Planning and Designing Women’s and Children’s Services Avoid These TOP 10

Problems for Best Outcomes A n n Allen, MSN, RN

Iwl hether you’re starting from scratch or revamping an exlsting unit plan-

ning, designing, or redesigning, women’s and children’s services can be both exdtmg and chal- lenging. And although every institution faces its own unique challenges and requrements, the fol- lowing 10 tips for avoiding peril can apply to almost any circumstance. Read on, and then get ready to redesign.

Prdblem 1 Failing to Obtain User Input From Staff Who knows better than the users what is needed in the work place to improve efficiency and increase user satis- faction?

Typically after a renovation project, process analysis reveals inherent problems that have become embedded within a unit’s care delivery; usually, those problems have been transferred into the refurbished process. So, it makes sense to identify problems with current processes and practices up front. In fact, failure to initially identi- fy the problems within current processes and practices can result in inefliciency and inconveniences in deliver- ing care. Without such analysis, the design or redesign of the care delivery services will be disconnected from the care delivery process.

Ann Allen, MSN, RN, is director of performance improve- ment at Lake Norman Regional Medical Center in Mooresvdh, NC, and i s a consultant regarding physical space design with Freeman White lnc. of Charlotte, NC.

Start by getting the users of the unit involved in the planning and developmental stages. Nurses, physicians, and ancillary staff, for example, can help to identify problems and study potential resolutions that may result in improvements to the processes, which can affect the design. They know first-hand about the current limita- tions in the care delivery system. Workflow analysis identifies the limitations and how extensively the limita- tions affect the processes that cause inefficiencies and inconveniences in delivering care.

This first pitfall is easily avoided if you simply engage all people who will be affected by the new unit in the design process. Input is the key to releasing the tremendous energy of the users to help improve the processes.

Problem 2 Failure to Study Operational Processes Before Design Processes can only be as good as they are designed to be.

How the physical design and the care delivery design will mesh is very important to outcomes when design- ing women’s and children’s services. Obtaining input from front line staff and managers regarding the flow of care delivery is essential to obtaining a successful outcome. Workflow studies give an opportunity for staff members to evaluate how they deliver care. These srudies also help to identify where and what improve- ments can be made to make the work process more eff ic ies Planning is instrumental to successful design and shoufd always include a workflow study. These studies also gan help determine optimal patient care delivery design for a unit to improve its processes and the outcomes of rbese processes.

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Workflow mock-ups help all members of the health care team visualize work in the room and analyze

what changes must occur.

Problem 3 Failure to Properly Train Staff Regarding Technological Improvements and Advancements Before Their Implementation Lack of education results in a lack of understanding of technology.

Technology in women’s and children’s services is extremely complex. For example, fetal monitors, which are used to monitor fetal well-being and uterine activity, are extremely complex in nature and can be intimidat- ing to staff members who use them in patient care. Inadequate training causes frustration among staff mem- bers who are unprepared in using the technology, and troubleshooting basic technological devices.

For example, computerization (i.e., bedside charting), requires that staff understand and use computers to input and obtain vital patient data. Labor beds have many unique additions that require additional training for staff to be able to quickly prepare and use a labor bed for delivery.

Acquiring the latest and most advanced technology is important in maintaining standards of care set to pro-

Top 10 Design Pitfalls 1. Failure to obtain user input from staff

2. Failure to study operational processes

3. Failure to properly train staff regarding

before design

technological improvements and advancements before their implementation

4. Failure to plan workspace in the LDR

5. Failure to plan for easy access into the system at the point of care

6. Failure to provide adequate storage space that is easily accessible from work areas

7. Failure to conduct feasibility studies and set realistic expectations for the operations of women‘s services

the grieving family when determining the aesthetics for the unit

9. Failure to identify future needs and plan for expansion of services if necessary

maintain multicare/treatment

8. Failure to recognize the unique needs of

10. Failure to plan for a room that can

vide optimal care and to provide safety for the patient. Just as important is the adequate preparation of staff in using these advances. The Joint Commission on Accreditation of Healthcare Organizations requires that staff members become properly trained and demonstrate competency in the equipment they use.

Problem 4 Failure to Plan Workspace in the LDR “Please move, there’s not room for me to get to my patient.”

