GHA HCD 11_97

Enhancing the Patient Experience: Design Drivers for

Urban Hospital Ambulatory Care

HEALTHCARE DESIGN 11Nashville, TN

Tim GramannCEO, GHA

James Harrell, FAIA, FACHAGBBN Architects, Inc

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TriHealthCincinnati, Ohio Two acute-care hospitals

with nearly 900 beds Good Samaritan (GSH) has

the highest market share in TriHealth’s four-county care, and Bethesda North (BNH) is #3

Over 10,500 births per year GSH is #1 in Ohio; BNH is #7

One of the largest robotic surgery programs in the U.S.

Over 50 outpatient service locations

Over 250 employed physicians

Over 1,700 physicians on medical staff

Over 10,000 employees 2

MAP

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GROUP HEALTH ASSOCIATES (GHA) Founded 1974 with 3

physicians 135 physician today Medical Center Model vs.

MOB Primary Care and 18

specialties working collaboratively

Connected with the Epic EMR

Integrated ancillaries on site

Coordinated scheduling to maximize convenience

Centralized practice management

Acquired by TriHealth in 2005 4

DRIVERS FOR A NEW FACILITY

Flagship in shambles Emergence from hospital to healthcare

system Support growth of hospital based

specialties

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Tim Gramann

-3 major business imperatives- First proposed 30 years ago- current plan initiated 8 years ago

65,000 SF Flagship in Shambles 50 years old Build as a concrete structure motel Extremely high operating costs No room for growth Inconsistent with group & system

aspirations Inadequate parking and vehicle drop-off

area

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Tim Gramann

- A premier medical group with a delabidated flagship- High operating costs include maintenance staff, repairs, off-site parking & utilities-Embarresment- purchased several properties for parking/gravel- entrance in rear; narrow driveway often blocked by a 1977 Lincoln

1977 Lincoln Continental

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And Mom Wonders why I don’t Bring my Friends Over…

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Emergence from Hospital to Healthcare System Support programs of care that cross

hospital & practice settings- Skin Cancer Center- Sinus Center- Weight Center

Reduction in Duplicate Services- mammography, dexascan- outpatient pharmacy- physical therapy

Greater integration with hospital based resources- radiologists & PACs

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Tim Gramann

- Highly competative and dynamic market- Skin Cancer Ctr - hotline, access to der, direct referral to surgery- Sinus Ctr - MRI, Consult, Surgery at 1 location- Weight Ctr - consult, program, surgery, follow-up- Womens Ctr - multiple specialists- Breat Ctr, research, Diabetic Ctr

Tim Gramann

- consolidation of mammograph & dexascan in womens ctr yet remained integrated with OB/Gyn- PT & Pharmacy consolidated to lower costs and optimize the patient experience

Support Growth of Hospital based Specialties Dermatology Otolaryngologist Sinus surgeon GI General GI ESRP Fellow Minimally Invasive Bariatric Surgeon Colorectal Surgeon Oncology Surgeon Breast Surgeon Orthopedic Surgeon (x2) Procedural Physiatrist

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Tim Gramann

- Growth critical to project ROI & system strategy- Hosptial based facility based on surgical specialties where suburban locations are more primary care and office based specialties- ultimately facility must be a destination for advances services and specialties

Separate yet Connected Building Identity Convenient interior vehicle drop-off,

parking and seamless entry Security & privacy A ‘sense of arrival’ Intuitive patient flow Branding entry points of complementary

specialties

Urban Hospital Campus Ambulatory Facility

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DESIGN CHALLENGES

Tim Gramann

- building identity objectives are difficult in the best of circumstances but made more challenging on large, dense, urban medical campus- patients will go to the old building, have trouble finding the new building & physicians will overreact- building must be connected to fully leverage the benefits of being on campus but connected creates its own challenges including another point of entry, expense and often undesirable space-Ultimately, the benfits for patients and physicians to coordinate care between inpatient and outpatient services will far outway the challenges.

Tim Gramann

- A big challenge in this environment is to create a seemless entry that is secure and private yet creates a 'sense of arrival' with an intuitive pathway to your destination- Operationally, it was decided that having separate elevators from the garage entrance to the lobby and from the lobby to the higher floors was essential.- this allows for a single reception to welcome guest while enhancing security- most importantly it creates the sense of arrival into the medial mall where one experiences the breath of services in a comfortable environment- a significant percentage of patients do not need to leave the main floor- muscular skeletal is located on the 1st floor integrated with imaging and PT minimizing movement of the less ambulatory patient

Tim Gramann

- On th eupper floors, complementary specialties are colocated to optimize interdisciplinary collaberation.- Large lobbies have multiple patient entryways to the care suites allowing for branding by department or specialty reenforcing the breath of services

Urban Hospital Campus Ambulatory Facility Planning for the immediate while preparing

for the future Balancing vision and reality Incorporation of a care team module suite

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DESIGN CHALLENGES

Tim Gramann

- The facility will be increasingly dynamic as the national healthcare system evolves and adapts to market forces including heathcare reform. - more than ever the facility must be able to adapt to the changing demands for specialties and services- Features include - team based module that supports any specialty - minimal barriers that prevent expansion and contraction of departments - administrative space designed for easy conversion to exam rooms - standardized exam rooms that support most specialties

Exam Room Design Arrangement - permits flexibility in

practice patterns. Team Approach - afford patients a more

comprehensive care.

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DESIGNING THE PATIENT CARE SUITEStandardization

DESIGNING THE PATIENT CARE SUITE

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PATIENTS / FAMILIES WANT QUICK AND CONVENIENT SERVICE

CLARITY OF ORGANIZATIONPARK CLOSE TO DOOR

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URBAN CAMPUSACCESS TO COMPREHENSIVE DIAGNOSTICSSAFETY NET OF HOSPITAL SERVICESCONVENIENCE FOR PHYSICIANS

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URBAN CAMPUSCOMPLEXITYMULTIPLE ACCESS POINTSMULTIPLE TRANSPORTATION CHOICES

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DESIGN GOALS

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Optimizing Patient Convenience Clarify Entrance Choices Rapid Check-in Welcoming, Hospitality-type Environment Positive Distractions

Coffee Shop Access to Nature Access to Artwork

DESIGN GOALS

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Immediate Access to Ancillary Services Pharmacy Physical Therapy Optometry Hospital Amenities

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GHA ENTRYHOSPITAL MAIN ENTRY HOSPITAL

GARAGE ENTRY & EXIT

BUS STOP

SIXTH FLOOR

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SIXTH FLOOR

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SIXTH FLOOR

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SEVENTHFLOOR

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EIGHTH FLOOR

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SIXTH FLOOR

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MED-MALL

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MED-MALL

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MED-MALL

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CLINIC RECEPTION

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CLINIC WAITING

GHA GRADE ENTRY

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PEDESTRIAN ENTRY AUTOMOBILE ENTRY

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GHA GRADE ENTRY

PEDESTRIAN ENTRY ELEVATORS

GHA HCD 11_97

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