Creating a Patient-Centered Care

Environment on a Medical-Surgical Nursing Unit Using

Evidence-Based DesignDebbie 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

July 2012 Nov 2012 Aug 2013 May 2014June 2012 2019-2020

Site Selection

SecVA announced the Brownsboro site as the location for the new Robley Rex VA Medical Center

Master Planning

Completed

22 Nov 2012

Construction

Award late 2015 Estimated completion, 3-4 years

Site Purchase

The Brownsboro site purchased 12 July 2012

Schematic Design

Initiated Aug 2013.

Projected

Completion

VAMC Louisville Replacement Medical Center Timeline

Schematic Design Completion

May, 2014

Begin stakeholder focus groups Aug 2013

Activation Team Hired

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

2. Patient education and information

3. Healing partnership with family and friends

4. Healing nutrition

5. Spirituality and personal healing resources

Sticher, 2011

6. Human touch

7. Healing Arts

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 AffairsVision for care deliverGuiding principles

VA Office of Construction & Facilities Management

VA and patient-centered careDeveloping and integrating a care delivery model

focused on patient centered care specifically as it applies to Veterans (Design Guide, 2011, p. 7).

VA and PlanetreePartnering 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 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 Medical-Surgical 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 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 veteran-

centered 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) Deputy Nurse Executive Associate Chief Nurses Nurse Managers Patient Safety Officer Infection Control Coordinator

Schematic Design User Group MeetingsSchematic 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 room-by-room level of detail

On-site user group meetings

Subject matter experts (SMEs) Deputy Nurse Executive Associate Chief Nurses Nurse Managers Front line staff Patient Safety Officer Infection Control Coordinator

Site visitsTrend 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

Implications1. Improve patient outcomes2. Improve staff morale3. Improve patient/family satisfaction4. 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 medical-surgical 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). Patient-centered 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 patient- and 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