Loyola University Oncology Center: Define the Problem First Healthcare Design Conference November 19, 2013 Kathleen Fujiu
Nurse Manager Inpatient Oncology, Loyola University Medical Center
Heather Hedlund Nurse Manager Bone Marrow Transplant, Loyola University Medical Center
Rana Lee Principal, SmithGroupJJR
Presentation Learning Objectives • Model-of-Care Definition
Discover how an integrated design and care delivery team can work together to develop a model-of-care to deliver a facility that is the physical extension of the program values and the future of caregiving.
• Innovations in Facility Planning and Assessment Learn how innovations in facility planning and assessment, through mapping and analysis of existing process and service flows, can reveal future opportunities in clinical excellence.
• Patient/Family-Centered Experience + Care Learn how a patient- and family-centered model-of-care and the appropriate integration of the science of medicine and the spirit of caring can transform the patient experience and path to physical and emotional well-being.
• Physical Constraints of Renovation Gain effective solutions for working within the constraints of existing configurations to provide a physical, functional and environmental transformation of clinical space.
Define the Problem First Overview • About Loyola University Medical Center • Inpatient oncology service line and bone marrow transplant program • Framework for the model-of-care study
• Current state
• Future state
• Summary
Loyola University Medical Center Loyola University Medical Center
Current State
3,900 SF
3,900 SF
3,400 SF
6,100 SF
3,900SF
Vision Physicians and staff of the Cancer Service are dedicated to healing and preventing cancer in people of Chicago and the Midwest through discovery, development and application of innovative patient care programs, research and education. Goals To achieve a level of care, research and education commensurate with NCI Clinical Cancer Center designation. Quality goals include: • Multidisciplinary, holistic care model in an ideal patient, family and staff environment • Enhanced translational and population-based research in the community • Increased academic and community education mission • Optimal patient/family experience and staff environment
Inpatient Oncology Program
Objectives • Enhance patient care solutions in keeping with broad service line, institutional, family- and community-
centered care delivery goals. • Implement a model that links safety and quality within the context of empathy, operational efficiency and
technology. Environmental Response • The built environment must support staff, patients and family members on the path to physical and emotional
well-being . • Design concepts and philosophies shall deinstitutionalize the health care facility and offer socialization,
respite, collaboration and tranquility. • Key design drivers include: respect for patient privacy, dignity and the need for control over one’s environment
in a private room.
Model-of-Care Framework
Model-of-Care User Groups Bone Marrow Transplant: Diana Amidei, Katie Bormann, Danielle Brandonisio, Maria Brunner, Joy Burns, Amanda Commers, Tara Dedic, Pat Dominguez, Jaime Firkus, Carrie Gallimore, Omana George, Melissa Hallman, Deidra Harris, Sarah Howe, Anna Jenero, Vonnie Jennings, Kelly Kasprzak, Kathleen Mahon, Gina Maida, Linda McCrorey, Linda Melone, Rachel Ochoa, Jovonne Owens, Lisa Payne, Olivia Phillips, Jennifer Rogers, Dorothy Schardt, Asta Siugzdinis, Brittany Stancati, Alex Tapia, Kristen Tucker, Kathleen Vavpotic, Jami White
Hematology Oncology: Kisha Allen, Thelma Apolinario, Sharon Barczak, Monica Bowie, Wanda Boykin, Gergana Buchkova, Lindsey Cavoto, Dragana Cipieau, Solita Ferrera, Mary Foley, Voncille Gibson, Julia Khan, Rachel Koranda, Marion Langevin, Brittany Larson, Alnita Lockett, Mary Maggio, Christine Murphy, Amanda Ortiz, Jean Rudolph, Anna Ruffolo, Lyuda Skoropad, Tonisha Smith, Linda Stackhouse, Katie Stone, Chris Tallian, Kristin Tate, Regina Terrado, Maria Tuxbury, Peggy Vallejo, Erna Wallace, Kandace Wilson
Staff: Aziz Ansari DO, Heather Antoniazzi, Barry Bennett, Regina Conway-Phillips, Madelyn Dupee, Kelly Eiden, Theresa Fortenberry, Bridget Gaughan, Sr. Fran Glowinski, Donna Fletcher Gonzalez, Mike Hopkins, Gloria Johnson, Shari Lichtenstein, Patricia Mumby, Alda Pleirys, Nancy Porter, Megan Swiderski, Peter Tortorice
Executive Committee Sharon O’Keefe
Patrick Stiff, MD
Barb Buturusis
Daniel Post
Ken Majetich
Chris Govero
Steering Committee Kathleen Fujiu
Heather Hedlund
Ken Majetich
Kevin Barton, MD
Tulio Rodriguez, MD
Patient/Donor Advisory Group Karen Alexander
Peggy Lafleur
Doris McGee
Jeana Rettig
Barb Buturusis
