2 TEXAS CHILDREN’S HOSPITAL

TCH Conversion $6.6M – Initial Construction Budget (10% Contingency Included) $6.6M – Actual Construction Budget $13 M – Overall Approved Project Budget $12.6M – Actual Total Commitment To Project Building Relationships with Community – Metro, Local Council Managing non-TCH tenants (Dental) – infrastructure heavy & delayed opening timing

Computer Simulation

Overview Of Simulation Modeling

ARRIVAL AT MEDICAL HOME PT TO SUB WAITING FOR NAVIGATOR GATHERS ANY SIGNITURES AND REVIEWS NECESSARY DOCUMENTS CHECK-IN KIOSKS FOR ESTABLISHED PATIENTS? 3-5 MINS PT TO SUB WAITING FOR NAVIGATOR GATHERS ANY SIGNITURES AND REVIEWS NECESSARY DOCUMENTS CHECK-IN KIOSKS FOR ESTABLISHED PATIENTS? 3-5 MINS SICK CHILD WELL VISIT NEW VISIT %$ WELL VS. SICK SICK CHILD WELL VISIT NEW VISIT %$ WELL VS. SICK SICK VISIT WELL VISIT NEW VISIT PT TAKEN TO EXAM ROOM VITALS TAKEN ON WAY LAB DRAW AR VITALS IF REQ 3-5 MINS PT TAKEN TO EXAM ROOM VITALS TAKEN ON WAY LAB DRAW AR VITALS IF REQ 3-5 MINS PT TAKEN TO EXAM ROOM VITALS TAKEN ON WAY 3-5 MINS PT TAKEN TO EXAM ROOM VITALS TAKEN ON WAY 3-5 MINS PT TAKEN TO EXAM ROOM VITALS TAKEN ON WAY 3-5 MINS PT TAKEN TO EXAM ROOM VITALS TAKEN ON WAY 3-5 MINS EXAM VISIT HISTORY & PHYSICAL TIME BASED ON ESTABLISHED PT HISTORICAL DISTRIBUTION 5-40 MINS EXAM VISIT HISTORY & PHYSICAL TIME BASED ON ESTABLISHED PT HISTORICAL DISTRIBUTION 5-40 MINS EXAM VISIT HISTORY & PHYSICAL TIME BASED ON ESTABLISHED PT HISTORICAL DISTRIBUTION 5-40 MINS EXAM VISIT HISTORY & PHYSICAL TIME BASED ON ESTABLISHED PT HISTORICAL DISTRIBUTION 5-40 MINS EXAM VISIT HISTORY & PHYSICAL TIME BASED ON ESTABLISHED PT HISTORICAL DISTRIBUTION MINS EXAM VISIT HISTORY & PHYSICAL TIME BASED ON ESTABLISHED PT HISTORICAL DISTRIBUTION MINS DISCOVERY OF ISSUE DISCOVERY OF ISSUE DISCOVERY OF ISSUE DISCOVERY OF ISSUE DISCHARGE IN EXAM ROOM UNLESS COMPLEX DISCHARD NEEDED 3-10 MINS DISCHARGE IN EXAM ROOM UNLESS COMPLEX DISCHARD NEEDED 3-10 MINS TO COMPLEX DISCHARGE AREA FOR SCHEDULING DIAG OR TREATMENT MINS TO COMPLEX DISCHARGE AREA FOR SCHEDULING DIAG OR TREATMENT MINS DISCHARGE IN EXAM ROOM UNLESS COMPLEX DISCHARD NEEDED 3-10 MINS DISCHARGE IN EXAM ROOM UNLESS COMPLEX DISCHARD NEEDED 3-10 MINS TO COMPLEX DISCHARGE AREA FOR SCHEDULING DIAG OR TREATMENT MINS TO COMPLEX DISCHARGE AREA FOR SCHEDULING DIAG OR TREATMENT MINS TO TREATMENT ROOM MINS TO TREATMENT ROOM MINS PATIENT LEAVE MEDICAL HOME THIS SIMPLIFIED FLOW DIAGRAM IS USEFUL TO LOOK AT THE NUMBER OF EXAM ROOMS IN A STANDARD CARE TRACK. HOW WITH THIS FLOW DIFFER FOR PED PATIENTS IN A CENTERING CONCEPT? WHAT % OF PATIENTS COULD THIS BE? DID WE WANT TO MODEL PATIENTS HAVING THEIR PERSCRIPTIONS BROUGHT TO THEM IN THE EXAM ROOM, OR WAITING IN A SUB-WAITING AREA? TCH MEDICAL HOME PEDI PATIENT PROCESS MODEL - 01/30/2012

Medical Home – Space Program Summary Total Area50,458 sfQuantity of Rooms Public Area3,528 sf Pediatric Service Module8,338 sf25 Exam Rooms, 2 Consult Rooms OB Service Module4,726 sf11 Exam Rooms, 4 Consult Rooms Centering Module2,030 sf2 Centering Rooms Service Module Support1,972 sf Diagnostics5,340 sf1 Gen Rad, 2 Ultrasound Pharmacy3,074 sf Eye Clinic5,733 sf4 Exam Rooms Dental Clinic3,560 sf9 Operatories Specialty Clinic2,160 sf4 Observation Rooms Member Education2,849 sf Administration4,874 sf Support2,273 sf

Site Selection Reflects Pilot Program Preferred Area  Membership Density  Proximity To Potential Partner Hospitals  Near Major Freeways site TMC CBD

Vehicular Access  Site Along Beltway Feeder Road  Can Be Approached From Multiple Directions N N I 45 B 8

Existing Building TCH Medical Home

Site Organization Parking 1. 1=Patient & Public Parking 2. Staff Parking 3. Patient Flow from Bus Stop 4. Main Entry 5. Public Retail Entry 6. Staff Entry N N

Public Areas 1. Main Entry/Drop-Off 2. Public Retail Entry - North/East Natural Light 3. Waiting/Circulation 4. Retail Corridor 3 1 a a 4 2 3

Program Plan a a 2 Public/Retail/EDU/Admin 1. Main Entry/Drop-Off 2. Public Retail Entry 3. Waiting/Circulation 4. Retail Corridor 5. Pharmacy 6. Dental 7. Optometry 8. Education 9. Administration Staff 10. Staff Work Area OB Program Space 11. OB Clinic 12. Centering Peds Program Space 13. Primary Care Clinic 14. Specialty Clinic 15. Diagnostics

Reception TCH Medical Home

Waiting TCH Medical Home

Team Workstations TCH Medical Home

Reception TCH Medical Home

3 Lessons Learned

POE Methodology (to be provided at learning session)

POE Results (to be provided at learning session)

Common Takeaways – Conversion “Pros”  Large, open footplate  Opportunity for various ceiling heights / high ceilings  Potential for second floor / mezzanine  Opportunity for skylights  Potential for separate front-of-house and back-of-house  Good visibility from major thoroughfares  Ample parking  Economical investment  Places care directly in the target community  Create a feeder system to or away from hospital campus

Common Takeaways - Conversion “Cons”  Inappropriate column spacing  Undersized / shared utilities with adjoining tenants  Usually no emergency generators  Inappropriate / unusable mechanical systems  Low-budget original construction  Poorly documented building alterations over time  Undocumented / undiscoverable existing conditions  Potential limitations to exterior façade changes  Significant saw-cutting for under-floor plumbing  High roof: ceiling-mounted equipment challenging  Security

Dianna JPS Allison TCH Diane FKP Lance