clinic 20xx roadmap
In an information age, the insights we get must be winnowed down through carefully selected lenses — only then do we understand the core principles that can withstand change. This roadmap lays out what data was collected for the report as well as how it was gathered.
healthcare system performance:
an international comparison (2014)
The rising healthcare costs in teh United States have been an ongoing concern for policy makers, healthcare providers and patients. In a recent Commonwealth report, it was found that, compared to ten other developed countries, the United States spent the most on healthcare, while the quality of care was rated among the lowest.
growth in ambulatory care construction projects in the next three years
According to a 2014 report from The Advisory Board, based on feedback from 38 hospitals and healthcare systems, over the next three years, ambulatory care facility consruction is projected to grow by 71 percent.
the expanding care continuum
With an increased focus on population health management and care coordination, the entire spectrum of outpatient care is now expanding. On one end, this includes the retail walk-in clinic (small satellite clinics that offer routine care) while on the other end of the spectrum are regional hubs, with a full suite of services serving an expansive catchment area.
The graphic below shows the importance of establishing a wellness network as a full spectrum of population care points, which are interwoven within communities.
on-demand patient expectations
"Time as premium" is a concept that suggests that, regardless of year of birth, the healthcare industry is responding to a "Generation Now" where they demand more care, better care and immediately available care.
the patient, then and now
Today’s patient has a wider range of payer models, ranging from public insurance to consumer-driven health plans, and has multiple medical conditions. Accordingly, today’s patient’s care is more complex, requiring careful management of several medications and an unprecedented level of coordination among caregivers across settings.
the new care team
We are seeing a growth of new care team members, such as the physician extender/nurse practitioner (who can take on some of the physician responsibilities), and physician/medical assistants who team with the key care provider to provide team-based care. Additionally, with a focus on whole health, a growth in ancillary support for the entire team via health coaches, case managers and behavioral health specialists has increased. We also are seeing the need for more technical knowledge due to the advances in the field, technology and electronic health records.
The challenge with a diverse team structure is that without care coordination, the system can fall apart.
big data's three v's
Electronic health records (EHRs) are one aspect of the data revolution that we are currently going through. In healthcare, this has resulted in the possibility of personalized and precise medicine discussed earlier. By definition, big data is data that exceeds the processing capability of a conventional database system and is characterized by three V’s: Volume, Velocity and Variety.
Remote monitoring has been made possible through innovations like wearable technology and cloud-based syncing. It gives care teams real-time updates of their patients, and the information is stored on the individual’s EHR. EHRs provide insight into the behaviors and risks of individuals, which, in turn, can be aggregated to determine preventive options for population groups. Applications already used by clinics to monitor their patients include ingestible and wearable technology and smartphone attachments.
Patients have two pathways of care through their smartphone: connect with a telenurse for consultation and follow-up care, or with a scheduler and physically go to a local clinic, which can connect with a regional hub virtually.
Care coordination requires continuous communication between a diverse care team and their patient, which activates the patient to participate in his or her own care. The availability of health information keeps patients and the care team in the loop remotely.
population health and wellness
Population health management (PHM) has been emphasized recently to combat the rise of chronic diseases. Engaging patients and managing the health outcomes of several million individuals is a complicated process, but rapid advancements in technology allow for care teams to not only manage these individuals but also collate these individuals into groups by similar risk factors.
Thinking of the patient as a consumer has shifted the thinking to developing more "hospitality-like" elements in health settings, where the health experience is crafted like a consumer experience. Retail health is healthcare that is consumer-driven, providing new consumer-oriented access points and choice-based, on-demand amenities, which go beyond retail clinics, MinuteClinics (CVS) and Walgreens.
facility innovation spread
journey through Surgery Department
Mapping the patient and family paths through the surgery department
patient experience mapping
Mapping the emotional levels of a patient experiencing the surgery department
care team configuration
The ICU is compromised of a complex and diverse care team that cares for the patient. The configuration demonstrates the need for space at the bedside. Our observations showed that at least eight people may be around the patient at the time of an admission. Thus space around the patient, and especially in the entrance to the room, is critical.
design diagnostic timeline
During programming and current state analysis (parametric analysis could continue through SD and DD). A Diagnostic should be proposed for units that are particularly problematic: low HCAHPS/high falls/inefficient throughput, etc. Ideally, if a unit is identified as an issue in current state based on the broader operational analysis (loo, a diagnostic has value. Simulation tools informed by the diagnostic can be used through out the process by the design team.