Richmond Community Health Access Center (CHAC) Integrated Facility Design Functional Design Event January 15 19, 2018

Transcription

1 Richmond Community Health Access Center (CHAC) Integrated Facility Design Functional Design Event January 15 19, 2018

2 Date / time Activities Monday Morning Review process & outcome of the week Mini Lean Education Review guiding principles / decision to date Map 7 flows on proposed floor plan (baseline) Assess and adjust the floor plan Monday afternoon Elder Roberta blessing Test scenarios in mock up and adjust the design Detail design for selected rooms (if time permits) Physician tour at 5pm Tuesday morning Plan the tour (develop survey questionnaire and planning) Review functional program (leaders only) Tuesday afternoon Guest tour Review comments from the tour guests Assess and adjust the design Physician tour at 5pm Wednesday morning Physician tour at 7:30 am Continue the design adjustments Detailed design for selected staff area (if time permits) Prep for the report out Wednesday afternoon Report out Document the design / functional program Demolish clinical area / build staff area Thursday Test scenarios for staff area Assess and adjust 3D Plan and prep for the tour Friday Guest tour Review comments from the tour guests Assess and Adjust layout Document the design and functional narrative (functional program)

3 Introduction

4 Opening and Welcoming Jennifer MacKenzie Chief Operating Officer

5 Outcomes of the Week Confirmed physical layout of the 3 rd floor Continue to develop functional narrative (Functional Program) Complete the detailed design for selected rooms

6 Integrated Facility Design (IFD) Components & Timelines 1. Evaluation & Planning Stage Orientation & Acclimation Planning/ Resourcing Project Management & Governance 2. Design & Development Stage Functional Design Future Service model discussion Jul 17 Jul 17 Sept 17 Jul 17 Sept 17 Jul 17 Aug 17 Sept 17 Dec 17 Jan 18 Analysis & Evaluation Conceptual Design Future Service model discussion Detailed Design 3. Delivery & Implementation Stage Work Design Daily Accountability Plan for Move In Fall 18 Process & Leader Standard Work Visual Management Move in 6

7 Lean Education

8 What Is Lean / Lean Principles? Mindset of Continuous Improvement (Focus on maximizing what is of value to the client / patient) Management System Engaging Empowering Aligning all improvements Methods Waste elimination Standardization Scientific Problem Solving (A3, STP, Correction Action, PDSA)

9 Mindset Relentlessly pursue improvements to increase patient/client value Simultaneously improve quality and cost wastes

10 8 Types of waste Any activity that uses resources but creates no value Defects error in paperwork, product quality or delivery Overproduction producing more or sooner than customer needs Waiting long periods of inactivity: people, information, machinery, or material Non-utilized staff intellectual waste Transportation Excessive movement of people, information or material Inventory Excessive storage and delay of information or products Motion Search for patient charts or supplies Extra processing Re-tests or re-exams The most dangerous kind of waste is the waste we do not recognize Shigeo Shingo

11 Process Complexity 939 & abnormal X-ray Transcribe into iphis Dictated 939s Send Referral in iphis Generate Validation Sheet Outstanding referrals iphis Pick up mail Open & date stamp Triage - Type 1 contact - Detox - Children - Symptomatic All documents received Yes No Hold unmatched Yes Onsite or Offsite File X-ray Abnormal 939 Normal / Normal Abnormal 939 & Normal report Pull previous record Request offsite No record Review by Dr. Elwood Enter treatment 939 & Tape required into iphis Abnormal Normal / Normal Abnormal Abnormal Normal / Dictation Abnornal Previous Files? Outbox to Pharmacy Validate Update Yes Upd? printed iphis report report Enter No Separate Print upd Evidence into - health units report iphis -physicians Enter end date into Pre-addressed, iphis pre-stamped envelop Mail Request Discharge Summary Proof narratives Print narratives Discard extra copies Reliability: 0.99 Probability of Success of the system: 52% X-ray or CD? Check CD CD - name - report Yes CD Batch CDs, read in Reading room Normal Send pick & yellow copies to Health Units Withdraw envelop & mail Create small envelop & withdraw card X-ray X-ray Yes Report? Enter Radiology No report Request abnormal X-ray report Check iphis for previous record Enter into iphis X-ray or CD? X-ray Radiologist Review Check No Evidence Box Yes Separate Field Ops & Vancouver X-rays File copy return File 939 File CD CD Match CD & 939 More dictations? No Initial comments To VGH for Radiologist Radiology review Enter To Dr. Radiology Elwood for report into review iphis File 939 Date stamp upon arrival Resulting system performance Increased reliability Probably also faster and lower cost Incoming mail Complete/ Incomplete? Complete Enter skin test result X-ray / CD X-ray X-rays Radiologist to review CD Incomplete Probability of Success of the system: 79% Are they important? No Hold for 5 days Return to Sender Receive complete documents Dr. Elwood reviews Dictation Transcribe into iphis Enter Radiology Report Print 2 validation sheets - Angela - Dr. Elwood Send report to Angela Enter No Evidence Separate pink & yellow 939 CD? CD & white 939 to Maria Yes CD Send to Radiology Radiology to read No Validate printed report File white 939 Enter Radiology Report File

12 Mindset Andon - never pass along known defects or incomplete work to downstream. Inspection at the end of the process is too late and is the least effective methods to assure quality. Plan-Do-Study-Adjust (PDSA) to achieve the perfection - Learn from failures more than success and be not afraid of making mistake!

