Small Projects/Big Change:

Transcription

1 Small Projects / Big Change: Three Small VA Projects With a Big Mission! Presenters: Eric R Lautzenheiser, AIA, ACHA Director of Health Facilities Planning Haley Driscoll, IIDA Senior Associate September 22, :15 AM 10:15 AM Learning Objectives: Learn how efficient and informal collaborative team techniques shaped clear planning and design direction Explore how the physical environment can support dynamic changes in clinical care models Explore the issues related to collaborative risk-taking for the consulting and clinical teams Review Lessons Learned in terms of the processes used to create a collaborative team Small Projects/Big Change: - Deal with subsets of clinical care that still come with a certain amount of stigma behavioral health and the process of dying - are generated for Veteran s Administration Hospital Sites - Because all three are remote from our professional setting, we worked closely with administration and clinicians on one/three day onsite work sessions. 1

2 Three Small Projects/Big Change: PTSD Return to Community VA Marion, Ill NK Bandhari w/ Three Small Projects PTSD Return to Community VA Marion, Ill NK Bandhari w/ Hospice Care VA Coatesville, PA Hospice Care VA Coatesville, PA Inpatient Behavioral Health VA Syracuse, NY Inpatient Behavioral Health VA Syracuse, NY Goals and Objectives: We want this to NOT be a medical model - these folks do NOT belong in our main facility! Jeremy Oster, General Engineer These folks need to heal without stigma. We need to address PTSD in every form combat experiences and those that have been sexually victimized. Onsite Worksesson Goals and Objectives: Understand the opportunities of the site and its immediate environment Facilitate a dialogue between an administrative team with a vision and clinicians who wanted to get down to business and were not, at the start, fully on-board Shape a return to community environment 2

3 Aerial/Site New Behavioral Health Destination Future Fitness Center (Future) Existing Outpatient Counseling Center Building Site Main Gate Floor Plan/Functional Zones Elevation Studies Food Prep Clinical Station Social/Family 3

4 Defined Image Collaborative Decisions Onsite Worksession Small Bedroom Pods, not a bedroom wing Nursing Station has informal visualization due to placement Small social spaces = range of choice Multiple access points to landscape for both active and passive recreation Three Small Projects PTSD Return to Community VA Marion, Ill NK Bandhari w/ Hospice Care VA Coatesville, PA Inpatient Behavioral Health VA Syracuse, NY Goals and Objectives: We do NOT want this to be a nursing home wing any more! Michael Carcanague, Project Section Supervisor No Veteran should be left to die alone, unless that is their wish.. James Tischler, MD Every Vet s transition is different- we need to support them and their family by being in the background Gary W. Devansky, Director CVAMC 4

5 Onsite Planning Goals and Objectives Match the hopes and vision of the key administrative and clinical staff with the budget. Listen to all key players, from the grounds keeping team to the physicians. i Explore what a model of care might be in a decentralized setting. Site Aerial Existing LTC Center Alternative Site Final Site with Nature Access Site Plan/Site Section Proposed Hospice Floor Plan/ Core Functional Zones Existing LTC Pavilion Entry & Visitor Parking Four-Suite Pod Resident Suites Nursing Touchdown Stat Supplies Entry/Shared Activities Entry Meditation/Counseling Social Dining, Lounge, Recreation 5

6 Floor Plan/Center Core Shared Outdoor Access Aesthetic Defined Image Focus Social Spaces Recreation Resident & Family Space Respite Departure Counseling Meditation & Viewing Floor Plan/Four Suite Pod Outdoor Terrace Resident Suite Bedroom Accessible Bath Family Room Floor Plan/Early Suite Studies Large Suite/933 sf Accessible Bath Nurse Server Family Toilet Family Room Medium Suite/ 758 sf Accessible Bath Nurse Server Family Toilet Family Room Medium Suite/ 633 sf Accessible Bath Nurse Server Family Room Nursing Awareness Touchdown St n Meds Linen Supplies 6

