditional healthcare venues face. The principles include the following:

  • Provide amenities and services that promote health, wellness, and healing in a tranquil environment
  • Welcoming, easy-to-navigate facility designed around customer/patient needs
  • Exteriors that are walkable and transit friendly

One of the guiding principles—design processes and flows that pull care to the patient whenever possible—reminds the planning team that simply co-locating services does translate into care coordination or even convenience, Cato says.

For example, if physicians determine X-rays are needed, patients should be able to walk to the imaging center without having to schedule and register for a separate service. Or if physicians order blood tests, patients won’t have to find the laboratory. “Can we deliver the care so that the lab gets drawn while the patient is in the physician office?” Cato says.

The guiding principles were used by the architects as they designed the facility, but Newingham and Cato and other Lee Health leaders also keep them top of mind.

“They are still what we hold true to today,” Cato says. “As we get into the mode of preparing to operate the facility, they support the direction that we are heading.”

Putting End Users Front and Center

After determining the mix of services that the Coconut Point facility will include, Lee Health leaders hired architects that used a 3P process to work out building layout and work flow. 3P—which refers to production, preparation, and process—is a Lean design concept in which the people who will use a space are intricately involved in the design.

The broad group of stakeholders met for design sessions to identify where the various services should be placed in the facility. “Whether we were focusing on the access points, on the flow of the patients, the flow of staff and providers or the flow of information, we started to design what the facility looks like to support those guiding principles,” Cato says.

Those flows were tested through simulations using life-size cardboard cutouts set up in a warehouse. For example, a mocked-up section of the emergency department included not just the clinical room, but the registration desk, triage area, and check-out point. Stretchers and clinical equipment were brought in to allow the design team to test the usability of various configurations.

“We would practice the flow and then modify the design, based on whether we were meeting the guiding principles,” Cato says. “We did simulation after simulation, with physicians, staff, and community members both observing and participating in the process. Every time we found something that we could change for the positive, we would correct it.”

The learning from those simulations was used to start drawing the design for the facility.

“It is an extensive process that creates a lot of ownership within the team,” Cato says. “And it gives you the different perspectives from everybody else’s eyes, which helps make it as efficient as possible.”

Lola Butcher is a freelance writer and editor based in Missouri.

Interviewed for this article:

Dave Cato is chief administrative officer outpatient services, Lee Health, Fort Myers, Fla.

Kevin Newingham is chief strategy officer, Lee Health, Fort Myers, Fla.

Discussion Starters

Forum members: What do you think? Please share your thoughts in the comments section below.

  • How is your organization using facility design to support value-oriented payment approaches?
  • How do you obtain community, physician, and staff input in facility design?
  • Has this type of collaborative effort worked for other initiatives you have been involved in?


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