Cleveland clinic
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Debbie Gregory RN, BSN spoke for the American College of Healthcare Architects at the Cleveland Clinic Patient Experience Summit on May 22, 2012.
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- 1. Improving the patient experience through design
- 2. Learning Objectives • Discuss the nurse’s role in advocating for a work environment that enhances work processes, patient safety and improved care delivery. • Identify specific design features and best practices that have demonstrated outcomes in improving organizational performance, patient outcomes and provider experiences. • Explore how patient care philosophies and care models should influence design and operational change. • Discuss future trend in healthcare and how we can improve intentional alignment between architecture and patient care delivery.
- 3. History of Nursing The Past • Florence Nightingale • Notes on Nursing • Environment
- 4. History of Nursing My History • 1984 - Vanderbilt University School of Nursing • 8 Hour Shifts • Semi-private Rooms • Centralized Model
- 5. History of Nursing Today’s Nurse • 12 hour shifts • Private Rooms • Decentralized Model
- 6. History of Nursing Tomorrow’s Nurse • Mobile Healthcare • Tele-health • Continuity of Care
- 7. Healthcare Architects Role • Form follows function • Adapt and React • What does the future hold?
- 8. Adapted from: Healthcare Leadership White Paper Series, 1 of 5, “The Business Case for Building Better Hospitals Through Evidence Based Design” by Blair L.Sadler, Jennifer DuBose, and Craig Zimring. Design Intervention Quality and Business Case Decrease infection, Increase Privacy, Increase Build Single Rooms Capacity, Increase Patient Satisfaction Increase Patient and Family Satisfaction, Reduce Provide Space for Family Overnight Family Stress Build Larger Bathrooms Reduce Falls, Reduce Staff Back Injury Install HEPA Filters throughout patient care Reduce airborne - caused infections areas Install hand washing sinks at each bedside Reduce Infection Install ceiling mounted lifts Reduce back injury Reduce patient and staff stress, reduce patient Reduce Noise sleep deprivation, increase patient satisfaction Reduce patient stress, reduce patient pain and Use music for positive distraction medication use Access to natural light in patient and staff Reduce patient anxiety and depression, reduce areas length of stay, increase staff satisfaction Use artwork and virtual-reality images to Reduce patient and staff stress, reduce patient provide positive distraction pain and medication use Build decentralized nursing stations Increase staff time spent on direct patient care Reduce staff time spent giving directions, Include effective way finding systems reduced patient and family stress.
- 9. Operational Improvement and Clinical Outcomes Drive Physical Design
- 10. Operational Improvement and Clinical Outcomes Drive Physical Design
- 11. PATIENT PERSPECTIVE Patient Care Philosophy
- 12. Philosophy of Patient Care
- 13. Patient Safety Focus
- 14. HCAHPS MEASURES Composite Measures • Communicate with Nurses • Communicate with Doctors • Responsiveness of Hospital Staff • Pain Management • Communication about Medications Individual Items • Cleanliness of the Hospital Environment • Quietness of the Hospital Environment Global Items • Overall Hospital Rating • Recommend the Hospital
- 15. HCAHPS MEASURES Composite Measures • Communicate with Nurses • Communicate with Doctors • Responsiveness of Hospital Staff • Pain Management • Communication about Medications Individual Items • Cleanliness of the Hospital Environment • Quietness of the Hospital Environment Global Items • Overall Hospital Rating • Recommend the Hospital
- 16. HCAHPS MEASURES Composite Measures • Communicate with Nurses • Communicate with Doctors • Responsiveness of Hospital Staff • Pain Management • Communication about Medications Individual Items • Cleanliness of the Hospital Environment • Quietness of the Hospital Environment Global Items • Overall Hospital Rating • Recommend the Hospital
- 17. HCAHPS MEASURES Composite Measures • Communicate with Nurses • Communicate with Doctors • Responsiveness of Hospital Staff • Pain Management • Communication about Medications Individual Items • Cleanliness of the Hospital Environment • Quietness of the Hospital Environment Global Items • Overall Hospital Rating • Recommend the Hospital
- 18. Hospital Focus
- 19. Hospital Focus
