Decentralizing nursing units at MD Anderson Cancer Center was intended to improve efficiency, teamwork, and the patient and caregiver experience. A study collected data before and after decentralizing three nursing units to evaluate the impact. Key findings included a decrease in time spent on documentation and at the centralized nurse station, and an increase in time spent at decentralized medication and supply areas and on the unit. Walking distance for nurses also increased with the decentralized design. The consistency of these changes across the three units provides evidence that decentralization can impact how nurses spend their time and perform tasks.
PolicyPLUS Webinar - Effective Policy Writing and ManagementQFHC
Why documentation is so important: Tips that could keep you out of trouble later.
Who should write policies (qualifications of good policy writers).
What are the differences between policies and procedures.
When to use handbooks, manuals, flowcharts vs. policies.
How to achieve consistency using standardized policy attributes and format.
How to organize policies (classifying and numbering).
When policies should be reviewed and/or revised.
Our speaker Candace J. Chitty, BSN, MBA, CPHQ, PCMH-CCE is a NCQA PCMH reviewer and an expert in the NCQA patient centered medical home model and recognition process
Understanding records management print and electronicFe Angela Verzosa
lecture presented by Fe Angela M. Verzosa at the Seminar Workshop sponsored by De La Salle University- Dasmarinas, on 4 December 2014 at Luis Aguado Viewing Room, Aklatang Emilio Aguinaldo, DLSU-Dasmarinas, Cavite
This project report describes the development of a records management system for the Maternal and Child Health Section of Mbarara Hospital in Uganda. The system was created to address challenges with the current paper-based recordkeeping system, which lacked organization, experienced information loss, and made data retrieval difficult. The project used an agile software development methodology called Extreme Programming (XP) to develop the computerized system. Key features of XP like iterative development, team collaboration, and frequent system testing were employed. The new electronic system is expected to bring improvements to record organization, information security, and access and search capabilities at the hospital.
An effective records management program has seven key attributes:
1. It creates only necessary records and destroys obsolete records.
2. It safely stores records, especially archival records.
3. It allows quick retrieval of records through efficient systems.
4. It uses appropriate information technology to manage records.
5. It promotes public use of archival records as a community resource.
6. It ensures records management is integrated into all organizational policies and procedures.
7. It recognizes that records management is a responsibility of all staff.
An electronic medical record (EMR) system allows doctors to digitally create and store patient records and health information. It enables multiple providers to securely access a patient's information electronically. EMR systems can improve healthcare quality by providing up-to-date patient information, clinical decision support, and care coordination between providers. However, some doctors may face challenges fully utilizing EMR capabilities and may require extra time to learn new systems.
Healthcare and medicine are being revolutionized by communications and computational resources. Understanding how the convergence of these enabling technologies is advancing our ability to get and stay well is the topic of this presentation.
The document discusses electronic medical record (EMR) systems. It begins by explaining how the healthcare sector has evolved from relying on physical files to using EMR systems. It then defines EMR systems as electronic health records created and managed by healthcare organizations. The key benefits of EMR systems include improved patient safety, care quality, and access to information. However, barriers like costs have limited widespread adoption. Current research focuses on improving interoperability between different EMR systems. Overall, EMR systems play important roles in healthcare by facilitating information sharing, collaboration and patient care.
Implementing ITIL Change Management
in a Global Organization
Presenter: Paul Fibkins, Senior VP Global Process Owner
Paul shares his practical experience Implementing ITIL Change Management Best Practices in a Global Financial Organization. He will describe their journey - from 100 fiefdoms to an ITIL federation that includes getting 10,000 IT professionals making 10,000 changes a week to row in the same direction.
PolicyPLUS Webinar - Effective Policy Writing and ManagementQFHC
Why documentation is so important: Tips that could keep you out of trouble later.
Who should write policies (qualifications of good policy writers).
What are the differences between policies and procedures.
When to use handbooks, manuals, flowcharts vs. policies.
How to achieve consistency using standardized policy attributes and format.
How to organize policies (classifying and numbering).
When policies should be reviewed and/or revised.
Our speaker Candace J. Chitty, BSN, MBA, CPHQ, PCMH-CCE is a NCQA PCMH reviewer and an expert in the NCQA patient centered medical home model and recognition process
Understanding records management print and electronicFe Angela Verzosa
lecture presented by Fe Angela M. Verzosa at the Seminar Workshop sponsored by De La Salle University- Dasmarinas, on 4 December 2014 at Luis Aguado Viewing Room, Aklatang Emilio Aguinaldo, DLSU-Dasmarinas, Cavite
This project report describes the development of a records management system for the Maternal and Child Health Section of Mbarara Hospital in Uganda. The system was created to address challenges with the current paper-based recordkeeping system, which lacked organization, experienced information loss, and made data retrieval difficult. The project used an agile software development methodology called Extreme Programming (XP) to develop the computerized system. Key features of XP like iterative development, team collaboration, and frequent system testing were employed. The new electronic system is expected to bring improvements to record organization, information security, and access and search capabilities at the hospital.
An effective records management program has seven key attributes:
1. It creates only necessary records and destroys obsolete records.
2. It safely stores records, especially archival records.
3. It allows quick retrieval of records through efficient systems.
4. It uses appropriate information technology to manage records.
5. It promotes public use of archival records as a community resource.
6. It ensures records management is integrated into all organizational policies and procedures.
7. It recognizes that records management is a responsibility of all staff.
An electronic medical record (EMR) system allows doctors to digitally create and store patient records and health information. It enables multiple providers to securely access a patient's information electronically. EMR systems can improve healthcare quality by providing up-to-date patient information, clinical decision support, and care coordination between providers. However, some doctors may face challenges fully utilizing EMR capabilities and may require extra time to learn new systems.
Healthcare and medicine are being revolutionized by communications and computational resources. Understanding how the convergence of these enabling technologies is advancing our ability to get and stay well is the topic of this presentation.
The document discusses electronic medical record (EMR) systems. It begins by explaining how the healthcare sector has evolved from relying on physical files to using EMR systems. It then defines EMR systems as electronic health records created and managed by healthcare organizations. The key benefits of EMR systems include improved patient safety, care quality, and access to information. However, barriers like costs have limited widespread adoption. Current research focuses on improving interoperability between different EMR systems. Overall, EMR systems play important roles in healthcare by facilitating information sharing, collaboration and patient care.
Implementing ITIL Change Management
in a Global Organization
Presenter: Paul Fibkins, Senior VP Global Process Owner
Paul shares his practical experience Implementing ITIL Change Management Best Practices in a Global Financial Organization. He will describe their journey - from 100 fiefdoms to an ITIL federation that includes getting 10,000 IT professionals making 10,000 changes a week to row in the same direction.
Medical classification coding vs clinical terminology codingSB BHATTACHARYYA
This document discusses the differences between medical classification codes and clinical terminology codes. Classification codes are used for statistical analysis and billing, while terminology codes represent clinical concepts and enable semantic interoperability. Classification codes focus on specific data items, while terminology codes code entire domains. The document provides examples of coding a medical procedure and condition using ICD, CPT, and SNOMED CT codes to illustrate how each system represents the information differently.
