Your Aging Patient Bed Tower - Top Ten Considerations When Renovating
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To hear Adrian's presentation, follow this link: http://snack.to/b7c9ekkz While the benefits of caring for inpatients within a private room have now been time tested, there are thousands who still receive care outside of this clinically preferred environment on a daily basis. As is often the case, the benefits may be clear, but the perceived cost of providing more private patient rooms has prevented the wholesale adoption of this basic principle throughout the United States. Building new bed towers has been an option for systems that could afford to build new facilities. However, many systems do not have that luxury or are landlocked, at capacity and cannot expand or afford to give up beds from their license. This session will provide a roadmap for the successful renovation of patient units to accommodate all private rooms, or enhanced 2-Bed rooms that incorporate best clinical practices in a cost effective manner. By breaking down the success factors into ten key considerations, this session will allow designers, managers, and contractors to plan and execute such projects more effectively. Case studies will be presented to demonstrate how this straightforward approach can increase the success of renovations that convert (primarily) double bedded units into single patient room units.
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Your Aging Patient Bed Tower - Top Ten Considerations When Renovating
- 1. Session E09 Your Aging Patient Bed Tower- Top Ten Considerations When Renovating
- 2. PresentersPresenters Adrian Hagerty, AIA, LEED AP Principal, Regional Vice President, National Capital Region PresentersPresenters p , g , p g Array Architects Patricia Malick AAHID EDAC Lean Green BeltPatricia Malick, AAHID, EDAC, Lean Green Belt Principal, Practice Area Leader-Interior Design Array Architects
- 3. Session E09Session E09 Your Aging Patient Bed TowerYour Aging Patient Bed Tower-- Top Ten Considerations When RenovatingTop Ten Considerations When Renovating While the benefits of caring for inpatients within a private room have now been time tested, there are thousands who still receive care outside of this clinically preferred environment on a daily basis. As is often the case, the benefits may be clear, but the perceived cost of providing more private patient rooms has prevented the wholesale adoption of this basic principle throughout the United States. Building new bed towers has been an option for systems that could afford to buildprinciple throughout the United States. Building new bed towers has been an option for systems that could afford to build new facilities. However, many systems do not have that luxury or are landlocked, at capacity and cannot expand or afford to give up beds from their license. This session will provide a roadmap for the successful renovation of patient units to accommodate all private rooms, or enhanced 2-Bed rooms that incorporate best clinical practices in a cost effective manner. By breaking down the success factors into ten key considerations, this session will allow designers, managers, and contractors to plan and execute such projects more effectively Case studies will be presented to demonstrate howand contractors to plan and execute such projects more effectively. Case studies will be presented to demonstrate how this straightforward approach can increase the success of renovations that convert (primarily) double bedded units into single patient room units. Learning Objectives: 1.Explore elements that create a renovated environment that is consistent with patient centered & family centered care. 2.Learn how inpatient renovation projects can improve operational efficiency. 3 Discuss how inpatient unit renovation projects present opportunities to implement sustainable design strategies3.Discuss how inpatient unit renovation projects present opportunities to implement sustainable design strategies. 4.Demonstrate the value of integrating infrastructure improvements with inpatient unit renovation projects.
