The Neenan Co. breaks ground on two medical projects

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November 18-December 1, 2015
Colorado Real Estate Journal

The Neenan Co. breaks ground on two medical projects

Design-build firm The Neenan Co. recently broke ground on two new medical projects, including the Melissa Memorial Hospital in Holyoke.

The Neenan Co. is the design-build partner on Melissa Memorial Hospital’s renovation and expansion project, which will include a specialty clinic and family practice addition, an on-site residence, an enclosed ambulance drop-off area and ambulance storage, another laboratory entrance and new office space, as well as improvements for helistop, parking and drives for the critical access hospital. The groundbreaking ceremony took place Oct. 12, with an anticipated completion in the summer of 2016.

The Neenan Co. also began work on the Sakakawea Medical Center in Hazen, North Dakota. The facility will replace the existing medical center and will serve as both a critical access hospital and a primary care medical home to meet the health care needs of the rural community and to promote the long -term well-being of the region through wellness and prevention programs and services offered beyond the hospital walls, according to The Neenan Company.

Neenan Co. wins Urban Design Award from Fort Collins

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November 18-December 1, 2015
Colorado Real Estate Journal

Neenan Co. wins Urban Design Award from Fort Collins

The Neenan Co. recently was awarded the 2015 Urban Design Award for Sustainable Design by the city of Fort Collins for its work on Colorado State University’s Powerhouse Energy Campus.

The Neenan Co. was honored with this biennial award that recognizes projects that improve the quality of life in Fort Collins. The firm oversaw the design and construction of the project. The Powerhouse Energy Campus is CSU’s expanded research facility, which includes the remodeled Engines and Energy Conversion Lab and a 65,000-square-foot addition that houses new office and research space. The project achieved LEED Platinum status, a goal that guided all of The Neenan Co.’s design and construction decisions throughout the process. The Neenan Co. also utilized a holistic approach and comprehensive modeling to achieve the building’s performance standards, the firm added.

‘Powerhouse co-directors Dr. Willson and Dr. Morgan DeFoort took a bold step and presented us with a valuable opportunity for new development and leadership in the realm of building systems and building behavior.’    – Bob Hosanna, The Neenan Co.

The LEED design features of the project include the building’s rooftop, which incorporates solar panels and wind turbines to create energy and boost the building’s long-term sustainability, a 26-mile tubing network circulating chilled water throughout the building’s structural system and into the caisson foundation rather than a traditional air conditioning system, an exterior of pre-finished interlocking metal panels to prevent air leakage from the interior, fiberglass window frames and glass panes for a higher efficiency rating, and customized low-voltage LED lights that attach to the ceiling with magnets and whose heat is absorbed by the floor slabs and redistributed throughout the building. The system design significantly decreased project costs and the campus achieves about 50 to 55 percent energy savings.

“Powerhouse co-directors Dr. Willson and Dr. Morgan DeFoort took a bold step and presented us with a valuable opportunity for new development and leadership in the realm of building systems and building behavior,” said Bob Hosanna, architect for The Neenan Co.

Optimizing the Patient Experience is a Win-Win Strategy

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Optimizing the Patient Experience is a Win-Win Strategy


Achieving operational targets by focusing on a new driver:
The transformation of the patient experience into a customer experience

This three-story, 106,862-square-foot outpatient facility houses a multispecialty clinic practice, an ambulatory surgery center and other outpatient services.
Picture 262
The new customer/patient experience begins at the pre-visit digital dialogue and continues through arrival, navigation and discharge pathways, supported by modified data- and metrics-driven protocols.


The shift toward the transformational customer experience introduces new variables related specifically to the patient experience, which need to be optimized in addition to traditional operational variables such as staff utilization, resource utilization, durations and revenue.

The public spaces at Coquille Valley Hospital are derived from those in modern hotels. Open and daylighted spaces are easy to navigate and anchored on the new café, a community gathering place.
The public spaces at Coquille Valley Hospital are derived from those in modern hotels. Open and daylighted spaces are easy to navigate and anchored on the new café, a community gathering place.

