Building Smart Without

Compromising Efficiency

Presenters

Bill Seed, Staff Vice President,

Universal Health Services

Angela Lee, AIA, ACHA, LEED AP,

Senior Vice President, HKS

Debajyoti Pati, PhD, FIIA, LEED AP,

Vice President and Director of

Research, HKS

Acknowledgments

• Summerlin Hospital,

Las Vegas, NV

• Texoma Medical

Center, Denison, TX

• Rapid Modeling

Corporation

50 Foot Rule

CAN LARGER INPATIENT BED UNITS AND

EFFICIENT USE OF NURSING TIME GO

HAND IN HAND?

QUESTION

Larger Unit Implications

• (+) Staffing efficiency

• (-) Large floor plate

• (-) Distances

between destinations

– (-) Longer walking

distance

– (-) Time spent walking

Acute care units have increased in floor area by 118 percent over the past 20 years (KSA)

Implications of Walking

• System efficiency

– Unnecessary walking

= Waste

• Care quality

– Time away from

patients (patient-

centric care)

– Medication errors

• Individual

performance

– Interactions with

workplace stressors

– Alertness, stress,

fatigue

Private Vs. Semi-Private

Trend Towards Smaller Units

CAN LARGER INPATIENT BED UNITS AND

EFFICIENT USE OF NURSING TIME GO

HAND IN HAND?

QUESTION

The UHS-HKS Projects

• Guiding principles:

– Proximity of services

– Amenities for care

– Decentralized nurses’

station

– Computer logistics

by focusing on

the efficiency of

flow, one can

focus on patient-

centric care and

supply nurses

everything they

need without

walking long

distances

BY OPTIMIZING FLOW AND REDUCING

POTENTIAL WASTE, THE LARGE UNIT

WOULD NOT RESULT IN WALKING

DISTANCES THAT ARE SUBSTANTIALLY

HIGHER THAN NATIONAL BENCHMARK

HYPOTHESIS

BY OPTIMIZING FLOW AND REDUCING

POTENTIAL WASTE, HOW NURSES SPEND

THEIR TIME WOULD NOT CONSTITUTE AN

OUTLIER

HYPOTHESIS

Texoma Medical Center

Recognized up front, inpatient strategies can save time, money and promote better patient care.

Texoma Medical Center

Use a racetrack configuration, which offers efficiency as well as easy wayfinding. The configuration provides the most efficient perimeter-to-core ratio and enables direct corridor sightlines for caregivers and patients. It also promotes separation of public and service areas.

Design Inpatient Unit as a Racetrack Configuration

Provides most efficient perimeter to core ratio.

Design Inpatient Unit as a Racetrack Configuration

Enables direct corridor sightlines for caregivers and patients.

Design Inpatient Unit as a Racetrack Configuration

Enables direct corridor sightlines for caregivers and patients.

Design Inpatient Unit as a Racetrack Configuration

Intermediate passages through the core reduce travel distances.

Design Inpatient Unit as a Racetrack Configuration

Lean/efficient double loaded corridors – Easy to Navigate

Summerlin Medical Center

A Patient Centered Expansion

Pinwheel design will minimize travel distances, promote patient safety, and maximize views from patient rooms.

A Patient Centered Expansion

New tower will blend with the existing hospital in effort to keep the publicly recognized hospital identity.

A Patient Centered Expansion

$100 million expansion and renovation in one of southern Nevada’s fastest growing communities in Las Vegas, Nevada

All of the changes were made externally, with breaking through the connecting wall as a final step

Summerlin Medical Center

Summerlin Medical Center

DATA COLLECTION

POST OCCUPANCY PERFORMANCE

Time-Motion Data

• Rapid Modeling

Corporation’s

programmed Palm PDAs

• 1 week on each unit

• Summer 2010

• Compared with TCAB

Time Study RN national

database

Walking Data

• Sportline pedometer

• 1 week on each unit

• Summer 2010

• Compared with 36-

hospital time-motion

study*

*Hendrich, A., M. Chow, B.A. Skierczynski & Z. Lu. (2008). A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time? The Permanente Journal, 12(3), 25-34.

