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TRADELINE_2007_Academic Medical Center Conference

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TRADELINE_2007_Academic Medical Center Conference

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TRADELINE_2007_Academic Medical Center Conference

  1. 1. TRADELINE: ACADEMIC MEDICAL CENTER CONFERENCETRADELINE: ACADEMIC MEDICAL CENTER CONFERENCE SAN DIEGO, DECEMBER 3, 2007SAN DIEGO, DECEMBER 3, 2007 Mapping our UnderstandingMapping our UnderstandingMapping our UnderstandingMapping our Understanding of Collaboration inof Collaboration in KnowledgeKnowledge Worker EnvironmentsWorker EnvironmentsKnowledgeKnowledge--Worker EnvironmentsWorker Environments to Academic Medical Centersto Academic Medical Centers Dr. Debajyoti Pati, PhD AIIADr. Debajyoti Pati, PhD AIIA HKS Inc.HKS Inc. -- Dallas, TexasDallas, Texas Dr Arthur St Andre MD FCCMDr Arthur St Andre MD FCCMDr. Arthur St. Andre, MD FCCMDr. Arthur St. Andre, MD FCCM Washington Hospital CenterWashington Hospital Center -- Washington, DCWashington, DC Tom Harvey, AIA MPH FACHATom Harvey, AIA MPH FACHA HKS Inc.HKS Inc. -- Dallas, TexasDallas, Texas WASHINGTON HOSPITAL CENTER
  2. 2. ObjectivesObjectives Review workplace strategies adopted to enhanceReview workplace strategies adopted to enhancep g pp g p collaborationcollaboration Understand the unique requirements of academicUnderstand the unique requirements of academic medical centersmedical centers Explore architectural design strategies to enhanceExplore architectural design strategies to enhance collaboration in academic medical centerscollaboration in academic medical centers WASHINGTON HOSPITAL CENTER 2
  3. 3. Three Pillars Of Academic Medical CentersThree Pillars Of Academic Medical Centers KNOWLEDGE & IDEA: generationKNOWLEDGE & IDEA: generation New procedures, new pedagogic techniques, new management stylesNew procedures, new pedagogic techniques, new management styles Patents, copyrights, publicationsPatents, copyrights, publications WORKFLOW DESIGN: innovationWORKFLOW DESIGN: innovation Optimize procedures (clinical, pedagogic, managerial)Optimize procedures (clinical, pedagogic, managerial) Innovations documented best practicesInnovations documented best practicesInnovations, documented best practicesInnovations, documented best practices OPERATION: EffectivenessOPERATION: Effectiveness P i d ffP i d ffPatient outcomes, student outcomes, staff outcomesPatient outcomes, student outcomes, staff outcomes WASHINGTON HOSPITAL CENTER 3
  4. 4. The ConnectorsThe Connectors KNOWLEDGEKNOWLEDGE Generation ContinuousContinuous Collaboration &Collaboration & InteractionInteraction WORK FLOWWORK FLOW Innovations OPERATIONSOPERATIONS Efficacy InteractionInteraction WASHINGTON HOSPITAL CENTER 4
  5. 5. Knowledge Workers Workplace DesignKnowledge Workers Workplace Design Who are kno ledge orkersWho are kno ledge orkersWho are knowledge workers:Who are knowledge workers: People who work with informationPeople who work with information People who develop knowledgePeople who develop knowledge People who use knowledgePeople who use knowledge Examples:Examples: Scientists, engineers, IT professionals, researchersScientists, engineers, IT professionals, researchers, g , p ,, g , p , WASHINGTON HOSPITAL CENTER 5
  6. 6. Tracing The Path Of Workplace DesignTracing The Path Of Workplace Design Trends in knowledge worker work environment over theTrends in knowledge worker work environment over the past decades:past decades: Customer responsiveness, efficiency, agilityCustomer responsiveness, efficiency, agility Less hierarchical unitsLess hierarchical units More autonomy in decisionMore autonomy in decision--makingmaking Team contributionsTeam contributions Inter and IntraInter and Intra--workgroup communicationworkgroup communicationg pg p WASHINGTON HOSPITAL CENTER 6
  7. 7. Driving ForceDriving Force Tom Peters and Robert H WatermanTom Peters and Robert H Waterman JrJr (1982) , “In(1982) , “In Search of Excellence”:Search of Excellence”:Search of Excellence :Search of Excellence : …many of the best ideas produced by knowledge worker teams found…many of the best ideas produced by knowledge worker teams found their germination in unscheduled ‘serendipitous’ encounters withtheir germination in unscheduled ‘serendipitous’ encounters with workers outside the team.workers outside the team. Workshop on Research Facilities of the Future, NewWorkshop on Research Facilities of the Future, New York Academy of Sciences (1993):York Academy of Sciences (1993):York Academy of Sciences (1993):York Academy of Sciences (1993): Emphasized need for “fostering interdisciplinary communication...andEmphasized need for “fostering interdisciplinary communication...and alleviating the sense of isolation that has long been the lot of thealleviating the sense of isolation that has long been the lot of the researcher” (researcher” (KreegerKreeger 1994)1994)researcher (researcher (KreegerKreeger, 1994)., 1994). WASHINGTON HOSPITAL CENTER 7