Innovative healthcare organizations believe that, indeed, it is possible to achieve, meet and exceed operational targets by focusing on this new driver: the transformation of the patient experience into a customer experience. On the other hand, the transformational customer experience has been the foundation of success for every other industry from consumer electronics to telecommunications to hospitality. Likewise, when a healthcare organization initiates operational optimization via a focus on the goals of the transformational customer experience, it is a win-win strategy.

A patient/customer-centric approach to care is also incentivized by the availability and great speed of communications and social media, which enable consumer comparisons. For example, the PriceWaterhouseCooper Health Research Institute surveyed 1,000 consumers in late 2012 to assess the state of healthcare ratings ( Nearly half (48 percent) of consumers said they have read health-related reviews, including patients’ reviews in social media, and one-third have used reviews to make decisions on where to get care.

Optimizing the Patient/Customer Experience:
In order to meet these new expectations and achieve the transformational customer experience, healthcare organizations need to consider several domains of care:

  • Access — including appointment scheduling, navigation/wayfinding, access to and portability of medical records
  • Quality and safety — including security, infection control, outcome metrics and comparisons against national standards
  • Experience — including speed, integration and consistency of service, comfort, privacy and loyalty

Optimization of access. Pre-visit protocols, information data harvesting and processing, wayfinding and navigation require modification of spatial and operational variables. The electronic health record data can be used to guide significant improvements in patient/customer registration, admission and processing. Similarly, new communication technologies enable distinct navigation and wayfinding solutions, such as information kiosks, interactive electronic signage systems and personal digital assistant devices. Indeed, the new customer/patient experience commences at the pre-visit “digital dialogue” with the call center often referred to as the customer portal and continues through arrival, encounter protocols and discharge pathways supported by significantly modified data- and metrics-driven protocols.

The call center is a powerful tool that leverages the immense and broad capacity of the new digital information data banks. Through this interactive port and communication pathway, customer/patients and the organization exchange information regarding demographics, health conditions, insurance, appointment needs and outcomes. The center also links care management protocols, quality and utilization metrics and navigation resources.

For example, Mercy Clinic in Rolla, Missouri, built a three-story, 106,862-square-foot outpatient facility housing a multispecialty clinic practice, an ambulatory surgery center and other outpatient services. Staffed at 0.5 FTE per care giver, the new customer center at the St. John’s Clinic is the epicenter of health information management, while also improving resource utilization (leveling) and vastly improving service quality. Located in a 1,800-square-foot suite within the building, supported by approximately 22 staff representing nursing, medical assistants, scheduling, billing and care coordinators, the customer center has become the main contact point for all patients. Appointments, billing inquiries and care coordination affairs are effectively managed. Additionally, the customer center assists in distributing services and is a resource-leveling tool.

Over time, many hospital campuses have evolved into mazes that are difficult to navigate. Technology is assisting with physical access and wayfinding within these campuses. Navigation apps, touch-screen kiosks, sounds, lights and color are used to guide and lead users to the many destinations within the medical center.

For example, the Carle Foundation Hospital is a 345-bed regional care hospital and Level 1 Trauma Center spanning over several city blocks in Urbana, Illinois, with a need to transform patient navigation/wayfinding. After several months of study and design, supported by Lean concepts and digital modeling, a multi-tier solution has been developed by The Neenan Company and will be installed this summer. The solution defines entry gates and creates circulation nodes, which, when linked by color- and graphic-coded pathways, becomes the new multi-technology wayfinding system. Traditional signs are the familiar tool; however, color, shapes, textures and sound add significant additional reinforcement. Electronic, interactive and video displays are introduced to further support the customer with PDA devices including apps and web pages.

Optimizing quality and safety. Quality and patient safety have always been essential elements of the healthcare industry. Traditional quality measurement was symbolic and only geared toward accreditation and regulatory compliance. The healthcare law introduces specific targets that are associated with payment formulas, which must be met by health plans and healthcare organizations. These variables are reported with transparency, allowing users to clearly evaluate care decisions. Several publicly accessible grading and comparison tools, such as Healthgrades, are easily available through the Internet.

Barton Health serves community members and visitors to the Lake Tahoe and Carson Valley, areas. The Tahoe Center for Orthopedics is a nationally recognized, comprehensive program for orthopedic excellence focusing on quality and patient-centered, personalized care, including prevention and wellness, non-invasive treatments and surgery and rehabilitation, to enable patients to return to a fully mobile lifestyle. Existing services have been housed in the hospital and an orthopedic clinic several blocks away, forcing patients to travel among departments and buildings to access the full range of services.

