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Coralville clinic design intended to aid patients

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CORALVILLE, Iowa — Dr. Rami Boutros often notices when, as a patient, he walks through a clinic staff area on his way to an exam room and sees doctors and nurses busy working or discussing patients.

"As a patient I've walked many times next to people and I wonder 'what's going on,'?" he said. "There is a lot of commotion, often talk about patients or cases."

That's the kind of behind-the-scenes activity that will be, essentially, hidden from patient view at the University of Iowa's new Iowa River Landing clinic, opening Oct. 8 in Coralville, Boutros said.

The nearly $72 million clinic was designed to use the "onstage/offstage" concept of customer service, one of the main ideas learned by UI Hospitals and Clinics staff during training in recent years with the Disney Institute, the professional development arm of the Walt Disney Company.

The institute offers training on corporate culture change and customer service, and UI officials have said Disney is well-known in the industry for its excellent customer service.

When deciding to incorporate the onstage/offstage concept, UI Health Care officials also looked to other hospitals around the country that use the concept, and decided it offers benefits in patient privacy and boosting staff work flow, said Boutros, executive medical director of off-site ambulatory care programs for UI Hospitals and Clinics.

The onstage portion describes the areas where patients are — entrances, lobbies, waiting areas, elevators, hallways and exam rooms — while offstage describes areas where staff work and enter and exit the building or staff areas.

At the new Iowa River Landing clinic, the patient enters the exam room through a door that connects the room with the patient hallway. Doctors and nurses enter through a second door on the opposite side of the room, which connects it to the offstage work area that patients don't see or walk through, Boutros said last week during a day of employee tours at the new clinic. So patients are never ushered through a busy hallway or work area where there are supplies, files and computers, where doctors and nurses are working or perhaps talking about another patient, he said.

"So basically, as a patient, I don't need to worry about what you're doing and how many people are standing and working on the computer," he said. "I want to get into the room, get my exam and leave. All that other stuff we do, you don't probably care about as a patient."

The purpose is for the main focus to be on the patient during each interaction, in an effort to make the experience better, Boutros said.

The design should offer benefits to both patients and staff, said Cynthia Heaton, assistant nurse manager at Iowa River Landing, which will offer outpatient services in numerous primary care and specialty areas, including internal medicine, pediatrics, cardiology, dermatology and women's health.

"So for patients, they don't need to see us coming in for work with our lunch bags, they don't need to see us discussing what's going on with a patient. All they see is the beautiful entrance, they come into the exam room, see the physician and leave," she said. "They don't see the hubbub of what happens, all they get is the result of what happens."

Staff will feel like they can talk more freely about cases knowing patients are not coming and going through the work area, Heaton said, and that hopefully will enhance communication and the team approach to patient care.

Often in other facilities, clinic staff has been "shoehorned in to previous construction," said Dr. George Phillips, in the general pediatrics department. Iowa River Landing has a great layout of space that will help boost the energy and work, he said.

"Here it's really been thought-out about how to minimize the time between where is my computer, where's my dashboard where I can see where my patients are, where's my room, where's my nursing staff," Phillips said. "It all flows more, and I think will be a lot more efficient."

When UI Health Care leaders first established a relationship with the Disney Institute, a plan to send staff to Orlando for training in 2010 at an expected cost of $130,000 drew criticism from some legislators and public. The hospital instead brought Disney Institute trainers to Iowa City on several occasions, running about $15,000.

UI officials believe the training and the concepts have and will lead to better experiences and services for patients, Boutros said.

The onstage/offstage concept is used on a smaller scale at two other UI clinics, in Muscatine and Riverside, but the opening of Iowa River Landing marks the first large-scale launch in a facility specifically designed and built to use it, Boutros said.

They'll also use Iowa River Landing to fine-tune the concepts and look for ways to integrate more of the onstage/offstage at the main hospital campus and other clinic locations, he said.

"It's more about transforming into a culture of everyday excellence," he said.

Information from: The Gazette, http://www.gazetteonline.com/