- 4. Session E09Session E09 Your Aging Patient Bed TowerYour Aging Patient Bed Tower-- Top Ten Considerations WhenTop Ten Considerations When RenovatingRenovating GeorgeGeorge CostanzaCostanza might disagree:might disagree:gg g gg g https://www.youtube.com/watch?v=VfvKc_9YbCs
- 5. operational efficiency01 IT infrastructure07 logistical02 accessibility08 life safety03 sustainability09y03 infection control04 y09 patient/family i l d10control04 patient 05 involved care10 Array’s Leansafety05 i i06 Array’s Lean Process Approach lean process engineering06 • University Hospitals • New York Presbyterian case studies
- 6. Recognizing “necessity is the mother of invention”
- 7. fi di thfinding the BALANCEBALANCE between LEAN & MEANLEAN & MEAN
- 8. 01 operational efficiency considerations • Using Lean Design principles, test the work flow within a unit to ensure maximum efficiency 01 unit to ensure maximum efficiency • Define Current State & Map Future State • Observe, , Envision, Model, Build Consensus Spaghetti Mapping DiagramsValue Stream Mapping
- 9. 01 operational efficiency considerations • Engagement with Caregivers and Patients 01 • Rapid Testing of Future State Solutions D t d i D i i• Data-driven Decisions Empathy MappingRapid Testing
- 12. 02 logistical considerations: feasibility study • Determine appropriate level of renovation required 02 • Develop a plan to effectively execute renovation that minimizes day-to-day disruptions to hospital operations • Proper Phasing is essential to success (vertical vs. horizontal stacked phasing, cost of escalation) • BIM can be used to assist Stacked Phasing decisions Vertical Stacked Phasing Horizontal Stacked Phasing
- 13. 03 life safety considerations • Providing a safe environment is utmost priority 03 priority • Using ILSM (interim life safety measures) will result in ZERO disruption to operationsp p • 3 main steps in planning and implementation of ILSMs: (1) Pre-Construction Assessment (2) Development and Daily Monitoring of an(2) Development and Daily Monitoring of an ILSM Compliance Checklist (1) Close-out of the ILSM to transition back(1) Close out of the ILSM to transition back to standard operating procedures.
- 15. It’s more than justIt s more than just WASHINGWASHING h dyour hands.
- 16. 04 infection control considerations • 1 in 20 patients acquire an infection during hospital stay 04 • Aspergillus- most common microbes associated with construction ICRA (i f ti t l i k t) ltidi i li d t d t• ICRA (infection control risk assessment)- multidisciplinary, documented assessment process to proactively identify and mitigate risks from infection that could occur during construction activities • Process should begin in early stages with stakeholders; CM with strong track record
- 17. A nurturing environment =A nurturing environment = HAPPY Patients =HAPPY Patients = higher HCAHPS scoreshigher HCAHPS scores
- 18. 05 patient safety considerations • Patient Unit Design should promote healing and foster patient and family collaboration 05 foster patient and family collaboration • Provide adequate support zones to reduce hazards • Consider proximity of bed to bathroom; lifts • Install multi-function lighting options & controls • Provide patient control of shading, education and entertainment • Incorporate noise reducing design elements • Integrate equipment and alarm configuration • Provide materials which are easily cleaned AND maintained
- 19. 06 engineering considerations • HVAC system can account for more than 50% of the cost 06 cost • Comprehensive facility condition assessment is necessary- surprises can be expensivey p p • Ideal opportunity to correct facility deficiencies= improved operational costs over the life of the facility
- 20. ARE NOT THE ANSWERARE NOT THE ANSWER
- 21. 07 IT infrastructure considerations • CINS (Clinical Integration Networks) allow caregivers to access the data of patients 07 access the data of patients • EMR access becomes hub for all activity on floor • Provide Access to Point of Care (POC) Mobile Technology, Nurse Call Innovations • Patient Entertainment, Education, Communication & Surveys
- 22. ACCESSibilityACCESSibility is more than just clearancesis more than just clearances
- 23. 08 accessibility considerations • “Barrier-Free Health Care Initiative”- goal of ensuring that persons with disabilities have access to medical 08 that persons with disabilities have access to medical information as well as physical access • “ADA Path of Travel” requirement- visualize entire pathq p of travel from the drop off point to patient’s destination • Verify that constructed solution meets design criteria and ADAG requirementsand ADAG requirements.
- 24. Can you make your father’sy y OLDSMOBILE run like a PRIUS?PRIUS?
- 25. 09 sustainability considerations • Environmentally-friendly design & system choices 09 • Investigate opportunities to recycle construction waste • Identify design and engineering options that reduce electricity and• Identify design and engineering options that reduce electricity and water use • Focus on selecting sustainable project materials that support highg p j pp g indoor environment quality (IEQ), and green cleaning
- 26. ““WeWe’’re all in thisre all in this““WeWe’’re all in thisre all in this TOGETHER.TOGETHER.””TOGETHER.TOGETHER.””TOGETHER.TOGETHER.TOGETHER.TOGETHER.
