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PDC_2015_People Side of Change

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PDC_2015_People Side of Change

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PDC_2015_People Side of Change

  1. 1. The People Side of Change Managing Expectations Early to Eliminate Workarounds Post Occupancy Informing the transition process
  2. 2. Jennie Evans, RN, BS, EDAC, LEEP AP, Lean Six Sigma CE Associate Principal and Sr. Vice President HKS Architects Adeleh Nejati, PhD, MArch, EDAC Architect and Design Researcher HKS Architects Meredith Slosberg, MBA, FACHE, CSC Lean Six Sigma Green Belt Deployment Leader Organizational Effectiveness Akron Children's Hospital Acknowledgment: Center for Advanced Design Research and Evaluation Principal Investigator: Upali Nanda
  3. 3. 1. Articulate the relationship between project planning and transition planning for people. 2. Identify opportunities to deploy change engagement directives during the project planning and implementation process. 3. Identify why change engagement is necessary, and effective, in all planning and design projects, based on systematically collected data. 4. Learn about three key talking points to begin conversations about implementation in your organization.
  4. 4. 275,000 sf patient care tower  75 bed NICU  39 room emergency department  6-OR outpatient surgery center  High risk delivery area Continuing to deliver on the promises that were written in 1890, our campus expansion will enhance the high quality, compassionate and family- centered care that we have delivered to the communities we serve for over 120 years.
  5. 5. Pre-Design Design Transition Occupancy Visioning Emerging Trends Current to Future State Site Visits Site Visits Dept. Mock Ups Spaghetti Diagrams Expectation Check Survey Ambassadors Pulse points Leadership Training Ambassadors Trials Post Design Mock-up Pulse Points Expectation Check Survey Akron: Integrating Design and Change Management
  6. 6. Existing ED Future ED 39 Rooms 27,907 DGSF 26 Rooms 21,800 SF
  7. 7. Future NICUExisting NICU 59 Beds 27,843 SF 63 Private / 6 Twin = 75 Beds 68,179 DGSF
  8. 8. • Preparedness must consider model of care and work flow differences in • Team Collaboration • Visibility • Walking distances • Care delivery processes • Post-occupancies identify spaces are not always used as intended • Communication pathways are not established • Team collaboration / Devices are under utilized • Decentralized work stations are not used • Visibility of peers • Nurse servers are not used • Walking Distances Recent survey of healthcare administrators cites failure to create buy-in as one of the top 2 barriers to sustainable change. • American College of Healthcare Executives, Journal of Healthcare Management
  9. 9. progress productivity (effort) project management timeline human response to change goal change management area of impact endings exploration new beginnings Source: Pritchett LLC
  10. 10. Pre-Design Design Transition Occupancy Visioning Emerging Trends Current to Future State Site Visits Site Visits Dept. Mock Ups Spaghetti Diagrams Expectation Check Survey Ambassadors Pulse points Leadership Training Ambassadors Trials Post Design Mock-up Pulse Points Expectation Check Survey Akron: Integrating Design and Change Management
  11. 11. Survey 1 Survey 2 June 2013 Oct 2013 May 2014 ED Timeline Survey 3 Survey 4 Jan 2015 June 2015 1. Leader Training Starts 2. Trials Start 3. Town Halls 4. Pulse Points Start 5. Trauma Room Mock up 6. Ambassadors Design Phase Complete
  12. 12. 1. Leader Training Starts 2. Focus Groups Survey 1 Survey 2 Design Phase Complete June 2013 Oct 2013 June 2014 NICU Timeline Trials Start Survey 3 Survey 4 Nov 2015 June 2015
  13. 13. • Awareness • Language and storytelling • Messaging • On-going dialogue • Values and Key Behaviors • Pulse Points
  14. 14.  Formalize it  Overt communicate  Venues − Daily Huddles − Staff meetings − Department meetings − Governance councils − Town halls − Focus groups − Email and intranet − Ambassadors − Surveys