Health Information Technology & Nursing InformaticsJil Wright
This document discusses health information technology and nursing informatics. It begins with an introduction by Jil Wright who identifies herself as a nursing informatics "geek". The document then provides resources for more information on health IT and nursing informatics. It discusses how nursing informatics integrates nursing science, computer science, and information science to support patients, nurses, and healthcare providers. Examples of clinical information systems and technologies that can help transform nursing practice are also provided, such as electronic medical records, wireless systems, and RFID technologies. Meaningful use requirements and examples of how health IT can improve documentation and the nursing process are summarized as well.
Important features of document management system softwareDigismartek
Digismartek : often referred to as Document Management Systems is the use of a computer system and software to store,manage and electronic images of paper based information.
lecture presented by Fe Angela M. Verzosa at the Seminar-workshop on Archives and Records Management for Open Government sponsored by the Commission of Human Rights (CHR) in partnership with the International Council of Museums-Philippines (ICOM-Philippines), De La Salle University-Manila University Library, and the Philippine Association of Museums (PAMI) held on 22 May 2012 at the Commission on Human Rights, UP Diliman, Quezon City
The document discusses healthcare information technology and its evolution. It defines common terms like EMR, EHR, HIS, HL7, DICOM and PACS. It states that computerized physician order entry (CPOE) can significantly reduce medication errors and preventable adverse drug events. The hospital information system (HIS) is described as an integrated system that manages administrative, financial and clinical data across different departments. Several standards organizations are working to develop standards for interoperability between different health IT tools and electronic medical records.
IT Governance or Corporate governance of information technology is a subset discipline of corporate
governance, focused on information and technology (IT) and its performance and risk management.
The interest in IT Governance is due to the ongoing need within organizations to focus value creation efforts
on an organization's strategic objectives and to better manage the performance of those responsible for creating this value in the best interest of all stakeholders.
The document discusses electronic document management systems (EDMS) and enterprise content management (ECM). It provides an overview of key concepts in document management including creation and distribution, filing and storage, indexing, search and retrieval, business process management, and security. It outlines problems with paper-based systems and how EDMS addresses these issues through electronic creation, storage, retrieval, security controls and disaster recovery. The document also covers different types of EDMS, features of EDMS that enable information sharing, and functions that EDMS can provide to organizations.
The document discusses the history and evolution of nursing informatics from Florence Nightingale's time to the present. It covers key topics like the development of hospital information systems in the 1950s-1960s, the definition and purpose of nursing informatics according to the ANA, general and specialist informatics competencies, nursing informatics specialties, the importance of informatics in healthcare delivery, and various informatics applications in areas like critical care, community health, and ambulatory care.
What is Health Informatics?
HI Goals
HI stakeholders
HI subfields / subspecialties
Healthcare trends & HI
HI professional environments
HI education / training opportunities & degrees
HI organizations / journals / meetings / events
HI professional certificates
HI books
A document management system (DMS) is a computer system used to store and track electronic documents. It allows organizations to digitally manage documents through their creation, distribution, and deletion. Key benefits include cost savings from less paper usage, improved search and security of documents, and audit trails showing who accessed or updated documents. Document management systems also enable remote access to documents and enhance staff productivity, cost reductions, knowledge sharing, and corporate transparency.
The document discusses various challenges faced by hospitals in achieving NABH accreditation. Some of the key challenges mentioned are: lack of a team approach and proper project planning for accreditation; incorrect gap analysis of NABH standards; dealing with inertia from clinicians and staff; inconsistent processes due to lack of SOPs and training; and unsafe facility environment issues like blocked fire exits and improper electrical safety. The document provides suggestions on addressing these challenges through measures like decentralizing accreditation tasks, conducting proper gap analysis, developing SOPs and training programs, and ensuring staff involvement and buy-in for quality improvement.
Supportive supervision training for Quality Improvement SpreadAdetola Oladimeji
This document provides an introduction to supportive supervision for mentor facilities. It defines supportive supervision as ongoing mentoring to ensure skills are applied in practice and develop public health capacities. The aim is to increase individual confidence through focused observation, mentorship and feedback. Six key areas of supportive supervision are identified: joint problem identification, joint problem-solving, training adults, time management, two-way communication, and coaching.
The document outlines how supportive supervision differs from traditional supervision by emphasizing routine encounters, observation and feedback rather than fault-finding. It also details the supportive supervision cycle of informing workers, observing performance, improving skills and work conditions, and motivating workers. Finally, it discusses best practices for planning, conducting and following up
Community Health Information Tracking System (CHITS) is a free open source electronic health record system used in Philippine health centers. It allows easy access to patient records and appointment scheduling. To implement CHITS, a team is created and trained on its use. Telenursing uses telecommunication to provide nursing care remotely through connected medical devices. It has advantages like increased access and monitoring but also disadvantages like decreased quality of care and privacy/security risks. Computer protection measures include user education, access restrictions, data backups, and disposal of unneeded data. Philippine hospitals have developed information systems through technology upgrades, expanded testing, and maintaining a pool of trained medical professionals.
How to Evaluate Emerging Healthcare Technology with Innovative AnalyticsHealth Catalyst
As healthcare systems are pressured to cut costs and still provide high-quality care, they will need to look across the care continuum for answers, reduce variation in care, and look to emerging technologies. This article walks through how to evaluate the safety and effectiveness and of emerging healthcare technology and prioritize high-impact improvement projects using a robust data analytics platform. Topics covered include:
The importance of identifying variation in innovation.
Ways to improve outcomes and decrease costs.
The value of an analytics platform.
The reliable information that produce sparks for innovation.
Identifying and evaluating emerging healthcare technology.
Knowing what data to use.
The difference between efficacy and effectiveness in evaluation of emerging healthcare technology.
Info-Tech Research Group provides research and advice on IT issues. They have a methodology for developing an IT strategy in 8 steps that involves determining the scope, assessing the current state of IT and business drivers, developing a target vision, defining initiatives, building a roadmap, executing the plan, and reviewing progress. Their process is grounded in established frameworks and is designed to ensure business needs are understood and the strategy delivers value. Info-Tech can help organizations develop an effective strategy by gathering diagnostic data, overcoming common barriers, and tailoring the approach based on an organization's size and needs.
This document outlines the requirements and processes for supporting applications in a production environment. It lists the types of documentation needed, such as architecture overviews, system agreements, job dependencies, and configuration details. It emphasizes defining responsibilities for stakeholders and having service level agreements, runbooks, agent notes, and knowledge transfer. The key processes highlighted are reviewing and signing off on support documentation, setting up environment access, addressing defects and change requests, and establishing release and communication procedures between business and IT.
Policies are guides for are to follow and procedures are the steps we can take. This slide
charge illustrates the 7 stages of the policy and procedure development process
ASC provides automated contract lifecycle management solutions tailored for specific industries. Their core product, ASC Contracts, is a web-based platform that allows customers to securely create, approve, store, and monitor legally binding agreements. It offers customizable templates and workflows, integrates with other systems, and facilitates agreement monitoring and compliance. Key benefits include reduced costs, increased productivity, improved data accuracy, and enhanced compliance oversight through features like electronic signatures, auditing, and reporting.
Electronic Records Management An OverviewKen Matthews
The document provides an overview of electronic recordkeeping (ERK) in the government. It defines key terms, describes objectives and critical success factors for ERK projects. It reviews legal requirements and business benefits, and introduces planning checklists for records managers and IT staff considering an ERK project.
