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HCD_2013_Akron Perception

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HCD_2013_Akron Perception

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HCD_2013_Akron Perception

  1. 1. #HCDCon
  2. 2. Perception is Real; Perception is Reality Understanding perceptual realities to resolve human factors/change management issues Jennie Evans, RN, BS, LEED AP, EDAC, Vice President, HKS Architects Meredith Slosberg, EMBA, Deployment Leader, Akron Children's Hospital Upali Nanda, PhD, EDAC, Vice President, Director of Research. Executive Director, CADRE
  3. 3. Agenda • Setting the Stage • Perception: What is it? Why it matters… • Staff Perception of Design • Tools to Use
  4. 4. Objectives Establish an understanding of: – The importance of perception and the need to address it in the design approach – How nurses’ perception to certain design attributes can affect operational efficiency and team work – How to recognize resistant behaviors and how to address them on your project – Tools that can be applied to a design project, your team, or within your firm
  5. 5. Akron Children’s Hospital 275,000 sf patient care tower • 30-room emergency department • 72-bed neonatal intensive care • 6-OR outpatient surgery center • Shell space: maternal/ fetal
  6. 6. Guiding Principles • Patient-centered healing environment • Multi-disciplinary approach to care • Ability to recruit and retain the highest quality physicians • Facility design with life cycle and operational costs in mind • Facility that is a beacon to the community • Organization that supports the future of healthcare delivery
  7. 7. Integrated Project Delivery Integrated Project Delivery Structural Landscape Architecture Construction Operations MEP Facility Operations & Clinical Operations
  8. 8. Integrated Clinical Operations 4 Workshops Per Team + Design • 20 – 25 design team members – Physicians – Nurses – Ancillary – Support • Staff lean training • Consultant Lean training Integrated Operations Rehabilitative Services Materials Management EVS Pharmacy Lab Respiratory
  9. 9. Step 1 – Value Stream Mapping Value Stream Mapping Extraordinaire • Done in advance of the workshops • Dedicated operational improvement staff (Center of Operational Excellence)
  10. 10. Step 2: 3P Event – Paper Dolls Integrating Process into Design • Draft space program • Stacking • Translated the value stream map into design • 7 revisions
  11. 11. Step 3: Full Scale Mock Ups Full scale mock up – Week long workshops – Built full departments – Falcon board on stands – Rooms sized to plan Scenarios – Patient care scenarios verified configuration – Identified where new processes were required – Identified conversations required with other departments
  12. 12. Process Value Add 1. Understand consequences, design choices and competing priorities 2. Understand space and choice in design outcome 3. Understand processes and initiate change management 4. Several people understand and communicate the future state
  13. 13. Akron Value Add • Team performance moved from low to high • Leaders emerged • Team commitment to design • Initiated change management
  14. 14. With the best intentions in design… Why is operationalizing still a challenge?
  15. 15. Is the nature of change dictated by facility design or process design? Process Design Facility Design
  16. 16. PROCESS DESIGN NEED FOR PATIENT and family privacy and increased individual MONITORING DE-CENTRALIZED NURSING STATION and single rooms versus arena rooms DESIGN PROCESS DE-CENTRALIZED NURSING STATION and single patient rooms CHANGE IN SOCIAL INTERACTION and daily communication BETWEEN NURSES PROCESS DESIGN CHANGE IN SOCIAL INTERACTION and daily communication BETWEEN NURSES SOCIAL HUBS / BREAK ROOMS ON THE UNIT/reliable, easy to use technology
  17. 17. Perception Facility Design Process Design
  18. 18. Perception (from the Latin perceptio, percipio) is the organization, identification, and interpretation of sensory information in order to represent and understand the environment. (wiki) Perception is the lens through which we see the world
