Hospital of the Future Planning a new Medicine/Telemetry Unit with confidence

Transcription

1 GE Healthcare Infrastructure Solutions Hospital of the Future Planning a new Medicine/Telemetry Unit with confidence Humber River Regional Hospital

2 The Background Humber River Regional Hospital (HRRH) is a major 560-bed acute care facility that currently provides services at three sites (Church, Finch and Keele) and serves 800,000 residents in the northwest Greater Toronto Area (GTA). As part of its strategic goal to deliver the right care at the right time in the right place, HRRH plans to build a modern 656-bed acute care hospital that will bring the majority of acute care services at the existing sites under one roof. This new facility that will be a hub for healthcare in the region is scheduled to open in HRRH s Board of Directors and senior team understood from the start that designing Ontario s most modern acute care hospital a digital showcase developed to the highest possible environmental standards would require strategic leadership and strategic partnerships. New building codes and provincially mandated design requirements mean that many patient areas in a brand new site will be up twice the size of old standards. That underscored the importance of streamlining current practices and processes before the move to avoid dramatically increasing hospitaloperating costs. HRRH engaged GE Healthcare early in the process to lead a Hospital of the Future (HoF) project in order to inform the planning and architectural design of the expanded facility.

3 The Challenge: Improving Efficiency in Medicine/Telemetry We re building a greenfield hospital, which gives us a tremendous opportunity to align optimal workflow processes with optimal architectural design, says Barb Collins, HRRH s chief operating officer. To take full advantage of this opportunity, we assembled the Hospital of the Future team several years before we plan to break ground at the new site. We chose to work with GE Healthcare because of their proven expertise in Lean methodologies and simulation technologies and deep rooted understanding of healthcare. On September 30, 2008, HRRH and GE Healthcare began a four-month project to understand current practices and processes in two units Finch Medicine and Church Telemetry and then develop a future state layout based on Lean workflow principles. One of the most striking findings was that nurses in the current units walk about five kilometres each day to deliver patient care. Moving existing practices to the new, larger facility would see this sneaker time rise to 11 kilometres a day a loss of productive time that represented an unacceptable increase in hospital operating costs. Addressing this challenge became an essential component of the HoF team s work. The Solution The HoF team performed a detailed clinical workflow analysis of the Medicine and Telemetry units using Lean methodologies and a GE Healthcare proprietary parametric computerized simulation model. This unique model allowed HRRH to efficiently and effectively evaluate the impact of multiple changes in operative parameters such as technology, capacity, clinical workflow, layouts and demand patterns on clinical efficiency before committing to bricks and mortar. Phase 1 In the first phase of the project, the HoF team gathered primary observational and secondary data, and interviewed frontline staff to understand their needs based on the clinical workflow and challenges in the current acute Medicine and Telemetry units. Throughout the data collection and analysis phase of the project, which included extensive observational data collection, the HoF team used Lean thinking to identify waste in HRRH s operations. This waste included problems that interfered with workflow or activities that did not provide value to patients. Lean tools such as Process Maps, Circles of Work, Circles of Travel, Value Stream Maps, Time Value Analysis (TVA), Voice of Your Staff (VOYS) and opportunity grids were employed to characterize and communicate challenges in the current state. Both nursing staff and physicians validated the challenges identified by the HoF team. Nursing Circle of Work Direct Care Detail E-charting 16% Indirect Patient Care 16% Paper Documentation 3% Travel 13% Direct Patient Care 38% Extra Processing 10% Unscheduled Events 2% Med Admin 9% Vitals & Blood Sugars 15% Clinical Interventions 9% Assist Patient 44% Checking on Patients 3% Other 11% Between September 30, 2008 and January 15, 2009, Andy Day and the HoF team led by Li Peckan completed the following activities: Methodology & Timelines 20 April April 30 May May 5 June 09 8 June July 09 7 Aug 09 Kick-Off MS1 Report MS2 Report MS3 Report Onsite Data Collection Observational Research Front-Line Staff Interviews Secondary Data Mapping Define Clinical Pathways Statistical Data Analysis Data Preparation Executive Review As-Is Findings Management Team Report-Out MS2 Review of As-Is Simulation Model Brainstorm for To Be Future Scenerios MS3 Results of To Be Simulation Runs Recommendations

