Facts & Thoughts:
- Hospitals are dangerous:
- chance of dying through error between 1:300 - 1:700
- 10% of all patients get wrong meds.
- for every 1k patient days, 3.5 patients fall; and it costs 20k for unlitigated cases.
- CDC estimates 1.7M hospitals acquired infections with 100k deaths/year & costs 5B.
- Only 14-30% staff wash hand between patients. (too busy!!)
- Evidence Based Design: take benificial design & study it and see if it's cost-effective and if it's benificial.
- Evidence Based Medicine: take top practices and investigate whether or not they're warranted and if so why doesn't eveyone else do them (i.e. asprin within 30 minutes of heart attack)
Ideas about EBD Principles:
- Imporve Helathcare Quality and Safety:
- MRSA testing: investigate cost, and perhaps implement.
- Hand washing: come up with innovative ideas that encourge it i.e gloves with GEL inside
- Noise reduction: soundproofing walls,ceilings,floors also use GPS&PDA for physicians
- Create a Patient & Family Centered Environment
- Create more of a Hotel feel to hotel or more of a Homey feel to room
- Support care of the whole person
- retrospective vs. postproductive studies
- Create a positive work environment
- To address nursing shortage, utilize technology to assit/reduce work-load
- Seperate technical nurse work vs. clerical
- Design for Maximum Standardization, Future Felxibility and Growth
- Smart rooms that remember doc preference [light, music, equipment...]
- Combine adaptive room with AI
Site Visit Report
- Hospital main entrance is very gloomy; the dark marble might be suitable for a corporate setting but not for a children's hospital.
- Corridors weren't wide enough. Thinking about it, I am not sure any corridor I've seen could fit two rolling beds (side by side) and the idea of one corridor servers everything is just not functional.
- Waiting rooms were extremly boring, there didn't seem to be enough material/resources to keep children engaged or occupied while they waited.
- New transfusion lounge/area was very small, although the new entertainment chairs were very nice.
- Not too many windows to let in the natural sun light. Seems that they rely on electric lighting to compensate.
- Segregation of Traffic! there should be multiple paths/corridors that resolve the traffic issue and must be wide enough to fit two rolling beds side by side.
- More sunlight! the new design should allow for as much sunlight as possible. Perhaps they could have complete floor to ceiling glass windows to maximum light exposure (ofcourse there would be shutters/blinds/..etc to control it)
- Waiting rooms should be more fun for children; whether it be more video consoles or better entertainment centers (bigger TV's) and if sound is an issue you could use wireless headset to limit noise.
- Donor Recognition should utilize the "Grand Stairs" in the main entrance. Since the new design has a stair case that seperates two areas (i believe they were talking about thinking of the higher area as a stage) the steps could be used to put the names of the donors on each one; so people would read the names as they approach the stair case.
- Replace fish tanks with LCD monitors that display different images (fish, balloons, cartoon characters, ..etc)
- Donor Contribution: Julia Jones was explaining the philanthropic contribution of some of the donors and how the amounts vary in size and publicity. One comment was that someone who donated a million dollars wanted their name on a recognition board; yet someone who donated 18 million didn't even leave his/her name!
- Parking Situation: When I asked Julia about the parking situation, she explained that it was a problem. Currently the new design doesn't account for parking and as of today there are 30 parking spots (4 reserved for handicapped) to accommodate 40,000+ visitors annually!!!
- Aesthetic Sanitation: David Cowen was commenting about noticing antibacterial dispeners mounted on the wall (I'm guessing to encourage sanity among workers since 14-30% wash their hands between patients) and Julie was concerned that donors would not be pleased by it's aesthetic affect on the building.
Patient Centered Care
Thoughts & Conclusions
- The main idea I got from the class was that the healthcare system is looking to evolve into a more Patient Centered Care system. Where the patient's desire/needs/wishes are more of a priority rather than a suggestion.
- One of the ideas I had was to have all staff & personnel attend "Patient Centered Care" courses, lectures, or seminars. Furthermore, there should be an ongoing update of their basic skills to ensure they keep up to date with the latest methodologies & schools of thought regarding that matter.
- Healthcare providers should always place themselves in their patient's shoes. Asking themselves "What if I were this child's parent" thereby getting more involved rather than thinking of them as another patient with another set of problems.
- Adopt a room: this was one of the most interesting ideas. I think it allows people with specific causes close to their hearts, help others with their experience and suggestions.
