THE ROAD LESS TRAVELED: FACILITATING CULTURAL CHANGE … · THE ROAD LESS TRAVELED: FACILITATING...
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SEPTEMBER 30, 2009 1 THE ROAD LESS TRAVELED: FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT The Road Less Traveled: Facilitating Cultural Change in Healthcare Through the Built Environment Built Environment September 30, 2009 Presenters • Robert Y. Copeland, Jr. FACHE CEO McCune-Brooks Regional Hospital Carthage, Missouri THE ROAD LESS TRAVELED: FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT • Earl R. Wilson ACHE, ASHE, LEEDyAP Senior Associate HMN Architects, Inc. Overland Park, Kansas The Road Less Travelled The Road Not Taken “I shall be telling this with a sigh Somewhere ages and ages hence: THE ROAD LESS TRAVELED: FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT Two roads diverged in a wood, and I — I took the one less traveled by, And that has made all the difference.” — Robert Frost Learning Objectives • Explore how institutions can take the opportunity of building a replacement hospital to re-invent how they provide healthcare services. • Reinforce the internal cultural changes THE ROAD LESS TRAVELED: FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT needed to compete in the marketplace. • Learn how strategies for incorporating daylight and nature into patient care spaces as part of the healing process were employed.
Transcript of THE ROAD LESS TRAVELED: FACILITATING CULTURAL CHANGE … · THE ROAD LESS TRAVELED: FACILITATING...
SEPTEMBER 30, 2009 1
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
The Road Less Traveled:Facilitating Cultural Changein Healthcare Through the Built Environment
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Built Environment
September 30, 2009
Presenters• Robert Y. Copeland, Jr.
FACHECEOMcCune-Brooks Regional HospitalCarthage, Missouri
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
• Earl R. WilsonACHE, ASHE, LEEDyAPSenior AssociateHMN Architects, Inc.Overland Park, Kansas
The Road Less Travelled
The Road Not Taken
“I shall be telling this with a sighSomewhere ages and ages hence:
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
g gTwo roads diverged in a wood, and I —
I took the one less traveled by,And that has made all the difference.”
— Robert Frost
Learning Objectives• Explore how institutions can take the
opportunity of building a replacement hospital to re-invent how they provide healthcare services.
• Reinforce the internal cultural changes
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
needed to compete in the marketplace.
• Learn how strategies for incorporating daylight and nature into patient care spaces as part of the healing process were employed.
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Learning Objectives• Explore how the objectives for patient- and
family-centered care were executed through strategies in the planning and design of the facility.
• Discover what lessons were learned about
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
• Discover what lessons were learned about the overall results and patient satisfaction.
• Learn to embrace the challenges of healing.
AgendaWelcomeHistoryOur StoryA JourneyBridging Culture & Design
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Bridging Culture & DesignSetting the StageBig IdeasResultsA ChallengeDiscussion
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
BACKGROUND
Local EnvironmentExisting Facility Issues
Carthage, Missouri
• Location:Southwestern part of Missouri, near Joplin
• Statistics:
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Statistics:Founded in 1842Population: 12,668
• Americana:“Maple Leaf City”Route 66Battle of Carthage
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Carthage, Missouri• Home to:
Leggett & PlattWilliams LightingSchreiber CheesePrecious Moments
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
• Notable Natives:Marlin Perkins
NaturalistBelle Starr
Wild West OutlawDr. Janet Kavandi
Astronaut
Our Prior Facility• Issues:
Federal style building constructed in 1929 with numerous additions.Hampered by:
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Hampered by:Inadequate ParkingRestricted Access
Renovation was possible but would not have facilitated the type of change we wanted.
Issues•Surgery & Endoscopy
Departmental areas were split onto two floors.Compromised segregation of
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
segregation of sterile/non-sterile areas.Central sterile services occupied left over hallways, closets, etc.Inadequate facilities for:
Pre-op CarePost-op CarePatients, Staff & Visitors
OR #2
Issues•Emergency & Imaging
Compromised segregation of sterile/non-sterile areas.No decontamination space
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Trauma Room
space.Inadequate space for supplies and storage.Inadequate facilities for patients, staff and visitors.