  19. 19. Change starts with a perception of its need, so a wrong initial perception is the first barrier to change http://www.uv.es/~pardoman/resistencias.PDF Change and Perception
  20. 20. • Changes in the workplace naturally create uncertainty and can be emotionally challenging • Nurses often feel that change is imposed on them and their views are not taken into consideration. This perception does little to empower them to own changes occurring and adapt behaviors to sustain improvements (Bowers, 2011) Source: Press Ganey comparison of customer satisfaction and employee satisfaction scores of 18 hospitals in their database Change and Perception
  21. 21. 1. Myopia or inability of the company to look into the future with clarity 2. Denial or Refusal to accept any information not expected / desired 3. Perpetuation of ideas- the tendency to go with the present thoughts though the situation has changed 4. Implicit assumptions 5. Communication barriers 6. Organizational silence http://www.uv.es/~pardoman/resistencias.PDF Resistance to Change
  22. 22. Change and Motivation Resistance to change may also be due to low motivation for change caused by: 1. Direct costs of change – Loss of daily interaction with the team 2. Cannibilization cost- change brings success to a product but at the same time losses to others – Privacy benefit to patient, loss to staff 3. Past failures – Concerns about resource support – technology choices 4. Different interests among employees and management http://www.uv.es/~pardoman/resistencias.PDF
  23. 23. Driving and Resisting Forces A Force Field Analysis of IT change 1. Participation 2. Communication 3. Competency 1. Fear 2. Lack of skill
  24. 24. What role do “expectations” play in shaping perceptions? Measure perception But also measure expectation SATISFACTION -5 PERCEPTION 5 EXPECTATION 10 = -
  25. 25. Expectation Survey Pulse-point surveys at every 4 months – till 6 months post-occupancy Involvement Expectation Perception
  26. 26. Akron Expectation Survey 30% 50% 19% 1% How prepared do you feel to work in the new environment Not at all Little bit Moderately Very much so
  27. 27. Expectation Survey Knowledge of New Environment None Low Medium High Very high Rating Count Level of involvement in the new design 27.0% (10) 32.4% (12) 13.5% (5) 16.2% (6) 10.8% (4) 37 Level of knowledge about the new environment 2.7% (1) 21.6% (8) 48.6% (18) 21.6% (8) 5.4% (2) 37 Level of knowledge about the new processes regarding patient care, support and ancillary services? 11.1% (4) 58.3% (21) 19.4% (7) 8.3% (3)2.8% (1) 36
  28. 28. Expectation Survey Key Expectations N IC U RATING IN V O L V E M E N T K N O W L E D G E -E N V IR O N M E N T K N O W L E D G E -P R O C E S S E S P R E P A R E D IN V O L V E -A D A P T E X P E C T -E F F IC IE N C Y E X P E C T -M A IN T E N A N C E & a m p ;C L E A N IN G E X P E C T -C O M M U N IC A T IO N E X P E C T -P A T IE N T E X P E R IE N C E E X P E C T -P A T IE N T S A F E T Y E X P E C T -F A M IL Y E X P E R IE N C E E X P E C T -S T A F F E X P E R IE N C E E X P E C T -D IA G N O S T IC -C O N N E C T IO N E X P E C T -A C C E S S -S U P P L IE S E X P E C T -S T O R A G E -S U P P L IE S E X P E C T -P A T IE N T H A N D L IN G E X P E C T -C O L L A B O R A T IO N E X P E C T -R E D U C E D -N O IS E E X P E C T -R E D U C E D -S T R E S S 0 2 4 6
  29. 29. Expectation Survey The relationship between involvement and expectation Involveme nt Expecta tion Percepti on INVOLVEMENT IN DESIGN PROCESS SIGNIFICANTLY CORRELATED TO KNOWLEDGE OF ENVIRONMENT AND KNOWLEDGE OF PROCESSES. NOT CORRELATED TO HOW PREPARED NURSES FEEL. LOWER EXPECTATIONS FOR STAFF CONCERNS COMPARED TO PATIENT CONCERNS INVOLVEMENT IN DESIGN HIGHLY CORRELATED TO THE FOLLOWING: EXPECTATION OF EFFICIENCY EXPECTATION OF ACESS TO SUPPLIES EXPECTATION OF PATIENT HANDLING EXPECTATION OF IMPROVED COLLABORATION EXPECTATION OF PATIENT SAFETY INVOLVMENT IN DESIGN NOT CORELATED TO PATIENT EXPERIENCE AND FAMILY EXPERIENCE RATINGS
  30. 30. “It’s the Size of a Football Field”
  31. 31. Leading Transition During Change Impact on people
  32. 32. Transition During Change Impact on People progress productivity (effort) project management timeline human response to change GOAL change management area of impact endings exploration new beginnings
