What would your ideal primary care office look like?

I have been both a provider of care and a patient in many primary care offices. As a provider, I often thought that the way things were laid out could be improved to make us more efficient. As a patient, I have often reflected how similar all physician offices are – front desk, with or without a glass window, relatively large waiting room and exam rooms arranged along corridors.  I can remember as a physician, coming out of a room and walking down the long corridors to find another member of our team, to ask for help with something. As a patient, I was once “forgotten” in an exam room over the lunch hour (I didn't complain too much because I had back pain and lying on my side on the exam table felt comfortable).

GBMC has embraced the patient-centered medical home concept. We have taken our existing primary care offices and have used them in a new way. On a recent visit to our Hunt Valley site at mid-afternoon I noticed that the waiting room was empty….the way we want it to be because we don’t want people waiting….and I realized that the waiting room was now just a lot of wasted space.

So I am very excited to tell you about a 3P going on this week on the ground floor of the North Pavilion on the GBMC campus. A team, led by Sarah Whiteford MD, and Ben Hand MD are designing the new home of Family Care Associates, one of our GBMA practices! Drs. Whiteford and Hand spent some time last month in Seattle at the Virginia Mason Institute, part of the Virginia  Mason Health System. Virginia Mason is a national leader in patient centered care and one of the first healthcare companies in the country to fully adopt Lean as a business model. A consultant from the Institute is guiding our team’s work this week.

Dr. Sarah Whiteford (left), Bryan Niles, construction project manager (center),
 and Dr. Ben Hand (right) work at designing a more efficient office that
 will not only enhance the patient experience but create more joy for the staff. 

Do you remember what a 3P is? We discussed the concept in What’s a 3P, the blog installment of October 26, 2012, when we talked about the process for designing our new inpatient pharmacy.

3P is a lean tool that stands for production, preparation, and process. The tool helps us invent new designs that follow lean principles and drive out waste. In this case, waste is defined as anything that the customer would not pay for. Most patients will pay for time discussing their problems with their doctors but are not excited about paying for waiting rooms or filling out forms.

Most physician offices use “batch” processing and move the patient from point A to point B to point C throughout the process. You come in and you wait. You are called to register and you wait. You are then called to have your vital signs and height and weight taken, you are brought to a room and you wait. Your physician or nurse practitioner comes in and deals with you and you wait to then be checked out of the office. The time waiting is nothing more than a characteristic of the design for patient flow.

If you were going to design the process that would be used for you as the patient how would you design it? I would like to arrive, be welcomed, brought to a room, my vital signs taken if necessary and then have my physician begin the visit with me. When he or she was done, I would like to leave with my instructions for the future.

Drs. Whiteford and Hand, along with medical assistants, care managers, and other members of their team now have the wonderful opportunity of designing a space that is better able to deliver care with less waste of time, effort and resources for all - I will be excited to see what they come up with! Stay tuned.