- Adaptable rooms: Interesting idea, to me it reminds me of having a "Lego" room. You could easily change the building blocks (in this case furniture) and you can assemble the room how ever it desirable or convenient (i.e. more family space vs. more work space).
- Tube Med. delivery: One of the most creative ideas of delivery. My thoughts would be to have certain tubes for certain medication or certain rooms.
Technology & Medicine
Electronic Medical Records
Children's Healthcare of Atlanta - D. Heather
Clinical involvment in design detail
- With facilities, innovative ideas have to come before project scope is defined, therefore avoiding restrictions of budget and plans (area)
- Clinical people should be on the design table, and should be involved in trainging in order to be more effective in design table talks.
- Master Facilities Plan (MFP) Overview:
- 360 million expansion on 2 hospital campuses
- bed capacity to increase from 430 - 505
- 640k SqFt new construction and 237K Sq ft. renovation
- Not all problems are fixed (budget constraints)
- So many factors involved with the MFP team, seems everyone is involved and empowered to voice their opinoin in the design process (programming phase). I think that allows to cover all aspects/points of view for every component.
- Bringing orginizations in design process could make better choices in design phase or in the phase of buying technology (COW vs. Handheld).
- Phase 1: Cross Functional Teams:- Pharmacy, Lab, Materials MGT, .. etc
- Best practices according to whom?
- Phase 2: Teams refocused on Care Areas: change focus on care area (children)
- Identify key processess: Clinical care, Family support, Business operations
- Include all perspectices: Patient/family, physician, staff
Facilitating Team Process - David Cowan –
What an Engineer Does
- How we collect data, stat analysis .. pretty much tacking a number on everything
- Sturcture: Bldg. Equipment Tools ..etc
- Process: The steps used to achieve solution.
- Outcome: Result of process.
- Basically seeing if it works, how it works and does it satisfy all requirements.
- Utilize project managment principles to better handle project in terms of time,effort,...etc
How Teams work
- Leadership: draw out skills of diverse group members & manage their skills to achieve your goals.
- Brainstorming: avoid getting sucked into one idea direction, not allow one discipline to dominate
- Structured Decisions
- Divide & Conquer
- Deference: honoring the decision.. make sure you agree to and fully support idea
- Pediatrics: Not like adult hospitals ..
- Healthcenter: complex with clinics & inter-relationships between hospitals.
- Cultural Context: Different hospitals & functionality means things are done differently.
- Balancing the Priorities: make sure you don't deviate from priority list, more money might become available but it shouldn't stray the process.
Group Projects & Ideas
- Spatial Solutions: Rooms can expand & could have different layouts
- Patient Flow: Keep related services close by.
- Way Finding: Solutions: KIOSKS, GPS, RFID audio.
- Streamlining registrations: Solution is KIOSKS or Kids Cow
- Information (tracking & updates): Solution Step By Step Dashboard
- Security/Kid finding: Solution embedding RFID trackers in patient bracelets.
Problems Refinement: Gerri Lamb
- What's the problem you're trying to solve.
- What are the characteritics needed to be considered for solution.
- Information passing to kids/family
- How to make hospitals more fun/educational to kids
- lack of hand washing cause high infection rate in hospitals
- a mother (parent) are easily distracted (children)
- waiting rooms are not adaptable for different functions & uses (& boring)
Problem Refinement: Group Presentation
Ideas seem to be more concise, however, some are still general. It's interesting that all the presentation overlap or intersect over/about some points; which i don't know if that's because everyone is thinking along the same lines or if they're all set on one set of problems.
- As far as patient retention goes, the patients are not financially capable of making complete payment if any, therefore i am not sure that would be a problem.
- I actually like the waiting time problem.
- I agree with the evidence presented especially visualization of signs.
- Repeating patient history is a problem dependant on hospital charting method.
- I wondering if repeat vistors (unneccessary) are educated about their child(ren)'s disease.
PROBELM REFINEMENT: TEAM PRESENTATION
- "Lack of coherent information and communication from physicians and nurses"
- Room aesthetics: cost benifit analysis for private vs. shared rooms
- Floor map design complexity. I really liked the complexity/time graph.
- Hospital not conducive to healing..
1) More percise about probelm definition: narrower scope. 2) Evidence that is examples, ideas Vs. research evidence. 3) Principles -> Evidence -> Circumstances (find opportunities for desing/innovation) 4) Work from Principle towards solution using evidence & benchmarking 5) Nature of clients (kids, families, cases) and work on a solution.