To support and expand the mission of this program, Barton Health has commenced the development of a new Wellness Center of Excellence. The design of a new 27,000-square-foot facility adjacent to the hospital significantly consolidates and integrates related services to optimize access and delivery, without duplicating costly hospital-based services and equipment, such as MRI. A formerly separate wellness and fitness training center also will be incorporated into the same center.  Leveraging high-altitude training will also offer the market a carefully defined athletic program and service line. A covered parking garage is attached to the center.

Optimizing the experience. Today’s healthcare organizations can achieve speed and consistency of service without compromising the patient/customer experience, including privacy, comfort and convenience. To this end, the facility solutions and the intent of healthcare organizations match those of the hospitality industry. As a result, the sterile, imposing and institutional appearance is being replaced by hotel-like lobbies where comfort is paramount. Daylight and environmental sustainability are also demanded by communities, and healthcare organizations have accepted the challenge to deliver facilities with greatly improved performance.

Coquille Valley Hospital, a critical access hospital in Coquille, Oregon, exemplifies the new commitment to addressing customer needs with a transformational experience for the patient/customer, family and community. The replacement hospital introduced private, single-occupancy patient rooms supported by interventional programs and public spaces derived from those in modern hotels. Open and daylighted spaces are easy to navigate and are anchored on the new “café,” which has become the community’s gathering place. Further, the transformational experience ensures compliance with HIPAA and accessibility while optimizing flow. A patient-centric design supported by Lean concepts and digital modeling brings services to the patient instead of the reverse. It is about service, convenience and deliberate effort to deliver value for the customer.

Healthcare innovators have shifted from the traditional organization-centric approach toward a patient/customer-centric approach to care. They are using metrics, Lean concepts and digital modeling at all phases of this process to measure their outcomes and foster continuous improvement. Leveraging a growing body of metrics and benchmarks to optimize patient stay durations reduces wasted resources and inventory. Indeed, it is a win-win strategy.

Photos courtesy of  LaCasse Photography.

Author: Miguel Burbano de Lara
For over 35 years, Miguel Burbano de Lara, AIA, NCARB, has followed a passion for healthcare design. He has worked at The Neenan Company since 1999, where he focuses on Lean theory, design innovation and accelerated delivery.

The Neenan Company, Sakakawea Medical Center Break Ground on New Medical Facility

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The Neenan Company, Sakakawea Medical Center Break Ground on New Medical Facility

HAZEN, N.D. — The Neenan Company, in partnership with Sakakawea Medical Center, has broken ground on a new medical center in Hazen, North Dakota. 

The new facility will replace the existing medical center and will enable the Sakakawea Medical Center to serve as both a critical access hospital and a primary care medical home to meet the emergency needs of the rural community and to promote the long-term well-being of the region through wellness and prevention programs and services offered beyond the hospital walls.

The Neenan Company is the design-build partner for the Sakakawea Medical Center project, which will feature a modular design allowing for maximum flexibility for patient care, as well as a care team space that will facilitate high-performing teams comprised of physicians, clinicians and administrators to guide care delivery programs and patient engagement strategies.

The groundbreaking ceremony took place on Oct. 14, with an anticipated completion in December 2016.

Hospital to break ground next Monday

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The Holyoke Enterprise
Written by Holyoke Enterprise

Hospital to break ground next Monday

Melissa Memorial Hospital plans to have a ceremony to commence the master facility building project Monday, Oct. 12, at 1 p.m. on the west side of the building near Holyoke Family Practice.

A brief groundbreaking ceremony outside followed by light snacks and beverages in the group room will celebrate the culmination and hard work of East Phillips County Hospital District board members, former CEO John Ayoub, the Neenan Company, interim CEO Jim Murphy, interim CFO Jason McCormick, and many other countless staff and community members that supported the expansion.

The new expansion is a way to meet the present and future needs of patients and the community as MMH continually strives to provide excellent care. The project is to be the final stage of Melissa Memorial’s master facility plan.