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Issues•Inpatient Care
Medical and Surgical care was split onto two floors.Predominately semi-private rooms.Critical care provided in
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Medical/Surgical Patient Room
Critical care provided in a ward setting.Inefficient bed mix. Inadequate space for supplies or storage.No facilities for family-centered care.
Issues•Other Functions
Administrative, cardiac and physical therapy services were scattered across town.Obsolete kitchen and other service spaces.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Rehab Gym
other service spaces.Lack of meeting, training and conference space.Absolutely no space for community events.Parking and expansion were major concerns.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
OUR STORYA New Approach
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
A JOURNEY
We Have a ChoiceA Different Point of View & Experience
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Healthcare Is Broken
• Experientially• Financially• Spiritually
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
p y
Take a New Approach• Goals:
Redefine what healthcare means.Determine how best to execute that care.I t b th d
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Incorporate both new and traditional concepts that enhance the healing process.Embrace change in healthcare creatively.
The Challenge• Imagine a different
healthcare experience.
“Some men see things asthey are and say, ‘Why’?
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
I dream of thingsthat never were and say,‘Why not’?”
— Robert F. KennedyUniversity of Kansas
March 18, 1968
A Different Point of View• We need to change our
point of view.
We looked at McCune-Brooks Regional Hospital
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Brooks Regional Hospital with new eyes…
…through the eyesof experiences.
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Create a New Experience• Experiences are personal.
“Experiences are inherently personal, existing only in the mind of an individual who has been engaged on an
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been engaged on an emotional, physical, intellectual or even spiritual level.”
— Joe Pine & Jim GilmoreWelcome to the Experience Economy
Harvard Business Review
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
BRIDGING CULTURE & DESIGN
Bridging Culture & DesignDesign Goals & Principles
Bridging Culture & Design• We used this opportunity to improve:
ProcessesOutcomesCulture
• Incorporate best management
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
• Incorporate best management practices.
Apply Evidence Based Research.Allow for the unknown.Streamline and reorganize everywhere.Learn from the best, no matter where.
Design & Planning Goals• Admissions
Make the pre-admission process more patient-friendly.Provide single point of care service.
Concierge & Admissions
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gPre-Admission Services, etc.
• Emergency ServicesDesign flexible zoning & private rooms.Provide women’s emergency care.Address infection control needs.
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Design & Planning Goals• Surgery and Endoscopy
Consolidate services.Provide a better ratio of pre/post rooms.Design more adaptable O.R.s.
Focus on outpatient care.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
p• Diagnostic Imaging
Fully implement the “on-stage” idea.Create a women’s center.
Allow for new technologies & digital format.
Design & Planning Goals• Respiratory Therapy
Consolidate functions from different departments.Provide patient-centered sleep therapy services.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
• Food ServiceConvert to a room-service approach.
Design & Planning Goals• Inpatient Care
Provide a truly restorative environment & responsive patient care.Design adaptable/universal patient rooms.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Provide a family-centered environment.Rooming-inFamily room
Planning Principles• Create a new experience.
Create a new patient experience.Design a new staff experience.
“A new play commands a new stage.”
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— B. Joseph Pine, II
• Think from the patient’s point of view.
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THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
SETTING THE STAGE
Learning From DisneyEvidence-Based Design Hypotheses
Learning from Disney• The Disney Experience
One of the world’s greatest marketers.• Key concepts in creating an
experience:L k f t iti t t i
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Look for opportunities to create surprise & delight.Make individuals feel special.Be true to your brand.People talk about their experiences.
Learning from Disney• Create a Memorable Experience“Work is theatre…Even those businesses which do not yet stage experiences must understand that whenever employees work in front of customers an act of theatre occurs…
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
front of customers an act of theatre occurs… the question isn’t whether your employees are performing, it’s whether they are performing in mundane or memorable ways.”
— Joe Pine & Jim GilmoreWelcome to the Experience Economy
Harvard Business Review
Evidence-Based Hypotheses• Patient Satisfaction:
Access to nature will increase patient satisfaction scores.
