9/15/2011 D09. Planning For Accountability: Designs To Support Team-Based Medicine. Speakers. Learning Objectives

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Allan O’Connor’
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Learning Objectives Learn what is team-based medicine and why is it so important in today s economy Discuss how existing healthcare infrastructures challenge successful implementation

1 D09 Planning For Accountability: Designs To Support Team-Based Medicine Healthcare Facilities Symposium & Expo Speakers Fred Foote, Capt. Ret., MC, USN The Institute for Integrated Health Baltimore, MD Lora Sh Schwartz, AIA, LEED AP, EDAC Owner, Forecast Planning Washington, DC Healthcare Facilities Symposium & Expo Learning Objectives Learn what is team-based medicine and why is it so important in today s economy Discuss how existing healthcare infrastructures challenge successful implementation of team-based settings Hear from a care giver what challenges are ahead Explore case studies, recent innovations to foster team interaction, improved communication and improving integrated care Healthcare Facilities Symposium & Expo 1

Emerging Models for Accountability 4 HOLISM

Reductionism: Descartes Discourse on Method

(currently = organ system medicine) Good

Holism: Tends to be defined operationally

2 Emerging Models for Accountability 4 HOLISM MEDICAL HOME Medical Home Model Wholist Care Image: RMS website What is Holistic (= Whole-Person) Care? Reductionism: Descartes Discourse on Method Divide the body into knowable parts (currently = organ system medicine) Good systems of measurement = rational care Whole-person Woepe issues (suffering, outcomes, public health) remain obscure Holism: Tends to be defined operationally Can address whole-person issues Uneasy relationship with mathematical physics Hard to measure 5 Definitions 6 2

use of nature, art, and spirituality) Combine

complete system of medicine able to deal with full

Patient/Family-Centered Care (PFCC) Use of the

Multidisciplinary care integration Wellness

3 Definitions and we want it They had it: (Hippocratic medicine combined rationalism with use of nature, art, and spirituality) Combine organ system medicine with holistic approaches = complete system of medicine able to deal with full range of health concerns 7 Care Continuum Patient/Family-Centered Care (PFCC) Use of the built environment (Evidence-Based d Design) Multidisciplinary care integration Wellness interventions (nutrition, exercise, alternative medicine (CAM), arts, etc.) 8 Multi-Disciplinary Care Integration 9 Integrated Assessment Medical Home Integrated Management Image: thepcmh.org 3

Departure from the Conventional 10 Programmatic Considerations

Practice redesign (Integrated) 2) Payment reform (Holistic) 3)

SETTINGS, EVIDENCE BASED DESIGN Practice Re-design MEDICAL HOME

4 Departure from the Conventional 10 Programmatic Considerations 11 Three major changes of the current health care system 1) Practice redesign (Integrated) 2) Payment reform (Holistic) 3) Patient engagement (Patient Centered) WORKFLOW, TYPES OF SETTINGS, EVIDENCE BASED DESIGN Practice Re-design MEDICAL HOME 12 Proactive Integrated team Team directed Holistic approach Self management 4

Medical Home - Types of Settings 13 Care Settings - Cognitive health - Nutritional health - Emotional health Info Mgmt

SMITHGROUP NICoE Signatures Interdisciplinary approach to care that leverages pattern recognition of physical,

among providers, warriors, and their family members Hospitality culture that puts the needs of the warrior and family

5 Medical Home - Types of Settings 13 Care Settings - Cognitive health - Nutritional health - Emotional health Info Mgmt Settings - Data Rooms / IT Closets - Telemed Conferencing Common Areas - Waiting areas - Parking Impact - Security/Mechanical Image: thepcmh.org National Intrepid Center of Excellence 14 TBI/PTSD OUTPATIENT FACILITY BETHESDA, MD 70,000 SF OPENED 2010 AoR: SMITHGROUP NICoE Signatures Interdisciplinary approach to care that leverages pattern recognition of physical, behavioral, social, and spiritual conditions Family-centered approach to care that emphasizes cooperative planning among providers, warriors, and their family members Hospitality culture that puts the needs of the warrior and family first Commitment to use a holistic platform in concert with advanced technology Lifelong follow-up care and support for warriors and their family members Environment that fosters resilience growth for warriors, family, and staff 15 5

6 NICOE - Model of Care Copyright Frederick Foote and Expertech Solutions Unauthorized duplication prohibited. 16 TBI/PTSD: Why Holistic Care? EBD: Multimodal healing environment Multidisciplinary care integration: sine qua non of successful treatment Include families: modify warrior s social milieu Wellness: Literature shows these modalities cure TBI/PTSD symptoms and cure or improve signs of dementia 17 An Unprecedented Investment 40% of patient hours 25% of staff 30% of floor space 18 6

