Miron Construction's health care services team and experience-based design experts worked collaboratively with NORTHSTAR's design partners and owners to create unique and ideal experiences for patients, staff and the community.

1. TRANSFORMING A CRITICAL ACCESS HOSPITAL
NORTHSTAR Health System - Hospital Addition and Renovation
A Miron Construction Case Study
WHAT WILL IT TAKE? HOW DO PATIENTS DECIDE Health System. Shrinking marketshare
Every healthcare organization aspires WHERE TO GO FOR CARE? and a desire to stay up-to-date with
to attract and retain patients. Appealing Conventional thinking has long held that emerging patient needs necessitated
websites, public awareness and outreach most patients base their hospital choice change. Rampage went on to state “our goal
efforts market key services. Announcements on clinical reputation, its location, or their was to [envision] the hospital of the future.
of awards, praise and other c linical physicians’ recommendations. Recently, To think differently than before—that is
recognition let potential patients know of hospital executives have begun recognizing how marketshare will be [gained]. Our
your success. But does any of this impact that patients also consider non-clinical clinical outcomes are superb, [but] we have
decision-making? factors, such as comfortable rooms, surgical to connect on the non-clinical elements
education and convenient registration of the experience.” Rampage was faced
Research says no. New research indicates with this challenge and couldn’t help but
procedures, when choosing where to seek
that patients and physicians are increasingly get excited about NORTHSTAR’s new
treatment.
likely to base their choice of hospital on opportunity. Early in 2008, Rampage
non-clinical aspects of their visit—like NORTHSTAR Health System (formerly launched an effort to “re-imagine” the
the overall patient experience (McKinsey Iron Count y Communit y Hospital) critical access hospital experience. He and
& Company Quarterly, 2009). Yet, few understands just how important non-clinical his team hired Miron Construction Co.,
hospitals have the marketing skills, key factors have become. “Our opportunity is Inc. to develop and construct an addition,
organizational structure or the strategic immense. While this facility has served which encompassed 25,000 square feet of
approach to deliver a distinctive experience the Iron County [Michigan] community new space, and complete the renovation
in ways similar to those of retail and well for 35 years, we had to change,” states of 13,000 square feet of existing space.
hospitality companies. Bruce Rampage, CEO of NORTHSTAR

2. F , NORTHSTAR “creating a unique environment
for patients and their families. Building four walls wasn’t enough.
Miron was selected because they look at projects di erently.”
BRUCE RAMPAGE
CEO of NORTHSTAR Health System
CHALLENGE “Being a great hospital was not enough SETTING THE STAGE
for us,” explained Rampage, who joined From the beginning of the project, it
NORTHSTAR Health System (formerly Iron
County Community Hospital) was struggling NORTHSTAR less than three years ago. was important to align the experience to
to remain relevant with an outdated facility. From day one, he says he focused on “creating NORTHSTAR’s overall strategic plan. “We
Although the hospital had excess capacity, a unique environment for patients and their realized that to simply build was not enough,”
they were unable to provide the cutting-edge families. Building four walls wasn’t enough. commented David G. Voss, Jr., CEO of
services that the surrounding community Miron was selected because they look at Miron. “Twenty-five percent of a patient’s
demanded. NORTHSTAR recognized the projects differently.” experience has to do with the outside walls;
need to reposition themselves by re-imagining the rest is influenced by what happens inside
the critical access hospital of the future. Understanding that each patient is unique
the facility. Successful projects encompass
was at the core of the NORTHSTAR strategy.
more than schedule, budget, quality and
“Most hospitals apply a ‘one-size-fits-all’
constructability.”
mentality to understanding the patient
experience. We recognize that patients no In the ever-changing world of healthcare, it is
longer want a ‘one-size-fits-all’ approach to as vital to consistently deliver on promises, as
healthcare” asserted Rampage. it is to stay on the cutting-edge of technology.
