MeritCare

A healing environmentDon Marty shares with Jenn Monroe MeritCareÔÇÖs vision of healing and sustainability. As it celebrates a century of serving the healthcare needs of the greater Fargo, North Dakota, region, MeritCare is already making plans for the next 100 years. Since it was established in the early 1900s as Fargo Clinic and St. LukeÔÇÖs Hospital, MeritCare has expanded its service area 250 miles west to east, from Jamestown, North Dakota to Bemidji, Minnesota. It is the largest private employer in North Dakota, with more than 7,100 employees, and boasts the largest hospital in North DakotaÔÇö583 beds on two campusesÔÇöand the largest medical group practice, with 450 physicians, 36 other medical providers and 190 physiciansÔÇÖ assistants and advanced practice nurses. Each year, MeritCare sees nearly 24,000 hospital admissions, more than 48,000 emergency center visits (it operates a Level II trauma center), more than 2,200 births and more than 19,000 surgeries. On the outpatient side, it sees more than 1.5 million medical group patient visits per year and more than 117,000 visits to its six walk-in clinics.MeritCare began planning for its future a decade ago, says Don Marty, executive partner, facility services, and has what is known as the North addition, completed in 2005, to show for it. It was the largest facility project in the organizationÔÇÖs historyÔÇöa five-year, $55 million renovation effort that included the addition of a common, north-facing entrance for both the hospital and clinic, along with a four-level addition and a two-tier parking deck for visitor and patient parking, as well as renovations of the surgical and ChildrenÔÇÖs Hospital in-patient units. Nor-Son Inc. was construction manager on the project, which was designed by Wild and Associates. An area just to the west of the new main entrance became a healing garden, complete with walking paths, benches and a variety of flowers and trees. ÔÇ£Our theme for the project was ÔÇÿa healing environment,ÔÇÖÔÇØ Marty says of the North addition. ÔÇ£WeÔÇÖre pretty proud of it.ÔÇØThe North addition was Phase One of a Master Facility Plan that will take MeritCare into the year 2030, and Marty says it was a fairly simple place to start. Through surveys, patients and families indicated that they wanted easier and less confusing access to the medical center, more private rooms and rooms that are more aesthetically pleasing and more conducive to healing and family needs. The direction the renovation plan took was in direct response to this feedback.ÔÇ£Our focus was to create one main entrance and the inpatient renovation,ÔÇØ Marty says. ÔÇ£It was easy because we knew what we needed to do. Phase Two is a little more difficult, a little more nebulous. Healthcare has changed since 1998.ÔÇØOne of the largest changes and challenges for MeritCareÔÇöand the industry in generalÔÇöis that the prices for services cannot be increased to help increase an organizationÔÇÖs margin. ÔÇ£In healthcare, our revenues are pretty much fixed,ÔÇØ Marty explains. ÔÇ£We have to reduce our costs. ThatÔÇÖs a different way to look at healthcare.ÔÇØ MeritCare is studying its 17 clinical sites around Fargo and how best to consolidate them from an efficiency standpoint. Ideally, the organization would like to reduce its facilities to ten or fewer. ÔÇ£What happens naturally when you consolidate is you find more efficient use of space,ÔÇØ Marty says.It also is looking into developing a 140-acre property it acquired within the city limits that would put a new medical campus near major access points into and out of Fargo (I-94, and 57th and 45th streets). ÔÇ£WeÔÇÖve started some campus planning,ÔÇØ Marty says. ÔÇ£One of our guiding principles is to optimize sustainable design principles.ÔÇØThese sustainable design principles will have, at their core, LEED standards. Marty says he wasnÔÇÖt sure whether or not the organization would apply for LEED certification, but it certainly will build to LEED standards. ÔÇ£The certifications arenÔÇÖt as important as building to the standards,ÔÇØ he says. ÔÇ£Healthcare is just starting to look at sustainable design. WeÔÇÖre lagging a little bit behind higher education and other business sectors.ÔÇ£WeÔÇÖve recognized healthcare facilities as really great users of resources,ÔÇØ Marty continues. ÔÇ£We want to be good stewards in how we build and how we use energy and manage waste. Healthcare is known for a lot of charity care and benefits to a community, but we need to start taking ownership of how we manage our resources.ÔÇØAlready MeritCare has ÔÇ£greenedÔÇØ its cleaning processes and is concentrating on energy management. It recently updated two stand-by cogeneration plants on each of its hospital campuses, which can take over electrical generation within seconds of interruption in order to maintain the energy output even in the event of a disaster, natural or otherwise. A ÔÇ£Go GreenÔÇØ committee has been formed to evaluate and support other green ideas from associates.But before MeritCare begins any new project, its five lean engineers study the organizationÔÇÖs processes. Although its lean program is fairly young, Marty is already seeing some benefits. For example, as the organization has been studying its two hospital campuses, itÔÇÖs predicting that it will need 100 new inpatient beds by 2012 and an additional 100 by 2017. ÔÇ£By leaning our process, we donÔÇÖt think we will have to build a square foot,ÔÇØ he says. ÔÇ£ThatÔÇÖs been an eye-opener for us.ÔÇØEven though the Toyota model has 14 lean principles, MeritCare has added a new number oneÔÇöÔÇ£the patient comes first.ÔÇØ This is helping the organization as it converts its patient rooms into private rooms, a challenge for structures built in the 1960s. There have been compromises made to allow for space for technology, private bathrooms, and space for actual patient care. ÔÇ£WeÔÇÖve been fairly successful at that,ÔÇØ Marty says.MeritCare also has been successful in getting all its employees to embrace the lean initiative. In addition to education through open forums and a special section of the organizationÔÇÖs intranet dedicated to lean principles and processes, all of the organizationÔÇÖs more than 7,100 associates are required to be involved with a lean project each year. ÔÇ£The secret is communication,ÔÇØ Marty says.┬á