ARCC_2015_Promedica

1. Research based practice:
Field Research +
Parametric Analysis in
Medical Planning and
Design
Upali Nanda, PhD
Camilla Moretti, AIA
Ryan Gathman, AIA
Adeleh Nejati, PhD
HKS Inc.

2. ……it is important to
define a problem before designing a solution
continuously test the solution to make sure it
works

3. Learn how field research and simulation tools can be combined
Explore how research and analytics can be rapidly deployed for design
Learn about how design decision making can be fundamentally transformed through
data and performance driven approaches
LEARNING OBJECTIVES
noun
1.
the systematic investigation into and
study of materials and sources in order to
establish facts and reach new
conclusions.
verb
1.
investigate systematically.

4. PROMEDICA TOLEDO HOSPITAL AND TOLEDO
CHILDREN’S HOSPITAL
Campus Overview
Community based since 1927
Operating 600 beds
Tertiary care, Level 1 Trauma
Center, 100,000+ ED visits,
Level 3 NICU, 24/7
Cardiology, Telestroke
Network

5. DESIGN PROCESS
JULY SEPTMAY JUNEAPRIL
CURRENT
STATE
FUTURE
STATE
DEMAND FORECAST
DESIGN
OPERATIONS
RESEARCH
GUIDING PRINCIPLES
WORKSHOPS

6. Reported Observed Spatial
RESEARCH
CURRENT STATE FUTURE STATE

7. PHASES OF
WORK
INTEGRATING
RESEARCH IN PRACTICE
FUNCTIONAL
DESIGN
IMPLEMENTATION
DOCUMENTS
RESEARCH
“INFORM”
CONCEPT
SD
DD
CA
CD
RESEARCH
“AND
CONFIRM”
TARGET
Create design aims based on key
performance goals of the organization
EXPLORE/ EXPERIMENT
Gather Knowledge; Understand Users;
Simulate Scenarios; Test Prototypes. Use
Tools That Balance Technology With Empathy
DEFINE
Link Design Solution to Performance Hypothesis
MEASURE
Identify key metrics in design and
performance and collect baseline data
MONITOR
Confirm design is implemented as planned;
towards targeted performance goals
TEST
Test the success of the design post-occupancy;
evaluate if target was achieved

8. RESEARCH: START WITH A TARGET
KEY PERFORMANCE INDICATORS

9. RESEARCH IN THE FIELD
A 2.5 DAY DESIGN DIAGNOSTIC

10. FIRST TO FILL UNIT
(mostly full
occupancy)
2 wings
4 nursing stations
20 rooms in each wing
2 meds/supply rooms
1 nourishment room
2 soiled linen
2 equipment
MED-SURG UNIT
KEY PERFORMANCE INDICATORS

11. Unused
Kitchen
Unused
Pyxis Rm
Opaque
Doors in
Meds/Su
pplies
Unit Clerk
Opp Side
Minimally
used
Consult
Rm
Off-stage
“hide-
aways”
SPACE UTILIZATION

12. COMMUNICATION 1
(Care Coordination)
Activities involving care coordination of a patient, team meetings and huddles,
work-related conversations with co-workers, educating and mentoring
COMMUNICATION 2
(Socialization)
Communications with co-workers but not pertaining to patient care or work;
socializing
DOCUMENTATION Charting, scanning, documenting, printing
MED 1
(Med Preparation)
This activity pertained to the preparation of medications
MED 2
(Med Administration)
This pertained to the delivery and administration of medication to the patient
PATIENT CARE 1 This pertained to any clinical activity involving patient interface
PATIENT CARE 2 This pertained to any non-clinical activity involving patient interface
ACTIVITY ANALYSIS

13. ACTIVITY ANALYSIS

14. ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY)

15. First two hours of shift
ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY vs. NIGHT)

16. Unit Clerk + Central Nurse
Station have visibility to only 3 of
10 rooms. There is also very little
visibility to staff, to call if
needed.
“We are constantly
moving patients to
get confused patients
closer to the nurses
station. They are way
too far away in the
back rooms.”
VISIBILITY
PARAMETRIC ANALYSIS + FIELD RESEARCH

17. WALKING

18. Proximity Calculator | Rapidly Generated Heat Map
Excessive
Distance
Reasonable
Distance
PROXIMITY ANALYSIS
PARAMETRIC MODELING