7 Fully Integrated Care Conventional Settings Clinic Space Standards Exam RoomConsultation Treatment OfficePt. Education Exam/Consult Pt Education Lg. Exam & Team Areas Conference Room Education & Data Centers Integrated Assessment 21 7

8 Thinking outside the exam room 22 More group appointments: proactive, populationbased approach, especially for chronic care and preventive services. Robust Telemedicine and Telehealth web-based interaction Educational & Preventative Opportunities EBD Response to New Care Model EDUCATION/ RESEARCH CLINICAL 23 Clinical Waiting 24 8

9 EDUCATION National Intrepid Center of Excellence EDUCATION ADD INTERIOR IMAGES _ DIVE LAB & AUDITORIUM National Intrepid Center of Excellence DATA CENTER National Intrepid Center of Excellence 9

10 Therapeutic, Whole-Person Approach 28 Open Gym - Interaction 29 Central Park Meditation 30 10

11 Patient/Family Support 31 Engaging the Outdoors 32 NICoE Holism I: The Built Environment Basic EBD: air, light, noise, green, etc. Tailored for TBI/PTSD patients Art, nature, spirituality Four virtual reality suites Built environment derived from holistic care elements (principles-based design) 33 11

NICoE Holism II: Care Integration Group assessments by neuropsychiatric team (6 providers) and by wellness team (6 providers) Single unified care plan Long-term case management for implementation and

Staff of Family Agenda Coordinators ACEP Program: warrior/family cognitive skills optimization FOCUS-CI: 3-5 session family strengthening program (staff family therapists) Train family members as

12 NICoE Holism II: Care Integration Group assessments by neuropsychiatric team (6 providers) and by wellness team (6 providers) Single unified care plan Long-term case management for implementation and outcomes analysis Linked to Medical Home project and integrated administration (Joint Task Force) 34 NICoE Holism III: Patient/Family-Centered Care All warriors bring family, Involvement in care plan Staff of Family Agenda Coordinators ACEP Program: warrior/family cognitive skills optimization FOCUS-CI: 3-5 session family strengthening program (staff family therapists) Train family members as coaches in nutrition, exercise, substance abuse, and mind/body medicine 35 NICoE Holism IV: Wellness Program Full-time staff in: nutrition, exercise/recreation, complementary/ alternative medicine (CAM); healing arts; spirituality Create individualized program in wholefoods nutrition; exercise, mind/body medicine (MBM) Trial wellness/cam activities while at NICoE Daily home progress reports Leverage unit Chaplains and families for effect 36 12

NICoE Healing Arts Program Heal warriors through active

spectrum) Warrior chooses a 1-year art-making project pojec

database) Part of larger campus-wide program (Feb 2011) 37 VA

REHAB CENTER SAN ANTONIO, TX 90,000 SF OPENING 2012 AoR:

13 NICoE Healing Arts Program Heal warriors through active art-making Weekend Arts Fair to show arts modalities (wide spectrum) Warrior chooses a 1-year art-making project pojec Mentorship in home location by volunteer artist mentor (develop database) Part of larger campus-wide program (Feb 2011) 37 VA Facilities 38 INPATIENT & OUTPATIENT TRAUMATIC BRAIN INURY & REHAB CENTER SAN ANTONIO, TX 90,000 SF OPENING 2012 AoR: SMITHGROUP ADD EXTERIOR IMAGE FIRST FLOOR AUDIE MURPHY VA MEDICAL CENTER POLYTRAUMA CENTER 13

appointments Open access scheduling Move towards more hospital based MOB s Contact Us QUESTIONS?

14 TEST FIT VA MEDICAL CENTER TUSCALOOSA, AL Lessons. 41 Rethink workflow optimize performance Multi-disciplinary Interaction ti / teaming areas Group medical appointments Open access scheduling Move towards more hospital based MOB s Contact Us QUESTIONS? Fred Foote, Capt. Ret., MC, USN fred.foote@gmail.com Lora Schwartz, AIA, LEED AP, EDAC lora@4castplanning.com Planning For Accountability: Designs To Support Team-Based Medicine 14

OUTPATIENT TREATMENT WESTPORT, CONNECTICUT

OUTPATIENT TREATMENT WESTPORT, CONNECTICUT ABOUT CLEARPOINT At Clearpoint, we focus on healing the whole person: mind, body, and spirit. Our comprehensive care methods set clients up for long-term success