Neighborhood Outpatient Center

Providence Regional Medical Center Everett (PRMCE) serves a primary service area (PSA) of over 500,000 patients in north suburban Seattle. PRMCE is a member of Providence Health & Services—one of the largest not-for-profit health networks in the Western United States. Between 2005 to 2011, PRMCE implemented a $500 million campus expansion and renovation project, including a new 12-story bed tower. To strengthen its presence in the PSA and ensure support for its new and improved campus facilities, PRMCE wanted to develop a network of off-campus outpatient facilities to offer patients coordinated, comprehensive, convenient services. After running a national competitive process, PRMCE selected NexCore Group to plan and implement the ambulatory network.

The 43,000 SF Providence Medical Building Monroe was the first facility developed for the ambulatory network. A mere 8 months after the facility opened (October 2013), Providence Medical Group experienced a 34% increase in the average number of new visits per month and a 70% increase in the average number of walk-in clinic visits per month. 

Ambulatory Network Planning

NexCore studied the primary service area (PSA) and collaborated with PRMCE to plan the ambulatory network. NexCore’s process employed a retail distribution methodology that divided the PSA into convenience-based retail trade areas and identified the optimal site vicinity in each submarket. Taking into consideration demographic analysis, physician supply/demand factors, and the competitive environment, NexCore with PRMCE created an ambulatory network plan that detailed the development of facilities in each submarket, estimated the costs and schedule for development, and prioritized the submarkets and projects for implementation. 

The city of Monroe, a strategic submarket of Eastern Snohomish County that lies approximately 30 miles northeast of Seattle, was prioritized due to competitive factors and because PRMCE had a 30-year presence in the submarket that urgently needed improvement and expansion. 

Site Acquisition & Business Planning

NexCore defined and studied the Monroe PSA, selected and acquired the optimal site, and worked with  PRMCE to complete a business plan that included determination of physician complement and outpatient services mix, estimation of service line volumes, development of space program, and estimation of project costs and cost of occupancy assumptions.

NexCore also performed development tasks including site planning, entitlement, selection and supervision of architect and contractor, and project management. In addition, NexCore helped the local Providence team obtain system approval for the project, which included participation in the project budget, operational pro formas, and a narrative description of the project rationale.

A Model for the Future

PRMCE wanted the Monroe facility to stand as a model for the future, promoting Providence’s core strategy of creating healthier communities. Strategic objectives included:

• Provide a stronger presence in a desirable submarket to offset a competitor’s strategy of affiliating with a local, 68-bed hospital in Monroe.
• Replace an existing primary care clinic with a new facility designed around a delivery system for managing population health using lean design and innovative technologies.
• Maximize caregiver and patient efficiency. 
• Bring the project to market quickly.
• Create a Providence Health & Services prototype for utilization throughout the system.  

Comprehensive Programming

The original building program called for 50,000 SF; however, NexCore was able to work closely with Providence and the architect during the program validation phase to reduce the building size to 43,000 SF, while maintaining all services and reducing the hospital’s cost of occupancy. 

The facility provides coordinated, comprehensive services under one roof, with space for more than 30 medical providers in the areas of primary care, cardiology, ENT, gastroenterology, general surgery, midwifery, neurology, neurosurgery, OB/GYN, orthopedics, pain management, physical medicine and rehab, sleep health, and urology. The facility program includes:

• Urgent care center
• Full-service imaging center
• Non-invasive diagnostics
• Laboratory
• Retail pharmacy
• Coffee bistro
• Education and conference center

Coordinated, Seamless Delivery of Care

The NexCore team utilized lean concepts to design an efficient and effective clinic that supports a positive patient and caregiver experience and creates greater operational efficiency. All care delivery is focused on patient comfort, convenience, and use of cutting-edge technology, including:

• Centralized check-in
• Self-rooming — Patients can go straight to their exam room, rather than sitting in wait areas.
• Patient portal — Allows patients to communicate with their physician, request prescription refills, schedule appointments online, and view their electronic health record.
• Consolidated electronic health records — Includes medical history, test results, medication lists, immunization records, physician instructions, and health education information.
• Versus patient flow system — Provides the ability to locate patients, staff, and equipment in real-time and to optimize patient flow and clinical operations while improving patient and staff satisfaction.

Immediate Impact

By creating an integrated team early in the process, NexCore was able to identify and resolve all operational, design, and construction decisions in real time, avoiding delays. NexCore broke ground on November 5, 2012, and physicians saw their first patients on October 7, 2013—eleven months from construction start to finish. A typical medical building of this size takes 14 to 16 months to complete.

The facility construction was also $1 million dollars under budget. Even with advanced imaging in the facility, the cost per square foot was $209 compared to $250 for a similarly-sized facility. 

In the first 8 months after opening, Providence experienced the following improvements in clinic operations:

• 70% increase in the average number of walk-in clinic visits per month (1,135 to 1,932)
• 34% increase in the average number of new visits per month (241 to 349)
• 22% increase in the average number of total visits per month (5,594 to 6,823) 
• 16% increase in the average number of patients per provider per month (375 to 435) 

In addition, the centralized check-in design allows 7 patient services representatives to check in an average of 400 patients per day for multiple departments. The median time interval between patient check-in and checkout for an office visit has been greatly reduced:

• 49% reduction: Pediatric medicine 
• 36% reduction: Family medicine 
• 34% reduction: Internal medicine 
• 7% reduction: Walk-in clinic:

This facility won the 2014 Providence President’s Award for Strategic Innovation, a system-wide recognition of excellence.