The AdventHealth East Orlando campus is bringing together its Gastroenterology (GI), Colorectal Surgery and General Surgery groups into one multidisciplinary clinic space. The Digestive Health and Surgery Institute and designer RS&H have finalized plans for the 8,000-square-foot facility, which will open in 2021.
“We wanted to create a destination center to serve patients with digestive and surgical healthcare needs,” said Ross Coapstick, executive director of AdventHealth’s Digestive Health and Surgery Institute. “There is collaboration in the clinical care of patients within these three services, and our institute is a representation of the cross collaboration of programs.”
The facility also represents a paradigm shift for AdventHealth, which operates nearly 50 hospital campuses and hundreds of care sites in diverse markets throughout nine states.
“With the design team’s help, we were able to envision a combined office for GI and Colorectal, as well as General Surgery,” said Vanessa Bershad, executive director of market and business development for AdventHealth. “We weren’t quite maximizing the space we had, so we took the opportunity to say, ‘Let’s do this differently.’ We needed a cultural shift in how we build physician offices that will allow us to flex as the market grows.”
Traditionally, space demands allowed for healthcare providers to build their own clinics for their individual practices. However, in 2019 AdventHealth officials were facing site constrictions at the East Orlando campus, which has grown exponentially to the point where some practices were running out of space.
“We initiated the process as we always had – with plans to build these groups their own clinics,” Coapstick said. “We were duplicating everything.”
Therein lied the problem. If a facility is built to serve just one specialty or group, it cannot be well utilized for whatever the future holds – whether that group or specialty grows or contracts.
“We wanted a clinic that would be much more flexible and focused on maximizing productive space,” Bershad said. “You don’t want to walk into a clinic and see huge offices, break rooms and administrative space that isn’t being utilized. We needed to focus on better patient rooms as well as floor plans allowing for future expansion.”
To get a better idea of what these spaces could look like, AdventHealth officials and RS&H designers visited several facilities across the country, studied other local practicing AdventHealth clinics and worked with the Colorectal, GI and General Surgery physicians to gain their feedback.
“We learned that there is a better way to do this,” Bershad said. “We had to show value to the physicians, demonstrating that if they want to grow – and we fully intend to grow these service lines – we needed to find a way to get there that isn’t asking for more capital five years from now.”
While the pitch made sound business sense, the physician groups needed input on how to make the vision for this multidisciplinary clinic an even better reality.
“We arrived at this idea as a group of administrators, and then we had to turn to our physician groups and say, ‘We have this amazing idea – we’re going to put you in the same office… What do you think?’” Coapstick said. “We took a step back with our designers and brought the physicians’ voices to the table. They showed us insights we would never have had as non-clinicians. They guided the design and made it work to address their individual clinical needs.”
RS&H project manager Itzel Lozada, AIA, and her team held meetings and interviews with the different physician groups and administrative staff to better understand their must-haves for the space.
While some physicians had no concern over shared space, others had been accustomed to having their own private offices and wanted to keep them. Lozada and her team had to creatively develop a floorplan that could be tailored to both groups.
There was clearly a need to keep physician offices in proximity to both the clinic and the hospital campus. A fundamental design driver discovery occurred during site visits to several academic medical centers across the US. Health systems like the University of Utah and Yale ran clinic spaces as a time share using a standard design. In this model the physicians did not have their own office space in the clinic. They did, however, have personal offices back on the main hospital campus.
As the design matured through nearly two dozen iterations, the individual physician offices turned into 12 45-square-foot landing spaces intended for multiple physician use.
“By still having these offices, we were able to meet the needs of the physicians who require a place to retreat to, do some work, make calls and review charts,” Lozada said. “It also gives them a place to go to decompress after surgery or a procedure.”
The 12 office areas are also equipped with the necessary technology to perform telehealth, an important benefit especially during the COVID-19 pandemic.
For the clinic space, RS&H developed a footprint that features similar clusters throughout the facility – a town center where the nurses’ station is centrally located with support spaces that are surrounded by the exam rooms.
“The design provides the practical benefit that if you leverage the square footage of the office and optimize it to include more clinically productive space, the result is a better value for our organization and our patients,” Coapstick said. “It lowers the cost of care by elimination of duplicative resources.”
When the AdventHealth and RS&H team dug into the utilization rates of some offices, they saw that several exam rooms were being utilized only half the time.
“We had open rooms every Friday and during procedural blocks, which resulted in a lot of space that wasn’t being utilized as well as it should,” Bershad said. “Because the physicians perform endoscopies and surgeries outside of the clinic, there has to a balance between their office time and procedural time. This makes for a lot more room to play Tetris with than if we were working with a primary care group where physicians are always in their offices.”
Administrative resources like scheduling also needed to be reimagined to create a more efficient facility. The new layout features an administration area that connects to both the suites and the conference room. Barn doors on scheduling offices create privacy without swinging out into the corridor. Not only will the administrative staff be pooled together, but they will be cross-trained to support each of the three practices.
With the innovative design finalized, AdventHealth officials will now focus on operationalizing the facility as construction begins. If the model proves successful after opening in 2021, it could be scaled and used at other AdventHealth campuses.
Success will be defined by realizing the efficiencies the team intended to create.
“A big struggle we have across our region is that there are very few easy additions – we’re constrained by older buildings, walls and capital limits,” Bershad said. “This facility design will allow us some easier growth. If we do find we’re not using certain areas of the building, we can evolve much easier in this new space than we can in the traditional designs.”
“With the collaboration between the practices, we now have an opportunity for seamless referrals and immediate consults,” Coapstick said. “It’s the right way to go.”