the va’s · enterprise wide planning and design standards . ... one-stop-shop; bringing services...

The VA’s

Emotional Context of Space Presenters:

Laura Krejci, Associate Director, VHA Office of Patient Centered Care

Gary Fischer, Senior Healthcare Architect, Office of Construction and Facilities Management

Mary Therese Hankinson, Patient Centered Care Coordinator, VA NJHCS

Barbara Huelat, Design Principal, Huelat Parimucha Ltd

VETERANS HEALTH ADMINISTRATION

1. VHA Office of Patient Centered Care & Cultural Transformation – Laura Krejci

Enterprise wide operational and policy direction

2. VA Office of Construction & Facilities Management – Gary Fischer

Enterprise wide planning and design standards

3. VHA Facility/Local Level Implementation – Mary Therese Hankinson

4. A/E Strategies that can be Adopted by the Private Sector – Barbara Huelat

2

The VA Transformation to Patient

Centered Design

VA Office of

Patient Centered Care

and Cultural Transformation

Laura Krejci

Associate Director

VHA Office of Patient Centered Care

VETERANS HEALTH ADMINISTRATION 4

Honor America’s Veterans by

providing exceptional health care that

improves their health and well-being.


Current Approach

• Care based on visits

• Professional autonomy drives variability

• Professionals control care

New Approach • Care based on continuous

healing relationships

• Care is customized according to patient needs and values

• Patient is source of

control

Crossing the Quality Chasm, Institute of Medicine

11/4/2013

5


1. Provide Veterans personalized, proactive, and patient-driven health care.

2. Incentivize measureable improvements in health outcomes.

3. Align resources to deliver sustained value to Veterans.

http://colegacy.org/news/wp-content/uploads/2011/05/iStock_000021588051_Large.jpg

http://www.google.com/imgres?imgurl=http://us.123rf.com/400wm/400/400/vizarch/vizarch1211/vizarch121100023/16572959-big-pile-of-money-isolated-on-white-dollar-version.jpg&imgrefurl=http://www.123rf.com/photo_16572959_big-pile-of-money-isolated-on-white-dollar-version.html&usg=__rHeiI7k-2ElSwsnfTtXszLMz228=&h=1002&w=1200&sz=154&hl=en&start=7&zoom=1&tbnid=YgBmGAh0we_MgM:&tbnh=125&tbnw=150&ei=-5gvUZnHM6vYyAGwsoAQ&prev=/search?q=money&hl=en&safe=active&gbv=2&tbm=isch&itbs=1&sa=X&ved=0CDYQrQMwBg

http://www.google.com/imgres?imgurl=http://www.smbceo.com/wp-content/uploads/2010/08/hiring.jpg&imgrefurl=http://www.smbceo.com/2010/08/26/hiring-best-employees/&usg=__UgIavRJNOty-2dgnlS_PNJvppzY=&h=188&w=200&sz=27&hl=en&start=17&zoom=1&tbnid=Oiu0wCLtpjgLPM:&tbnh=98&tbnw=104&ei=XpkvUebUAqmCygGqnoGYCA&prev=/search?q=hiring+the+right+people&hl=en&safe=active&gbv=2&tbm=isch&itbs=1&sa=X&ved=0CEoQrQMwEA

http://www.google.com/imgres?imgurl=http://www.bsd405.org/portals/0/Departments/Technology/images/Technology_management_LG_FOC.png&imgrefurl=http://www.bsd405.org/about-us/departments/technology.aspx&usg=__axzltGbsfKW-dy-M6BIruIC7r5s=&h=255&w=700&sz=262&hl=en&start=4&zoom=1&tbnid=UyVt9ZNpW773BM:&tbnh=51&tbnw=140&ei=jZkvUeCXE6mMyQHonIDADg&prev=/search?q=technology&hl=en&safe=active&gbv=2&tbm=isch&itbs=1&sa=X&ved=0CDAQrQMwAw

http://vaww.infoshare.va.gov/sites/OPCC/Photos/Birmingham/VA Secretary visits Veterans in Pallative Care.JPG


Healing Communication

Healthy Partnerships

Personal Mastery

Change

Meaningful experience and outcomes

11/4/2013 9

Components of Proactive Health and Well-being

VETERANS HEALTH ADMINISTRATION 11/4/2013 12

1. What REALLY matters to you in your life?

2. What brings you a sense of joy and happiness?

3. On the following scales from 1-5, with 1 being great,

circle where you feel you are on the scale.


