PHOTO CAPTION: With a heavy focus on preventive care, the new Fort Belvoir Community Hospital in Northern Virginia pairs patients and their families with teams of providers who make up their “medical home.” Here, Dr. Cathy Tieu and Barbara Venable gauge the reactions from LeAnn Redlinger’s patch test to diagnose skin allergies during a dermatology appointment, July 27, 2012. DOD photo by Tina Staffieri
July 8, 2013
By Donna Miles
FORT BELVOIR, Va., July 8, 2013 – When the Fort Belvoir Community Hospital opened its doors in August 2011, it represented a long list of “firsts.” It was the nation’s newest, most technologically advanced military treatment facility, the first one to receive gold-level LEED “green” construction certification, and one of just two joint hospitals in the Military Health System.
Less than two years later, the staff at the Defense Department’s newest treatment facility is implementing another first: an ambitious new strategy that its commander hopes will help redefine military health care.
One of the most striking things about the gleaming new hospital is that despite its 1.3-million-square foot footprint, it has only 120 inpatient beds. Most of the facility is built around 440 examination rooms and 55 clinics that concentrate on outpatient care and preventive medicine, Army Col. Chuck Callahan, the hospital commander, told American Forces Press Service.
“The outpatient arena is where health care takes place in 2013,” he said. “Good health care is focused on prevention, which means you don’t need to get hospitalized.”
With that goal in mind, the hospital staff is working to keep patients healthy and, when they need medical care, to make it the most positive experience possible.
This is the foundation of the new strategy Callahan began rolling out last year. Tapping the hospital staff and patients directly, he incorporated almost 700 of their suggestions into a plan designed to improve the care provided.
“This strategy we have embraced really belongs to the staff and patients of the organization, and we are now in the process of beginning to implement them,” Callahan said.
Early indications are positive, he said. Making appointments is easier than ever before. Parking is convenient. The facility itself is inviting. And most important of all, Callahan said, everything about the hospital operation is focused directly on patients and their families.
People who have tried to see a doctor when they are sick probably know the pitfalls of a reactionary health care system. Getting squeezed in for a same-day appointment can be difficult, at best. If a condition requires a visit with a specialist, that draws treatment out even longer and often requires multiple appointments.
“The notion of patient- and family-centered care means we look at the way care is delivered from the perspective of the patient, both individually and as a population,” Callahan said. It’s a proactive approach that boils down to “‘What health care do you need and how do we provide it to you?’ rather than the opposite, ‘Here is what we have and sorry if it is not what you need,’” he said.
The centerpiece of this model is an ongoing relationship between patients and their providers.
Patients are assigned to a “medical home” -- a team of doctors, nurses and specialists who oversee their care. “This is a group that puts their arms around that group of patients and manages their health -- not just treats their disease,” Callahan said.
As a result, patients know who to call when they have health issues or questions. When they need to make an appointment, they can feel confident that they’ll get one, and be seen by providers who know their conditions and medical histories.
Patients with complex medical issues also have ready access to the “medical neighborhood” within the hospital, Callahan said. No longer do they need to schedule multiple visits with a series of specialists who may never communicate with each other. Instead, providers from across the “neighborhood” coordinate through medical home to provide interdisciplinary care.
“That’s all the providers, plus the patient and family, in the same room, talking through the treatment and management plan,” Callahan said. “It’s the model we are evolving as a hospital.”
The facility itself incorporates what Callahan called “evidence-based design” that supports healing. Design decisions were made to be therapeutic, incorporating natural light, outside views, healing gardens and pavilions inspired by nature: Eagle, River, Sunrise, Oak and Meadow.
Sections of the hospital are color-coded so visitors can quickly get their bearings. All in-patient rooms have just one bed, and a pull-out sofa that family members can sleep on. The design team tapped the Disney Corporation’s concepts of “on-stage” versus “off-stage” operations, relegating non-medical services to back hallways or non-prime hours.
While improving access to care when patients are sick and making the hospital experience as positive as possible are major goals of the new strategy, a foundation of the medical home concept is taking care of patients when they are healthy, Callahan said.
Instead of waiting for patients to call, he said, providers reach out to initiate required tests and procedures. They also rely heavily on social media and a secure Internet-based messaging system to answer patients’ health-related questions and provide health care information aimed at promoting health and well-being.
“The focus is on managing the patients so they get what they need and what they don’t even know that they need,” Callahan said. “It’s not just a matter of ‘What are you here for today?’
The goal is to keep you out of the hospital and keep you healthy. That’s much better than waiting until you are sick.”
Making these investments up front changes the paradigm in delivering health care, creating healthier beneficiaries and improving their quality of life, Callahan said.
As the Defense Department struggles with tough budget choices amidst skyrocketing medical costs, this proactive approach makes financial sense, he added.
“Treatment of disease is almost always more expensive than screening for and preventing disease. Almost always,” Callahan said. “So we are making the investment up front. As we move toward health and well-being, we are not only providing better health care to our beneficiaries. We are also going a long way toward saving health care costs in the long run.”
Callahan said he expects the new strategy to be fully in place within the next five years, but emphasized that he doesn’t anticipate a point where the staff will ever fully declare “mission accomplished.”
“Performance improvement is a journey. It is not a destination,” he said “Getting better as an organization is a journey, so we are going to continue to evolve our strategy to adapt to health care changes and better ways to provide for our patients.
“So there is never going to be a point of ‘arriving,’” he said. “In terms of health care, there will always be traveling.”
(Editor’s Note: This is the first in a series of two articles about the Fort Belvoir Community Hospital.)