Typically, when managing a patient in labor, the health care team uses only a limited area of the room surrounding the bed. Procedures, such as placing an epidural, IV maintenance, monitoring, and delivery babies, are performed in close proximity to the bed. Nearby, and within the room, are also an infant warmer, lighting switches, supply locations, charting area, and an emergency call bell.

In developing your design, room mock-ups can help staff visualize and determine a suitable work area and the appropriate placement of carts and other equipment in the work area. This is important for efficiency in the work processes and for user satisfaction. Workflow mock-ups help all members of the health care team visualize work in the room and analyze what changes must occur. Sufficient space also must be considered in the design phase to sup- port any emergency activities that may occur. It’s impor- tant to remember that emergencies require that staff mem- bers quickly access necessary equipment, call for assis- tance, and have enough space for all the emergency per- sonnel that may be needed and still access the patient.

Problem 5 Failure to Plan for Easy Access Into the System at the Point of Care Strained registration processes can severely affect the timeliness of treatment.

Cumbersome registration processes lead to difficulty in the processing of a laboring patient entering the sys- tem. The process becomes even more difficult if exten- sive care o r surgery is required early in the labor process. In some instances, infants may require labora- tory tests, chest X-rays, and other tests that are delayed due to the limitations of the registration process.

If the registration process has not been explored to identify flaws in the system, the new environment will be just that, a new environment, with the same old faulty system that causes the same problems that were present before the renovation project. Workflow analy- sis identifies the bottlenecks within the system and allows users to develop solutions before entering into a new environment.

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Problem 6 Failure to Provide Adequate Storage Space That’s Easily Accessible from Work Areas Space is a commodity in most facilities.

for facility managers and health care staff. The two most important aspects of storage are adequacy and ease of accessibility. Lacking either of these can signifi- cantly reduce a unit’s efficiency, productivity, and user satisfaction.

For example, providing only a small amount of stor- age space in a nursery will require numerous trips out of the nursery by staff to other supply locations. The same is true for a labor unit. Supply availability is critical to the staff for performing various patient care functions and activities. Endless trips to search for needed supplies may be avoided through a workflow analysis before the design process to determine where supplies will be stored and how the restocking process will occur. The workflow analysis helps staff to identify all the prob- lems within the current supply process and can help to avoid the problems inherently related to supply storage and maintenance.

Mock-ups of supply areas and of the patient care environment help to determine the most efficient loca- tion for supplies. This step will also help determine the main location for the unit’s central supply area from which the restocking of supplies will occur. Improvement in this process will improve user satisfac- tion and efficiency in care functions.

Storage is a common problem that creates frustration

Problem 7 Failure to Conduct Feasibility Studies and to Set Realistic Expectations for the Operations of Women’s Services Consideration should be made as to how and what would be required for the main OR staff to support ser- vices in OB unit.

Every obstetric unit wants to have and maintain an operating suite in the unit for cesarean procedures.

Assessing Your Environment In response to the need for proactive error assessment within the health care setting and the need for a way to identify those settings more prone to promote errors of al l types, the AWHONN Consulting Group (ACG) has devel- oped an assessment service to evaluate the patient safety quotient of obstetrical and neona- tal units and to consult with nurses, administra- tors, and others in designing and implementing systems to create an environment that values patient safety and prevention of errors. Created in 1999, the ACG is a team of national expert clin- icians, administrators, and managers who pro- vide on-site services to health care providers. ACG is uniquely positioned to move organiza- tions to the most current thinking on care for women and newborns.

Often, if a mother experiences complications, which can compromise the infant’s well-being, it becomes impera- tive that a cesarean section be performed. Having an operating room suite in the obstetric unit gives physi- cians quick and ready access to perform such surgeries.

An operating room within an obstetric unit requires trained staff to operate it and to perform as a surgical team. Staff members must be trained to circulate and scrub for C-sections; they must have competencies for assisting with C-sections, and these competencies must be demonstrated and maintained.

Having staff ready to function competently when the unit opens can be a problem if the facility fails to evalu- ate the feasibility and reality of this need. Experience and competency do not occur overnight; thus, plans must be made early in the project design to determine if this service can be safely provided and maintained. Determining the number of operating rooms to establish is an area that planners and designers must study close- ly. If a facility doesn’t have qualified staff to support an operating room, it doesn’t make sense to open a unit with two operating rooms.

