Quality healthcare is not explicitly synonymous with efficiency, but Intermountain Healthcare is determined to deliver both with the help of ZGF Architects. 

As a leader in healthcare planning, ZGF takes a hands-on, participatory approach to engaging patients, families and clinicians in the design process to help clients reinvent key processes and transform the way they provide care. Planning, designing and building healthcare facilities serves our communities for many years, and the innovation and creativity on one project can lead to improvements on a larger scale to ultimately benefit society.

In a recent Center for Healthcare Design webinar, ZGF’s own Barbara Anderson, a principal and senior medical planner, and Tim Hatch, director of strategic planning at Intermountain Medical Group, discussed how the largest healthcare provider in Utah used Lean design principles to plant seeds of cultural change across their entire healthcare system.

Despite its progressive approach in clinical quality, Intermountain Healthcare had not previously considered how the capital planning process could help drive clinical outcomes, patient and staff satisfaction, or measurable improvements in their operations. ZGF designed two clinics between 2014 and 2016 that changed the way Intermountain approached capital projects, saving the organization time and money and enhancing standard practices that impacted clinical outcomes, efficiencies and the patient experience. Barbara served as a liaison between the design team, clinical staff, patients and the organization’s leadership during planning.

Using the Park City Medical Center expansion project – which included a 30,000-square-foot renovation to the existing facility, and the subsequent design of the Cottonwood Medical Clinic, a new four-story, 78,668-square-foot building – as case studies, Barbara and Tim shared insights and lessons learned from integrating Lean principals into the Intermountain facility design process.

1. The Lean process enhanced operational efficiency and patient satisfaction. Understanding the organization’s current practices enabled the design team to step back and identify opportunities for improvement. The process facilitated by ZGF significantly shifted the way clinic leadership thought about flow and operations, and ultimately, resulted in improved care integration and patient satisfaction. Initial measurable outcomes included:

• Deliberate pull systems, such as staggered scheduling, central registration, and check-out and scheduling from exam rooms, improving operational efficiency and reducing patient lead times;
• Fewer physician offices and more off-stage team spaces where discussions between providers, medical assistants, nurses and specialists could readily take place, enhancing team-based care;
• Separation of onstage and offstage circulation, keeping the business element of the enterprise behind closed doors, resulting in a more calming environment for patients; and
• Standardized exam room layouts allowing for future flexibility to accommodate the growth of any specialty.

2. Baseline design planning and onboarding helped maximize time with the design team. Building on key learnings from the Park City expansion project, Intermountain leadership refined their design approach for the Cottonwood Medical Clinic. Expanding on the pre-planning process, clinical staff were internally onboarded prior to engagement with the ZGF team to understand the current state, flows, volumes and utilization. Not only did this maximize time with the design team, it also reduced the number of integrated design events from eight (on the Park City project) to five (on the Cottonwood project), resulting in significant efficiencies and cost savings for the organization.

3. A “magic moment” happened when ownership of Lean principles transferred from the design and leadership team to staff. There’s an old saying that goes something like, “When the student is ready, the teacher will appear.” In other words, timing is everything. Intermountain Healthcare was on a quest for change and the timing was right to engage ZGF in the design process. While there was some initial reluctance on the part of the client’s stakeholders, including providers who were resistant to changes in flow and operations, ZGF facilitated events to ensure their voices were heard and instill a sense of ownership. The results came to life when the clinical staff saw the transformation in action. For example, integrating phlebotomists into the patient visit by performing blood draws in exam rooms rather than having patients walk to the lab, led to improved patient-satisfaction ratings, and contrary to initial thinking, improved utilization of exam rooms.

The seeds of change planted during the Park City and Cottonwood projects grew to have major impacts on the way Intermountain Healthcare approaches capital projects today. These changes in behavior and practice required many conversations, data and analyses to support ZGF’s design theories and real-time simulation to help staff get comfortable and confident in their new approach. Now, Lean design principles are engrained in Intermountain Healthcare and the client can’t imagine doing it any other way.