Nemours duPont Pediatrics: Innovation Inspired by the Affordable Care Act

A new outpatient facility in Southern New Jersey is designed to improve the patient experience as well as the health of the entire community.

THE AFFORDABLE CARE ACT strives to achieve a three-part aim: improve the experience of care for individuals, improve the health of populations and lower per capita health care costs. Developers of health care facilities are encouraged to innovate and be creative to help achieve these goals. This should result in new approaches to the design and development of health care real estate. Perhaps no other change in health care delivery has been directly linked to the Affordable Care Act (ACA) than the shift of treatment delivery to outpatient facilities.

Before the ACA, hospitals were rewarded financially for filling beds, even though the net effect was higher costs without, necessarily, a higher quality of service. Any systemic efficiencies that reduced admission rates were a threat to profits. The ACA has completely changed this notion. Rather than focusing on filling beds, the health care system has shifted to a model that aims to provide patients with easy access to high-quality care at a more competitive cost. Health care providers are being rewarded for the quality rather than the quantity of the services they provide. Those who are embracing this new era of health care delivery are therefore building the capability and infrastructure to offer more services in outpatient settings, where patients can be treated more efficiently and cost effectively than in hospitals.

As adaptors to this new health care marketplace, innovators like the Nemours Alfred I. duPont Hospital for Children are aligning themselves with the objectives of the ACA’s three-part aim. This is no stretch for Nemours, since improving health and the experiences of patients and their families has always been at the core of their mission and values. One example of this can be found at a new outpatient facility now under construction in Southern New Jersey.

Nemours duPont Pediatrics, Deptford, is a 65,000-square-foot pediatric health care facility in Deptford, New Jersey. The project broke ground in April 2015 and is on track to be completed in summer 2016. It will provide specialized pediatric care, therapeutic services, an ambulatory surgery center and imaging capabilities, including MRI, ultrasound and x-rays. The main goal of this project for Nemours has been to improve health and maximize the amount and types of services it provides to families in the Southern New Jersey market.

Efficiency Is the Name of the Game

One of the design goals for this project was operational efficiency, which primarily meant utilizing space as resourcefully as possible. When patients and their families enter the facility, they will be greeted by a registrar at a central check-in area in the public lobby, which will be surrounded by various seating options in the shared waiting space. Rather than replicate a waiting area for each specialty or service, all patients will wait in one large, comfortable, open area. That area will also offer amenities to improve the patient experience, including a cafe, natural light and a playroom for patients’ siblings.

Almost all exam rooms will be identical. This flexible design will enable almost any doctor to see nearly any patient in any room. (Minimal exceptions include ophthalmology, which requires a different layout to accommodate bulky equipment.) This strategy ensures that Nemours can vary the type and number of specialty physicians who practice out of each room every hour of every day, if needed, and enables maximum utilization of the space.

In many traditional health care settings, a doctor leaving an exam room often steps into a private office to input information, respond to messages and so forth. At Nemours duPont Pediatrics, Deptford, all exam rooms will be fully equipped for telemedicine and electronic medical record documentation, so the vast majority of the doctor’s work can be completed within the exam room itself.

Physicians who need to access or input information after they leave an exam room can pop into “touchdown” areas immediately adjacent to the exam pods, where several computers will be available at sitting or standing height. The physician can then quickly move on to the next patient. Several small private spaces within the touchdown area will be equipped with sliding doors, providing places where staff members can have private discussions. None of these private areas will be “owned” by any one doctor or staff member; they will therefore be encouraged to use the areas only as necessary.

The two-story building has several sets of stairs, all of which are strategically located within the clinical care areas. This will enable staff to collaborate and quickly access different parts of the building without having to walk through public spaces.

By ensuring that every space is used as efficiently as possible, Nemours duPont Pediatrics, Deptford, has been able to reduce its overall costs, from development and construction through staffing. In addition, the facility will be able to schedule physicians and other health care providers more efficiently, allowing them to see more patients and reducing their overall wait time.

