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WHD_2012_Patient Unit Comparison Study

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WHD_2012_Patient Unit Comparison Study

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WHD_2012_Patient Unit Comparison Study

  1. 1. Retaining the Caring Presence and Healing Touch in New Generation Asian Hospitals: Learning from the American Experiment 8TH DESIGN & HEALTH 2012 KUALA LUMPUR
  2. 2. Agenda  Introduction – Decentralization  Study Objectives  Context – MD Anderson Cancer Center  Data Collection  Findings  Summary
  3. 3. INTRODUCTION
  4. 4. Drivers and Design Impacts  Single patient rooms  Larger footprints  Proximity challenges  Decentralization  Decentralization  Use of technology  Healing presence/time at the bedside  Teamwork
  5. 5. Hypothesized Impacts  Patient focused  More time with patient  Improved efficiencies  Reduced non-productive time  Reduced walking distance  Collaboration, teamwork and mentoring?  Stress reduction?  Chaos, noise  Socialization  Productivity improvement
  6. 6. OBJECTIVE
  7. 7. Objective To examine the impact of decentralization on operational efficiency and teamwork – drivers of the healing touch and caring presence.
  8. 8. Goals of the Study for MD Anderson  Assist in adaptation to the new unit design  Identify new processes for Communication Collaboration Task completion Larger unit footprint  Seek opportunities Education and training Modify design elements
  9. 9. STUDY CONTEXT
  10. 10.  Texas Medical Center (42 member institutions, 13 major hospitals with 66,000 employees)  A healthcare component of the University of Texas  Founded in 1941, M. D. Anderson has grown to over 18,000 faculty and staff  More than $2.2 billion annual revenue M.D. Anderson Cancer Center
  11. 11. M.D. Anderson Cancer Center Growth  1998 – 1999 20% growth in patients  1999 – 2008 80% growth in patients 75% increase in employees  115% increase in research revenue  2012 Projections 50% growth in patients from 2006
  12. 12. Then and Now
  13. 13. Typical Nursing Floor (4) 13-bed Units All Private Rooms Central Nurse Station Racetrack Design Service & Public Elev. Albert B. and Margaret M. Alkek Hospital THEN
  14. 14. Central Nursing Station Albert B. and Margaret M. Alkek Hospital THEN
  15. 15. Unit Configuration  Centralized work concept  Open medication prep areas  Family waiting areas small/lacking  Wayfinding challenges THEN
  16. 16. Key Design Goals and Objectives The new Alkek patient units were designed reviewing current evidence-based concepts in a manner that:  Promotes patient and family centered care  Maximizes efficiency of work effort for all members of the care team  Includes ergonomic considerations that minimize the physical burden of patient care delivery  Promotes interdisciplinary collaboration NOW
  17. 17. 1. Improved staff circulation within core 2. Decentralized staff stations at patient rooms 3. Decentralized meds and equipment 4. Created team rooms 1 1 22 3 3 3 3 4 44 4 Design Solutions - Staff N NOW
  18. 18. Decentralized Nurse/Staff Stations • Decentralized nurse/staff stations with patient view window • Improved view of patients for assessment purposes • Encourages staff time with patients • Decreases staff travel time • Distributed supplies/linen • Creates quieter environment Storage rooms and alcoves • Maintain hallways free of equipment • Support service areas (Lab, Nutrition) TEAM MEDS SUPPL Y Unit Staff Support Areas NOW
  19. 19. Inpatient Floors 15–17 Typical patient room Increased room size (ranges from 251 s.f.–298 s.f.)  Outboard toilet improves visibility of patient  ADA-sized toilet enhances accessibility  Improved family space  Easier access to patient  Caregiver work area within patient room  PPE alcove outside room NOW
  20. 20. DATA
  21. 21. Data Collection J F M A M J J A S O BEFORE DATA AFTER DATA UNIT A UNIT B UNIT C UNIT A UNIT A NEW UNIT B NEW UNIT C NEW 2011
  22. 22. Data Collection Protocol  14 staff data points for day shift/14 data points for night shift (per unit)  RNs carried PDAs and completed corresponding pedometer logs  PDA vibrates 30 times/12 hours, tasks and location entered  Filled out surveys
  23. 23. Data Types  Nursing time:  Rapid Modeling PDA  Walking distance:  Pedometer  Acute stress:  Current Mood State Questionnaire  Presenteeism:  Koopman Stanford Presenteeism Scale (Modified)  Staff interaction and collaboration  KU Scale
  24. 24. TCAB PDA
  25. 25. PDA TCAB Data Classification  Task Type  Value adding  Non value adding  Necessary  Task Category  Direct care  Indirect care  Administrative  Personal  Waste  Documentation  Other  Task Location  Nurse station  Patient room  On the unit  Patient medication  Supply storage  Conference room  Off unit  Documentation server  Other
