miron construction - osi patient experience

Reimagine The Patient ExperienceA Miron Construction Case Study

AttAchment – it’s the new measurement for patient and staff success in today’s highly competitive health care environment. Attachment leads to a deeper, more meaningful connection between patients, providers, and staff members that results in lasting and prof itable relationships.

Orthopedic & Sports Institute physicians and administrators understand that the winning differentiator is no longer the product or service, but the level of patient attachment – the extent to which an organization creates an intimate, enduring relationship with the patient. Research shows that attached customers are important to the life blood of any organization.

In a recent survey, 79% of executives state that customers who are engaged or attached recommend products and services to others, 64% say engaged customers are frequent purchasers, and 61% believe they provide frequent feedback on products and services. In addition, almost 55% of executives claim that engaged customers are less price sensitive. 1

1 The Economist Intelligence Unit, March 2007

Are we proud of the patient experience The Institute provides? Are we confident that we are the provider of choice in our community? Do we provide the experience we would want for our family members or friends if they were hospitalized?

Together, The Orthopedic & Sports Institute and Miron wanted to answer these three questions. To assume we knew the answers was simply not enough. To guess, was living in the past. We realized that in an emerging age of change within the healthcare setting we needed to reexamine the traditional practices of Orthopedic care and provide greater sensitivity and responsiveness to our services. Reimagining the experience was our only choice.

This case study draws lessons from the experience of a highly innovative Orthopedic Clinic in Appleton, Wisconsin. One that illustrates how the integration of the ideal patient experience and innovative technology is possible. Outlined are the strategies put in place, the roadblocks they faced and overcame, and the key successes.

Three Tough Questions Were Asked

“Are patients ever attached to a

building? At Miron Construction,

we realize that simply to build is not

enough. For our projects to be highly

innovative and supremely successful,

they must transform how people feel,

take their thoughts and emotions to

an entirely new level.”

David G. Voss, Jr.

President, Miron Construction

◂ 2 ▸

Reimagine The Patient Experience

How do you build a healing environment? What happens if. . . ? What happens when. . .?

Experience ecology requires that each and every element of the facility is designed to create a unified and cohesive environment based on patient and clinician outcomes. These actions form a greater balance, which is consistent with the diagnostic and therapeutic activities taking place. More importantly, this balance must enhance, not tear apart patients, families, employees, and providers varying self-identities. Ideal patient experiences must trigger, not close down, creative innovations and identify the purest form of patient feelings. Environments should sustain positive thoughts and not provoke boredom, anger, apprehension or apathy.

Three critical elements were required to build this type of transforming healing environment.

Physical•

Behavioral•

Informational•

Each area communicates independently, yet strongly to all end users as they join together in understanding and creating the ideal patient experience. These elements are often forgotten or executed erroneously. At best, their uniqueness remains unappreciated and separated. In answering the three tough questions for The Institute, all three elements were uncovered, understood, mapped and ultimately brought to life.

PhysicalPhysical elements include all aspects of spatial integration. These include furnishings with an understanding of the fabric pattern and color, illuminations, textures, scents, temperature, flora, sounds, taste and apparel worn by participants. Is the physical space creating the desired outcomes?

“We used the expected emotional

outcomes from process users

connected with the optimized patient

flow from functional owners, to create

value for patients, staff members and

physicians alike. What was once a

sacred space was up for discussion.

Anything was possible.”

Curt Kubiak

Executive Director, The Institute

A Miron Construction Case Study

Experience Ecology

Behavioral

Physical

Informational

ECOLOGY

BehavioralBehavioral elements include all movement sequence interactions between the patient and clinicians determining how they advance through the space and the time required to do so. Are the behavioral elements aligned to the outcomes desired? Is there transparency throughout the setting, between departments, from one day to another?

InformationalInformational elements include all forms, documents, communication collateral, spoken words, gestures, posture, impressions, signage, technology, or other forms of media exchange. Is there integration between the informational elements and the behavioral? Are the informational elements based on the patient or the clinic?

◂ 4 ▸

“Patients and staff need to work

collaboratively to reimagine and design

the ideal experience based on all three

elements – without this understanding,

the unique and personalized patient

experience will be lost. ”

Steve Tyink

Vice President Business Innovation,

Miron Construction


Copyright © 2008 by Miron Construction Co., Inc. All rights reserved.

Why does the nurse have to wake me up throughout the night? Why do I have to wear an open-back gown exposes me? Why do I have to eat ‘hospital food’?

The Institute eliminated patient concerns f rom the very beginning by understanding what patients don’t like in a ‘typical’ surgery center. In the research conducted over a 4-month period, the above six items caused 76% of the respondents surveyed felt additional stress and anxiety during the their stay.