4 The analysis captured the complex interdependencies among interacting units within the hospital for example, 81.4% of the Medicine Unit s patients arrive from the Emergency Department, while just 15.6% come from in-patient floors and 3.0% from the Critical Care Unit. It also drew attention to all the time-consuming work a nurse does beyond providing direct and indirect patient care. It became clear that some of this work did not require a nursing degree and could be provided by other types of caregivers. Spaghetti Diagram Medicine Church Location Trips/12h shift Medication cart 53 Medication Room 9 Patient Room(s) 87 Supply/Linen 16 Computer 2 Soiled Utility 7 RN Station 21 Locate Equipment 19 Other Travel 9 Total Distance Traveled: 5.3 km per 12 hour shift per nurse Med Room w/fridge Charting Computers Equipment Storage Supply Cart Med Cart Shower Laundry/Garbage Shoot Dirty Utility and Equipment Storage Clean Utility Current sneaker time: nurses walk 5km/shift in the current, compact hospital layout Rueben Devlin, HRRH s CEO Staff Lounge Supply Cart Med Cart Pantry Supply Cart A Spaghetti Diagram is one of the most simple and impactful Lean tools that can help a team to visualize and understand their current workflow. The first phase of the project gave HRRH staff and leaders insight into the entire spectrum of care delivery processes and practices within and across departmental boundaries. It also allowed them to develop informed recommendations for improvements that could be made in their current processes before they move into their new facility. Hospitals have to use their human resources efficiently and front-line staff often have the best suggestions for improvement, says HRRH s CEO, Rueben Devlin. We made sure staff and physicians were involved in the HoF team s analysis work from the beginning, and they participated in every step of the process to reduce their sneaker time and validate ideas. Phase 2 In the second phase of the project, the HoF team translated primary observations and secondary data analyses into a computer simulation model which is known as the currentstate model. Information collected during the first phase including patient mix and volume data, workforce and capacity planning, key cycle-time and patient pathway activities was entered into the parametric simulation model. The currentstate model was calibrated to within 1.5% accuracy by comparing simulated to actual data. Results from running the simulation model accurately reflected the bottlenecks and constraints identified through historical data, and these results were in line with expected outcomes. HRRH clinical staff validated the model an essential step before moving on to future-state scenario testing and then brainstormed and prioritized ideas for the new facility around these themes: How do we want our units to be designed? What is essential to have in each patient care area? How do we want to handle isolation patients? What do we want technology to do for us? Do we want to segregate patient care by acuity level?

5 Simulation Model Results from the HoF project will be used as the basis for improving patient and work flows in the design of the Medicine and Telemetry units for the new hospital. In fact, some recommendations have already been implemented to optimize flow in HRRH s current facilities. Phase 3 In the final phase of the project, the HoF team utilized the staff s brainstorming ideas and harnessed GE Healthcare s Hospital of the Future Lean layout expertise to develop to be scenarios. By blending design, workflow patterns and processes with current practices and possible future technologies, the simulation created a functional picture of how the Medicine and Telemetry units could operate in the new facility. Using this picture, the team developed and tested possible design options using simulation models. Three possible layouts were tested in the to be scenarios two were provided by the HRRH design team and one was developed by GE Healthcare. Each layout included dedicated isolation areas, Automated Drug Inventory Systems (ADIS) and staff lounges. Layered into the baseline scenario were new technologies, including wall-mounted vitals machines at patient bedsides and telemetry monitors that automatically downloaded results into the Electronic Patient Record (EPR) system saving nurses re-work and a trip to the nursing station. Also included in the scenarios were new patient care roles designed to relieve nurses of specific duties that do not require a nursing degree and new ways of caring for Alternative Level of Care (ALC) patients to best meet their needs effectively and efficiently. An effective design to enhance patient care was the ultimate goal for HRRH. I think the Hospital of the Future exercise would be valuable for any hospital that is undergoing significant redevelopment or a new build, says Scott Jarrett, HRRH s vice president, patient services. By starting the process early, and testing recommendations on the ground in our current facilities, we have gained confidence that we will have the resources to deliver high-quality, patient-centred care in our new facility. Traditional planning models lead to traditional hospitals where workflow is an afterthought and the redesign often starts soon after initial construction is completed. Lean thinking and technology planning enrich the planning and design process, promoting form follows function and leading to forward-facing facilities designed to enhance the clinical workflow with contemporary, strategic technologies and practice patterns. The ultimate goal was to ensure that the final design for the new Medicine and Telemetry units was as effective as possible. Ultimately, GE Healthcare s proposed layout reduced staff travel by 20%, while other simulated model parameters demonstrated that HRRH could improve their patient experience by reducing delayed tasks by 30%. The HRRH design team has incorporated the GE Healthcare layout into their building plans.

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