Healthcare Design - September 2016 - 72

In Focus

2/11

HE DESIGN OF a new medical/surgical unit can cause
mixed emotions among users of the space: excitement from knowing that an improved work environment typically equates to improved workflow but
also anxiety regarding changes to staff processes
and delivery of care. A classic example of this can be
found in transitioning from a centralized to a decentralized model.
The existing body of knowledge on decentralized models is littered
with research studies demonstrating improved working conditions,
such as reduced travel distances and more time spent in patient rooms.
However, it's also acknowledged that users may experience a disconnection with colleagues due to an increased physical distance from one
another and find that supplies often aren't restocked appropriately.
Similar implications were experienced during the build-out project of an academic med/surg unit at Froedtert Hospital and the
Medical College of Wisconsin in Milwaukee. Staff were used to working in a traditional environment and were skeptical that an update
could make a difference. However, the project team used research,
along with John Kotter's eight-step change management theory, to
aid the staff in adapting to changes in care delivery and the physical space. The unit was transformed from being centralized, where a
majority of the supplies, medications, and charting/team stations
were located at the elbow of the L-shaped unit, to decentralized,
where these areas are now located at the bedside or right outside the
patient room.
Kotter, the Konosuke Matsushita Professor of Leadership Emeritus at the Harvard Business School, introduced change management
theory in 1996. His research found that organizations make eight
common mistakes resulting in change failure. He transitioned these
mistakes into eight steps that are needed for organizational transformation. The first three support a climate that promotes change by gathering buy-in from staff, creating a comprehensive project team, and
working toward a shared vision. Steps four through six address the need
for communication, information sharing, and supporting the team to
think creatively by removing barriers. The final two steps make sure
change is continuously improved and implemented. For this project, if
frontline staff were resistant to change, desired outcomes established
by the project team and organization wouldn't have been met-no matter how the unit was designed. So, ultimately, change management was
used alongside design research to help staff become more willing to
accept and adapt to planned shifts in their processes and surrounding
environment.

STEP

BUILD

COALITION

VA R I O U S E X P E R T I S E A N D I N S I G H T S

The new decentralized
24-bed inpatient unit
has supply servers and
charting outside each
patient room, along with
handwashing stations
throughout. During predesign meetings, staff
researched and provided
hand drawings of what
they wished the servers
would resemble, including
doors above for supply
crates and drawers
below for medication and
personal protective equipment, very similar to the
final design.

For this project, the voices that were most impactful were those of the frontline staff. A project team was assembled that engaged staff to
influence design decisions. Members included
nurses, nursing assistants, nursing leaders, physicians, residents, therapists, supply chain workers, nutrition experts, and more. As the project
progressed, staff were divided into teams that
represented different user types and asked to
engage in a variety of exercises. These exercises
included space adjacency diagramming, where
teams were able to organize the space according to their needs; "speed dating," where teams
asked one another questions about their processes; and information gathering, where teams
were assigned to investigate specific topics of
interest. All of these exercises aided in developing ownership from staff on future physical and
operational changes.
For example, during an adjacency diagramming exercise, staff indicated that what they
wanted closest to the bedside were supplies,
linens, equipment, and charting stations. As a
result, staff realized they were actually asking for
a more decentralized environment to improve
inefficiencies around their current workflow.

S T E P 1 : C R E AT E A S E N S E O F U R G E N C Y A N D A S H A R E D
VISION

Three individuals from the HGA design team spent a week on the unit
gathering qualitative data through patient and staff interviews and quantitative data through direct shadowing of staff. Just the presence of the
designers asking questions and recording time-and-motion data was paramount in receiving buy-in from staff. It demonstrated to them that the design would be meaningful and data-driven, not just aesthetically pleasing.
At the first project meetings, documented findings were shared with staff
that highlighted opportunities for improvement. Staff realized that if they
worked in an improved environment of care delivery, their ability to provide better patient care would be strengthened.

SEPTEMBER 2016

S T E P 3 : F O R M O P E R AT I O N A L A N D

All the data collected during the early phases
of design was used to inform the development
of a design criterion called "critical to quality,"
or CtQ, a Lean term in which critical needs (either operational or physical) are identified and
addressed to support a quality clinical outcome

HCDMAGAZINE.COM

DARRIS LEE HARRIS PHOTOGRAPHY

DESIGN GOALS

http://www.HCDMAGAZINE.COM

Healthcare Design - September 2016

Table of Contents for the Digital Edition of Healthcare Design - September 2016