Integrating the Process
Learning Objectives
• Discover the role of the nurse in healthcare design and
determine how nurses can be leaders.
• Learn about evidence based design and list areas of design
that have been proven to improve patient outcomes.
• Learn current design and technology trends and relate
those scenarios to their current work environment.
• Identify nurse leadership initiatives to align the
architecture and technology to support processes and work
flow.
Vanderbilt
Nursing
School
1984
1984
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Open Wards
Semi Private Rooms
Centralized Nursing
8 hours shifts
Rolling Medicine
Carts
Today
• Private Rooms
• Decentralized
Nursing
• 12 hours shifts
• Bar Code Medication
• Patient Entertainment
• Family Area
Support and optimize
the delivery of care
models through
architecture and
technology
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Nurses have unique
perspectives
- Patient Safety
- Family/Care giver needs
- Physician Interactions
- Infection Control
- Working with Teams
- Work flow and processes
- Medication Safety
- HIPAA Compliance
- Communication
- Organizational Culture
- Organizational Initiatives
- Care model/Patient care
philosophy
- Critical thinking skills
- Outcomes oriented
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Interdisciplinary leadership
Communication &
relationship building
Knowledge of the healthcare
environment
Business skills
Professionalism
Transformational leadership
Stichler, JF (2007). Nurse Executive Leadership Competencies for Health Facility Design. JONA, 37(3), 109-112.
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Nurse Executive
- Validating that the design
supports the strategic vision,
mission, values and culture
of the organization
- Stay involved
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Chief Nursing Officer
- Ensuring that the design
supports the professional
practice model
- Insure project continuity
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Director
- Articulating how the design
will affect costs, market
share, satisfaction levels
- Design principles metrics
- Change management
- Policies and procedures
- Training
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Manager
- Determining how the
design affects staffing and
patient flow
- Giving staff time to
participate
- Create enthusiasm
- Team Builder
- Staffing
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Staff Nurse
• Giving input to the
architect team
• Soliciting creative ideas
• “Being present”
• Team Supporter
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Nurse Project Manager
• Coordinating the
interdisciplinary process of
design, giving a voice to all
providers and patients
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Nurse Project Director
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Nurse Consultant
• Managing millions or
billions of dollars; keeping
the project on time and
within budget
• Big picture/managing details
• Internal to the organization or
external in the architects office
• Integrating the voice of nursing
patient care and design
• Who’s on the project team?
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Nurse
Architect/Designer
• Interfacing the design
world with health care
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Nurse Researcher
Nurse Technology
Expert on work flow
analysis
Evidence based design
is the intentional
attempt to base design
and construction
decisions on “evidence”
or “research” to
improve outcomes for
patients and staff.
Schiphol Airport in Amsterdam
Alzheimer Bus Stop
The Benrath Senior Center - Düsseldorf,
Germany
First
Evidence based
Design
Practitioner….
It may seem a strange
principle to enunciate as the
very first requirement in a
Hospital that it should do the
sick no harm.
Florence Nightingale, 1859
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Group of researchers
from Texas A&M and
GeorgiaTech combed
through several thousand
scientific articles.
More than 600 research
studies were found that
establish a link between
hospital design and
improved outcomes for
patients and staff.
The studies were
assessed on their rigor,
quality of research
design, sample sizes and
degree of control.
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Patient
confidentiality
Noise
Nature
Daylight
Positive distraction
Social support
Improved
communication
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Medication errors
Patient falls
Infection control
Ergonomic design
Improved layout
for reduced steps
Consistency in
design
Healthcare Work Environment
(Architectural/Engineering Perspective)
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Square Footage Requirements
Building Codes and Regulations
Space Planning
Adjacencies
Infrastructure
Used by permission: Roger K. Lewis, FAIA, Architect & Planner Columnist,
"Shaping the City," The Washington Post, Professor Emeritus, University of
Maryland School of Architecture, Planning and Preservation
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Healthcare Setting
Work Processes
Workforce Demographics
Culture and Geographic Location
Information Technology
You have to understand how a nurse works in a room in order to
design it well
Design Process
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Programming
Schematic Design
Design Development
Contract Documents
Construction
Nursing Process
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Assessment
Planning
Intervention
Evaluation
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Operational Model
 Care Delivery Philosophy
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Patient Population
 Specialty, Geriatrics, etc.