- 20. Don’t Lose Focus • Satisfaction is highly subjective. What matters a great deal to one patient may not be as relevant to another. • Hospitals don’t have to reinvent their process - Common sense changes can be transformative. • HCAHPS by itself doesn't ask about privacy, emotional support, shared decision making or coordination of care. But it fulfills CMS's vision to be a short set of measures to make comparisons between hospitals. It wasn't designed to be a quality improvement tool by itself. • Technology ahead of Practice Transformation • Quality and Safety Measures
- 21. Don’t Lose Focus • Satisfaction is highly subjective. What matters a great deal to one patient may not be as relevant to another. • Hospitals don’t have to reinvent their process - Common sense changes can be transformative. • HCAHPS by itself doesn't ask about privacy, emotional support, shared decision making or coordination of care. But it fulfills CMS's vision to be a short set of measures to make comparisons between hospitals. It wasn't designed to be a quality improvement tool by itself. • Technology ahead of Practice Human Touch Transformation • Quality and Safety Measures
- 22. NURSES HOLD THE KEY
- 23. NURSES HOLD THE KEY • Listening • Touching • Empathy • Caring • Compassion
- 24. Influences Driving Design • Evidence Based Design • The Patient- Family Experience • Quality Improvement Initiatives • Operational Efficiencies • Government Regulations
- 25. Influences Driving Design • Evidence Based Design • The Patient- Family Experience • Quality Improvement Initiatives • Operational Efficiencies • Government Regulations Nurse - Patient Relationship
- 26. The Value of Clinical Input • Understanding the goals and objectives of the care delivery model • Provide insight about staffing ratios, skill mix, equipment needs and technology needs. • Regulatory Knowledge - HIPAA, JCAHO, IHI, AHRQ, CME and the CDC. • Identify opportunities to enhance the work processes
- 27. The Value of Clinical Input • Understanding the goals and objectives of the care delivery model • Provide insight about staffing ratios, skill mix, equipment needs and technology needs. • Regulatory Knowledge - HIPAA, JCAHO, IHI, AHRQ, CME and the CDC. • Identify opportunities to enhance the work processes
- 28. The Value of Clinical Input • Understanding the goals and objectives of the care delivery model • Provide insight about staffing ratios, skill mix, equipment needs and technology needs. • Regulatory Knowledge - HIPAA, JCAHO, IHI, AHRQ, CME and the CDC. • Identify opportunities to enhance the work processes
- 29. The Value of Clinical Input • Understanding the goals and objectives of the care delivery model • Provide insight about staffing ratios, skill mix, equipment needs and technology needs. • Regulatory Knowledge - HIPAA, JCAHO, IHI, AHRQ, CME and the CDC. • Identify opportunities to enhance the work processes
- 30. The Value of Clinical Input • Understanding the goals and objectives of the care delivery model • Provide insight about staffing ratios, skill mix, equipment needs and technology needs. • Regulatory Knowledge - HIPAA, JCAHO, IHI, AHRQ, CME and the CDC. • Identify opportunities to enhance the work processes
- 31. Nurse Leaders in Healthcare Design NIHD is a professional organization formed to promote healthcare design standards, promote inclusion of nurses in healthcare design, provide educational programs for its members, and disseminate new ideas for all areas of health care design. NIHD promotes collaborative and interdisciplinary educational training to all disciplines within the healthcare community and construction community.
- 32. Nurse Leaders in Healthcare Design Research Committee - Terri Zborowsky Education Committee - Joyce Durham Membership Committee - Daina Pitzenberger Industry Partner Committee - Kim Denty www.nursingihd.com
- 33. Healthcare Design Nurse Roles • Architect Firms • Facility Planning Office • Engineering Firms • Director of • Construction Operations and Company Facility • Furniture Company Management • Equipment • Project Manager Company • Transition Officer
- 34. Jan Stichler Sandie Colatrella Joyce Durham Marjorie Serrano Maria Posada Pam Redden and Daina Pitzenberger Jan Stichler Joyce Benjamin
- 35. Nurse Participation is the Key Moving Forward Find your clinical champion Collaborate with facility clinical experts Support your nurses with an NIHD membership ($199/year)
- 36. NURSES ARE HUMAN TOO!!