• Mission for Life and Health

• A Personalized Health Plan

• Training and Skill building

• Support to succeed

13


Mission for Life and Health

A Personalized Health Plan

Training and Skill building

Support to succeed


.

http://vaww.infoshare.va.gov/sites/OPCC/Photos/Greater Los Angeles/16a_health buddy sm.jpg


15

FY 10, 11, 12, 13 – Sites Funded for Innovation Grants * * Note that sites may have multiple projects funded


Lessons Learned

1. Role of Leadership

2. Engaging Veteran Patients/Family Members

3. Enculturating Staff

4. Fostering Innovations

5. Staff Roles and Priorities

6. The Role of VA Organizational Structures/Processes

7. Implementing Environment of Care Changes and the

impact on a Patient Centered Culture.

16

VA Office of

Patient Centered Care

and Cultural Transformation

Laura Krejci

Associate Director

VHA Office of Patient Centered Care


2


3


4


5


8


9


10


15


18


Veterans committed their

lives, health, and

well-being to Mission

Success in defense of our

country.

19 VETERANS HEALTH ADMINISTRATION

VA Office of Construction

& Facilities Management

Gary Fischer

Senior Healthcare Architect

Office of Construction and Facilities Management


Office of Acquisitions, Logistics

and Construction (OALC)

Office of Construction and Facilities Management

(OCFM)

Office of Strategic Management

Facilities Planning Development – Programs for Design +

SCIP

Facilities Standards Service – Planning and Design Stds

Consulting Support Services – Major Project Reviews

Cost Estimating & A/E Selection – Program Support

2


Standards/References/Resources –

VA CFM Website: TIL

Space Criteria

Design Guides

Design Manuals

Specifications

Equipment Lists

3


Technical Information Library

Let’s all use Arial Bold when adding text.

The size of the font may vary depending on the amount of information

on each slide, but 16 should be the smallest font we use.

If we all use this same bullet format our slides will be consistent.

If you are adding pictures or drawings you may need a totally blank

slide like the one that follows.

4


Space Planning Criteria Chapters

PG-18-12

65 Services/Departments

Chapter Contents:

Purpose and Scope

Operating Rationale

Input Data Questions

Space Criteria – space identification; NSF

Design Considerations

Functional Relationships/Diagrams

5


Design Guides – PG-18-12

Conceptual, Planning, Operational and

Design Narratives

Key Room Guide Plates:

Floor Plan

Reflected Ceiling Plan

Room Data Sheet

Equipment List

6


Inpatient Units and Rooms

- Private Patient Rooms w/ Private TLT/SHR

- Family / Care Giver Amenities in Room:

- Sleeping Space,

- Personal Storage,

- Work Area: media / computer access, writing, etc.

- Family / Care Giver Amenities on Unit:

- Lounge

- Pantry

- Laundry Facilities

- Health Education Resource Kiosk/Work Area

7


Inpatient Units and Rooms

Patient/Family Centered Elements

- Private Patient Rooms w/ Private TLT/SHR

- Family / Care Giver Amenities in Room:

- Sleeping Space

- Personal Storage

- Work Area: media / computer access, writing, etc.

