The Edmonton Clinic: Orientation 101 July – August 2012

1. The Edmonton Clinic: Orientation 101July – August 2012

2. How Did We Get Here? Why Are We Here?

3. True Story… A sweet grandmother telephoned St. Joseph 's Hospital. She timidly asked, "Is it possible to speak to someone Who can tell me how a patient is doing?"The operator said, "I'll be glad to help, dear. What's the name and room number of the patient?"The grandmother in her weak, tremulous voice said, "Norma Findlay, Room 302."The operator replied, "Let me put you on hold while I check with the nurse's station for that room."

4. True Story (con’t) After a few minutes, the operator returned to the phone and said, "I have good news. Her nurse just told me that Norma is doing well. Her blood pressure is fine; her blood work just came back normal, and The grandmother said, "Thank you. That's wonderful. I was so worried. God bless you for the good news."The operator replied, "You're more than welcome. Is Norma your daughter?" The grandmother said, "No, I'm Norma Findlay in Room 302. No one tells me anything."

5. VISION “Edmonton Clinic will be a leading, state-of-the-art enabler of integrated, patient centered clinic care, education and research” (Functional Program 2006)

6. Vision 2020 Goals • Providing the right service, in the right place and at the right time • Enhancing access to high quality services in rural areas • Matching workforce supply to demand for services • Improving coordination and delivery of care • Building a strong foundation for public health • Source: “Vision 2020: The Future of Health Care in Alberta, 2008”

7. AHS Ambulatory Care: Past & Future • Location of Ambulatory Clinics • Walter Mackenzie Centre • Clinical Sciences Building • Aberhart Centre • College Plaza • Garneau Professional Building • Ambulatory Current State • Competing inpatient & academic requirements • Internal department silos; team care increasing • Emphasis on customer service, access • New services & technologies (e.g., eClinician) • Significant process variability • Provincial resources impacted by Alberta economy • Trailers (various) • Glenrose Rehabilitation Hospital • Van Vliet Centre • Dentistry/Pharmacy Centre

8. The Real Past….

9. Inpatient philosophy Specialty care Complex patients Higher resource per case Privacy Safety Family-centered care Focus on transition of patients from acute to sub-acute/secondary facilities Ambulatory philosophy High volume Repetitive transactions Lower resource per case Customer service & consumerism Convenience & accessibility Coordination of related services Flexibility & modularity Shared support AHS Ambulatory Care

10. Ideal Patient Experience

11. Guiding Principles: Ambulatory Care Gold Standards • I can easily access and schedule my care and navigate through AHS. • My providers share one source of information about me and coordinate my plan of care. • I have choices in my health care and my decisions are respected. • I know what to expect and have information and assistance as I need it. • Everyone shares ownership for delivering my Gold Standard experience. • I feel comfortable and secure in a caring environment.

12. Core Operating Principles • Patients and their families can easily access Care and navigate through the Alberta Health System. • Providers share one source of patient information and coordinate plans of care. • Patients have choices in their healthcare and their decisions are respected. Note: Core Operating Principles have been adapted from Ambulatory Care – Gold Standard Patient Experience (Jan 2007) and based on feedback from the 6 Operational Planning Sub-groups.

13. Core Operating Principles • Patients know what to expect and have information and assistance as needed. • Everyone shares ownership of the Ideal Patient Care Experience. • Patients are comfortable and feel secure in the patient care environment. • A Team Care model will be the standard model for care within The Clinic.

14. Benefits of the Edmonton Clinic • Integrated Ambulatory Care experience for patients • Enhanced research opportunities • Implementation and support for an interprofessional model of care • Optimal use of clinic space

15. Overall Guardrails • A “centralized,” common scheduling platform & basic functionality of an electronic health record (EHR). • Limited number of providers will be assigned offices in EC based on clinical need. • General Clinic hours of operation will be 0800 -1800 Mon. – Fri. with exceptions as clinically appropriate. • Clinical exam rooms will be flexibly assigned, not “owned”. • Clinical programs will have “level” schedules.

16. Overall Guardrails • Programs will share common spaces (e.g., waiting, lounges, interdisciplinary rooms & conference rooms). • Standardized approach to assigning resources throughout the building to ensure minimum service standards are met (e.g., check-in, patient rooming, room turnover). • Team Care is coordinated appropriately for the needs of the patient. • Each clinical area will develop an education/learning and clinical research plan to ensure that adequate space is available to support these missions.

