Pembury PFI Hospital Single Beds Symposium on Single Bed Ward Accommodation Bernard Place Director of Healthcare Planning and Commissioning The Decision Making Process Cardiff 14 June 2007 1
Overview of the Pembury Scheme Maidstone and Tunbridge Wells currently in Appointment Business Case (ABC) state of 300m PFI Project Allows Consolidation of current Kent and Sussex Hospital (Tunbridge Wells) and Pembury Hospital onto one site 512 Single rooms with ensuite facilities Opening scheduled December 2010 Affordable within 15% normalised income metric 2
3 The Hospital Model Design
Original Acute Hospital Design Strategy Original Acute Hospital Design Strategy 4
5 Aerial View of Pembury Site
6 Equion s Proposed Design
7 Proposed movement strategy
8 Pembury flythrough
Single Room Design 9 Features of Single Room with Ensuite Facilities Standardised layout Head of bed direct line of sight from door Large vision panel in door to room Clinical basin at entrance and exit to encourage use Staff zone and family zone Maximised natural light and views Acoustically controlled Naturally ventilated Bathroom on bed head wall and grab rail from bed to bathroom Half leaf door to enable emergency access to bathroom Single Room Design Ensuring design and service delivery improves care Single rooms v Wards Acuity adaptive rooms Segregation of patient rotes Protection of clinical environment Fixtures and fittings Patient safety evidence. developing ward design
10 Simple direct staff communication
11 Vocera
Basic economics of patient safety PFI Rule of Thumb - Every 10m capital investment generates a revenue cost (an availability charge ) of 1.0m Capital investment in patient safety needs to be more than offset by revenue savings Revenue savings need to be cash releasing i.e. they support a reduction in operating costs sufficient to enable the servicing of the additional cost of capital investment in patient safety. Patient safety has to be important enough for stakeholder to generate a willingness to pay or a positive consumer preference 12
Board Decision Making Process - Principles Patient safety not simply a normative operational and professional requirement but a business imperative Board wanted patient safety to be part of the brand Strategic view about next 5-10 years Reassurance that this approach worked in Europe, North America and independent sector Director of Nursing and Estates Director visit to St Joseph s Hospital West Bend Wisconsin with NPSA, May 2005 13
Board Decision Making Process Policy Context Patient Choice Payment by results Consumerism (single room vs.bays relative cost shift) NHS Estates minimum 50% single room guidance 14
Board Decision Making Process Local Context 25 % Tunbridge Wells population have access to independent sector health care Current hospital fabric so poor that PPI and local community receptive to radical solution Spectacular development site 15
Board Decision Making Process - Evidence Single Rooms Standardisation Infection Prevention and Control Falls Medication Errors Therapeutic environment light, views, acoustics, odours Sleep Family centred care Staffing Levels 16
Board Decision Making Process Serendipity CEO former nurse Infection control national political imperative and major pubic concern Patient safety culture hospital should do no harm Building techniques e.g. prefabrication at sufficient maturity to enable costs to be contained, Consortium (Equion) receptive and responsive to 100% single rooms 17
Conclusion Key challenge is to effect as much change as possible to support single room approach before hospital opens Staffing levels to Healthcare Commission norms Improve proportion of purposeful nursing care time from 30% Improve quality and effectiveness of nursing observation Improve infection prevention and control Remove central nursing stations and replace with distributed stations Trial Vocera Improve near patient data entry Standardise ward processes Resolve source of communication problem e.g. multiple patient records Trial theatre scrubs as ward uniform 18
19 Pembury Model
End Thank you Question and answer session 20