- 27. 10 patient/family-involved care id ti • Opportunity to reinvent the patient 10 considerations pp y p experience - Wow Factor – Inspire Confidence - Create Generative Spaces - Promise, Deliver, Delight!, , g • Use Amenity & Touchpoint mapping toy p pp g elevate the patient/family experience
- 28. OINTS OF IMPACTOINTS OF IMPACT Mapping the Patient and Visitor ExperienceMapping the Patient and Visitor Experience Wayfinding Clarity… I know where I am going Patient Centered… Family Focused I know where I am going WELCOME DISCOVER RESPITE RECOVER First Impressions… I made the right choice Gathering Zones… I need a breather
- 29. S H D W G Th ?So How Do We Get There?
- 32. A New Approach PROCESS LED DESIGN Solution Discovery Creation Analysis
- 33. CASE STUDY University HospitalsUniversity Hospitals MacDonald Women’s Hospital
- 34. Project Drivers:Project Drivers: • Aging Infrastructure • Parity with other University Health System Hospitals • Create a patient-centered healing environment for high-Create a patient centered, healing environment for high risk maternity patients
- 35. patient and family centered 1. information sharing 2. foster collaboration / participation / education/ p p / 3. honor patient and family perspectives 4 accommodate diversity (cultural; socio economic)4. accommodate diversity – (cultural; socio-economic) 5. right support/right place/right time 6. proximity to Level III NICU
- 36. operational ideals 1 li / f i i i i1. quality / safety initiatives 2. support UH model-of-care 3. technology and equipment integration 4 de-centralized caregiver zones4. de centralized caregiver zones 5. improve acoustics / ergonomics i l ‘ i6. exceptional ‘guest’ service
- 37. Current State:
- 38. Current State:
- 39. Inspiration: strength .. joy .. trust .. beauty .. promise .. growth .. calm .. warmth
- 40. Team Station:
- 41. Unit Corridor & Team Stations:
- 43. University Hospitals MacDonald Women’s Hospital PHASE 1 July 2, 2013 – Page 43 NICU ACCESS
- 44. CASE STUDY NewYork-Presbyterian HospitalNewYork Presbyterian Hospital Milstein Tower
- 45. overview Milstein Enhancement Bed Unit Renovation current state Typical Floor Project Challenges:Project Challenges: • Project Scope: 5 Floors, 20 Bed Units, 680 Beds • Construction Start: 4Q 2012 • Construction Complete:t u t p t 1Q 2018 • Project Cost: 160MillionProject Cost: 160Million
- 46. Overview Milstein Enhancement Bed Unit Renovation current state existing conditions
- 47. Overview Milstein Enhancement Bed Unit Renovation current state existing conditions
- 48. current state best practice influencers vision current state • infrastructure deficiencies • out of sync with World‐Class reputation • patient and family perspective state best • safe, equitable • patient and family centered • operational ideals practice i fl • patient experience improvement strategies • HCAPHS, patient satisfaction scores id b d d iinfluencers • evidence based design • “patients first” mission • building towards an experience vision • building towards an experience • stakeholder survey, amenity mapping, image dialogue
- 49. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example Modern with clean lines classic & natural elementsModern with clean lines, classic & natural elements Perceived as a place of science while having the warmth of a home. image survey results: design vocabulary
- 50. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example 3%39%58% A B C19 13 1 # of respondents # of respondents # of respondents image survey results: art
- 51. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example 45%42%12% 45%42%12% 1 2 34 14 15 # of respondents # of respondents # of respondents image survey results: cars
- 52. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example 61%39% %% 1 213 20 # of respondents # of respondents image survey results: home
- 53. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example 73%27%27% 1 29 24 # of respondents # of respondents image survey results: hotel
