Patient-Centric Facility offers Expanded Services with Integrated Approach
Former military personnel, dignitaries, staff and project team members turned out in force last week to salute the official opening of the new Bend Veterans Affairs Community Based Outpatient Clinic (CBOC) which features significantly expanded services and an innovative patient-centric healthcare delivery approach.
The ribbon cutting of the 27,000 square foot center was the culmination of a four-year effort to provide additional services to support more than 6500 Central Oregon area veterans, and is over double the size of the previous facility which had been housed across the road on Wyatt Court since 2000.
New treatment options offered now include audiology – utilizing new state-of-the-art soundproof booths to conduct hearing tests – and physical therapy, which promises to be a boon to patients who previously had to travel over the pass to the main Portland VA Medical Center (PVAMC) for such services.
“With this move, we are excited to also offer expanded services to our Veterans in our eye clinic,” said John Shea, VA operations manager at the Bend clinic. “We will also be offering physical therapy and continue with our primary care, home-based primary care, mental health services, and our dermatology and hand clinics.”
The Bend CBOC is expanding other existing services such as podiatry and counseling for post-traumatic stress and the facility is also designed to increase the VA’s ability to deliver “tele-health” services (health-related services and information via telecommunications technologies such as video conferencing) which will include compensation and pension exams and more mental health care options, along with an improved weight reduction program.
“We will now also have a clinical pharmacist on site and will begin building additional programs around this specialist,” added Shea.
“We are extremely thrilled to get in our new facility – we think this expansion will really help provide our veterans the care they need right here, reduce the need to travel and improve the health care experience of those we serve.”
Bill Murray, strategic planner with Portland VA, said his department had seen a steadily growing demand for services since the original clinic’s inception, which led to a request to VA central office in Washington DC for funding authorization to pursue expansion options.
After receiving the green light to move forward, a Federal Request for Proposal contracting process resulted in the engagement of a team including Fratzke Commercial Real Estate to assist in site selection, Steele Associates Architects to lead design and SunWest Builders to undertake construction.
The site search began in earnest two years ago, and after a shortlist of possible options was drawn up, the Courtney Drive site eventually won out as best matching criteria including location, accessibility, ample parking, adaptability and bandwidth capacity.
The building was previously used for medical offices and the overhaul for VA purposes included a complete gutting of the interior and custom retrofitting incorporating the addition of a second elevator to allow separate access for both staff and patients.
Murray added, “The design process embraced a team effort involving all of the stakeholders and services associated with the building having input on how to best optimize function.
“The VA is constantly attempting to improve ways of delivering primary care and other services, and has piloted the concept of Patient Aligned Care Teams which puts the patient in control of healthcare and requires a different staffing, construction and design approach.
“In traditional clinic design, the physician, nursing staff and technicians may be in separate offices, but the PACT approach brings all together in one work space with the patient as the focus and the team acting as a conduit to other services that may be needed – increasing access, coordination, communication and continuity of care – and cutting out the referral step.”
The PACT concept is garnering widespread attention for allowing patients to have a more active role in their health care and is also associated with increased quality improvement, patient satisfaction and a decrease in hospital costs due to fewer hospital visits and readmissions.
“This enables everyone to work closely together and is a very collaborative model where each team member has a role in treating the patient,” added Murray.
“Another important part of this project was the technological component accommodating a sophisticated tele-health set-up. Many specialist consults can now be conducted electronically with a variety of connections including, for example, a cardiac consult utilizing an EKG and electronic stethoscope, where all the data can be taken electronically which again minimizes travel needs for both physicians and patients.
“We have also added a teaching component so we can train people in the Bend area and have the capacity to handle future expected growth as this is the main hub drawing patients from a 100-mile radius, with the next nearest such facility being in the Dalles.
“The previous location was space constrained and the design didn’t mesh with our current operating model. Everyone is very happy with how the new facility turned out and the project was a wonderful team effort which is a testament to the amount of planning and preparation involved.”
SunWest Project Manager Wayne Powderly said the VA’s approach in starting at the developer level and seeking a team including real estate, design and construction to submit one proposal worked well, with the building owners also being valued and involved members of the team.
He added, “When we got in there we basically demoed the interior down to the studs. The building outside skin was fine and its envelope fitted perfectly in this case.
“A couple of the bigger challenges involved in the project involved cutting the slab to accommodate the prefabricated sound booths, which were sizeable and had to be set flush, and significant additional plumbing which left the floor looking like Swiss cheese at one stage!