2

3. Tyink, Miron’s Vice President of Business SOLUTION
Innovation and one of our Experience-Based At the core of the NORTHSTAR transformation
Design team members. “Reverse outcome were seven non-negotiable ‘Guide Lights’ that
modeling actually begins with understanding NORTHSTAR and Miron Construction used to
the outcomes that occur at every patient help lead the organization through re-design
attach point within the hospital setting.” and construction efforts. “We never wavered
from the core guiding lights. At every step
Experience-Based Design (EBD) of the transformation process, we asked
in healthcare focuses on capturing and ourselves: does it align with the strategy?
understanding patient and caregiver needs, Does it align with the [guide] lights?” stated
not simply their view of the process—for Tyink.
instance, the efficiency and speed at which
Seven Guide Lights:
they travel through the system. Instead,
it deliberately sets targets and establishes 1. Intentionally design the
patient experience.
benchmarks for subjective outcomes: personal
feelings a patient and caregiver experience at 2. Understand the ideal patient ecology.
critical points along the care pathway. 3. Involve every level of the organization
in the creation.
“Our healthcare services team and Experience- 4. Research best and innovative practices
Based Design experts work collaboratively (both inside and outside the healthcare
with design partners and owners to create industry) and use them.
unique and ideal experiences for patients, staff 5. Choose wisely what you measure
and the community,” Tyink elaborated. and hold people to it.
6. Listen to patients, but more
e EBD process begins with the formation
importantly, watch what they do.
of Innovation Teams in which current staff
7. Define the standards that will
and physicians serve as co-creators of the
set us apart.
experience. Employees selected from various
Before you can exceed patient expectations, disciplines were brought together to answer
you must thoroughly understand what questions such as: Why does NORTHSTAR
those expectations are. For NORTHSTAR, exist? What makes our hospital unique?
Evidence-Based Design Accreditation
re-imagining the patient experience began What are we going to be famous for? If we
and Certification
with the organization defining and setting disappeared tomorrow, would we be missed
a project vision, creating project drivers, and why? Throughout the design and construction
and determining expectations and desired process, Evidenced-Based Design principles
Innovation Team members identified and were followed. This process bases design
outcomes. e ultimate goal was to link the
created an experience that is original and decisions about the built environment
new facility to patients’ unique needs and
relevant to the Iron County community. on credible research to achieve the best
align people and behaviors to deliver new outcomes. Critical to the NORTHSTAR mission
“Here is the truth,” added Rampage “we
solutions. was designing a facility that: A) reduced
can’t be something we’re not. e hospital
patient slips & falls; B) Lowered nosocomial
has been here for a long time. Our beliefs,
NEXT STEPS infections: C) Eliminated inaccurate prescription
truths and cause are different than that of our
To begin the process, Miron scheduled medication D) decreased nurse attrition rate
competitors. e community knows us as a
‘Innovation Sessions’ for all 350 employees (through the elimination of steps) E) minimized
trusted guide and partner. We had to create patient transfer rates; F) reduced noise and
as a way to jumpstart the process of
the experience around who WE are.” improve air quality. Most importantly, we
re-thinking and understanding what was
developed single patient rooms and access
important to patients, the community Miron explored and challenged what
to nature and natural lighting.
