Collaborative Rewards
Seamless design enables joint venture to reduce costs and enhance care
Elevated costs are stimulating innovation in the health care construction industry. Increasingly, the motivation to maximize resources, reduce waste and enhance overall results causes groups and departments to form alliances in ways that might not have been deemed feasible a few years ago, according to a July/August Healthcare Construction & Operations (HCO) article by Michael Klinger.
A prime example is Weston Regional Medical Center, a joint venture between two major health care providers: Ministry Health Care, in Milwaukee, and Marshfield Clinic. At the new Weston Regional Medical Center, in Weston, Wis., an inventive business arrangement—coupled with creative design concepts—has helped the project succeed. The final product is becoming a model for new projects in other parts of the country.
The new $92.5 million medical center includes a diagnostic and surgical services center, medical office buildings and Wisconsin’s most technologically advanced hospital. A 650,000-square-foot complex designed and engineered by HGA Architects and Engineers, the facility encompasses the 475,000-square-foot Saint Clare’s Hospital; the 90,000-square-foot Marshfield Clinic Weston Center; and an 85,000-square-foot medical office building operated by Ministry Medical Group. Incidentally, both the hospital and medical group are operated by Ministry Health Care.
Designing a huge medical campus with some shared services is a complex and daunting undertaking. The complexities range from practical issues (where to place shared resources) to legal considerations (how to ensure compliance with Stark Law provisions created to prevent hospitals from providing physicians with incentives for using the facility). Detailed planning and research, combined with staff trust and feedback were crucial to creating a successful outcome for all parties.
Collective Efforts
The alliance between the physicians’ group and the hospital is most evident in the Diagnostic & Treatment Center (DTC). The centrally-located complex places expensive, high-tech equipment in a location that is easily accessible to a number of departments on campus. The center—which is home to a variety of support services, as well as cafeteria services and a pharmacy—was needed to avoid duplication of those high-cost elements, according to Ministry Health Care CEO Jeff Martin.
In considering the collaborative arrangement, competition was a major consideration, says Thomas Grice in the July 2006 issue of Today’s Facility Manager. Grice, facilities services manager for Ministry Health Care in the complex, states: “We didn’t want to compete for services on the campus. So, we decided to enter a joint venture. As a result, many ancillary services, including radiology, heart care, laboratory, and same day surgery, are housed in the DTC. It’s the center core of the building.”
Creating a DTC was a feasible solution, says Dr. Gary Zimbric in the same Today’s Facility Manager article. Zimbric, the Marshfield Clinic Eastern Division medical director, explains: “The goal from the beginning was to create an integrated complex that combined both inpatient and outpatient experience, and at the same time was cost-effective in avoiding unnecessary duplication of high cost, high technology support services like CT and MRI scanners, laboratories, cardio-diagnostics, and radiology. The challenge was to place services in a location that would assist multiple locations. The solution was to place the DTC at the core of the complex.
Although a cost-efficient move, housing multiple departments and services in a common area creates a unique set of complications, points out Al Pennebecker, Ministry’s administrator on the project. “When you create a shared relationship, there are a lot of policies that need to be jointly developed and there’s a business aspect that’s fairly complex,” Pennebecker tells HCO. “But for the patient, operationally, it’s a very good move.”
Kurt Spiering, AIA, ACHA, health care principle-in-charge for HGA, points out that shared operations can present potential legal challenges. “The question of how to integrate service and provide incentives for both physicians and hospitals without providing illegal advantages is something many people are intrigued by,” Spiering explains to HCO.
“The solution is what we did at Weston,” Spiering adds. “[The two companies] created a third-party joint venture that is separate from both the hospital and the clinic.” He adds, “If you can achieve both convenience and seamlessness and still be in separate occupancy, that’s where you gain real savings without sacrificing on ongoing operations.”
Cost Savings
As another challenge, HGA also had to create a building that could expand and fit expected future growth—about 300 percent in terms of square foot, according to the Today’s Facility Manager July 2006 article. “We had to build it to be adaptable and flexible,” Spiering says. “We chose a linear progression for expansion rather than concentric. A concentric approach probably would have decreased some of the distances between departments in the first phase. But at some point they would have to expand to a second or third module, which would create way-finding and expansion issues for certain core services. The linear design will allow for growth to occur in a logical sequence.”
As a result, HGA designed the facility with a fixed core to contain elevator shafts and mechanical rooms and closets, as well as staff circulation hallways. “We centralized those aspects and made that a key element of the design,” says Spiering. “The intent was to allow functional space modules to be added in the future without having to do major renovations to key structural elements.”
Cost savings were also realized from using less expensive grades of construction where possible. The clinic, hospital administrative offices and many outpatient services were built in business-occupancy space, saving 15 percent compared with traditional hospital-construction grade, according to Spiering.
However, Spiering adds that building at different grades won’t work for every feasibility. “It sounds wonderful if you can put the lab into a free-standing building that’s business occupancy, but it might mean that you have to travel another 200 feet each time you’re delivering a specimen,” he explains.
“You have to analyze each one on its merits, but there are endless bundles of services that do make sense to be in this business occupancy versus the institutional type occupancy that hospitals are built in.”
Addressing Staff and Patient Requirements
Improving patient care was a main driver of the design approach taken by the Weston project, according to Al Pennebecker, who also serves as Ministry’s regional vice president for facilities and support services. “The primary reason that we went a non-traditional route was to get the caregivers closer to the patients,” he states in HCO. “We were pursuing a variable acuity model of care, and in doing that, we wanted to get nurses and assistants closer to the patient for faster, more direct care. They have a visual line-of-sight to the patients at all times.”
To accomplish this HGA chose a concept that aimed to address the needs of nurses and assistants alike, while also meeting the competitive demands for patient comfort and privacy. “We settled on a decentralized concept that calls for setting up the unit in pods, so that nursing assistants are never far from the materials that they need,” explains HGA’s Brent Peterson, who worked primarily on the in-patient design for the Weston facility.
Electronic bedside charting was installed between every other room, creating 12 charting stations on a floor with 24 beds. The additional charting stations not only conserve nurses’ time and energy, but they also help to enhance the healing experience for patients.
Peterson explains: “We’re using a ‘patient experience process’ to help the staff put the patient and family members first. Then we find solutions for how they can meld their work process around what’s already fundamental to the customer.”
This article was reproduced for educational purposes from a July/August 2006 Healthcare Construction & Operations Facility of the Month article entitled “All Together Now” by Michael Klinger, as well as a July 2006 Today’s Facility Manager article by Anne Vazquez.