Creating a Patient-Centered Care
Environment on a Medical-Surgical Nursing Unit Using
Evidence-Based DesignDebbie Hunt MSN RN CNOR NE, B/C DNP (candidate)
Academic Advisor: Olivia May, DNP, CRNP
Clinical Advisor: Terri Joiner, FNP-BC
June 1, 2014
Objectives
Discuss the background of the project
Define patient-centered care
Discuss the process
Discuss the results
Discuss implications
Why replace the current hospital?
Space, fire, and life safety issues
Floor to floor heights
Distance between structural columns
200,000 sq/ft short of space needed for workload
Current infrastructure does not allow renovation to accommodate current and future health care design criteria
Background
2004 - Capital Assets Realignment for Enhanced Services (CARES) commission
2006 – Secretary for Veterans Affairs accepts recommendation
2012 – Site selected and purchased
2012 – Core Activations team established
2013 – Focus Groups and Schematic Design 1
2014 – Schematic Design 1 completed
July 2012 Nov 2012 Aug 2013 May 2014June 2012 2019-2020
Site Selection
SecVA announced the Brownsboro site as the location for the new Robley Rex VA Medical Center
Master Planning
Completed
22 Nov 2012
Construction
Award late 2015 Estimated completion, 3-4 years
Site Purchase
The Brownsboro site purchased 12 July 2012
Schematic Design
Initiated Aug 2013.
Projected
Completion
VAMC Louisville Replacement Medical Center Timeline
Schematic Design Completion
May, 2014
Begin stakeholder focus groups Aug 2013
Activation Team Hired
Defining Patient-Centered Care
Referenced as far back as the 1950’s but not prioritized (Cliff, 2012)
Other priorities including patient safety, delivery of quality care and operating budgets.
2001 – Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century
Institute for Healthcare Improvement definition
Patient-centered care moves to the forefront
Institute for Healthcare Improvement
Independent not-for-profit organization founded 25 years ago
Partners with visionaries, leaders, and front-line practitioners around the globe
IHI Patient-Centered Care definition
The Planetree Organization
Founded in 1978
Mission – patient-centered focus
Sticher, 2011
Nine Elements
1. Human interaction
2. Patient education and information
3. Healing partnership with family and friends
4. Healing nutrition
5. Spirituality and personal healing resources
Sticher, 2011
6. Human touch
7. Healing Arts
8. Alternative and complementary care
9. Healing environments.
Process
Defining the Vision
Space planning
Stakeholder management
Site visits
Defining the vision
Why is this important?Provide a foundation for decision making
Department of Veterans AffairsVision for care deliverGuiding principles
VA Office of Construction & Facilities Management
VA and patient-centered careDeveloping and integrating a care delivery model
focused on patient centered care specifically as it applies to Veterans (Design Guide, 2011, p. 7).
VA and PlanetreePartnering with Planetree
Veteran Centered Care Core Principles
Honor the veteran’s expectations of safe, high quality, accessible care
Enhance the quality of human interactions and therapeutic alliances
Solicit and respect the veteran’s values, preferences, and needs
Systematize the coordination, continuity, and integration of care
Empower veterans through information and education
Incorporate the nutritional, cultural and nurturing aspects of food
Provide for physical comfort and pain management
Ensure emotional and spiritual support
Encourage involvement of family and friends
Ensure that architectural layout and design are conducive to health and healing
Introduce creative arts into the healing environment
Support and sustain an engaged work force as key to providing veteran centered care (Design Guide, 2011, p. 7)
Space planning
Multidisciplinary, integrated activity Activations team Leadership Architect and Engineer firm Department leadership Central Facilities Management (CFM) Veterans Integrated Services Network (VISN)
Stakeholder Management
What is stakeholder management?“a process of enabling stakeholders to
identify, negotiate and achieve their objectives, such as social, environmental or economic, through active participation in the project process” (Rowlinson and Cheung, 2008, p. 611 as cited in Brammer and Millington, 2004, and Palunen, 2006)
Institute for Patient and Family Centered Care (IPFCC) patient and family-centered care concept
“Patient- and family-centered care is an approach to health care that shapes policies, programs, facility design, and staff day-to-day interactions. It leads to better health outcomes and wiser allocation of resources, and greater patient and family satisfaction (2014, para. 1).