This document summarizes a study examining the impact of decentralizing nursing units at MD Anderson Cancer Center. Data was collected before and after the transition to new units with decentralized nurse stations, medication rooms, and supplies. Findings included an increase in time spent walking and documenting for nurses, though collaboration was mixed with some improvements but staff also feeling more isolated at times. Overall, the study found that simply changing the physical design did not automatically achieve the desired outcomes and that operational processes and culture change are also needed to fully realize benefits from decentralization.
This document discusses the importance of perception in resolving human factors and change management issues during design projects. It provides an overview of a project to design a new patient care tower at Akron Children's Hospital that used an integrated project delivery approach involving clinical staff. The project employed various tools and techniques to manage staff perceptions and expectations during the design process, including value stream mapping, mockups, and pulse surveys. The presentation emphasizes that perception is reality, and change starts with addressing initial perceptions. It also discusses how involving staff voices, managing expectations, and closing gaps between perception and reality are key to leading successful transitions during change.
Medical classification coding vs clinical terminology codingSB BHATTACHARYYA
This document discusses the differences between medical classification codes and clinical terminology codes. Classification codes are used for statistical analysis and billing, while terminology codes represent clinical concepts and enable semantic interoperability. Classification codes focus on specific data items, while terminology codes code entire domains. The document provides examples of coding a medical procedure and condition using ICD, CPT, and SNOMED CT codes to illustrate how each system represents the information differently.
Health Information Technology & Nursing InformaticsJil Wright
This document discusses health information technology and nursing informatics. It begins with an introduction by Jil Wright who identifies herself as a nursing informatics "geek". The document then provides resources for more information on health IT and nursing informatics. It discusses how nursing informatics integrates nursing science, computer science, and information science to support patients, nurses, and healthcare providers. Examples of clinical information systems and technologies that can help transform nursing practice are also provided, such as electronic medical records, wireless systems, and RFID technologies. Meaningful use requirements and examples of how health IT can improve documentation and the nursing process are summarized as well.
Important features of document management system softwareDigismartek
Digismartek : often referred to as Document Management Systems is the use of a computer system and software to store,manage and electronic images of paper based information.
lecture presented by Fe Angela M. Verzosa at the Seminar-workshop on Archives and Records Management for Open Government sponsored by the Commission of Human Rights (CHR) in partnership with the International Council of Museums-Philippines (ICOM-Philippines), De La Salle University-Manila University Library, and the Philippine Association of Museums (PAMI) held on 22 May 2012 at the Commission on Human Rights, UP Diliman, Quezon City
The document discusses healthcare information technology and its evolution. It defines common terms like EMR, EHR, HIS, HL7, DICOM and PACS. It states that computerized physician order entry (CPOE) can significantly reduce medication errors and preventable adverse drug events. The hospital information system (HIS) is described as an integrated system that manages administrative, financial and clinical data across different departments. Several standards organizations are working to develop standards for interoperability between different health IT tools and electronic medical records.
IT Governance or Corporate governance of information technology is a subset discipline of corporate
governance, focused on information and technology (IT) and its performance and risk management.
The interest in IT Governance is due to the ongoing need within organizations to focus value creation efforts
on an organization's strategic objectives and to better manage the performance of those responsible for creating this value in the best interest of all stakeholders.
The document discusses electronic document management systems (EDMS) and enterprise content management (ECM). It provides an overview of key concepts in document management including creation and distribution, filing and storage, indexing, search and retrieval, business process management, and security. It outlines problems with paper-based systems and how EDMS addresses these issues through electronic creation, storage, retrieval, security controls and disaster recovery. The document also covers different types of EDMS, features of EDMS that enable information sharing, and functions that EDMS can provide to organizations.
The document discusses the history and evolution of nursing informatics from Florence Nightingale's time to the present. It covers key topics like the development of hospital information systems in the 1950s-1960s, the definition and purpose of nursing informatics according to the ANA, general and specialist informatics competencies, nursing informatics specialties, the importance of informatics in healthcare delivery, and various informatics applications in areas like critical care, community health, and ambulatory care.
What is Health Informatics?
HI Goals
HI stakeholders
HI subfields / subspecialties
Healthcare trends & HI
HI professional environments
HI education / training opportunities & degrees
HI organizations / journals / meetings / events
HI professional certificates
HI books
A document management system (DMS) is a computer system used to store and track electronic documents. It allows organizations to digitally manage documents through their creation, distribution, and deletion. Key benefits include cost savings from less paper usage, improved search and security of documents, and audit trails showing who accessed or updated documents. Document management systems also enable remote access to documents and enhance staff productivity, cost reductions, knowledge sharing, and corporate transparency.
The document discusses various challenges faced by hospitals in achieving NABH accreditation. Some of the key challenges mentioned are: lack of a team approach and proper project planning for accreditation; incorrect gap analysis of NABH standards; dealing with inertia from clinicians and staff; inconsistent processes due to lack of SOPs and training; and unsafe facility environment issues like blocked fire exits and improper electrical safety. The document provides suggestions on addressing these challenges through measures like decentralizing accreditation tasks, conducting proper gap analysis, developing SOPs and training programs, and ensuring staff involvement and buy-in for quality improvement.
Supportive supervision training for Quality Improvement SpreadAdetola Oladimeji
This document provides an introduction to supportive supervision for mentor facilities. It defines supportive supervision as ongoing mentoring to ensure skills are applied in practice and develop public health capacities. The aim is to increase individual confidence through focused observation, mentorship and feedback. Six key areas of supportive supervision are identified: joint problem identification, joint problem-solving, training adults, time management, two-way communication, and coaching.
The document outlines how supportive supervision differs from traditional supervision by emphasizing routine encounters, observation and feedback rather than fault-finding. It also details the supportive supervision cycle of informing workers, observing performance, improving skills and work conditions, and motivating workers. Finally, it discusses best practices for planning, conducting and following up
Community Health Information Tracking System (CHITS) is a free open source electronic health record system used in Philippine health centers. It allows easy access to patient records and appointment scheduling. To implement CHITS, a team is created and trained on its use. Telenursing uses telecommunication to provide nursing care remotely through connected medical devices. It has advantages like increased access and monitoring but also disadvantages like decreased quality of care and privacy/security risks. Computer protection measures include user education, access restrictions, data backups, and disposal of unneeded data. Philippine hospitals have developed information systems through technology upgrades, expanded testing, and maintaining a pool of trained medical professionals.
How to Evaluate Emerging Healthcare Technology with Innovative AnalyticsHealth Catalyst
As healthcare systems are pressured to cut costs and still provide high-quality care, they will need to look across the care continuum for answers, reduce variation in care, and look to emerging technologies. This article walks through how to evaluate the safety and effectiveness and of emerging healthcare technology and prioritize high-impact improvement projects using a robust data analytics platform. Topics covered include:
The importance of identifying variation in innovation.
Ways to improve outcomes and decrease costs.
The value of an analytics platform.
The reliable information that produce sparks for innovation.
Identifying and evaluating emerging healthcare technology.
Knowing what data to use.
The difference between efficacy and effectiveness in evaluation of emerging healthcare technology.
Info-Tech Research Group provides research and advice on IT issues. They have a methodology for developing an IT strategy in 8 steps that involves determining the scope, assessing the current state of IT and business drivers, developing a target vision, defining initiatives, building a roadmap, executing the plan, and reviewing progress. Their process is grounded in established frameworks and is designed to ensure business needs are understood and the strategy delivers value. Info-Tech can help organizations develop an effective strategy by gathering diagnostic data, overcoming common barriers, and tailoring the approach based on an organization's size and needs.
