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TRANSCRIPT
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
Lori Cihon, RN
• President, Acacia Dory, LLC
• 216.392.6717
Paula Timco, MBA