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Field Research +
Parametric Analysis
How Current State Analysis
leads to Future State
Optimization
Upali Nanda
Alison Avendt
Steve Jacobsen
Camilla Moretti
AGENDA
ContextTrue North Objectives- beyond designing a building Move to researchField Research + Parametric Analysis Findings Translation into design
Learn how field research and simulation tools can be combined
Explore how research and analytics can be rapidly deployed for design
Understand how parametric models are created and the importance of good data to inform these models
Learn about how design decision making can be fundamentally transformed through data and performance driven
approaches
LEARNING OBJECTIVES
ABOUT PROMEDICA
ABOUT PROMEDICA
• 15,000 employees
• $2.7 billion in revenue
• Fully integrated system
• 12 acute care hospitals in NW Ohio & SE Michigan, 2300 beds
• Paramount Insurance with 316,000 members
• Over 800 employed physicians
• ProMedica Transportation Network ground and air ambulance
• Ambulatory surgery centers, Home Care and Hospice, Inpatient Rehab, Skilled Nursing facilities, OP lab and radiology sites
• “and growing”
PROMEDICA TOLEDO HOSPITAL AND TOLEDO CHILDREN’S HOSPITAL
Campus Overview
Community based since 1927Operating 600 bedsTertiary care, Level 1 Trauma Center, 100,000+ ED visits, Level 3 NICU, 24/7 Cardiology, TelestrokeNetwork
• Modern patient tower, latest technology
• Patient and family centered
• Safe, effective, high quality treatment environment
• Efficient workflows to eliminate bottlenecks, lean design and process
• Attract and retain an engaged workforce of high quality physicians and caregivers
THE FUTURE NOW
GUIDING PRINCIPLES
• Create efficient, safe, quality and flexible patient care environments within new patient tower
• Create efficiency through co-location and consolidation of services within the facility
• Replace processes that create a sense of two levels of care, creating a consistent customer experience
• Improve access, wayfinding, and parking for patients accessing services throughout campus
• Identify the best services, the right capacity and appropriate access for those within the new patient tower
• Meet budget and scheduling expectations throughout project
DESIGN PROCESS
JULY SEPTMAY JUNEAPRILCURRENT
STATE FUTURE STATE
DEMAND FORECAST
DESIGN
OPERATIONS
RESEARCH
GUIDING PRINCIPLES
WORKSHOPS
INTEGRATED FUNCTIONAL PLANNING AND DESIGN
DEMAND FORECAST
• Current State volume analysis
• Future State Forecast and Projections
• Future State imperatives
• Recommendations for Future State capacity & services
Lean Process Improvement workshops
• Understand Current State
• Eliminate waste
• Define Desired Future State
• Design through Mock-ups
OPERATIONS
RESULTS FOR FUTURE STATE
STRATEGY
DESIGN
OPERATIONS
RESEARCH
GUIDING PRINCIPLESREINFORCING
PROMEDICA’S MISSION
RIGHT SIZED AND OPTIMIZED FOR FUTURE
REDUCE WASTE AND IMPROVE PROCESS
DATA DRIVEN DESIGN
DRIVING FUTURE FORWARD
Reported Observed Spatial
RESEARCH
CURRENT STATE FUTURE STATE
PHASES OF
WORK
INTEGRATING
RESEARCH IN PRACTICE
FU
NC
TIO
NA
L
DE
SIG
N
IMP
LE
ME
NT
AT
ION
DO
CU
ME
NT
S
RESEARCH
“INFORM”
CONCEPT
SD
DD
CA
CD
RESEARCH
“AND
CONFIRM”
TARGETCreate design aims based on key