• Pain Management & Medication Use:Large windows & lack of shadows will
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
gimprove pain management scores & decrease medication use.
• Patient Safety:Wide entries at patient rooms & at patient toilets will help reduce slip & fall incidents.
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Evidence-Based Studies• Bright light (natural & artificial) can
improve health outcomes:Bright light reduces the effects of depression, agitation, SAD, bipolar and other disorders.
— Seven distinct studies (1996)
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Sunlight in patient rooms improves psychosocial health, quantity of medications used, and medication costs.
— Walch, et al. (2004)
Patients who suffered heart attacks had half the mortality rate in sunny rooms.
— Beauchemin & Hays (1998)
Evidence-Based Studies• Effect of light on improving patient
health:Exposure to bright morning light is effective in reducing agitation in elderly patients with dementia.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
— Lovell, et al. (1995)
Exposure to morning light is more effective in reducing depression than evening light.
Views onto sunny spaces were twice as effective as those that looked onto spaces in shadow.
— Beauchemin & Hays, et al. (1996 to 2006)
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
BIG IDEASSeven Ideas for Transformation
The Big Ideas• We developed several “Big Ideas.”
They became the framework for our new hospital;And were essential in the way we looked at the interaction between:
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
HealthcareThe Built Environment
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The Big Ideas1. Create a new patient experience.2. Bring care to the patient, not just
figuratively, but in actual practice.3. Provide a healing and restorative
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
environment for patients, families & staff.
The Big Ideas4. Integrate nature as key part of the
healing process.5. Engage all senses in the patient
care environment.
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6. Provide “on-stage” & “off-stage” spaces.
7. Tell a story.
1. A New Patient Experience• Create a new patient experience.
Experiences begin in the community & are rooted in the culture of the hospital.
• “Beacons of Light” Announce a place that nurtures a sacred
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Announce a place that nurtures a sacred trust in healthcare.
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1. A New Patient Experience• Reinforce the patient experience.
Departments and functions were reorganized to reinforce the new patient experience.
Concierge & Admitting
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
g gPre-Admission & Outpatient CareEmergency CareDining & Food Service
Wayfinding was key in shaping the patient experience.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
1. A New Patient Experience• Create a healing & restful
environment.Provide a place where patient-centered & family-centered care can flourish.Reduce visual clutter & unwanted noise
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Reduce visual clutter & unwanted noise.Wireless devices minimize overhead paging.Carpeting is used in all non-invasive areas.
The patient rooms were designed to:Make patient care more effective & efficient.Harmonize with the other big ideas.
Decentralized Decentralized Nurse StationNurse Station
Nurse ServerNurse Server
Document Document StationStation
ADA Patient ADA Patient Toilet & ShowerToilet & Shower
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Patient ZonePatient Zone
Family ZoneFamily Zone
Caregiver ZoneCaregiver Zone
Flat Screen TV Flat Screen TV & Refrigerator& Refrigerator
Family Touch Family Touch Down StationDown Station
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THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
2. Bring Care to the Patient• Bring care to the patient — not just
figuratively, but in everything we do.We examined and questioned everything:
Roles, responsibilities, relationships,
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Roles, responsibilities, relationships, departments, flow, etc.
Provide decentralized patient care. Direct observation.
Provide universal rooms.Yields flexibility in room assignments.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
3. Provide for Healing• Provide areas of rest and respite:
A quiet library with a fireplace.Family gathering areas.Places to sit & talk, or take in a view.
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THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
3. Provide for Healing• Incorporate natural light & views.
Sunlight is essential for life.Daylight provides natural illumination for most tasks.
Glare is controlled to minimize visual
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
discomfort.The outdoor spaces were designed so that views are not obscured by shadows.
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30’
Solar Study: Summer SolsticeSolar Study: Summer SolsticeTHE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
8:00
30’
Solar Study: Winter SolsticeSolar Study: Winter Solstice
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THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
4. Integrate Nature• Use nature as an ally in healing.
As humans, we are innately connected to nature.Create a feeling of intimacy with a special environment, with views of
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
p ,nature & water, even while in bed.
