Using Evidence-Based Design to Optimize Healthcare Outcomes

Transcription

1 2017 NFPA Conference & Expo Using Evidence-Based Design to Optimize Healthcare Outcomes Kirsten Waltz, AIA ACHA, LEED AP, EDAC, President U.S. Operations, Steffian Bradley Architects Lynn Kenney, EDAC, SASHE Director of Industry Relations, The Center For Health Design

2 Objectives Provide an overview of the evidence-based design process and why it matters Highlight how evidence-based design can inform code language Discuss the role that evidence-based design plays in project planning and design to optimize health care outcomes Review the impact on first cost and lifecycle costs Explore a case study

3 The Center For Health Design Transforming healthcare environments for a healthier, safer world through design research, education, and advocacy.

4 Lots of Challenges Focus on safety, quality care Focus on safety, quality care Healthcare reform Pay-for-Performance Pay-for-Performance Reimbursement Reimbursement consequences consequences Market consolidations Market consolidations Efficiency Patient experience Health information & technology advances Staff retention Access to care

5 Maximizing Reimbursement by Design Trends Pay-for Performance Programs Payment Reduction Payment Incentive Hospital Value Based Purchasing - Patient experience - Outcomes (infections, falls, etc.) - Processes of care - Efficiency Hospital Readmissions Reduction Hospital-Acquired Conditions Reduction Reduction in base DRG payments FY 13 1% FY % FY % FY % FY % Up to a 3% payment amount reduction on all Medicare discharges 1% payment reduction for hospitals in the lowest performing quartile Reductions can be earned back, plus more through incentive payments dependent on the total HVBP score In 2015, 4 of 5 hospitals were penalized under one or more of the programs; one in three major teaching hospitals will be penalized under all three pay-forperformance programs. FY 2017: up to 6% of Medicare reimbursement at risk The goal is to use facility design to help improve healthcare outcomes.

6 The UNITED STATES Remains LAST in Overall Ranking of HEALTHCARE QUALITY, but FIRST for total expenditures. United Kingdom Switzerland Sweden Australia Germany and The Netherlands New Zealand and Norway France Canada United States $8,508/capita

7 Quality and Cost Issues

8 We ve done a great job reducing the risk of fire in health care, now it s time to focus on reducing HAIs 5,650 structure fires 4 deaths 160 injuries 722,000 HAIs 75,000 deaths Affects 1 in 25 patients every single day! Source: Fires in Health Care Facilities, Campbell, Richard, 2016, NFPA.org Source: Evidence-Based Design

9 The Impact of HAIs 75,000 HAI deaths each year is the equivalent of 535 passenger jets crashing each year

10 Evidence-Based Design THE PROCESS OF BASING DECISIONS ABOUT THE BUILT ENVIRONMENT ON CREDIBLE RESEARCH TO ACHIEVE THE BEST POSSIBLE OUTCOMES

11 The Dynamic EBD Process 1. Define goals Organizational readiness/continuous improvement Occupancy 8. Measure (POE) 2. Find evidence Pre-design (KR, POEs, journals, surveys, etc) Construction 7. Monitor implementati on during construction 3. Critically interpret the evidence Design Design 6. Collect baseline performance measures 5. Hypothesize 4. Create & innovate EBD concepts into the design Design Design

12 The Environment of Care The six components of the EOC highlight the interdependent areas in which the physical environment can serve as an enabler or barrier to desired outcomes and behaviors: 1. Concepts (delivery of care model) 2. People (Facility and service users) 3. Systems design 4. Layout and operational planning 5. Physical environment 6. Design process and implementation

13 Lean and EBD EBD Overview Pre-Design DISCOVER Schematic APPLY Development TEST/PREDICT Documentation VERIFY Post-Occupancy COMPARE LEAN Patient Experience Big Questions Critical to Quality Current-State Evaluation Future-State Operational Models Rapid Prototyping Adjacencies Strategic Space Program Gather Baseline/ Current-State Data through Valid Methods Set Optional Standards & Goals Special Project Support (if necessary) Metrics Evaluation Performance Report EBD Gather Baseline/ Current-State Data through Valid Methods Use Baseline Data to Develop Future-State Methods, Prototypes, & Program Test & Calculate Advantages of Future-State Models with Baseline Data; Aid in Decision Making Hypothesize Outcomes Verify Application of Evidence Collect Data Using Same Pre-Design Methods; Compare Data Sets & Test Hypotheses

14 Design Strategies and Related Outcomes Reduced HAIs ** Reduced medical errors Reduced patient falls Single-bed rooms Access to daylight Views of nature Noisereducing finishes * * * * * Reduce pain * ** * * Improve sleep Increase patient satisfaction Source: Ulrich et al., 2008 ** * * * ** * * * * Appropriate lighting

15 The Knowledge Repository A user-friendly library/bibliography of healthcare design resources that continues to grow Online decision making tool 3,383 citations 550+ key point summaries (KPS) Acute, Residential & Ambulatory Care citations 45 full articles available 39 CHD produced articles available

16 EBD can contribute to improved Outcomes by Providing innovative, adaptable designs. Reducing medical errors and associated costs. Improving satisfaction, safety, and efficiency of caregivers, especially aging caregivers and therefore improving recruitment and retention. Improving care, quality and patient satisfaction by reducing noise, falls, infections, and other adverse events. Designing a supportive physical environment for technology integration and reengineered work processes.

17 Addresses Healthcare Trends/Challenges Developing design strategies targeted to improve clinical, environmental and safety outcomes. Research is Used EBD uses relevant evidence to educate the project team and guides the development of design strategies. The integration of these strategies is linked to achieving outcomes. New Research is Created Conducting post occupancy evaluation/research to create new evidence and report the results.

