Healthcare Case Study: Collaborative Care
By Anne Vazquez
Published in the July 2006 issue of Today’s Facility Manager
The gentle curves and expanses of glass that characterize the Weston Regional Medical Center convey a serene and welcoming mood. And that’s just what the doctor ordered for this new 540,000 square foot health care complex in Weston, WI, a collaboration between two regional health organizations, Ministry Health Care and Marshfield Clinic.
Under Ministry Health Care’s domain in the complex are Saint Clare’s Hospital, a 366,169 square foot, 86-bed facility and the Ministry Medical Group Clinic, an 81,915 square foot facility, which houses physician offices. Marshfield Clinic owns and operates its Marshfield Clinic Weston Center on the site, a 92,346 square foot facility in which 50 physicians offer comprehensive primary, specialty, and surgical care services.
Located at the heart of the complex is the Diagnostic & Treatment Center (DTC), a shared services facility, which Ministry and Marshfield own jointly; Ministry provides facility management services. This partnership was inspired by the organizations’ desire to create a facility that would offer numerous medical services while maximizing assets. Occupying 124,653 square feet within the complex, DTC operations include inpatient and outpatient diagnostic imaging, therapeutic services, and same day surgery.
In considering a partnership, “we didn’t want to compete for services on the campus,” explains Thomas Grice, facilities services manager for Ministry Health Care in the complex. “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.”
Explains Dr. Gary Zimbric, the Marshfield Clinic Eastern Division medical director, “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.
Building Ahead Of The Curve
Initially, another challenge was the need for flexibility in the design and construction process. Certain aspects of the facility were not yet determined in the context of the joint venture. To start the planning process at this point required a work in progress approach.
Knowing they wanted to build a state-of-the-art facility that would encompass multiple care offerings, Ministry Health Care and Marshfield Clinic hired the Milwaukee, WI office of Hammel, Green and Abrahamson, Inc. (HGA) Architects and Engineers in the fall of 2001 to begin the design process.
Kurt Spiering, AIA, ACHA, health care principal in charge for HGA, explains, “We put together prototypical programs based on volumes that the executive team provided us. Still, we couldn’t work in a vacuum, and we needed feedback from end users.”
To address how all the elements would fit together in the most productive and beneficial way, department heads from other Ministry locations were assembled. The aim was to provide best practices and other insight into how the elements within the complex should complement each other.
In addition to the potential changes in spaces, HGA also needed to design the complex for expected future growth—about 300% in terms of square footage. “We had to build it to be adaptable and flexible,” says Spiering.
“We provided enough flexibility in the perimeter and infrastructure design so we could accommodate just about any change the client would make,” Spiering explains. “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 wayfinding 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.”
Communication Through Automation
At the outset, Ministry Health Care and Marshfield Clinic decided a main driver would be to incorporate cutting edge technology into both the facility management and health care aspects of the operations.
Saint Clare’s is the first hospital in the state to have a completely digital patient record including computerized physician order entry. The building infrastructure, as well as various aspects of health care delivery, has been automated since the facility opened.
Grice, who had previously worked in the facilities departments at other Ministry sites, notes that the organization had been implementing digital systems in some of its existing buildings. “In our older buildings, we have tried to integrate systems as much as we could,” he says. “But we couldn’t do everything. Here, we decided to start at ground level and integrate everything we possibly could.”
On the facility management side, all building systems in the complex are linked through a building automation system (BAS). Taking advantage of the integration, Grice is working toward providing what he terms “just in time” maintenance, noting that his department can identify and address problems with equipment often before occupants even know there is a problem.
“We have placed accelerometers on all of our larger equipment, including pumps and chillers, to monitor their vibrations in real time,” he explains. “The accelerometers measure vibrations according to a baseline figure. If vibrations are outside of normal parameters, the accelerometer communicates with the BAS, which sends an alert to the CMMS to generate a work order.”
While managing a facility of this nature can present quite a challenge, Grice says that frequent communication between Ministry and Marshfield has made the day to day operations run relatively smoothly. “It’s a team approach,” he says. “And so far, it has worked out very well.”
He points out that an emphasis on process mapping has also helped to avoid potential problems. “We use process mapping in virtually all of our operations procedures, even down to how a work order is placed,” he says. “We do it to create consistency and standardization. It also helps us to identify steps in the process that aren’t working.”
Through the use of technology and integration, the Weston Regional Medical Center strives to provide a state of the art environment for those who matter most—the patients. However, planners did not forget to focus on the more personal experiences of patients while in the facility.
For example, natural light is present throughout many of the areas, including some procedure rooms. Natural stone, wood, fabrics, and fiber art in the public spaces create a comforting ambience. And outside gardens provide a respite for both patients and visitors.
In the inpatient sections, visiting family and friends were also considered with patient room furnishings that accommodate an overnight stay. Each waiting area contains a fireplace and computer ports to create a welcoming and convenient atmosphere.
“One of my favorite things about the project is that it’s a relatively large building with a small hospital feel,” says Spiering. “We were able to break down the scale of the facility to make it comfortable and friendly, rather than overwhelming.”
As the Weston Regional Medical Center continues to grow in central Wisconsin, one thing is for sure, the staff collaborating behind the scenes contributes daily to the healing mission of the facility.
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