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    Christian Green
    Christian Green, MA

    As part of its strategic plan, Virginia Mason Medical Center, Bainbridge Island, Wash., wanted to expand patient access and grow the medical center. To rise to that challenge, practice leaders created an action plan for optimizing office space to address impediments to bringing in more patients.

    According to Catherine Edwards, MD, physician section head, primary care, and Somer Shields, MBA, CMPE, director, Virginia Mason Medical Center, creating an action plan is less complicated than you might think. “One of the big goals is that you can learn how to do that without having to make a major financial investment in facility change,” Shields says. “You don’t need to build a new building or have a huge remodel to implement some of the changes that we’ve made in terms of access for patients.”

    Although change doesn’t happen overnight, the first step is to assess your space to determine how your practice can be more efficient. 

    Scan your space

    Observe what’s going on in your office space, both in terms of physical space and time space. Next, answer some basic questions, including:

    • What do your exam rooms look like; e.g., beds, chairs, computers?
    • How mobile is your work space?
    • How do staff and providers use work stations and are there any barriers to using them?
    • How are providers grouped?
    • How is space being used in terms of hours of operation?
    • Are there bottlenecks or barriers that need to be overcome to increase efficiency; e.g., do you have weekend or early/late hours? Are appointment times staggered? Do providers and staff work the same days/hours?


    As Shields expresses, “It’s amazing what you can see in even half a day of sitting on the floor … the information you get from watching what happens in your own space is fascinating.” Once you do this, you can begin collecting data in three categories: utilization, operations and findings.

    Utilization

    Utilization is the weighted average time a patient spends in an exam room. It’s defined as the time a patient checks in until he or she leaves, taking into account the extra time it takes for new patients. The formula is as follows:

    • Number of new patient visits multiplied by exam room occupancy time equals the number of minutes utilized
    • Number of established patient visits multiplied by exam room occupancy time equals the number of minutes utilized
    • Total minutes utilized divided by total visits equals the average time per visit.

    Operations

    How many hours is your office open during the week? Regardless of whether you have multiple offices, you can set a baseline average to compare utilization in all offices. The formula is as follows:

    • Hours of operation per week multiplied by days of operation per year multiplied by number of exam rooms available equals total hours available
    • Divided by 60 equals total minutes available
    • Divided by exam rooms equals total minutes per exam.

    Findings

    What does this mean in terms of optimal utilization? As illustrated in the above formula, if a practice is utilizing its space completely and in flow, the number of rooms needed is much lower than what’s typically utilized. However, as Shields notes, “We know that’s not realistic; we don’t operate in perfect flow … but there is a standard within the community that says if we get to about 70% utilization, that is our target.” The formula is as follows:

    • Total minutes per exam multiplied by average time per visit divided by total visits equals the exam rooms needed
    • Divided by the 70% utilization target equals the actual rooms needed.

    As shown in Figure 1, rooms were being underutilized in the medical center, but many staff and providers thought otherwise. “The perception at the time was that we didn’t have enough space,” Shields asserts.

    Once capacity was assessed, Virginia Mason made the data visible to providers and staff (Figure 2) to demonstrate where they were falling short of the 70% utilization target. The medical center was then able to ask why a specific space was being utilized more (or less) and how it could make changes to better utilize unused space.

    As a result, over a two-year period, Virginia Mason went from 40% utilization to 60% utilization, all thanks to tracking data and making appropriate adjustments. 

    Reimagine and optimize space

    Once you’ve scanned your space, you can then transition from the traditional model, in which there are fixed exam rooms and designated offices to a shared space, in which optimization and collaboration take precedence. “We have eliminated offices,” Edwards emphasizes. “Not even leadership has offices; it’s a team-based model with pods. There are work areas and team rooms for people to be able to have private conversations, and everyone else is co-located in a very collegial way that also lets us use our space more effectively.”

    In this model, flexibility matters most, with pop-up clinics, mobile computer workstations, mobile supplies and equipment, modular walls to divide spaces, and shared exam rooms for staff and providers. Flexibility is particularly helpful for high-volume practices that have seasonal variances in how busy they are, such as when flu vaccines are being provided.

    The same holds true for how time is used in space. For example, providers don’t always have to work Monday through Friday or take lunch at noon. As Shields points out, much of patient scheduling is determined by patient demand. “We live in a community that is on an island, so many people take the ferry to Seattle for work,” Shields remarks. “Some of those patients appreciate being able to come in really early for an appointment, get to work and then go home at night … so we made some changes to accommodate that.”

    In addition to space and time, patient flow is another important component of reimaging practice space. Virginia Mason tackled this by adopting a new model that emphasizes patient flow. Some of the key components include:

    • Patients self-room: Once they’ve checked in at the front desk, patients walk to the exam room, unless they have mobility or cognitive issues, and meet simultaneously with a medical assistant and a provider.
    • Collect key visit data ahead of time: This saves time on the day of the visit, especially with new patients.
    • Patient appointments by phone or televideo: Virginia Mason is in the early stages of its telehealth journey, but it’s a key consideration going forward.
    • Patients seen in a group setting: Educational visits can be streamlined by seeing patients with the same chronic condition in one room.


    These continuous flow methods can be utilized to further the patient experience, as the goal is to see things through the patients’ perspective to improve care by being more efficient and effective. “The challenge in our clinical flow is if we’re going to make this better for everybody all around and use our space differently, everything in our clinical experience is value added,” Edwards says. She notes there shouldn’t be any redundant steps, waiting during handoffs or delays during the visit.

    Results

    Reassessing the way it utilizes space has helped Virginia Mason increase patient access and accelerate growth. According to Shields, the medical center saw:

    • A 24% reduction in patient length of visit
    • A 22% reduction in length of room stay
    • A 39% reduction in patient time alone.


    In turn, this has led to greater patient satisfaction, and the payoff is coming to fruition, Shields contends: “We’re starting to feel enthusiasm about what we’ve done is working, that it’s made sense and that we’re on the right track.”
     

    Christian Green

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