PDC_2015_Promedica

1. Field Research +
Parametric Analysis
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

3. ABOUT PROMEDICA

4. ABOUT PROMEDICA
• 15,000 employees
• $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 HOSPITAL AND 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 patient tower, 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
• Create efficient, 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 SEPTMAY JUNEAPRIL
CURRENT
STATE
FUTURE
STATE
DEMAND FORECAST
DESIGN
OPERATIONS
RESEARCH
GUIDING PRINCIPLES
WORKSHOPS

9. INTEGRATED FUNCTIONAL PLANNING AND DESIGN

10. DEMAND FORECAST
• Current State volume analysis
• Future State Forecast and
Projections
• Future State imperatives
• Recommendations for Future
State capacity & services

11. Lean Process Improvement workshops
• Understand Current State
• Eliminate waste
• Define Desired Future State
• Design through Mock-ups
OPERATIONS

12. RESULTS FOR FUTURE STATE
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
CURRENT STATE FUTURE STATE

14. PHASES OF
WORK
INTEGRATING
RESEARCH IN PRACTICE
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 WITH A TARGET
KEY PERFORMANCE INDICATORS

16. RESEARCH IN THE FIELD
A 2.5 DAY DESIGN DIAGNOSTIC

17. FIRST TO FILL UNIT
(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
Unit Clerk
Opp Side
Minimally
used
Consult
Rm
Off-stage
“hide-
aways”
SPACE UTILIZATION

19. COMMUNICATION 1
(Care Coordination)
Activities involving 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

20. ACTIVITY ANALYSIS

21. ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY)

22. First two hours of shift
ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY vs. NIGHT)

23. w ww w
w
ww
w
w
w
w
w ww w
w
w
w ww w
w WoW
Charging
THE “WOW” EFFECT
DESIGNING FOR MOBILITY/ FLEXIBILTY

24. POSITIVE NEGATIVE
Love the WOWs, 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 2.00 3.00 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 4.40 4.50 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 staff to 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

29. WALKING

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 50 100 150 200 250
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 +
PARAMETRIC ANALYSIS

33. PATIENT CARE: INDIVIDUAL ASSESSMENT 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 to Clean
Supplies/Medication Room
Clean Supplies/Medication
Room to Patient Room
Patient Room to Nurse Station
A SIMPLE MED EVENT

35. Nurse Station to Patient 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 actual vs. 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 and variability 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
IN PRACTICE
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
PARAMETRIC ANALYSIS OF PLAN CONFIGURATIONS

41. UNIT CONFIGURATION

42. VISIBILITY & COLLABOTATION

43. UNIT SECURITY & CORE POROSITY

44. THE PROCESS

45. MED-SURG: THE ONE THING
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 ONE THING
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
The Field 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

48. GOING FORWARD
CURRENT
STATE
FUTURE
STATE
DESIGN
STRATEGY.
OPERATIONS.
RESEARCH.

49. questions