At NYP's David H. Koch Center, the Future of Ambulatory Care Is Now

Added on Jun 20, 2019

ambulatory_careAt NewYork–Presbyterian’s David H. Koch Center, the Future of Ambulatory Care Is Now
By Andrea Fitzgerald

What will exceptional ambulatory care look like in the future? That is the question that guided leadership at NewYork–Presbyterian (NYP) when envisioning and planning the David H. Koch Center, a 734,000-square-foot ambulatory care facility in Manhattan that opened last April. To make their vision a reality, NYP leaders, in collaboration with patient and family advisors and Weill Cornell Medicine, partnered with three design firms to build this state-of-the-art treatment center from the ground up.

“Health care is shifting from inpatient to outpatient care,” said Richard Evans, senior vice president and chief experience officer at NYP. “We wanted to respond to this trend by creating a facility that better collocates services, provides a seamless experience, and utilizes the best technology to better meet our patients’ needs and preferences.”

Taking such a collaborative, patient-centered approach to planning the center resulted in technology features and other design elements that reduce wait times and stress, support and include family members, and consider each patient holistically. As a result, the facility’s scores for Overall Rating and Likelihood to Recommend are in the 97th and 98th percentiles, respectively, and leadership anticipates improvements in safety, quality, workforce engagement, and financial performance, as well.

Reducing Stress and Anxiety in an Outpatient Setting

Waiting and uncertainty are consistent operational challenges in a traditional ambulatory setting. In order to create a healing environment that was as stress-free as possible, the project team worked together to brainstorm ways in which the design and function of the David H. Koch Center could create an integrated patient experience. To begin, NYP leaders convened staff and patient and family advisors to map out the care journey of patients across services. “We would imagine a patient’s journey for endoscopy, for example, from diagnosis to aftercare, and think about what the key moments of truth in that journey are that we wanted to make sure go perfectly,” Evans explained.

Registration rose to the top for patients regardless of procedure or service line. “The usual process can be inconvenient and repetitive. Most of the time after setting up an appointment, you go in, check in at a desk where you either go through or fill out a lot of information, and then sit in the waiting room, all of which costs the patients and families time,” Evans said.

The Koch Center gives that time back, first by enabling patients to complete their paperwork online before their visit. Then, upon arrival, patients and family members are greeted by patient ambassadors and offered personalized smartbands that provide access to the building and information about their visit. They can even download the NYP app for step-by-step directions to their room.

For those having a procedure, this private prep and recovery room serves as a “home base” for the patient and family throughout their visit. It’s not called home base just because it features a TV, Wi-Fi, and other amenities to help the patient and family relax and get some work done, according to Evans. Rather, it is a central location assigned to the patient and family so that the movement from place to place that usually characterizes an ambulatory care visit is minimized.

“Traditionally, you’re called from a waiting room, brought to a procedure room, and then brought to a different area for recovery where your family can only visit for so many hours of the day,” Evans said. At the Koch Center, the team comes to patients at their home base, brings them to the procedure room, and then returns with them to that base where the family can stay throughout the visit. This significantly improves patient experience and flow, according to Evans.

As patients undergo their procedure, family members also have the ability to access common areas, including a café and quiet lounge, where they can decompress and eat while receiving real-time text message updates that keep them apprised of their loved ones’ progress. After treatment, patients can use the NYP app to access discharge instructions and test results, and schedule video follow-up appointments with physicians.

The goal of all of these features is to help patients and families focus on their health and healing and continue their lives with minimal disruption, according to Evans.

Integrating Care in a Single Location

To provide even the most complex patients such a seamless experience, the project team set out to integrate services and technologies not only in the same building, but in the same room when possible. A notable example is the MR/PET/Angiography suite, which combines key imaging technologies used for minimally invasive procedures to enable clinicians to diagnose, plan, precisely guide, and complete procedures without having to move patients from room to room or even table to table.

“We use cutting-edge technology, not because it’s bright and shiny, but because it provides a better experience for patients as well as their families and caregivers,” Evans said.

If there is a need for additional therapy or treatment that can’t be provided in the same room, it can still be provided during the same visit. Patients with a cancer diagnosis, for example, may be taken for infusion and radiation oncology services located on the sunny fourth floor rather than the basement, as in many hospitals, or to Integrative Health and Wellbeing to receive nutrition, psychological care, and mind–body therapies that are complementary to their clinical care.

Having such technologies and services all in one location allows the Koch Center to compress multiple patient visits into one and avoid roadblocks that come with needing to transport a patient three city blocks away for another service, Evans explained. “There may still be delays if a procedure runs long, but we never have people waiting for their turn, in a hallway and without enough blankets or anything like that,” he added.

In addition to having a significant impact on the patient experience, such individualized, coordinated care also has safety and quality implications. Because of the attention to detail in the building’s design and function—from unified patient schedules to the templated design of procedure floors—there is less opportunity for delays, errors, and service failures and more opportunity for delivering exceptional, compassionate care, according to Evans.

“Health care is hard enough. We try to sand off the rough edges of the delivery and experience,” he said.

Continuing to Elevate the Patient Experience

Based on the center’s latest Ambulatory Surgery CAHPS survey scores, it appears that NYP leaders have sanded off many of those edges. The Koch Center ranks in the 98th percentile for Likelihood to Recommend and the 97th percentile for Overall Rating of Facility, making it the highest performing ambulatory surgery site for Overall Rating across the system.

Even with this success, NYP continues to seek opportunities to deliver exceptional care to patients at the center and across the system. “We don’t want patients just to get the best care in the new building,” Evans said. “We want to introduce them to health care, and our system specifically, with a great experience and set that expectation of quality and patient centricity.” To that end, the organization is beginning to emulate the Koch Center’s streamlined registration process and strategy of patient journey mapping, among other features and processes being implemented there, across all of the NYP inpatient facilities.

In this way, the center, with its smartband technology, private waiting and recovery rooms, and integrative health and wellbeing program, is leading the way to a bright future in both ambulatory and inpatient care.