This document outlines the requirements and processes for supporting applications in a production environment. It lists the types of documentation needed, such as architecture overviews, system agreements, job dependencies, and configuration details. It emphasizes defining responsibilities for stakeholders and having service level agreements, runbooks, agent notes, and knowledge transfer. The key processes highlighted are reviewing and signing off on support documentation, setting up environment access, addressing defects and change requests, and establishing release and communication procedures between business and IT.
Policies are guides for are to follow and procedures are the steps we can take. This slide
charge illustrates the 7 stages of the policy and procedure development process
ASC provides automated contract lifecycle management solutions tailored for specific industries. Their core product, ASC Contracts, is a web-based platform that allows customers to securely create, approve, store, and monitor legally binding agreements. It offers customizable templates and workflows, integrates with other systems, and facilitates agreement monitoring and compliance. Key benefits include reduced costs, increased productivity, improved data accuracy, and enhanced compliance oversight through features like electronic signatures, auditing, and reporting.
Electronic Records Management An OverviewKen Matthews
The document provides an overview of electronic recordkeeping (ERK) in the government. It defines key terms, describes objectives and critical success factors for ERK projects. It reviews legal requirements and business benefits, and introduces planning checklists for records managers and IT staff considering an ERK project.
This document summarizes a study examining the impact of decentralizing nursing units at MD Anderson Cancer Center. Data was collected before and after the transition to new units with decentralized nurse stations, medication rooms, and supplies. Findings included an increase in time spent walking and documenting for nurses, though collaboration was mixed with some improvements but staff also feeling more isolated at times. Overall, the study found that simply changing the physical design did not automatically achieve the desired outcomes and that operational processes and culture change are also needed to fully realize benefits from decentralization.
This document discusses the importance of perception in resolving human factors and change management issues during design projects. It provides an overview of a project to design a new patient care tower at Akron Children's Hospital that used an integrated project delivery approach involving clinical staff. The project employed various tools and techniques to manage staff perceptions and expectations during the design process, including value stream mapping, mockups, and pulse surveys. The presentation emphasizes that perception is reality, and change starts with addressing initial perceptions. It also discusses how involving staff voices, managing expectations, and closing gaps between perception and reality are key to leading successful transitions during change.
Challenges of Summative Usability Testing in a Community Hospital Environment...David Schlossman MD
Findings of a summative scenario based ehr usability testing protocol and challenges of conducting the research in a private practice community hospital environment.
This document summarizes a presentation on how emergency department design impacts safety and efficiency. It discusses 14 domains of physical design that were studied, including entry/public waiting, patient intake, configuration, care-giver work areas, and physician work areas. Certain design elements like visibility, queuing, and security provisions in the entry area significantly affect both safety and efficiency. The study's findings can help hospitals optimize their emergency department design.
Your aging patient bed tower top ten considerations when renovatingArray Architects
While the benefits of caring for inpatients within a private room have now been time tested, there are thousands who still receive care outside of this clinically preferred environment on a daily basis. As is often the case, the benefits may be clear, but the perceived cost of providing more private patient rooms has prevented the wholesale adoption of this basic principle throughout the United States. Building new bed towers has been an option for systems that could afford to build new facilities. However, many systems do not have that luxury or are landlocked, at capacity and cannot expand or afford to give up beds from their license. This session will provide a roadmap for the successful renovation of patient units to accommodate all private rooms, or enhanced 2-Bed rooms that incorporate best clinical practices in a cost effective manner. By breaking down the success factors into ten key considerations, this session will allow designers, managers, and contractors to plan and execute such projects more effectively. Case studies will be presented to demonstrate how this straightforward approach can increase the success of renovations that convert (primarily) double bedded units into single patient room units.
Formation of a multi-discipline advanced endoscopy inpatient teamJason Sims
A multi-discipline advanced endoscopy inpatient team was formed to decrease bottlenecks in patient flow in a limited unit work space. The team identified common causes of bottlenecks like unstable patient comorbidities, altered anatomy, additional needed interventions, and tardiness. They collected data on procedure times, wait times, and patient volumes. An intervention was implemented where the inpatient team assesses patients before arrival to expedite the process and free up rooms. Considerations included staff engagement, unit design, and dedicated transport. The team aimed to improve efficiency through process changes while maintaining quality care.
Ambulatory Health Care Facility of the Future: Integrating Lean Workflow Rede...The Neenan Company
For more information, go to http://neenan.com or call 970.493.8747
As presented on March 19, 2010 at the 2010 AMGA Annual Conference
Presented by: Randall Huss, M.D., President, and Gerald Dowdy, VP Operations, St. John’s Clinic – Rolla Division; and Miguel Burbano de Lara, AIA, NCARB, Senior VP Healthcare, The Neenan Company
When faced with the opportunity of designing a new ambulatory facility to house a multi-specialty clinic practice, ASC and other outpatient services to be completed a year after implementation of their EHR, the St. John’s Clinic-Rolla team partnered with a progressive architectural team, The Neenan Company, to design and build a facility around the new electronic workflows. They integrated Lean workflow redesign and Lean facility design elements to achieve a facility capable of supporting the digital, paperless ambulatory practice of the future.
College Writing II Synthesis Essay Assignment Summer Semester 2017.docxclarebernice
College Writing II Synthesis Essay Assignment Summer Semester 2017
Directions:
For this assignment you will be writing a synthesis essay. A synthesis is a combination of two or more summaries and sources. In a synthesis essay you will have three paragraphs, an introduction, a synthesis and a conclusion.
In the introduction you will give background information about your topic. You will also include a thesis statement at the end of the introduction paragraph. The thesis statement should describe the goal of your synthesis. (informative or argumentative)
The second paragraph is the synthesis. You will combine two summaries of two different articles on the same topic. You will follow all summary guidelines for these two paragraphs. The synthesis will most likely either argue or inform the reader about the topic.
The conclusion paragraph should summarize the points of your essay and restate the general ideas.
For this essay you will read two research articles on a similar topic to the previous critical review essay as you can use this research in your inquiry paper. You will summarize both articles in two paragraphs and combine the paragraphs for your synthesis. In the synthesis you must include the main ideas of the articles and the author, title, and general idea in the first sentences.
This essay will be three pages long and the first draft and peer review are due June 15. You must turn them in hardcopy in class so you can do a peer review.
Running head: THESIS DRAFT 1
THESIS DRAFT 3Thesis Draft
Katelyn B. Rhodes
D40375299
DeVry University
Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014).
Historic Timeline
In the early-to-mid 1990’s, bench top analyzers entered the clinical laboratory scene. These analyzers were much smaller than the conventional analyzers being used, and utilized touch-screen PCs for ease of use. For this reason, they were able to be used closer to the patient’s bedside or outside of the laboratory environment. However, at this point in time, laboratory testing results were stored within the device and would have to then be sent to the main central laboratory for analysis.
Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more ...
This document discusses how field research and parametric analysis were used to inform the design of a new patient tower for ProMedica Toledo Hospital. Researchers conducted observations and activity analysis of a current med-surg unit to understand issues like wasted walking, limited visibility, and unused space. A parametric model was developed to simulate different design configurations and sequences of staff activities. Key findings included that multi-tasking did not reduce time and point-of-use supplies could improve efficiency. The research helped define targets for the future state design focused on decentralization, proximity of supplies, and improved care coordination.