  8. 8. Driving ForceDriving Force In research and development laboratoriesIn research and development laboratories i ti t h i l f i l h bi ti t h i l f i l h bcommunication among technical professionals has beencommunication among technical professionals has been shown to be a significant determinant of technicalshown to be a significant determinant of technical performance and the productivity of project teamsperformance and the productivity of project teams WASHINGTON HOSPITAL CENTER 8
  9. 9. Interaction::CommunicationInteraction::Communication Collaboration COMMUNICATION /INTERACTION EFFECTIVENESS /INTERACTION Out of Box Thinking INNOVATION Out of Box Thinking WASHINGTON HOSPITAL CENTER 9
  10. 10. Interaction DimensionsInteraction Dimensions Three DimensionsThree Dimensions TypologiesTypologiesThree DimensionsThree Dimensions PeoplePeople IntraIntra--workgroupworkgroup vsvs InterInter-- TypologiesTypologies IntraIntra--group :: Spontaneous :: Formalgroup :: Spontaneous :: Formal IntraIntra--group :: Spontaneous :: Informalgroup :: Spontaneous :: Informal IntraIntra group :: Scheduled :: Formalgroup :: Scheduled :: Formal workgroupworkgroup TimeTime SpontaneousSpontaneous vsvs ScheduledScheduled IntraIntra--group :: Scheduled :: Formalgroup :: Scheduled :: Formal IntraIntra--group :: Scheduled :: Informalgroup :: Scheduled :: Informal InterInter--group :: Spontaneous :: Formalgroup :: Spontaneous :: Formal InterInter--group :: Spontaneous :: Informalgroup :: Spontaneous :: Informalpp CommunicationCommunication FormalFormal vsvs InformalInformal g p pg p p InterInter--group :: Scheduled :: Formalgroup :: Scheduled :: Formal InterInter--group :: Scheduled :: Informalgroup :: Scheduled :: Informal WASHINGTON HOSPITAL CENTER 10
  11. 11. ConservativeConservative vsvs GenerativeGenerative Knowledge ConservativeKnowledge Conservative Knowledge GenerativeKnowledge Generative IntraIntra--group::Spontaneous::Formalgroup::Spontaneous::Formal IntraIntra--group::Spontaneous::Informalgroup::Spontaneous::Informal IntraIntra group::Scheduled:: Formalgroup::Scheduled:: Formal IntraIntra--group::Spontaneous::Formalgroup::Spontaneous::Formal IntraIntra--group::Spontaneous::Informalgroup::Spontaneous::Informal IntraIntra gro p Sched led Formalgro p Sched led FormalIntraIntra--group::Scheduled:: Formalgroup::Scheduled:: Formal IntraIntra--group::Scheduled:: Informalgroup::Scheduled:: Informal InterInter--group::Spontaneous:: Formalgroup::Spontaneous:: Formal InterInter group::Spontaneous::group::Spontaneous:: IntraIntra--group::Scheduled:: Formalgroup::Scheduled:: Formal IntraIntra--group::Scheduled:: Informalgroup::Scheduled:: Informal InterInter--group::Spontaneous:: Formalgroup::Spontaneous:: Formal I tI t S t I f lS t I f lInterInter--group::Spontaneous::group::Spontaneous:: InformalInformal InterInter--group::Scheduled:: Formalgroup::Scheduled:: Formal InterInter--group::Scheduled:: Informalgroup::Scheduled:: Informal InterInter--group::Spontaneous:: Informalgroup::Spontaneous:: Informal InterInter--group::Scheduled:: Formalgroup::Scheduled:: Formal InterInter--group::Scheduled:: Informalgroup::Scheduled:: Informal InterInter--group::Scheduled:: Informalgroup::Scheduled:: Informal Effectiveness Innovation WASHINGTON HOSPITAL CENTER Effectiveness Innovation 11
  12. 12. Impact of Physical StructureImpact of Physical Structure Two dimensions of physical structure have beenTwo dimensions of physical structure have beenTwo dimensions of physical structure have beenTwo dimensions of physical structure have been investigated with respect to interaction activityinvestigated with respect to interaction activity (1) distance/proximity between potential communication partners and(1) distance/proximity between potential communication partners and(1) distance/proximity between potential communication partners and(1) distance/proximity between potential communication partners and (2) degree of enclosure provided by physical barriers(2) degree of enclosure provided by physical barriers WASHINGTON HOSPITAL CENTER 12