Exciting details of the new project will include a specialty clinic and family practice expansion, a new on-site residence, an enclosed ambulance drop-off area, an on-site ambulance storage shed, a new lab entrance, new space for offices, and improved areas for helistop, parking and drives.

Speciality clinic and family practice expansion
Since moving into the new building in 2008, the speciality clinic has experienced a 50 percent increase in visits. A brand-new addition to the west side of the building will better utilize the growing facility.

This will allow for increased patient visits, visiting specialists in the speciality clinic and increased numbers of providers with a team-based care approach in family practice.

New on-site residence
An on-site residence will allow for maximized possibilities of a potential rural residency program. It will provide safe, secure, comfortable and convenient housing for traveling specialty providers and their families.

It will be more efficient in utilizing the hospital’s utilities and housekeeping services as MMH consolidates its properties to a campus-like setting.

Enclosed ambulance drop-off area
An enclosed ambulance drop-off area will improve patient comfort and safety despite Mother Nature’s harsh elements. It will also provide additional areas for improved decontamination resources and documentation areas for staff, along with storage for supplies and training equipment.

On-site ambulance storage shed
A new on-site ambulance storage shed will provide faster daytime access for emergency responses, along with easier access for maintenance and additional storage.

New lab entrance and new space for offices
A new additional entrance to the laboratory will be more convenient for patients. Some existing space will also be repurposed for offices and patient/family consultation.

Improved helistop, parking and drives
New helistop, parking and drives will increase accessibility to the hospital and provide convenient parking.

The project is estimated to cost $4.9 million. First Pioneer National Bank will finance $2 million, and the rest will be paid from savings.

The Neenan Company is the architectural design company that has been working on the design plans. The company specializes in hospital design and meeting crucial building codes for the health care industry.

Parking and patient services will not be interrupted during this time. The building project is anticipated to be complete by June or July of 2016.

For more information, visit

Neenan in development mode with multitenant project

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October 7-October 20,2015 – Colorado Real Estate Journal – Page 13
Larimer & Weld Counties

Neenan in development mode with multitenant project

by Jill Jamieson-Nichols


The Neenan Co. is back in development mode with redevelopment of the former Value Plastics building in Fort Collins.

The project at 3325 S. Timberline Road is the first since the company completed the OnCore Manufacturing Services building in Longmont in 2011. Neenan specializes in industrial, medical and office build-to-suits for clients.

The Neenan Co. designed the Value Plastics building in 1995 and recently purchased it for $3.66 million for conversion from industrial to multitenant office space. Completetion is anticipated in January.

The building contains 29,000 sf of the first floor and 10,500 sf on the second floor.

“We’re excited to expand the firm’s focus and return to our offering of real estate development services,” said David Shigekane, The Neenan Co. president. “With the market conditions continuing to improve,  this is the ideal time to engage with clients on high-caliber development projects.”

The Neenan Co. began providing development services in 1981 and has owned or co-owned more than 40 properties. Its projects include the Redstone Professional Office Building on Poudre Valley Health System’s Harmony Campus, Melco Industries in Westminster and Avista Medical Plaza in Louisville, including the Avista I and II medical office buildings.

Rural rivals create award-winning partnership

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Rural Roads Online | bridges | Fall 2015

Rural rivals create award-winning partnership

How cooperation cured health centers

By Lauren Donovan

Sakakawea Medical Center board president Christie Obenauer and chief administrator Darrold Bertsch say the cure for what ailed local health institutions was cooperation. They and Coal Country Community Health Center share NRHA’s Outstanding Rural Health Organization honor.

Two of rural North Dakota’s rival health centers have teamed up to learn they feel better together than apart.

Neither the Sakakawea Medical Center in Hazen nor the Coal Country Community Health Center in Beulah was terminally ill, but competition instead of cooperation was weakening their bottom lines.

The diagnosis was obvious enough, but it was the cure that took some doing.

Starting four years ago, the two flagship medical entities began discussing the novel idea of talking to each other.

A fresh, healthy mindset blew in, and in April the two entities received a coveted award from the National Rural Health Association.

NRHA’s Outstanding Rural Health Organization award recognized the two as one, though technically each is still operated separately.

It’s where they’ve come together that’s been financially healing and given them the distinction of being the only hospital-clinic combination in the country to do so.