A retrospective look at a facility’s C-section history during the past three years will provide a snapshot of the number of emergency C-sections that have been per- formed. This information, and current and projected OB volumes, will help determine the need for an addi- tional OR. Resource allocation is costly in this area, not only in staff, but also in liability. Therefore, careful analysis and feasibility studies must be conducted to determine the reality of the projected need.

Problem 8 Failing to Recognize the Unique Needs of the Grieving Family When Determining the Aesthetics for the Unit Happiness is sometimes clouded by grief in the obstetric area.

Grieving families and exuberant families are found in women’s services areas. Although design focus is to pro- vide an environment that will draw and serve potential expectant families, outcomes are not always what we

ACG assists organizations and groups in the diagnosis of problems and in the implementa- tion of solutions by addressing organizational, operational, and management issues. ACG‘s team of expert clinicians, administrators, man- agers, and educators are skilled in the following: .Translating standards and guidelines into practice H New program design and development

Staff development and training Development of risk management programs Operational assessment and redesign

For more information on ACG‘s assessment ser- vice to evaluate the patient safety quotient of obstetrical and neonatal units and other services, contact Vernell Dewitty at (202) 261-2432 or email her at vernelld@awhonn.org.

December 2000/Januarv 2001 A W H O N N L i f e l i n e s 27

expect. When outcomes are less than favorable, pregnant women and their families must be in an environment that supports more than the excitement of a new baby. The entire health care team must also be trained to work with special sensitivity toward these patients and their families.

Softer, calmer pictures and wall coverings can pro- vide an environment that supports both the exuberant new parents and the grieving family. Designating a small, quiet room in which husbands and other family members can gather is important. Women who have to cope with unexpected outcomes-even fetal loss-need space to deal with their own emotions; thus, a quiet room is essential in an OB unit. It can also provide fam- ilies with a place of solitude apart from the woman.

Problem 9 Failure to Identify Future Needs and Plan for Expansion of Services if Necessary Nursery level needs change as volume and customer demands change.

Failing to anticipate the need for additional services, such as a Level I1 o r I11 nursery, can create major prob- lems when future expansions are needed. Identification of code requirements for the nursery space must be made when planning an increase in the level of care that the nursery will provide. Limitations must be identified before the design phase to avoid complications when trying to convert to a higher level of service.

tion to the current nursery should include expansion areas. Thus, space will be available in the future, i f needed. Input from the entire health care team regarding what will be ,ceded to support the increase in the level of care to be provided is essential to ensure that the area designed meets the needs of all users. Code requirements must be identified and addressed in the initial planning and design phase to enable a facility to later expand and implement desired services.

To prevent major renovating costs later, space delega-

Failing to anticipate the need for additional

services, such as a Level I1 or I11 nursery,

can create major problems when future expansions are needed.

Problem 10 Failure to Plan for a Room That Can Maintain Multicaremreatment Obstetrics is volume driven.

To handle the peaks in the obstetric area, the unit should be 'fluid-flexible.' The environment must stretch to accommodate many patients. This need can best be seen when all the labor rooms are full and a patient pre- sents to the unit who is near delivery and there is 'no room in the unit.' To relieve this problem, a multi- carehreatment room can be a positive addition to an obstetric unit.

able information relating to the various ways that a room can be used to nieet a facility's needs. Adding a multiuse room provides flexibility to a confined unit. Planning before the design phase is necessary to identify such needs. Consider now what resources will be needed and where and how these resources will be maintained and obtained. +

Again, a workflow study analysis can provide valu-

Share Your Passions! We want to know what you're passionate about! And we have two departments in AWHONN Lifelines designed

to let you speak out about issues related to nursing, women's health, and newborn care of concern to you:

Commentary Reflections on Women's Health This is a no-holds-barred editorial-speak out

on an issue within nursing, women's health, or

newborn care, and, in 600 to 800 words, let your

colleagues know why you're so passionate about

this area.

Tell Lifelines readers of your own personal experi-

ences in nursing and as a women's health care con-

sumer in 800 to 1,600 words. Previous issues have

dealt wi th multiple births, home birth options,

neonatal loss, surviving breast cancer, and change

within the industry.

To submit an dr t ick foi convder;ition, Eni,jiI L /k / / r i e \ , i t I i f e l i i w w ciivhoiiii org or c d l the AWHONN Fax On Dmiand <jt

(800) 395 7373 and request documents hJ60 "Authoi Guideline>" and #J61 "Author Application "

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