By Donna Miles
American Forces Press Service
FORT BELVOIR, Va., July 8, 2013 – When the Fort Belvoir Community
Hospital opened its doors in August 2011, it represented a long list of
“firsts.” It was the nation’s newest, most technologically advanced
military treatment facility, the first one to receive gold-level LEED
“green” construction certification, and one of just two joint hospitals
in the Military Health System.
With
a heavy focus on preventive care, the new Fort Belvoir Community
Hospital in Northern Virginia pairs patients and their families with
teams of providers who make up their “medical home.” Here, Dr. Cathy
Tieu and Barbara Venable gauge the reactions from LeAnn Redlinger’s
patch test to diagnose skin allergies during a dermatology appointment,
July 27, 2012. DOD photo by Tina Staffieri
(Click photo for screen-resolution image);high-resolution image available. |
|
Less than two years later, the staff at the Defense Department’s
newest treatment facility is implementing another first: an ambitious
new strategy that its commander hopes will help redefine military
healthcare.
One of the most striking things about the gleaming
new hospital is that despite its 1.3-million-square foot footprint, it
has only 120 inpatient beds. Most of the facility is built around 440
examination rooms and 55 clinics that concentrate on outpatient care and
preventive medicine, Army Col. Chuck Callahan, the hospital commander,
told American Forces Press Service.
“The outpatient arena is
where healthcare takes place in 2013,” he said. “Good healthcare is
focused on prevention, which means you don’t need to get hospitalized.”
With that goal in mind, the hospital staff is working to keep patients
healthy and, when they need medical care, to make it the most positive
experience possible.
This is the foundation of the new strategy
Callahan began rolling out last year. Tapping the hospital staff and
patients directly, he incorporated almost 700 of their suggestions into a
plan designed to improve the care provided.
“This strategy we
have embraced really belongs to the staff and patients of the
organization, and we are now in the process of beginning to implement
them,” Callahan said.
Early indications are positive, he said.
Making appointments is easier than ever before. Parking is convenient.
The facility itself is inviting. And most important of all, Callahan
said, everything about the hospital operation is focused directly on
patients and their families.
People who have tried to see a
doctor when they are sick probably know the pitfalls of a reactionary
healthcare system. Getting squeezed in for a same-day appointment can be
difficult, at best. If a condition requires a visit with a specialist,
that draws treatment out even longer and often requires multiple
appointments.
“The notion of patient- and family-centered care
means we look at the way care is delivered from the perspective of the
patient, both individually and as a population,” Callahan said. It’s a
proactive approach that boils down to “‘What health care do you need and
how do we provide it to you?’ rather than the opposite, ‘Here is what
we have and sorry if it is not what you need,’” he said.
The centerpiece of this model is an ongoing relationship between patients and their providers.
Patients are assigned to a “medical home” -- a team of doctors, nurses
and specialists who oversee their care. “This is a group that puts their
arms around that group of patients and manages their health -- not just
treats their disease,” Callahan said.
As a result, patients know
who to call when they have health issues or questions. When they need
to make an appointment, they can feel confident that they’ll get one,
and be seen by providers who know their conditions and medical
histories.
Patients with complex medical issues also have ready
access to the “medical neighborhood” within the hospital, Callahan said.
No longer do they need to schedule multiple visits with a series of
specialists who may never communicate with each other. Instead,
providers from across the “neighborhood” coordinate through medical home
to provide interdisciplinary care.
“That’s all the providers,
plus the patient and family, in the same room, talking through the
treatment and management plan,” Callahan said. “It’s the model we are
evolving as a hospital.”
The facility itself incorporates what
Callahan called “evidence-based design” that supports healing. Design
decisions were made to be therapeutic, incorporating natural light,
outside views, healing gardens and pavilions inspired by nature: Eagle,
River, Sunrise, Oak and Meadow.
Sections of the hospital are
color-coded so visitors can quickly get their bearings. All in-patient
rooms have just one bed, and a pull-out sofa that family members can
sleep on. The design team tapped the Disney Corporation’s concepts of
“on-stage” versus “off-stage” operations, relegating non-medical
services to back hallways or non-prime hours.
While improving
access to care when patients are sick and making the hospital experience
as positive as possible are major goals of the new strategy, a
foundation of the medical home concept is taking care of patients when
they are healthy, Callahan said.
Instead of waiting for patients
to call, he said, providers reach out to initiate required tests and
procedures. They also rely heavily on social media and a secure
Internet-based messaging system to answer patients’ health-related
questions and provide healthcare information aimed at promoting health
and well-being.
“The focus is on managing the patients so they
get what they need and what they don’t even know that they need,”
Callahan said. “It’s not just a matter of ‘What are you here for today?’
The goal is to keep you out of the hospital and keep you healthy. That’s much better than waiting until you are sick.”
Making these investments up front changes the paradigm in delivering
healthcare, creating healthier beneficiaries and improving their quality
of life, Callahan said.
As the Defense Department struggles with
tough budget choices amidst skyrocketing medical costs, this proactive
approach makes financial sense, he added.
“Treatment of disease
is almost always more expensive than screening for and preventing
disease.
Almost always,” Callahan said. “So we are making the investment
up front. As we move toward health and well-being, we are not only
providing better healthcare to our beneficiaries. We are also going a
long way toward saving healthcare costs in the long run.”
Callahan said he expects the new strategy to be fully in place within
the next five years, but emphasized that he doesn’t anticipate a point
where the staff will ever fully declare “mission accomplished.”
“Performance improvement is a journey. It is not a destination,” he said
“Getting better as an organization is a journey, so we are going to
continue to evolve our strategy to adapt to healthcare changes and
better ways to provide for our patients.
“So there is never going to be a point of ‘arriving,’” he said. “In terms of healthcare, there will always be traveling.”
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