“If what we do is to benefit the community we can’t go wrong.”

—Christie Obenauer, Sakakawea Medical Center board president


Darrold Bertsch, who started as chief administrator of the Hazen hospital, now splits his time doing the same for the Beulah clinic.

The clinic operates under Health Resources and Services Administration (HRSA) funding guidelines that are tilted toward low-income and underserved populations and require that the top administrator be a clinic employee.

Christie Obenauer, hospital board president, says it took some doing to persuade HRSA to go along with sharing the administrator of a critical access hospital, but, after seeing and believing, the agency recently signed an agreement formalizing the arrangement.

“Nobody else is doing this right now. Now, they’re seeing that this could be a model,” Obenauer adds.

Besides sharing an administrator, the boards of each entity have two mutual members. Talk at the board tables helps avoid expensive redundancies, such as $500,000 CT scanners each one had at one time, and find ways to be more efficient.


“There had been a huge left-hand-didn’t-know-what-the-right-hand-was-doing effect.”

—Aaron Garman, Coal Country Community Health Center medical director

Coal County Community Health
Care medical director
Aaron Garmon.
Beulah clinic board
president DJ Erickson


“Health care is constantly shape-shifting, and now it’s all about prevention. It’s cool to be able to do that. No one is on an island. As a community member is diagnosed with something, there’s the involvement of more people,” Obenauer says.

DJ Erickson, Beulah clinic board president, says the arrangement is not only good for the communities, but it’s a relief to step back from the infighting that had characterized relations for so long.

He adds that Bertsch is getting the job done for both entities, and morale has improved.

“Each has a core team of managers, and they’re doing the work now that they should have been doing,” Erickson says.

Aaron Garman, the clinic’s medical director, says the arrangement prevents competition that can be unhealthy, especially when the communities are relatively small.

“There had been a huge left-hand-didn’t-know-what-the-right-hand- was-doing effect,” Garman says.

Today, the hospital and clinic boards are striving for the benefit of both, sharing resources and training and even bouncing health care  providers back and forth as needed, he says.

Bertsch says the result is the hospital and clinic have a much improved cash-on-hand status and have collectively gone from 2.2 percent in the red to 11 percent as a net margin of profitability.

Garman and Obenauer agree wellness for a community is easier now that the gloves are off and hands are clasped.

“If what we do is to benefit the community—if we do that—we can’t go wrong,” Obenauer says.

Watch and learn

View the health centers’ Outstanding Rural Health Organization award acceptance video and many more at

And discover other effective rural partnerships and strategies for financial and clinical success at the National Rural Health Association’s Rural Health Clinic (Sept. 29-30-Oct 2) Conferences in Kansas City.

Visit for the full agendas and to register.


This article originally appeared in The Bismarck Tribune on April 19, 2015

Transforming health care from the inside out

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Health Facilities Management

Transforming health care from the inside out

by Miguel Burbano de Lara, AIA, NCARB

Three strategies that incorporate facility design to help deliver better care at lower cost

Photo courtesy of the Neenan Co.
HealthProMed’s new 44,200-sq. ft. clinic addresses critical service gaps in an underserved neighborhood, where patients traditionally obtained care in the hospital emergency department by providing access to expanded care services.

In the United States, the health care system has evolved based on insurers’ reimbursement protocols. In the past, insurers’ reimbursements typically followed a simple formula: the higher the acuity level of the health care setting, the higher the reimbursement. As a result, episodic illness — in many cases, the result of chronic conditions like high blood pressure, heart disease and diabetes — often was treated in the inpatient setting. Over time, this health care delivery model turned hospitals into “profit centers.”

Over the past few years, this delivery model has changed dramatically as acute care costs increased and associated insurance reimbursements decreased. Health care organizations have responded by analyzing specific market needs and adjusting their supply channels to meet patients’ needs at the most appropriate care setting — a hospital, clinic, primary care physician’s office or one or more specialist offices. And they are increasing their focus on prevention, community health and wellness to reduce the incidence of disease.

Truly innovative health care organizations are taking a step further, employing information technology and facility design to support new models of patient care. Their goal is to transform health care services delivery – ensuring better access to care, increased quality and safety, and better outcomes for their patients; essentially, improved operational efficiency and reduced cost for their organizations. And many are succeeding.