and the NORTHSTAR staff. “From the employees and patients really wanted
beginning, Bruce challenged the entire team. and what they really needed. The team
We used the non-traditional approach of watched, listened and understood not just the
reverse-outcome modeling,” explained Steve words, but the behaviors. “Too often when
A Miron Construction Case Study

4. TRANSFORMING A CRITICAL ACCESS HOSPITAL
NORTHSTAR Health System - Hospital Addition and Renovation
understanding the voice of the customer, clinical outcomes. Without intentionally procedure to chance. Why on earth does the
healthcare organizations think they ‘know’ designing the experience, you leave the healthcare industry leave the experience to
what is desired. Why then do we still use a entire encounter to chance. How should the chance?” questioned Rampage. To his point,
hospital gown that everyone hates, one that experience go? What types of feelings are we following is a snapshot of a patient’s typical
was invented in the early '20s?” asks Tonya experience at a hospital:
trying to elicit? What do patients say about
Dittman, a Miron EBD Leader. “Innovation
NORTHSTAR after their first encounter? You hide in the parking lot until your
Teams bring newly created experiences to life,
“We would never leave a diagnosis or surgical appointment. Next, you walk inside and
and ensure they continue long after they are
developed because the solutions belong to provide your name. A receptionist asks for
the NORTHSTAR team, not to Miron. A “The changes that have occurred your insurance card. Your name is called and
complete cultural transformation occurs, one at the Hospital, in both our you’re brought into a small, cold and sterile
that is organized to deliver the ideal patient room. Someone you have never met asks
services and physical facility,
experience.” you to remove your clothes and hands you a
have been tremendous. From
paper gown with an exposed backside. en
the beginning, the team set out
At project inception, Miron facilitated you are left to stare at a wildlife photo on
various workshops with NORTHSTAR team to create a critical access hospital
the wall. You wait, and wait, and wait a little
members using the Seven Guide Lights, their that was unique and focused on
more while paging through a House Beautiful
project vision and drivers, an Innovation reducing stress and anxiety for
magazine. After at least a fifteen minute wait,
Team summary, and EBD tools to guide the every patient and their families
you are finally greeted by your doctor. is
experience process. e following is an outline while improving their clinical
type of experience is no longer acceptable.
regarding how the ‘Guide Lights’ made an outcomes. I can't say enough about
impact on the transformation: the transformation.” Our teams identified 32 experience action
items when the project commenced, all of
ROBERT W. POSSANZA, SR.
1
Intentionally design the patient Former Board President which needed to be incorporated into the
experience. Too often the entire NORTHSTAR Health System new facility. To bring these innovations to
experience is overshadowed by more pressing life, 11 Innovation Teams (see right) were
4

5. 3
formed to facilitate the implementation of Involve every level of the
the ideal experience. Guided by the Miron organization in the creation
Reverse Outcome Modeling Tool, impression of the ideal patient experience.
areas and attach points were understood at New healthcare research underscores just
each intersection with the NORTHSTAR how important non-clinical elements have
brand. To begin the innovation experience, become. An online survey by McKinsey &
outcomes were understood first and process Company of more than 2,000 US patients
issues second. with commercial insurance or Medicare
regarding their attitudes toward the patient
2 Understand the ideal patient experience revealed that most of them are
ecology. How did we begin to willing to switch healthcare providers for
understand patients? We listened. We learned better service and amenities (McKinsey &
that each patient comes to our facility with Company Quarterly, 2009). In fact, many
a different set of expectations, requirements have already asked their physicians to refer
them to specific facilities specializing in
and needs. We listened to compliments,
providing this type of care. In a separate
complaints and concerns from the patients at
survey, doctors revealed that they are often
key interaction points during the traditional
willing to accommodate a patient’s request
hospital experience. We knew, through our
for a referral to a healthcare organization that
research, that the expectations of a perpetual
offers a positive experience—sometimes even
patient differ greatly from the expectations
if it has a lesser clinical reputation.
of an elective patient who has little time for
testing, treatment and healing. We conducted Staying ahead of the competition was
focus groups to better understand what the critical to the long-term vision and success
PROCESS
expectations of occasional, elective, perpetual of NORTHSTAR. Creating innovative
Innovation Teams were created around
and complex critical patients were. Our solutions that did not yet exist in healthcare
the following key interaction points with
ultimate goal was to ensure that the elective was the challenge. NORTHSTAR’ iTeams,
patients:
compr ised of individuals f rom e ver y
patient, who literally has numerous surgical 1. Patient Education & Registration
department in the hospital, were provided
options available to them and will only endure
with the knowledge, research, and tools 2. Patient Welcoming & First Impressions
one poor experience before finding a new
to determine where the discrepancies lied 3. Hospice & Home Healthcare
hospital, would be satisfied with our facility
between the current and ideal state in order
and services. 4. Patient Discharge
to create a new and ideal experience for
5. Follow-Up/Home Health
Finally, our team listened and integrated patients. Who better to create the ideal
patient experience than those who live, eat 6. NORTHSTAR Tour & Wayfinding Story
the thoughts, belief s and feelings of
and breathe hospital life? These are the 7.