17. Planning and Design Principles

18. Patient Centered: • Implementation of pre-registration processes • Consistent check-in processes across clinics • Booking of follow up appointments • Building design features an on-stage, off-stage concept • Intuitive way finding principles

19. Student Centered: • Interdisciplinary rooms located on each floor, in close proximity to the clinical areas • Rooms equipped with Telehealth to support participative education and learning for both patients and staff

20. Research Focused: • Research space designed into the building to facilitate clinical trials and research • Education and Research Committee in place to review ways to enhance research activities in the Edmonton Clinic • Enhanced research opportunities with the EMR

21. Flexibility: • Exam and procedure rooms designed on a grid to enable flexible scheduling of rooms between providers • Standardized room size, layout and furnishings to accommodate changes in use of the space • Like clinics located adjacent to each other to promote sharing of space as well as developing linkages between programs

22. Information Technology • Wireless IT infrastructure • eClinician – Scheduling & electronic medical record (EMR) solution for clinics moving into the Edmonton Clinic • Interconnectivity to the University of Alberta for ease of access for clinicians

23. A to Z of Building Facts…

24. Areas and Locations of Ambulatory Clinics: • Outpatient Volume (2008) = 370,000 visits • Outpatient Volume = Accommodating 1 million patient visits

25. Access to EC Level 1: • Northwest corner  Fire Department & staff with card access • Northeast corner  LRT • Main entrance • Corridor 1X114 • Parkade • Southwest  Aberhart • Southeast corner

26. Access to EC (con’t) Level 2: • Northeast  pedway • Parkade

27. Access to EC (con’t) Level 0: • Northeast  Tunnel • West side  loading dock

28. Amenities: Staff • Washrooms • Lockers: • Staff side of building  northwest corner • Limited clinics/departments have lockers • Managers determined assignment • Staff provide lock • Staff Meeting rooms: • Include TV, fridges, microwaves & phone • No coffee pots or bottle water dispensers

29. Amenities: Public • Vending Machines & water fountains  public elevators • Public vs. patient washrooms: • Public in main corridors (north – south) • Patient within clinic space • Barrier Free • Non-Gender specific

30. Amenities: Public • ATM  level 1 & 2 near parkade • Phones: • 1 pay phone  level 1 near parkade • DATS & Taxi 1 each  level 1 near parkade • Public Resource Learning Centre (Level 1): • Like a library with computers and printer • For public & staff • Open Mon-Fri from 0800 to 1615h

31. Amenities: Public • Prayer and Meditation room: • Level 2 • Multi-denominational  • Food Market & Coffee Bar  RFP presently • Locker: • Limited clinics/departments • Padlock operated

32. Is This a Public or Patient Washroom?

33. What Room Do You Think This Is?

34. Leadership in Energy and Environmental DesignLEED EC is being constructed to achieve a silver certification Third-party certification program and an internationally accepted benchmark for the design, construction and operation of high performance green buildings. Why is this important to AHS?

35. Design Optimize energy performance Water efficient landscaping 30% Water use reduction Staff and Clients are encouraged to use other means of traveling to and from the Clinic

36. Construction Construction waste diverted from landfills Use of building materials from recycled material Over 20% of the materials in the building are extracted and manufactured regionally Over 50% of the wood products come from a sustainable source certified by the FSC Low emitting materials used

37. Other Features Ongoing measurement and verification to monitor utility usage Green housekeeping Green education

38. Paging.. • Quiet philosophy • No overhead paging • Fire Voice Activation System for Emergency Preparedness  code red

39. Emergency Power • Limited emergency power due to size of generator • Building code affected degree of emergency power • Generator can only have 80% of load • Life saving measures is NB: • Fire pumps, fire alarms, smoke evacuation fans • 2 elevators

40. Emergency Power: Specific Examples • Egress lightening in hallways •  power to offices, meeting/classrooms, •  power to exam rooms • Procedure rooms: • Procedure light no power • Lights either side of stretcher have power

41. Emergency Power: Specific Examples •  Medical gases •  Medical vacuum (suction) •  power medication fridges, Pyxis medstation, blood fridges • Biomedical waste cooler • Dentistry has unique power

42. Emergency Power: IT •  Laptop works if battery charged •  Wall clocks battery operated • UPS for ~ 5 – 15 min: • Wireless access & Network • Security Cameras • VOIP phones •  PC/Printers

43. Quick Facts? • You need to page a staff member to return to your clinic. How would you do that? • Where are the public elevators? • How can you tell difference from staff vs. patient washrooms? • Where is the staff side of the building?

44. Parking: • 8 levels with ~ 1200 stalls • 10 short term parking stalls at front of EC • Entrance and exit to 115 Street; no access to 83rd Ave • Vestibules/elevators: • Pay on foot stations • Wheel chair corals • Blue help phones near stairwells

45. Parking (con’t) • Level 0: • Loading dock & mail room • Level 1: • Parking Office • Access to EC • DATs, Taxis, & ambulances • Short term & courier • Reciprocal • Bike storage

46. Parking (con’t) • Level 2: • Access to EC • Barrier free parking

47. Parkade

48. Room Types • # of Clinical rooms: • Consult: 21 Exam: 181 • Procedure: 28 Other types: 251 • # of Non-clinical rooms: • Communication Centers • Interdisciplinary, meeting & conference • Offices (limited) • Staff meeting Total number of rooms is 1199

49. Security: What is the Philosophy? Goals: • Well defined perimeter security • Controlled access to public areas • Staff  call for assistance, panic alarms & CCTV Mid level threat: • Vehicle theft • B & E, Assaults • Workplace violence

50. Security: What is in place? • Landscaping  Intermittent in size & texture • Signage consistent, uniform & able to be seen from street • CCTV cameras: • Entries & exits • Elevator lobbies • Public waiting & reception areas • ATMs & vending machines • Access to Pharmacy • At risk hallways/areas • Some stairwells in the parkade