  13. 13. Knowledge Workplace StrategiesKnowledge Workplace Strategies Conservative/CollaborativeConservative/Collaborative GenerativeGenerative StrategiesStrategies Visibility/ enclosureVisibility/ enclosure StrategiesStrategies Global configuration of spacesGlobal configuration of spaces Accessibility/ proximityAccessibility/ proximity Themes/FocusThemes/Focus Work stationsWork stations and circulationand circulation Themes/FocusThemes/Focus Neighborhoods and MainNeighborhoods and MainWork stationsWork stations Meeting roomsMeeting rooms Communal spacesCommunal spaces gg StreetsStreets Corridors more thanCorridors more than circulation spacescirculation spaces Circulation ‘collection points’Circulation ‘collection points’ Support spacesSupport spaces WASHINGTON HOSPITAL CENTER 13
  14. 14. Owens Corning World Headquarters,Owens Corning World Headquarters, Toledo OhioToledo OhioToledo, OhioToledo, Ohio Individual workspaces open and highly collaborative. Private enclavesIndividual workspaces open and highly collaborative. Private enclaves available for use by any employee.available for use by any employee. Corridors intentionally widened to encourage interactionCorridors intentionally widened to encourage interactionCorridors intentionally widened to encourage interaction.Corridors intentionally widened to encourage interaction. Eighty teaming rooms located throughout the facility; furnished withEighty teaming rooms located throughout the facility; furnished with presentation equipment, computer logpresentation equipment, computer log--in, and teleconferencing capabilities.in, and teleconferencing capabilities. Survey result from more than 400 Owens Corning employees 90 days afterSurvey result from more than 400 Owens Corning employees 90 days afterSurvey result from more than 400 Owens Corning employees 90 days afterSurvey result from more than 400 Owens Corning employees 90 days after occupancy:occupancy: 88% report a high level of teaming with departmental co88% report a high level of teaming with departmental co--workersworkers 66% report a high level of teaming across departmental boundaries66% report a high level of teaming across departmental boundaries66% report a high level of teaming across departmental boundaries66% report a high level of teaming across departmental boundaries Source: The Integrated Workplace, USGSA, 1999 Photo Courtesy of Owen Corning WASHINGTON HOSPITAL CENTER Photo Courtesy of Owen Corning 14
  15. 15. Social Security Administration Headquarters,Social Security Administration Headquarters, Woodlawn MarylandWoodlawn MarylandWoodlawn, MarylandWoodlawn, Maryland One “break out” area for 8 people at every 15One “break out” area for 8 people at every 15--2020 k t ti di / ti d tt d th h t thk t ti di / ti d tt d th h t thworkstations; vending/eating areas dotted throughout theworkstations; vending/eating areas dotted throughout the plan for informal gathering; large and small conferenceplan for informal gathering; large and small conference roomsrooms Atria to bring more light into existing large floor plates.Atria to bring more light into existing large floor plates. Some of the atria woven into pedestrian malls andSome of the atria woven into pedestrian malls andpp pathwayspathways Closed offices limited only to directors and deputyClosed offices limited only to directors and deputyy p yy p y commissionerscommissioners Source: The Integrated WASHINGTON HOSPITAL CENTER Workplace, USGSA, 1999 15
  16. 16. UGA Biological Sciences ComplexUGA Biological Sciences Complex “… having informal break“… having informal break--out spaces “woven into theout spaces “woven into the l k fl th th t k d t th d fl k fl th th t k d t th d fnormal work flow rather than tacked onto the ends ofnormal work flow rather than tacked onto the ends of corridors in outcorridors in out--ofof--thethe--way places.”way places.” h b kh b k “ f ll l d“ f ll l d…the break…the break--out spaces were “carefully placedout spaces were “carefully placed conference areas to facilitate both scheduled and casualconference areas to facilitate both scheduled and casual discussions.”discussions.” Source: Wineman and WASHINGTON HOSPITAL CENTER Serrato, 1997 16
