2. Perception is Real;
Perception is Reality
Understanding perceptual realities to
resolve human factors/change
management issues
Jennie Evans, RN, BS, LEED AP, EDAC, Vice President, HKS Architects
Meredith Slosberg, EMBA, Deployment Leader, Akron Children's Hospital
Upali Nanda, PhD, EDAC, Vice President, Director of Research. Executive Director, CADRE
3. Agenda
• Setting the Stage
• Perception: What is it?
Why it matters…
• Staff Perception of Design
• Tools to Use
4. Objectives
Establish an understanding of:
– The importance of perception and the need to
address it in the design approach
– How nurses’ perception to certain design attributes
can affect operational efficiency and team work
– How to recognize resistant behaviors and how to
address them on your project
– Tools that can be applied to a design project, your
team, or within your firm
5. Akron Children’s Hospital
275,000 sf patient care tower
• 30-room emergency department
• 72-bed neonatal intensive care
• 6-OR outpatient surgery center
• Shell space: maternal/ fetal
6. Guiding Principles
• Patient-centered healing
environment
• Multi-disciplinary approach to
care
• Ability to recruit and retain the
highest quality physicians
• Facility design with life cycle
and operational costs in mind
• Facility that is a beacon to the
community
• Organization that supports the
future of healthcare delivery
8. Integrated Clinical Operations
4 Workshops Per
Team + Design
• 20 – 25 design team
members
– Physicians
– Nurses
– Ancillary
– Support
• Staff lean training
• Consultant Lean
training
Integrated
Operations
Rehabilitative
Services
Materials
Management
EVS
Pharmacy
Lab
Respiratory
9. Step 1 – Value Stream Mapping
Value Stream Mapping Extraordinaire
• Done in advance
of the workshops
• Dedicated
operational
improvement staff
(Center of Operational
Excellence)
10. Step 2: 3P Event – Paper Dolls
Integrating Process into Design
• Draft space program
• Stacking
• Translated the value
stream map into design
• 7 revisions
11. Step 3: Full Scale Mock Ups
Full scale mock up
– Week long workshops
– Built full departments
– Falcon board on stands
– Rooms sized to plan
Scenarios
– Patient care scenarios
verified configuration
– Identified where new
processes were required
– Identified conversations
required with other
departments
12. Process Value Add
1. Understand consequences,
design choices and
competing priorities
2. Understand space and
choice in design outcome
3. Understand processes and
initiate change
management
4. Several people understand
and communicate the
future state
13. Akron Value Add
• Team performance
moved from low to high
• Leaders emerged
• Team commitment to
design
• Initiated change
management
14. With the best intentions in design…
Why is operationalizing still a challenge?
15. Is the nature of change dictated by facility
design or process design?
Process
Design
Facility
Design
16. PROCESS DESIGN
NEED FOR PATIENT and family
privacy and increased individual
MONITORING
DE-CENTRALIZED NURSING
STATION and single rooms versus
arena rooms
DESIGN PROCESS
DE-CENTRALIZED NURSING
STATION and single patient rooms
CHANGE IN SOCIAL INTERACTION
and daily
communication BETWEEN NURSES
PROCESS DESIGN
CHANGE IN SOCIAL INTERACTION
and daily
communication BETWEEN NURSES
SOCIAL HUBS / BREAK ROOMS ON
THE UNIT/reliable, easy to use
technology
18. Perception (from the Latin perceptio, percipio) is the organization,
identification, and interpretation of sensory information in order to
represent and understand the environment. (wiki)
Perception is the lens through
which we see the world
19.
20. Change starts with a perception of its need, so a wrong
initial perception is the first barrier to change
http://www.uv.es/~pardoman/resistencias.PDF
Change and Perception
21. • Changes in the workplace
naturally create uncertainty
and can be emotionally
challenging
• Nurses often feel that change
is imposed on them and their
views are not taken into
consideration. This
perception does little to
empower them to own
changes occurring and adapt
behaviors to sustain
improvements
(Bowers, 2011)
Source: Press Ganey comparison of customer
satisfaction and employee satisfaction scores of
18 hospitals in their database
Change and Perception
22. 1. Myopia or inability of the company to look into the future with
clarity
2. Denial or Refusal to accept any information not expected /
desired
3. Perpetuation of ideas- the tendency to go with the present
thoughts though the situation has changed
4. Implicit assumptions
5. Communication barriers
6. Organizational silence
http://www.uv.es/~pardoman/resistencias.PDF
Resistance to Change
23. Change and Motivation
Resistance to change may also be due to
low motivation for change caused by:
1. Direct costs of change
– Loss of daily interaction with the team
2. Cannibilization cost- change brings success to a product but
at the same time losses to others
– Privacy benefit to patient, loss to staff
3. Past failures
– Concerns about resource support – technology choices
4. Different interests among employees and management
http://www.uv.es/~pardoman/resistencias.PDF
24. Driving and Resisting Forces
A Force Field Analysis of IT change
1. Participation
2. Communication
3. Competency
1. Fear
2. Lack of skill
25. What role do “expectations”
play in shaping perceptions?