• Refresh the spirit.Water is a universal symbol of healing, a journey, rebirth, a cleansing element, and clarity.The passages are bridges over the
4. Integrate Nature
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
p g gbrook, both literally & figuratively.
5. Engage All Senses • Create vistas.
Sightlines were carefully designed to frame views & provide places for rest & reflection.
• Use sound to reduce stress
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
• Use sound to reduce stress.The soothing sound of rippling water reinforces the visual image of the brook.Piano music provides counterpoint.
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THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
5. Engage All Senses• An art program provides positive
distractions.Artwork by local artists helps reinforce a sense of place & the community.
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THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
6. On-Stage & Off-Stage• Provide both “on-stage” and “off-
stage” spaces.“On-stage” areas:
The hospital is a stage in which employees “act” as caregivers.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
gThey help set the stage for a positive experience.
“Off-stage” areas:Were created for employees to de-stress, rejuvenate, and re-energize for their roles.
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THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
7. Tell a Story• “The Journey of Life”
Through the architecture we created a story of healing and care…in which a patient realizes they are connected to the environment…
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and have become a part of nature’s unique ability to create, revitalize and release…and celebrate the sacred trust in healthcare.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Flowing along…..Flowing along….. THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
…..just as water does.…..just as water does.
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THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Searching ….. THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
..…for what it means...…for what it means.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
That’s the way…..That’s the way….. THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
..…that life goes...…that life goes.
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THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Standing…..Standing….. THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
..…by my River of Dreams...…by my River of Dreams.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
-- Randall BeersRandall Beers THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
RESULTS
Press Ganey Surveys & OperationsLessons Learned
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The Results
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The Results
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Press Ganey Inpatient SurveyPress Ganey Inpatient Survey
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Quietness
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The Results
Procedures &Procedures & RRevenueevenue 6/30/20076/30/2007 6/30/20096/30/2009 ChangeChangeOR Hours / Mo. 91 155 +70%Endoscopy Procedures / Mo. 84 125 +49%Diagnostic Procedures / Mo. 1,681 2,210 +76%Outpatient & Clinic Visits / Mo 1 955 2 684 +73%
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Outpatient & Clinic Visits / Mo. 1,955 2,684 +73%ADC (89% Occupancy Rate) 17.97 22.27 +24%Increase in Gross Revenues +38%
The Results
Patient StatisticsPatient Statistics 20072007 20092009 ChangeChangePatient Days 539 625 +16%ALOS (Medical / Surgical) 4.8 4.1 <15%ALOS (Swing Beds) 7.3 5.6 <23%ALOS (Generations Unit) 13 3 11 9 <11%
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ALOS (Generations Unit) 13.3 11.9 <11%Slips & Falls / Discharge Day 1.7% 1.1% <35%
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Results• Patient Satisfaction
Press Ganey ratings are above the 90th percentile for most inpatient categories.
Overall Hospital Rating & Level of CarePatient Rooms, Noise Level & Visitor Comfort
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• Greatest Areas of SuccessInpatient CareSpecialty ClinicsSurgeryFood Service
Results• Patient Safety
Slips & falls have been reduced.Additional study is needed to confirm that wide doorways help reduce fall incidences.The solid color flooring in the Generations
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Unit performs well for minimizing slips & falls.
• Medication UsagePRN & pain medication use is reduced.
Based on staff reports & interviews.Generations Unit PRN usage has been reduced ~50%.
Results• Evidence-Based Design Hypotheses
Average Length of Stay (ALOS)ALOS has been reduced (4.1 vs. 4.8 days). The hypothesis that access to natural light & nature will help improve patient outcomes
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appears to be validated.Pain Management
Retrospective interviews appear to validate the hypothesis that access to nature & natural light reduce discomfort & demand for pain medications.
Results• Transition Planning
Equipment lease terms were adjusted to coincide with move-in.
This minimized the numbers of moved items & bundled set-up & calibration costs.
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Apply new systems & procedures before move-in to shake out issues & build the new culture.It is difficult to keep your “eye on the ball” with patient service in the midst of planning & construction.