The typical orthopedic stay is a profoundly stressful experience. You arrive already in discomfort only to be subjected to a litany of indignities: patients are poked and prodded, reduced to wearing flimsy gowns, and dependent on strangers for information, food and help going to the bathroom. The typical surroundings only aggravate the situation. Just when you need home comforts the most – perhaps a quiet sunlit space, some soft cotton sheets – you are thrust into a dreary cinder-block room, set under the glare of florescent lights, and left writhing on a sea of antibacterial fabrics and hard plastic surfaces with an endless sound track of disembodied voices emanating from an intercom over your head. Is this a positive, healing experience?

The ‘Typical’ Stay

“The ‘typical’ hospital stay; the entire

healthcare continuum, is experiencing

a revolution in how care is delivered.

It is time to change all aspects of the

delivery.”

Dave Kuplic, MD

Orthopedic Surgeon, The Institute


A friendly concierge at reception smiles and welcomes a patient by first name. Boutique, hotel-style amenities including flat-screen televisions, which can be used to access the Internet, patient-education materials, water features, natural elements, and even room-service menus. All overnight rooms have wireless phone systems and monitoring devices so that patients can have direct contact with their caregivers rather than going through the reception desk. With less phone calls and overhead paging, patients and overnight guests experience a better night’s sleep. Each room has a wireless laptop computer so that nurses and caregivers retrieve patient charts only steps from the bedside. Since family members often stay for long shifts, why not offer day beds for ease of rest. Patients enjoy pre-selected music and movies from iTunes (asked by their physician in the last consultation before surgery).

The bottom-line is this: People from all walks of life have an innate desire to feel a part of something special, to believe and understand that their thoughts and feelings matter. At The Orthopedic Institute they do matter. Patients can enjoy the following, everyday, every time, without fail- this is our vision...

Prescriptions - Filled immediately through physician interaction.

Just Imagine

“Much like great art, colors, fabrics and

style can represent a different feeling

for each participant. We do understand

that if the patient experience comes

first, positive patient sensations

will be brought to life; enabling the

participants to feel completely special

within their healing process. What is

the overall experience attempting to

represent? Like a great novel, you are

compelled to keep reading.”

Angie Laux, R.N.

Administrative Coordinator,

The Institute

◂ 6 ▸


Concierge - Services to assist every step of the way (including elderly guidance).

Flex Room – Nurses move patients less often when all rooms have equipment that folds out to provide critical systems such as anesthesia gases, and heart monitors. This design feature cuts down on noise and the infections that may pass from patient-to-patient in shared rooms.

Recovery Room – Private pre and post-surgical patient rooms for comfortable and seamless recovery, enhanced infection control and greater privacy. Modeled after a Ritz-Carlton hotel room.

Atrium - Visitors enjoy comfortable surroundings to remain connected to their family and friends being treated.

Hospitality Center – Institute concierge assist you in preparing the coffee of the day. Juices, coffee and snacks are available as well.

The Institute Room Service - Patients order their meals through a 24-hour staffed room service department via telephone or by request.

Therapeutic Bodywork – Feature a variety of alternative medical services such as yoga and palates.

In-room Scheduling – Rather than sending the patient to another sub-waiting area, patients are scheduled for diagnostics and imaging in the exam room.

Soundscapes – Personal choice of music is offered and available through headphones.

Institute Gowns - Designed with the patient, not the clinic in mind. Easy to use ‘tear-away’ pants and shirts that create comfort, ease of use, warmth and respect.

Blissful Bedding – 300 count thread linens, choice of pillow softness.

“Health care delivery needs to change.

The old thoughts that helped to create

the patient experience of the past are

no longer valid. From the beginning,

our extended stay process must be

designed in a unique way, based on

how our patients feel with outcomes

that exceed industry standards.”

David Eggert, MD



So how do you reimagine the patient experience? How do you build an ideal healing environment? What should happen if. . .? What should happen when. . .?

Miron, along with 52 staff member of The Institute identified the experience areas, attachpoints, outcomes and actionable items that realign and transform how patients experience and feel Orthopedic care. Incorporating the patient experience Reverse Outcome Modeling process, evidence-based design can be achieved. The objective of ROM is to translate the design elements established to directly impact patients’ physical and psychological health, thus reducing patient stress and promoting rapid recovery. Without beginning with outcomes in mind and working backwards, the behaviors required to ground swell change would not have realized.

The Miron healing design process focuses on three primary ways in which the environment can influence patient outcomes:

Medical Care The environment can support or impede caregiver actions and medical interventions. Is the environment easy or diff icult for providers to do their jobs facilitating helpful or harmful impacts?

