HGA Architects and Engineers
Firm's role on the project: Planning, Programming, Architecture, Design, Interiors
EBD Goal
To enhance staff efficiency, delivery of care, and the patient experience by leveraging both Lean and EBD processes in a medical-surgical unit. It was imperative that project goals and objectives were well-defined and that final solutions achieved a level of success.
Overview
This project is a model for the renovation of other inpatient units in the North Tower at Froedtert Hospital. The shell of the inpatient bed tower is L-shaped and each floor is approximately 19,400 square feet with double-loaded corridors. The existing unit had 32 single patient rooms, with supplies and support areas centrally located at the elbow of the unit.
Challenge
To streamline care delivery and standardize workflow, Lean exercises such as critical-to-quality prioritization, peer-to-peer interviewing, and space adjacency diagramming were held with user groups. In addition, the evidence-base design process helped make informed design decisions and validated implementation of process improvement strategies.
Early in the design process, a three-day data gathering event was conducted on the existing medical-surgical unit. Staff and patients were shadowed and interviewed to understand current-state workflow patterns, operational needs, and users’ perceptions. The quantitative and qualitative data gathered were analyzed and significant findings were listed as "needs". These "needs" were categorized into common themes to develop a comprehensive list of Critical-to-Quality (CtQ) metrics (patient satisfaction, family-centered care, physician satisfaction, efficiency, flow and utilization, and patent safety). The project team used this list to guide design decisions and operational changes, evaluate prototypes and assess mock-ups.
Common travel paths uncovered during shadowing were diagrammed in three proposed prototypes to compare differences in travel distances. This exercise was paramount in receiving buy-in from key stakeholders for room count and size. Future-state predictions were made by comparing current-state results in a benchmark database. For example, one design assumption estimated that approximately 6% to 9% of nurses’ time spent traveling would be saved and transferred to time spent in patient rooms.
Solution
The new unit has 24 single-patient rooms, approximately 300 square-feet each. Each room incorporates bedside charting, hand-washing station, family zone, and a private toilet room. Decentralized features include: a nurses’ charting station and supply server outside each room, medication dispensing and nourishment area in the middle of each corridor, and a central team and break area at the elbow of the unit.
Results
The same research tools used during pre-design were implemented in a three-phased post-occupancy evaluation. Shadow data were collected at 3, 8, and 12 months post-occupancy to determine if assumptions and predictions were met. The unit manager received a brief report summarizing the findings and operational suggestions.
The phased approach successfully documented how nurses’ workflow became more efficient within the space over time. As predicted, time spent traveling significantly decreased (p< 0.001) by 6% or 36 minutes per nurse. On average, a nurse traveled 2.08 miles per 10-hour dayshift, which is one of the lowest recorded findings compared to other benchmark studies. Nurses spent approximately 45% of their time providing direct patient care, a 6% increase and 82% of nurses’ time was spent on value-added activities, e.g. charting and retrieving supplies or medications. Over time, staff substantially reduced the frequency of trips to areas on the unit, resulting in a more efficient workflow. Since moving to the new unit, there has been a 25% reduction in ALOS (average length of stay) and an increase in patient satisfaction to 87%.