Barry Schatz
Team Participants
34 people
32 people
17 people
6 people
SmithGroupJJR:
Andy Vazzano
Rana lee
Jens Mammen
Ann Cosgrove
Jonathon Glass, MD
SmithGroupJJR:
Andy Vazzano
Rana Lee
Jens Mammen
Ann Cosgrove
Rod Vickroy
SmithGroupJJR:
Rana Lee
Rod Vickroy
5 people 6 people
Current State – Corridors
Current State – Ancillary Support Areas
Current State – Staff Areas
Current State – Patient Areas
Dietary - Meals
Dietary - Nourishment
Soiled Linen Housekeeping Supplies Waste- General
Waste- Hazardous
Waste- Recyclable
Clean Linen
Pharmacy - Specials
Patient Supplies
Pharmacy - General
Blood Products
Current State – Nursing Unit Flows
Current State – Nursing Unit Flows
Current State – Themes
Patient / Family Support Services
Dietary - Meals
Dietary - Nourishment
Soiled Linen
Housekeeping Supplies
Waste- General
Imaging
Clinical Laboratory
Education / Research
Waste- Hazardous
Waste- Recyclable
Pharmacy - Specials
Patient Supplies
Clean Linen
Pharmacy - General
Blood Products
N
6- North 6- South
6- West
Current State – Process Flows
Current State – Travel Distances
Weighted Distribution – Based on FREQUENCY of flows Nurse Travel Distances – Best + Worst Case Scenarios
Nurse : Patient = 1 : 5
Nurse Total Travel Distance per ONE SHIFT:
Best Case = 2,820 ft x 5 = 14,100 = 47 Football Fields
Worst Case = 4,925 ft x 5= 24,625 ft = 82.1 Football fields
Average walking pace = 264 ft/min
Total Walking Time per ONE Nurse per ONE SHIFT:
Best Case = 53 min
Worst Case = 93 min
Future State :
Best Case = 5,500 ft= 18.5 Football Fields = 21 min
Worst Case = 10,500 ft = 35 Football Fields = 40 min
Current State • Significant centralization of materials and
supplies at the floor level causes:
• significant congestion
• long travel distances for caregivers
• When decentralized, supplies and medications are in inconsistent locations:
• omnicells
• electrical closets
• storage rooms in adjacent buildings
• Inconsistent access to housekeeping support functions
Current State vs Future State – Material Supplies
Current State Plan Future State Plan
Current State Analysis – Patient, Caregiver & Family Experiences
Privacy Dignity Hygiene
Support Balance Community
Exercise Dietary Communication Amenities Logistics
Current State • Patients are not initially observant of physical environment, whereas the care
partner experience is immediate
• Physical environment does not reinforce high level of quality of care
• Patients experience anxiety + fear concerning infection control
• Private room configuration does not support communication
• Magnitude of stress + anxiety increased for patients/families who come from farther distances (+ 3 hours)
Goals • Physical environment is sensitive to length-of-stay and congruous with the
high quality level of medicine and care
• Private room will address many of the environmental shortcomings, but will also be aided by improved patient/family support spaces
• Create community of support for the patient and care partner
• Robust and varied vehicles of communication to support care
• Enhanced interaction with ancillary services via distinct spaces on the floor
Current State – Experience Map (Negative)
Current State – Experience Map (Positive)
Concept / Visioning
Integrate the science of medicine with the spirit of caring to produce the miracle of healing.
Theme 1:
Theme 2:
Culture of Caring: Compassion
World-Class Medicine: Research, Innovation
Experience Themes
Experience Themes
Culture of Caring: Compassion Attributes: Warm
Supporting Friendly Accommodating
Personal Soothing
Resulting experience: Interaction Healing touch Active involvement Relationships Emotional engagement
Design Spectrum
Warm Familial Comforting Calming Engaging
Encouraging Purposeful Organized Focused Modest
Meaningful Confident Inspirational Enriching Clean
Town Center
Patient Residence
Neighborhood
Clinical Care Center
Future State
10 beds
10 beds
9 beds
10 beds
Future State – Program Zones
Central Core Program Experiences
TOWN CENTER Environment to be hospitality or residential in appointment and ambience Arrival Zone -Welcomes family and patient to floor. Immediate visual connection to next great room in the Town Center Great Room -Central for all family activities, open space with multiple destination portals leading to resident neighborhoods Cafe Zone/ Family Kitchen Family Business/Internet Touchdown Family Laundry/Lockers
Future State– Neighborhood Zone
Define the Problem First Summary
• Determine advocacy groups. • Identify the appropriate champions/experts. • Engage end users in the process. • Include patients and family members. • Utilize Lean principles to optimize flows. • Ask questions and validate responses. • Prepare the staff for change.