  15. 15. NICU Focus Groups, Focused Voice Fears • Loneliness • Lack of help from fellow nurses • Increased dependence on technology • Looking incompetent for asking for help Leadership Advocacy • Communication technology • Simulation time • Parent/family expectations Single room line of sight and patient safety
  16. 16.  When town halls don’t work  Prn/evenings/week-ends/tight shifts  1:10 ratio  Flash drives or intranet  Consistent regular messaging from leadership to staff and back  Regular meetings for Ambassadors
  17. 17. • Respiratory • Fast Track • Distance to Transport • Suture Cart • Communication devices • Pulse Ox • Staffing Model • Supply carts
  18. 18. Stake holder Issue Action RN -Develop/implement new FT/triage process -Development of staffing model for new ED -Develop education and communication plan -Continue use of ambassadors, tours and behaviors/values role out Physicians -Staffing -New roles/interactions with fellows -Room assignments -Even flow of patients through entire ED -Develop education and communication plan -Recruitment -Consider flow/teamwork when developing new FT/triage process NPs Registration/Secretaries Respiratory Integrating Transport in ED operation -continue presence at huddles in ED -Global plan around integrating into services in new building Mental Health Technicians -maintaining consistent processes with new and revolving staff -developing guidebook for RN/MHT staff -scripting to communicate what to expect to families MAs Suture Staff -integrating suture staff in FT -geographic separation creates some challenges in communication/touchdown space -uncertainty around change at satellites -continue to monitor, remind ED staff of where suture staff may reside
  19. 19.  To do a regular check in with the staff to assess their perceptions, expectations and level of preparedness for the move  To use the survey results to inform specific change engagement initiatives  To analyze the survey to understand how involvement in the design of the new facility, and new processes, contributes to staff preparedness and adaptation for the new move
  20. 20. ED 1: N= 47 ED 2: N= 88 14.9 51.1 31.9 4.34.5 9.1 68.2 18.2 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 Leadership Medical staff Clinical staff Non-clinical staff %ofParticipants Job Role ED 1 ED 2 12.8 6.4 48.9 10.6 8.5 2.1 10.69.1 11.4 42.0 9.1 8.0 10.2 9.1 0.0 10.0 20.0 30.0 40.0 50.0 60.0 < 6 mths < 1 yr 1-5 yrs 6-10 yrs 10-15 yrs 15-20 yrs > 20 yrs %ofParticipants Years of Experience ED 1 ED 2 ED Survey Demographic
  21. 21. 16.3 8.2 71.4 4.1 9.3 2.3 86.0 2.3 0.0 20.0 40.0 60.0 80.0 100.0 Leadership Medical staff Clinical staff Non-clinical staff %ofParticipants Job Role NICU1 NICU2 8.2 6.1 30.6 6.1 6.1 8.2 34.7 2.3 2.3 46.5 9.3 2.3 4.7 32.6 0.0 10.0 20.0 30.0 40.0 50.0 < 6 mths < 1 yr 1-5 yrs 6-10 yrs 10-15 yrs 15-20 yrs > 20 yrs %ofParticipants Years of Experience NICU1 NICU2 NICU 1: N= 49 NICU 2: N= 43 NICU Survey Demographic
  22. 22. Level of Involvement and Knowledge Type of Involvement in the Facility Design Type of Involvement in the Process Design Perception of Preparedness How prepared do you feel to work in the new environment? Perception of Adaptation To what extent do you feel your involvement in/ knowledge of design will help you adapt to your new environment? Preparedness Make ready ahead of time Adaptation Adjust to a new state
  23. 23. 3.4 1.4 1.8 1.6 2.2 2.5 3.7 0.9 1.7 1.6 2.6 2.6 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Years of Experience Level of Involvement Level of Facility Knowledge Level of Process Knowledge Preparedness Adaptation ED1 ED2 Summary Results for ED and NICU Surveys – Mean Comparison T-test: Significantly different from Survey 1 to 2 NICU 1: N= 49 NICU 2: N= 43 ED 1: N= 47 ED 2: N= 88 4.6 1.4 2.0 1.4 1.9 2.6 4.5 1.4 2.2 1.5 2.1 2.7 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Years of Experience Level of Involvement Level of Facility Knowledge Level of Process Knowledge Preparedness Adaptation NICU1 NICU2
  24. 24. Importance of involvement in design phase will be a recurring theme today For ED, a range of activities informed preparedness including:  10 trials  Ambassadors  Leadership training  Interactive mock-up of trauma room Some leadership/staff trust issues were more pressing. Only a small core group involved. Leadership matters!
