{"id":60913,"date":"2023-08-30T11:19:26","date_gmt":"2023-08-30T15:19:26","guid":{"rendered":"https:\/\/healthcaredesignmagazine.com\/?p=60913"},"modified":"2023-12-18T23:17:05","modified_gmt":"2023-12-19T04:17:05","slug":"mass-general-brigham-adopts-templated-clinic-design","status":"publish","type":"post","link":"https:\/\/healthcaredesignmagazine.com\/projects\/mass-general-brigham-adopts-templated-clinic-design\/","title":{"rendered":"Mass General Brigham Adopts Templated Clinic Design"},"content":{"rendered":"

This article was originally published on August 30, 2023, and is among <\/em>Healthcare Design\u2019s most-read articles of 2023. To see a full list, click here<\/a>.<\/em><\/p>\n

Over the last 30 years since Mass General Brigham<\/a> (MGB) was established, many of the health system\u2019s ambulatory facilities have been operated as outpatient departments of academic medical centers. Over time, however, surveys revealed that patients were looking for more convenient, comprehensive, community-based healthcare options beyond the hospital setting.<\/p>\n

\u201cTo deliver on the promise of lower cost care closer to home for our patients, we decided to launch a new entity to operate freestanding clinics and ambulatory surgery centers throughout the community,\u201d says Lindsay Gainer, enterprise vice president of community operations at MGB (Boston).<\/p>\n

This new concept, called Integrated Care (iCare), reimagines the patient and provider experience by creating a more streamlined model of relationship-based care than the standard hospital model. A traditional clinic design separates medical services into distinct departments and reserves exam rooms for certain specialties; the iCare model holistically integrates multiple disciplines and specialties into one cohesive, flexible facility designed to promote connection and collaboration.<\/p>\n

To bring this model to market, MGB engaged Gensler<\/a> (Chicago and Boston) in 2019 to provide architectural, interior, and digital experience design. The health system took a templated approach to iCare to help meet the goal of opening multiple ambulatory centers in rapid succession.<\/p>\n

\u201cWe didn\u2019t want to have to redo the design and architectural planning every single time,\u201d Gainer says. \u201cThe template was meant to be cost effective so we could scale quickly.\u201d<\/p>\n

The original plan was to build at least 15 iCare facilities throughout Massachusetts and New Hampshire within five years, and although factors like COVID-19, capital availability, and regulatory hurdles delayed that plan, the first iCare facility opened in Salem, N.H., in September 2022.<\/p>\n

Clinical space template<\/h2>\n

The design process started with \u201ca template that was location agnostic,\u201d Gainer explains, allowing the core components (like clinical exam rooms, imaging capabilities, and shared staff workspaces) to be modified to meet the available space and programmatic needs at each site.<\/p>\n

This resulted in three size options reflecting different program mixes\u2014ranging from a small 20,000-square-foot primary care clinic with some specialties and simple imaging capabilities to a 40,000-square-foot clinic with multimodal imaging capabilities to a 60,000-square-foot option that includes an ambulatory surgery center.<\/p>\n

With the goal to \u201csimultaneously maximize patient care space while improving the experience for patients and providers,\u201d Gainer says the project team used Lean thinking and visual signaling to make the clinics easy to navigate and efficient to use.<\/p>\n

For example, all of the iCare facilities will feature shared staff workspaces instead of individual offices and flexible, modular exams rooms that can swing to suit any specialty. These elements eliminate extra steps and wasted space, Gainer explains, allowing the facilities to pack in more services and providers than a traditional clinic with dedicated departments.<\/p>\n

However, each facility can also be customized with local artwork and place-based graphics\u2014like the mural that spans all three levels of the Salem building. Material selection may also differ from one site to the next, although sustainability will be a priority in every decision.<\/p>\n

\u201cWe intentionally selected materials with a low carbon impact by specifying materials with recycled content, working with manufacturers that take back and recycle materials, and avoiding materials that contain harmful chemicals,\u201d Scot Latimer, principal and health sector leader at Gensler.<\/p>\n

First iCare clinic opens in Salem, N.H.<\/h2>\n

Gensler and MGB began planning the first few iCare locations simultaneously, and Salem became the first to market\u2014serving as the pilot site.<\/p>\n

Spanning 60,000 square feet over three floors, the Salem facility contains the full spectrum of programmatic components in the iCare template\u2014featuring advanced imaging on the first floor, four outpatient operating rooms on the third floor, and 31 flexible exam rooms across several floors that support primary care, behavioral health, medical and surgical specialty care, and other services like cardiac testing, physical therapy, audiology, and optometry.<\/p>\n

\u201cThis is the most clinically dense project I have ever worked on,\u201d Latimer says. \u201cThe building packs a lot of services into a tight envelope while maintaining a calm, restorative environment for patients and providers.\u201d<\/p>\n

Exam room efficiencies<\/h2>\n

Instead of segregating departments into customized suites designed for each specialty, the exam rooms on the second floor feature standardized designs that allow practically any specialty to occupy a room on any given day, thanks to a flexible, modular design<\/a>.<\/p>\n

