How Design Helps Health Systems Move from Sick Care to Health Care, with Paula Widerlite
“Sick care” refers to the emphasis that health care has traditionally focused on treating symptoms and illnesses instead of promoting whole patient care, including preventative care and expanding access to health care for at-risk patients. Paula Widerlite, Chief Strategy Officer at the Anne Arundel Medical Center (AAMC), is today’s guest on the Gensler Design Exchange, and she talks with Gensler Firmwide Health & Wellness Practice Area Leader, Tama Duffy Day, on improving patient access to health care through strategic systems and design.
In this interview, Paula and Tama tackle the “tsunami of change” happening in the health care industry. They note how provider focus is shifting on a range of issues, and that the need to evolve from ‘sick care’ to ‘well care’ is leading to trends like the rise of ‘telehealth,’ which is expanding health care access to a large number of rural patients. At the same time, patient expectations are evolving, and providers need to incorporate the latest technology to improve convivence and overall patient experiences to keep up. In response to these shifts in provider focus and patient expectations, designers should be active participants in the strategic planning of health care centers, focusing on leveraging smart design interventions to improve patient outcomes and promote health system flexibility.
As a regional health system in Annapolis, Md., between the two major cities of Baltimore and Washington, D.C., the Anne Arundel Medical Center cares for a population of approximately 1.2 million people. The hospital is the state’s third busiest, serving its community with nearly 1,000 affiliated physicians and 4,000 employees.
Over the 102 years since AAMC first opened its doors, it has remained true to its philosophy of providing patients with quality personalized care, collaborating with the community, engaging its entire workforce, and diversifying its services and areas for growth.
According to Paula, there are three words that truly define the AAMC experience: “Living Healthier Together.” Crafted in February 2010 by AAMC staff and executive leadership, this mission mirrors key components of the health care reform signed into law that year, which has helped the organization adapt to a changing healthcare landscape. Its pillars include patient-centered care and collaboration with the community to improve access to quality, cost-effective health care for all.
During their conversation, Tama and Paula discussed how the hospital is adapting its tech and design strategies to enhance the health care experience for patients and physicians alike, and to reach rural or elder patients who may not be able to travel to office visits easily:
TAMA: You talked earlier about the patients that you serve. I’m guessing that the type of patients you serve [varies] broadly in terms of access to health care and what patients can afford.
PAULA: Yes, definitely. Absolutely.
TAMA: You mentioned “a tsunami of change,” which… I feel that I recognize [in] how I seek healthcare [as opposed to] 10 years ago.
When you mentioned yourself as the Chief Strategy Officer, I love that you said you were a guardian. When I think of a guardian, I think of someone who is overseeing a physical environment as well. Many of the things you mentioned are social aspects of care. How does the design of the physical environment play a role in “Living Healthier Together”?
PAULA: We really need to provide access to the patients where they are and not necessarily assume that they’re going to be able to access healthcare where we are. So when a patient is discharged to a nursing home or a home health agency, we need to coordinate that care and manage that care.
It also means identifying what gaps exist via community health needs assessment, understanding what the priorities are in our community, and then improving access in ways that are easier for the patient, such as [through] primary care, mental health [treatment], and [therapy for] substance use disorders.
None of this takes place inside our hospital… and a lot of the care that these patients need can be given in their primary care offices [or] in their community-based clinics [through our affiliate physicians].
TAMA: Which is obviously about reaching beyond the hospital walls, [unlike] the traditional practice of health care in the past [that] was more centered around the hospital.
You’ve mentioned this community-based focus that you have for the Anne Arundel Medical Center patients. You also mentioned a community needs assessment. Could you describe what that is and how you go about assessing the community’s needs?
PAULA: [A community needs assessment is] required of all hospitals every three years. We just completed our second one, and we do it in collaboration with the other hospitals in our service area, with other public agencies [and] private agencies.
We conduct interviews of stakeholders, physicians, [and] patients and use secondary data and primary research data to identify what the needs are. That’s where you find some of these broader needs like difficulty getting to the doctor. Or problems with people having access to healthy food. We often find things in the way of oral hygiene or dental care.
