Pembury PFI Hospital – Single Beds Symposium on Single Bed ...
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1 Pembury PFI Hospital – Single Beds Symposium on Single Bed Ward Accommodation Bernard Place – Director of Healthcare Planning and Commissioning The Decision Making Process Cardiff – 14 June 2007
Transcript of Pembury PFI Hospital – Single Beds Symposium on Single Bed ...
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Pembury PFI Hospital – Single BedsSymposium on Single Bed Ward
AccommodationBernard Place – Director of Healthcare Planning and Commissioning
The Decision Making ProcessCardiff – 14 June 2007
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Overview of the Pembury Scheme
• Maidstone and Tunbridge Wells currently in Appointment
Business Case (ABC) state of £300m PFI Project
• Allows Consolidation of current Kent and Sussex Hospital
(Tunbridge Wells) and Pembury Hospital onto one site
• 512 Single rooms with ensuite facilities
• Opening scheduled December 2010
• Affordable within 15% normalised income metric
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The Hospital Model Design
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Original Acute Hospital Design Strategy
Original Acute Hospital Design Strategy
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Aerial View of Pembury Site
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Equion’s Proposed Design
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Proposed movement strategy
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Pembury flythrough
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Single Room Design
Features of Single Room with Ensuite FacilitiesStandardised layout Head of bed direct line of sight from doorLarge vision panel in door to roomClinical basin at entrance and exit to encourage useStaff zone and family zoneMaximised natural light and viewsAcoustically controlledNaturally ventilatedBathroom on bed head wall and grab rail from bed to bathroomHalf leaf door to enable emergency access to bathroom
developing ward design
• Ensuring design and service delivery improves care
• Single rooms v Wards
• Acuity adaptive rooms
• Segregation of patient rotes
• Protection of clinical environment
• Fixtures and fittings
• Patient safety evidence.
Single Room Design
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Simple direct staff communication
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Vocera
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Basic economics of patient safety
PFI Rule of Thumb - “Every £10m capital investment generates a revenue cost (an “availability charge”) of £1.0m
Capital investment in patient safety needs to be more than offset by revenue savings
Revenue savings need to be “cash releasing” i.e. they support a reduction in operating costs sufficient to enable the servicing of the additional cost of capital investment in patient safety.
Patient safety has to be important enough for stakeholder to generate a “willingness to pay” or a “positive consumer preference”
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Board Decision Making Process -Principles
Patient safety not simply a normative operational and professional requirement but a business imperative Board wanted patient safety to be ‘part of the brand’Strategic view about next 5-10 yearsReassurance that this approach worked in Europe, North America and independent sectorDirector of Nursing and Estates Director visit to St Joseph’s Hospital West Bend Wisconsin with NPSA, May 2005
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Board Decision Making Process –Policy Context
Patient ChoicePayment by resultsConsumerism (single room vs.bays relative cost shift)NHS Estates minimum 50% single room guidance
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Board Decision Making Process –Local Context
25 % Tunbridge Wells population have access to independent sector health careCurrent hospital fabric so poor that PPI and local community receptive to radical solution Spectacular development site
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Board Decision Making Process -Evidence
Single RoomsStandardisationInfection Prevention and ControlFallsMedication ErrorsTherapeutic environment – light, views, acoustics, odoursSleepFamily centred careStaffing Levels
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Board Decision Making Process –‘Serendipity’
CEO former nurse Infection control national political imperative and major pubic concernPatient safety culture – “hospital should do no harm”Building techniques e.g. prefabrication at sufficient maturity to enable costs to be contained, Consortium (Equion) receptive and responsive to 100% single rooms
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Conclusion
Key challenge is to effect as much change as possible to supportsingle room approach before hospital opensStaffing levels to Healthcare Commission normsImprove proportion of ‘purposeful nursing care time’ from 30%Improve quality and effectiveness of nursing observationImprove infection prevention and controlRemove central nursing stations and replace with distributed stationsTrial VoceraImprove near patient data entryStandardise ward processesResolve source of communication problem e.g. multiple patient recordsTrial theatre ‘scrubs’ as ward uniform
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Pembury Model
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End
Thank you
Question and answer session
