Designing a Healthy Work Environment Architecture-Operations-Technology

1. Designing a Healthy Work EnvironmentArchitecture-Operations-Technology Integrating the Process

2. Learning Objectives • Discoverthe role of the nurse in healthcare design and determine how nurses can be leaders. • Learn about evidence based design and list areas of design that have been proven to improve patient outcomes. • Learn current design and technology trends and relate those scenarios to their current work environment. • Identify nurse leadership initiatives to align the architecture and technology to support processes and work flow.

3. Design Focus –Patient Care Delivery Vanderbilt Nursing School 1984

4. Patient Care Delivery 1984 • Open Wards • Semi Private Rooms • Centralized Nursing • 8 hours shifts • Rolling Medicine Carts

5. Patient Care Delivery Today • Private Rooms • Decentralized Nursing • 12 hours shifts • Bar Code Medication • Patient Entertainment • Family Area

6. Designing a Healthy WorkEnvironment Support and optimize the delivery of care models through architecture and technology

7. Nursing Roles in Healthcare Design • Nurses have unique perspectives • Patient Safety • Family/Care giver needs • Physician Interactions • Infection Control • Working with Teams • Work flow and processes • Medication Safety

8. Nursing Roles in Healthcare Design • HIPAA Compliance • Communication • Organizational Culture • Organizational Initiatives • Care model/Patient care philosophy • Critical thinking skills • Outcomes oriented

9. New Nurse Competencies Needed • Interdisciplinary leadership • Communication & relationship building • Knowledge of the healthcare environment • Business skills • Professionalism • Transformational leadership Stichler, JF (2007). Nurse Executive Leadership Competencies for Health Facility Design. JONA, 37(3), 109-112.

10. Leadership Roles and Responsibilities • Nurse Executive • Validating that the design supports the strategic vision, mission, values and culture of the organization • Stay involved • Chief Nursing Officer • Ensuring that the design supports the professional practice model • Insure project continuity

11. Leadership Roles and Responsibilities • Director • Articulating how the design will affect costs, market share, satisfaction levels • Design principles metrics • Change management • Policies and procedures • Training

12. Leadership Roles and Responsibilities • Manager • Determining how the design affects staffing and patient flow • Giving staff time to participate • Create enthusiasm • Team Builder • Staffing

13. Leadership Roles and Responsibilities • Staff Nurse • Giving input to the architect team • Soliciting creative ideas • “Being present” • Team Supporter • Nurse Project Manager • Coordinating the interdisciplinary process of design, giving a voice to all providers and patients

14. Leadership Roles and Responsibilities • Nurse Project Director • Managing millions or billions of dollars; keeping the project on time and within budget • Big picture/managing details • Nurse Consultant • Internal to the organization or external in the architects office • Integrating the voice of nursing patient care and design • Who’s on the project team?

15. Leadership Roles and Responsibilities • Nurse Architect/Designer • Interfacing the design world with health care • Nurse Researcher • Nurse Technology Expert on work flow analysis

16. Evidence based design Evidence based design is the intentional attempt to base design and construction decisions on “evidence” or “research” to improve outcomes for patients and staff.

17. Schiphol Airport in Amsterdam

18. Alzheimer Bus StopThe Benrath Senior Center - Düsseldorf, Germany

19. First Evidence based Design Practitioner…. It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. Florence Nightingale, 1859

20. Design research • Group of researchers from Texas A&M and GeorgiaTech combed through several thousand scientific articles. • More than 600 research studies were found that establish a link between hospital design and improved outcomes for patients and staff. • The studies were assessed on their rigor, quality of research design, sample sizes and degree of control.

21. Links were identified between hospital design and improved outcomes for patients & staff in the following areas: • Patient confidentiality • Noise • Nature • Daylight • Positive distraction • Social support • Improved communication • Medication errors • Patient falls • Infection control • Ergonomic design • Improved layout for reduced steps • Consistency in design

22. Healthcare Work Environment (Architectural/Engineering Perspective) • Square Footage Requirements • Building Codes and Regulations • Space Planning • Adjacencies • Infrastructure

23. Used by permission: Roger K. Lewis, FAIA, Architect & Planner Columnist, "Shaping the City," The Washington Post, Professor Emeritus, University of Maryland School of Architecture, Planning and Preservation

24. Healthcare Work Environment(Clinical Perspective) • Healthcare Setting • Work Processes • Workforce Demographics • Culture and Geographic Location • Information Technology You have to understand how a nurse works in a room in order to design it well

25. Nursing Process Design Process vs. the Nursing Process • Assessment • Planning • Intervention • Evaluation Design Process Programming Schematic Design Design Development Contract Documents Construction

26. Inpatient Unit Influences on Design • Operational Model • Care Delivery Philosophy • Patient Population • Specialty, Geriatrics, etc. • Teaching vs Non-Teaching • Staffing • Unit Secretary • Team • Physician Specialty HKS Architects

27. Inpatient Unit Influences on Design • Processes • Supplies • Medications • Other Services • Communication • Workflow & Devices • Documentation

28. Design Trends • Charting Alcoves • Computerized Charting • Meaningful Use • Nurse Servers • Bar-coding • RFID

29. Design Trends = More Systems • OR Integration • Nurse Call • DAS • Telemetry • Network Hardware • Physiomonitoring • Security • Emergency Power

30. Private Rooms • Widely accepted as most beneficial. • Implemented in almost all hospitals. • Semi-private rooms generally occur only for: • Elderly patients who feel less confused with roommate. • Veterans who appreciate camaraderie of roommate. • Behavioral/Psychiatric settings • Small hospitals with too few resources.