7 Typical Resident Suite Social Family Food Prep Terrace Access from Living Access from Bedroom Entry Nurse Touchdown Family Access Bathroom Hoist with direct path from Bed Roman Shower to max assist Bedroom View to Landscape Access to Terrace Direct Access to Bathroom Collaborative Decisions Onsite Worksession Provide as many self-actualizing choices as possible in resident suite. Provide nursing care, but do so inconspicuously. Accommodate family when present. Access to light and nature. Resident dignity Three Small Projects PTSD Return to Community VA Marion, Ill NK Bandhari w/ Hospice Care VA Coatesville, PA Inpatient Behavioral Health VA Syracuse, NY Goals and Objectives: We want this to be very different from what we have but we have no idea what to do with the space we are getting to achieve that. Michael Reed, Contracts Officer We need to find a different way of creating interaction between our staff and our patients Judy Hayman, MD, Psychiatrist You can see that this place looks like a set for One Flew Over the Cuckoo s Nest we need to change it; our veterans deserve better Anonymous comment from Staffer during Walkthrough 7

8 Existing Conditions: Onsite Worksession Goals and Objectives Understand the challenges and opportunities of the existing space Open a dialogue between frustrated clinicians and the planning team Explore what might be possible Create a learning curve for staff about current trends and directions in the industry Floor Plan/Non-Negotiable Negotiable Elements Option A.1 Seclusion Suite Exam Meds Staff Lounge Group Conference Offices Riser Locations Electrical Shaft Structural Grid Space contains door to mechanical space, cannot be used for private functions Shower Offices Laundry Active Day Quiet Day Quiet Room Interview Dining Great Sightlines Access to natural light for staff/nursing station Requires demolition of former exterior wall Three Risers represent challenges Some two-bed rooms share a toilet for a ratio of 4:1 8

9 Option B Option C Showers Seclusion Suite Conference Meds Staff Lounge Quiet Office Suite Showers Meds/Nour Seclusion Suite Conf Staff Lounge Office Suite Quiet Dayroom Dining Group Active Dayroom Patient Laundry Admissions Suite Access to Sightlines no natural light for better than staff/nursing Option C station UNLESS 8-0 Admissions corridor issue suite is resolved collocates Four Risers admissions represent functions challenges Office suite Quiet Dayroom Group Active Dayroom Quiet Room Dining Patient Laundry Admissions Suite Physician s Assistant Interview Exam Existing Wall can Remain Admissions suite collocates admissions functions Office suite Sightlines not as extensive as Option A Series Four Risers represent challenges Floor Plan/Funtional Zones Staff Interaction Station Final Charting Floor plan, And Meds/Nour to photos keyed to plan Office/1:1 Therapy Offices Conference Back Door Defined Image go to PP for behavioral Health Resident Social Zone Dining Quiet Group Therapy Active Intake: Interview Exam Nurse Clinician 9

10 Defined Image Collaborative Decisions Onsite Worksession Create interaction component with Nursing station push into the former corridor Multiple locations for social activity Natural Light and View wherever possible Careful zoning for staff comfort and ease of operations Emphasis on warm, inviting aesthetic Lessons Learned Working onsite in our client s home gave us a visceral understanding of their challenges and their culture of care Nothing promotes bonding more effectively than a bad cup of lukewarm coffee in the early evening as issues, challenges and opportunities are discussed, reviewed and explored! Optimal solutions are best generated via collaborative discussion. Key Elements in Making an Onsite Work Do the homework beforehand Work onsite in the client s base get to know their facility and how they use it Get leadership buy-in in order to achieve administrative and clinical participation Strike a balance between talk time and work time, but leave time for informal discussions after hours Listen, reflect, listen, reflect and then respond. 10

11 What are the Risks/Onsite Collaboration? CONCERN!!! What if no one comes? What about conflict? What if my material is not polished and finished? What if no clear solution evolves? Reality Make sure the client buys in prior to showing up and work onsite. (they cannot avoid you if you are in the old conference room down the hall) Use differences of opinion creatively to help shape an optimal solution. It won t be that s part of the success we, as professionals, get to see them in their home, and they get to see us being creative One always does, generally with substantive buy-in as an optimal solution Questions? 11