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.