Our recently completed study identified 55 needs, and we prioritized five of those. Some of those priority areas are mental health, palliative care, end-of-life care, pain management, care coordination, [and] some disparities in health equity issues that we’re focused on, such as infant mortality. It really can cover the broad spectrum of improving the health status of the community.
TAMA: You mentioned that you’re near urban areas, but that [AAMC] is still rural, [and] that it is challenging [for patients] to travel around the Bay to receive the care that you are providing.
Were any of the needs assessment that you found surprising?
PAULA: Often times, in the more rural areas, access to primary care and even specialty care can be a bit of a challenge for patients. We are responding through promoting virtual care or telehealth, or access to urgent care, or care in clinics.
We have to really be creative on how we make sure we can reach these patients because they can be often times in remote locations. The investments [health care systems] make tell the story. In our case, we’re making significant investments in electronic health records. We’re investing in primary care expansion. We’re investing in clinics. We’re investing in data analytics.
So, to your point about the community health needs assessment, we use it to understand what more about our community what we need to guide our care delivery system, [and look] at our relationships with long-term care providers and all of those things to improve overall population health for our community.
TAMA: Just last week, I attended a presentation of the Veterans Administration on their increase in access to and [in] providing telehealth around the country.
How have you been able to encourage and educate your patients that that is an option?
PAULA: We really don’t have to work too hard to educate our patients about the benefits of virtual health care or telehealth. Many of us expect to access services online or virtually — that’s the way we shop, that’s the way we make reservations for dinner, that’s the way we access our bank these days.
In health care, I think patients are expecting that [too]. They expect to go on the website, get what they need, [and] make a registration for their physician appointment. The challenge isn’t so much in educating the patient, the challenge is more on integrating this into our care delivery model. Sometimes reimbursement can be a barrier. Sometimes technology can be a barrier. But really, the patients, they’re ready for it.
I’d like to take us back into the built environment and talk about experience within the physical space. You mentioned the importance of patient and family-centered care. [How] can designers who create spaces look at creating an experience within your physical environment that’s powerful and memorable in positive ways?
PAULA: We just completed a project that we’re very proud of that is designing the space quite differently for our patients, all with the objective of improving the experience. It was just completed, and it was described to me as a physician office designed with an on-stage area and an off-stage area.
[When] patients enter, the waiting room is somewhat limited, [and] we get them right into the room where they are going to see their physician — that’s the on-stage area where they’re going to get their services. The back door [of the exam room] is the off-stage area where the registration might take place [and] the labs might be drawn.
We have this dual entrance into an exam room [that] takes up much less room. It allows for a better interaction between the physician and the patient, and it actually helped us to increase the ratio of exam rooms per doctor with a decrease in the waiting room area.
We also have this living wall [of] live plants that’s very pleasing for the patient. It looks more like a hotel lobby, if you will. We think that it really is improving the patient experience, and we’re excited about it.
TAMA: I truly believe that design does impact health, and you’ve just mentioned many ways where design can impact the health of the provider, the caregiver, the staff, the patient, their family, [and] maybe even the executives that run the Anne Arundel Medical Center.
At the beginning, you said a part of what you do is strategize and you have your feet in both the future and the present. As a strategist, what is your biggest challenge?
PAULA: I think there’s two challenges that characterize how I spend my day. One is uncertainty and the other one is execution.
We’re in this era of uncertainty — not exactly sure how access to care will be impacted, not sure how we’ll get paid, [and] not sure how technology will impact us. Yet, we’re expected to develop and execute strategies or chart a course in a very uncertain environment.
I would say that folks probably have a “Vision 2020,” [and] they probably are looking at how they design their facilities and how they introduce telehealth and improve access [to health care]. But it’s really all in the execution that will differentiate us.
Interested in learning more? Listen to the full episode now on Soundcloud, Apple Podcasts, Spotify, Google Play, Stitcher and Libsyn. To find out more about the Anne Arundel Medical Center, visit their website.
As always, thanks for tuning in!