performance goals of the organization
EXPLORE/ EXPERIMENTGather Knowledge; Understand Users;
Simulate Scenarios; Test Prototypes. Use
Tools That Balance Technology With Empathy
DEFINELink Design Solution to Performance Hypothesis
MEASUREIdentify key metrics in design and
performance and collect baseline data
MONITORConfirm design is implemented as planned;
towards targeted performance goals
TESTTest the success of the design post-occupancy;
evaluate if target was achieved
RESEARCH: START WITH A TARGET
KEY PERFORMANCE INDICATORS
RESEARCH IN THE FIELD
A 2.5 DAY DESIGN DIAGNOSTIC
FIRST TO FILL UNIT(mostly full occupancy)
2 wings4 nursing stations20 rooms in each wing2 meds/supply rooms1 nourishment room2 soiled linen 2 equipment
MED-SURG UNIT
KEY PERFORMANCE INDICATORS
Unused Kitchen
Unused Pyxis Rm
Opaque Doors in Meds/Su
pplies
Unit Clerk Opp Side
Minimally used
Consult Rm
Off-stage “hide-aways”
SPACE UTILIZATION
COMMUNICATION 1
(Care Coordination)Activities involving care coordination of a patient, team meetings and huddles,
work-related conversations with co-workers, educating and mentoring
COMMUNICATION 2
(Socialization)Communications with co-workers but not pertaining to patient care or work;
socializing
DOCUMENTATION Charting, scanning, documenting, printing
MED 1
(Med Preparation)This activity pertained to the preparation of medications
MED 2
(Med Administration)This pertained to the delivery and administration of medication to the patient
PATIENT CARE 1 This pertained to any clinical activity involving patient interface
PATIENT CARE 2 This pertained to any non-clinical activity involving patient interface
ACTIVITY ANALYSIS
ACTIVITY ANALYSIS
ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY)
First two hours of shift
ACTIVITY ANALYSIS (FIRST 2 HOURS: DAY vs. NIGHT)
w ww w
www
ww
ww
w ww w
ww
w ww w
w WoW
Charging
THE “WOW” EFFECT
DESIGNING FOR MOBILITY/ FLEXIBILTY
POSITIVE NEGATIVE
Love the WOWs, but...Not enough plug
points.No place to store.
On-the-go charting
No log-in, log-out issues
Flexibility
Mobile storage for nurses
Corridor parking
Bedside charting
Corridors are now work spaces
Patient Mobility Deterrent
Increased Sound Levels
Potential HIPAA violations
Units in the room are unused
No way of telling where a nurse is
Infection Risk?
Unit Clerk + Central Nurse Station have visibility to only 3 of 10 rooms. There is also very little visibility to staff, to call if needed.
“We are constantly moving patients to get confused patients closer to the nurses station. They are way too far away in the back rooms.”
VISIBILITY
PARAMETRIC ANALYSIS + FIELD RESEARCH
0.00 1.00 2.00 3.00 4.00 5.00
DocumentationStation to Patient
Head
Peer- Peer
Documentationstation to patient
room door
Unit clerk to entrance
VISIBILITY
STAFF PERCEPTION
4.20 4.30 4.40 4.50 4.60 4.70 4.80 4.90 5.00
Hearing the patient and thealarms
Seeing the patient
Being able to monitor vital signsremotely
VISIBILITY/ MONITORING
STAFF PERCEPTION: DESIGNING FOR “AUDITORY” VISIBILITY
LEADERSHIP
Cannot find staff to round up and motivate them.
BEDSIDE NURSE
Sometimes can’t find other nurses. Miss the physicians each time.
NURSING ASSISTANT
Difficult to get help when needed.
UNIT CLERK
Tough to know where RN/NAs are if they leave the walky-talkies.
