ARCC_2015_Promedica
36
Research based practice: Field Research + Parametric Analysis in Medical Planning and Design Upali Nanda, PhD Camilla Moretti, AIA Ryan Gathman, AIA Adeleh Nejati, PhD HKS Inc.
-
Upload
upali-nanda -
Category
Design
-
view
76 -
download
0
Transcript of ARCC_2015_Promedica
Research based practice:
Field Research + Parametric Analysis in Medical Planning and Design
Upali Nanda, PhDCamilla Moretti, AIARyan Gathman, AIAAdeleh Nejati, PhD
HKS Inc.
……it is important to
define a problem before designing a solution
continuously test the solution to make sure it works
Learn how field research and simulation tools can be combined
Explore how research and analytics can be rapidly deployed for design
Learn about how design decision making can be fundamentally transformed through
data and performance driven approaches
LEARNING OBJECTIVES
noun1.the systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions.verb1.investigate systematically.
PROMEDICA TOLEDO HOSPITAL AND TOLEDO CHILDREN’S HOSPITAL
Campus Overview
Community based since 1927Operating 600 bedsTertiary care, Level 1 Trauma Center, 100,000+ ED visits, Level 3 NICU, 24/7 Cardiology, TelestrokeNetwork
DESIGN PROCESS
JULY SEPTMAY JUNEAPRILCURRENT
STATE FUTURE STATE
DEMAND FORECAST
DESIGN
OPERATIONS
RESEARCH
GUIDING PRINCIPLES
WORKSHOPS
Reported Observed Spatial
RESEARCH
CURRENT STATE FUTURE STATE
PHASES OF
WORK
INTEGRATING
RESEARCH IN PRACTICE
FU
NC
TIO
NA
L
DE
SIG
N
IMP
LE
ME
NT
AT
ION
DO
CU
ME
NT
S
RESEARCH
“INFORM”
CONCEPT
SD
DD
CA
CD
RESEARCH
“AND
CONFIRM”
TARGETCreate design aims based on key
performance goals of the organization
EXPLORE/ EXPERIMENTGather Knowledge; Understand Users;
Simulate Scenarios; Test Prototypes. Use
Tools That Balance Technology With Empathy
DEFINELink Design Solution to Performance Hypothesis
MEASUREIdentify key metrics in design and
performance and collect baseline data
MONITORConfirm design is implemented as planned;
towards targeted performance goals
TESTTest the success of the design post-occupancy;
evaluate if target was achieved
RESEARCH: START WITH A TARGET
KEY PERFORMANCE INDICATORS
RESEARCH IN THE FIELD
A 2.5 DAY DESIGN DIAGNOSTIC
FIRST TO FILL UNIT(mostly full occupancy)
2 wings4 nursing stations20 rooms in each wing2 meds/supply rooms1 nourishment room2 soiled linen 2 equipment
MED-SURG UNIT
KEY PERFORMANCE INDICATORS
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
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
ACTIVITY ANALYSIS
ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY)
First two hours of shift
ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY vs. NIGHT)
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
WALKING
Proximity Calculator | Rapidly Generated Heat Map
Excessive Distance
Reasonable Distance
PROXIMITY ANALYSIS
PARAMETRIC MODELING
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
FIELD RESEARCH + PARAMETRIC ANALYSIS
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
Nurse Station to Clean Supplies/Medication Room
Clean Supplies/Medication Room to Patient Room
Patient Room to Nurse Station
A SIMPLE MED EVENT
Nurse Station to Patient Room
Patient Room to Clean Supplies/Medication RoomClean Supplies/Medication Room to Patient RoomPatient 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
FIELD RESEARCH PARAMETRIC MODEL
DEVELOPING A SEQUENCE MAPPERBASED ON FIELD RESEARCHSO EVERY DESIGN CONFIGURATION CAN BE ASSESSED
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
RESEARCH DURING DESIGN
PARAMETRIC ANALYSIS OF PLAN CONFIGURATIONS
UNIT CONFIGURATION
VISIBILITY & COLLABOTATION
UNIT SECURITY & CORE POROSITY
THE PROCESS
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
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
WHY THIS MATTERS
CURRENT STATE
FUTURE STATE
The Field Research + Parametric Analysis helped us see what we didn’t see beforeHelped us have more informed conversations with our peopleHelped us create clear targets going forwardHelped us Achieve
Getting nurses closer to the patientsDecrease time away from the bedImprove Key Performance Indicators
HCAHPSFalls with InjuryErrorsStaff Satisfaction
OWNER’S PERSPECTIVE
PHASES OF
WORK
INTEGRATING
RESEARCH IN PRACTICE
FU
NC
TIO
NA
L
DE
SIG
N
IMP
LE
ME
NT
AT
ION
DO
CU
ME
NT
S
RESEARCH
“INFORM”
CONCEPT
SD
DD
CA
CD
RESEARCH
“AND
CONFIRM”
TARGETCreate design aims based on key
performance goals of the organization
EXPLORE/ EXPERIMENTGather Knowledge; Understand Users;
Simulate Scenarios; Test Prototypes. Use
Tools That Balance Technology With Empathy
DEFINELink Design Solution to Performance Hypothesis
MEASUREIdentify key metrics in design and
performance and collect baseline data
MONITORConfirm design is implemented as planned;
towards targeted performance goals
TESTTest the success of the design post-occupancy;
evaluate if target was achieved
De Ja VuVe Ja Du
