2 TEXAS CHILDREN S HOSPITAL TCH Conversion 6

2 TEXAS CHILDREN’S HOSPITAL

TCH Conversion $6. 6 M – Initial Construction Budget (10% Contingency Included) $6. 6 M – Actual Construction Budget $13 M – Overall Approved Project Budget $12. 6 M – Actual Total Commitment To Project Building Relationships with Community – Metro, Local Council Managing non-TCH tenants (Dental) – infrastructure heavy & delayed opening timing

Computer Simulation

Overview Of Simulation Modeling

TCH MEDICAL HOME PEDI PATIENT PROCESS MODEL - 01/30/2012 EXAM VISIT HISTORY & PHYSICAL TIME BASED ON ESTABLISHED PT HISTORICAL DISTRIBUTION 5 -40 MINS SICK VISIT DISCOVERY OF ISSUE DISCHARGE IN EXAM ROOM UNLESS COMPLEX DISCHARD NEEDED 3 -10 MINS TO TREATMENT ROOM 20 -90 MINS ARRIVAL AT MEDICAL HOME PT TO SUB WAITING FOR NAVIGATOR GATHERS ANY SIGNITURES AND REVIEWS NECESSARY DOCUMENTS CHECK-IN KIOSKS FOR ESTABLISHED PATIENTS? 3 -5 MINS PT TAKEN TO EXAM ROOM VITALS TAKEN ON WAY LAB DRAW AR VITALS IF REQ 3 -5 MINS TO COMPLEX DISCHARGE AREA FOR SCHEDULING DIAG OR TREATMENT 10 -20 MINS DISCOVERY OF ISSUE DISCHARGE IN EXAM ROOM UNLESS COMPLEX DISCHARD NEEDED 3 -10 MINS PATIENT LEAVE MEDICAL HOME SICK CHILD WELL VISIT NEW VISIT %$ WELL VS. SICK WELL VISIT NEW VISIT THIS SIMPLIFIED FLOW DIAGRAM IS USEFUL TO LOOK AT THE NUMBER OF EXAM ROOMS IN A STANDARD CARE TRACK. HOW WITH THIS FLOW DIFFER FOR PED PATIENTS IN A CENTERING CONCEPT? WHAT % OF PATIENTS COULD THIS BE? PT TAKEN TO EXAM ROOM VITALS TAKEN ON WAY 3 -5 MINS EXAM VISIT HISTORY & PHYSICAL TIME BASED ON ESTABLISHED PT HISTORICAL DISTRIBUTION 5 -40 MINS EXAM VISIT HISTORY & PHYSICAL TIME BASED ON ESTABLISHED PT HISTORICAL DISTRIBUTION 10 -60 MINS TO COMPLEX DISCHARGE AREA FOR SCHEDULING DIAG OR TREATMENT 10 -20 MINS DID WE WANT TO MODEL PATIENTS HAVING THEIR PERSCRIPTIONS BROUGHT TO THEM IN THE EXAM ROOM, OR WAITING IN A SUB-WAITING AREA? PATIENT LEAVE MEDICAL HOME

Medical Home – Space Program Summary Total Area 50, 458 sf Quantity of Rooms Public Area Pediatric Service Module OB Service Module Centering Module Service Module Support Diagnostics 3, 528 sf 8, 338 sf 4, 726 sf 2, 030 sf 1, 972 sf 5, 340 sf Pharmacy Eye Clinic Dental Clinic Specialty Clinic Member Education Administration Support 3, 074 sf 5, 733 sf 4 Exam Rooms 3, 560 sf 9 Operatories 2, 160 sf 4 Observation Rooms 2, 849 sf 4, 874 sf 2, 273 sf 25 Exam Rooms, 2 Consult Rooms 11 Exam Rooms, 4 Consult Rooms 2 Centering Rooms 1 Gen Rad, 2 Ultrasound

Site Selection Reflects Pilot Program Preferred Area - Membership Density Proximity To Potential Partner Hospitals Near Major Freeways site CBD TMC

Vehicular Access - Site Along Beltway Feeder Road Can Be Approached From Multiple Directions I 45 B 8 N

TCH Medical Home Existing Building

Site Organization 3 Parking 1. 1=Patient & Public Parking 2. Staff Parking 3. Patient Flow from Bus Stop 1 6 4 2 4. Main Entry 5. Public Retail Entry 6. Staff Entry 1 5 2 6 N

Public Areas 1. Main Entry/Drop-Off 3 2. Public Retail Entry a 1 a - North/East Natural Light 3 3. Waiting/Circulation 2 4. Retail Corridor 4

Program Plan Public/Retail/EDU/Admin 1. 2. 3. 4. 5. 6. 7. 8. 9. Main Entry/Drop-Off Public Retail Entry Waiting/Circulation Retail Corridor Pharmacy Dental Optometry Education Administration 13 Peds Program Space 13. Primary Care Clinic 14. Specialty Clinic 15. Diagnostics a 15 7 10. Staff Work Area 11. OB Clinic 12. Centering 1 14 Staff OB Program Space 3 10 a 2 3 5 11 4 9 6 8 11 10 12

TCH Medical Home Reception

TCH Medical Home Waiting

TCH Medical Home Team Workstations

TCH Medical Home Reception

3 Lessons Learned

POE Methodology (to be provided at learning session)

POE Results (to be provided at learning session)

Common Takeaways – Conversion “Pros” - Large, open footplate - Opportunity for various ceiling heights / high ceilings - Potential for second floor / mezzanine - Opportunity for skylights - Potential for separate front-of-house and back-of-house - Good visibility from major thoroughfares - Ample parking - Economical investment - Places care directly in the target community - Create a feeder system to or away from hospital campus

Common Takeaways - Conversion “Cons” - Inappropriate column spacing - Undersized / shared utilities with adjoining tenants - Usually no emergency generators - Inappropriate / unusable mechanical systems - Low-budget original construction - Poorly documented building alterations over time - Undocumented / undiscoverable existing conditions - Potential limitations to exterior façade changes - Significant saw-cutting for under-floor plumbing - High roof: ceiling-mounted equipment challenging - Security

JPS Dianna Prachyl DPrachyl@jpshealth. org TCH Allison Muth ABMuth@texaschildrens. org FKP Diane Osan DOsan@fkp. com Lance Winn LWinn@fkp. com