A Patient-Centered, Community Health Vision Comes to Life

When Advocate Health Care (Advocate), Advocate Medical Group (AMG), and Advocate Dreyer Medical Clinic (ADMC) decided to implement a new ambulatory strategy throughout the Chicagoland area, they needed a team who shared the same vision of a future with high-quality, affordable and accessible healthcare in the communities they serve. Through a collaborative partnership with an Integrated Lean Project Delivery (ILPD) team, comprised of HDR, IMEG (formerly KJWW), Boldt Construction and trade partners working alongside Advocate stakeholders, a prototype was developed based on efficient operations, patient engagement, sustainability and technology for a clinic of the future.

The Project Vision was named Care360. This integrated ambulatory care model focuses on the broader context of how people connect to health, wellness and well-being. Because decisions that affect health are often made outside of the traditional healthcare system, those systems must be intentionally designed to cater to that need and ensure that operations, environments and approach to care are fully aligned to meet patients where they are, even when they fall outside of conventional boundaries.

It’s a lot like a loop. Though there are more than 30 clinics to be delivered over a 10-year planning horizon, each successive clinic will reap the benefits of the last through a continual learning process. The innovation that occurs in the collocated working atmosphere promotes a collective informed decision process that generates higher-quality treatment environments for Advocate Health Care.

Ascertaining volumes and growth analytics, visit duration, patient journey, visit types, hours and days of operation, intake time, and staffing ratios were all instrumental in the development of a standardized process. This allowed the ILPD to produce a clinic module that is repeatable and scalable, while accommodating specialized services referred to as “Bolt-Ons,” depending on the community needs and location. Applying Lean concepts eliminated unnecessary operational steps and led to a more efficient care delivery model reducing a primary care visit from over an hour to 36 minutes and improving face-to-face time for providers and patients.

Principles to Govern the Design Process

Guiding principles were developed to ensure that Advocate’s vision is manifested in a way that is intelligent, flexible and forward-looking:

• Cultivate lifelong relationships through small, frequent interactions: Engage customers inside and outside the facility walls in small ways where they live, work and play; do so in ways that are frequent, thoughtful and meaningful.
• Multiple points, one system: Health and wellness takes place 24 hours a day, 365 days a year in a variety of settings. No matter where the interaction is initiated, care is coordinated and integrated across one system. This allows for simplicity and ease of navigation, whether self-directed or assisted.
• Right care, right place, right time, always: Deliver an experience that is evidence-based, standardized and accessible when and where the patient wants it. Utilizing a team-based approach, maximize each member’s expertise and capabilities.
• Collaborate across boundaries: Include internal and external partners to promote health, wellness and wellbeing.
• Constant focus on respect for people: Take the time to discover the fundamental and sometimes hidden needs of both patients and caregivers. This focus on the whole person is shared across teams who deliver care that is culturally sensitive, anticipates needs and respectfully engages people.
• Design for change: Create environments, facilities and technology to be flexible, modular and adaptable to support patient needs through the most efficient flow, processes and care delivery.

Path to the Ideal State

This highly collaborative effort kicked off in January 2014 with a Synapse Visioning Session. Subsequently, a series of Rapid Improvement Events helped implement the newly developed vision of Advocate’s future through 2024 and beyond. This collaboration focused on four platforms in order to realize the Care360 Integrated Ambulatory Care Model: patient experience, operations, technology and sustainability.

Understanding that Advocate, AMG and ADMC are already advanced individually in each of these areas, the team seized this extraordinary opportunity to learn from one another and work toward an optimized and systematic approach in all areas.

Given the variation and complexity involved in the effort to pursue the Care360 Integrated Ambulatory Care Model, the following tools were used throughout the process:

• SYNAPSE: Human-centred design workshops are used to imagine the future and explore innovative ways to shape it. Sessions are highly structured and are built around a series of design activities. The process is fast, focused and organized to generate deep insight into complex problems and encourage rapid prototyping that yields conceptual development.
• Lean Six Sigma: The team’s methodology embraces Lean Six Sigma, a process improvement methodology that aims at producing a repeatable and reliable process that increases value-added time and decreases defects. The goal is to minimize variation in the environment in order to assure that the processes are repeatable and reliable.
• 2P/3P Events: Lean 2P (Preparation/Process) and Lean 3P (Production/Preparation/Process) events are highly-facilitated rapid improvement events lasting three to five days each and involve multidisciplinary teams from all organizations. The goal is to simultaneously optimize design and operations through live, operational simulations within the proposed design under realistic conditions.
• Data-Driven Design: The project team utilizes a combination of 3D simulation and parametric modelling to create an iterative, virtual framework based on project variables for studying operational and design variations and alternatives simultaneously. By mapping current processes and using current state information (including arrival times, staffing models, resource utilization, durations and travel distances), simulation software models the current state system and optimizes it in a virtual environment to reduce variation and bottlenecks prior to live implementation.

Advocate’s goal is to provide affordable healthcare to Chicagoland and easy access to the communities they serve. Our Care360 strategy as envisioned has led to a high performance ILPD team working in partnership with Advocate to deliver on the brand promise of delivering high quality, cost effective facilities to meet the needs of their patient population.