Creating a Patient-Centered
Care Environment on a
Medical-Surgical Nursing Unit
Using Evidence-Based Design
Debbie Hunt MSN RN CNOR NE, B/C DNP (candidate)
Academic Advisor: Olivia May, DNP, CRNP
Clinical Advisor: Terri Joiner, FNP-BC
June 1, 2014
Objectives
 Discuss the background of the project
 Define patient-centered care
 Discuss the process
 Discuss the results
 Discuss implications
Why replace the current hospital?
 Space, fire, and life safety issues
 Floor to floor heights
 Distance between structural columns
 200,000 sq/ft short of space needed for workload
 Current infrastructure does not allow renovation to
accommodate current and future health care design
criteria
Background
 2004 - Capital Assets Realignment for Enhanced Services
(CARES) commission
 2006 – Secretary for Veterans Affairs accepts
recommendation
 2012 – Site selected and purchased
 2012 – Core Activations team established
 2013 – Focus Groups and Schematic Design 1
 2014 – Schematic Design 1 completed
VAMC Louisville
Replacement Medical Center Timeline
Site Selection
SecVA announced
the Brownsboro site
as the location for
the new Robley Rex
VA Medical Center
June 2012
Master Planning
Completed
22 Nov 2012
July 2012
Site Purchase
The Brownsboro
site purchased
12 July 2012
Nov 2012
Activation
Team
Hired
Begin
stakeholder
focus groups
Aug 2013
Aug 2013
Schematic
Design
Initiated Aug
2013.
Construction
Award late
2015 Estimated
completion, 34 years
May 2014
2019-2020
Schematic Design Projected
Completion
Completion
May, 2014
Defining Patient-Centered Care
 Referenced as far back as the 1950’s but not prioritized
(Cliff, 2012)
 Other priorities including patient safety, delivery of
quality care and operating budgets.
 2001 – Institute of Medicine report Crossing the Quality
Chasm: A New Health System for the 21st Century
 Institute for Healthcare Improvement definition
 Patient-centered care moves to the forefront
Institute for Healthcare
Improvement
 Independent not-for-profit organization founded 25
years ago
 Partners with visionaries, leaders, and front-line
practitioners around the globe
 IHI Patient-Centered Care definition
The Planetree Organization
 Founded in 1978
 Mission – patient-centered focus
Sticher, 2011
Nine Elements
1. Human interaction
6. Human touch
2. Patient education and
information
7. Healing Arts
3. Healing partnership with
family and friends
4. Healing nutrition
5. Spirituality and personal
healing resources
Sticher, 2011
8. Alternative and
complementary care
9. Healing environments.
Process
 Defining the Vision
 Space planning
 Stakeholder management
 Site visits
Defining the vision
 Why is this important?
 Provide a foundation for decision making
 Department of Veterans Affairs
 Vision for care deliver
 Guiding principles
VA Office of Construction &
Facilities Management
 VA and patient-centered care
 Developing and integrating a care delivery model focused
on patient centered care specifically as it applies to
Veterans (Design Guide, 2011, p. 7).
 VA and Planetree
 Partnering with Planetree
Veteran Centered Care Core
Principles
 Honor the veteran’s expectations of safe, high quality, accessible
care
 Enhance the quality of human interactions and therapeutic
alliances
 Solicit and respect the veteran’s values, preferences, and needs
 Systematize the coordination, continuity, and integration of care
 Empower veterans through information and education
 Incorporate the nutritional, cultural and nurturing aspects of
food
 Provide for physical comfort and pain management
 Ensure emotional and spiritual support
 Encourage involvement of family and friends
 Ensure that architectural layout and design are
conducive to health and healing
 Introduce creative arts into the healing environment
 Support and sustain an engaged work force as key to
providing veteran centered care (Design Guide, 2011, p.
7)
Space planning
 Multidisciplinary, integrated activity
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Activations team
Leadership
Architect and Engineer firm
Department leadership
Central Facilities Management (CFM)
Veterans Integrated Services Network (VISN)
Stakeholder Management
 What is stakeholder management?
“a process of enabling stakeholders to identify,
negotiate and achieve their objectives, such as
social, environmental or economic, through
active participation in the project process”
(Rowlinson and Cheung, 2008, p. 611 as cited in
Brammer and Millington, 2004, and Palunen,
2006)
Institute for Patient and Family
Centered Care (IPFCC) patient
and family-centered care concept
 “Patient- and family-centered care is an approach
to health care that shapes policies, programs,
facility design, and staff day-to-day interactions.
It leads to better health outcomes and wiser
allocation of resources, and greater patient and
family satisfaction (2014, para. 1).