- 54. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example 39%52%9% 1 2 3 39% 3 52%9% 17 13 # of respondents # of respondents # of respondents image survey results: front door
- 55. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example How should the Milstein Tower be perceived by patients and families? 58% 1st choice 9% 1st choice 33% 1st choice 58% 9%33% # of respondents # of respondents # of respondents 3rd choice 58% place of science temporary home spa / resort18 11 3 # of respondents p # of respondents
- 56. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example What adjectives describe the aesthetic goals the enhanced bed unit? a) sleek and modern 4 b) warm and cozy c) quiet and peaceful 4 2 9c) quiet and peaceful d) educational and engaging 9 1 e) ______________________ 17
- 57. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example Image Survey Total Responses Preferred #1 Preferred #2 Preferred #3 Preferred #4 Preferred #5 A ‐ Wood Stone/Textures/Tones 31 14 10 3 1 3 B Simplicity/Clean Lines 31 7 6 3 5 10 77% 23% 32%B ‐ Simplicity/Clean Lines 31 7 6 3 5 10 C ‐ Luxe/Amenity Rich 31 3 4 6 7 11 23% 32% 58% D ‐ Color Saturated 31 4 6 13 8 0 E ‐ Patterns/Shape/Texture 31 2 5 4 12 8 68% E Patterns/Shape/Texture 31 2 5 4 12 8 65% image results survey
- 58. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example Preferred Not Preferred . 77% 23% 32% 58% 68% 65% image results survey
- 59. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example What adjectives describe the aesthetic goals the enhanced bed unit? a) sleek and modern 4 b) warm and cozy c) quiet and peaceful 4 2 9c) quiet and peaceful d) educational and engaging 9 1 e) f) Write in: “All of the above” 6 6 Write in: “A+C” 4Write in: “welcoming” or “technology”
- 60. CIRCULATION VERTICAL CIRCULATION Milstein Enhancement Bed Unit Renovation MER / IT / SHAFTS PATIENT BEDS (QUAD) PATIENT BEDS (ISO) PATIENT BEDS (DOUBLE) PATIENT BEDS (SINGLE) CLINICAL SUPPORT OFFICE / ADMIN SUPPORT IMAGING
- 64. Milstein Enhancement Bed Unit Renovation exampleexample
- 65. enhancements: overview enhancement level comparison example
- 66. enhancements: overview enhancement level comparison example
- 67. enhancements: overview enhancement level comparison example
- 68. enhancements: overview enhancement level comparison example
- 69. Milstein Enhancement Bed Unit Renovation $154.2M TOTAL BED UNIT PROJECT $154.2M TOTAL BED UNIT PROJECT $141.1M TOTAL BED UNIT PROJECT $141.1M TOTAL BED UNIT PROJECT TOTAL BED UNIT PROJECT FUNDING INCLUDING INFRASTRUCTURE AND IT TOTAL BED UNIT PROJECT FUNDING INCLUDING INFRASTRUCTURE AND IT TOTAL BED UNIT PROJECT FUNDING EXCLUDING INFRASTRUCTURE AND IT TOTAL BED UNIT PROJECT FUNDING EXCLUDING INFRASTRUCTURE AND IT Bed Unit Enhancements FACE Program Contingency Alignment Infrastructure IT
- 70. HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH phasing scenario studies - example MCKEEN BEHAVIORAL HEALTH INFECTIOUS DISEASE 9 HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH MCKEEN NEUROSURGERY NEUROLOGY / EPILEPSY REHABILITATION NEURO ICU8 SURGERY TRANSPLANT SURGERY / ORTHOPEDICS HOSPITALIST MEDICAL SURGICAL GENERAL GENERAL 7 6 MEDICAL ONCOLOGY SURGICAL ONCOLOGY GENERAL MEDICINE GENERAL MEDICINE CARDIAC SURGERY STEP DOWN CARDIAC ICU CARDIOLOGY CARDIAC 6 5 EXISTING STACKING PHASE 0: CONSTRUCTION COMPLETION: PROJECT COSTS: NA NA STEP-DOWN EXISTING STACKING DIAGRAM NA NA
- 71. HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH phasing scenario studies - example BEHAVIORAL HEALTH 9 HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH ORTHOPEDICS / TRANSPLANT TRANSPLANT MCKEEN NEUROLOGY / EPILEPSY REHABILITATION NEURO ICU8 NEUROSURGERY MEDICAL ONCOLOGY SURGICAL ONCOLOGY GENERAL GENERAL 7 6 INFECTIOUS SURGERY SWING SPACE RENOVATE FOR CARDIAC HOSPITALIST GENERAL MEDICINE GENERAL MEDICINE 6 5 INFECTIOUS DISEASE CARDIAC SURGERY STEP DOWN CARDIAC ICU CARDIOLOGY CARDIAC CARDIAC PHASE 16: CONSTRUCTION COMPLETION: PROJECT COSTS: 1Q2019 $154 2M STEP-DOWN RENOVATE CARDIAC 1Q2019 $154.2M