your aging patient bed tower - top ten considerations when renovating

Session E09

Your Aging Patient Bed Tower- Top Ten Considerations When Renovating

PresentersPresenters

Adrian Hagerty, AIA, LEED APPrincipal, Regional Vice President, National Capital Region

PresentersPresenters

p , g , p gArray Architects

Patricia Malick AAHID EDAC Lean Green BeltPatricia Malick, AAHID, EDAC, Lean Green BeltPrincipal, Practice Area Leader-Interior Design

Array Architects

Session E09Session E09

Your Aging Patient Bed TowerYour Aging Patient Bed Tower-- Top Ten Considerations When RenovatingTop Ten Considerations When Renovating

While the benefits of caring for inpatients within a private room have now been time tested, there are thousands who still receive care outside of this clinically preferred environment on a daily basis. As is often the case, the benefits may be clear, but the perceived cost of providing more private patient rooms has prevented the wholesale adoption of this basic principle throughout the United States. Building new bed towers has been an option for systems that could afford to buildprinciple throughout the United States. Building new bed towers has been an option for systems that could afford to build new facilities. However, many systems do not have that luxury or are landlocked, at capacity and cannot expand or afford to give up beds from their license. This session will provide a roadmap for the successful renovation of patient units to accommodate all private rooms, or enhanced 2-Bed rooms that incorporate best clinical practices in a cost effective manner. By breaking down the success factors into ten key considerations, this session will allow designers, managers, and contractors to plan and execute such projects more effectively Case studies will be presented to demonstrate howand contractors to plan and execute such projects more effectively. Case studies will be presented to demonstrate how this straightforward approach can increase the success of renovations that convert (primarily) double bedded units into single patient room units.

Learning Objectives:

1.Explore elements that create a renovated environment that is consistent with patient centered & family centered care.

2.Learn how inpatient renovation projects can improve operational efficiency.

3 Discuss how inpatient unit renovation projects present opportunities to implement sustainable design strategies3.Discuss how inpatient unit renovation projects present opportunities to implement sustainable design strategies.

4.Demonstrate the value of integrating infrastructure improvements with inpatient unit renovation projects.

Session E09Session E09

Your Aging Patient Bed TowerYour Aging Patient Bed Tower-- Top Ten Considerations When Top Ten Considerations When RenovatingRenovating

George George CostanzaCostanza might disagree:might disagree:gg g gg g

https://www.youtube.com/watch?v=VfvKc_9YbCs

operationalefficiency 01 IT

infrastructure07

logistical02 accessibility08

life safety03 sustainability09y03infectioncontrol04

y09patient/familyi l d10control04

patient05

involved care10

Array’s Leansafety05

i i06

Array’s LeanProcess Approach

leanprocess

engineering06 • University Hospitals• New York Presbyterian

casestudies

Recognizing “necessity is the mother of invention”

fi di thfinding theBALANCEBALANCEbetween

LEAN & MEANLEAN & MEAN

01 operational efficiency considerations

• Using Lean Design principles, test the work flow within a unit to ensure maximum efficiency

01unit to ensure maximum efficiency

• Define Current State & Map Future State

• Observe, , Envision, Model, Build ConsensusSpaghetti Mapping DiagramsValue Stream Mapping

01 operational efficiency considerations

• Engagement with Caregivers and Patients

01• Rapid Testing of Future State Solutions

D t d i D i i• Data-driven DecisionsEmpathy MappingRapid Testing

02 logistical considerations: feasibility study

• Determine appropriate level of renovation required

02• Develop a plan to effectively execute renovation that

minimizes day-to-day disruptions to hospital operations

• Proper Phasing is essential to success(vertical vs. horizontal stacked phasing, cost of escalation)

• BIM can be used to assist Stacked Phasing decisions

Vertical Stacked Phasing Horizontal Stacked Phasing

03 life safety considerations

• Providing a safe environment is utmost priority

03priority

• Using ILSM (interim life safety measures) will result in ZERO disruption to operationsp p

• 3 main steps in planning and implementation of ILSMs:

(1) Pre-Construction Assessment

(2) Development and Daily Monitoring of an(2) Development and Daily Monitoring of an ILSM Compliance Checklist

(1) Close-out of the ILSM to transition back(1) Close out of the ILSM to transition back to standard operating procedures.

It’s more than justIt s more than justWASHINGWASHING

h dyour hands.

