Expect the Unexpected: A health care construction case study


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The three critical elements required
to build this type of transformational
healing environment were: Physical,
Behavioral, and Informational. By
understanding the Experience
Ecology and the outcomes of all
three areas in conjunction with one
another, sustainable change can
take place, allowing for a patient-
specific experience centered on
quality outcomes.

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Expect the Unexpected: A health care construction case study

  1. 1. Expect The Unexpected Neuroscience Group of Northeast Wisconsin A Miron Construction Co., Inc. Healthcare Case Study
  2. 2. Contents“Our purpose is to serve Introduction 8 with the greatest intent, Walk 10to show compassion and provide the ultimate Talk 18 healing environment.” Create 42 Act 66 Philip A. Yazbak, M.D., F.A.C.S., President Neuroscience Group
  3. 3. Introduction “To be the center of all, working in collaboration with Miron Construction Co., Inc. and Plunkett Raysich excellence and the Architects, LLP to create a facility unlike any recognized leader other. of comprehensive, As for why we should do this, the answer is in our purpose ~ to serve others ~ and in compassionate neuroscience the Neuroscience Group Vision . . .“To be services in Northeast the center of excellence and the recognized leader of comprehensive, compassionate Wisconsin.” neuroscience services in Northeast The Neuroscience Group of Wisconsin.” Northeast Wisconsin Mission Breaking new ground was our only choice. Statement Creating the unexpected, our mission. Our exploration process was under way. The Creating the unexpected is a thrilling future was ours to shape; the unexpected, but daunting challenge. Sustaining the to create. unexpected, even more so. Still, we considered it our privilege—in fact, our responsibility—to write the most compelling “What is the new way chapter in the history of neuroscience of thinking? That which medicine and healthcare construction. created the patient Constructing a state-of-the art building was out of the question. Creating a beyond-the- experience of the past is no state-of-the-art experience was our dream. longer relevant. From the It was also our greatest challenge, one that excited everyone involved, connecting us to beginning, we must design a mission unlike any other. and construct the patient A cross-functional team of physicians, experience in a unique way... practitioners, and other key team members from Neuroscience Group agreed that the ideal way.” setting the standard meant building on the Steven J. Price, M.D., Neurologist already-strong foundation . . . exploring Neuroscience Group new territory . . . innovating . . . and, above E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 9
  4. 4. Walk
  5. 5. “Are patients ever attachedto a building? At MironConstruction, we realize thatsimply to build is not enough.For our projects to be highlyinnovative and supremelysuccessful, they must transformhow people feel, taking theirthoughts and their emotions toan entirely new level.”David G. Voss, Jr., PresidentMiron Construction Co., Inc. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin
  6. 6. “The transformation process beganwith three outcomes in mind—each focused on emotion, themost important aspect of the IdealPatient Experience.We asked ourselves the followingquestions: How well-cared for doour patients feel when they’re withus? How do families feel about thecare we’re providing for their lovedones? How does our team feel insetting and exceeding the standardfor comprehensive, compassionatecare?Our facility needed to cater to eachone of the outcomes of thosequestions, and that is why itsdesign and construction was sointegral our goals.”Margie Wiess, Ph.D., CEONeuroscience Group E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 15
  7. 7. Collaborative Innovation bestdescribes the process used tobring our Creating the UnexpectedDream to life. We could not haveasked for finer, more creative,more innovative partners during thisprocess than Miron ConstructionCo., Inc. and Plunkett RaysichArchitects, LLP.Keeping the desired outcomes inmind, the first and only choice forbuilding the Ideal Patient Experiencewas Miron Construction Co., Inc. ofNeenah, Wisconsin. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 17
  8. 8. Talk
  9. 9. The three critical elements requiredto build this type of transformationalhealing environment were: Physical,Behavioral, and Informational. Byunderstanding the ExperienceEcology and the outcomes of allthree areas in conjunction with one “Working together, we createdanother, sustainable change cantake place, allowing for a patient-specific experience centered on a culture of innovation. True toquality outcomes. their mission, we significantlyIt was important to align eachelement with the expectations of the improved the quality of patientpatient and Neuroscience Group.However, it was even more criticalthat each element was designed to care and, at the same time,support and complement the otherelements. One or more of these reduced costs. For example,main elements are often overlookedor executed poorly, neglectingnot only their uniqueness, but the through close scrutiny ofinterdependence of all three. function and patient interaction, each exam room was right sized six inches smaller than originally programmed. This resulted in significant construction cost savings.” Mike Scherbel, Partner Plunkett Raysich Architects, LLP