  33. 33. Transition During Change Three Themes 1. Actively solicit staff and provider voices beyond the leadership level throughout process design 2. Manage expectations 3. Close gap between perception and reality
  34. 34. All 3 Themes Leadership Training Emergency Services Outpatient Surgery NICU
  35. 35. Actively Solicit Staff and Provider Voices
  36. 36. THEMES – Emergency Medicine Leaders Should • Get more involvement of staff Hope We Can • See floor plan • Have mock trials • Trial, trial, trial • Orient • Spend time in new space THEMES - NICU Leaders Should • Address staffing concerns • Get more nursing voice Hope We Can • Get familiar with new space • Work on processes • Investigate new unit • Spend time in new unit • Trial equipment • Trial mock assignments Expectation Survey Pulse Point Surveys- Every 4 months till 6 months after occupancy
  37. 37. Focused Group, Focused Voice Fears • Loneliness • Lack of ready help from fellow nurses • Increased dependence on technology • Looking incompetent for asking for help Leadership Advocacy • Communication technology • Simulation time • Parent/family expectations
  38. 38. Manage Expectations
  39. 39. Manage Expectations Dependability Family Teamwork Respect Flexibility • Productivity • Strength • Happiness • Passionate • Health • Faith • Passionate • Courage • Positive Perseverance • Unexpected Delights • Strong Work Ethic • Honest • Trust • Truth • Manners • Authenticity • Transparent • True to yourself • Compassionate • Loyalty • Integrity • Courage • Passionate • Creativity • Open-minded • Seeking new learning opportunities We Love Children! Pediatric Environment is Very Satisfying Friendly Culture @ ACH • Love of children • Positive outcomes for children • Seeing children melts your heart • Help kids • Support families so they don’t feel alone • Voice for children • Get to be a “big kid” • Save a kid’s life • Culture vs. Adult – more teamwork here • We get to fix things for others • Problem-solvers • Feel connected to bottom line – helping families and children • Engaging families • MDs actually talk to you • Someone will always help you • Impressed by friendly staff/surgeons • Warm, welcoming team • Try to do the right thing all of the time Welcoming Clean Efficient • “Can I help you with this patient?” • Friendly • People smiling • Kids laughing • Nervous parents feel like only their child is there today • Teamwork • Upbeat, positive, friendly, welcoming, smiling, laughing • Cooperative, calm parents • Happy to be in a good facility • Clean • Smells clean • Bright • Uncluttered • Efficient, but unrushed • Nice pace • Organized • Quiet with a bit of crying • Awesome huddle board • Busy – controlled Key Behavioral Indicators 1. Make eye contact, smile and acknowledge all team members, patients and families. 2. Give and accept constructive feedback from all team members. 3. Actively engage each other in creating a positive patient experience through continuous process improvement. 3 Promises Master Plan Guiding Principles
  40. 40. Manage Expectations Lean Six Sigma Education
  41. 41. Manage Expectations Communication: Timeline, Huddles, Ambassadors, Interactive Boards
  42. 42. Close The Gap Between Perception and Reality
  43. 43. Trialing
  44. 44. Close the Gap Between Perception and Reality Creative reality checks, orientation, simulation
  45. 45. Closing The Gap early….. • Facility mock-ups MANDATORY for a much larger group of staff and providers – Not voluntary – address clinical culture changes • Make future CARE DELIVERY model much more widely disseminated earlier to all staff and providers impacted by the design • Have designers ADVOCATE for a design that blends a little more employee satisfaction with patient experience as the two are intertwined in a successful patient experience
  46. 46. Perception Facility Design Process Design Listen to Voices Manage Expectations Close Gap between Perception & Reality
  47. 47. It is not about making buildings… It’s about building culture Questions?

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