Martha Harvey
West Park Healthcare Centre
Cliff Harvey
North York General Hospital
Design Session:
From Theory to Practice
Thinking @ Work
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Ontario’s Quality Journey
Are we any closer?
Etch A Sketch
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Is it our Definition of Quality?
or
Is it our Process to Arrive at Quality?
Or is it Both???
What is the Issue?
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Quality is an Omnipresence Word
IDEAL
Politics- Economics
GOOD
Ethical-Moral
REAL
Aesthetics
TRUE
Scientific
Quality
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System Thinking
Seeking
Patterns
Scenario
Planning
Absolve
Resolve
Solve
Dissolve
Strategic
Foresight
Design Thinking
System vs Design Thinking
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Mental Model
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Scientific Management
Administrative management
Operational Research
Mental Model
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Mental Model
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System Thinking
Complex
Adaptive
Systems
Wicked Problems
(Rittel & Weber)
Messes
(Ackoff)
Design Thinking
Wicked Problems
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Louis Kahn
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What is the shadow of white light …
Black …
I think that it is a time of our sun on trial
of all our institutions on trial
I was brought up when the sunlight was yellow,
And the shadow was blue
Louis Kahn
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Capitalist Dilemma
Invest for:
Performance
Efficiency
Innovation
Capital Dilemma
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System Thinking
Prototyping
Design Research
Simulation
Story Telling
Mental Models
Stakeholders
Mapping
Dialogue
Scenario Planning
Foresight …
Visioning
Analytics
EBD Research
LEAN
Standards
User Groups
Mock-ups …
Design Thinking
Thinking Tools
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Tim Brown
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Bridging the Gap
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Bridging the Gap Between
Strategy and Operations
Bridging the Gap
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Claude Debussy
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Music is
the space
between the
notes
Claude Debussy
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Linear Process
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Linear Process
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Complex Adaptive Systems
Learning / Emerging
Heterarchical
Nested Systems: Ecology
Complex Adaptive Systems (CAS)
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Nested Systems Design
Social
Organization
Service
Design
Nested Systems
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Quality is an omnipresence word
IDEAL
Politics- Economics
GOOD
Ethical-Moral
REAL
Aesthetics
TRUE
Scientific
Quality
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Map out your Problems
4
Regulations
3
Policies
2
Guidelines
1
Standards
Find the Right Tools
Mapping
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Etch A Sketch
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Building an
INTEGRATED CAMPUS OF CARE
Building an Integrated Campus of Care
Date
“Breaking New Ground”
December 8, 2014
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West Park at a Glance
 Founded in 1904 as a tuberculosis
sanatorium
 Three programs of care:
• Specialized rehabilitation (130 beds)
• Complex continuing care (140 beds)
• Long-term care (200 beds)
 Serving 7,000+ patients per year
• 1,400+ inpatient admissions
• 57,000+ ambulatory visits
 Serving adults of all ages:
• >45% of rehab patients are less than 65
• >80% of CCC patients are older than 65
 Staff:
• 885 employees, 85 physicians, 225
volunteers, residents and students
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West Park Services
West Park’s patients come
from all over Ontario:
 Province-wide:
Tuberculosis and Chronic
Assisted Ventilatory Care
(CAVC)
 Regional: Specialized
rehabilitation services –
Acquired Brain Injury
(ABI), Respiratory,
Amputee
 Local: Rehabilitation,
Complex Continuing Care,
and Long Term Care
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Our Challenge
 Expected service demand growth
- 50% over the next two decades
 Primary barrier - outdated
facilities and service capacity:

60% of patients are in 4-bed rooms

Only two private rooms per 26-bed unit

Limits ability for:
- isolation capacity
- optimal infection control
- use of modern equipment
and technology
 Limited space for patient and
staff consultations
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RFP Road Map
“Building a Plane While Flying”
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Boeing Dreamliner Collaboration
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“Breaking New Ground”
Integrated and Collaborative Model for Planning
Collaborative team to create an integrated project:
 Consultant continuity between MoHLTC Capital Planning Stages
2&3
 Functional Programming role fully integrated within the overall
design scope of the PDC
 Clinical involvement from the start
 Holistic approach
 Need strong project vision
 Greater creativity and innovative thinking when planning
solutions and processes
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“Breaking New Ground”
Pre-functional Programming Toolkit
 A set of planning principles based on research, bestpractice and evidence-based design
 First Ontario hospital to “pilot” a formal process
 Hand-off of toolkit to PDC team to build on
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Elements of Toolkit
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User Groups
 Involved from the start - Lean workshops,
Functional Programming, prototyping, etc.
 Stakeholders - staff, patients, families,
physicians, volunteers, community agencies,
etc.
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Lean
 Bring value to the patient and reduce waste
 Operationally efficient
 Workshops:
• Current State Patient Flow Maps
• Future State Patient Flow Maps
• Value Stream Mapping
• 3P Workshops
 Determine extent of Lean – transitional versus
transformational
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Prototyping
 Test workflow, space requirements, placement
of FF&E, etc.
 Throughout planning and design phases
 On-site design lab, off-site design lab, 3P
process
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‘Day In The Life’ Tool
 Capture the patient experience
 Validate planning and design from the patient’s
perspective
 User stories – test for quality of healthcare design
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“Take Aways”
1. Pre-Functional Programming Toolkit
•
Worth the effort
2. PDC Early Involvement
•
Enhanced integration and collaboration
3. Early Clinical Integration
•
Assists with early translation of clinical perspectives
4. User Involvement
•
Key throughout entire process
5. Lean, Prototyping, Day in the Life
•
Valuable tools
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(picture: P. Hagan)
THANK YOU
Martha Harvey, RN, BScN, MSc Healthcare Quality, EDAC
Senior Project Manager, Clinical Integration
Campus Development, West Park Healthcare Centre
martha.harvey@westpark.org
416.243.3600 ext. 2059
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