Here is a closer look at three key strategies used by health care innovators to achieve this transformational goal: shifting care from inpatient to outpatient environments; patient-centric, wellness solutions; and the application of hospitality and Lean enterprise concepts and digital modeling to redefine health care operations and redesign facilities.

Shifting care from the hospital and emergency department to outpatient environments

Hospitals are anchored in tradition and process. Health care organizations must make strategic and operational changes to enable the shift to non-acute patient care, when medically appropriate, from the hospital to outpatient environments. They must analyze the unique needs of each of their markets and deploy their resources accordingly.

Payment, technology and patient-access forces have powered this change. In particular, the high costs of emergency department (ED) visits for routine care and in-hospital surgery admissions for noncomplex procedures are the impetus for the rise of urgent care centers and the accelerated growth of outpatient surgery centers. In both instances, payment structures are motivators; additionally, innovation in technology, care protocols and facility design enable the shift. Changes in physician referral strategies and patients’ improved service access have contributed to making the shift possible.

For example, HealthProMed built a new outpatient urgent care clinic in San Juan, Puerto Rico, with the specific goal of addressing critical service gaps in an underserved neighborhood, where patients traditionally obtained care in the hospital ED. A review of the data indicated that a vast majority of the hospital’s ED visits could have been treated in an outpatient setting, underscoring the waste of professional resources and the exorbitant cost of delivering primary and urgent care in an acute care setting.

Patients also have access to expanded care services at the new 44,200-sq. ft. clinic, including primary care, diagnostics, lab, dental and mental health services. Wellness and health education programs were also introduced to help patients prevent illness and manage common chronic conditions like high blood pressure, heart disease and diabetes.

HealthProMed’s performance data are evidence of the benefits:

  • The number of patient visits has increased from approximately 50,000 to 75,000.
  • The number of patients served has increased from 14,000 to 16,000.
  • The number of providers has increased from 10 to 15.
  • The number of staff supporting wellness and education programs has increased from 15 to 25.

Patient-centric solutions: the patient-centered medical home and wellness model

Health care organizations are shifting from provider-centric to patient-centric models of care. The patient-centered medical home is a way of organizing primary care that emphasizes effective communication among patients and caregivers and coordination of all facets of a patient’s care. Medical homes have the potential to provide higher-quality care at lower costs, and to improve the experience of care for both patients and providers.

Photo courtesy of the Neenan Co.
Sutter Gould Medical Foundation’s Turlock Care Center operates on the principles of a patient-centered medical home. The care center offers urgent care, family medicine, internal medicine, pediatrics, specialty care, radiology and laboratory services.

A patient-centric medical facility locates patient registration and discharge at the point of care and not at the front desk. Similarly, it brings services like phlebotomy, ultrasound and portable diagnostic imaging to the patient instead of sending the patient out for these services.

This model requires a reorganization of the traditional roles and responsibilities into a collaborative care team, which integrates health care providers and support staff under new protocols, responsibilities and tasks. The care team model reduces the number of staff positions, including appointment scheduling, reception and discharge, increasing efficiency and reducing costs. More importantly, it enables comprehensive coordination of the patient’s care along the entire continuum of care — over time, among various places of service, and among various providers — and introduces new health education, wellness and counseling programs.

Effective use of electronic health records (EHRs), other digital technologies and performance metrics support this operational shift. These new tools are transforming health care delivery from patient access and diagnostic testing to generation of billing and performance metrics.

A patient call center or service portal (accessed by telephone, often via a toll-free number, or via the Web) is essential for this new operational model, serving to integrate appointments, medical records, triage, performance metrics and communication processes. Access to digital information enhances productivity and transparency. The new electronic data bank is HIPAA-compliant and satisfies portability needs.

These tools and processes also create vastly different patient and staff flows, which require innovative space solutions.

For example, the Sutter Gould Medical Foundation’s Turlock (Calif.) Care Center, which opened in August 2014, operates on the principles of a patient-centered medical home. The care center offers urgent care, family medicine, internal medicine, pediatrics, specialty care, radiology and laboratory services.