  17. 17. Scottish Enterprise, UKScottish Enterprise, UK bookable hot desks and hot offices, touchdown facilities,bookable hot desks and hot offices, touchdown facilities, t d b tht d b thstudy boothsstudy booths flexible project spacesflexible project spaces ‘oasis’ social/service centers‘oasis’ social/service centersoasis social/service centersoasis social/service centers an innovation theatre (for team brainstorming)an innovation theatre (for team brainstorming) range of informal meet spaces, including a large caférange of informal meet spaces, including a large caférange of informal meet spaces, including a large caférange of informal meet spaces, including a large café facilityfacility traditional meeting and conference roomstraditional meeting and conference rooms no dedicated officesno dedicated offices So rce Working itho t WASHINGTON HOSPITAL CENTER 17 Source: Working without walls. Allen et al (2004)
  18. 18. Office of Government Commerce, UKOffice of Government Commerce, UK Bright and colorful breakout areas for:Bright and colorful breakout areas for: Greeting visitorsGreeting visitors Meeting informallyMeeting informally Taking a breakTaking a breakgg Located at entrance of each floorLocated at entrance of each floor Small tables, soft seats, refreshmentsSmall tables, soft seats, refreshments Source: Working without walls. Allen et al (2004) Adjacent to mobile staff touchAdjacent to mobile staff touch--down pointsdown points Helps OGC staff from different offices meet, exchange ideas,Helps OGC staff from different offices meet, exchange ideas, identify opportunities for collaborationidentify opportunities for collaboration WASHINGTON HOSPITAL CENTER 18
  19. 19. Furniture As CatalystsFurniture As Catalysts Casual meeting areas. Courtesy of Herman Lobby seating providing impromptu workspace. Miller Inc. p Photo by Hoachlander- Davis Photography courtesy of High-tech conference Ease of reconfiguration incourtesy of GSA Public Buildings Service Marketing High-tech conference space with flexible furniture arrangements and state-of-the-art technology. Ease of reconfiguration in team environments. Courtesy of Steelcase North America. WASHINGTON HOSPITAL CENTER Division. Courtesy of Steelcase North America. 19
  20. 20. Two Excellent SourcesTwo Excellent Sources USGSA (1999).USGSA (1999). The Integrated Workplace: AThe Integrated Workplace: A C h i A h t D l i W kC h i A h t D l i W kComprehensive Approach to Developing Workspace.Comprehensive Approach to Developing Workspace. http://www.gsa.gov/gsa/cm_attachments/GSA_DOCUMhttp://www.gsa.gov/gsa/cm_attachments/GSA_DOCUM ENT/integrated workplace rpt pdf R2OD26 0Z5RDZENT/integrated workplace rpt pdf R2OD26 0Z5RDZ--g _ p _ p _p _ _g _ p _ p _p _ _ i34Ki34K--pR.pdfpR.pdf Allen, T., Bell, A., Graham, R., Hardy, B.,Allen, T., Bell, A., Graham, R., Hardy, B., SwafferSwaffer, F., F. (2004).(2004). Working without walls: An insight into theWorking without walls: An insight into the transforming government workplace.transforming government workplace. www.degw.comwww.degw.comg g pg g p gg WASHINGTON HOSPITAL CENTER 20
  21. 21. Unique Dynamics in Academic Medical Centers Unique Dynamics in Academic Medical CentersAcademic Medical CentersAcademic Medical Centers KNOWLEDGEKNOWLEDGE Generation Resource AvailabilityResource Availability ContinuousContinuous Collaboration &Collaboration & InteractionInteraction WORK FLOWWORK FLOW Innovations OPERATIONSOPERATIONS Efficacy InteractionInteraction y WASHINGTON HOSPITAL CENTER 21
  22. 22. Operational ChangeOperational Change -- Motivating FactorsMotivating Factors Scientific EvidenceScientific Evidence T h l i I tiT h l i I ti CT MRI PETCT MRI PETTechnologic InnovationTechnologic Innovation –– CT, MRI, PETCT, MRI, PET Knowledge ExpertiseKnowledge Expertise –– seasoned clinicianseasoned clinician Process ExpertiseProcess Expertise –– e.g. IHIe.g. IHI Regulatory RequirementsRegulatory Requirements –– The JointThe Joint Risk ManagementRisk Management Fiscal ImperativesFiscal Imperatives Fear of CatastropheFear of Catastrophe –– e.g. avian flu, anthraxe.g. avian flu, anthrax WASHINGTON HOSPITAL CENTER 22
  23. 23. Themes in Knowledge GenerationThemes in Knowledge Generation and Utilization Workplacesand Utilization Workplacesand Utilization Workplacesand Utilization Workplaces Knowledge generation subKnowledge generation sub--specialization can detractspecialization can detractKnowledge generation subKnowledge generation sub specialization can detractspecialization can detract from cross discipline creativityfrom cross discipline creativity Workflow DesignWorkflow Design OperationsOperationsWorkflow DesignWorkflow Design OperationsOperations Translation hurdlesTranslation hurdles –– ‘Knowledge generation’ and‘Knowledge generation’ and i t t t h t th kill di t t t h t th kill drequirements stretch our systems, the skills andrequirements stretch our systems, the skills and experience of practitioners and resourcesexperience of practitioners and resources WASHINGTON HOSPITAL CENTER 23