04 infection control considerations

• 1 in 20 patients acquire an infection during hospital stay

04• Aspergillus- most common microbes associated with construction

ICRA (i f ti t l i k t) ltidi i li d t d t• ICRA (infection control risk assessment)- multidisciplinary, documented assessment process to proactively identify and mitigate risks from infection that could occur during construction activities

• Process should begin in early stages with stakeholders; CM with strong track record

A nurturing environment =A nurturing environment =HAPPY Patients =HAPPY Patients =higher HCAHPS scoreshigher HCAHPS scores

05 patient safety considerations

• Patient Unit Design should promote healing and foster patient and family collaboration

05foster patient and family collaboration

• Provide adequate support zones to reduce hazards

• Consider proximity of bed to bathroom; lifts

• Install multi-function lighting options & controls

• Provide patient control of shading, education and entertainment

• Incorporate noise reducing design elements

• Integrate equipment and alarm configuration

• Provide materials which are easily cleaned AND maintained

06 engineering considerations

• HVAC system can account for more than 50% of the cost

06cost

• Comprehensive facility condition assessment is necessary- surprises can be expensivey p p

• Ideal opportunity to correct facility deficiencies= improved operational costs over the life of the facility

ARE NOT THE ANSWERARE NOT THE ANSWER

07 IT infrastructure considerations

• CINS (Clinical Integration Networks) allow caregivers to access the data of patients

07access the data of patients

• EMR access becomes hub for all activity on floor

• Provide Access to Point of Care (POC) Mobile Technology, Nurse Call Innovations

• Patient Entertainment, Education, Communication & Surveys

ACCESSibilityACCESSibilityis more than just clearancesis more than just clearances

08 accessibility considerations

• “Barrier-Free Health Care Initiative”- goal of ensuring that persons with disabilities have access to medical

08that persons with disabilities have access to medical information as well as physical access

• “ADA Path of Travel” requirement- visualize entire path q pof travel from the drop off point to patient’s destination

• Verify that constructed solution meets design criteria and ADAG requirementsand ADAG requirements.

Can you make your father’sy y

OLDSMOBILErun like a

PRIUS?PRIUS?

09 sustainability considerations

• Environmentally-friendly design & system choices

09• Investigate opportunities to recycle construction waste

• Identify design and engineering options that reduce electricity and• Identify design and engineering options that reduce electricity and water use

• Focus on selecting sustainable project materials that support high g p j pp gindoor environment quality (IEQ), and green cleaning

““WeWe’’re all in this re all in this ““WeWe’’re all in this re all in this TOGETHER.TOGETHER.””TOGETHER.TOGETHER.””TOGETHER.TOGETHER.TOGETHER.TOGETHER.

10 patient/family-involved care id ti

• Opportunity to reinvent the patient

10 considerations

pp y pexperience

- Wow Factor – Inspire Confidence- Create Generative Spaces- Promise, Deliver, Delight!, , g

• Use Amenity & Touchpoint mapping to y p pp gelevate the patient/family experience

OINTS OF IMPACT OINTS OF IMPACT Mapping the Patient and Visitor ExperienceMapping the Patient and Visitor Experience

Wayfinding Clarity…I know where I am going

Patient Centered…Family Focused

I know where I am going

WELCOME DISCOVER RESPITE RECOVER

First Impressions…I made the right choice

Gathering Zones…I need a breather

S H D W G Th ?So How Do We Get There?

Conventional Approach

A New ApproachPROCESS LED DESIGN

Solution

Discovery

CreationAnalysis

CASE STUDYUniversity HospitalsUniversity Hospitals

MacDonald Women’s Hospital

Project Drivers:Project Drivers:

• Aging Infrastructure

• Parity with other University Health System Hospitals

• Create a patient-centered healing environment for high-Create a patient centered, healing environment for highrisk maternity patients

patient and family centered

1. information sharing

2. foster collaboration / participation / education/ p p /

3. honor patient and family perspectives

4 accommodate diversity (cultural; socio economic)4. accommodate diversity – (cultural; socio-economic)

5. right support/right place/right time

6. proximity to Level III NICU

operational ideals1 li / f i i i i1. quality / safety initiatives

2. support UH model-of-care

3. technology and equipment integration

4 de-centralized caregiver zones4. de centralized caregiver zones

5. improve acoustics / ergonomics

i l ‘ i6. exceptional ‘guest’ service

Current State:

Inspiration:

s t re n g t h . . j oy . . t r u s t . . b e a u t y . . p ro m i s e . . g rowt h . . c a l m . . w a r m t h

Team Station:

Unit Corridor & Team Stations:

PrivatePatient Room:

University HospitalsMacDonald Women’s Hospital

PHASE 1

July 2, 2013 –

NICU ACCESS

CASE STUDYNewYork-Presbyterian HospitalNewYork Presbyterian Hospital

Milstein Tower

overview

Milstein Enhancement Bed Unit Renovation

current state

Typical Floor Project Challenges:Project Challenges:

• Project Scope: 5 Floors, 20 Bed

Units, 680 Beds

• Construction Start:

4Q 2012

• Construction Complete: t u t p t

1Q 2018

• Project Cost: 160MillionProject Cost: 160Million

Overview


current state

existing conditions

current state best practice influencers vision

currentstate

• infrastructure deficiencies• out of sync with World‐Class reputation• patient and family perspective

state

best

• safe, equitable• patient and family centered• operational ideals

practice

i fl

• patient experience improvement strategies• HCAPHS, patient satisfaction scores

id b d d iinfluencers • evidence based design

• “patients first” mission• building towards an experience

vision

• building towards an experience• stakeholder survey, amenity mapping, image dialogue

Overview current state influencers vision

Milstein Enhancement Bed Unit Renovation example

Modern with clean lines classic & natural elementsModern with clean lines, classic & natural elements Perceived as a place of science while having the warmth of a home.

image survey results: design vocabulary



3%39%58%

A B C19 13 1# of respondents # of respondents # of respondents

image survey results: art



45%42%12% 45%42%12%

1 2 34 14 15# of respondents # of respondents # of respondents

image survey results: cars



61%39% %%

1 213 20# of respondents # of respondents

image survey results: home



73%27%27%

1 29 24# of respondents # of respondents

image survey results: hotel



39%52%9%1 2 3

39%3

52%9%17 13

# of respondents # of respondents # of respondents

image survey results: front door



How should the Milstein Tower be perceived by patients and families?