18 Baystate Health Baystate Franklin Baystate Mary Lane Baystate Wing Baystate Noble Baystate Medical Center Five Hospitals Baystate Visiting Nurse + Hospice Tertiary Center Western MA Main Campus Five Hospitals Baystate Visiting Nurse + Hospice Tertiary Center for Western MA Main Campus

19 Baystate Health-Hospital of the Future

20 Phased Opportunities Completed Jan 2012 Completed Sept Completed June 2016 Phase 1 GSF: 641,000 45% Shell (283,500 sq ft) Heart + Vascular Center 96 Inpatient Beds 30 ICU Beds 6 Hybrid OR s Phase 2 GSF: 72,000 fit-out Emergency + Trauma Center 132 Beds- 4 pods Integrated Radiology Phase 3 GSF: 74,630 fit-out 5,100 Reno South Wing Fit-Out Inpatient Pharmacy 96 Inpatient Beds X-Ray PT Gym Pre-op services

21 Developing a Proactive Procedure Getting team members around the table (owner, designers, contactors and trade partners) to see where the gaps in the process lay. Patient experience Staff engagement & satisfaction Safety Project timeline Budget Lessons learned

22 Framework for Success Culture of Continuous Improvement All POE challenged previous phases and allowed the team to learn from it in an evidencebased way Integrated Project Delivery fostered the culture of continuous improvement as a way of challenging the team to make the best design decisions POE for Employees POE for Patients and Families POE for Design Process and Team

23 Timeline Jan 2012 Phase 1 Mass Mutual Wing Opened Sept 2012 POE w/users Completed Oct 2012 POE Evaluated Phase 1 Planning Started for Phase 3 (South Wing) June 2013 POE w/patients and Family Completed on Phase 1 Design Started for Phase 3 Sept 2013 Design Team POE and Committe d to IPD Process June 2016 Opening of Phase 3 (South Wing) June 2017 Future POE to be Performed

24 Hospital of the Future Location on 6 th Floor

25 Phased Floor Plan

26 There is No POE

27 Pick Your POE Categories Safety/Security Access/Wayfinding Patient Room/Bathroom Design Off-stage/On-stage Work and Support Areas Design of Clinical Suites

28 Employees POE Percentages of Employees to Complete the POE, Sept 2012

29 Floor Plan Opportunities for Improvement Distance b/w nurse stations is too far Communication b/w team members is difficult Staff feels isolated Line of sight to patient rooms is limited Nurse cannot see patient rooms from one station OA work space not near public entry PHASE 1 PHASE 3

30 Floor Plan HOF Phase 1 Distance b/w nurse stations is too far Communication b/w team members is difficult Staff feels isolated Line of sight to patient rooms is limited Nurse cannot see patient rooms from one station OA work space not near public entry 32 Beds, 7 Nurse Stations

31 Floor Plan HOF Phase 4 32 Beds, 4 Nurse Stations

32 POE Value Based on the categories that are established, healthcare organizations and designers can better understand the needs and wants of patients and staff. This understanding assists in evidenced-based decision making during design & construction, which can better healthcare environment s and potentially better HCAHPS Scores.

33 POE Findings Safety and Security felt very safe or safe Opportunities for Improvement Panic buttons functionality, staff lack of knowledge, and locations Staff feelings of isolation with large floor plate and decentralized nurse stations felt there was adequate lighting felt badge access was satisfactory

34 POE Findings Access/Wayfinding Opportunities for Improvement Signage on and off units; general, emergency, and elevator felt wayfinding was good or very good

35 POE Findings Patient Rooms Opportunities for Improvement Location of nurse call behind toilet is not accessible Location of staff emergency button blocked by computer workstation Visibility of clock for staff and patients felt patient rooms were always or usually quiet at night felt aesthetic features were successful felt layout and navigation was very good or good Felt the rooms and bathrooms were always or usually clean

36 Patient-Family Advisory Lowest Scores on Scale 1-5

37 Patient-Family Advisory Highest Scores on Scale 1-5 Ability to control room temperature by up to 2 degrees warmer/cooler 5

38 Shared Goal The value in developing a proactive procedure to eliminate life safety issues was shared amongst all parties. 100% level of compliance from conception design to commissioning

39 Determine Design Efficiencies Caught potential issues with opening protective types, device location for smoke detectors, and alignment of sprinkler and fire alarm notification zones with building separations Code Consultant with the team for all phases. Increased number of compliance review checks. Example: Damper variance per 2015 IBC Identifying alternative methods of compliance can save significantly on cost. ($100,000+ const. cost)

40 SOC Findings Prior to Occupancy

41 SOC Findings Prior to Occupancy

42 Before & After (Examples)

43 Typical Findings Fire Door Gaps Fire Door Labels Door hardware labels and details Fire wall construction Drywall patching Fireproofing Exit signage Emergency Lighting

44 Points to remember 1. Solutions are informed from evidence be prepared to meet the owner s expectations that the design team uses research 2. Make sure you define your goals design what you want to achieve 3. Think beyond first costs understand the business side of the equation (outcomes, reimbursement, reputation) 4. Focus the research on patient, staff and resource outcomes study the impact of your design decisions 5. Healthcare design is a strategic investment as part of an integrated approach to improve safety, quality, access and cost issues

45 2017 NFPA Conference & Expo Lynn Kenney, EDAC, SASHE Kirsten Waltz, AIA, ACHA, LEED AP, EDAC

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