  25. 25. 27.7 31.9 29.8 10.6 8.0 36.4 39.8 15.9 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 Not at all A little bit Moderately so Very much so %ofParticipants ED1 ED2 32.7 44.9 18.4 4.1 14.0 65.1 16.3 2.3 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 Not at all A little bit Moderately so Very much so %ofParticipants NICU1 NICU2 NICU 1: N= 49 NICU 2: N= 43 ED 1: N= 47 ED 2: N= 88
  26. 26. 23.4 21.3 36.2 19.1 10.2 39.8 33.0 17.0 0.0 10.0 20.0 30.0 40.0 50.0 Not at all A little bit Moderately so Very much so %ofParticipants ED1 ED2 10.2 42.9 28.6 18.4 7.0 39.5 30.2 23.3 0.0 10.0 20.0 30.0 40.0 50.0 Not at all A little bit Moderately so Very much so %ofParticipants NICU1 NICU2 NICU 1: N= 49 NICU 2: N= 43 ED 1: N= 47 ED 2: N= 88
  27. 27. Level of involvement in the facility design Level of Knowledge of New Facility Level of Knowledge of New Process Preparedness Make ready ahead of time Adaptation Adjust to a new state[S1, S2] [S1] ED Survey Result Level of Involvement & Knowledge [S1] [S2] Correlation Prediction Survey 1 Survey 2
  28. 28. Preparedness Make ready ahead of time Adaptation Adjust to a new state[S1, S2] Level of Knowledge of New Facility Level of Knowledge of New Process Level of involvement in the facility design NICU Survey Result Level of Involvement & Knowledge [S1] [S2] Correlation Prediction Survey 1 Survey 2
  29. 29. Level of involvement in the facility design Preparedness Make ready ahead of time Adaptation Adjust to a new state Level of Knowledge Process Facility ED only Summary Result Level of Involvement & Knowledge
  30. 30. Being involved in facility design was key: • To increase knowledge of process and knowledge of environment • To increase ED’s perceptions of both preparedness and adaptation • To increase NICU’s perception of adaptation but not preparedness This points to how the future design configuration affects the current model of care. The new NICU design has a huge impact on current model of care. The new ED is a larger space but has less impact on the model of care. Preparedness and adaptation seem to be more closely aligned when the new model of care is similar to the old model of care.
  31. 31. Knowledge of facility and knowledge of process did not have the same impact on each group. • Knowledge of process and facility increased NICU’s perception of their ability to be ready ahead of time. • Knowledge of facility increased ED’s perception of their ability to adjust to the new space. • Knowledge of process increased ED’s perception of their ability to be ready ahead of time. Since our goal is to have our employees ready to utilize the space in a way that is congruent with intended use we need to pay attention to providing them with both types of information. However, one group may need a certain type of information more than the other and at different times in the transition process.
  32. 32. Pre-Design Design Transition Occupancy Part of design team Tour mock up Patient care processes Choosing design options Workshop report outs Regular communication Part of design team Tour mock up Patient care processes Choosing design options Workshop report outs Regular communication Trialing new equip/ tech Trial new equip/tech Leadership training Focus groups Regular communication Trial new equip/tech Leadership training Focus groups Regular communication
  33. 33. 13 23 9 6 7 27 7 20 4 9 11 69 0 10 20 30 40 50 60 70 80 Part of the Design Team Tour Mock-up Create Patient Care Processes Choose Design Options Attend Workshops report outs Regular Communication NumberofParticipants ED1 ED2 10 13 10 16 8 38 5 13 7 6 3 39 0 10 20 30 40 50 60 70 80 Part of the Design Team Tour Mock-up Create Patient Care Processes Choose Design Options Attend Workshops report outs Regular Communication NumberofParticipants NICU1 NICU2 NICU 1: N= 49 NICU 2: N= 43 ED 1: N= 47 ED 2: N= 88
  34. 34. NICU 1: N= 49 NICU 2: N= 43 ED 1: N= 47 ED 2: N= 88 46.9 14.3 28.6 44.2 9.3 34.9 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Trial of New Equipment & Technology Leadership Training Focus Groups %ofParticipants NICU1 NICU2 23.4 21.3 31.9 35.2 6.8 12.5 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 Trial of New Equipment & Technology Leadership Training Focus Groups %ofParticipants ED1 ED2
  35. 35. Involved in trialing new equipment and technology Preparedness Make ready ahead of time Adaptation Adjust to a new state Involved in leadership training Involved in focus groups Part of the design team Toured the mock up Involved in creating the patient care processes in the new department Involved in choosing unit design options for the new department Attended the workshop report outs either in person or via webex Receive and read regular communication on your unit design TypeofInvolvementin FacilityDesign TypeofInvolvementin ProcessDesign [S1] [S1] [S2] Prediction Survey 1 Survey 2 ED Results