13 Basic Lean Principles Make the process flow 7 flows of medicine Patient / Client flow Family flow Provider flow Information flow Medication flow Equipment flow Supply flow Pull processing to minimize blocked and congested flow through a facility or process

14 Methods Standard Work the most effective of performing work the simplest way therefore the fastest way has 4 components: Content, Sequent, Outcome, Time

15 Methods Visual management of signals for move or produce is essential for synchronized rapid response

16 Methods Work is performed in a single piece, just in time, continuous flow manner.

17 Management Lean management system (LMS) - Three elements

18 Management Daily management system (DMS) Provide direction and purpose for the day Engage, coach and mentor frontline staff in problem solving Focus on daily process to monitor, maintain, and continuously improve their work Everyone has two jobs For leaders: to lead and to develop leaders For staff: do work and improve work

19 Lean Facility Design Principles Design around flow (patient streams) not departments or provider groups Create multiple simple flows rather than single complex flows Simple flows are more reliable, easier to control and nevigate Link process steps together without interprocess waiting. Waiting can be reduced by increasing department flexibility Focus on the process within, make the building flexible (build camping tents, not castles)

20 Lean Facility Design Principles Create Line-of-Sight Improves safety, communication, ability to level-load Separate Front-of-House from Back-of-House Benefits patient experience and efficiency of support functions Make Work Areas narrow-and-deep not wide-and-shallow Reduces travel and improves communication Avoid too much space Increases travel, encourages clutter, conceals waste

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22 VCH-Richmond Community Health Access Center IFD Event January 15-19

23 Guiding Principles Centered on clients, families and caregivers Be evidence informed Focus on transformation - not be limited by current models or systems/processes Integration and coordination driven by client need, outcomes and ease of access Optimize a continuous pathway of care for patients between all services and providers Service delivery will be in the location best suited for the client, i.e. clinic based or outreach based Model of Care will be based on the Triple Aim Improve health and wellness of all population holistically (physical, emotional, social and spiritual) Improve client, family, caregiver, provider and support staff s experience of care Improve per capital cost of care without compromising quality effectiveness and appropriateness

24 Decisions to Date Population-Focused Care and Service Delivery Approach Child-bearing families; Youth; Adults/Older Adults Designate key service hubs for these populations Enhance reach and access serve more people through technology; face-to-face; out in the community; at home; in clinics; in groups Integrated and coordinated model of care one care plan per client 2018 Alderbridge: Adults/Older Adults Foundry Development: Youth 24

25 Vision for Community Model of Care From Patchwork of services and locations to Population-based Integrated Hubs of Care Client and family-centered care Integrated and coordinated care delivery Built on a foundation of Primary Care Service Delivery Single point of access to Adult and Older Adult services and resources Every Door is the Right Door Single Coordinated Care Plan for the same client Integrated Chronic Disease Strategy Evidence and best practice informed services Sustainable model of care into the future Retain responsibility for client through transitions of care; throughout acute stay and discharge care planning Avoidance of facility admission Proactive, preventive, continuity of care reduce/avoid need for ED and acute care 25

26 Alderbridge - Adult/Older Adult services Wellness & Chronic Disease Management Adult Mental Health Substance Use High Needs Older Adults Diabetes Education Adult Mental Health Team Home Health - CM, RN, Rehab Fall Prevention Ann Vogel QRT Tobacco Reduction Respiratory Program ACT Frail Elder NP Community Geriatrician Chronic Disease Management Nurses OASIS Cardiac Rehab Community Care Clinic GAP Primary Care Clinicians Bariatric Outpatient Rehab (Arthritis, Hand Therapy and PT) Gilwest Continence Counselling Priority Access Older Adult Mental Health Palliative Program and Palliative Pain and Symptom Management Clinic General Internal Medicine Foot clinic Pain clinic 26

27 Available Space Allocation Alderbridge Access, assessment, care coordination and service delivery (short and longterm) targeting Adults and Older Adults Accessing Space at Garratt Wellness Center Education, wellness promotion center Group interventions Gym Community partnership and engagement 27

28 7671 Alderbridge: Community Health Access Centre

29 Base building:

30 Base building:

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32 Space Planning Focus on space use for patient and staff flows (and) with key adjacencies Space has been determined through LMFM planning (incl.vch and CSA standards) Shared spaces for similar service delivery functions Guided by the Vision for Community Model of Care Space use intended to facilitate interdisciplinary care and integration of care Incorporate Lean Principles Flexible, multi-use spaces Building envelope/exterior walls cannot be modified Large elevators: main client/public access One reception area for the 3 rd floor Once build is complete (walls, plumbing, etc.) further change is problematic and expensive Part time staff will share workspaces 32

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34 Norm & Behavior What we will do Leave our hat at the door Participate and invite participation Be curious, creative, inventive Listen and learn Be champion of the principles client/family = 1 st priority Unafraid of conflict Respectful challenge / criticism Imagine and be open to all ideas Will take risk Have fun What we won t do Talk over others Make own assumptions Over-protective of our own programs Fight Walk away from discomfort Undermine the process Use acronyms/abbreviations, jargon Keep ideas to self Will not feed the white elephant Be negative Hold on to the past How we will behave Be open minded Be respectful Have a sense of humour Be supportive of risk Seek knowledge Create a culture of enquiry and a safe environment for critical enquiry Be present Enable issue awareness Ensure everyone has a chance to be heard Self manage own airtime How we won t behave Defensive On our devices Dismissive Judgemental Complain Be provider centric Self-interested Rude Reserved