Theory to Practice

Physician Practices have Evolved Large Group Structure Sole Proprietor/Employed Partnership/ P.C. Average loss per employed provider today = $176,463

The Facilities Reflected the Practice Model of the Day Practice 1 Practice 2 Practice 3 Practice 4 Single Building Multiple Buildings

Separate Practices ■ Separate windowless Waiting Areas ■ Multiple Reception/Check-In/Check Out Staff ■ Underutilized exam rooms ■ Practice-specific exam rooms ■ 1,400 building gross square feet/provider

Some Numbers… ■ 220,000 Population of Greater Nashua, NH ■ 70,000 Patients served by D-H Nashua ■ 225,000 Visits per year ■ $115M Annual Revenues ■ 90 Physicians and Associate Providers ■ 400 Full and Part Time Staff

Included groups  Internal Medicine  Family Medicine  Pediatrics  Gastroenterology  General Surgery  Orthopedics  Podiatry  Occupational Medicine  Physical Therapy  Cardiology  Obstetrics  Gynecology  Dermatology 90 Providers

Other components  Urgent Care  Imaging with CT/MRI  Medical Oncology  Endoscopy  Allergy Clinic  Administration  Support

A New Practice Model Consolidated Location Greater efficiency and collegiality through consolidation of practices/buildings. Medical Home Model A primary care team, led by the physician, working collaboratively to address the acute, chronic and preventative needs of patients. Multi-Disciplinary Practice Patient and staff benefits of placing primary care and specialists into a single building.

A Remarkable Project A completely re-engineered approach From the parking lot to the bathrooms, how can we make this the best possible process? A physician champion Leadership was able to foster creativity in an entire organization and drive consensus.

Tools of Communication The Blog

Dartmouth-Hitchcock Goals Macro ■ Improve Provider efficiency ■ Improve the staff/provider experience ■ Improve the patient experience

Dartmouth-Hitchcock Responses Universal Exam Room throughout ■ Avoids constant renovation and allows exams to be used by all Exam rooms are not proprietary ■ Requires fewer exam rooms No hardwall divisions between practice types ■ Allows sharing of exam rooms and promotes collegiality No hardwall physician offices ■ Providers have both on-stage and off-stage workspaces

Floor Plan Diagrammatic Layout for Modular Planning Design Concept

Floor Plan Diagrammatic Layout for Modular Planning Design Concept

Level 2

Typical Room Layout

Internal Shared Workspace

Admitting

Level 3

Level 4

Level 1

Infusion

Ground Floor

morrisswitzer environments for health Site Plan

Interior Stairs

Ceiling Detail

The Results ■ DH-Nashua now sees 30% more patients with the same staffing ■ Building Gross per Provider was approx. 950sf ■ The building and site were constructed for $223/sf ■ Patient, provider and staff satisfaction are up dramatically

Top 4 Differences from Benchmark EMPOWERMENT: It’s okay to challenge the way we currently do things. WORKING ENVIRONMENT: Employees are treated with respect here, regardless of their job. LEADERSHIP: This organization’s senior leaders have a well-formulated strategy for the present. SUPERVISION: My supervisor encourages us to continually improve our performance. above average above average above average above average

Bill Repichowskyj, AIA Partner, Director of Design MorrisSwitzer morrisswitzer.com | thank you Christine A. Schon, MPA, FACMPE VP Community Group Practices Dartmouth-Hitchcock hitchcock.org | Kimberly N. Montague, AIA, EDAC, LEED BD+C Manager, Healthcare A+D Herman Miller hermanmiller.com |