Focus on the User Experience

No matter how efficient a health care facility is, people will not use it unless it provides a positive experience for patients and their families. Designers and developers therefore must approach these projects from the perspective of the user. For Nemours, that means receiving input from parents whose children receive care from the Nemours system. Nemours regularly surveys a diverse group of families and employees who have intimate experience with many of the inpatient and outpatient services Nemours provides. Much of the planned user experience at Nemours duPont Pediatrics, Deptford, is based on input from this group.

First and foremost, location is key. To determine the ideal location for the new facility, Nemours conducted an in-depth analysis of the area, including travel patterns, consumer behavior and the local business footprint. The selected location, near the Deptford Mall, was chosen for several reasons. These include the nearby convergence of major highways, which provides easy access from a large geographic area, as well as the proximity of the mall, a frequent destination for many families. The site is also large enough for plenty of surface parking and a substantial covered canopy for patient drop-off and pick-up. All of these factors will make it extremely convenient for parents and other caretakers to fit a child’s medical appointment into their daily routines.

But arriving at and getting into the facility is just the beginning of the positive user experience. While, as noted earlier, there will be a single waiting area for all of the specialty care practices, that area will be divided into zones to address various patient populations, with age-appropriate seating and activities for children, teenagers, caretakers and others. Nearly every piece of furniture in the waiting area will include a built-in outlet for charging electronic devices. When it’s time for a child to move to an exam room, parents will be able to leave their other children in a separate, secure and monitored playroom, where they will be entertained while their brother or sister is seen by a physician.

Each exam room will be furnished with a banquette rather than one or two chairs, allowing families to sit together and comfort anxious children, while also providing additional floor space for diaper bags, purses or backpacks. There is no separate check-out area; when a patient’s visit is complete, the check-out process will be completed in the exam room. This will be a tremendous convenience for patients and their parents, as well as a space and cost saver for the facility.

Improving Health for the Long Term

The ACA seeks to improve not only the quality of traditional medical care and the manner in which it is delivered, but also opens the door for coverage of additional types of care offerings, including nutrition counseling, healing touch, massage and other forms of complementary medicine. Nemours duPont Pediatrics, Deptford, will offer several of these services.

In addition, the facility will provide spaces for educational opportunities, with the long-term health of the patient in mind. Conference rooms and other spaces will offer places where physicians and outside groups can meet as well as educate patients, parents and other members of the community via classes and seminars.

Innovative health care facilities such as this one help shift the focus of health care from a treatment model to one of prevention. Numerous studies have shown that long-term health outcomes are improved when patients take a proactive approach to their health. Facilities such as Nemours duPont Pediatrics, Deptford, will help patients and their parents to do just that.

Planning for Future Innovation

Designing, developing and marketing innovative medical facilities is a leadership-driven process. The Nemours organization emphasizes continuous improvement, which is reflected in their design and construction projects. Nemours duPont Pediatrics, Deptford, was designed and is being constructed with the ACA’s three-point aim in mind, but it was also designed for potential future expansion and changes in the health care landscape.

The site is large enough to enable the building to be expanded, should that be necessary in the future. The building design is also flexible enough to enable the structure to be adapted to shorter-term growth as well as changes in technology. Designers have incorporated a variety of technological capabilities into the building, both for current medical uses, such as electronic records and telemedicine, as well as for potential future uses. Extra data ports, large cabling networks and moveable furniture will enable Nemours to accommodate new devices as well as meet the needs and desires of physicians and other staff.

As a result of the Affordable Care Act, the shift in medical treatment to an outpatient model has begun and will continue, with the goal of providing better care for all populations. When people know that they and their family members can receive care in an efficient, pleasant and easy-to-access environment, they are more likely to continue to access care, mitigating the chances that they will need more serious and costly medical care down the road. Nemours duPont Pediatrics, Deptford, is setting the stage for future projects that will continue to consider and address the needs of all users, including patients, family members, caretakers, physicians and other health care providers.