  24. 24. Operational StrugglesOperational Struggles Passing care from one provider to anotherPassing care from one provider to another –– the batonthe baton Comparative Standardized Clinical/ Resource Use Index Team effectivenessTeam effectiveness –– Fulfilling expectations and sharingFulfilling expectations and sharing information across servicesinformation across services Delegation broader array of cliniciansDelegation broader array of clinicians3 4 1010 g yg y Documentation overloadDocumentation overload Input timeInput time Display chaosDisplay chaos 2 ceUseIndex 3 4 5 6 7 8 9 A B CD E F GHI J3 4 5 6 7 8 9 A B CD E F GHI J Display chaosDisplay chaos Management of devices, process applications (e.g.Management of devices, process applications (e.g. CPOE), data applications (e.g. EMRs), policy/proceduralCPOE), data applications (e.g. EMRs), policy/procedural and process documentsand process documents 0 1 Resourc 55 and process documentsand process documents Communication among clinical and technical personnelCommunication among clinical and technical personnel (within institute and with industry)(within institute and with industry) -1 -2 -1 0 1 Clinical Performance Index WASHINGTON HOSPITAL CENTER ICU Unit XXXXXXX 24
  25. 25. More Silos than Meet the EyeMore Silos than Meet the Eye Clinical servicesClinical services Direct providersDirect providers -- physicians, nurses, therapists, physician assistants,physicians, nurses, therapists, physician assistants, nurse practitioners, social workers, pharmacists, nutritionists, physicalnurse practitioners, social workers, pharmacists, nutritionists, physical therapytherapy Clinical servicesClinical services –– radiology, laboratoryradiology, laboratory Administrative servicesAdministrative services –– leadership, administrativeleadership, administrative management, quality services, clerical, biomedicalmanagement, quality services, clerical, biomedical engineering IT DES transport facilitiesengineering IT DES transport facilitiesengineering, IT, DES, transport, facilitiesengineering, IT, DES, transport, facilities Corporate managementCorporate management PatientsPatients -- CommunityCommunityPatientsPatients -- CommunityCommunity IndustryIndustry Regulatory AuthoritiesRegulatory Authorities WASHINGTON HOSPITAL CENTER Regulatory AuthoritiesRegulatory Authorities 25
  26. 26. Process Hurdles Idea and Workflow DesignProcess Hurdles Idea and Workflow Design Geographic dispersionGeographic dispersion –– multi institution systemsmulti institution systemsg p pg p p yy CentralizationCentralization –– Decentralization tensionDecentralization tension Meeting overloadMeeting overload –– effectivenesseffectiveness Email overloadEmail overload Minimal cross silo face to face timeMinimal cross silo face to face time Time dispersionTime dispersion -- cross shiftcross shift Industry interactionsIndustry interactions ‘Adolescent’ systems‘Adolescent’ systemsAdolescent systemsAdolescent systems Highly configurable devices and systemsHighly configurable devices and systems WASHINGTON HOSPITAL CENTER 26
  27. 27. VisualVisual (Inter/Intranet)(Inter/Intranet) andand AudioAudio (Telecom)(Telecom) SolutionsSolutionsAudioAudio (Telecom)(Telecom) SolutionsSolutions SimulationSimulation –– physical and virtualphysical and virtualp yp y Improve procedural performance and using devicesImprove procedural performance and using devices Evaluation and management of patientsEvaluation and management of patients ReplayReplay TiVoTiVoReplayReplay –– TiVoTiVo Chat roomsChat rooms Search toolsSearch tools RemoDocRemoDoc™™Search toolsSearch tools TelecomTelecom –– voice activation, teleconferencingvoice activation, teleconferencing Surveillance toolsSurveillance tools -- eICUeICU WASHINGTON HOSPITAL CENTER 27
  28. 28. Informal InterchangeInformal Interchange –– Design ImplicationsDesign Implications Clinical arenasClinical arenas –– formal and informal ‘meeting’ spacesformal and informal ‘meeting’ spacesg pg p Cross discipline clusteringCross discipline clustering –– Offices, Conference roomsOffices, Conference rooms ‘Water cooler’ exchange‘Water cooler’ exchange –– ‘Libraries’, Lounge areas,‘Libraries’, Lounge areas, ElevatorsElevators ‘Enhanced’ informal meeting areas‘Enhanced’ informal meeting areas –– Cafeterias,Cafeterias, HallwaysHallwaysHallwaysHallways WASHINGTON HOSPITAL CENTER 28