Primary Stakeholders for MedicalSurgical Unit
 Deputy Nurse Executive
 Nursing unit staff
 Pharmacy
 Discharge Planners
 Food and nutrition
 Environmental management services
 Healthcare providers
 Veterans and families
Presentations
 Staff meeting presentations
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Multiple meetings on all shifts
Defining patient-centered care
Review of renderings
Brainstorming
 Veteran Service Organizations (VSO) presentations
 Monthly meetings
 Defining patient-centered care (different from veterancentered care?)
 Review of renderings
 Brainstorming
Schematic Design User Group
Meetings
 Schematic Design 1 – further develops concept plan to a level
of detail that includes functional and adjacency requirements
and establishes the aesthetics of the design (A/E submission
Requirements, 2013, p. 16).
 On-site user group meetings
 Subject matter experts (SMEs)
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Deputy Nurse Executive
Associate Chief Nurses
Nurse Managers
Patient Safety Officer
Infection Control Coordinator
Schematic Design User Group
Meetings
 Schematic Design 2 – further refine the solution developed in
SD1 and to validate that project goals and parameters are
reflected in the design, which is further developed at a roomby-room level of detail
 On-site user group meetings
 Subject matter experts (SMEs)
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Deputy Nurse Executive
Associate Chief Nurses
Nurse Managers
Front line staff
Patient Safety Officer
Infection Control Coordinator
Site visits
 Trend toward evidence-based design
 Examples of evidence-based design
 Best practices
 Planetree
Site Visits
 Norton Brownsboro
 Jewish Hospital Medical Center East
 University of Louisville Hospital
 University of Kentucky Hospital
 Las Vegas VA
 Orlando VA
 Palo Alto VA
Discussion
 Implications
1. Improve patient outcomes
2. Improve staff morale
3. Improve patient/family satisfaction
4. 10 designated Planetree hospitals “exceed the
Centers for Medicare and Medicaid Services
(CMS) national averages on several core
measures (Frampton and Guastello, 2010, p. 52)
Sharp Coronado Hospital Study
 Retrospective study examining data from two medicalsurgical units over five years.
 One unit had implemented Planetree and one had not
 Planetree unit demonstrated:
1. Shorter average lengths of say
2. Statistically significant lower costs per case
3. Higher average overall patient satisfaction scores
(Frampton &Guastello, 2010)
Conclusion – So What?
 VA mission to create a patient-centered care
environments that are Veteran centric
 Exciting time for Veterans and those involved
References
A/E Submission Requirements for VA Medical Center Major New
Facilities, Additions & Renovations. Retrieved from
http://www.cfm.va.gov/til/ae/aeSubMaj.pdf.
Cliff, B. (2012). Patient-centered care: The role of healthcare
leadership. Journal of Healthcare Management / American
College of Healthcare Executives, 57(6), 381-383.
Design Guide. (2011) Department of Veterans Affairs Office of
Construction & Facilities Management design guide November
29, 2011. Retrieved from
http://www.cfm.va.gov/til/dGuide/dgInpatientNU.pdf
Frampton, S., and Charmel, P. (2009) Putting Patients First:
Best Practices in Patient-Centered Care, 2nd ed. San
Francisco: Jossey-Bass.
Frampton, S. B., and Guastello, S. (2010). Patientcentered care: More than the sum of its parts. The
American Journal of Nursing, 110(9), 49-53.
Garon, S. (2006). Space project management lessons
learned: a powerful tool for success. Journal of
Knowledge Management, 10(2), 103-112.
Institute for Healthcare Improvement (2014). About IHI.
Retrieved from
http://www.ihi.org/about/Pages/default.aspx
Institute for Healthcare Improvement (2014). Person- and
Family-Centered Care. Retrieved from
http://www.ihi.org/Topics/PFCC/Pages/Overview.aspx
IPFCC Frequently Asked Questions (2014). What is patientand family-centered health care? Retrieved from
http://www.ipfcc.org/faq.html
Rowlinson, S., & Yan Ki Fiona, C. (2008). Stakeholder
management through empowerment: modelling project
success. Construction Management & Economics, 26(6),
611-623. doi:10.1080/01446190802071182
Stichler, J.F. (2011). Patient-Centered Healthcare Design.
Health Facility Design, 41(12), 503-506.
VA Executive Summary 2008 (n.a.) Retrieved from
Louisville Replacement Hospital SharePoint.
VA Space and Equipment Planning System (2014). Office of
Construction & Facilities management. Retrieved from
http://www.cfm.va.gov/TIL/planning.asp