  10. 10. Guided Co-Creation:A collaborative, connectedexperience during which arepresentative selection ofNeuroscience Group employeesdesigned organizationaltransformation. Stakeholders hada voice during the entire innovationprocess. This group was known asthe Innovation Team. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 23
  11. 11. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 25
  12. 12. To create the unexpected and bringthe outside in, the architecturalfeatures of the building needed tocomplement the natural landscapeelements. The goal… to haveunique design elements thatcaptured the minds of each visitor. “We started with the outcomes – how we wanted our patients to feel – and moved backward from there. A very non-traditional approach.” Margie Weiss, Ph.D., CEO & Community Health Care Advocate Neuroscience Group E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 27
  13. 13. Design elements and patientoutcomes were identified, illustratedand examined to ensure they werebrought to life. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 29
  14. 14. Neuromarketing:The connection of the brainsynapses to the positive patientexperience are directly related andoften overlooked. Reaction - Physical reactions to objects and spaces Example: Employees stand on toes to reach something. Adaptation - When an object serves a purpose for which it was not intended Example: A box elevates a computer higher on a desk. Exploitation - Using existing conditions to accommodate needs Example: The space beneath a desk becomes a storage space. Conformity - Social norms and their patterns Example: Patients sit five seats apart and star at each other. Signaling - Communicating with patients Example: Post-it notes transform a refrigerator into a bulletin board. Stewardship - Caring for the environment Example: An organization relies excessively on paper for collecting information that could be transmitted electronically. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin
  15. 15. As advocates for communityhealth, NSG recognized that thenew facility presented both achallenge and an opportunity tointegrate sustainable design intothe construction and operationalstrategies. A healing environment ispredicated upon the premise thatthe land, people and building mustall work together in holistic harmony.The design process was stimulatedby patterns found in nature andbrought to life through Miron’s C5Process. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 33
  16. 16. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 35
  17. 17. Neuroscience Group leaderswere aware of the economic andenvironmental benefits of designingand building “Green”. Sustainablebuildings lower operating costs,improve employee retention,enhance occupant comfort andhealth, increase building valuation,decrease strain on communityinfrastructure systems and helpto create patient-centered high-performance healing environments. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 37
  18. 18. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 39
  19. 19. All factors were considered beforeimmersing the team in any decisionmaking. Much like a fashion runway,preferences in colors, fabrics,and style are unique for everyone.However, we do know that ifdesigned with patient-experienceoutcomes as the primary focus,sensations come to life, enablingpatients to feel completely specialand in control of their healingprocess.
  20. 20. Create
  21. 21. “Taking ownership of thisproject has been deeplygratifying for our team. Thebuilding process, in particular,was carefully planned,integrated and executed, verymuch in the spirit of how wehandle patient care. Miron wascommitted, from the beginning,to build an environment of trustfor all involved.”Susan G. Hibbs, M.D., NeurologistNeuroscience Group E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin
  22. 22. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 47
  23. 23. Bringing the building to life wouldnot have been possible withoutthe use of Building InformationModeling (BIM) and Dan Bayer,Miron’s BIM specialist. The Mironteam was equipped to forward planand visualize the outcome, allowingfor the NSG team to analyzethe results. Real BIM successwas driven by living the virtualenvironment experience. Miron’suse of BIM tools helped to defineand visualize the outcomes beforethe first shovel entered the ground. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 49
  24. 24. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 51
  25. 25. The Innovation Team was ableto assist Neuroscience Groupin reducing patient registrationwaiting time from 13 minutes to35 seconds. This savings notonly lowered the initial time spentin the reception room by thepatient, but also allowed for a moreconsistent scheduling workflow.Because patients rarely arrive 30minutes early for their appointment,additional slots were available toaugment the schedule. With thechange in design and caregiverbehaviors, two to three slots perprovider per day were opened fordirect patient care. This changeadded 6% additional revenue tothe top line each year, resulting ina 1.4% increase to the bottom line.Outcome-based design changesdo make a difference… in patientfeelings, in caregiver connectionsand in bottom line profitability. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin
  26. 26. NSG’s green vision is a unifyingtheme, encompassing of allaspects of the project. MironConstruction Co., Inc. was selectedto assist in the implementationof this vision. Rather than hiringa sustainability expert, Miron hadthe talent, tools and knowledge tobring the dream to life. Without apartner who understands and livessustainable excellence, NSG’sLEED® initiative would not havebeen possible. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 55
  27. 27. New ideas for the patient examroom transformed into the wayNeuroscience Group is perceivedboth internally and externally. Tocreate the ideal outcome in theexam room setting, the experience-design team used the revolutionaryRapid-Access Prototyping toolthat challenges traditional thoughtprocesses. “Healthcare patientexam room design has changedvery little since it was created 30years ago” commented Philip A.Yazbak, M.D., “In fact, if you readperiodicals from years past, examroom design today is substantiallythe same. The challenge is thatour health care delivery system haschanged quite dramatically.” E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 57
  28. 28. “Physicians, healthcare architects,clinical assistants and associatepractitioners from the group co-created the ideal exam room,”Dr. Steven Price said. “First, wecleared out one of our 10 x 10exam rooms and began designingthe experience from there. Therevolutionary change we werelooking for would not have comefrom simply rearranging theenvironment that already existed.And so,” Price continued, “wechallenged traditional thinking bystarting with an open palette.”“What was once a sacred spacewas up for discussion. Anythingwas possible.” commentedWeiss. “Soon, everything becamepossible.” Foam items were putin place, illustrated, identified, andthe creativity began. “We startedwith the expected emotionaloutcomes connected with patientflow and physician expectations,”added Steve Tyink, VP of BusinessInnovation at Miron. “Then we tookthese expectations to the realm ofthe unexpected, our ultimate goal.”The results? No more frighteningmodels of half brains, no moreposters of the human body greetingpatients as they entered the examroom. “Together, we created theultimate in patient privacy and anexam-room environment that waswarm, welcoming, and reassuring.” E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 59
  29. 29. Three realities and levels ofexpectation can be formed within aclinical setting: • Patients receive less than what they expect. Example: They would like to enjoy some coffee, however, it is nowhere to be found. • Patients receive what they expect. Example: Coffee is available through a confusing countertop serve dispenser with styrofoam cups. • Patients receive more than what they expect. Example: A Coffee Barista stands ready to exceed all patient expectations.Each outcome brings decidedlydifferent feelings and emotions. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 65
  30. 30. Act
  31. 31. “Just as evidence-basedmedicine is revolutionizinghealth care, evidence-baseddesign is transforming thehealth care environment. Wenow have at our disposal provenmethods for improving patientoutcomes, safety, attachmentlevels, as well as staff retentionand service efficiency. Ourevidence-based design alsoresults in improvements toclinical outcomes, economicperformance, productivity,Press-Ganey patient satisfactionand community measures.”Steven J. Price, M.D., NeurologistNeuroscience Group
  32. 32. Members of the NeuroscienceGroup Innovation Team touredother firms where alternativemethodologies are currently in use.These trips provided discoveryand insight into the specific areasneeded. Best practices wereidentified at Cabela’s, REI Outfitters,Lush Cosmetics, Whole Foods, toname a few. Direct observation andanalysis challenged perceptionsand changed outcomes. E x pe c t Th e Un e x pe c t e d | The Neuroscience Group of Northeast Wisconsin 71
  33. 33. “By simply altering processes,modeling impression areas and attachpoints, understanding outcomes and shifting behaviors, the experience at the Neuroscience Center now closely reflects the organization’s mission and commitment to its patients. The result? An experience that is unforgettable. The ultimate healing environment and ideal patient experience have beencreated and are well underway.” Gizell R. Larson, M.D., Neurologist Neuroscience Group
  34. 34. AcknowledgmentsWe would like to thank the following people and firms who shared their passionand dedicated their expertise to the successful creation of the NeuroscienceCenter:Miron Construction Co., Inc.President/Principal: David G. Voss, Jr.Vice President/Principal: Tim Kippenhan, LEED® APProject Manager: Andy DerksenProject Superintendent: Jim ZeiglerVP, Business Development: Corey BrumbaughVP, Health Care Services: Dennis LynchConceptual Estimator: David SchaetzProject Coordination: Jodette Friedrich & Kelly McCarthyVP, Business Innovation: Steve TyinkPlunkett Raysich Architects, LLPArchitectural Design and RenderingsPartner: Michael H. Scherbel, AIA, NCARBProject Architect: Mary Spriggs, AIA, CSI, CDTSenior Planner: Daniel J. Becker, AIA, LEED® APInterior Design: Dan EffenheimEngineering Concepts, Inc.HVAC & Plumbing EngineerGEI ConsultantsElectrical EngineerSTS/AECOM AssociatesCivil EngineerPierce Engineers, Inc.Structural EngineerAll Content © 2008 Miron Construction Co., Inc.Professional PhotographyArk Media Group, LLCMargie Weiss, Ph.D.Weston Imaging Group, LLCGraphic DesignSarah Parker
  35. 35. Corporate Office Regional Offices US $16.991471 McMahon Drive Wausau, WINeenah, WI 54956 Madison, WI www.miron-construction.comp. 920.969.7000 Cedar Rapids, IAf. 920.969.7393 This book contains recycled material.