Ronan Herlihy on Engaging Clinicians with data on their ordering practicesCirdan
The appropriate ordering project uses data extracted from Electronic Medical Record to create dashboards to inform and engage clinicians in ordering practices. This presentation looks at the techniques used to create answers for the clinicians questions and discusses the purpose behind 12 dashboards. It looks at the change management approaches and challenges.
The initial pilot project has been embraced by a number of local health districts in NSW and templates have been made available along with training tools.
CHOC Children's Hospital implemented an interdisciplinary Patient Flow Improvement Team to address issues with patient throughput and capacity. The team developed technology-enabled solutions across the continuum of care from pre-admission to discharge. This included an electronic bed board, standardized admission processes, and automated discharge workflows. Data from the systems showed improvements such as a 27% increase in ED admissions, 76-80% faster discharge times, and an 81% reduction in cancelled admissions. The initiatives helped align practices with strategic goals of ensuring timely access to care.
The document summarizes a study on improving connectivity for clinicians through a wireless infrastructure and mobile devices. It discusses bottlenecks observed for clinicians, results showing time savings from improved access to patient information and communication, and economic modeling showing the investment in wireless technology was cost effective. It concludes that putting individuals at the center of connected care through technology and process changes can improve outcomes when implemented as part of a larger healthcare reform program.
This document summarizes a presentation on using data and informatics to improve allied health services. It discusses the history of allied health and challenges with data collection. Examples are provided of projects in New Zealand that used data to enhance patient and clinician experiences, reduce hospital-acquired infections, and inform staffing needs. The presentation emphasizes standardizing data to facilitate benchmarking and applying knowledge gained from data analysis to drive improvements in allied health.
Increase nursing time spent with patients: the holy grail. A mixed method res...Kasia Bail
This document summarizes a mixed methods study evaluating the impact of a digital bedside nursing chart on nursing time spent with patients. Key findings include:
- Nurses' time spent at the bedside increased slightly by 2% with the digital chart, while time at the nurse station increased by 5%.
- Nurses reported slightly less missed care (17% decrease) while patients reported a larger decrease in missed care (26% decrease).
- Nurses' walking distances decreased by 17% with the digital chart.
However, qualitative findings highlighted issues with the implementation process and ergonomic design that disrupted clinical workflow and may have caused pain or injury in some nurses. Extraneous variables like ward characteristics and patient volumes
Business Research Project Part 1 Business Problem a.docxhumphrieskalyn
Business Research Project Part 1: Business Problem and Research Questions
Belen MacKenzie, Daniel Ivy, Kari Stormoen, Latoya Hill, Siead Hasan
QNT/561
University of Phoenix
April 14, 2014
Andjelka Srdic
Running head: BUSINESS RESEARCH PROJECT PART1: BUSINESS PROBLEM
1
BUSINESS RESEARCH PROJECT PART1: BUSINESS PROBLEM
6
Introduction
The organization chosen for this assignment is Pomona Valley Hospital Medical Center (PVHMC) in Southern California. It is a public, nonprofit acute hospital facility in addition to four offsite facilities. PVHMC serves two neighboring counties of Los Angeles and San Bernardino County. The mission of PVHMC is to provide high quality, cost effective health care services to residents of the greater Pomona Valley. Over the next five years, the hospital will complete construction of a new Outpatient Pavilion and expanded Emergency services to better meet the needs of the community.
Products and Services Provided
PVHMC offers a wide range of products and services related to healthcare. In addition to having an emergency department, some of the services provided are oncology, women and children’s care, cardiac and vascular care, kidney stones, physical therapy, robotic surgery, and sleep disorders. Specific to women’s health, PVHMC has specialized equipment to create 3D mammograms. The robotic surgery utilizes a state of the art console that operates four robotic arms allowing for precise surgical incisions. A state of the art cardiac rehab program compliments cardiovascular services offered (Pomona Valley Hospital Medical Center, 2013).
Addressing Problems with Research
According to the American College of Healthcare Executives, one of the problems or dilemmas that healthcare facilities face daily is financial challenges. This has been an issue for the past five to ten years. PVHMC struggles on a daily basis with figuring out how the facility will gain profit. This is a problem that management and personnel can address with research by researching grants that will help support some of the programs and healthcare the facility needs to care for the people.
There are other concerns that PVHMC must address with research, competition and the latest products. It is important the company keeps up with its competition in which giving the best care to patients is important. There is so much that goes into that concern as well with the highest level of customer service to pair with the hospital’s healthcare. Also, the products play a part in helping to cure pain and diseases. Hospitals must be competitive with the latest technology, equipment and treatment plans for patients. The best way to do this is through market research. Market research would provide the hospital with the knowledge needed to make informed decisions to achieve the overarching strategic plan.
The quest for cutting edge medicine creates a major dilemma. The high cost of delivering care has been culprit to several hospitals closing its emergency ro ...
CTC101– College Success Seminar Weekly Journal AssignmentsMargenePurnell14
CTC101– College Success Seminar
Weekly Journal Assignments
Due Dates: 11:59 p.m. EST, Sunday of Units 1, 2, 6, 7, and Friday of Unit 8
Points: 100 each
Overview:
The purpose of the journal assignments is to be an ongoing individual conversation between you and
your instructor. All conversations in the journal are strictly between you and your instructor and
cannot be seen by other students.
Instructions:
Each week that a journal is assigned, you will answer specific journal questions supporting your work
with evidence from the provided resources.
Requirements:
• Use critical thinking about course ideas and concepts and connect them to your
experiences.
• Reflect on your experiences with a personal application and connection to learning.
• Use professional language, grammar, and spelling.
Be sure to read the criteria below by which your work will be evaluated before you write
and again after you write.
Evaluation Rubric for Weekly Journal Assignments
CRITERIA Did Not Meet Expectations Needs Improvement Competent
Meets or Exceeds
Expectations
(0-23 points) (24-29 points) (30-35 points) (36-40 points)
Content
Reflection
Reflection
states only
what was read
or heard in
class without
any further
development.
Reflection
raises ideas from the
coursework with
limited sharing about
what it means to you
and what you think
about the ideas.
Reflection shares the
meaning you
place on coursework
experiences and how
they connect to
support your
success.
Reflection reveals
critical thinking about
course ideas and
concepts that
connect the meaning
of the ideas and ways
to make them work
for you in college and
life.
(0-17 points) (18-22 points) (23-26 points) (27-30 points)
Personal
Growth
Inadequate
evidence of
reflection.
Limited evidence of
reflection on own
work with a personal
application and
connection to
learning.
Evidence of
reflection on own
work with a personal
application and
connection to
learning.
Strong evidence of
reflection on own
work with a personal
application and
connection to
learning.
(0-17 points) (18-22 points) (23-26 points) (27-30 points)
Writing
Quality
Poor writing
style lacking in
standard
English, clarity,
and language
used and/or
frequent errors
in grammar,
punctuation,
usage, and
spelling. Needs
work.
Average and/or
casual writing
style that is
sometimes
unclear and/or with
some errors in
grammar,
punctuation,
usage, and spelling.
Above-average
writing style and
logically organized
using standard
English with
minor errors in
grammar,
punctuation, usage,
and spelling.