58%1st choice

9%1st choice

33%1st choice

58% 9%33%

#of respondents # of respondents # of respondents

3rd choice 58%

place of science temporary home spa / resort18 11 3# of respondents p # of respondents



What adjectives describe the aesthetic goals the enhanced bed unit?

a) sleek and modern 4b) warm and cozy

c) quiet and peaceful

4

2

9c) quiet and peaceful

d) educational and engaging91

e) ______________________ 17



Image Survey Total Responses Preferred #1 Preferred #2 Preferred #3 Preferred #4 Preferred #5

A ‐Wood Stone/Textures/Tones 31 14 10 3 1 3

B Simplicity/Clean Lines 31 7 6 3 5 10

77%

23% 32%B ‐ Simplicity/Clean Lines 31 7 6 3 5 10

C ‐ Luxe/Amenity Rich 31 3 4 6 7 11

23% 32%

58%

D ‐ Color Saturated 31 4 6 13 8 0

E ‐ Patterns/Shape/Texture 31 2 5 4 12 8

68%

E Patterns/Shape/Texture 31 2 5 4 12 865%

image results survey



Preferred Not Preferred .

77%

23% 32%

58%

68%

65%

image results survey



What adjectives describe the aesthetic goals the enhanced bed unit?

a) sleek and modern 4b) warm and cozy

c) quiet and peaceful

4

2

9c) quiet and peaceful

d) educational and engaging91

e)

f)

Write in: “All of the above” 6 6 Write in: “A+C”

4Write in: “welcoming” or “technology”

CIRCULATION

VERTICAL CIRCULATION


MER / IT / SHAFTS

PATIENT BEDS (QUAD)

PATIENT BEDS (ISO)

PATIENT BEDS (DOUBLE)

PATIENT BEDS (SINGLE)

CLINICAL SUPPORT

OFFICE / ADMIN SUPPORT

IMAGING

ELEVATOR LOBBYLOBBY

SCHEMATIC VIEW

UNIT CORRIDORCORRIDOR

SCHEMATIC VIEW

PRIVATE ROOMROOM

SCHEMATIC VIEW


exampleexample

enhancements: overviewenhancement level comparison example


$154.2MTOTAL BED UNIT PROJECT



$141.1MTOTAL BED UNIT PROJECT TOTAL BED UNIT PROJECT

FUNDING INCLUDINGINFRASTRUCTURE AND IT

TOTAL BED UNIT PROJECTFUNDING INCLUDING

INFRASTRUCTURE AND IT

TOTAL BED UNIT PROJECTFUNDING EXCLUDING


TOTAL BED UNIT PROJECTFUNDING EXCLUDING


Bed Unit Enhancements

FACE Program

Contingency Alignment

Infrastructure

IT

HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH

phasing scenario studies - example

MCKEENBEHAVIORAL

HEALTHINFECTIOUS

DISEASE9


MCKEEN

NEUROSURGERYNEUROLOGY /

EPILEPSYREHABILITATION NEURO ICU8

SURGERY TRANSPLANTSURGERY /

ORTHOPEDICSHOSPITALIST

MEDICAL SURGICAL GENERAL GENERAL

7

6 MEDICALONCOLOGY

SURGICALONCOLOGY

GENERALMEDICINE

GENERALMEDICINE

CARDIAC SURGERYSTEP DOWN

CARDIAC ICU CARDIOLOGY CARDIAC

6

5

EXISTING STACKINGPHASE 0: CONSTRUCTION COMPLETION: PROJECT COSTS:

NA NA

STEP-DOWN

EXISTING STACKINGDIAGRAM NA NA


phasing scenario studies - example

BEHAVIORALHEALTH9


ORTHOPEDICS / TRANSPLANT

TRANSPLANT MCKEEN

NEUROLOGY / EPILEPSY

REHABILITATION NEURO ICU8 NEUROSURGERY

MEDICALONCOLOGY

SURGICALONCOLOGY

GENERAL GENERAL

7

6 INFECTIOUS

SURGERY SWING SPACE

RENOVATE FORCARDIAC

HOSPITALISTGENERALMEDICINE

GENERALMEDICINE6

5

INFECTIOUSDISEASE

CARDIAC SURGERYSTEP DOWN

CARDIAC ICU CARDIOLOGY CARDIACCARDIAC

PHASE 16: CONSTRUCTION COMPLETION: PROJECT COSTS:

1Q2019 $154 2M

STEP-DOWN

RENOVATE CARDIAC 1Q2019 $154.2M

QUESTIONS & ANSWERS