- Family / Care Giver Amenities on Unit:

- Lounge

- Pantry

- Laundry Facilities

- Health Education Resource Kiosk/Work Area

8


Polytrauma Rehabilitation Center

San Antonio VAMC

9

Inpatient Unit w/ Physical Therapy – 2nd Floor

Family Room

Patient/Family Game Room

Patient/Family Kitchen/Dining

Plan Courtesy: SmithgroupJJR


Private Patient Room - Zoning

Inpatient Room:

Family Sleep and

Work area

Patient Lift over bed

and into Toilet/Shwr

Automatic Door at

Tlt/Shwr

10

Plan Courtesy: SmithgroupJJR


Private Patient Room

• P

Photo Courtesy: Charles Smith

11


Physical Therapy on Inpatient Unit

On Unit

Therapy

Photo Courtesy:

Charles Smith

12


PACT – Primary Care Patient Aligned Care Teams

Paradigm Shift to “Veteran/Patient Focused” Care

– Patient Aligned Care Team – PACT =

Veteran at the center of the care delivery and plan

One-stop-shop; Bringing services to the Veteran

Integrated Team Based Care

– Staff Working to License; Empower front-line staff to act

– Smooth Coordination / Enhanced Collaboration

– Specialty Care Embedded in Primary Care: MH, Dietary, Pharmacy, SW

Reduce Face-2-Face visits; Increase Virtual Care, Group Care,

Telehealth

Lean Management and Operations planning strongly endorsed

13


14

San Jose VA Outpatient Clinic

Typical Clinic Floor


San Jose VA Outpatient Clinic

Typical PACT Module

15

VHA Facility/Local Level Implementation

Mary Therese Hankinson

Patient Centered Care Coordinator

VA New Jersey Health Care System


Planetree – focus groups/listening sessions

Idea Bank

Consumer Satisfaction Council

We’re Listening – continuous feedback

Survey of Health Care Experiences of Patients Truth Point

VHA All Employee Survey

Listening Venues to Capture Voices

of Veterans and Employees


Conducted during March 2010 for

the following groups:

Patients

Pharmacy staff

Medical Center

(non-pharmacy) staff

Themes Identified:

Privacy

Convenience

Confusion:

Noise/Flow/Congestion

Communication: clarify

process

Waiting time Issues

Employees that care

Listening Sessions for Pharmacy Pebble Project

Capturing Voices for

Evidenced Based Design


Creating a patient centered pharmacy using

principles of Veteran centered care, evidence

based design and Planetree healing

environment will result in improved processing

times, reduced wait times and increased patient

as well as employee satisfaction.

Hypothesis for Pharmacy

Redesign at VA NJHCS


1. Decentralized/specialized pharmacy work: consultation space

2. Incorporate regulatory criteria: adjustable-height counters at drop-off and pick-up to meet needs of customers

3. Apply lean principles: Small robot in fill area for auto fill, manual fill and checking in same area for efficient workflow

1 2 3

Reference: Kelly C and Redman M. Rx for pharmacy Spaces: A user-centered approach.

www.healthcaredesignmagazine.com (November 2009, Vendome Group, LLC publisher

Literature Review

Outpatient Automated Pharmacy

http://www.healthcaredesignmagazine.com/


Solution: Use technology to increase

patient access and staff productivity

(Script Center, Dispensing robotics, and

Bar Coding Information Systems)

Pharmacy Redesign

Final Rendering

Courtesy of Array Healthcare

Facilities Solutions

Technology and VA NJHCS

Pharmacy Renovation


VA NJHCS

Pharmacy Renovation


FOCUS GROUPS (listening sessions) used during Planetree organizational and

progress assessment

Examples of Themes

Parking Noise and Quietness

Environments Sense of Safety and Security

Privacy Way finding

Capturing Voices of Veterans,

Employees, Volunteers and Families


Quiet hour - implemented to allow

patients to take 1 to 2 hours of nap/rest

after lunchtime.

Door hinges were padded/ oiled to

prevent squeaks and slamming.

Phone volumes turned down to low

All wheels in the unit were oiled.

Yacker Trackers

Signage

Recharge: Quiet Campaign


Sleep Menu Preferences

39% (112) of patients did not request a sleep aid

60% (177) of patient requested a sleep aid(s)

34% (84) CD Player

29% (72) Warm Blanket

12% (29) Eye mask

11% (26) Sound Machine

10% (24) Aromatherapy

Less than 5% (12) requested Medcalm,

sleeping pill, or pain pill

2011 Planetree Grant Preserving Patient / Resident Sleep

Recharge: Sleep Menu


VA National Average VANJHCS

84.7

87

83.9

90.6

83.7

88.5

84.2

89.9

84.4

87.2

2009 2010 2011 2012 2013 YTD

Q9 -During this hospital stay, how often was the area around your room quiet at night?