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Teaching vs NonTeaching
Staffing
◦ Unit Secretary
◦ Team
◦ Physician Specialty
HKS Architects
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Processes
 Supplies
 Medications
 Other Services
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Communication
◦ Workflow & Devices
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Documentation
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Charting Alcoves
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Computerized Charting
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Meaningful Use
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Nurse Servers
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Bar-coding
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RFID
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OR Integration
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Nurse Call
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DAS
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Telemetry
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Network Hardware
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Physiomonitoring
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Security
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Emergency Power
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Widely accepted as most beneficial.
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Implemented in almost all hospitals.
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Semi-private rooms generally occur only
for:
• Elderly patients who feel less
confused with roommate.
• Veterans who appreciate
camaraderie of roommate.
• Behavioral/Psychiatric settings
• Small hospitals with too few resources.
Single-Handed Rooms
Pros:
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Concept is accepted by many organizations.
Standardization of all patients approached from same
side is convenient and helps in responding to codes
in room.
Some hospitals incorporated angled corner walls to
increase view from hallway.
Single-handed rooms
Cons:
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Mirror-imaged rooms
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Limited evidence of being safer – difficult to judge
because every patient is different.
Challenge to observe 2 patients at once from
communication station outside rooms.
Extra cost for not having back to back toilets (no
hard numbers for difference).
Pushback from nurses that they can’t adapt to
mirror-imaged rooms.
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Very convenient and saves time.
TJC had issue with contamination from patient to patient – everything
in room must be taken out when terminally cleaned.
Now TJC accepts if minimum number of towels, linens, and supplies
are put in cabinet. Need to make sure it is stocked appropriately and
without unnecessary materials.
Issues:
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Who stocks cabinet.
Building codes can require the door in
the corridor to have a closer, which
makes server hard to keep open.
Location can be inconvenient and hard to
access from corridor and inside patient
room.
Need to displace personal effects to use
bedside table for treatment.
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Reduces medication errors by ensuring correct
medicine and dosage.
Better than barcode medication administration
because it is not interrupted by leaving to get
medicine once scanned.
Provides charge, capture, and inventory
management.
Operational issue: who stocks machine and how
often.
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Infrastructure of steel supports above ceiling being built in.
More institutions want lifts in every room. Now only a percentage
of rooms get lifts – typically in bariatric rooms.
H-type gantry lift (moves in 4 directions) is preferred over the
single rail lift, which has less flexibility.
Some hospitals have lifts into bathrooms.
Some hospitals utilize lift teams.
Issues:
• Because lifts are not in every
room, nurses often don’t know
how to use them.
• Need education included in lift
purchase.
• Many lifts don’t have the
necessary lift ability of 1000
pounds.
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Need more bariatric rooms to allow for increase in
heavier patients.
Issue of hygiene – make bariatric rooms with wet
rooms with drains, hoses, and a hazmat
containment pool.
Problem with bathroom – need greater
distance from wall for bariatric patients,
but that exceeds
the code for ADA.
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One console controls TV, lighting, draperies,
music, and call system for nurse.
Wireless keyboards for internet, communication,
controls, and meal selection.
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Equipment: Keeps track of all
equipment in hospital – helps locate
and maintain inventory.
Patients: Especially helpful in ER –
reduces need for security and helps
monitor vulnerable and dangerous
patients.
Staff: Very beneficial for ER and
Specialty Services staff. Mostly used
with Nurse Calls.
Robots
• Take dietary orders with filter for
patient’s specific dietary needs and
deliver meal trays.
• Remote doctor robot has doctor’s
face on screen and 2-way
communication from remote
location. Allows for clinicians to be
involved without having to be
present.
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Simplifies the many components of the
operating room into one easy-to-use interface.
Helps nurses and surgeons make decisions with centralized
control of medical devices and information.
 Attracts better surgeons and more patients,
improves patient outcome and experience,
and increases efficiency.