  29. 29. How Can Physical Design Contribute?How Can Physical Design Contribute? KNOWLEDGEKNOWLEDGE Generation ContinuousContinuous Collaboration &Collaboration & I t tiI t ti WORK FLOWWORK FLOW Innovations OPERATIONSOPERATIONS Efficacy InteractionInteraction y WASHINGTON HOSPITAL CENTER 29
  30. 30. Key Characteristics to TargetKey Characteristics to Target Foster collaborative opportunitiesFoster collaborative opportunities Students / trainees and facultyStudents / trainees and faculty Physicians and other and care giversPhysicians and other and care givers Care givers and researchersCare givers and researchers Care givers and familyCare givers and family Complex,Complex, segragatedsegragated contextcontext Patient Care (patient care and supportPatient Care (patient care and support EDUCATION PATIENT CARE Patient Care (patient care and supportPatient Care (patient care and support areas)areas) TeachingTeaching ResearchResearch RESEARCH Connections / Linkages betweenConnections / Linkages between NeighborhoodsNeighborhoods WASHINGTON HOSPITAL CENTER 30
  31. 31. NeighborhoodsNeighborhoods EDUCATION PATIENT CARE RESEARCH WASHINGTON HOSPITAL CENTER 31
  32. 32. Spontaneous / Informal CollaborationSpontaneous / Informal Collaboration Corridors / HallwaysCorridors / Hallways Intersections / “Nodes”Intersections / “Nodes” Spontaneous collaboration points WASHINGTON HOSPITAL CENTER 32
  33. 33. Spontaneous / Informal CollaborationSpontaneous / Informal Collaboration LobbiesLobbies (entries / elevators) “Great Spaces”“Great Spaces” (atria / gardens)(e t es / e e ato s) Spontaneous collaboration pointsp WASHINGTON HOSPITAL CENTER 33
  34. 34. Formal / Scheduled CollaborationFormal / Scheduled Collaboration Classroom/Lecture HallClassroom/Lecture Hall Conference RoomConference Room WASHINGTON HOSPITAL CENTER 34
  35. 35. Formal / Scheduled CollaborationFormal / Scheduled Collaboration Simulation LabsSimulation LabsProcedure SpacesProcedure Spaces WASHINGTON HOSPITAL CENTER 35
  36. 36. Workflow EnhancersWorkflow Enhancers “Physical”“Physical” Clinical PathwaysClinical Pathways Optimal ProximitiesOptimal Proximities by Designby Design Dept A 1 1 Dept A 2 2Dept B 3 3 4 4 WASHINGTON HOSPITAL CENTER 36
  37. 37. Workflow EnhancersWorkflow Enhancers Clinical Care /Clinical Care / P d SP d S Multidisciplinary OfficeMultidisciplinary Office Cl tCl tProcedure SpacesProcedure Spaces ClustersClusters O.R. Medicine ` Surgery I.R.G.I. Collaborative Cluster WASHINGTON HOSPITAL CENTER 37
  38. 38. Operations EnhancersOperations Enhancers Lean Design PrinciplesLean Design Principles Sink Fridge Minimal travel distancesMinimal travel distances Aggregated work spacesAggregated work spaces Spontaneous collaborationSpontaneous collaborationSpontaneous collaborationSpontaneous collaboration opportunitiesopportunities Stove WASHINGTON HOSPITAL CENTER 38
  39. 39. Simulation as a ToolSimulation as a Tool Trains, then builds individual accuracy and precisionTrains, then builds individual accuracy and precision F ilit t t i t tiF ilit t t i t tiFacilitates team interactionFacilitates team interaction Fosters innovation in group settingsFosters innovation in group settings Reaction from multiple perspectives toReaction from multiple perspectives toeact o o u t p e pe spect es toeact o o u t p e pe spect es to diverse situationsdiverse situations Team collaboration through interdisciplinaryTeam collaboration through interdisciplinary responsesresponses WASHINGTON HOSPITAL CENTER 39
  40. 40. Workflow EnhancersWorkflow Enhancers Digital Results ReportingDigital Results Reporting Ubiquitous Data AccessUbiquitous Data Access Data Sources Patient Room Exam Room Proc Room IT Sim L b Respite Zone IT LabZone Collaborative Correlated Analysis Kiosk Portal Collaborative Resource Center Instant Consult Center WASHINGTON HOSPITAL CENTER 40
  41. 41. Workflow EnhancersWorkflow Enhancers Kiosk PortalKiosk Portal WASHINGTON HOSPITAL CENTER 41
  42. 42. Workflow EnhancersWorkflow Enhancers InstantInstant C lt C tC lt C tConsult CentersConsult Centers WASHINGTON HOSPITAL CENTER 42
  43. 43. Workflow EnhancersWorkflow Enhancers CollaborativeCollaborative R C tR C tResource CentersResource Centers WASHINGTON HOSPITAL CENTER 43