NORTHSTAR staff members. rough the Food Service
individuals who best understand patient
utilization of 12 Experience-Based Design 8. Oncology
needs and desires because they’ve spent their
tools including Innovation Teams (iTeams), 9. Imaging
careers interacting with them. Empowering
the team was able to understand the current
team members to share thoughts, ideas 10. Branding
state and, more importantly, the ideal state.
and solutions is the best way to encourage 11. Housekeeping
e behavioral, informational, and physical
ownership of altered processes and systems.
components through which any experience
4
is delivered must be modified to support and Research best and innovative
deliver the newly constructed experience. We practices (both inside and
needed to determine how to model, create and outside the healthcare industry) and
ultimately replicate these experiences through use them. Some very special companies,
process changes in order to repeatedly bring such as Southwest Airlines, Apple and
the NORTHSTAR experience to life. Panera Bread, focus their efforts on creating
A Miron Construction Case Study

6. TRANSFORMING A CRITICAL ACCESS HOSPITAL
NORTHSTAR Health System - Hospital Addition and Renovation
attachment with their customers as a natural a complete cultural transformation occurs Everyone can identify with positive and
order of business. With NORTHSTAR, we within your organization. negative service experiences. For example,
knew we had to look from the ‘outside in’ you’ve walked into a health club where you
To ensure that the measurement process is
to create a new model for the experience. feel energized and excited to start, or continue
on-going, NORTHSTAR leadership created
We looked at things from an entirely new on, your journey toward achieving a healthy
e PACE team (Promoting a Culture of
perspective, for our inspiration. We wanted to lifestyle. And you’ve no doubt walked into
Excellence) staff initiative. The initiative
learn how the best-of-the-best command space one where the receptionist is on the phone,
is led by the PACE UP group comprised
within their market. What is it that created you can’t find a towel, or the locker room is
of department managers. The initiative is
their uncontested space? Was it pricing, a disaster area. Most likely you leave with a
charged with keeping the culture alive and
advertising, marketing, facilities, innovation, horrible impression of the facility and, in turn,
holding team members accountable for not
or service? We toured numerous organizations the organization.
only continuous improvement activities, but
in order to gain an understanding of what they
the metrics associated with system deployment Why is it that some places connect with us and
were doing to differentiate themselves from
activities as well. some don’t? e answer: If you understand
the competition (in some cases gaining five to
that the front steps to your facility are as
seven times the market share of their rivals). Employee recognition is key for
important as the person greeting patients at
transformational success at NORTHSTAR.
Here is what we found. Each organization the front door, you get it. If you think your ad
To recognize staff members for their great
understood the outcome of their customers’ budget is more important than your parking
patient care and process improvement
experiences before they ever occurred. lot, you don’t. Your parking lot is where
activities, the 'Shining Star' program was
rough the assistance of Experience-Based people first connect with your facility. Make
created. Each month patient care stories are
Design tools, they intentionally recreated it memorable. Rethink the signage. Consider
recognized and highlighted for other staff
those ideal experiences to elicit those same ease of navigation. Plant flowers for visual
members to learn from.
emotional outcomes, time after time. interest. Tell a story and be unique. It’s all
about customer attachment.
5 Choose wisely what you measure
6 Listen to patients, but more
importantly, watch what they do.
and hold people to it. In order to
be successful, you can’t merely copy what
other successful organizations are doing to
Few healthcare organizations systematically
seek to understand what patients value in
7 us apart. Integrating new hospital
standards into our overall plan was critical to
the non-clinical aspects of their hospital
ensure quality care. Measuring outcomes the success of the project. Documenting and
visits. We needed to understand the process,
involves understanding what best-in-class standardizing processes ensured nothing was
systems and impression areas that create the
organizations’ goals are and how they have left to chance. “Department leaders worked
‘Ideal Patient Experience’ before we designed
achieved those goals through process and hard throughout the design and construction
and constructed the new facility. Perceptions
operational improvement. Once you have that phase of the project to standardize many areas
of service providers, including hospitals, are
information, you have to determine how to of the new hospital,” commented imaging
formed the moment the experience begins.