FINDINGS

POST OCCUPANCY PERFORMANCE

Time Data by Task Type

• Value adding:

– Comparison with

TCAB data

Proportion of time spent in value adding tasks: Minimum, Q1, Mean, Q3, Maximum

34.6%

59.1% 64.2% 68.0%

96.4%

59.8%59.5%TEXOMASUMMERLIN

Time Data by Task Type

• Non value adding

tasks:

– Comparison with

TCAB data

Proportion of time spent in non value adding tasks: Minimum, Q1, Mean, Q3, Maximum

0%

9.1% 11.5% 13.7%

33.9%

8.2% 10.5%TEXOMA SUMMERLIN

Time Data by Task Type

• Necessary tasks:

– Comparison with

TCAB data

Proportion of time spent in necessary tasks: Minimum, Q1, Mean, Q3, Maximum

2.6%

21.6% 24.2% 27.5%

50.0%

TEXOMASUMMERLIN32.0%30.0%

Time Data by Task Category

• Direct Care Time:

– Comparison with

TCAB data

Proportion of time spent in direct care: Minimum, Q1, Mean, Q3, Maximum

47.8%43.0%

91.5%15.7%

43.2% 48.3% 51.6%

TEXOMASUMMERLIN

Time Data by Task Category

• Indirect care time:

– Comparison with

TCAB data

Proportion of time spent in indirect care : Minimum, Q1, Mean, Q3, Maximum

1.7%

13.6% 17.0% 20.1%

37.0%

12.0% 16.5%

TEXOMA SUMMERLIN

Time Data by Task Category

• Documentation:

– Comparison with

TCAB data

Proportion of time spent in documentation: Minimum, Q1, Mean, Q3, Maximum

1.6%

15.1% 18.0% 21.1%

38.5%

15.8%10.5%

TEXOMASUMMERLIN

Time Data by Task Category

• Administration:

– Comparison with

TCAB data

0% 19.2%

TEXOMA SUMMERLIN

16.0% 19.4%

3.2%5.2% 6.5%

Proportion of time spent in administration: Minimum, Q1, Mean, Q3, Maximum

Time Data by Task Category

• Personal:

– Comparison with

TCAB data

Proportion of time spent in personal work: Minimum, Q1, Mean, Q3, Maximum

0%

3.4% 4.5% 5.4%

16.9%

1.0% 2.1%TEXOMA SUMMERLIN

Time Data by Task Category

• Waste:

– Comparison with

TCAB data

Proportion of time wasted: Minimum, Q1, Mean, Q3, Maximum

0%

1.9% 2.9% 3.5%

9.8%

3.0%1.7%TEXOMASUMMERLIN

Time Data by Task Level

• Nurse station:

– Comparison with

TCAB data

Proportion of time spent in nurse station: Minimum, Q1, Mean, Q3, Maximum

0%

27.8% 36.1% 44.2%

89.9%

54.9%47.3%TEXOMASUMMERLIN

Time Data by Task Level

• Patient room:

– Comparison with

TCAB data

Proportion of time spent in patient room: Minimum, Q1, Mean, Q3, Maximum

3.8%

34.6% 40.7% 44.7%

80.7%

37.2%36.3%TEXOMASUMMERLIN

Time Data by Task Level

• Medication:

– Comparison with

TCAB data

Proportion of time spent in medication: Minimum, Q1, Mean, Q3, Maximum

0%

13.4% 16.8% 20.6%

45.6%

15.8% 17.3%

TEXOMA SUMMERLIN

Time Data by Task Level

• Off the unit:

– Comparison with

TCAB data

Proportion of time spent of the unit : Minimum, Q1, Mean, Q3, Maximum

0%

1.8% 3.3% 4.2%

22.0%

0.3% 0.8%TEXOMA SUMMERLIN

Walking Data

0 mile 1 mile 2 miles 3 miles 4 miles 5 miles

Day Shift Range

36-Hospital

Night Shift Range

36-Hospital

36-Hospital Study Individual Walking Distance Range

Day ShiftSummerlin

Night ShiftSummerlin

Night ShiftTexoma

Day ShiftTexoma

CONCLUSION

• The unit operations and efficiencies are

similar to the middle 50% of TCAB

participant hospitals.

• While retaining efficiencies in time

distribution across activities and walking

distances, the two units successfully

incorporated larger number of beds

while reducing construction costs.

• A healthcare provider can significantly

reduce construction costs but operate

with the same efficiencies.

• Integrated decision-making with a primary focus on the efficiencies of flow can be used to address the seemingly difficult task of achieving larger inpatient bed units as well as efficient use of caregiver time.