Given the current economic situation and pending healthcare reform, healthcare owners aren't just looking for the most aesthetic, inviting healthcare environments to promote customer loyalty. Today's clients are relying upon their design teams to create healing, evidence-based environments that promote safe and effective medical care while optimizing operations.

From minimizing staff walking distances to streamlined distribution of medications, these multifaceted teams are charged with diligently looking at ways to cut down on excessive space to work more efficiently, optimize staff efficiencies through proven, researched options, as well as offer viable alternatives that promote quality and safety.

The introduction of clinicians to the design conversation

HKS formed the Clinical Solutions & Research (CS&R) group four years ago. These clinicians, architects, medical planners, and researchers, who have dedicated their lives to healthcare, bridge the gaps between form, function, and healthcare operations-working in tandem with healthcare design specialists-to incorporate day-to-day hospital workflow and operations into the design process.

The core group of full-time clinicians offers specialties in nursing, major diagnostic and treatment services, medical technology, information systems, quality improvement, patient safety, infection control, and research. This experienced team shares a broad spectrum of knowledge including master planning, programming, planning, and operational experience, as well as process design and workflow.

In addition to working on HKS projects, the CS&R group conducts research projects throughout the country-all of which have been the topic of presentations and industry articles.

Together, with experienced healthcare architects, the CS&R group works with clients to help them understand what is possible-what could be and what should be, based on their specific circumstances and goals. The HKS clinicians facilitate discussion, conduct and share research, and create an ideal state by challenging traditional thinking.

Lean operations at Flower Mound

At Texas Health Resources (THR) Presbyterian Hospital of Flower Mound, lean operations-eliminating waste and improving efficiency-was the goal.

Instead of the industry standard of 2,300 building gross square feet per bed, the hospital has streamlined its unit to 1,900 building gross square feet per bed without minimizing quality, safety, and healing care.

How did they do it? Working with the CS&R group from the initial design, THR's Senior Vice-President Cindy Slaydon provided a list of challenging areas and operational inefficiencies within the hospital environment. The group took the list and worked to improve efficiency in each and every area.

For example, Slaydon felt that shared spaces would streamline square footage throughout the hospital. And, she was right. CS&R, working with HKS designers, located the prep-recovery on the first floor next to the emergency department. Since the prep-recovery area is not used at night, it can flex into emergency space-taking advantage of census ebbs and surges. The ICU is co-located with PACU on the second floor, allowing the two units to share support space for medications and supplies. Waiting spaces are also minimized to allow shared use.

Following three months of operational planning and programming, CS&R provided a 100-page manual with a flow chart of operations and a section dedicated to each department. It's not a policy and procedure manual, but a user guide for the hospital leadership team.

When opened in 2010, Presbyterian Hospital of Flower Mound will provide approximately 100 patient beds, an emergency department, and a wide range of medical services in an operationally optimized facility.

Less stress at Children's Healthcare of Atlanta

More than 30 nurses from the Children's Healthcare of Atlanta at Egleston and Scottish Rite hospitals volunteered to participate in the research study, working in spaces designed with natural light and nature views while others worked in white-walled interior spaces with limited, non-nature, or no views.

What research found was that while views did not impact chronic stress during the 12-hour work shift, they had significant impact on acute stress levels and alertness. These results were derived from multivariate statistical analysis of a series of hypothesized stressors on nurses.

Providing views is shown to be a significant, possibly critical, factor to a caregiver's focus on their subject (the patient) and their tasks (caregiving). This finding warrants a change in healthcare facility planning and operational policies.

When designing the new facility, administrators embraced the importance of views and visual relief specifically for staff work areas as capital planning and budgeting is conducted, and emphasized the importance of adequate and well-distributed space for employee respite and relaxation when on break or at lunch.

Decentralized medication storage at work at Houston Medical Center

CS&R-working with Georgia Institute of Technology-conducted a research study measuring the time nurses spent on medication-related activities at Houston Medical Center to fine-tune its operations. Their research predicted that designing decentralized medication storage, specifically through nurse servers, has a significant impact on reducing walking distances and increasing patient care time.

To improve efficiencies within the Houston Medical Center's surgical neuro/ortho unit, administrators looked at two options when designing. The first option was creating one central medication room, while the second included creating a number of decentralized nurse servers.

“We wanted to compare how one design performed compared to the other,” says Grady W. (Skip) Philips III, chief operating officer with Houston Healthcare. “To access the two scenarios, we commissioned a MedModel simulation study, working with a team of clinicians and management staff.”

The result of the MedModel simulation suggested that, on average, nurse servers in patient rooms reduced nurse walking by 576 feet over a 12-hour shift (note that reduction in walking will vary depending on the patient population being served). This translates into an increase of 30 minutes in direct care time.

A look back

Improving the patient experience has been the topic of discussion for decades. The concept of patient-centered hospital care traces back to 1977 with Angelica Thierot's introduction of the Planetree model, which stresses the importance of the physical environment in promoting the healing process.

In 2000, all of these healing concepts were put to the test through a process called evidence-based design introduced through The Center for Health Design's Pebble projects. Results were measured and defined-creating evidence-based design. Healing architectural design and cost-effective facilities work hand-in-hand successfully positioning the health providers to attract patients, physicians, and staff.

Today, with the inclusion of clinicians on the project team, the subject matter is broadening to include optimizing operations through design.

“Following the study, we implemented the model on our new medical tower that opened the spring of 2009,” says Philips. “It is a hybrid which includes the strategic placement of routine, non-packaged medicines in the patient rooms in conjunction with bedside medication verification.”

Currently, three of the CS&R group's decision tools are copyrighted and used exclusively by healthcare providers when designing patient rooms, deciding between headwalls and ceiling booms, and determining bed unit size.

The group's paper titled, “Inpatient Unit Flexibility: Design Characteristics of a Successful Flexible Unit,” was named the Best International Research Project at the 2009 Design & Health International Academy Awards. The award was presented at the Sixth Design & Health World Congress, held June 27, 2009.

In addition to healthcare white paper and article contributions, the group takes their healthcare show on the road regularly serving as speakers at key conferences with organizations including The Center for Health Design, Tradeline, Healthcare Facilities Symposium & Exposition, and the American Society for Healthcare Engineering.

The group envisions developing original research on topics that will have a wide influence on projects completed at HKS as well as throughout the healthcare industry. This ideal healthcare facility is highly productive, efficient, and streamlined, delivering healthcare in an aesthetic, poetic environment that contributes to healing. HD

Tom Harvey is Principal/Director, Terry Ritchey, RN, MBA, is Vice President/Manager, and Debajyoti Pati, PhD, FIIA, is Director of Research, all with HKS Clinical Solutions & Research.

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Healthcare Design 2010 April;10(4):34-38