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PDC_2015_Promedica
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.
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PDC_2015_Promedica
- 1. Field Research + ParametricAnalysis How Current State Analysis leads to Future State Optimization Upali Nanda Alison Avendt Steve Jacobsen Camilla Moretti
- 2. AGENDA Context True North Objectives-beyond designing a building Move to research Field Research + Parametric Analysis Findings Translation into design Learn how field research and simulation tools can be combined Explore how research and analytics can be rapidly deployed for design Understand how parametric models are created and the importance of good data to inform these models Learn about how design decision making can be fundamentally transformed through data and performance driven approaches LEARNING OBJECTIVES
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- 4. ABOUT PROMEDICA • 15,000employees • $2.7 billion in revenue • Fully integrated system • 12 acute care hospitals in NW Ohio & SE Michigan, 2300 beds • Paramount Insurance with 316,000 members • Over 800 employed physicians • ProMedica Transportation Network ground and air ambulance • Ambulatory surgery centers, Home Care and Hospice, Inpatient Rehab, Skilled Nursing facilities, OP lab and radiology sites • “and growing”
- 5. 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
- 6. • Modern patienttower, latest technology • Patient and family centered • Safe, effective, high quality treatment environment • Efficient workflows to eliminate bottlenecks, lean design and process • Attract and retain an engaged workforce of high quality physicians and caregivers THE FUTURE NOW
- 7. GUIDING PRINCIPLES • Createefficient, safe, quality and flexible patient care environments within new patient tower • Create efficiency through co-location and consolidation of services within the facility • Replace processes that create a sense of two levels of care, creating a consistent customer experience • Improve access, wayfinding, and parking for patients accessing services throughout campus • Identify the best services, the right capacity and appropriate access for those within the new patient tower • Meet budget and scheduling expectations throughout project
- 8. DESIGN PROCESS JULY SEPTMAYJUNEAPRIL CURRENT STATE FUTURE STATE DEMAND FORECAST DESIGN OPERATIONS RESEARCH GUIDING PRINCIPLES WORKSHOPS
- 9. INTEGRATED FUNCTIONAL PLANNINGAND DESIGN
- 10. DEMAND FORECAST • CurrentState volume analysis • Future State Forecast and Projections • Future State imperatives • Recommendations for Future State capacity & services
- 11. Lean Process Improvementworkshops • Understand Current State • Eliminate waste • Define Desired Future State • Design through Mock-ups OPERATIONS
- 12. RESULTS FOR FUTURESTATE STRATEGY DESIGN OPERATIONS RESEARCH GUIDING PRINCIPLES REINFORCING PROMEDICA’S MISSION RIGHT SIZED AND OPTIMIZED FOR FUTURE REDUCE WASTE AND IMPROVE PROCESS DATA DRIVEN DESIGN DRIVING FUTURE FORWARD
- 13. Reported Observed Spatial RESEARCH CURRENTSTATE FUTURE STATE
- 14. 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
- 15. RESEARCH: START WITHA TARGET KEY PERFORMANCE INDICATORS
- 16. RESEARCH IN THEFIELD A 2.5 DAY DESIGN DIAGNOSTIC
- 17. 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
- 18. Unused Kitchen Unused Pyxis Rm Opaque Doors in Meds/Su pplies UnitClerk Opp Side Minimally used Consult Rm Off-stage “hide- aways” SPACE UTILIZATION
- 19. 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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- 21. ACTIVITY ANALYSIS (FIRST2 HOURS: DAY)
- 22. First two hoursof shift ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY vs. NIGHT)
- 23. w ww w w ww w w w w www w w w w ww w w WoW Charging THE “WOW” EFFECT DESIGNING FOR MOBILITY/ FLEXIBILTY
- 24. POSITIVE NEGATIVE Love theWOWs, but... Not enough plug points. No place to store. On-the-go charting No log-in, log-out issues Flexibility Mobile storage for nurses Corridor parking Bedside charting Corridors are now work spaces Patient Mobility Deterrent Increased Sound Levels Potential HIPAA violations Units in the room are unused No way of telling where a nurse is Infection Risk?
- 25. 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
- 26. 0.00 1.00 2.003.00 4.00 5.00 Documentation Station to Patient Head Peer- Peer Documentation station to patient room door Unit clerk to entrance VISIBILITY STAFF PERCEPTION
- 27. 4.20 4.30 4.404.50 4.60 4.70 4.80 4.90 5.00 Hearing the patient and the alarms Seeing the patient Being able to monitor vital signs remotely VISIBILITY/ MONITORING STAFF PERCEPTION: DESIGNING FOR “AUDITORY” VISIBILITY
- 28. LEADERSHIP Cannot find staffto round up and motivate them. BEDSIDE NURSE Sometimes can’t find other nurses. Miss the physicians each time. NURSING ASSISTANT Difficult to get help when needed. UNIT CLERK Tough to know where RN/NAs are if they leave the walky-talkies. COLLABORATION AND COMMUNICATION DIVERSE CARE TEAM NEEDS
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- 30. Proximity Calculator |Rapidly Generated Heat Map Excessive Distance Reasonable Distance PROXIMITY ANALYSIS PARAMETRIC MODELING
- 31. 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
- 32. FIELD RESEARCH + PARAMETRICANALYSIS
- 33. 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
- 34. Nurse Station toClean Supplies/Medication Room Clean Supplies/Medication Room to Patient Room Patient Room to Nurse Station A SIMPLE MED EVENT
- 35. 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
- 36. FIELD RESEARCH PARAMETRIC MODEL DEVELOPING A SEQUENCE MAPPER BASED ON FIELD RESEARCH SO EVERY DESIGN CONFIGURATION CAN BE ASSESSED
- 37. 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
- 38. 1) Waste andvariability in walking 2) Multi-tasking not a time saver 3) limited point of use access to supplies reduces efficiency 4) Nourishment is part of med delivery 5) low visibility and connectivity effects care coordination 6) unplanned usage of WOWs can transform corridor into a workspace FINDINGS
- 39. 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
- 40. RESEARCH DURING DESIGN PARAMETRICANALYSIS OF PLAN CONFIGURATIONS
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- 43. UNIT SECURITY &CORE POROSITY
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- 45. 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
- 46. 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
- 47. 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
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