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OHA Annual Meeting

Engaging Nurses in the Development of New Facilities

Lori Cihon, RNDirector of NursingSouthwest GeneralHealth Center

Paula Timco, MBA PresidentAcacia Dory, LLC

Today’s Learning Objectives

• Nurses in building a better hospital facilityEngage

• The building processLearn

• The work environment & patient experienceImprove

The Big Picture

• Would you ever build your house without being involved?

• Would you build your house without an architect?

• Would you ever buy a car without test driving it?

• Would you buy a car that was made by people who never drove a car?

Then Why….

Build a hospital

without involving

nurses in every

aspect of the

design?

Building the Case

• The U.S. has 2.8 million registered nurses working in hospitals

• The average tenure of nurse is 20+ years

• The percentage of care delivered by nurses in hospitals is 90%

• The nurse engages with every ancillary department in the

hospital

• The nurse engages with both patient & family, almost daily

• The evolution of the nurse’s role has made them more aware of

pharmacy needs, supply chain management, IT needs & use,

equipment use and storage and environmental services needs.

Construction vs. Nursing

See New Facility Needs In Different Ways• Square Footage

• # of Floors

• # of Beds

• Overall Function

• Electrical, plumping, HVAC positioning

• IT infrastructure

Construction

• Space within a patient’s room to deliver care

• Bathroom space & fixture positioning

• Space to chart

• Space to store

• Space to decompress

Nurses

About The Project

• Southwest General Health Center– Near Cleveland, Ohio

– 360 beds, medical/surgical/ED hospital with Level III trauma center

– Non-profit, founded in 1920 by the community it serves

– Nationally recognized by Healthgrades & voted top local places to work

– Affiliated with University Hospitals of Cleveland

• New Facility Project– 168 million dollar building project

• New 30,000 sq. ft. Emergency Department

• 24 bed Critical Care unit

• 96 private medical/surgical bed tower

• 250 car underground garage

• The last major building project was in 1975

The Engagement Structure

New Hospital

Steering

Primer

Mock Ups

Work Flows

Frontline Groups

Transition Planning

Project Objectives

Understanding How SWGHC Defines Value

Steering Committee

• Clinical & Non-clinical members

• Formed two years prior to facility completion

• Main purpose: serve as the gatekeeper for

decisions regarding:

• Design

• Construction

• Communications

• Director of Nursing-Clinical Lead

• Sift through clinical details of new facility

• Communicating details to clinical staff

• Managing multiple implementation plans

Steering Committee Goals

Primer

• Education of the process of building a new

facility

• Critical Steps

• Decision Points

• Copies of blueprints

• Review of project goals

• Establishment of guiding principles

The Plan, Design, Build Process

Predesign

Master Plan

Functional & Space Program

Schematic Design

Design analysis

Building concepts

Design Development

Refinement

Details

Construction Documents

Finished Plans

Contracts

ConstructionThe detailed shape of the building begins

TransitionOrientationAcclimationMove InPost Move Adjustments

Mock Ups

• Located across the street from main campus

• Physical representation of the key new areas

• Visualization

• Perception of space

• Perception of distance

• Experimentation for processes

• Design space for function

• Head walls

• Supply rooms

• Drives group decision making

Design Philosophy

• Keep the nurse closer to the bedside

• Bring all patient care within 60 feet of the patient

• Create 8 bed “neighborhoods”

• Supplies, Medications, Equipment

• Computers

• Promote a family friendly environment & encourage

participation in family member’s care

• In room family area

• On floor pantries

• Respite areas

• Bring the outside in- nature theme.

• Encourage a “team” environment

• Shared space

• Rooms for consultation

• Create space for staff.. “Healing Environment”

Designing Spaces For Patient Care

• On floor therapy equipment

• Locked “home med” drawers

• Designated work areas in Pt. room

• Shelving in bathroom for easy storage

• Bed pan holder near the toilet

• Space around the toilet

• Patient railings

• Nursing alcove

Designing Spaces For Families

• Family area in Pt. room

• Closet for coats/valuables & extra

seating, pillows

• On floor family pantry

• Corridor seating

• Natural light, big windows, park

views

Designing space for Nursing

Conference room design: light, sound, state of the art equipment

Space for Nursing…

Break room: “Healing Environment- quiet zone!”