With each exam room designed to be identical, different supply carts are wheeled in with instruments and supplies specific to the specialist using the room, whether a primary care physician, orthopedic doctor, or cardiologist. These rooms typically \u201cswing\u201d for half-day sessions, so an orthopedics cart in the morning might be replaced by a cardiologist cart for the afternoon.<\/p>\n

The only exceptions are three exam rooms dedicated to ophthalmology and one to optometry, which require heavier, more specialized equipment.<\/p>\n

Reducing wait times with dynamic room allocation<\/h2>\n

The strategic, standardized design of the facility\u2014particularly the flexibility of the second-floor exam rooms\u2014enables what Gainer calls \u201cnext room up\u201d efficiency or dynamic room allocation.<\/p>\n

This model assigns patients to the next available room instead of making them wait for a certain type of room that\u2019s been assigned to a specific doctor or specialty, while other rooms sit empty. Colored flags outside each exam room indicate whether a patient is waiting to be seen, providing visual signaling to help providers.<\/p>\n

\u201cThat\u2019s why we\u2019re able to work with a much more efficient provider-to-room ratio than you\u2019d normally have in a clinic by removing waste from our processes to make sure that we don\u2019t have underutilized exam rooms or long wait times,\u201d she says.<\/p>\n

The goal, she adds, is to achieve an exam room-to-provider ratio of 1.5:1\u2014compared to more traditional clinic ratios that can range from about 2:1 to as high as 4:1 for certain specialties.<\/p>\n

Using real-time location technology to aid clinic navigation<\/h2>\n

To take these rooming efficiencies to the next level, MGB designed a digital experience that will make it even easier for patients to navigate to exam rooms by leveraging real-time location technologies.<\/p>\n

\u201cMost of this design process occurred during the pandemic, when care was radically shifting to virtual modes,\u201d Latimer says. \u201cFrom a design perspective, this encouraged the team to envision and plan for flexibility for a progressively virtual engagement.\u201d<\/p>\n

The first phase of this technology is currently underway, with the installation of real-time locating systems (RTLS) in the building in July, which will go live this fall. When it\u2019s implemented, rather than waiting for a medical assistant (MA) to guide them to an exam room, patients will receive an RTLS badge at the reception desk and self-navigate<\/a> to their room, where the MA will be waiting.<\/p>\n

Wayfinding clues such as color-coded corridors and tonal transitions throughout the facility will be key markers to help guide patients to their rooms.<\/p>\n

Future exam room technology<\/h2>\n

In the future, this technology will give patients the opportunity to entirely \u201cself-room\u201d themselves, allowing contactless check-in using their own mobile devices. The technology will detect their arrival on-site and transmit a room assignment, allowing them to navigate directly to the next available exam room.<\/p>\n

\u201cIt\u2019s not a patient expectation; it\u2019s a basic consumer expectation to be able to do things quickly and easily from your phone. You can do so much with your bank or a restaurant from your phone,\u201d Gainer says. \u201cHealthcare is so far behind every other industry when it comes to self-service and digital innovation, so we\u2019ve really tried to lean into that.\u201d<\/p>\n

Other digital experience design elements currently in place include large monitors on the wall of every exam room where providers can share imaging results with patients, or video conference with family members or other medical providers during an appointment.<\/p>\n

While these technological capabilities might be dialed down in smaller future ambulatory facilities, Gainer says, \u201cIt was really critical for a clinic this large to incorporate virtual care as much as possible, given that these are community-based ambulatory centers and our whole mission is to bring care closer to home. Being able to integrate an e-consult with a subspecialist downtown is really powerful, so we\u2019ve got a lot of virtual capabilities built into these rooms,\u201d Gainer says, which helps future-proof the business as healthcare evolves with advancing technology.<\/p>\n

Modular clinic design<\/h2>\n

The exam rooms also utilize modular, demountable walls to allow adaptability in the future. These pre-assembled wall panels can easily be reconfigured to combine two 110-square-foot exam rooms into one large 220-square-foot procedure room or broken into three 70-square-foot pods for consults or telehealth visits.<\/p>\n

\u201cAs the business grows, this modular system will enable them to modify the building without having to do a complete demolition-renovation cycle,\u201d Latimer says. The building was also designed with the structural capacity to add a partial level, allowing future expansion beyond the shell, as well, he adds.<\/p>\n

Patients enter a two-sided exam room through one door, and providers enter from a separate \u201cbackstage\u201d staff entrance. \u201cWe wanted this to be a peaceful environment, so we very purposely separated the public and private traffic,\u201d Gainer says. \u201cEven now when we\u2019re full-tilt busy, it doesn\u2019t look or feel busy because everything is behind the scenes, so the whole building feels serene and calm.\u201d<\/p>\n

From the back of the exam rooms, the staff doors slide open into several large, shared workspaces designed to promote collaboration. This area is similarly constructed from modular pieces that allow the space to be easily reconfigured from a \u201cbullpen\u201d of workstations into one long table.<\/p>\n

Several enclosed phone rooms off to the side of this open workspace offer privacy where physicians can conduct telehealth consultations or private phone calls.<\/p>\n