The Turlock Care Center optimizes the use of EHR technology, Lean workflow processes and architectural solutions that sustain care team operations, including the concentrated point-of-care approach. Digital tools continue to be introduced to improve diagnostic and treatment protocols.

The Turlock Care Center is supported by a central patient navigation and information center, which is staffed at 0.5 per provider. Compared with the traditional distributed appointment system and patient triage/information center, the patient call center is a far more efficient way to manage patient flow and pre-visit and post-visit data.

Applying hospitality and Lean enterprise concepts and digital modeling to redefine health care

Sutter Gould Medical Foundation is projecting improvements in the application of hospitality and Lean enterprise concepts and digital modeling to redefine health care operations and redesign facilities.

As part of the transformation of health care into a patient-centered, efficient process, innovative health care organizations have adopted best practices from the hospitality industry and Lean enterprises.

Photo courtesy of the Neenan Co.
The Turlock Care Center optimizes the use of electronic health record technology, Lean workflow processes, and architectural solutions that sustain care team operations.

The hospitality industry is a worldwide leader in customer focus and guest satisfaction. It has created customer-centered services, as well as expanded guest services menus, such as cafeteria, fitness, office center and concierge. The industry also has introduced architectural and interior design innovations to improve the guest experience, including universal access (for able-bodied and disabled guests), better wayfinding, greater privacy and comfort, broadband digital connections and environmental sustainability.

Innovative health care organizations are adopting many of these hospitality concepts to increase market share and improve patient satisfaction.

The Lean enterprise movement, which originated in the automobile manufacturing industry, has swept across all industries, and has applied the concepts to eliminate all forms of waste and achieve continuous improvement in performance. As a result, they have increased efficiency, profitability and customer satisfaction.

Innovative health care systems are applying Lean concepts through digital modeling technology to redefine operations and redesign facilities. Digital modeling enables 3-D visualization of facility design and operational variables, such as patient flow and physician/staff workflow, and quantify (4-D and 5-D) the effects of design and operational alternatives on their objectives. These organizations are finding many opportunities to use modeling and the associated performance data harvested from models.  These include: anticipating the impact of moving from paper to digital work environments; testing and improving building performance and sustainability (e.g., energy efficiency); assessing staffing needs and redefining skill sets; and developing efficient just-in-time supply chain processes.

Hospital leaders have used Lean concepts and digital modeling to redefine their organizations and work processes and redesign facilities to support their migration from the traditional distributed model — a private office, exam room(s) and medical assistant for each physician — to a collaborative, care team model, achieving the objectives for safety, quality, access, efficiency and cost as a result.

For example, St. John’s Clinic in Rolla, Mo., built a new three-story, 106,862-sq. ft. outpatient facility to house a multispecialty clinic practice, an ambulatory surgery center and other outpatient services. They collaborated with their design-build team in applying Lean concepts and modeling tools to support the transformation of the traditional provider-centric operations into a patient-centered care team model and to design a facility that supports the new operations. Innovations included elimination of private physician offices as well as the reception and the waiting room, while adding in shared provider work spaces, and point-of-care patient registration, services and discharge.

St. John’s performance data show the gains in productivity and efficiency compared with that of a traditional model:

  • Overall building: total space reduction of 13 percent (from 124,167 sq. ft. to 106,862 sq. ft.)
  • Overall clinic space: reduction of 20 percent (from 76,945 sq. ft. to 61,113 sq. ft.)
  • Initial construction savings: $3.8 million
  • Overall capacity: increase of 16 percent (from supporting 49 providers to supporting 57 providers)
  • Annual rent savings: approximately $450,000
  • Annual operational savings: approximately $183,000
  • Annual savings per provider: approximately $3,400 per provider per year
  • 50 percent increase in recruiting success

It’s not just about cost

With total U.S. health care expenditures above 17 percent of the gross domestic product, American health care innovators have developed and applied these three strategies out of economic necessity to deliver health care at a lower cost. But as these strategies are put into place, health care innovators have seen improvement in quality, safety and patient satisfaction by increasing health care access, expanding services and growing capacity.

Miguel Burbano de Lara, AIA, NCARB, served as AIA Colorado North Chapter president in 2005 and is a member of many professional and civic organizations. He has worked at the Neenan Co. since 1999, where he focuses on Lean theory, design innovation and accelerated delivery. For more information, visit

The new hospital is a great addition to Prineville

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The new hospital is a great addition to Prineville


The veil was lifted from the St. Charles Prineville hospital this past weekend, and at first glance, the new facility is first rate and should serve the community well in the years ahead.

