Navigating a Pandemic: Planning Ideas for Pathways, People and Reduced Touch A visit to the doctor will not be the same after COVID-19. As our healthcare practitioners prepare to re-open medical office buildings after COVID-19 closures, they will be working in a very different medical landscape. Healthcare organizations are committed to delivering the best possible care for their patients, and are extremely conscious of new protocols for both patient and staff safety. LS3P is exploring with our clients ways in which clinics can adapt the physical environment to help maintain physical distancing and follow CMS recommendations for reopening facilities to provide non-emergent, non-COVID-19 healthcare. An adaptive response To get facilities operational as we continue to navigate this public health crisis requires a multifaceted approach. Designers and care teams need to collaborate to develop ways in which existing clinic layouts can support the separation, physical distancing, and infection prevention strategies that have become the “new normal” while continuing to provide a supportive patient and family experience with efficient workflow. Design Strategies can include: Bypassing Check-in / Vitals / Check-out stations Patients can be routed through a drive-up pre-screening area. Clinic staff would screen all patients for symptoms of COVID-19, including temperature checks; patients that pass screening would be directed to a dedicated vehicle “waiting room.” When notified to proceed to treatment areas, patients would go directly to their designated exam room. Vital signs can be taken and check-out can all be completed by clinic staff in the exam room, minimizing the number of interactions and physical locations. PPE Stations Face coverings, gloves, hand sanitizer, trash bins, and other PPE can be made available at multiple locations both inside and outside the facility. Additional donning and doffing stations with showers can be added temporarily to ease staff stress when coming to work and heading home to their families. Designing One-Way Patient Flow One-way patient flow can help achieve required physical distancing throughout the facility. This may require additional signage and temporary walls. Designers and care teams will need to plan circulation pathways that support staff workflow and identify areas where temporary separations may be needed while maintaining code egress compliance. One-way vertical circulation may also be necessary to reduce cross-contamination of patient flow throughout the facility. Staff Work Areas To allow adequate physical distancing for providers, teams may need to increase staff areas for virtual registration, scheduling, supply storage, PPE donning/doffing, and staff lounge areas. Patient Navigators As people traverse these new one-way traffic patterns, Patient Navigators can be stationed strategically to guide patients to and from exam rooms, procedural areas, and other services. These Patient Navigators will help control overcrowding in circulation spaces, maintain steady directional flow, and ensure PPE and cleanliness protocols are observed. Patient Navigators will also support a positive patient experience by providing personalized service and addressing patient concerns and questions. Increasing Telemedicine The current lockdown has taught us that an estimated 30% of clinical visits for some practices can be effectively transitioned to telemedicine visits, within CMS guidelines. Exam rooms can be easily converted to telemedicine space for providers to conduct both video and audio visits. These telemedicine rooms could be grouped strategically to further segregate providers and patients. In rural areas, these telemedicine exam rooms may be a place for patients without internet to connect with specialists at facilities outside their area. Implementing a Physical Distancing Seating Plan As operations ramp up, patients may need to spend part of their overall wait time within the facility in addition to the vehicle waiting room. Generously spaced seating arrangements can help facilitate physical distancing guidelines both in patient areas and staff areas. In shared work areas, transparent dividers may be installed to protect staff members who need face-to-face interaction to perform their clinical duties. Reducing Touch Enhancing infection prevention measures will be vital to avoid transmission originating from hands, equipment, air, etc. To minimize contact with door handles, buttons, and switches, facilities may need to implement automated features in high-touch areas for optimized passive infection prevention. Door openings could include hand-wave technology for an estimated $2,900 per opening; application of anti-microbial coatings and stringent cleaning protocols could reduce transmission opportunities via door handles. No-touch elevator keypads and voice-operated controls could reduce the need to touch elevator call buttons, though stringent cleaning protocols or dedicated elevator operator staff may provide a more cost-effective option. To avoid upgrades in existing facilities, Patient Navigators could be placed inside elevator cabs to serve as operators, providing enhanced customer service and convenience. Easily cleanable solid-surface materials and anti-microbial coatings may provide