Measure perception
But also measure expectation
SATISFACTION
-5
PERCEPTION
5
EXPECTATION
10
= -
28. Expectation Survey
Knowledge of New Environment
None Low Medium High Very high
Rating
Count
Level of involvement in the
new design
27.0% (10)
32.4%
(12)
13.5% (5)
16.2%
(6)
10.8% (4) 37
Level of knowledge about
the new environment
2.7% (1) 21.6% (8) 48.6% (18)
21.6%
(8)
5.4% (2) 37
Level of knowledge about
the new processes
regarding patient care,
support and ancillary
services?
11.1% (4)
58.3%
(21)
19.4% (7) 8.3% (3)2.8% (1) 36
29. Expectation Survey
Key Expectations
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30. Expectation Survey
The relationship between involvement and
expectation
Involveme
nt
Expecta
tion
Percepti
on
INVOLVEMENT IN DESIGN PROCESS SIGNIFICANTLY
CORRELATED TO KNOWLEDGE OF ENVIRONMENT
AND KNOWLEDGE OF PROCESSES.
NOT CORRELATED TO HOW PREPARED NURSES FEEL.
LOWER EXPECTATIONS FOR STAFF CONCERNS
COMPARED TO PATIENT CONCERNS
INVOLVEMENT IN DESIGN HIGHLY CORRELATED TO
THE FOLLOWING:
EXPECTATION OF EFFICIENCY
EXPECTATION OF ACESS TO SUPPLIES
EXPECTATION OF PATIENT HANDLING
EXPECTATION OF IMPROVED COLLABORATION
EXPECTATION OF PATIENT SAFETY
INVOLVMENT IN DESIGN NOT CORELATED TO
PATIENT EXPERIENCE AND FAMILY EXPERIENCE
RATINGS
34. Transition During Change
Impact on People
progress
productivity
(effort)
project management timeline
human response to change
GOAL
change
management
area of impact
endings exploration
new beginnings
35. Transition During Change
Three Themes
1. Actively solicit staff and provider voices
beyond the leadership level throughout
process design
2. Manage expectations
3. Close gap between perception and reality
38. THEMES – Emergency Medicine
Leaders Should
• Get more involvement of staff
Hope We Can
• See floor plan
• Have mock trials
• Trial, trial, trial
• Orient
• Spend time in new space
THEMES - NICU
Leaders Should
• Address staffing concerns
• Get more nursing voice
Hope We Can
• Get familiar with new space
• Work on processes
• Investigate new unit
• Spend time in new unit
• Trial equipment
• Trial mock assignments
Expectation Survey
Pulse Point Surveys- Every 4 months till 6 months after occupancy
39. Focused Group, Focused
Voice
Fears
• Loneliness
• Lack of ready help from fellow nurses
• Increased dependence on technology
• Looking incompetent for asking for help
Leadership Advocacy
• Communication technology
• Simulation time
• Parent/family expectations
41. Manage Expectations
Dependability Family Teamwork Respect Flexibility
• Productivity
• Strength
• Happiness
• Passionate
• Health
• Faith
• Passionate
• Courage
• Positive
Perseverance
• Unexpected
Delights
• Strong Work Ethic
• Honest
• Trust
• Truth
• Manners
• Authenticity
• Transparent
• True to yourself
• Compassionate
• Loyalty
• Integrity
• Courage
• Passionate
• Creativity
• Open-minded
• Seeking new
learning
opportunities
We Love Children! Pediatric Environment is Very
Satisfying
Friendly Culture @ ACH
• Love of children
• Positive outcomes for children
• Seeing children melts your heart
• Help kids
• Support families so they don’t feel
alone
• Voice for children
• Get to be a “big kid”
• Save a kid’s life
• Culture vs. Adult – more teamwork
here
• We get to fix things for others
• Problem-solvers
• Feel connected to bottom line –
helping families and children
• Engaging families
• MDs actually talk to you
• Someone will always help you
• Impressed by friendly staff/surgeons
• Warm, welcoming team
• Try to do the right thing all of the
time
Welcoming Clean Efficient
• “Can I help you with this patient?”
• Friendly
• People smiling
• Kids laughing
• Nervous parents feel like only their
child is there today
• Teamwork
• Upbeat, positive, friendly, welcoming,
smiling, laughing
• Cooperative, calm parents
• Happy to be in a good facility
• Clean
• Smells clean
• Bright
• Uncluttered
• Efficient, but unrushed
• Nice pace
• Organized
• Quiet with a bit of crying
• Awesome huddle board
• Busy – controlled
Key Behavioral Indicators
1. Make eye contact, smile and acknowledge all team members, patients and families.
2. Give and accept constructive feedback from all team members.
3. Actively engage each other in creating a positive patient experience through
continuous process improvement.
3 Promises Master Plan Guiding Principles
46. Close the Gap Between Perception and Reality
Creative reality checks,
orientation, simulation
47. Closing The Gap early…..
• Facility mock-ups MANDATORY for a much larger group of staff
and providers
– Not voluntary – address clinical culture changes
• Make future CARE DELIVERY model much more widely
disseminated earlier to all staff and providers impacted by the
design
• Have designers ADVOCATE for a design that blends a little more
employee satisfaction with patient experience as the two are
intertwined in a successful patient experience