Well written
and clearly
organized
using standard
English,
characterized
by elements of a
strong writing
style, and free
from grammar,
punctuation,
usage, and
spelling errors.
Overview:Instructions:Requirements:Be sure to read the criteria below by which your work will be evaluated before yo ...
Testing technology in the ‘real world’ of acute healthcare: making it work. Presented by Bernice Redley, Deakin University, Australia, at HINZ 2014, 12 November 2014, 12.22pm, Plenary Room
Lean Facility Design as an Agent of Organizational Change for the Future of H...The Neenan Company
The document summarizes St. John's Clinic's process in designing and building a new ambulatory healthcare facility in Rolla, Missouri to better support their transition to a new model of patient-centered, team-based care. Key aspects included conducting lean workflow analysis, visiting exemplar clinics, and designing the new facility based on lean principles to optimize space, efficiency and support the care team model. Initial challenges were overcome and the new clinic has led to improved patient satisfaction, increased capacity and reductions in space and costs while supporting the organizational transformation.
1. The document summarizes a study on wayfinding in hospitals that sought to understand what environmental cues people use to navigate.
2. Interviews and tracking of patients, visitors, and employees at a large hospital campus found that people primarily rely on maps, signs, and developing familiarity with landmarks.
3. Other design elements like architectural features, artworks, and furniture arrangements can also serve as landmarks to help orient people and develop familiarity with an unfamiliar environment.
This document discusses research on defining the design characteristics of a successful adaptable inpatient unit. The research studied six hospitals to understand what flexibility means to different stakeholders and how physical design influences flexibility. Key findings include that flexibility was found to mean adaptability, convertability, and expandability. Design characteristics like proximity of support spaces, lines of sight, and adjustable core spaces promoted flexibility by accommodating operational changes.
1. The study examined the influence of view duration and content on nurse stress and arousal levels. It found that arousal levels significantly decreased over the course of a shift while acute stress levels significantly increased, supporting the hypotheses.
2. Exposure to an external view, particularly a nature view, was associated with higher arousal levels and lower acute stress levels at the end of the shift. Those without a view or with a non-nature view saw greater deterioration in arousal and acute stress.
3. View duration and content had a small but statistically significant influence on arousal and acute stress levels, after controlling for other stressors. A nature view was most beneficial in maintaining arousal levels over the course of a shift.
TRADELINE_2007_Academic Medical Center ConferenceUpali Nanda
This document summarizes a conference presentation on designing workplaces to enhance collaboration in academic medical centers. It discusses how knowledge workers in these environments generate new ideas through both planned and spontaneous interactions. The presentation explores different dimensions of interaction and how physical workplace strategies like proximity and visibility can encourage both conservative sharing of knowledge as well as more generative collaboration. Examples are given of design features that support informal meetings and serendipitous connections between colleagues in medical centers.
The document discusses findings from observations of critical care units at a hospital. Key findings include:
- Medical staff spent most of their time at the patient bedside or gathering information at the nurses' station. Nurses spent most of their time on patient care or documentation tasks at the bedside.
- Ideal room designs were proposed with equipment and supplies organized around the patient bed to minimize staff walking distances and improve ergonomics.
- Future trends may include larger, flexible critical care rooms designed around patient needs and staff workflows.
The document discusses a study examining the association between view duration and content on staff stress and alertness levels. The study was conducted at a children's hospital and measured the chronic stress, acute stress, and alertness of 32 medical personnel over 12-hour shifts. Results showed no statistically significant difference in chronic stress levels before and after shifts. However, alertness levels were significantly lower after shifts, indicating that view may influence staff stress and alertness.
The document summarizes a study that assessed how different room configurations in adult medical-surgical units impact patient care activities. Participants ranked 23 criteria and evaluated 6 room layouts. Non-designers and designers had some differences in criteria rankings. Layouts B and F received the highest suitability scores while layouts with inboard toilets received negative ratings. The findings could help programming and design but questions remain about reliability and validity. Performance-based evaluation frameworks may improve traditional decision-making.
This document summarizes a study comparing medical gas booms to traditional headwalls in ICU patient rooms. Clinicians participated in simulations of various patient care scenarios using both systems. Physicians and respiratory therapists generally preferred booms for flexibility and ergonomics. Nurses preferred booms to reduce clutter and improve access to the patient's head. Family access and visibility were not significantly impacted by either system in most situations. The document outlines factors to consider when deciding between booms or headwalls, such as anticipated acuity level and procedures. Further research is suggested to enhance understanding of impacts on patient safety and day-to-day care delivery.
The document summarizes key findings from a study examining the impacts of patient room handedness on nursing care delivery. The study involved observing 20 left-handed and 20 right-handed nurses performing common nursing tasks like taking vitals and suctioning in different room configurations. The study found:
- There were predictable patterns of behavior among both left-handed and right-handed nurses within each group.
- There were statistically significant differences between left-handed and right-handed nurse behaviors.
- For the vitals task, the location of the IV and overhead table determined what side nurses positioned themselves on relative to the patient. For suctioning, nurse handedness and equipment locations influenced positioning.
1) The study examined the effects of positive distractions on the attention, behavior, and activities of pediatric patients waiting in dental and cardiac clinics.
2) It found that multi-sensory distractions like ambient art with sound were most effective at focusing patients' attention, and resulted in patients being calmer with less movement.
3) The type of distraction that worked best varied between the two clinics, suggesting that factors like a patient's illness or disability can influence their response to different distractions. Overall, positive distractions helped improve the waiting experience for pediatric patients.
BIM Forum_2010_Beyond a Reasonable DoubtUpali Nanda
1) Evidence-based design (EBD) emerged in healthcare to improve safety and outcomes using research-informed design decisions.
2) Studies found EBD strategies like decentralized nursing units reduced patient falls by 75% and transfers by 90%.
3) Other research linked factors like patient visibility and private rooms to lower mortality and infection risk.
4) For BIM to be truly evidence-based, it needs an empirical evidence base from built project performance and linkage to organizational goals, not just cost savings.
HCD_2010_Inflexibility in Flexible DesignUpali Nanda
The document summarizes research into nine domains of design decision-making that impact operational flexibility in acute care medical-surgical units: peer lines-of-sight, patient visibility, multiple division/zoning options, proximity of support, resilience to move services, inter-unit movements, service expansion options, adjustable support core, and expandable support core. The research identified several factors that can impede designing for optimal operational flexibility, including systemic, cultural, human, financial, and physical factors. Examples of impediments discussed include unanticipated consequences of information technology, lack of standardized communication platforms, and assumptions about IT implementation timelines not being realized.
PDC_2011_Building Smart Without Compromising EfficiencyUpali Nanda
The document discusses how larger inpatient bed units can be designed to efficiently use nursing time through optimized flow and reduced walking distances. Two case studies, Summerlin Hospital and Texoma Medical Center, incorporated racetrack unit designs that reduced travel distances and times spent walking compared to national benchmarks. Post-occupancy data found the units' time distributions across tasks and activities, as well as walking distances, were similar to other top performing hospitals, demonstrating how larger bed counts can be achieved without compromising efficiency.