\u201cEverything is shared workspace, so there are no individual offices,\u201d Gainer says. \u201cThat was to promote teamwork and collaboration, but also to level the hierarchy of the care team.\u201d<\/p>\n

A model for growth<\/h2>\n

The success of the iCare model starts with the streamlined workflow design, and the facility design supports that model, Gainer says\u2014not the other way around. Instead of working around highly specialized departments and individual offices, the iCare template is designed around the way iCare providers work together to efficiently serve patients.<\/p>\n

“We\u2019ve tested this clinic flow for years at Mass General Brigham, in brand new buildings and in old buildings, and it\u2019s just harder in an outdated building,\u201d Gainer says. \u201cForm really follows function, so it was a gift to design a building that\u2019s really meant for this kind of clinic flow.\u201d<\/p>\n

Tech-enabled rooms and shared workspaces allow seamless collaboration that makes providers more productive and engaged, resulting in a better experience for the patient. \u201cIt\u2019s amazing what you can do with really thoughtful, purposeful design of both the building and the workflows,\u201d Gainer says.<\/p>\n

And because the design is so standardized and modular, the same iCare template can continue to flex as patient needs evolve\u2014both in Salem and in the other communities where future ambulatory facilities are planned.<\/p>\n

\u201cWe don\u2019t know quite yet how many facilities we\u2019ll build or where they\u2019ll be,\u201d Gainer says, \u201cbut what\u2019s nice about this templated approach is that we\u2019re ready to go. Because the clinic is not specific in terms of specialty, the same template will work even as the patient care needs and market dynamics shift.\u201d<\/p>\n

Brooke Bilyj is a freelance writer and owner of Bantamedia in Cleveland. She can be reached at <\/em>brooke@bantamedia.com<\/em><\/a>. <\/em><\/p>\n

\u00a0<\/em><\/p>\n

Mass General Brigham Integrated Care project details<\/h2>\n

Project location: Salem, N.H.<\/p>\n

Project completion date: October 2022<\/p>\n

Owner: Mass General Brigham<\/p>\n

Total building area: 60,000 sq. ft.<\/p>\n

Total construction cost: Confidential<\/p>\n

Cost\/sq. ft.: Confidential<\/p>\n

Architecture: Gensler, Boston<\/p>\n

Interior design: Gensler, Boston<\/p>\n

General contractor: Consigli<\/p>\n

Engineering: ARUP USA<\/p>\n

Builder: Consigli<\/p>\n

Art consultant: LFA Art<\/p>\n

Art\/pictures: LFA Art<\/p>\n

AV equipment\/electronics\/software: Apple, Crestron, Chief, LG, NEC, Panasonic<\/p>\n

Carpet\/flooring: NORA, Interface, Stone Source, Terrami<\/p>\n

Ceiling\/wall systems: Armstrong, SVA, NanaWall<\/p>\n

Doors\/locks\/hardware: AD Systems, VT Industries, Curries<\/p>\n

Fabric\/textiles: LUUM<\/p>\n

Furniture\u2014seating\/casegoods: MillerKnoll, NaughtOne, Stylex, Nemschoff<\/p>\n

Handrails\/wall guards: Inpro<\/p>\n

Headwalls\/booms: Stryker<\/p>\n

Lighting: Sentient, FLOS, Axis, Viscor, Hubbell<\/p>\n

Signage\/wayfinding: Metro Sign<\/p>\n

Surfaces\u2014solid\/other: Wilsonart, Corian, Porcelanosa<\/p>\n

Wallcoverings: LUUM<\/p>\n

Project details are provided by the design team and not vetted by <\/em>Healthcare Design. <\/em><\/p>\n

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The healthcare system\u2019s new outpatient facility concept can flex to fit different community needs while improving the patient and staff experience.<\/p>\n","protected":false},"author":13605,"featured_media":60916,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[539,537],"tags":[],"acf":[],"aioseo_notices":[],"parsely":{"version":"1.1.0","meta":{"@context":"https:\/\/schema.org","@type":"NewsArticle","headline":"Mass General Brigham Adopts Templated Clinic Design","url":"http:\/\/healthcaredesignmagazine.com\/projects\/mass-general-brigham-adopts-templated-clinic-design\/","mainEntityOfPage":{"@type":"WebPage","@id":"http:\/\/healthcaredesignmagazine.com\/projects\/mass-general-brigham-adopts-templated-clinic-design\/"},"thumbnailUrl":"https:\/\/healthcaredesignmagazine.com\/wp-content\/uploads\/2023\/08\/mgorangewall-150x92.png","image":{"@type":"ImageObject","url":"https:\/\/healthcaredesignmagazine.com\/wp-content\/uploads\/2023\/08\/mgorangewall.png"},"articleSection":"Ambulatory Care \/ Clinics","author":[{"@type":"Person","name":"HCD Guest Author"}],"creator":["HCD Guest Author"],"publisher":{"@type":"Organization","name":"HCD Magazine","logo":""},"keywords":[],"dateCreated":"2023-08-30T15:19:26Z","datePublished":"2023-08-30T15:19:26Z","dateModified":"2023-12-19T04:17:05Z"},"rendered":"