31. Single-Handed Rooms Pros: • Concept is accepted by many organizations. • Standardization of all patients approached from same side is convenient and helps in responding to codes in room. • Some hospitals incorporated angled corner walls to increase view from hallway. Single-handed rooms Cons: • Limited evidence of being safer – difficult to judge because every patient is different. • Challenge to observe 2 patients at once from communication station outside rooms. • Extra cost for not having back to back toilets (no hard numbers for difference). • Pushback from nurses that they can’t adapt to mirror-imaged rooms. Mirror-imaged rooms

32. Nurse Servers • Very convenient and saves time. • TJC had issue with contamination from patient to patient – everything in room must be taken out when terminally cleaned. • Now TJC accepts if minimum number of towels, linens, and supplies are put in cabinet. Need to make sure it is stocked appropriately and without unnecessary materials. • Issues: • Who stocks cabinet. • Building codes can require the door in the corridor to have a closer, which makes server hard to keep open. • Location can be inconvenient and hard to access from corridor and inside patient room. • Need to displace personal effects to use bedside table for treatment.

33. Mini Pyxis in each room with barcode technology • Reduces medication errors by ensuring correct medicine and dosage. • Better than barcode medication administration because it is not interrupted by leaving to get medicine once scanned. • Provides charge, capture, and inventory management. • Operational issue: who stocks machine and how often.

34. Patient Lifts • Infrastructure of steel supports above ceiling being built in. • More institutions want lifts in every room. Now only a percentage of rooms get lifts – typically in bariatric rooms. • H-type gantry lift (moves in 4 directions) is preferred over the single rail lift, which has less flexibility. • Some hospitals have lifts into bathrooms. • Some hospitals utilize lift teams. • Issues: • Because lifts are not in every room, nurses often don’t know how to use them. • Need education included in lift purchase. • Many lifts don’t have the necessary lift ability of 1000 pounds.

35. Bariatric Design • Need more bariatric rooms to allow for increase in heavier patients. • Issue of hygiene – make bariatric rooms with wet rooms with drains, hoses, and a hazmat containment pool. • Problem with bathroom – need greater distance from wall for bariatric patients, but that exceeds the code for ADA.

36. Consoles for Patient Controls • One console controls TV, lighting, draperies, music, and call system for nurse. • Wireless keyboards for internet, communication, controls, and meal selection.

37. Locator Systems • Equipment: Keeps track of all equipment in hospital – helps locate and maintain inventory. • Patients: Especially helpful in ER – reduces need for security and helps monitor vulnerable and dangerous patients. • Staff: Very beneficial for ER and Specialty Services staff. Mostly used with Nurse Calls.

38. Healthcare Technology Trends Robots • Take dietary orders with filter for patient’s specific dietary needs and deliver meal trays. • Remote doctor robot has doctor’s face on screen and 2-way communication from remote location. Allows for clinicians to be involved without having to be present.

39. Integrated OR Suites • Simplifies the many components of the operating room into one easy-to-use interface. • Helps nurses and surgeons make decisions with centralized control of medical devices and information. • Attracts better surgeons and more patients, improves patient outcome and experience, and increases efficiency.

40. Hand Washing Monitoring • Helps ensure compliance and increases frequency of staff washing hands • Improves patient safety by reducing spread of infections

41. Operations: Today’sPracticeEnvironment Technology ahead of practice transformation

42. Healthcare Technology Trends Smart Beds • Alerts staff to changes in patient’s status and movement. • Can help reduce emergency reaction time. • Some issue with data overload due to info coming from Smart Beds and monitors.

43. Healthcare Technology Trends Integration • Wireless Phones • IV Pumps • Telemetry Systems • Admitting Systems • Bed Exit Systems • Smoke Detectors • Staff Location, Infant • Security & Asset Tracking • Ventilators, Pulse Ox, AB Monitors, etc

44. Communications Planning and Documentation

45. DOCUMENTATION: Where & How? Design Considerations • Philosophy • Budget • Devices • Flexibility HKS Architects HKS Architects

46. Wireless Communications • Improves staff to staff communication, patient to nurse communication, efficiency, and patient satisfaction. • Reduces reaction time and overall noise by eliminating paging. • Can also act as a recording device, nurse call system, and a device alarm.

47. SmartPhone • Healthcare applications specifically designed for iPhone being adopted and more being developed. • Improves workflow process, reaction time, and efficiency. • Technology is widely accepted and easy to use.

48. iPad Uses Today In Healthcare • Physicians Rounds – Physicians use their iPads for EHR, POE, Personalized Team Census (signout), E-Ticket (billing), web-based paging, and their hospital emergency department (ED) dashboard. • Education, distraction and preparation - Child life specialists use it to help patients manage stress during their stay. They use the iPad to show patients how physicians prepare for surgery; to play games with patients; and to educate them about their procedures or conditions. • X-ray images, EKG results and other patient monitoring programs - Used in inpatient and out patient settings by home health, hospice care workers, nurses, dietitians and pharmacists. • Staff documentation – Entering the patients information on a screen that doesn’t require turning your back to the patient. • Speech therapy – Speech therapist uses iPad/iPhone app Proloquo2Go with stroke victims and autistic patients to enable patients to speak through the devices to their care team.

49. Planning for the Future Mobile Health • Wireless • DAS • Smart Phones • Tablets • Emergency Power • Telehealth

50. Challenges Foreseen “The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.” Bill Gates