additional protections against infections. Frequently used items such as tables and other furnishings, door handles, computer keyboards, and textile products such as cubicle curtains will require frequent cleaning and should be durable and easy to maintain. Delivery staging Delivery staff can be screened at the drive-up pre-screen area before proceeding to the delivery entrance. A breakdown area can be provided at the delivery entrance, where materials can be safely removed from their shipping packaging and sanitized before being brought into the building. The road ahead We anticipate a ripple effect through healthcare systems with some long-lasting changes in the way we plan and design spaces for health care. This initial period of ‘adaptive response’ will give designers and care teams the opportunity to ‘test drive’ some of these design strategies and evaluate what solutions may transition into best practices in the future. LS3P has created several case studies of existing facilities implementing planning ideas for pathways, people and reduced touch. For more information please contact Willy Schlein, LS3P’s Healthcare Practice Leader. About the ContributorsRon Smith, AIA, ACHA, ACHE, EDAC, LEED AP Ron Smith, a Board Certified Healthcare Architect and past president of the AIA Academy of Architecture for Health, brings over 30 years of Healthcare planning and design experience in project types including hospitals, specialty clinics, cancer centers, academic medical centers, primary care clinics, federally qualified health centers, and long-term care facilities. Ron’s design expertise includes facility assessment, master planning, program management, project management for design and construction, functional and space programming, and Lean process design workshops. Ron is a leader in interdisciplinary design and collaborative stakeholder engagement. As an active member of the AIA Academy of Architecture for Health, Ron promotes the building of shared knowledge among healthcare architects and clients about design and research on the healthcare environment and its impact on patient care. He is the founder of the AIA AAH Research Committee, the author of a resource page on Therapeutic Environments for the Whole Building Design Guide, and an Affiliate Member of the American College of Healthcare Executives. Ron earned a Bachelor of Fine Arts in Interior Architecture from the Rhode Island School of Design, and is certified in Lean for healthcare. Helen Byce, AIA, LEED AP BD+C, GGP Senior Associate Helen Byce brings over 15 years of experience to LS3P, and her greatest strengths as an architect involve the planning and design of healthcare projects. These duties include all phases of the design process, from pre-design to construction administration. She enjoys the challenges that are inherent in health facility design and developing solutions to the complex problems that hospitals often face. Assisting the client to determine the best path to satisfy the most needs in the most affordable and efficient way is one of her greatest joys as an architect. Since joining LS3P, Helen has been a tremendous asset not only to the Greenville office, but to the entire firm. Her specialized healthcare expertise has strengthened LS3P’s designs firmwide, and her leadership in mentoring the next generation entering the architecture, construction, and engineering industries is an inspiration to others. Espy Harper, EDAC, SSGB Espy brings 18 years of specialized expertise in healthcare planning and design. A Six Sigma Green Belt with a Master of Architecture from the University of Michigan at Ann Arbor, Esperanza is highly skilled at data analytics, lean design principles, and design thinking in service to leading-edge healing environments. She is well-versed in using her strategic insight as it relates to functional programming, right-sizing of the facility, flexibility, and master planning, and is a frequent presenter on patient-centered design at national conferences. Lindsey Stang, AIA, GGP Associate Principal Lindsey Stang joined LS3P in 2011 after earning both a Bachelor of Architecture and a Master of Architecture + Health from Clemson University. With experience in all phases of design from programming to occupancy, Lindsey is highly skilled in medical planning and healthcare design. Her portfolio includes both renovation and new construction projects which draw from her diverse skills in architectural design, medical space planning, building information model coordination, and interior design. Lindsey brings an extraordinary level of creativity, planning, and design perspective to a project team, and she has worked extensively on some of the firm’s most intricate and complex projects. Clients appreciate Lindsey’s ability to distill complex programming and planning challenges into clear, simple design solutions. Lindsey’s design priority is assisting clients with challenges such as understanding the context in which they are planning their future growth, investing capital wisely, designing the best development path, and incorporating the most effective and innovative solutions to advance their strategic missions. Lindsey’s work has been featured in such publications as Design Intelligence (2006), Architect (2007), and Contract Magazine (2011).