  44. 44. A Vision for the FutureA Vision for the Future Nodes of Learning and CollaborationNodes of Learning and Collaboration Casual, but highly sophisticated resource centersCasual, but highly sophisticated resource centers Instant access to data for reference and discussionInstant access to data for reference and discussion Progress reports on subProgress reports on sub--specialization research and discoveryspecialization research and discovery Electronic notepads for interdisciplinary brainstormingElectronic notepads for interdisciplinary brainstorming Emerging clinical pathways to better outcomesEmerging clinical pathways to better outcomes Clinical “Kitchen of the Mind” WASHINGTON HOSPITAL CENTER 44
  45. 45. Review of Design GoalsReview of Design Goals 1.1. Integrate the physical environmentIntegrate the physical environment of academic medical centers,of academic medical centers, d fi d b i h di i i itid fi d b i h di i i itidefined by rich, diverse inquisitivedefined by rich, diverse inquisitive thinkingthinking WASHINGTON HOSPITAL CENTER 45
  46. 46. Review of Design GoalsReview of Design Goals 2.2. Accommodate spontaneousAccommodate spontaneous collaboration with convenient,collaboration with convenient, i iti t iti f li iti t iti f linviting opportunities for casualinviting opportunities for casual interactioninteraction WASHINGTON HOSPITAL CENTER 46
  47. 47. Review of Design GoalsReview of Design Goals 3.3. Support collaborative learning inSupport collaborative learning in the moment with convergence ofthe moment with convergence of ltidi i li k dltidi i li k dmultidisciplinary work areas andmultidisciplinary work areas and generous alternative conveninggenerous alternative convening spacesspaces WASHINGTON HOSPITAL CENTER 47
  48. 48. Review of Design GoalsReview of Design Goals 4.4. Inform and excite collaborativeInform and excite collaborative thinking with convenientlythinking with conveniently ibl i f ti t f llibl i f ti t f llaccessible information centers fullyaccessible information centers fully linked to all data resourceslinked to all data resources WASHINGTON HOSPITAL CENTER 48
  49. 49. Selected BibliographySelected Bibliography USGSA (1999).USGSA (1999). The Integrated Workplace: A Comprehensive Approach to DevelopingThe Integrated Workplace: A Comprehensive Approach to Developing WorkspaceWorkspace.. http://www.gsa.gov/gsa/cm_attachments/GSA_DOCUMENT/integrated_workplace_rpt_pdf_R2Ohttp://www.gsa.gov/gsa/cm_attachments/GSA_DOCUMENT/integrated_workplace_rpt_pdf_R2O D26_0Z5RDZD26_0Z5RDZ--i34Ki34K--pR.pdfpR.pdf Allen, T., Bell, A., Graham, R., Hardy, B.,Allen, T., Bell, A., Graham, R., Hardy, B., SwafferSwaffer, F. (2004)., F. (2004). Working without walls: An insightWorking without walls: An insight i t th t f i t k li t th t f i t k l ddinto the transforming government workplaceinto the transforming government workplace. www.degw.com. www.degw.com SerratoSerrato, M.,, M., WinemanWineman, J. D. (1997)., J. D. (1997). Enhancing communication in labEnhancing communication in lab--based organizationsbased organizations.. Proceedings of the Space Syntax Symposium University College London, London, volume 1, ppProceedings of the Space Syntax Symposium University College London, London, volume 1, pp 15 115 1 15 815 815.115.1 -- 15.815.8 Serrato,MSerrato,M.,., WinemanWineman, J. D. (1999)., J. D. (1999). Spatial and communication patterns in research andSpatial and communication patterns in research and developmentdevelopment. Proceedings of the Space Syntax Symposium University of Brasilia, Brasilia,. Proceedings of the Space Syntax Symposium University of Brasilia, Brasilia, volume 1 pp 11 1volume 1 pp 11 1 -- 11 811 8volume 1, pp 11.1volume 1, pp 11.1 11.811.8 Rashid, M.,Rashid, M., KampschroerKampschroer, K.,, K., WinemanWineman, J.,, J., ZimringZimring, C. (2006)., C. (2006). Spatial Layout and FaceSpatial Layout and Face--toto--faceface Interaction in OfficesInteraction in Offices–– A Study of the Mechanisms of Spatial Effects on FaceA Study of the Mechanisms of Spatial Effects on Face--toto--faceface InteractionInteraction. Environment and Planning B: Planning and Design, Vol. 33, pp. 825. Environment and Planning B: Planning and Design, Vol. 33, pp. 825––844844 WASHINGTON HOSPITAL CENTER g g g , , ppg g g , , pp 49