achieve comparable results given the unique team leader, Eric Beauchamp.
erefore, from the beginning, we studied
internal and external conditions of your
desired outcomes to determine their influence One example of an impression area where a
organization. And once changes are made, it
on the overall patient experience, and we new standardized process had a great impact
is vital to the success of the organization to
diagrammed the progression and flow of the on the staff and patients was the registration
continue to measure outcomes to ensure every
experience exchanges within the facility. In process. e registration team measured the
patient is receiving quality service every time
doing so, the vision for each area could be amount of time it took to travel through the
they step foot in your facility.
understood and then be designed to meet registration process. e team’s initial plan to
Instituting quantitative and qualitative that goal. Understanding the impression areas ‘speed up’ the process did not provide them
measurements encourages accountability. If you allowed us to analyze movement sequence, with the outcome they had originally expected.
measure it, they will respect it. NORTHSTAR spatial integration, patient interchange and They found that making the registration
established checks, balances and processes emotional connectivity. We were then able to process as short as p o s s i b l e i n c r e a s e d
to ensure continuity in the delivery of their identify service gaps and reinforce consistency anxiety in patients. Therefore, although
services. is is critical to guaranteeing that within the organizational brand experience. speed and efficiency were important, it was
6

7. also vital to ensure patients felt comfortable service for meals; First Impressionist position; RESULTS
and calm. Not only was the registration elimination of overhead paging; new forms
NORTHSTAR has already experienced amazing
process changed, but it was standardized so of communication including staff pagers and
results due to the organizational changes the
that each and every patient who enters the phones; patient pagers; electronic scheduling
team made. Highlights include:
doors has the same positive experience. and waiting patient identification practices;
and free discharge follow-up for all elderly 2010 Michigan Rural Health Quality
Other areas that were standardized at
patients by Home Health. Improvement Achievement Award
NORTHSTAR include: inpatient room tours, for overall customer service in inpatient,
radiology services, housekeeping, surgical IN CONCLUSION outpatient and ED services.
education, discharge planning, food service, In the sea of healthcare sameness, transforming
INCREASE IN MARKET SHARE
ICU preparation, hospice, and the list goes a critical access hospital begins at the top,
on. Every interaction point and area of the bottom and everywhere in between. 11% OUTPATIENT
service was evaluated to increase efficiency Creating the ideal patient experience for
and heighten the patient experience. Now NORTHSTAR Health System was truly a
48% ORTHOPEDICS
that these standards have been established, team effort, and it will take the commitment 30% CARDIOLOGY
it is up to the team to continually confirm of everyone on the team to continue to bring
that they are consistently delivered in order these ideal experiences to life. 82% VASCULAR
for NORTHSTAR to bring the ideal patient
experience to life on a continual basis.
97% HEMATOLOGY
To help create the ideal patient experience,
many innovations were added to
NORTHSTAR including: pre-warmed,
discrete mammography robes; iPods and
DVD players for inpatient and outpatient
rooms; customized “Catering to You” room
A Miron Construction Case Study

8. "The entire Miron team operated like an orchestra or well-choreographed
ballet. They touched every inch of our facility without one disruption to our
patient or staff. They left a piece of art, they were amazing."
MARK TOUSIGNANT
Chairman of the Board
NORTHSTAR Health System
Miron is committed to building more than just design partners to create unique, differentiating
buildings. We believe wholeheartedly in partnering experiences that exceed client expectations. We
with our clients to develop solutions that deliver know it is no longer enough to simply satisfy.
business results. For many, that means increasing At the end of the day, it’s all about helping
their bottom line, or enhancing their ability to our clients be successful. Experience-Based
CONTACT: Steve Tyink
recruit and retain the best and brightest. For Design is just one way we’re helping clients
920.969.7047 others, it’s giving them a competitive edge. Our deliver on their promises.
steve.tyink@miron- Experience-Based Design services offer our
construction.com clients the ability to distinguish themselves in an Simply stated: our commitment
increasingly competitive marketplace. That is why reaches beyond construction;
miron-construction.com we are committed to collaborating with owners and our passion brings dreams to life!