COLLABORATION AND COMMUNICATION
DIVERSE CARE TEAM NEEDS
WALKING
Proximity Calculator | Rapidly Generated Heat Map
Excessive Distance
Reasonable Distance
PROXIMITY ANALYSIS
PARAMETRIC MODELING
200
115
83
81
79
68
59
59
50
24
0 50 100 150 200 250
Break Room
Nourishment
Conference
Soiled Work
Equipment
Ice
Main Nurse Station
Meds
Linen
Wow Stations
Average Distance to PR
DISTANCE
PARAMETRIC MODELING
FIELD RESEARCH + PARAMETRIC ANALYSIS
PATIENT CARE: INDIVIDUAL ASSESSMENT NS→PR→NS
PATIENT CARE: ROUND ASSESSMENT
(at the start of and towards end of shift)NS→PR1→PR2→...→PRn→NS
MEDICATION DELIVERY
NS→CS→PR→NS
NS→CS→NS(Docum/CareCoor)→PR→NS
CALL RESPONSE NS→PR→NS
WALKING IS MORE THAN “DISTANCE”
THE IMPORTANCE OF SEQUENCES
Nurse Station to Clean Supplies/Medication Room
Clean Supplies/Medication Room to Patient Room
Patient Room to Nurse Station
A SIMPLE MED EVENT
Nurse Station to Patient Room
Patient Room to Clean Supplies/Medication RoomClean Supplies/Medication Room to Patient RoomPatient Room to Nourishment
Nourishment to Patient Room
Patient Room to Ice
Ice to Patient Room
Patient Room to Supplies
Supplies to Patient Room
Patient Room to Linen
Linen to Patient Room
Patient Room to Soiled
Soiled to Nurse Station
A SAMPLE MED EVENT
FIELD RESEARCH PARAMETRIC MODEL
DEVELOPING A SEQUENCE MAPPERBASED ON FIELD RESEARCHSO EVERY DESIGN CONFIGURATION CAN BE ASSESSED
Comparison of actual vs. optimal task pathways showed that multitasking not only didn’t decrease nurses’ travel distance,
it also slightly increase their walking.
MYTH: MULTI-TASKING REDUCES TIME
1) Waste and variability in walking
2) Multi-tasking not a time saver
3) limited point of use access to supplies reduces efficiency
4) Nourishment is part of med delivery
5) low visibility and connectivity effects care coordination
6) unplanned usage of WOWs can transform corridor into a workspace
FINDINGS
PHASES OF WORK
INTEGRATING RESEARCH IN PRACTICE
FU
NC
TIO
NA
L
DE
SIG
NIM
PL
EM
EN
TA
TIO
N
DO
CU
ME
NT
S
RESEARCH
“INFORM”
CONCEPT
SD
DD
CA
CD
RESEARCH
“AND CONFIRM”
TARGETCreate design aims based on key performance goals of the organization
EXPLORE/ EXPERIMENTGather Knowledge; Understand Users; Simulate Scenarios; Test Prototypes. Use Tools That Balance Technology With Empathy
DEFINELink Design Solution to Performance Hypothesis
MEASUREIdentify key metrics in design and performance and collect baseline data
MONITORConfirm design is implemented as planned; towards targeted performance goals
TESTTest the success of the design post-occupancy; evaluate if target was achieved
RESEARCH DURING DESIGN
PARAMETRIC ANALYSIS OF PLAN CONFIGURATIONS
UNIT CONFIGURATION
VISIBILITY & COLLABOTATION
UNIT SECURITY & CORE POROSITY
THE PROCESS
MED-SURG: THE ONE THING
Current State:• Waste and variability in walking• Limited point of use access to
supplies • Bed-side monitors unused• Low visibility and connectivity• Corridor as workspace• Unaccommodated WOWs
Future State:• Decentralization with
connectivity between nodes• Point of use supplies• Proximity of meds/ supplies/
nourishment• Care coordination facilitation
IT’S ALL ABOUT THE WALK- BUT MUCH MORE THAN DISTANCES
MED-SURG: THE ONE THING
Current State:• Waste and variability in walking• Limited point of use access to
supplies • Bed-side monitors unused• Low visibility and connectivity• Corridor as workspace• Unaccommodated WOWs
Future State:• Decentralization with
connectivity between nodes• Point of use supplies• Proximity of meds/ supplies/
nourishment• Care coordination facilitation
IT’S ALL ABOUT THE WALK- BUT MUCH MORE THAN DISTANCES
WHY THIS MATTERS
CURRENT STATE
FUTURE STATE
The Field Research + Parametric Analysis helped us see what we didn’t see beforeHelped us have more informed conversations with our peopleHelped us create clear targets going forwardHelped us Achieve
Getting nurses closer to the patientsDecrease time away from the bedImprove Key Performance Indicators
HCAHPSFalls with InjuryErrorsStaff Satisfaction
OWNER’S PERSPECTIVE
GOING FORWARD
CURRENT STATE
FUTURE STATE
DESIGN
STRATEGY. OPERATIONS.
RESEARCH.
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