Designing a clinic for the future—now

When the COVID-19 pandemic kick-started the move to more hybrid medicine, people started to design special virtual care spaces. For example, a hospital in the Netherlands created gorgeous little sound-resistant booths with good lighting, soundproofing and calming colours.Yet for most clinicians, using the phone in an empty examination room or office is sufficient. The push for new design comes from other areas: a patient population that requires more accessible features and the recognition that medicine is a collaborative effort.Supporting collaborationIn Carleton Place, Ont., the members of the Ottawa Valley Family Health Team are currently spread out across the rural community, most practising in their own clinics. It’s cozy for the patients, but the physicians have to be landlords and business managers while practising medicine.Dr. James Fullerton, physician lead of the health team, and Peter Hamer, CEO of the health team, had a dream of bringing everyone together under one roof, and that dream is about to come true. The Carleton Place Regional Health Hub is almost finished, with a move-in expected for the end of 2024 and patients welcomed in early 2025.While the 15 or 16 physicians who are part of the health team will occupy the first floor of the new four-storey building, there’s space for other healthcare professionals too. The building’s developer, M+H Properties Group, is currently working with a number of potential tenants, including a diagnostic imaging clinic, blood services lab, a pharmacy and optical services, said Brad McDonald, managing partner of M+H Properties Group. He’s also looking for an ophthalmologist, dermatologist, first aid training provider and is in discussions with other health service providers such as podiatry, physiotherapy, dentistry and massage therapy. He said he’d love to have a tenant who could provide mental health services, like psychiatry or psychology. There could also be room for some not-for-profit health groups if there’s funding from the province.It’s all to promote interprofessional collaboration. While consults are moving faster because of various e-platforms, there’s still nothing better than being able to walk down a hallway to ask something in person, Dr. Fullerton said. He sees this in the hospital when talking with specialists. “You can get more in one minute of doing that than in a three-page consult sometimes.” Having that connection brings the humanity and the interpersonal back into healthcare, he added.The collaborative aspect is so important to a new clinic in Surrey, B.C., that they put it in the name: iCollab Healthcare. The clinic doesn’t even have walls separating the various providers, explained Dr. Sikander Panesar, a family physician and president of iCollab Healthcare. A medical clinic, pharmacy, physiotherapy clinic, dentist’s office and optometry shop are all under one roof, flowing from one another with a series of gently sloping ramps.Pods and bullpensThe new clinics don’t only enhance collaboration between healthcare professionals, but also between physicians. The Carleton Place hub is designed with the ethos of retain, replace and recruit, Dr. Fullerton said. The project was prompted in part by a number of local physicians retiring or leaving practice. “We realized that in order to replace ourselves we needed to be doing something different than what we’d been doing,” Dr. Fullerton said. “We have to change from this mom and pop shop approach to something different.”The design was physician-driven, with members of the health team providing advice. “They know quite a bit about running practices and maximizing space, and what they like and what they don’t like, so what we did was put together a sub-committee for the design,” Dr. Fullerton explained. The committee included a new physician, one in mid-career and one near the end of their practice, all of whom worked with the designer.The result is a series of “pods” with four physicians and the clinical assistants working with them. “They’re big enough to be collegial and supportive but also more efficient as well.” The whole family health team will also have administration and nursing staff.The pod system has a number of advantages. It will preserve the small practice feel, without the physician needing to carry out all the extra tasks they needed to do in their old clinics, like being the landlord, changing the lightbulbs, fixing the IT, while giving allergy shots. “The idea is that in the future, ideally, doctors should be doing the things that only doctors can do,” Dr. Fullerton said.It also means that physicians early in their career can be put into pods with more experienced physicians who can mentor them if needed. “The idea is that the pod concept provides that little bit of extra medical support,” Dr. Fullerton said. “To me it’s the perfect concept, that you’re working independently in the pod but you’ve got people with years of experience next to you.”The health team hopes to grow from 15 or 16 physicians to 20, and the pod system allows for that growth.Another feature is the “bullpen,” shared working spaces just for the physicians. “This is a version of the doctors’ lounge, something that has been desperately lacking for several years,” Dr. Fullerton explained. “Years ago, our local doctors had coffee every morning in the doctors’ lounge at our hospital. This has essentially disappeared but was incredibly useful for morale, clinical support, collegiality, etc. I can state from personal experience that if it wasn’t for this doctors’ coffee lounge and the support of my wiser colleagues, I would have left clinical medicine 25 years ago.“Sometimes the only folks that can truly understand the ups and downs of being a doctor are other doctors.”The pods are standardized, but some physicians may choose to personalize them. The examination rooms promote good workflow and space. For example, the sinks are small so they don’t take up much space and the doors hinge to protect patient privacy if they’re changing. “It’s that type of thought that went into it,” Dr. Fullerton said.The iCollab examination rooms were also designed by physicians. There’s flexibility built in depending on if a physician wants to use a desktop or laptop computer. The team uses a cloud-based EMR so physicians have the choice. The examination rooms feature a special pull-out desk that will fit a laptop.Friendly vibeThe examination room designs at iCollab are pleasing to the eye. The four full-time physicians and two to three part-time or locum physicians often practice in hybrid care, but good design is important no matter how you’re in contact with the patient. “When you’re doing virtual care, you also need the environment to be inviting, whether it’s a simple phone call or a web call,” Dr. Panesar said, noting that most of iCollab’s physicians tend to prefer phone calls so they can also enter items into the EMR while talking to the patients.When designing iCollab, Dr. Panesar and partners noticed a lot of other clinics weren’t up to modern design standards and they wanted to create “a friendly vibe you’d get entering a nice restaurant or a grocery store. We wanted to make sure it was an inviting space,” Dr. Panesar said.The result is bright, airy colours, high ceilings, and lots of curves to create a calm, welcoming space. Dr. Panesar said they wanted patients to feel healthier the minute they stepped into the clinic.It’s also fully accessible, something that’s not always present in older clinics. “So many of the 40-year-old clinics have accessibility issues,” Dr. Fullerton noted. Some physicians in Carleton Place currently have to see their patients who use wheelchairs in the hospital because their clinics aren’t fully accessible. The new Carleton Place hub will also have better ventilation thanks to lessons learned from COVID-19.Meeting multiple primary healthcare needs in one space is great for the patient, providing a kind of one-stop convenience. This full integration “hopefully results in all ages taking care of their health, from their teeth, eyes, their bodies, their minds, etc.,” Dr. Panesar said. Families with young children will especially benefit from having everything together and having ramps makes it easy to manoeuvre strollers.“You have to remember, whenever you’re opening up a healthcare facility, you’re opening it up for the community,” Dr. Panesar said.The future clinic is a place where physicians, allied healthcare professionals and patients can come together in a welcoming, collegial space. It’s a place where doctors want to practice, and want to continue to practice.Enacting change is often difficult, but if you leverage the skills and energy of people in your community, “there are things that can be done in serving your own backyard,” Dr. Fullerton said. “There is room for improvement and there’s room for positivity if doctors are combining their resources.“This can be done, even within the landscape we have now.”

Designing a clinic for the future—now

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