The “Sneak Peek” comes nine days before the hospital officially opens its doors to patients, and when that day comes, residents in need of medical care will go from an aging 65-year-old facility with an outdated floor plan, to a new building that was designed with the intent of providing the most modern methods of health care and focusing on patient space.

Hospital CEO Jeanie Gentry proudly showed off the 36-room family clinic that meets people just inside the front door. She stressed that designers emphasized patient space over administrative and physician office space. Because medicine is now a team effort, rather than a single physician caring for a patient’s medical needs, the design includes pods where doctors work in a common area filled with work stations and computers. Yes, some private doctor offices remain to accommodate circumstances when privacy is important, but the hope is to improve transparency between patient and physician.

The clinic serves as a core location in the hospital with other departments like rehabilitation, laboratory and radiology located in adjacent areas around it. St. Charles is emphasizing a streamlined approach in which they can move patients efficiently through the hospital.

The emergency department includes upgrades that will improve patient privacy. Glass doors and walls close off each room as opposed to the curtains that separate many of the emergency beds at Pioneer Memorial Hospital.

Upstairs, the facility features in-patient rooms that emphasize not only patient comfort, but comfort for the families who are visiting them. Each room includes a couch that folds out to a bed and includes a table for those who need it.

Bottom line is Crook County is getting a major upgrade courtesy of many groups working together. The City of Prineville and Crook County leaders helped the construction process along with assistance from the county building department and city planning and public works. For example, the city completed an arduous sewer line extension this past winter in which they had to dig down more than 20 feet and pump groundwater while running large sewer pipe.

And none of the design and state-of-the-art should be mentioned without acknowledging the Neenan Company, who designed and built the facility.

Hundreds showed up for the “Sneak Peek” and we have to assume that they came away impressed with the new medical facility. We commend St. Charles for their vision and hard work on the massive project. Job well done.

Design of Critical Access Hospital Reflects Oregon Community

Posted on:

Medical Construction & Design

Posted September 14, 2015

St Charles Prineville Exterior Renderings (4)


Design of Critical Access Hospital Reflects Oregon Community

FORT COLLINS, Colo. — The Neenan Company recently celebrated the opening of St. Charles Health System’s new 62,000-square-foot critical access hospital, which will replace Pioneer Memorial Hospital in Prineville, Oregon. The official grand opening ceremony took place on Sept. 12.

The Neenan Company served as the Design-Build partner for the project. The new replacement facility includes a primary care medical home at the core, comingled with a critical access hospital. The critical access hospital’s features include an emergency department, imaging and laboratory services, two surgical suites and a procedure room, inpatient beds, physical and respiratory therapy spaces. It was designed to accommodate 12 primary care practitioners and visiting specialists; two onsite residential units were also included for visiting practitioners.

The Neenan Company used a strong thermal envelope and efficient systems to greatly improve the facility’s efficiency in comparison to the systems used in the former facility. Through design, the project team was able to reduce space and staff needs while increasing flexibility and capacity for patient care, at a lesser cost than other design options, by delivering shared ED space, pre- and post-operative space and observation patient rooms. The facility will also equip staff with better tools for diagnosis through use of the new imaging, lab, cardio-pulmonary and physical therapy spaces. The care team space is flexible and adaptable to the ever-changing medical workforce. It allows for different generations of caregivers to work collaboratively while maximizing the benefits of their individual working styles.

The surrounding community is also represented within the design, which incorporates local and regional building materials representative of the textures, materials, colors and aesthetics of the Prineville area.

The Neenan Company recently broke ground on its second project with St. Charles Health System – the addition to and renovation of the St. Charles Madras critical access hospital. The updated facility, located in Madras, Oregon, is scheduled for completion in early 2017. The hospital will improve the utilization of its ED, surgery and imaging by delivering an ED that is three times larger. This added space will allow for a higher volume of surgery, improve access for emergency obstetrics and gynecology in surgery and provide the public with better access to imaging services.

Renderings courtesy of The Neenan Company.