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Results• Vision & Commitment
The vision & goals were identified early. We had a common communication plan.There were solid liaisons in the project.There was commitment to the programmatic
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& fiscal goals of the project.It is essential that all team members fully understand & are equally committed to the vision.
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
A CHALLENGE
Change Begins HereNurture a Sacred Trust
Our Challenge to You• Change begins here.
“Never underestimate the ability of a small group of committed people to
h th ld
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change the world.
They’re the only oneswho ever have.”
— Margaret Mead
Our Challenge to You• Nurture a sacred trust in
healthcare.Design healthcare facilities to promote wellness, family values & a sense of the
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values & a sense of the community.
• Think from the patient’spoint of view.
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THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
BEGIN YOUR JOURNEY
“The journey is the reward.”— Chinese Proverb
Project Team• HMN Architects, Inc.
Architecture & Interior DesignOverland Park, KS, Springfield, MO
• Starizon, Inc.Experience ConsultingKeystone, CO
• Brack & Associates, P.A.MEP EngineeringT k KS
• Palmerton ParrishGeotechnical EngineeringSpringfield. MO
• Patti Banks AssociatesLandscape ArchitectureKansas City, MO
• Traffic Engineering Consultants Inc.
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Topeka, KS
• Bob D. Campbell & Co.Structural EngineeringKansas City, MO
• Walter P. Moore, Inc.Civil EngineeringKansas City, MO
• Santee Becker AssociatesFood Service DesignMission, KS
Traffic EngineeringOklahoma City, OK
• Hospital Management Consulting
FinancingNorth Kansas City, MO
• J.E. Dunn Construction Co.Construction Management ServicesKansas City, MO
Images• Photography:
Ed LaCasse PhotographyBenschneider Photography
• Videos:
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deosEdge Healthcare Marketing
References• The American Institute of Architects. (2005). Bringing Metrics to
the Table: Advancing the Metrics Trend to Planning, Design and Construction. AIA Press, Washington D.C.
• Ashish, K, M.D., Duncan, B., MD, Bates, D., M.D., MSc. (2000). Fatigue, Sleepiness and Medical Errors, Agency for Healthcare Research and Quality, C46.
• Beauchemin, K., & Hays, P. (1996). Sunny hospital rooms expedite recovery from severe and refractory depressions Journal
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
expedite recovery from severe and refractory depressions. Journal of Affective Disorders, 40(1-2), 49-51.
• Beauchemin, K., & Hays, P. (1998). Dying in the dark: Sunshine, gender and outcomes in myocardial infarction. Journal of the Royal Society of Medicine, 91(7), 352-354.
• Benedetti, F., Columbo, C., Barbini, B., Campori, E., & Smeraldi, E. (2001). Morning sunlight reduces length of hospitalization in bipolar depression. Journal of Affective Disorder, 62(3), 221-223.
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References• Blomkvist, V., Eriksen, C.A., Thorell, T., Ulrich, R.S. & Rasmanis,
G. (2004). Acoustics and Psychosocial Environment in Coronary Intensive Care. Occupational and Environmental Medicine.
• Eastman, C.I., Young, M.A., Fogg, L.F., Liu, L. & Meaden, P.M. (1998). Bright Light Treatment of Winter Depression. Archives of General Psychiatry, 55(10), 883.
• Falk, S.A., & Woods, N.F. (1973). Hospital Noise-Levels and Potential Health Hazards New England Journal of Medicine
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Potential Health Hazards. New England Journal of Medicine. 289(15), 774-781.
• Foss, K.R., & Tenholder, M.F. (1993). Expectations and Needs of Persons with Family Members in an Intensive Care Unit as Opposed to a General Ward. Southern Medical Journal, 86(4), 380-384.
• Friberg, T.R., & Borrero, G., (2000). Diminished Perception of Ambient Light: a Symptom of Clinical Depression? Journal of Affective Disorders, (61(1-2), 113-118.
References• Frost, R. (1997). Frost: Poems. New York, NY: Alfred A. Knopf.• Frumkin, H. (2001). Beyond toxicity: Human health and the natural
environment. Journal of Preventive Medicine, 20(3), 234-240.• Haq, S. & Zimring, C. (2003). Just down the road a piece: The
development of topological knowledge of building layouts. Environment and Behavior. 35(1), 132-160.