“Once the plans were finished we basically undertook a big tenant improvement project with a tight schedule. We started in March last year and were finished by October which is quite a turnaround, but we got it done on time with a lot of long days and had great liaison with the project management counterpart at the VA in Ryan Anderson. It was challenging and fast-paced, but really a fun project with a great all-round team.”
Powderly added that the building is set to adhere to the VA policy of attaining LEED (Leadership in Energy and Environmental Design) Silver level equivalency through meeting a number of criteria including recycling of materials, use of regional materials and inclusion of high efficiency mechanical and lighting systems.
Steele Associates Project Architect Krista Appleby said the building interior was designed to be open and flowing and “less institutional,” while utilizing natural light wherever possible as part of the “green” resource-management strategy.
She said, “The were a number of design meetings on how the clinic should look and the end result is a warm and inviting atmosphere which is also a tribute to the involvement of Melisse Kuhn with VA Facility Management Services in creating a soothing atmosphere with interior finishes and furnishings of a more hospitality-oriented nature.
“It was a great experience to work with the whole team and we had input from a number of sources, including some of the directors from Portland medical offices, lead doctors in various disciplines and veterans’ representatives themselves who attended several meetings.
“This was a collaborative effort in which everyone did a great job of flushing out the issues and putting together a great finished product.
“There was a strong sense of coordination in how healthcare should be delivered and the integrated approach was reflected in the design element.”
Steele Associates Principal Scott Steele added, “This is a special project. We have always appreciated the contribution of our military personnel and have actually donated services to three veterans’ memorials.
“It is wonderful that veterans in the region now have broader services and greater access to healthcare to help them.
“This was major remodel and we worked within the given parameters to help with an incredible transformation, which also offers a calming, soothing and non-institutional ambience.
“This was a great project which is fundamentally about what the community needed to do to care of veterans who have given service to our nation.”
The facility also fulfils part of the VA’s overall goal to increase mental health program services.
Last year, the VA provided specialty mental health services to 1.3 million veterans and since 2009 has increased its mental health care budget by 39 percent. Since 2007, the VA has seen a 35 percent increase in the number of veterans receiving mental health services, and a 41 percent increase in mental health staff.
Last year, as part of an ongoing review of mental health operations, it was announced that the VA would add approximately 1,600 mental health clinicians as well as nearly 300 support staff to its existing workforce of 20,590 mental health staff to help meet the increased demand.
VA operates the nation’s largest integrated health care system. With a health care budget of more than $50 billion, VA provided care to 6.1 million patients during 920,000 hospitalizations and nearly 80 million outpatient visits last year. VA’s health care network includes 152 major medical centers and more than 800 community-based outpatient clinics.
Veterans Affairs Clinic
2650 NE Courtney Dr., Doctors Park, Bend
Property Owner/Developer: Courtney VA LLC
Contractor: SunWest Builders
Project Cost: $5.9 million
Sitework: Start: 2012
Square Footage: 26,589
Amenities: Sustainable design to maximize health and wellness.
Financing: Q10/National Mortgage
Project Manager: Wayne Powderly
Supervisor: Mike Maxham
Engineer: Adam Bowles
Architect: Steele Associates Architects
Principal Architect: Team: Scott Steele, Krista Appleby, Sara Laudenslayer
Structural Engineer: Froelich Consulting Engineers
Civil Engineer: Hickman Williams & Associates
Mechanical Engineer: Interface Engineering
Subcontractors and Suppliers:
7 Peaks Paving, Western Protective Coatings, Springtime Landscape & Irrigation, Deschutes Concrete, Solid Rock Masonry, All Position Welding, Baxter Builders, Dimar Siding Co., Clowers Carpentry, Inc., ProShop Millwork & Design, Insulation by Davis, McMurray & Sons Roofing, Inc., Bend Commercial Glass, Bell Hardware, Dannick Corp., Custom Tint, CCI Bend LLC, John A. Varner Construction, Baptista Tile Company, Fabulous Floors, Inc., Judson Painting of Oregon, North Country Building Specialties, Interior Technology, Johnson Brothers TV & Appliance, American Sprinklers, Inc., Total Resource Plumbing, Otis Elevator Company, Cascade Heating & Specialties, Bend Electric, Inc., Apex Telecom, Inc.