  26. 26. FINDINGS
  27. 27. Identifying Patterns of Change Care processes, physical environment, culture and policies interact PATIENT PATIENT OUTCOMES PHYSICAL ENVIRONMENT CAREGIVER CARE PROCESSES GROUP PHENOMENA: CULTURE RELATIONSHIPS POLICIES
  28. 28. Identifying Patterns of Change Multiple unit comparison benefit
  29. 29. Identifying Patterns of Change  Performances change after intervention  The key question is consistency
  30. 30. PDA Task Category: Documentation 15 17 19 21 23 25 27 29 31 33 Unit A Unit B Unit C Before After
  31. 31. PDA Task Location: Nurse Station 25 27 29 31 33 35 37 39 41 43 45 Unit A Unit B Unit C Before After
  32. 32. PDA Task Location: On The Unit 0 2 4 6 8 10 12 14 16 Unit A Unit B Unit C Before After
  33. 33. PDA Task Location: Medication 0 2 4 6 8 10 12 14 Unit A Unit B Unit C Before After
  34. 34. PDA Task Location: Supply Storage 0 0.5 1 1.5 2 2.5 Unit A Unit B Unit C Before After
  35. 35. Pedometer Walking Distance 1.5 2 2.5 3 3.5 4 Unit A Unit B Unit C Before After
  36. 36. Collaboration/ Teamwork Question Direction Significance? UNIT PRIMARY WORKSPACE The amount of space in your primary workspace fits your needs UP 1 OF 3 You have sufficient work surfaces in your primary workspace for your equipment and work UP 1 OF 3 You have enough storage space in your primary workspace UP 2 OF 3 You can change your workspace as needed to fit your needs UP 1 OF 3 PRIVACY IN PRIMARY WORKSPACE You have enough privacy in your primary workspace to do your job (e.g.,documentation, charting, and/or dictation) well. UP 0 OF 3
  37. 37. Collaboration/ Teamwork Question Direction Significance? PRIVACY IN OTHER SPACES You feel that you are not interrupted by others as you work in patient rooms DOWN 0 OF 3 You feel that you are not interrupted by others as you work in medication room/s DOWN 0 OF 3 ENVIRONMENTAL FEATURES Your primary workspace gets enough natural light DOWN 0 OF 3 Your primary workspace has sufficient illumination for your needs DOWN 0 OF 3 You are able to control the temperature in your primary workspace when needed DOWN 0 OF 3 You are able to control air velocity/movement when needed DOWN 1 OF 3
  38. 38. Collaboration/ Teamwork Question Direction Significance? UNIT WORK SUPPORT When you need a computer, there is one available UP ALL You can easily monitor your patients from unit workspaces DOWN 0 OF 3 The people you need to work with are available in the unit when you need them DOWN 2 OF 3 Overall, you are pleased with the design of your unit in relation to your work DOWN 0 OF 3
  39. 39. Collaboration/ Teamwork Question Direction Significant? COLLABORATION + TEAMWORK Overall, the layout of your unit supports teamwork or collaboration DOWN ALL Your unit has adequate space for formal team meetings UP ALL Your unit has adequate space for informal team meetings or interactions UP 1 OF 3 Meeting spaces are generally available in your unit UP 1 OF 3 Patient rooms are large enough for teamwork and collaboration UP ALL Corridors are wide enough for informal interactions UP 1 OF 3
  40. 40. Collaboration/ Teamwork Question Direction Significance? WALKING You spend more time walking in your unit in relation to other activities UP 2 OF 3 Walking takes away from the time you would otherwise have for patient care UP ALL Walking takes away from the time you would otherwise have for collaborative work UP 2 OF 3
  41. 41. Focus Group Interviews The Nurses Speak…  Increase in computerized documentation  Medication room is now farther from many rooms. Lots of walking  Location of pneumatic tube station  Finding “other staff” difficult  Different processes for medication record use on each unit
  42. 42. Lessons Learned Operational planning vs reality  Paper intensive processes  Added Telemetry reduced ICU census  Geographic patient assignments new reality  Chemo and blood products require two-nurse checks  Feelings of isolation  Missed ‘teachable moments’ for new staff  Infection control discussions  Medications “at the bedside” on the wish list  Cannot get all supplies to the bedside
  43. 43. SUMMARY
  44. 44.  Operational design must match physical design intervention to achieve desired outcome  Culture change is the most important challenge  Unit size and shape appears to be key determining factors affecting collaboration and teamwork
  45. 45. Healthcare Pamela Redden, MD Anderson Cancer Center predden@mdanderson.org Debajyoti Pati, Texas Tech University d.pati@ttu.edu

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