Intervention: Quiet Campaigns and Sleep Menu

Veteran Satisfaction with Quietness

of the Hospital Environment


Advantages of

Single-Bed Rooms:

Lower nosocomial infection rate Standardization in room layout Fewer patient transfers and disruptions Shorter length of stay Reduced noise levels Better patient-staff communication

IOM Attributes of Patient Centeredness and

Inpatient Renovations to Single Bed Rooms


Voice of the Veteran and Employees for

CBOC Renovation and Relocation: Parking, Healing Environments, Sense of Safety & Security, Privacy & Way Finding


Integrative Therapies

Room for Yoga

Center for Health and Wellness

opened on March 18, 2013

Center for Health and Wellness


Q47b-How would you rate the following aspects of your room: b. Privacy level in your room

Intervention: We initiated Planetree Architectural Assessments during 2006 to develop strategies for

creating healing environments and renovated inpatient units to create private rooms.

Privacy in your room – Top Box “Excellent, Very Good and Good” Responses


Implementation of FIRST in

Home Based Primary Care Program

Comprehensive analysis

of home environments

using evidence-based

design and suggestions

for home and lifestyle

modifications.

Biggest challenges: stairs,

bathroom safety, getting in

and out of house

Falls Injury Reminder Strategies

(FIRST)


Less clutter

More light and color to brighten areas in the home

Less throw rugs

Strategies to prevent falls at home

Security at home

Equipment to prevent falls

Information about hearing and eyes

Devices such as canes

Available resources

How to safely fall and get up

Exercise

Networking opportunities

Caregiver Feedback from FIRST


Heart of the Home Experiential

Learning for Cultural transformation


Planetree Bronze Recognition

Barbara Huelat, FASID, EDAC, AAHID

Design Principal

Huelat Parimucha Ltd

A/E Strategies that can be

Adopted by the Private Sector


How to Capture the

Voice of the Customer?

Patient involvement

Vision Session

Conversation

User Meetings

Patient Centered Design Principals

2


Woman’s Wellness Clinic

Community Living Center


Lessons Learned from

VA Planetree Projects

The Patient Experience

Veteran Expectation

Vet’s Interaction

Listening to Needs

Creative Solutions

The Staff’s Experience

The Importance of Nature

Telling the Story

It’s the Vet’s Journey, Life Experience & Healthy Outcomes

4


Core Tenants

Patient Centered

Veteran Expectation

Human Interaction

Respect, Value, Preferences & Needs

Continuity & Integration of Care

Empowerment through Information & Education

Physical Comfort

Family & Friends

Architecture & Design

Emotional & Spiritual Support

Creative Arts

Engaged Workforce

5


“New Tools”

Integrative Design Process

Defining the “Patient Centered “ approach to design

Patient Centered Design Reports – by Phase

Patient Centered Drawings/documents – by Phase

Patient Centered User Reviews

8


Now, we can help them be mission ready for their lives,

optimizing their health in service of what matters to them.

How Will We Identify Success?

When Veterans achieve outcomes

they never even imagined.

9 VETERANS HEALTH ADMINISTRATION

Laura Krejci, Associate Director for Research,

Innovations and Communication

VHA Office of Patient Centered Care &

Cultural Transformation

Email: [email protected]

Phone: 678-796-3645

Gary Fischer, Senior Healthcare Architect,

VA Office of Construction & Facilities

Management


Phone: 202-632-4898

10

Mary Therese Hankinson, Patient

Centered Care Coordinator

VA New Jersey Health Care System


Phone: (973) 676-1000 X2672

Barbara Huelat, Design Principal

Huelat Parimucha Healing Design


Phone: 703-838-8414

the va’s · enterprise wide planning and design standards . ... one-stop-shop; bringing services...

Documents