  50. 50. Selected BibliographySelected Bibliography Rashid, M., Zimring, C., Wineman, J., Flaningam, T., Nubani, L., Hammash, R. (2005).Rashid, M., Zimring, C., Wineman, J., Flaningam, T., Nubani, L., Hammash, R. (2005). TheThe Effects of Spatial Behaviors and Layout Attributes on Individuals' Perception ofEffects of Spatial Behaviors and Layout Attributes on Individuals' Perception of Psychosocial Constructs in OfficesPsychosocial Constructs in Offices. Proceedings of the Fifth International Space Syntax. Proceedings of the Fifth International Space Syntax Conference, Delft, NetherlandsConference, Delft, Netherlands Rashid,M., Zimring, C., Wineman, J. (2006).Rashid,M., Zimring, C., Wineman, J. (2006). Modular versus Landscaped Office: AModular versus Landscaped Office: A C i f S B h i d E i t l P tiC i f S B h i d E i t l P ti P t d t thP t d t thComparison of Space, Behavior and Environmental PerceptionComparison of Space, Behavior and Environmental Perception. Paper presented at the. Paper presented at the Environmental Design Research Association (EDRA) 37 Conference, Atlanta, GA, May 03Environmental Design Research Association (EDRA) 37 Conference, Atlanta, GA, May 03--0707 Penn, A., Desyllas, J., Vaughan, L. (1999).Penn, A., Desyllas, J., Vaughan, L. (1999). The space of innovation: interaction andThe space of innovation: interaction and communication in the work environmentcommunication in the work environment Environment and Planning B: Planning & DesignEnvironment and Planning B: Planning & Designcommunication in the work environmentcommunication in the work environment. Environment and Planning B: Planning & Design,. Environment and Planning B: Planning & Design, vol.26, no. 2, pp 193vol.26, no. 2, pp 193--218218 Oldham, G. R., Rotchford, N. L. (1983).Oldham, G. R., Rotchford, N. L. (1983). Relationship between office characteristics andRelationship between office characteristics and employee reactions: a study of the physical environmentemployee reactions: a study of the physical environment Administrative Science QuarterlyAdministrative Science Quarterlyemployee reactions: a study of the physical environmentemployee reactions: a study of the physical environment. Administrative Science Quarterly,. Administrative Science Quarterly, vol. 28, pp 542vol. 28, pp 542 -- 556556 Rashid, M., Zimring, C. (2003).Rashid, M., Zimring, C. (2003). Organizational Constructs and the Structure of Space: AOrganizational Constructs and the Structure of Space: A Comparative Study of Office LayoutsComparative Study of Office Layouts. Proceedings of the Fourth International Space Syntax. Proceedings of the Fourth International Space Syntax WASHINGTON HOSPITAL CENTER p y yp y y g p yg p y Conference, University College London.Conference, University College London. 50
  51. 51. Selected BibliographySelected Bibliography Rashid, M.,Rashid, M., ZimringZimring, C. (2005)., C. (2005). Psychosocial Constructs and Office Settings: A Review of thePsychosocial Constructs and Office Settings: A Review of the Empirical LiteratureEmpirical Literature. Proceedings of the Environmental Design Research Association (EDRA) 36. Proceedings of the Environmental Design Research Association (EDRA) 36p ca te atu ep ca te atu e oceed gs o e o e a es g esea c ssoc a o ( ) 36oceed gs o e o e a es g esea c ssoc a o ( ) 36 Conference, Vancouver, CanadaConference, Vancouver, Canada SundstromSundstrom, E., Altman, L. (1989)., E., Altman, L. (1989). Physical environments and workPhysical environments and work--group effectivenessgroup effectiveness.. Research in Organizational Behavior , vol.11, pp 175Research in Organizational Behavior , vol.11, pp 175 -- 209209 Campbell, D. E., Campbell, T. A., (1988).Campbell, D. E., Campbell, T. A., (1988). A new look at informal communication: the role ofA new look at informal communication: the role of the physical environmentthe physical environment. Environment and Behavior, vol. 2, pp 211. Environment and Behavior, vol. 2, pp 211 -- 226226 Hatch, M. J. (1987).Hatch, M. J. (1987). Physical barriers, task characteristics, and interaction activity inPhysical barriers, task characteristics, and interaction activity in research and development firmsresearch and development firms. Administrative Science Quarterly, vol. 32, 387. Administrative Science Quarterly, vol. 32, 387 -- 399399 Rashid, M., Craig, D.,Rashid, M., Craig, D., ZimringZimring, C.,, C., ThitisawatThitisawat, M. (2006)., M. (2006). Sedentary and Fleeting Activities andSedentary and Fleeting Activities andgg gg ( )( ) y gy g Their Spatial Correlates in OfficesTheir Spatial Correlates in Offices. Proceedings of the 37th Annual Conference of the. Proceedings of the 37th Annual Conference of the Environmental Design Research Association (EDRA), Atlanta, GAEnvironmental Design Research Association (EDRA), Atlanta, GA WASHINGTON HOSPITAL CENTER 51

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