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ARCC_2015_Promedica
Research based practice: Field Research + Parametric Analysis in Medical Planning and Design The document discusses how field research and parametric analysis were used together in the design process of a medical-surgical unit renovation. Field research involved observing nurse activities and spatial utilization. Parametric analysis modeled walking distances, visibility, and other metrics. This informed the design by identifying issues like wasted walking and limited visibility. It also helped set targets for the future design like decentralized nursing stations and point-of-use supplies to decrease nurse travel time and improve outcomes. Post-occupancy the research approach helped evaluate if design goals were achieved.
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ARCC_2015_Promedica
- 1. Research based practice: FieldResearch + Parametric Analysis in Medical Planning and Design Upali Nanda, PhD Camilla Moretti, AIA Ryan Gathman, AIA Adeleh Nejati, PhD HKS Inc.
- 2. ……it is importantto define a problem before designing a solution continuously test the solution to make sure it works
- 3. Learn how fieldresearch 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. PROMEDICA TOLEDO HOSPITALAND 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. DESIGN PROCESS JULY SEPTMAYJUNEAPRIL CURRENT STATE FUTURE STATE DEMAND FORECAST DESIGN OPERATIONS RESEARCH GUIDING PRINCIPLES WORKSHOPS
- 6. Reported Observed Spatial RESEARCH CURRENTSTATE FUTURE STATE
- 7. PHASES OF WORK INTEGRATING RESEARCH INPRACTICE 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. RESEARCH: START WITHA TARGET KEY PERFORMANCE INDICATORS
- 9. RESEARCH IN THEFIELD A 2.5 DAY DESIGN DIAGNOSTIC
- 10. FIRST TO FILLUNIT (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. Unused Kitchen Unused Pyxis Rm Opaque Doors in Meds/Su pplies UnitClerk Opp Side Minimally used Consult Rm Off-stage “hide- aways” SPACE UTILIZATION
- 12. COMMUNICATION 1 (Care Coordination) Activitiesinvolving 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
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- 14. ACTIVITY ANALYSIS (FIRST2 HOURS: DAY)
- 15. First two hoursof shift ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY vs. NIGHT)
- 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
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- 18. Proximity Calculator |Rapidly Generated Heat Map Excessive Distance Reasonable Distance PROXIMITY ANALYSIS PARAMETRIC MODELING
- 19. 200 115 83 81 79 68 59 59 50 24 0 50 100150 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. FIELD RESEARCH + PARAMETRICANALYSIS
- 21. PATIENT CARE: INDIVIDUALASSESSMENT 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. Nurse Station toClean Supplies/Medication Room Clean Supplies/Medication Room to Patient Room Patient Room to Nurse Station A SIMPLE MED EVENT
- 23. Nurse Station toPatient 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. FIELD RESEARCH PARAMETRIC MODEL DEVELOPING A SEQUENCE MAPPER BASED ON FIELD RESEARCH SO EVERY DESIGN CONFIGURATION CAN BE ASSESSED
- 25. Comparison of actualvs. 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. RESEARCH DURING DESIGN PARAMETRICANALYSIS OF PLAN CONFIGURATIONS
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- 29. UNIT SECURITY &CORE POROSITY
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- 31. MED-SURG: THE ONETHING 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. MED-SURG: THE ONETHING 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. WHY THIS MATTERS CURRENT STATE FUTURE STATE TheField 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. PHASES OF WORK INTEGRATING RESEARCH INPRACTICE 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. De Ja VuVeJa Du
- 36. Ready for Questions& Comments unanda@hksinc.com