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Putting patients first in office redesign

It’s one thing to look at an architectural rendering on paper and quite another to walk through a 3-D model of your proposed work space.

Last week, doctors, nurses, administrative staff and even a few parents from Akron Children’s NeuroDevelopmental Science Center gathered in a large warehouse just east of downtown Akron and spent time walking in and out of exam rooms crafted from heavy-duty cardboard.

It’s a prototype of the future NeuroDevelopmental Science Center.

The center is one of the hospital’s busiest programs with 27,000 patient visits each year. Many of these patients require frequent visits because of chronic conditions like cerebral palsy and epilepsy and about 25 percent have mobility issues or are confined to wheelchairs.

While the center spans about 26,000 square feet, there has been growing consensus that the space is not well designed for patient families who have to maneuver lots of corners and narrow hallways. Meanwhile, healthcare providers spend too much of their valuable time walking.

“More than a year ago, we began talking about how we could redesign the space to improve patient care, reduce wait times and make more valuable use of the time our doctors and nurses have to spend with patients,” said Sherry Valentine, Akron Children’s Lean Six Sigma-trained project leader.

Valentine organized a three-day Kaizen in the warehouse made available by Phil Maynard, a member of Akron Children’s Hospital’s Board of Directors.

Although computer-aided design is helpful in such projects, nothing is better than having the opportunity to actually walk down proposed hallways (marked off by masking tape) and enter and exit “rooms” in 3D. After all, if something doesn’t work – a room is too small or doorway too narrow – you can easily change it at this stage.

Here are some of the proposed changes:

  • The new space will have “pods” for specialties like neurology, physiatry and developmental pediatrics. They will resemble neighborhoods and allow for better collaboration among providers.
  • Exam rooms will be smaller, in general, but there will be more of them. Each room will have a wider-than-average door for patients and a second door for the physicians to enter. The physician entrance leads to the pod of private offices and space for the team to meet, discuss cases, and conduct research and train residents and fellows.
  • Physician offices will also be smaller but more will be added to accommodate new hires.

“We are getting rid of paper and doctors don’t buy books like they used to,” said Bruce Cohen, MD, director of Neurology at Akron Children’s. “Our offices will have glass walls to allow natural light from the windows to travel into the clinical areas. This will also allow patients and others to see we are in our offices but at work. Medicine shouldn’t be a clandestine operation.”

Exam rooms will be designed for better physician-patient communication. Now, doctors must turn their backs on patients to read medical reports. A half-oval shaped desk will allow for better eye contact and a computer screen on an articulating arm will make it easier for the doctor to show a parent an imaging study.

With conversion to electronic medical records, there is no longer a need for a room devoted to shelves of paper records.

The size of the waiting room will be reduced by about 50 percent, but there should be much less waiting and better flow of patient traffic throughout the day, thanks to an improved scheduling system. Appointment times will be staggered, a new policy for late arrivals will be implemented, and much of the work of checking in will be done before arrival.

When patients exit the elevator, they will turn right and see the front door to the practice. It’s now hidden from view and leaves many feeling lost. Sliding glass doors will open with the push of a button.

On the last day of the Kaizen, Judy Doyle, the coordinator of Akron Children’s Parent Mentor program, and several parents walked through the space. A few pushed strollers and wheelchairs and imagined how the space would work for a toddler – or teen – with special needs.

Jackie Smolinski was one of the parents. Her 4-year-old son, Luke, sees four specialists in the NeuroDevelopmental Science Center and has, on average, 20 appointments per month.

“I appreciated the opportunity to share my thoughts,” said Smolinski, who typically also travels with her daughter and Luke’s service dog. “It’s definitely better to learn what works now, when it can be fixed, rather than later.”

Dr. Cohen said, in 30 years of practicing medicine, this is the first time he has participated in such a hands-on, collaborative planning of work space. He thinks patients will walk away happier.

And, if all goes as planned, patients will be in and out quicker.

According to Valentine, the plan calls for shaving 10 minutes off the current average appointment time of 66 minutes.

“That will enable us to see 2,000 more children per year,” she said.

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