Healthcare Design - September 2013 - 64

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back and it really makes sense-if you turned
the building upside down, what all would fall
out of it? That's all the stuff we need to put
into the building. That's the facility readiness
standpoint.
From an operational readiness standpoint, in
that NICU example, you've got the facility ready
and the nurse call
[system] is installed.
Now, when can we
get the nursing unit
on the floor to start
training on that nurse
call? When can the
nursing unit get in the building to understand
their new operational processes? Is it a new
system? What bells and whistles on the system
are new and how will that enable them to provide patient care?
Facility readiness really starts on day one [of
the project]-it's when you meet with the engineers and designers, and you're getting that
facility planned, designed, and constructed.
I could argue that the operational readiness
piece should start then, as well, in terms of
what workflows and procedures are being
developed as the design moves forward. Then
the operational readiness piece is in a proactive
planning state rather than a reactive planning
state.

"We have to understand the
staffing model well in advance
of certification of occupancy."

Where do the "5 rights of operational readiness" come in? Can you break them down
for us?
First, staff orientation, education, and training.
Then, how does that play into the facility readiness coordination? Then the proper operating
sequences are how a department is going to
interact with other departments. For example,
what does the operating sequence look like in
your new facility from a patient presenting in
the ED? How do they get admitted? What is
their operating sequence to go from the ED, to
imaging, then to surgery? What's the process
of getting them from surgery into a step-down
unit? All those different things, the way we've got
to map out their processes so, again, nothing is
new on day one.
For appropriate staff alignment-I'll go back
to the NICU example-we had a 13-open-bay
NICU department with staff who knew exactly
what to do in that setting. When we went to
the 24-private-room ICU, the staffing model
changed. We have to understand the staff-

www.healthcaredesignmagazine.com 09.13

ing model well in advance of certification of
occupancy. We have to understand what
the proper ratios are in terms of nursing staff
and patients to make sure there's no waste,
that there's no overstaffing, because those
are real dollars.
And technology is probably one of the
things we run into the most in terms of the
grandiose size of this topic. It is so everevolving. With that in mind, there's always
going to be the training from an IT perspective and a technology perspective of all types
of systems within these new facilities. We're
also seeing a lot of these sophisticated
healthcare facilities rolling out their new EMR
projects.
So you have all sorts of new systems and
applications that staff are not only trying to
learn and understand what they do to help
provide patient care, but then they're also
trying to learn and orientate themselves to a
new department, along with a new staffing
plan, staffing ratio, and new employees.
You have a whole lot of dynamics coming
together.
What kind of training/orientation should
be done to ensure staff is ready to use a
new space as the design intended?
One thing we like to do is take a phased approach in terms of the orientation. We'll do a
building/life safety orientation to get everybody accustomed to where they're going to
park, what door they're going to go into. It's
easy to assume that people know how to get
into the building because I've been in it 20-30
times, but a lot of these third-shift nurses
haven't. So you have to be very detailed as to
all the steps you need to take to get people
into the building, where the egress points are,
where the stairwells are, and then gradually
come back and do your department-specific
tours.
One thing we do is scavenger hunts, making this a department-specific activity where
you can't go to the next realm of training
unless you know where the pneumatic tube
is, know where the clean room is, and know
where the medical dispensing stations are
within the unit. And then start conducting
your day-in-the-life scenarios. We've seen a
lot of clients that will spend one whole day,
24 hours, and staff a department prior to
go-live and run through different scenarios

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Healthcare Design - September 2013

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