Primary Stakeholders for Medical-Surgical Unit
Deputy Nurse Executive
Nursing unit staff
Pharmacy
Discharge Planners
Food and nutrition
Environmental management services
Healthcare providers
Veterans and families
Presentations
Staff meeting presentations Multiple meetings on all shifts Defining patient-centered care Review of renderings Brainstorming
Veteran Service Organizations (VSO) presentations Monthly meetings Defining patient-centered care (different from veteran-
centered care?) Review of renderings Brainstorming
Schematic Design User Group Meetings
Schematic Design 1 – further develops concept plan to a level of detail that includes functional and adjacency requirements and establishes the aesthetics of the design (A/E submission Requirements, 2013, p. 16).
On-site user group meetings
Subject matter experts (SMEs) Deputy Nurse Executive Associate Chief Nurses Nurse Managers Patient Safety Officer Infection Control Coordinator
Schematic Design User Group MeetingsSchematic Design 2 – further refine the solution
developed in SD1 and to validate that project goals and parameters are reflected in the design, which is further developed at a room-by-room level of detail
On-site user group meetings
Subject matter experts (SMEs) Deputy Nurse Executive Associate Chief Nurses Nurse Managers Front line staff Patient Safety Officer Infection Control Coordinator
Site visitsTrend toward evidence-based
design
Examples of evidence-based design
Best practices
Planetree
Site Visits
Norton Brownsboro
Jewish Hospital Medical Center East
University of Louisville Hospital
University of Kentucky Hospital
Las Vegas VA
Orlando VA
Palo Alto VA
Discussion
Implications1. Improve patient outcomes2. Improve staff morale3. Improve patient/family satisfaction4. 10 designated Planetree hospitals “exceed
the Centers for Medicare and Medicaid Services (CMS) national averages on several core measures (Frampton and Guastello, 2010, p. 52)
Sharp Coronado Hospital Study
Retrospective study examining data from two medical-surgical units over five years.
One unit had implemented Planetree and one had not
Planetree unit demonstrated:1. Shorter average lengths of say
2. Statistically significant lower costs per case
3. Higher average overall patient satisfaction scores (Frampton &Guastello, 2010)
Conclusion – So What?
VA mission to create a patient-centered care environments that are Veteran centric
Exciting time for Veterans and those involved
References
A/E Submission Requirements for VA Medical Center Major New Facilities, Additions & Renovations. Retrieved from http://www.cfm.va.gov/til/ae/aeSubMaj.pdf.
Cliff, B. (2012). Patient-centered care: The role of healthcare leadership. Journal of Healthcare Management / American College of Healthcare Executives, 57(6), 381-383.
Design Guide. (2011) Department of Veterans Affairs Office of Construction & Facilities Management design guide November 29, 2011. Retrieved from http://www.cfm.va.gov/til/dGuide/dgInpatientNU.pdf
Frampton, S., and Charmel, P. (2009) Putting Patients First: Best Practices in Patient-Centered Care, 2nd ed. San Francisco: Jossey-Bass.
Frampton, S. B., and Guastello, S. (2010). Patient-centered care: More than the sum of its parts. The American Journal of Nursing, 110(9), 49-53.
Garon, S. (2006). Space project management lessons learned: a powerful tool for success. Journal of Knowledge Management, 10(2), 103-112.
Institute for Healthcare Improvement (2014). About IHI. Retrieved from http://www.ihi.org/about/Pages/default.aspx
Institute for Healthcare Improvement (2014). Person- and Family-Centered Care. Retrieved from http://www.ihi.org/Topics/PFCC/Pages/Overview.aspx
IPFCC Frequently Asked Questions (2014). What is patient- and family-centered health care? Retrieved from http://www.ipfcc.org/faq.html
Rowlinson, S., & Yan Ki Fiona, C. (2008). Stakeholder management through empowerment: modelling project success. Construction Management & Economics, 26(6), 611-623. doi:10.1080/01446190802071182
Stichler, J.F. (2011). Patient-Centered Healthcare Design. Health Facility Design, 41(12), 503-506.
VA Executive Summary 2008 (n.a.) Retrieved from Louisville Replacement Hospital SharePoint.
VA Space and Equipment Planning System (2014). Office of Construction & Facilities management. Retrieved from http://www.cfm.va.gov/TIL/planning.asp