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    David N. Gans
    David N. Gans, MSHA, FACMPE

    As social distancing and other factors have helped flatten the curve of COVID-19 infections, medical group practices face a new challenge after reopening during a pandemic: Balancing the need for safety with the need to efficiently see patients in the office setting that results in patient satisfaction.

    David Baker, vice president of healthcare development, Ryan Companies, Minneapolis, Minn., recently joined me on the Executive Session podcast to share his insights into how practice leaders can make changes to facility design that are consistent with social distancing, use of personal protective equipment (PPE) and new standards for sanitizing and cleaning facilities brought about to minimize the spread of coronavirus infection.

    From waiting rooms to ‘just-in-time’ experiences

    Already, the reopening of medical practices has necessitated significant short-term changes to practice space, such as the replacement of the normal waiting room in favor of asking patients to wait in a car or outside the clinic space.

    Baker notes that the rapid expansion of virtual care and triage, along with collection of needed documents from patients via digital means, are steps to bring healthcare closer to just-in-time arrivals that leverage real-time schedule updates, communicated to patients’ mobile devices.

    “COVID-19 was a big tipping point for healthcare delivery in this country,” Baker said. Now, patients are texting practices about their arrival to the parking lot and then awaiting instructions from a nurse or staff member about how to enter the office. “You’re literally greeted at the door and taken directly into an exam room,” Baker said. “A lot of groups, they completely abandoned the traditional waiting room for a check-in,” and instead pushing to just-in-time arrivals that are more in line with other consumer services, such as OpenTable for restaurant reservations or seat selection for movie theater tickets.

    “The social distancing is actually going to be driving more-efficient delivery of care,” Baker added, which means that the time actually spent in the clinic will be more focused on quality time between a provider and patient, if practices re-engineer processes.

    Space is what you make of it

    While waiting room changes are largely driven by concern to prevent potential infection and a desire to minimize time and resources devoted to cleaning, there remains opportunity for practice leaders to rethink what type of square footage is needed going forward. If renting, a reduced need for waiting room space could lead to selecting a smaller space with lower rent costs, which also leads to less furniture and less cleaning.

    The ability to greet and patient and take him or her directly to a treatment or examination room can make that person feel more comfortable and that their needs are being better accommodated, which strengthens the relationship the patient has with providers and the organization.

    Baker said that physician efficiency often is a driving force in designing facilities that opt against waiting areas. Multispecialty groups have embraced the ambulatory care center model for decades now, but now in the COVID-19 era, “congregating these clinical spaces into one mini-campus” help enable patients to get the range of care they need — primary care, diagnostic imaging, labs and more — in a medically based wellness center.

    Adding different components such as HEPA filters and changeable HVAC flows can allow for what Baker calls “medical flex space” — a core building that can be reconfigured from clinical rooms to procedure suites, or converted into safe zones for potential COVID-19-infectious patients.

    Other space considerations include mixed-use developments where the first-floor suites include offerings such as cafes, fitness centers or walking tracks that a patient could take advantage of when an appointment cannot begin on schedule.

    Examining touchpoints and reducing costs

    As patients return for in-office visits, Baker notes that pushing more processes into cloud-based applications that can be run on tablets or iPads opens up more real-time data exchange with less touching of paper, pens and even provider workstations. With a standard workstation, it is difficult to ensure a keyboard, mouse and monitor can be sanitized, versus a flat, tablet-style device that can quickly be cleaned. In the process of minimizing risk of infection, a practice may eliminate the need for a workstation for a cheaper, handheld device.

    This “less-is-more” approach can be extended to how much cabinetry is needed going forward. If equipment could instead be brought into a room as needed, Baker notes that it could have an impact in the overall capital costs for the facility if practice processes can be updated to work with less square footage.

    Additionally, recent improvements in technology are enabling improved cleaning via options such as UV-C light and no-touch, motion-sensor-activated lights. UV-C light cleanings holds the potential to save significant amounts of time and money on manual cleaning by staff.

    Baker said many organizations are opting for glass panels and sliders instead of walls and doors, often with a simple handle made of copper, silver or brass — all of which to make it more difficult for viral material to survive, in addition to being easier to clean than other surfaces. Other facilities are embracing “maze” entry to bathrooms, often found in airports, in which there is no door but privacy is maintained by a wall to walk around.

    Thinking beyond the pandemic

    Oftentimes, medicine has had significant improvement and technological change during times of crisis, such as improvement in surgical techniques and patient evacuation during wat times — innovations that sometimes become a new norm for the industry.

    The COVID-19 crisis has changed how healthcare does business, but as Baker notes, it must be done in a way that changes the patient experience for the better. “There’s always going to be a need for healthcare, and the patient is always going to look to and trust their physician,” Baker said. “But the physicians can provide the best level of care” when the environments created for patients to experience lead to higher patient satisfaction and provider productivity. These changes would have staying power beyond the shorter-term reactions to COVID-19 and unlock better reimbursement and lower costs in the long run.

    David N. Gans

    Written By

    David N. Gans, MSHA, FACMPE

    David Gans, MSHA, FACMPE, is a national authority on medical practice operations and health systems for the Medical Group Management Association (MGMA), the national association for medical practice leaders. He is an educational speaker, authors a regular Data Mine column in MGMA Connection magazine and is a resource on all areas of medical group practice management for association members. Mr. Gans retired from the United States Army Reserve in the grade of Colonel, is a Certified Medical Practice Executive and a Fellow in the American College of Medical Practice Executives.

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