Miron Experience Tool: Rapid Access Prototyping HealthCare Example: 23-Hour Stay Process

“We realized that many of our patients wanted to avoid the traditional stay for partial knee replacement” commented David Ritzow, MD, Orthopedic Surgeon of The Institute. “In fact, once we began asking, we became aware of the possibilities.”

From the beginning, The Institute utilized Miron’s unique experience tools, systems and methodologies to create the extended stay process. “We started with the outcomes – how a patient felt – and moved backwards. Very non-traditional.”

“We started with the outcomes –

how a patient feels – and moved

backwards. Very non-traditional, but

incredibly important. The key to a

healing environment involves every

aspect of the The Institute.”

David Ritzow, MD


◂ 8 ▸

Reverse Outcome Modeling


“Just as evidence-based medicine is

revolutionizing health care treatment,

evidence-based design is transforming

the healthcare environment. We now

have at our disposal proven methods

for improving patient outcomes, safety,

attachment, as well as staff retention

and service efficiency.”

Dennis Lynch

VP Health Care Services,

Miron Construction Co., Inc.

said Ritzow. To create this revolutionary new process, the experience tool of Rapid Access Prototyping was implemented. The Miron experience based design team challenged traditional thought processes.

Health Status An environment has the ability to strengthen or impair a patients’ health status by reducing or encouraging existing conditions and feelings.

Miron Experience Tool: Barrier ObservationHealth Care Example: Patient Greeting & Way finding

Typically very little thought or experience based design energy is focused on issues related to the patient greeting. In understanding the current flow and barriers to the ideal experience, 5 experience barriers will exist.

What are the physical barriers to the ideal outcomes?

What are the communication barriers to the ideal outcomes?

What are the sight barriers to the ideal outcomes?

What are the spatial considerations to the idea outcomes?

What is the movement sequence (behaviors) to consider?

In many hospital or clinical settings, barriers to the ideal experience must be identified, understood and corrected. We recently discovered that the average greeting and patient way finding time was reduced by over 4 minutes through the integration of the barrier observation tool. This tool resulted in the understanding and need for a pre-surgical welcome packet. “Our patients were often confused, lost and frustrated. Although we assumed they understood, the opposite was often the case,” commented Angie Laux, ASC Coordinator. “Due to the protocols established long ago, the patient outcomes of feeling cared for, welcomed, respected and acknowledged were lost and patient anxiety increased from the moment they entered the facility. It had to change.” Due to this process, patients now understand how to enter the building and where


to go and look for their patient services representative, a familiar face from our pre-surgical conference and welcome packet.

Causes of Illness The environment can protect patients from, or expose patients to their subsequent healing.

Miron Experience Tool: Impression Areas & AttachpointsHealth Care Example: Sounds Heard During Postoperative Recovery

What are the main impression areas that affect a patient’s experience?

What are the specif ic attachpoints that make up the impression area?

What are the outcomes that you want the pat ient to f ee l about the attachpoints?

By identifying the main impression area (postoperative surgery center) and the many attachpoints associated with the selected impression area (recovery room), patient feelings and outcomes can be determined. Without this breakdown, the task is unmanageable and generally focuses efforts on the transactional portions of care. Outcomes become integrated within the behaviors of the providers, creating a transparent delivery system.

What if a caregiver raises their voice, receives a cell phone call or a recovering patient hears an overhead page? Patient recovery time is extended and the healing environment of the patient is not ideal.

By simply altering processes, modeling impression areas and attachpoints, understanding outcomes and shifting behaviors, the experience becomes unforgettable. The ultimate healing environment and patient experience is created and underway.

◂ 10 ▸

“By simply altering processes,

modeling impression areas and attach

points, understanding outcomes and

shifting behaviors, the experience

at The Institute now closely reflects

our vision and commitment to

patients. The Result? An experience

that is unforgettable. The ultimate

healing environment and ideal patient

experience have been created and are

well underway.”

Chris Weinlander, MD

Anesthesiologist, The Institute


When we were able to identify what to change – when, where and how – The Institute was then capable of designing a unique experience filled with efficiency and effectiveness. With the assistance of the experience-based design team, the tools allowed The Institute to:

Observe the current employee and patient experience through fresh eyes•

Enhance the current experience to achieve desired patient outcomes•

Intentionally orchestrate experiences which achieve business results.•

Innovation comes to life through the eyes of the patient and helps to ensure desired outcomes happen every time, everyday, without fail, no exceptions. The statement “that’s the way it’s always been done,”

...is simply no longer acceptable…

…reimagine the experience with Miron Construction.

Steve Tyink, VP Business InnovationMiron Construction Co., Inc.

☎ 920.969.7047

� [email protected]

Experience Innovation


1471 McMahon DriveNeenah, WI 54956

P 920.969.7000

F 920.969.7393

www.miron-construction.com

miron construction - osi patient experience

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