This document discusses using parametric modeling to optimize nurse walking distances and enhance workflow in hospital unit design. It presents a theoretical framework for how walking distance as a driver can impact environmental quality, human outcomes like time in patient care, and organizational outcomes. A case study compares centralized and decentralized nurse stations in a 36-bed unit, finding decentralized reduced distances by up to 36%. Future research opportunities include building parametric tools to automatically generate and evaluate design alternatives based on user-defined criteria.
This document discusses using design projects as laboratories for research. It outlines three initiatives - technology, sustainability, and human and organizational behavior. For each initiative, it provides examples of research projects, including one that used computational fluid dynamics to study airflow in exam rooms and another that examined the impact of view duration and content on nurse stress. It advocates conducting field research and simulations on a project to study human behavior, energy performance, and other factors. The goal is to integrate research findings into design to improve individual, organizational and environmental wellbeing while overcoming resistance factors like billability and time.
This document discusses how design often focuses on vision while neglecting other senses like smell, sound, and touch. It provides an overview of each sense and how they differ in range, directionality, and distance. The historical hierarchy of the senses placed sight and hearing above smell, taste, and touch. New research suggests smell allows for richer emotions and memory associations than previously thought. The document calls for greater consideration of all the senses in design to improve sensory experiences and coherence. It provides examples of how senses interact crossmodally and the potential for designing spaces that concur, correspond, and cohere across the sensory modalities.
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.
The document provides information about a session on neuroarchitecture and aging. It begins with welcome and CE information. It then describes how the aging brain undergoes changes that impact sensory perception and cognitive function. As people age, their senses of hearing, vision, smell, taste and touch decline. The session will discuss research on the aging brain and senses, and explore design strategies that can address sensory changes and support brain health for older adults. These include addressing visual challenges through lighting, color contrast and glare reduction, as well as fall prevention through clear wayfinding and safe circulation.
The document discusses the importance of change management and stakeholder engagement throughout the design and transition process for new healthcare facilities. It provides examples from Akron Children's Hospital's expansion projects including a new emergency department (ED) and neonatal intensive care unit (NICU). Surveys of ED and NICU staff before and after the moves assessed levels of involvement in the projects, knowledge of the new spaces and processes, and perceptions of preparedness and ability to adapt. Results showed that greater involvement in facility design increased later perceptions of preparedness and adaptation for both groups. However, the new NICU design more significantly impacted workflows, so involvement was more important for feeling prepared ahead of time. The findings emphasize tailoring change engagement strategies to
The document discusses lessons learned from a study on applying lean thinking and integrated project delivery (IPD) to healthcare construction projects. It found that full-scale mockups were the most effective lean strategy. It also found that learning was an important implicit benefit not tracked. While IPD led to benefits like collaboration, some challenges included perceived imbalance of influence and optimal use of lean strategies. To fully evaluate the costs and benefits of lean-IPD approaches, factors like time costs for additional participation and documentation need to be accounted for.
PDF SubmissionDigital Marketing Institute in NoidaPoojaSaini954651
https://www.safalta.com/online-digital-marketing/advance-digital-marketing-training-in-noidaTop Digital Marketing Institute in Noida: Boost Your Career Fast
[3:29 am, 30/05/2024] +91 83818 43552: Safalta Digital Marketing Institute in Noida also provides advanced classes for individuals seeking to develop their expertise and skills in this field. These classes, led by industry experts with vast experience, focus on specific aspects of digital marketing such as advanced SEO strategies, sophisticated content creation techniques, and data-driven analytics.
Fonts play a crucial role in both User Interface (UI) and User Experience (UX) design. They affect readability, accessibility, aesthetics, and overall user perception.
Explore the essential graphic design tools and software that can elevate your creative projects. Discover industry favorites and innovative solutions for stunning design results.
Maximize Your Content with Beautiful Assets : Content & Asset for Landing Page pmgdscunsri
Figma is a cloud-based design tool widely used by designers for prototyping, UI/UX design, and real-time collaboration. With features such as precision pen tools, grid system, and reusable components, Figma makes it easy for teams to work together on design projects. Its flexibility and accessibility make Figma a top choice in the digital age.
Connect Conference 2022: Passive House - Economic and Environmental Solution...TE Studio
Passive House: The Economic and Environmental Solution for Sustainable Real Estate. Lecture by Tim Eian of TE Studio Passive House Design in November 2022 in Minneapolis.
- The Built Environment
- Let's imagine the perfect building
- The Passive House standard
- Why Passive House targets
- Clean Energy Plans?!
- How does Passive House compare and fit in?
- The business case for Passive House real estate
- Tools to quantify the value of Passive House
- What can I do?
- Resources
Decormart Studio is widely recognized as one of the best interior designers in Bangalore, known for their exceptional design expertise and ability to create stunning, functional spaces. With a strong focus on client preferences and timely project delivery, Decormart Studio has built a solid reputation for their innovative and personalized approach to interior design.
Technoblade The Legacy of a Minecraft Legend.Techno Merch
Technoblade, born Alex on June 1, 1999, was a legendary Minecraft YouTuber known for his sharp wit and exceptional PvP skills. Starting his channel in 2013, he gained nearly 11 million subscribers. His private battle with metastatic sarcoma ended in June 2022, but his enduring legacy continues to inspire millions.
Visual Style and Aesthetics: Basics of Visual Design
Visual Design for Enterprise Applications
Range of Visual Styles.
Mobile Interfaces:
Challenges and Opportunities of Mobile Design
Approach to Mobile Design
Patterns
1. E74: Teaming Up
Does unit decentralization impact teamwork and
operational efficiencies?
Pamela Redden, MS, BSN,RN, EDAC, Director, Clinical Facilities Development
UT MD Anderson Cancer Center
Janet Sisolak, Project Director
UT MD Anderson Cancer Center
Debajyoti Pati, PHD, FIIA, LEED AP.
Executive Director, CADRE; Rockwell Endowment Professor, Texas Tech
2. Acknowledgments
HKS Architects
- Study sponsor and institutional support
Center for Advanced Design Research &
Evaluation (CADRE)
Texas Tech University
- Institutional support
3. Learning Objectives
Understand the impact of decentralization on
the way nurses spend their time (efficiency).
Understand the impact of decentralization on
walking distance.
Understand the potential influence of
decentralized operations on presenteeism and
acute stress of care providers.
Understand the impact of decentralization on
care providers’ teamwork and collaboration.
4. Agenda
Drivers of decentralization
Key questions
The evidentiary challenge
The MD Anderson project
Study data
Key findings
6. Bed utilization:
• Male – Female
• Smoker – Non
Smoker
• Infection
Build fewer beds
Increase
flexibility
Driver of Decentralization: Single Room
7. Key Area of Change # 1
Increase in floor
area per patient:
• Larger footprint
for the same
number of beds
8. Key Area of Change # 2
Support space
optimization:
• Race track
configuration
• Decentralization
9. Hypothesized Impact Areas
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
10. Agenda
Drivers of decentralization
Key questions
The evidentiary challenge
The MD Anderson project
Study data
Key findings
11. Key Questions
Does decentralization influence time spent
in walking, queues, and hunting and
gathering?
Does it reduce non-productive tasks?
12. Key Questions
Does decentralization influence staff
interaction and collaboration?
13. Agenda
Drivers of decentralization
Key questions
The evidentiary challenge
The MD Anderson project
Study data
Key findings
14. The AECOM Study
Six units
Three hospitals
Measurements:
- Functional space use
- Patient visibility
- Noise level
- Nurse perception of
work environment
Findings:
- Time spent on
telephone/ computer/
admin higher in
centralized
- Consultation/
interaction less
frequent on
decentralized
Centralized vs. Decentralized Nursing Stations: Effects on
Nurses’ Functional Use of Space and Work Environment
(Terri Zborowsky, et al.)