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Helps ensure compliance
and increases frequency
of staff washing hands
Improves patient safety
by reducing spread of
infections
Technology ahead of practice transformation
Smart Beds
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Alerts staff to changes in patient’s
status and movement.
Can help reduce emergency reaction
time.
Some issue with data overload due to
info coming from Smart Beds and
monitors.
Integration
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Wireless Phones
IV Pumps
Telemetry Systems
Admitting Systems
Bed Exit Systems
Smoke Detectors
Staff Location, Infant
Security & Asset
Tracking
Ventilators, Pulse Ox,
AB Monitors, etc
Communications
Planning and
Documentation
Design
Considerations
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Philosophy
Budget
Devices
Flexibility
HKS Architects
HKS Architects
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Improves staff to staff communication, patient
to nurse communication, efficiency, and
patient satisfaction.
Reduces reaction time and overall
noise by eliminating paging.
Can also act as a recording device,
nurse call system, and a device alarm.
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Healthcare applications
specifically designed for
iPhone being adopted and
more being developed.
Improves workflow process,
reaction time, and efficiency.
Technology is widely accepted
and easy to use.
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Physicians Rounds – Physicians use their iPads for
EHR, POE, Personalized Team Census (signout), ETicket (billing), web-based paging, and their
hospital emergency department (ED) dashboard.
Education, distraction and preparation - Child life
specialists use it to help patients manage stress
during their stay. They use the iPad to show patients
how physicians prepare for surgery; to play games
with patients; and to educate them about their
procedures or conditions.
X-ray images, EKG results and other patient
monitoring programs - Used in inpatient and out
patient settings by home health, hospice care
workers, nurses, dietitians and pharmacists.
Staff documentation – Entering the patients
information on a screen that doesn’t require turning
your back to the patient.
Speech therapy – Speech therapist uses iPad/iPhone
app Proloquo2Go with stroke victims and autistic
patients to enable patients to speak through the
devices to their care team.
Mobile Health
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Wireless
DAS
Smart Phones
Tablets
Emergency Power
Telehealth
Challenges Foreseen
“The
first rule of any technology used in a
business is that automation applied to an
efficient operation will magnify the efficiency.
The second is that automation applied to an
inefficient operation will magnify the
inefficiency.”
Bill Gates
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Increases efficiency
Reduces administrative work
Improves safety for patients and staff
Improves workflow processes
Better reaction times
Improves patient experience
Convenience
Many are easy to use
Improves communication and decision
making
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Difficult to change culture of routine and “old
ways,” especially among older staff
Learning curve for some technology
Requires training
Data overload
Until staff are sure of devices, need backup –
dual info
If not widely integrated, less likely to use or
remember how to use
Not all advances have proven benefits
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Evidence Based Design is improving the
healthcare environment
A Nursing Advocate needs to be at the table
Technology is ahead of practice
transformation
Designing for technology must become
evidence based to improve healthcare
delivery and determine best practices
Aligning:
Corporate Vision
Clinical Vision
Architecture Vision
IT Vision
NIHD Founding
Board of Directors
Nurses Planning Session
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Nursing Institute for Healthcare Design ( NIHD)
◦ www.nursingihd.com
Center for Health Design (CHD)
◦ www.healthdesign.org
Joint Commission Resources
◦ www.jcrinc.com
Institute for Healthcare Improvement
◦ www.ihi.org
Agency for Healthcare Research and Quality (AHRQ)
◦ www.ahrq.org
Robert Wood Johnson Foundation (RWJF)
◦ www.rwjf.org
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Health Environments Research & Design
Journal (HERD)
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Facility Care
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Healthcare Design
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Journal of Nursing Administration- Healthcare
Design Feature
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Critical Care Nursing Quarterly – Design Issue
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Healthcare Design’13
◦ November 16-19, 2013
◦ Orlando, Florida
◦ Nursing Institute for Healthcare Design
• ASHE PDC 2014
• March 16-19, 2014
• Orlando, Florida
Debbie Gregory RN, BSN
Senior Clinical Consultant
SSR Technology Group
Smith, Seckman, Reid, Inc.
615-714-6794
dgregory@ssr-inc.com
The Nursing Institute for Healthcare Design
www.nursingihd.com