Three Phases of Facility Design

Southcentral Foundation’s facilities are designed to maximize efficiency, support relationship-based care, and reflect the Alaska Native culture and values that make up SCF’s Nuka System of Care. However, SCF’s facilities were not always the way they are today. Back when SCF was establishing the Nuka System of Care, our facilities had a much more “traditional” medical design, where physicians had private offices, physicians sat with physicians and nurses sat with nurses, and managers had their own offices as well. Following are three phases of facility design SCF went through while redesigning its facilities to support its new relationship-based care system.

• Phase One. In this phase, SCF built offices adjacent to clinic spaces and prioritized seating disciplines together. We had nurse stations and integrated procedure rooms. We later remodeled to put offices mixed within clinics, with an office after every few exam rooms, and made seating be integrated, for multi-disciplinary teams. However, this presented some challenges—providers and customer-owners had to walk long distances, there was a lot of traffic by private exam rooms, and the shared waiting area had a ‘busy’ feel and not much privacy.
• Phase Two. In this phase, we remodeled the lobby and moved it to a location with windows to make use of natural light and make it feel more connected to nature. We seated integrated care teams together, with two teams per office, and seated other providers such as behaviorists and dieticians close to the teams. We put the offices on the perimeter around the exam rooms, and de-officed managers to make them more accessible to care workers. This phase had many advantages, but challenges included the fact that clinics had the ‘wrong’ scale (being larger, resulting in congestion and lack of privacy), there were not enough clinical rooms, and providers still had to walk long distances to rooms from offices.
• Phase Three. In phase three, we maximized clinical space, creating 170 clinical encounter rooms. We split departments back to smaller ‘team’ practices and decentralized health information centers into every waiting area. We placed shared specialty rooms and equipment along the central spine. In this phase, the emphasis shifted toward more team space; there are no nurse stations or manager offices anymore. Shared resources such as behaviorists, dieticians, pharmacists, and coverage providers are visible and accessible to care teams. This phase represented a structural shift, conveying a private, respectful feeling to customer-owners.

 SCF’s Learning Institute has also consulted with other organizations on facility design, supporting their efforts to build and/or remodel facilities to reflect their organizational values and better serve their customers. One such organization is Little Shell Tribe of Chippewa Indians. SCF has published a case study about our consultation with Little Shell on facility design; it is available on our facility design consultation page. If you have any questions about SCF’s approach to facility design, feel free to contact the SCF Learning Institute.