Anyone working in healthcare today knows that the dynamics are constantly shifting and that change is inevitable. From technology upgrades to improved work processes to new regulations, nothing, it seems, remains static.
MORE THAN 80% RECONFIGURABLE SOLUTIONS
So when Bluewater Health began making plans for a renovation that combined two facilities under one roof, adding 285,000 square feet (five floors) of new construction and updating five floors (335,000 square feet) of the existing facility, they planned for change by choosing the most flexible and “forgiving” solutions available. Indeed, they opted for reconfigurable solutions rather than fixed built-ins in more than 80 percent of their new facility.
The renovation was the largest public sector redevelopment project in Sarnia-Lambton’s history and one of Herman Miller’s most comprehensive solutions of reconfigurable casework and walls in North America. These reconfigurable components displaced traditional fixed millwork and fixed wall construction in more than 20 areas of the hospital, from lab and oncology to surgical suites and intensive care units.
“I can’t stress enough the importance of having flexibility when planning spaces,” says Lisa Regan, Bluewater’s Director of Transition Planning. “Our work processes are changing all the time as we implement continuous improvement initiatives.”
Like many hospitals today, Bluewater is focused on mitigating risks relating to the care and safety of patients. So the Design Development was highly consultative process involving staff, stakeholders, architects, Herman Miller clinical strategists, and the Herman Miller dealership, Facility Resources, who all provided input into the flexible design solution. “It’s hard to see what the future will hold, but we did our best based on the way we work,” says Regan.
Change Is Inevitable
And as Julie Sless, Vice President Herman Miller Canada Healthcare Division, points out, even though you may be using the most up-to-date design standards and practices when starting a construction or renovation project, by the time a facility is complete, those practices may already be outdated.
“For example, the whole thought process around medication room design was changing while Bluewater was still in the construction phase,” says Sless. “It would have been very costly to go in and start making changes at that point, but because everything was reconfigurable, we knew we could change things around later without too much disruption or downtime.”
And that’s exactly what happened. Hospital staff realized almost immediately after moving in to the new hospital that some adjustment would have to be made, from work area layouts to entire department reconfigurations. As Regan and other staff members learned, “You really have to ‘live’ in your space awhile before you understand how it’s going to work for you.”
Fortunately, the reconfigurable solutions they had chosen, including Ethospace Nurses’ Stations and the Co/Struc system, gave them the ability to easily change things that weren’t working. And that’s the beauty of reconfigurable, says Sless. “You don’t have to get it perfect because you know you can make changes down the road.”
Two Areas Requiring Immediate Change
Two areas in particular were identified as most critical in needing changes were the Emergency Department (ED) and Maternal/Infant/Child (MIC).
In the ED, where nearly 97,000 patients are seen annually:
- There was too much congestion in the caregiver station and not enough workspace to support work flow.
- There was minimal space in the medication preparation area and a lack of privacy made concentration difficult. Public access to the Accudose posed a safety hazard.
- Space was too tight in the triage/registration area; patients were also concerned about a lack of privacy and confidentiality.
“From a risk and safety perspective and also from a work flow perspective, we knew right away it wasn’t working,” says Regan. “Plus, we were about to embark on a new initiative in that department to decrease wait times and improve service, so the space really needed to function well to support that.”
Similar problems were occurring in the MIC area. Conditions were cramped in the medication room, and medication security was an issue. Because of the position of a dividing wall, the caregiver station was too cramped. And, work areas needed to be reconfigured to better support workflow.
Facility Resources and Herman Miller Healthcare’s team worked closely with the managers of the two departments to observe and photograph activities in the problem areas. The team made suggestions and those ideas were discussed with staff.
Z-AXIS a Real Time-Saver
Extremely beneficial during this period was Herman Miller’s Z-Axis, a visualization tool that provides three-dimensional drawings of layouts so that clinicians can see how the space will perform. “We would show the staff different scenarios in the actual room so they could see how their work would flow, then we’d get their input, make the necessary tweaks, and bring back the changes to show them, all in a matter of hours,” says Sless. “And later, when they signed off on the drawings, they knew exactly what they were getting.”
The re-design process took about six months. “There was a lot of back and forth during that time, but we really wanted to get it right,” says Regan. “We all had our ideas, but the nurses are the ones who work with it every day, so their input was very valuable.”
Involve Staff In A Meaningful Way
Indeed, Regan says two of the biggest lessons she learned throughout the whole process were 1) involve staff in the scenario planning and help them determine priorities for the redesign, and 2) don’t rush into making changes.
“We needed to take our time to be sure we got to the root cause of the problem and not just provide a quick fix,” she says. Would the change in space help work flow? Would it increase safety? Would it provide better patient care and service?
Once the changes were agreed upon, implementation began. Walls were moved, work areas reconfigured, spaces realigned; components were added to some places, taken away in others.
Minimal Downtime And Disruption
Had the hospital not gone with reconfigurable solutions to begin with, making changes like these would have been monumental, if not impossible—requiring a capital approval, building permit, engineering fees, construction dust barrier, major demolition, new construction, coordination of trades, and a significant relocation of existing patient services—and it would have taken months.
“But these changes were made in about 11 days,” attests Regan, “and it didn’t create the havoc it would have had if we had to tear out walls, minimizing not only the risk of infection, but the dust and noise and all the things that negatively impact patients.”
Going with a flexible, adaptable environment has other benefits as well. It is more sustainable from a Life Cycle Assessment perspective. Reuse has less environmental impact relating to energy consumption and greenhouse gas emissions. Any leftover parts or pieces can be reused versus sending construction waste to the landfill. Says Regan, “We get requests all the time for a work surface here, an overhead bin there, and sometimes they are significant reconfigurations. I always tell people it’s like Lego.” Operational costs relating to change in a reconfigurable environment are much less expensive than with traditional fixed architecture.
The impact of the changes was immediate as patient care and work flow improved dramatically. And in all cases the reconfigurable casework and walls were less expensive than conventional construction as illustrated in the “Less Cost” chart.
“I’ve heard nothing but positive comments since we made the changes in the fall of 2011,” says Regan, adding that the nurses “absolutely love the new med rooms, where there’s plenty of space and privacy so they can concentrate.”
Change Is The New Norm
As the staff at Bluewater look to the future, they see more changes on the horizon, as programs expand or new regulations arise, says Regan. “For example, right now Canada is implementing new accessibility laws for wheelchairs, and we can just go tweak our walls or doorways for the new dimension requirements, which will be a lot easier for us than for somebody who’s dealing with fixed architecture.”
In fact, says Sless, “I think change is going to be the norm at Bluewater. And that’s a good thing. What’s bad is when hospitals can’t afford to make changes, so they don’t. That can lead to all kinds of potential problems in terms of patient care and productivity. But today’s flexible solutions make change both easy and affordable.”
*Bluewater Health was the first acute care hospital in Ontario to achieve LEED Certification, and one of the first in Canada. They were also the focus of a Herman Miller Life Cycle Assessment Study completed by a third-party research company, Five Winds, comparing the environmental impact of fixed and reconfigurable systems; reconfigurable won out in most every category, including energy consumption for initial build and for its reusability/replacement benefits. The post-post results from the reconfiguration demonstrate significantly lower environmental impact relating to greenhouse gas emissions, energy demand, and waste.