19. 200
115
83
81
79
68
59
59
50
24
0 50 100 150 200 250
Break Room
Nourishment
Conference
Soiled Work
Equipment
Ice
Main Nurse Station
Meds
Linen
Wow Stations
Average Distance to PR
DISTANCE
PARAMETRIC MODELING

20. FIELD RESEARCH +
PARAMETRIC ANALYSIS

21. PATIENT CARE: INDIVIDUAL ASSESSMENT NS→PR→NS
PATIENT CARE: ROUND ASSESSMENT
(at the start of and towards end of shift)
NS→PR1→PR2→...→PRn→NS
MEDICATION DELIVERY
NS→CS→PR→NS
NS→CS→NS(Docum/CareCoor)→PR→NS
CALL RESPONSE NS→PR→NS
WALKING IS MORE THAN “DISTANCE”
THE IMPORTANCE OF SEQUENCES

22. Nurse Station to Clean
Supplies/Medication Room
Clean Supplies/Medication
Room to Patient Room
Patient Room to Nurse Station
A SIMPLE MED EVENT

23. Nurse Station to Patient Room
Patient Room to Clean Supplies/Medication
Room
Clean Supplies/Medication Room to Patient
Room
Patient Room to Nourishment
Nourishment to Patient Room
Patient Room to Ice
Ice to Patient Room
Patient Room to Supplies
Supplies to Patient Room
Patient Room to Linen
Linen to Patient Room
Patient Room to Soiled
Soiled to Nurse Station
A SAMPLE MED EVENT

24. FIELD RESEARCH  PARAMETRIC MODEL
DEVELOPING A SEQUENCE MAPPER
BASED ON FIELD RESEARCH
SO EVERY DESIGN CONFIGURATION
CAN BE ASSESSED

25. Comparison of actual vs. optimal task pathways showed that
multitasking not only didn’t decrease nurses’ travel distance,
it also slightly increase their walking.
MYTH: MULTI-TASKING REDUCES TIME

26. RESEARCH DURING DESIGN
PARAMETRIC ANALYSIS OF PLAN CONFIGURATIONS

27. UNIT CONFIGURATION

28. VISIBILITY & COLLABOTATION

29. UNIT SECURITY & CORE POROSITY

30. THE PROCESS

31. MED-SURG: THE ONE THING
Current State:
• Waste and variability in walking
• Limited point of use access to
supplies
• Bed-side monitors unused
• Low visibility and connectivity
• Corridor as workspace
• Unaccommodated WOWs
Future State:
• Decentralization with
connectivity between nodes
• Point of use supplies
• Proximity of meds/ supplies/
nourishment
• Care coordination facilitation
IT’S ALL ABOUT THE WALK- BUT MUCH MORE THAN DISTANCES

32. MED-SURG: THE ONE THING
Current State:
• Waste and variability in walking
• Limited point of use access to
supplies
• Bed-side monitors unused
• Low visibility and connectivity
• Corridor as workspace
• Unaccommodated WOWs
Future State:
• Decentralization with
connectivity between nodes
• Point of use supplies
• Proximity of meds/ supplies/
nourishment
• Care coordination facilitation
IT’S ALL ABOUT THE WALK- BUT MUCH MORE THAN DISTANCES

33. WHY THIS MATTERS
CURRENT
STATE
FUTURE
STATE
The Field Research + Parametric Analysis helped us see what we didn’t see
before
Helped us have more informed conversations with our people
Helped us create clear targets going forward
Helped us Achieve
Getting nurses closer to the patients
Decrease time away from the bed
Improve Key Performance Indicators
HCAHPS
Falls with Injury
Errors
Staff Satisfaction
OWNER’S PERSPECTIVE

34. PHASES OF
WORK
INTEGRATING
RESEARCH IN PRACTICE
FUNCTIONAL
DESIGN
IMPLEMENTATION
DOCUMENTS
RESEARCH
“INFORM”
CONCEPT
SD
DD
CA
CD
RESEARCH
“AND
CONFIRM”
TARGET
Create design aims based on key
performance goals of the organization
EXPLORE/ EXPERIMENT
Gather Knowledge; Understand Users;
Simulate Scenarios; Test Prototypes. Use
Tools That Balance Technology With Empathy
DEFINE
Link Design Solution to Performance Hypothesis
MEASURE
Identify key metrics in design and
performance and collect baseline data
MONITOR
Confirm design is implemented as planned;
towards targeted performance goals
TEST
Test the success of the design post-occupancy;
evaluate if target was achieved

35. De Ja VuVe Ja Du

36. Ready for Questions & Comments
unanda@hksinc.com