OASC | DEVELOPMENT

Where Form Leads Function:

Enhancing Staff, Patient Experience in the OASC

PART 2 IN A SERIES

By Joseph F. Jalkiewicz, Contributing Editor

A computer rendering of Key-Whitman’s future waiting area.

A truism of architecture is that “form follows function,” which certainly applies to the practical design of today’s ophthalmic ASCs. With respect to their impact on the emotional well-being of staff and patients, however, form arguably leads function.

Indeed, the best OASC designs go beyond the functional and regulatory demands of governmental bureaucracy to fulfill the emotional and experiential needs of the surgeons, staff and patients who inhabit those spaces. It’s likely that few recognize this more than those who are in the midst of upgrading or building a new OASC — such as the team at Key-Whitman Eye Center in Dallas, Texas.

“Designing an OASC to maximize the impact and experience of surgeons, staff and patients entails careful and thorough planning,” says Jeffery S. Eckert, AIA, senior principal of Eckert Wordell, the architectural firm retained by Key-Whitman. “From an architectural standpoint, a design is not a challenge, but rather an opportunity.”

As outlined in our May cover story, Key-Whitman is in the midst of constructing a new OASC in North Dallas to replace its current center in the city’s Uptown section. At two stories and 35,000 square feet, the new medical building will host a new OASC as well as an optical center, a Lasik center, a specialty eye clinic and a research center. The 12,500-square-foot OASC alone will be more than twice the size of Key-Whitman’s current OASC and comprise four operating rooms and separate femtosecond laser and YAG rooms. The project is slated to be completed by spring 2016.

As one of the oldest OASCs in Texas, it was founded in 1984 by Charles Key, MD, Key-Whitman employs approximately a dozen staff members, including two registered nurses, two licensed vocational nurses, three scrub technicians and three ophthalmic assistants. The eye care center performs 5,000 cataract and general ophthalmic surgical procedures per year and takes in $5.5 million in annual revenues, says Executive Director Dan Chambers, MBA, COE.

At an estimated tenant improvement cost of the ASC-leased space reaching $3 million to $3.5 million, the project has been designed not only to meet myriad functional, regulatory, and financial demands, but perhaps more importantly to address the needs of its most important stakeholders — surgeons, staff and patients.

Designed for Physicians and Staff

This design places special emphasis on efficiency of use with respect to the operating rooms and other treatment spaces — a quality lacking in the team’s existing facility.

“Efficiency of OR use and turnover is too often overlooked in the OASC,” says Jeffrey Whitman, MD, president and chief surgeon at Key-Whitman. “The days of the hospital OR [setting] as the example [for an OASC] are long gone. Ophthalmic surgeons want in and out — this allows for the scheduling of additional cases as well as being able to get back to the office in a reasonable time.”

Mr. Eckert agrees. “Among the top, in demand, architectural design elements for surgeons are efficiency and incorporating technology so the physician can practice his craft while providing staff with the ability to care for patients in the most efficient manner.”

Achieving efficient design, he adds, begins in the planning phase with an assessment of patient movement from reception to pre-op, to femtosecond laser work-up, to procedure, and then to surgery. The result, Mr. Eckert and the rest of the team expect, will be to dramatically improve upon the existing facility’s clunky and inefficient layout.

“Our present ORs share the same floor as our clinic, which makes it uncomfortable for visiting surgeons to use our facility,” Dr. Whitman says, adding that the elevator opens up to a wide waiting room shared by the office and ASC. “With optimal placement of ORs and stand-alone femto laser rooms, efficient flow can be achieved without interfering with any OR’s use.”

With respect to the nursing and support staff, the new facility has been designed to address desires for more efficient workflows, adequate workspace, technologically productive devices, easy-to-clean/maintain areas to manage infection control, and temperature- and humidity-controlled workplace. In addition, the new building “incorporates more storage space for our staff, including a stock room dedicated solely to IOL supplies, as well as space for critical equipment,” Mr. Chambers says.

Plans also call for more definitive separation of behind-the-scenes staff functions from patient interaction areas — for the benefit of both staff and patients, Eckert says. “Separating patient flow from staff function is imperative. In the case of the Key-Whitman OASC, the support spaces were provided behind the OR rooms, with direct access to the clean storage area and decontamination/clean sterilization area, so as to provide ease of access and to maintain separation from patient encounters,” says Mr. Eckert.

Designed for Patients

Though it is important to address the needs of the care team, no OASC can exist without a steady stream of patients who, the quality of care being equal, are increasingly taking into account the aesthetics and clinical environment of a center and how it affects their emotional comfort and well-being.

“Aesthetically, it’s important to view your center through the eyes of your patients and design for a premium experience,” says Key Whitman Associate Administrator Nikki Hurley, RN, MBA, COE. “Our patients’ average patient age is dropping, and younger, baby boomer patients have high expectations.”

Compared to the current facility, Ms. Hurley says, the new OASC will have larger and more private pre- and postoperative areas for patients, and better flow for laser and surgical patients. There are also more private areas suitable for financial discussions, white noise for more privacy, and “more thoughtfully designed” treatment areas, she adds.

“Currently, we have our femto laser in a separate area but our new center has a well-designed separate femto room that won’t interrupt patient flow into the operating room,” Ms. Hurley says. “This design promotes a better patient experience, with capabilities for anesthesia administration prior to the femto procedure, and it enhances the staff and physician’s experience on busy surgical days because everything is closer together.”

“Patients arrive with expectations for their care,” she says. “It’s our job to make patients feel comfortable and to provide a relaxing atmosphere. All of this adds up to excellent outcomes and — hopefully — exceeding expectations.”

Mr. Eckert agrees and adds that almost all patients consciously and unconsciously rapidly begin asking themselves — and answering — a series of questions as soon as they get to an OASC to assess their own comfort levels as they make their way through the process. It would be wise, he says, for OASC teams contemplating renovation or building projects of their own to ask themselves similar questions.

“The patient’s perception is immediately influenced upon arrival as he considers his surroundings,” says Mr. Eckert. Consider this: ‘Is the entry well defined with a covered, protected drop-off area? Is there sufficient parking?’ Upon entering the OASC suite, is the patient greeted by the staff in a quiet and appropriate manner? Is the reception room sized appropriately to handle the patient volume, while also providing amenities to put them at ease? Are there enough pre-op rooms to allow for patient work-ups to be done in a quiet, semi-private or private setting? Are there enough post-op rooms to handle the types of cases and volume, and to allow family members to join the patient without disrupting pre- and post-op functions?’”

In the Key-Whitman plan, he says, “it was decided to separate the pre-op areas from the post-op areas with a nurse’s station that provides staff with the ability to service both areas while separating these functions.”

First impressions leave lasting impressions, Ms. Hurley adds. “By putting yourself in the patient’s place, you can easily imagine many ways to better their experience,” she says. “Patients want the best care possible with the most advanced technologies and procedures, and they want all of these things in an easy, efficient manner. We must exceed their expectations if we expect to earn the referrals of their friends.” ■