Retrofitting Emergency Departments - The KPIs, process and strategic stages


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Mark Aiken, Senior Project Manager at ARUP explains his innovative ways to retrofit emergency departments, with a focus on how to manage staff flow yet ensure clinical safety and operations. He also explains how ARUP managed to help decrease patient wait times whilst retrofitting.

Mark will be speaking at the Retofitting for Healthcare Facilities 2011. This event forms part of the Australian Healthcare Week. For more information about the event, please visit or call + 61 2 9229 1000. Alternatively, you can email

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Retrofitting Emergency Departments - The KPIs, process and strategic stages

  1. 1. Retrofitting Emergency Departments: The KPIs, process and strategic stages Q&A with Mark Aiken, Senior Project Manager at ARUP Retrofitting For Sustainability Summit 2011 Australian Healthcare Week 2011Retrofitting is a difficult task for any type of building but especially with healthfacilities, daily operations can be very disruptive to both the staff carrying out thetreatment and the patient seeking recovery, it’s therefore essential thatcommunication and collaboration between all.Health IQ : Why retrofit? What are the benefits of retrofitting health facilitiesand who will this benefit?Mark: Some of the key benefits for retrofitting health facilities really comingabout from the reduction of costs in capital outlays for the state government. Theother one I guess is because this project, for example, with an ED within an existinghospital campus, one of the key problems was that the ED’s locality to otherdepartment was essential to stay where it was, and there was a lack of the lack ofland available elsewhere or in close proximity to the area to allow us to actually buildnew, so just by the very constraints of the existing campus which we basically wereguided towards retrofitting.Health IQ: Can you highlight some innovative techniques which you appliedto the retrofit projects within the health facilities, why was it used and how itwould benefit the facility and/or the patients?Mark: In terms of innovative techniques, one of the techniques we recogniseobviously retrofitting an emergency department which is operational 24/7.Retrofitting every square inch of it and expanding it in a functional area brings abouta lot of risks. The key is obviously safety to patients. So, one of the techniques weutilised early on the piece was that we decided that what we needed was to reallycontrol that staging in a lot more controlled fashion.So we try to develop a more integrated project team, so the traditional method ofdesigning, you’d have your design teams that would then interact with user groupslike the Emergency Department, clinicians and nurses etc, in order to design thefacility. In addition to that, we held a couple of staging workshops, where the wholefocus of the one-day workshop was that the design team andthe user group teams got together and looked at how we might
  2. 2. actually stage the works. This ensured we didn’t impact our patient safety or clinicaloperations.So in doing that though one of the innovations that became notable I guess is theuser groups got to understand a lot more of the constraints around the design buildand the design team then understood the actual business of the ED, nurses and thedoctors on that site. I think this created a far better high-performing teamenvironment, which really brought everyone together, I think that was quiteinnovative and good; and rolling on from that, once we started getting in to thestaging works, we recognised that we are introduce a new style of clinical mode ofcare so to speak.So what we did was – we introduced change management process at the start of theconstruction period as well. So thereby - change is always easy to introduce whenat times of project change, to having construction work happening around with a timefor change for the nurse and the doctors, we introduce those – that changemanagement during construction, and I think that was quite effectively taken up betaken up.Health IQ: It says more about the culture as well as the project team. So howdo you continue to measure to retrofit with financially viable - so how can youensure your best return on investment.Mark AikenAgain, because a health facility doesn’t lean itself towards real economic andfinancial viability, one of the key drivers is the clinical services plan, so they’refollowing on from that whole keeping the project operational during construction.One of the KPIs we looked at was the patient wait times, and so what we did was –when we did introduce that fast track system (as part of the change managementprocess), we were able to counteract the increased wait times that will happen withconstruction on site. So what we did see over the first 8 months of construction, weactually saw a decrease is patient wait times because of an introduction of the fasttrack streaming process - that was one way we measured our success at this projectI suppose. It doesn’t have dollar incentive attached to it but what it does have is –people not waiting as long to critical care in an Emergency Department which I thinkhas a far better outcome than dollars.Health IQ: Now this is the topic that you would be speaking of at the conference,maybe take us to the process of the retrofit to ensure the building remains asfunctional as possible throughout these times and what strategies were employedspecifically.Mark: Specifically, we broke this project down into about 5 different stages.The first stage that we did was, we field out an area using a storeroom into a 3-bayfast track area that way we could fast track, carry 3, 4 or 5 patients through that area.That was done right before we even started doing any other work. And the firststage was obviously the ambulance bay and mainly working outat the front of the building, so we did that work first, and then in
  3. 3. order to reduce impact on patients arriving at ED, we actually slugged in a temporarydemountable building under there (as part of the waiting room), because that wasactually built into the construction cost, that then also becomes an asset for thehealth issue in the future, they can utilise that in remote clinics, up in northQueensland there are lot of areas with remote clinic use and that can be utilised inthose locations after this project is finished and then stage 3 basically internal fit outs,so that’s basically the short and sweet of it. It’s 2 years worth of mingler andconstruction. So it’s a long process for those guys operating at area but we’ve doneour best towards the contractor and the user groups to really minimise the impact onthe clinical service delivery and we’re closing on completion in January 2011,hopefully everything goes well between now and then.Mark Aiken will present at the conference on ‘Remaining Fully FunctionalThroughout the Retrofit Project’. The Australian Healthcare Week combines 5essential health events in to one big week. For more information on this particularstream visit or alternatively call at 02-9229-1000 for information or to register. You can also email us