Ambulatory Vision Flourishing in Chicago

Developing A High Performance Ambulatory Platform

The busy intersection of North Clark Street, West Barry Avenue and North Halsted Street in Chicago sits at the heart of the north side neighborhood in Lakeview. What used to be an aging Sports Authority (that was originally a grocery store), has become an Advocate Outpatient Center, a full-scale transformation with welcoming landscaping, generative materials and ambulatory specialty services for the surrounding community.

This is the 26th clinic developed by the Advocate Outpatient Collaborative, an interdisciplinary team that shares a vision of the future with high-quality, affordable and accessible healthcare for the communities they serve.

Eight firms encompass the Advocate Outpatient Collaborative, an Integrated Lean Project Delivery team that work together on every project and share in both the risks and rewards, comprised of HDR, IMEG, Boldt, Martin Petersen, Glass Solutions, Huen Electric, LeJeune Steel and The Rockwell Group. They were formed to develop a scalable and repeatable clinic model based on efficient operations, patient engagement, sustainable and technology adaptable for a clinic platform of the future. Five years later, they have completed 26 outpatient centers with a revised target of 50 within a 10-year planning horizon.

How the ILPD Team Works

Operating under a shared project vision called Care360, continuous learning and the application of evolving strategies are deployed under a branded architectural language. With five to ten projects underway simultaneously, the team is constantly learning from details, both small and large, that can inform future projects while maintaining a continuous feedback loop for those previously occupied.

The Core Team conducts bi-weekly innovation meetings to address hot topics, active projects, lessons learned and future forecasted resource needs. There are no one-off projects that fall outside of the Outpatient Collaborative. The consistent cadence of face-to-face workshops creates an incubator for problem solving and innovative ways of applying lessons learned for a consistently branded outpatient center.

Big room meetings are complimented with virtual meetings as well. The gap between design, construction and owner is bridged in our redesigned collocation office. This approach has proven to be very effective, especially with the Lakeview clinic which was a complicated wholesale retrofit in the City of Chicago.

The PMT meets bi-weekly as well to address global issues and review post occupancy evaluations from staff and caregivers to gain feedback on operations and facility performance. We optimize communications thru an uninterrupted flow of information where all firms and stakeholders have a voice but act as a unified team.

Senior Editor John Caulfield of Building Design & Construction Magazine spoke with the team and describes in his article, “IPD Super Teams Hit Jackpot for Clients,” how the contract works: “Each project has an allowable budget that Advocate’s board approves. The company and the collaborative then agree on a target cost with reduction goals. The difference between the budget and target constitutes the contract’s incentive compensation layer. Advocate keeps 50% of the savings achieved below the target cost, and the signatories split the other half, based on the scope of their work and the portion of their profit each contributes to the risk pool.”

Modularity Enhances the Ambulatory Kit-of-Parts

The initial challenge was to create a kit-of-parts that was scalable, repeatable and adaptable to each clinic’s needs. In short, the ILPD team had to create a process to do more with less.

Both digital platform and physical mock-up were used to create the core module. Rapid iteration allowed the team to test, configure and improve upon the core module and ultimately select two operating models:

• Separate Corridor: care team traffic and patient traffic flow through separate areas.
• Shared Corridor: care team traffic and patient traffic flow through the same area.

Both options are designed around a care team workspace at the center of the core, and can be augmented with “bolt-on functions,” such as lab, imaging, rehabilitation, retail pharmacy, ambulatory surgery and more, to complete a comprehensive specialty clinic in its entirety.  

At locations where a tenant fit-out in an existing facility is desired, we use a derivative of either core module with a complement of established model room geometries and select components from the kit-of-parts. Our goal is to always preserve the brand while optimizing the use of our standardized components.     

A prefabrication approach was developed concurrently to save time and cost. Within each clinic are standard model rooms and components. The Exam Rooms for instance can account for a significant share the built program, thus we have delivered fully constructed rooms and installed into the building shell. Team Prefab, which is comprised of our trade partners, have also developed prefabricated assemblies on-site and improved the efficiency and performance of the built environment, which reduces our waste stream targets and energy usage.

The modular and standardization strategy has resulted in over a dozen different configurations of assembling the kit-of-parts with an aggregation of core modules, bolt-on functions and inspiring evolution of the Advocate Outpatient Center brand experience.  

The Advocate Outpatient Collaborative ILPD team recently won the 2019 Symposium Distinction Team Award at the Healthcare Facilities Symposium & Expo in Boston, Massachusetts.