Workflows

• Hired a workflow process consultant with a

healthcare construction background

• Assist nurses in redesigning their workflows

• Shadowing

• Simulations

• Lean techniques

• Assure that the form of the new spaces

followed the functional needs

• Consultant was also key in putting together

transitional planning

Frontline Groups

• Clinical Lead pulled groups together to work

on specific projects:

• Call system

• Visitation

• Cleaning

• Stocking & supplies

• Front Desks

• Policy Development

• Allowed staff to truly “own” their area and

become familiar with it

Transitioning Planning

• Multi-faceted Planning

• Pre-Planning & Education

• Plan Development

• Move Day

• Post Move

Steps to Transition

Pre-Planning & Education

Plan Development

Move Day Post Move

Frontline /Ancillary

Committees

Nurse Educators

Staff Training

Equip/Supplies

Teams

Policy Revisions

Corporate

Communications

• E-newsletter

• Sharepoint

Dept. Director Plans

Move diagrams

Move project plans

Assigned Move

Coordinators

Wayfinding Team

Pre-move

communications

-Physicians,

families, Pts,

Ancillary

Hour by hour

plan

Ongoing floor,

hospital, patient,

family

communication

Command Center

“One Voice”-

Nurse in Charge

Decommissioning

of “legacy” floors

90 day-No Change

Rule

Staff “Idea” boards

Post move

refinement

Education

• Mock Runs

• “Day in the Life Of” exercise

• Visual Management/Resource Book

• Scavenger hunts

• Equipment Training

• Workflow Training

• Geographic orientation

Move Plan

• Visual Depiction-Map

• Detailed Project Plan

• Command Center

• “One Voice”-nurse in charge

• Ongoing communications

• Multidisciplinary coordination

Outcomes

3rd q 2014 to 4th q 2014

Room %le Rank 1% to 99%

Visitor & Family Inpatient %le Rank

3% to 98%

Nurses %le Rank 21% to 96%

Admit order to bed assign

96 to 65 minutes

79.5

86.8

84.7

88.7

79.3

85

86.685.6

89.7

83.3

85.3

83

89.8

86.2

90.2

80.5

86.1

87.3

86.2

89.9

83.284.8

+3.5

+3

+1.5 +1.5

+1.2 +1.1

+0.7 +0.6

+0.2

-0.1

-0.5

-1

-0.5

0

0.5

1

1.5

2

2.5

3

3.5

4

72

74

76

78

80

82

84

86

88

90

92

Room Visitors &Family

Physician OverallAssessment

Meals OverallHospitalRating

Tests &Treatments

PersonalIssues

Nurses Discharge Admission

Inpatient Mean Scores: Q1 2015 vs Q4 2014 - Received date – Press Ganey

Q4-2014 Q1-2015 Q1 2015-Q4 2014 Value change

Patient Experience Comments

From Press-Ganey Survey:

“I felt extremely safe and like I was in a 5 star hotel”

“Very efficient…well organized for personnel and patient needs”

“The new tower and ER are beautiful, clean, quiet and modern. I had

everything I could have wanted/needed”

“The room was brand new, but the girls were well trained, worked hard”

“Highly recommend, very caring, very informed-would not know other

patients were even there”

“I feel very comfortable and very well treated”

“The ER was bright, airy & beautiful-nurses & everyone were very nice”

Lessons Learned

• Communicate, Communicate!!

• Work with resource to keep the teams intact!

• Planning is key!

• Workflow, policy, training.

Our New Hospital

For More Information

• Director of Nursing, Southwest General Health Center

• 440.816.8725

• lcihon@swgeneral.com

Lori Cihon, RN

• President, Acacia Dory, LLC

• 216.392.6717

• ptacaciadory@roadrunner.com

Paula Timco, MBA