  36. 36. Preparedness Make ready ahead of time Adaptation Adjust to a new state [S2] Involved in trialing new equipment and technology Involved in leadership training Involved in focus groups Part of the design team Toured the mock up Involved in creating the patient care processes in the new department Involved in choosing unit design options for the new department Attended the workshop report outs either in person or via webex Receive and read regular communication on your unit design [S1] [S2] Prediction Survey 1 Survey 2 TypeofInvolvementin FacilityDesign TypeofInvolvementin ProcessDesign NICU Results
  37. 37. Part of the design team Preparedness Make ready ahead of time Adaptation Adjust to a new state  Touring the mock up  Creating the patient care processes  Attending the workshop report outs ED  Trialing new equip/ tech  Leadership training  Focus groups NICU ED & NICU Summary Result Type of Involvement Process design involvement is more critical when the model of care changes
  38. 38. Key Learnings: Type of Involvement • Being part of design team led to both more adaptation and preparedness for ED and NICU • ED’s involvement in design activities led to more adaptation • NICU’s involvement in process activities led to more preparedness We’ve said this multiple times. Being actively involved in the design phase of the project matters when it comes to being prepared and adapting to a new space. Type of involvement produces different results. Understanding the type of involvement that leads to either adaptation or preparedness help leaders select the best activities for change engagement.
  39. 39. Summary of ED Qualitative Results ED1 and ED2 ED1 ED2 Excited about Newness, clean environment, more space, better patient flow and processes. Concerned about Proximity to main hospital, adjusting to changes, staffing issues Lack of involvement in design, not enough computers. Communications Facility designers Should have Involved more staff, considered PICU and or locations, design issues. Management/ senior leadership should have Involved more staff, considered PICU and or locations Design issues Comments Looking forward to prepare for move, see new building, staffing.
  40. 40. Summary of NICU Qualitative Results NICU1 and NICU2 NICU1 NICU2 Excited about Private rooms, clean and new environment Windows New equipment Concerned about Staffing, patient safety Size of unit vis-à-vis response time, not able to see babies constantly, how to get help in emergent situations, not having enough time with babies (parent satisfaction), distance between patients and supplies Nurse safety, staff morale, proximity of staff Facility designers Should have Involved more staff members Designed private rooms and pods Made rooms smaller Management/ senior leadership should have Considered staffing Involved more staff Be concerned about staff concerns Comments Familiarize with space and processes before moving, tour facility, staffing Have concerns addressed Discuss workflow and processes, practice on new communication system
  41. 41. Pre-Design Design Transition Occupancy Akron: Integrating Design and Change Management Visioning Emerging Trends Current to Future State Site Visits Site Visits Dept. Mock Ups Spaghetti Diagrams Expectation Check Survey Ambassadors Pulse points Leadership Training Ambassadors Trials Post Design Mock-up Pulse Points Expectation Check Survey
  42. 42. progress productivity (effort) project management timeline human response to change GO LIVE endings exploration new beginnings human response to change post go-live! Source: Pritchett 2013 and Meredith Slosberg 2014
  43. 43. Design Team  Recommend the need for pre- design operational planning with cross-functional teams  Choose design team members who will serve as ambassadors - Provide job descriptions  Implement initiatives to engage staff who are not at design table - Collect responses to specific questions - Post images / drawings - Communicate - Solicit constant feedback Healthcare Leadership  Integrate Change Engagement concepts into the design/project plans  Create early dialogue with all staff and continue through post go-live − go to the people − use many modalities  Establish ambassador program − how to get many voices while maintain a small decision-making group  Establish pulse point checks and continue three to six months post occupancy
  44. 44. • What interventions help staff prepare and adapt and when should they be implemented? • What kind of ripple effect do these results (with the staff) have on the patient and family? • What role does leadership play in the staff’s willingness to adapt and be prepared? • What design process is the most effective for preparing staff for their new environment?

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