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St. Elizabeth Hospital, Appleton, WI

January 2017
EDAC Advocate Firm Project
Darris Lee Harris Photography, 2014


Firm's role on the project:  Planning, Programming, Architecture, Design, Interiors


EBD Goal 

To align critical inpatient needs to produce Critical to Quality Outcomes (CtQs) for a new bed tower at St. Elizabeth Hospital using Lean process improvement. To create a research design tool that facilitates data collection and uses results from both parts of the study to inform the design process, and compare and report the results of the design decisions. 



HGA developed a tool to evaluate the effectiveness of strategies implemented in the design and planning of a new medical-surgical unit at St. Elizabeth Hospital in Appleton, WI. The tool was used to collect data during both the pre- and post- occupancy evaluation (POE) of the new bed tower and represents an ideal way to utilize research methods. 



The goal of Lean process improvement is to streamline care delivery and standardize workflows and to create a more productive work environment and safer care delivery. However, actions frequently are not taken to ensure that process improvement strategies meet a level of success. Studies and tools are needed to present how design research can play a crucial role in validating the significance of Lean impact.


The existing facility of St. Elizabeth Hospital, a member of Affinity Health System, was built in 1965. The replacement four-story bed tower opened in January 2015. This study focused on the medical-surgical unit on Floor 3 of the new tower. The new unit is approximately 21,000 square feet with a rectangular, single-loaded corridor and a 12-foot-wide central core. There are three “neighborhoods,” each consisting of five single-patient rooms on either side of the core (30 beds per floor). Each neighborhood core consists of a collaboration hub, medication room, clean supply and equipment room, soiled workroom, and equipment alcove. Patient rooms are approximately 320 square feet and have bedside charting, a pass-through supply server, hand sanitization station, toilet room with shower, and charting station with an observation window outside the door. The configuration of this decentralized unit configuration has two to three nurses assigned to each neighborhood. 



This project provided an opportunity to develop a series of measurement tools that allowed HGA and the client to create baseline measurement tools that were used again after occupancy to evaluate the success of both the Lean process improvements and the design decisions. This study applied a mixed-method approach using data from staff surveying, nurse shadowing, unit acoustic readings, and retrospective data collection, both pre- and post-occupancy.

Final results showed nurses transitioning from a centralized care model where a majority of their work occurred at the central charting station or at the workstations on wheels (WOWs) to a decentralized model where nurses worked at one of three designated collaboration hubs dispersed throughout the unit. In the baseline environment, approximately 75 percent of nurses’ workflow paths involved stopping in the corridor to access WOWs, whereas the most common work path in the new environment was streamlined between the collaboration hub, medication room, and patient rooms. In addition, the overall unit and patient room designs had increased staff’s perceived perception of work performance by 43 and 30 percent, respectively. Similarly, staff was significantly more satisfied with the overall unit design (up 26 percent) and patient rooms (up 24 percent). Unit layout and patient safety were predictor variables of unit and patient room satisfaction.

Clinical outcome measures for this facility will be evaluated in early 2017, when enough data has been accumulated for significant testing. Acoustical readings are being reevaluated following the addition of a white-noise system because of patient complaints that the unit was too quiet. The goal is to conduct this level of study on every design project, whether healthcare or another market sector. 

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