• Heath, Y. & Gifford, R. (2001). Post-occupancy evaluation of therapeutic gardens in a multi level care facility for the aged
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therapeutic gardens in a multi-level care facility for the aged. Activities, Adaptation & Aging, 25(2), 21-23.
• Joseph, A., Ph.D. (2006). The impact of light on outcomes in healthcare settings. The Center for Health Design.
• Lewey, A.J., Bauer, V.K., Cutler, N.L., Ahmed, S., Thomas, K.H., et al. (1998). Morning Light vs. Evening light treatment of patients with winter depression. Archives of General Psychiatry, 55(10), 890-896.
References• Lovell, B.B, Ancoli-Israel, S. & Gevietz, R. (1995). Effect of bright
light treatment on agitated behavior in institutionalized elderly subjects. Psychiatry Research, 57(1), 7-12.
• Moeser, S.D. (1988). Cognitive mapping in a complex building. Environment & Behavior, 20(1), 21-49.
• Mularez, L. A. (1990). Theory M: A restructuring process.• Pine, J. & Gilmore, J., (1998). Welcome to the experience
economy Harvard Business Review
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economy. Harvard Business Review.• Pine, J., (1999). The Experience Economy: Work Is Theatre &
Every Business a Stage. Boston: Harvard Business School Press.• Press Ganey Associates, Inc. (2009). Patient satisfaction reports.
South Bend, IN., (7/1/2005 through 2/28/2009). • Rothschild, J. M., M.D., M.P.H. (2005). “Closed” intensive care
units and other models of care for critically ill patients.
References• Smith, J., ASLA, LEED AP, (2007). Health and nature: The
influence of nature on design of the environment of care. The Center for Health Design.
• Topf, M. & Dillon, E. (1998). Noise-induced stress as a predictor of burnout in critical care nurses. Heart Lung, 17(5), 567-574.
• Tse, M.M., Ng, J.K., Chung, J.W. & Wong, T.K. (2002). The effect of visual stimuli on pain threshold and tolerance. Journal of Clinical Nursing 11(4) 462-469
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Nursing, 11(4), 462-469.• US Census Bureau. (visited: 11/29/08). 2000 Census.
http://www.census.gov/. • Ulrich, R.S. (1984) View through a window may influence recovery
from surgery. Science, 224(4647), 420-421.• Ulrich, R.S. (1999) Effects of gardens on health outcomes: theory
and research. Healing Gardens. New York, NY: Wiley.
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References• Ulrich, R., Ph.D., Quan, X., Zimring, C., Ph.D., Joseph, A., Ph.D.,
Choudhary, R., (2005). The role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime opportunity. The Center for Health Design, Concord, CA.
• Ulrich, R., PhD,. Joseph, A., PD., (2007). Sound control for improved outcomes in healthcare settings. The Center for Health Design, Concord, CA.
• Walch J M Rabin B S Day R Williams J N Choi K & Kang
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• Walch, J.M., Rabin, B.S., Day, R., Williams, J.N., Choi, K. & Kang, J.D. (2005). The effect of sunlight on post-operative analgesic medication dosage: A prospective study of spinal surgery patients. Psychosomatic Medicine, 67(1),156-163.
CopyrightThis presentation is protected by US and International copyright laws.
Reproduction, distribution, display and use of the presentation without written
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ppermission of the speaker is prohibited.
© HMN Architects, Inc. 2009
Thank YouRobert Y. Copeland, Jr.FACHECEO McCune-Brooks Regional Hospital3125 Dr. Russell Smith Way Carthage, MO 64836 [email protected]
McCUNEMcCUNE--BROOKSBROOKSREGIONAL REGIONAL HOSPITALHOSPITAL
THE ROAD LESS TRAVELED:FACILITATING CULTURAL CHANGE IN HEALTHCARE THROUGH THE BUILT ENVIRONMENT
Earl R. WilsonACHE, ASHE, LEEDyAPSenior AssociateHMN Architects, Inc.Overland Park, [email protected]
