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Research based practice:
Field Research +
Parametric Analysis in
Medical Planning and
Design
Upali Nanda, PhD
Camilla More...
……it is important to
define a problem before designing a solution
continuously test the solution to make sure it
works
Learn how field research and simulation tools can be combined
Explore how research and analytics can be rapidly deployed f...
PROMEDICA TOLEDO HOSPITAL AND TOLEDO
CHILDREN’S HOSPITAL
Campus Overview
Community based since 1927
Operating 600 beds
Ter...
DESIGN PROCESS
JULY SEPTMAY JUNEAPRIL
CURRENT
STATE
FUTURE
STATE
DEMAND FORECAST
DESIGN
OPERATIONS
RESEARCH
GUIDING PRINCI...
Reported Observed Spatial
RESEARCH
CURRENT STATE FUTURE STATE
PHASES OF
WORK
INTEGRATING
RESEARCH IN PRACTICE
FUNCTIONAL
DESIGN
IMPLEMENTATION
DOCUMENTS
RESEARCH
“INFORM”
CONCEPT
SD
DD...
RESEARCH: START WITH A TARGET
KEY PERFORMANCE INDICATORS
RESEARCH IN THE FIELD
A 2.5 DAY DESIGN DIAGNOSTIC
FIRST TO FILL UNIT
(mostly full
occupancy)
2 wings
4 nursing stations
20 rooms in each wing
2 meds/supply rooms
1 nourishm...
Unused
Kitchen
Unused
Pyxis Rm
Opaque
Doors in
Meds/Su
pplies
Unit Clerk
Opp Side
Minimally
used
Consult
Rm
Off-stage
“hid...
COMMUNICATION 1
(Care Coordination)
Activities involving care coordination of a patient, team meetings and huddles,
work-r...
ACTIVITY ANALYSIS
ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY)
First two hours of shift
ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY vs. NIGHT)
Unit Clerk + Central Nurse
Station have visibility to only 3 of
10 rooms. There is also very little
visibility to staff, t...
WALKING
Proximity Calculator | Rapidly Generated Heat Map
Excessive
Distance
Reasonable
Distance
PROXIMITY ANALYSIS
PARAMETRIC MOD...
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 Nurs...
FIELD RESEARCH +
PARAMETRIC ANALYSIS
PATIENT CARE: INDIVIDUAL ASSESSMENT NS→PR→NS
PATIENT CARE: ROUND ASSESSMENT
(at the start of and towards end of shift)
NS→...
Nurse Station to Clean
Supplies/Medication Room
Clean Supplies/Medication
Room to Patient Room
Patient Room to Nurse Stati...
Nurse Station to Patient Room
Patient Room to Clean Supplies/Medication
Room
Clean Supplies/Medication Room to Patient
Roo...
FIELD RESEARCH  PARAMETRIC MODEL
DEVELOPING A SEQUENCE MAPPER
BASED ON FIELD RESEARCH
SO EVERY DESIGN CONFIGURATION
CAN B...
Comparison of actual vs. optimal task pathways showed that
multitasking not only didn’t decrease nurses’ travel distance,
...
RESEARCH DURING DESIGN
PARAMETRIC ANALYSIS OF PLAN CONFIGURATIONS
UNIT CONFIGURATION
VISIBILITY & COLLABOTATION
UNIT SECURITY & CORE POROSITY
THE PROCESS
MED-SURG: THE ONE THING
Current State:
• Waste and variability in walking
• Limited point of use access to
supplies
• Bed-...
MED-SURG: THE ONE THING
Current State:
• Waste and variability in walking
• Limited point of use access to
supplies
• Bed-...
WHY THIS MATTERS
CURRENT
STATE
FUTURE
STATE
The Field Research + Parametric Analysis helped us see what we didn’t see
befo...
PHASES OF
WORK
INTEGRATING
RESEARCH IN PRACTICE
FUNCTIONAL
DESIGN
IMPLEMENTATION
DOCUMENTS
RESEARCH
“INFORM”
CONCEPT
SD
DD...
De Ja VuVe Ja Du
Ready for Questions & Comments
unanda@hksinc.com
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ARCC_2015_Promedica

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ARCC_2015_Promedica

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ARCC_2015_Promedica

  1. 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. 2. ……it is important to define a problem before designing a solution continuously test the solution to make sure it works
  3. 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. 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. 5. DESIGN PROCESS JULY SEPTMAY JUNEAPRIL CURRENT STATE FUTURE STATE DEMAND FORECAST DESIGN OPERATIONS RESEARCH GUIDING PRINCIPLES WORKSHOPS
  6. 6. Reported Observed Spatial RESEARCH CURRENT STATE FUTURE STATE
  7. 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. 8. RESEARCH: START WITH A TARGET KEY PERFORMANCE INDICATORS
  9. 9. RESEARCH IN THE FIELD A 2.5 DAY DESIGN DIAGNOSTIC
  10. 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. 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. 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. 13. ACTIVITY ANALYSIS
  14. 14. ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY)
  15. 15. First two hours of shift ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY vs. NIGHT)
  16. 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. 17. WALKING
  18. 18. Proximity Calculator | Rapidly Generated Heat Map Excessive Distance Reasonable Distance PROXIMITY ANALYSIS PARAMETRIC MODELING
  19. 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. 20. FIELD RESEARCH + PARAMETRIC ANALYSIS
  21. 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. 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. 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. 24. FIELD RESEARCH  PARAMETRIC MODEL DEVELOPING A SEQUENCE MAPPER BASED ON FIELD RESEARCH SO EVERY DESIGN CONFIGURATION CAN BE ASSESSED
  25. 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. 26. RESEARCH DURING DESIGN PARAMETRIC ANALYSIS OF PLAN CONFIGURATIONS
  27. 27. UNIT CONFIGURATION
  28. 28. VISIBILITY & COLLABOTATION
  29. 29. UNIT SECURITY & CORE POROSITY
  30. 30. THE PROCESS
  31. 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. 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. 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. 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. 35. De Ja VuVe Ja Du
  36. 36. Ready for Questions & Comments unanda@hksinc.com

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