15. The Taiwan Study
Two units
Two hospitals
Measured:
- Staff interaction
- Patient falls
Findings:
- Less communication
in decentralized
model
- Less patient fall
events in
decentralized model
Impact of Architectural Design on Communication among
Hospital Staff. (Chai Hui Wang)
16. The WHR Study
Four units
One hospital
Measured:
- Patient satisfaction
- Nurse satisfaction
- Communication
- Walking distance
- Medical outcomes
- Organizational outcomes
Findings:
- Increase in patient
satisfaction
- No significant
differences in any
other parameters
The Effects of Nursing Unit Spatial Layout on Nursing
Team Communication Patterns, Quality of Care and
Patient Safety (Franklin Becker et al)
17. Agenda
Drivers of decentralization
Key questions
The evidentiary challenge
The MD Anderson project
Study data
Key findings
18.
19. Location - the heart of the Texas Medical Center, Houston, TX
M.D. Anderson Cancer Center Background
20. • 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 Background
21. • 1998 – 1999
20% growth in patients
• 1999 – 2008
80% growth in patients
75% increase in employee
115% increase in research
revenue
• 2012 Projections
50% growth in patients
from 2006
M.D. Anderson Cancer Center Growth
24. 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
30. 1.Need to maximize
the number and
size of patient
rooms per floor
using current
industry and best
practice standards
2.Need to improve
wayfinding for
families and
visitors
3.Need to add
family spaces &
amenities on floor
2 2
11
3
NN
Design Challenges – Patient/Family
31. 1.Need to increase
access to nursing
stations
2.Need to improve
staff and patient
circulation
3.Need to improve
support and staff
areas
1 1
22
3 3
NN
Design Challenges – Staff
32. Key Goals and Objectives
The new Alkek patient units will be 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
33. Key Goals and Objectives
Additionally, key design elements should be
considered in relation to these guiding
principles:
Promote safety for patients
Enhance support for patients and their families,
recognizing that the family plays an active role in
the healing process
Meet/exceed the needs of the care givers -
integrate technology, maximize staff productivity,
increase time at the patient bedside, minimize
footsteps, enhance ergonomics
34. Design
Design-Build project McCarthy/HKS
Nursing Leadership Design Team 2006
Surveys on design topics- staff, physicians, caregivers,
patients
Focus Groups
- Medical Team Members
- Staff
- Patients & Family Members
Bulletins & Postings
SharePoint Site
35. Design Solutions - Patients/family
1.Increased footprint
to accommodate
more rooms per
floor
2.Improved
wayfinding on unit
3.More family
waiting
4.Added consult
room
1
11
1
33
22
44
NN
37. 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
38. Inpatient Rooms
Room Zones
• Family Zone
- Sleep Sofa
- Additional Storage for Family
- Individual Television
• Patient Zone
- Flexible Acuity
- Desk Work Area
- Headwall Ergonomics
• Staff Zone
- Hand washing sink inside room
- Locked medication storage
- C5 mobile computer
39. 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
40. Unit Staff Support Areas
Medication Rooms
• Locked medication rooms added to
each pod on the new units
• Addresses Joint Commission
standards for medication security
• Permits focused, uninterrupted
medication preparation by the
nursing staff
Team Station
• Fully outfitted admin area for Roving
Patient Service Coordinator/Staff
utilization
• Central Physiologic Monitoring
41. Team Room
Team Rooms
• Multi-purpose rooms located on each
pod to foster interdisciplinary
collaboration and teamwork
• MediaScape Smart Media
Collaboration Table from
Steelcase – data network
connections w/ ability to display
images from on-board desktop
computers or laptops.
• Web conferencing capable
• Educational Initiatives
• Glass walls of Team Rooms can
be reconfigured if future utilization
changes
44. Unit Model
STAFFING
Staffing typically 2-3 patients/RN
Support staff: CNAs and PSCs
Clinical Nurse Leader, AD, ANMs
PATIENTS
Leukemia
Lymphoma
Stem Cell Transplant
“Mixed” hematology
45.
46. Goals of the QI Project
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
47. Study 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
49. Pre Occupancy Data Collection
“Pre” Data Collection
January 18 – 31, 2011
G11 (Stem Cell Transplant) Alkek
Hospital
P6 (Hematology) Lutheran Pavilion
February 1 – 7, 2011
G9 East (Lymphoma Service) Alkek
Hospital
Written Surveys for 2 weeks – January 15
– 31.
50. Activation and Occupancy
“Bed shortage”/high census impacts
Phased occupancy
November 8, 2010 G16 G10W 26 beds to G16 48
beds
March 7, 2011 G17E: 12 beds open
March 14, 2011 G17W: 12 beds open
May 16, 2011 G15: G9E to G15
51. Post Occupancy Data Collection
“Post” Data Collection
September 8 – 22, 2011
G11 & G17 SW
September 26 – October 9, 2011
G15 & G17 SE
Written Surveys for 2 weeks – September 1 – 15
52. Activation and Occupancy
Activation
Management Team
Operations
Planning
Move
Management
Communications Training
Facility
Readiness
•Programs/Service
s
•Policies
•Systems/Procedu
res
•HR Functions
•Process Design
•Operating Budget
•Scheduling/
Sequencing
•Packing/
Labeling
•Department
Relocation
Management
•On-Going Staff/
Employee
Communication
•Opening Events
•Patient
Communication
•General Facility
Communications
•Operation
Simulations
•Training &
Orientation
•Master Training
Schedule
•Facility
Planning/
Development/
Construction
•Furniture/
Equipment/
Signage
•Facility
Completion/
Startup
56. Educational Resources
• Short computer-based training modules developed to assist with
training utilizing Camtasia PowerPoint Voice Over Program
• Vocera
• Bedside supply cabinets
• Biohazard and linen pass-thru cabinets
• Team Rooms
• Multidisciplinary workrooms
• Medical team rounds
• Unit orientation
• Medication room
57. Operational Factors
Children’s Cancer Hospital Expansion needed temporary inpatient
unit.
Issues with showers and smoke dampers requiring moves of patients
floor to floor before full occupancy.
Increase in monitored beds-
decrease in ICU census
58. Operational Factors
Operating a 24 bed “unit” vs. 13 bed “pod”
Physician and medical team “centralized practice” concept
Staff rotations
Unit culture/staff roles
59. Post Occupancy Reviews
Staff feedback sessions August, 2011
Themes:
o “Unit Spread Out”, harder to find people/staff
o Patient assignments now need to consider
geography
o “View windows” yes or no?
o Pod vs. Unit function
o Like new medication room/system
o Team room use by medical staff
o Push button locks vs. badge
60. Agenda
Drivers of decentralization
Key questions
The evidentiary challenge
The MD Anderson project
Study data
Key findings
62. 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
63. 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
64. 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
65. Agenda
Drivers of decentralization
Key questions
The evidentiary challenge
The MD Anderson project
Study data
Key findings
84. Implications
On unit location
increase
Associated with
nurse station use
decrease?
Does this
represent an
increase in inter-
personnel
collaboration/
interaction.
89. 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