- 37. NURSES ARE HUMAN TOO!!
- 38. THANK YOU!!! Debbie Gregory RN, BSN dgregory@ssr-inc.com 615-714-6794 The Nursing Institute for Healthcare Design www.nursingihd.com
Notas do Editor
- Thank you for the opportunity to speak to you today. An audience with Healthcare Specific Architects is a privilege. It is my goal to advocate for the Nurse’s Work Environment and Improve the patient experience and outcomes through improving the delivery of care. On behalf of my nursing colleagues I want to thank you for your commitment to healthcare design and the improved delivery of patient care.\n
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- We all know the history of nursing and the focus on the physical environment. Florence Nightingale’s famous “Notes on Nursing” have been the spring board of this discipline. Natural Light, Fresh Air, and infection control measures are all results of the research of Florence.\n
- As a young person, I wanted to be a nurse or interior designer. Back then there was No connection between the two disciplines - I chose the healthcare path. I began my career at the VA Hospital in Nashville, TN. I worked med surg, step down, SICU, the OR and recovery room. Things were a bit different back then - the uniforms, the nursing care model, .....\n
- Over the years as we have collectively evaluated the design of the healthcare environment changes have evolved...12 hour shift, private rooms, decentralized care. The push to keep the nurse at the bedside has dictated many of these changes.\n
- The healthcare landscape continues to change rapidly. With mobile healthcare, Computerized Charting and\nThe thing that hasn’t changed over the years is the heart of the nurse. The core values of touch, nurture, etc. Nurse are still the key to the patient’s experience.\n
- As a healthcare architect you are committed and focused on the “form follows function” philosophy. This is second nature to you. Over the years you have had to react and respond to the changes within healthcare. Although you are not a healthcare professional, everything that affects healthcare professionals - affects you. You must proactively be poised to adapt and rethink the design of the healthcare environment.\n
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- The focus on the future of healthcare design must involve optimizing the nurses work environment in harmony with the operational design. We know that nurses walk an averageA mismatch between the physical transformation of inpatient units over time and the clinical processes that it supports has contributed to the nonproductive use of nursing time. In a 36-hospital time-motion study, a team from Ascension Health, Kaiser Permanente, and Purdue University found that the average total walking conducted by nurses ranges between 2.4 and 3.4 miles on a 10-hour day shift, and 1.3 and 3.3 miles on a 10-hour night shift. That translates to a higher extreme of about 4 miles on a 12-hour shift. These figures confirm some other studies that found similar long walking time for nurses.\n
- Today’s healthcare landscape is in continuous flux. Government regulations are driving the management of our health information. Hospitals are very distracted today with the implementation of Epic, Cerner and others. You probably can’t get your clients to focus on the design projects because they are so distracted with their Cerner or Epic “go live”. Now we are going to focus our attention on Patient Satisfaction Scores. Different patient care philosophies drive the focus of the care delivery and the healing environment. \n
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- Terri Zborowsky - AECOM\nJoyce Durham - Health Strategies and Solutions\nDaina Pitzenberger - Linbeck Construction\nKim Denty - Duke Medical Center\n
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- Pam Redden- MD Anderson\nJan Stichler\nMarjorie Serrano - Blue Cottage Group\nDaina Pitzenberger - Lindbeck Construction\nSandie Collatrella - Avante Architecture\n
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- Nurses are the best at work arounds - \nPieces of paper for organization and notes\nWe at NIHD are committed to educate nurses to come to the table ready to have meaningful discussions and innovative ideas\nBe strategic and intentional about clinical participation\nNew level of collaboration and perspective\n
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