Mark Aiken, Senior Project Manager at ARUP explains his innovative ways to retrofit emergency departments, with a focus on how to manage staff flow yet ensure clinical safety and operations. He also explains how ARUP managed to help decrease patient wait times whilst retrofitting. Mark will be speaking at the Retofitting for Healthcare Facilities 2011. This event forms part of the Australian Healthcare Week. For more information about the event, please visit www.AustHealthWeek.com.au or call + 61 2 9229 1000. Alternatively, you can email enquire@iqpc.com.au

1. Retrofitting Emergency Departments: The KPIs, process
and strategic stages
Q&A with Mark Aiken, Senior Project Manager at ARUP
Retrofitting For Sustainability Summit 2011
Australian Healthcare Week 2011
Retrofitting is a difficult task for any type of building but especially with health
facilities, daily operations can be very disruptive to both the staff carrying out the
treatment and the patient seeking recovery, it’s therefore essential that
communication and collaboration between all.
Health IQ : Why retrofit? What are the benefits of retrofitting health facilities
and who will this benefit?
Mark: Some of the key benefits for retrofitting health facilities really coming
about from the reduction of costs in capital outlays for the state government. The
other one I guess is because this project, for example, with an ED within an existing
hospital campus, one of the key problems was that the ED’s locality to other
department was essential to stay where it was, and there was a lack of the lack of
land available elsewhere or in close proximity to the area to allow us to actually build
new, so just by the very constraints of the existing campus which we basically were
guided towards retrofitting.
Health IQ: Can you highlight some innovative techniques which you applied
to the retrofit projects within the health facilities, why was it used and how it
would benefit the facility and/or the patients?
Mark: In terms of innovative techniques, one of the techniques we recognise
obviously retrofitting an emergency department which is operational 24/7.
Retrofitting every square inch of it and expanding it in a functional area brings about
a lot of risks. The key is obviously safety to patients. So, one of the techniques we
utilised early on the piece was that we decided that what we needed was to really
control that staging in a lot more controlled fashion.
So we try to develop a more integrated project team, so the traditional method of
designing, you’d have your design teams that would then interact with user groups
like the Emergency Department, clinicians and nurses etc, in order to design the
facility. In addition to that, we held a couple of staging workshops, where the whole
focus of the one-day workshop was that the design team and
the user group teams got together and looked at how we might

2. actually stage the works. This ensured we didn’t impact our patient safety or clinical
operations.
So in doing that though one of the innovations that became notable I guess is the
user groups got to understand a lot more of the constraints around the design build
and the design team then understood the actual business of the ED, nurses and the
doctors on that site. I think this created a far better high-performing team
environment, which really brought everyone together, I think that was quite
innovative and good; and rolling on from that, once we started getting in to the
staging works, we recognised that we are introduce a new style of clinical mode of
care so to speak.
So what we did was – we introduced change management process at the start of the
construction period as well. So thereby - change is always easy to introduce when
at times of project change, to having construction work happening around with a time
for change for the nurse and the doctors, we introduce those – that change
management during construction, and I think that was quite effectively taken up be
taken up.
Health IQ: It says more about the culture as well as the project team. So how
do you continue to measure to retrofit with financially viable - so how can you
ensure your best return on investment.
Mark Aiken
Again, because a health facility doesn’t lean itself towards real economic and
financial viability, one of the key drivers is the clinical services plan, so they’re
following on from that whole keeping the project operational during construction.
One of the KPIs we looked at was the patient wait times, and so what we did was –
when we did introduce that fast track system (as part of the change management
process), we were able to counteract the increased wait times that will happen with
construction on site. So what we did see over the first 8 months of construction, we
actually saw a decrease is patient wait times because of an introduction of the fast
track streaming process - that was one way we measured our success at this project
I suppose. It doesn’t have dollar incentive attached to it but what it does have is –
people not waiting as long to critical care in an Emergency Department which I think
has a far better outcome than dollars.
Health IQ: Now this is the topic that you would be speaking of at the conference,
maybe take us to the process of the retrofit to ensure the building remains as
functional as possible throughout these times and what strategies were employed
specifically.
Mark: Specifically, we broke this project down into about 5 different stages.
The first stage that we did was, we field out an area using a storeroom into a 3-bay
fast track area that way we could fast track, carry 3, 4 or 5 patients through that area.
That was done right before we even started doing any other work. And the first
stage was obviously the ambulance bay and mainly working out
at the front of the building, so we did that work first, and then in

3. order to reduce impact on patients arriving at ED, we actually slugged in a temporary
demountable building under there (as part of the waiting room), because that was
actually built into the construction cost, that then also becomes an asset for the
health issue in the future, they can utilise that in remote clinics, up in north
Queensland there are lot of areas with remote clinic use and that can be utilised in
those locations after this project is finished and then stage 3 basically internal fit outs,
so that’s basically the short and sweet of it. It’s 2 years worth of mingler and
construction. So it’s a long process for those guys operating at area but we’ve done
our best towards the contractor and the user groups to really minimise the impact on
the clinical service delivery and we’re closing on completion in January 2011,
hopefully everything goes well between now and then.
Mark Aiken will present at the conference on ‘Remaining Fully Functional
Throughout the Retrofit Project’. The Australian Healthcare Week combines 5
essential health events in to one big week. For more information on this particular
stream visit www.aushealthcareweek.com.au/retroffiting or alternatively call at 02-
9229-1000 for information or to register. You can also email us at
enquire@iqpc.com.au