At Cherokee Indian Hospital's outpatient clinics, the space is designed to enable a patient-centered medical home (PCMH) care model. The key element is co-location, with three to four teams of providers and staff working in a shared, open team space. Co-location was first piloted in an older facility, where minor renovations created two team spaces. While there was some initial skepticism, they saw many benefits, primarily in increased efficiency and communication.
Patient scheduling, nurse case management and population health management functions all happen in the same space with the same team. All members of the care team, including MAs, case managers, nurses and physicians, report greater awareness of clinic activity; less time is spent looking for other team members and critical information is easier to access. Most of the providers' time is now spent in the collaborative space, where they remain available to each other to discuss complex cases or to conduct warm hand-offs of patients to members of the extended care team. Patients have access to a pharmacist, nutritionist and behavioral health specialist during a visit. Patients like having direct access to this broader team, and the provision of care is more efficient and satisfying for care team members as well.
“As a physician, I am not running around to find the team members I need to coordinate care, and I don't have to worry about the patient not following up with a behavioral health specialist or dietician because we provide the warm hand-off in real-time.”—Michael Toedt, MD, FAAFP, Family Physician, Cherokee Indian Hospital
“As a physician, I am not running around to find the team members I need to coordinate care, and I don't have to worry about the patient not following up with a behavioral health specialist or dietician because we provide the warm hand-off in real-time.”
Cherokee Indian Hospital will be opening a new facility in fall 2015 and is committed to using team rooms and co-location of the extended care team going forward. They have found that adjacent team rooms with partially open space between teams work best, and so there will be no private offices in the new facility. Care team members will face each other at round table work stations as opposed to having their backs to each other at desks around the perimeter of a room, facilitating team work, communication and efficiency.
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