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SEPTEMBER 24-26, 2024
Austin Convention Center - Austin, Texas

From the bedside to the C-Suite to consulting: Insights from an expert of integrating new technology

By: Caryn Hewitt, MBA, BSN, CENP, CPHQ, Senior Director, Consulting Services at CenTrak

The expression, “It takes a village…” isn’t exclusive to parenting. In my experience, thoughtfully planning, strategizing, and implementing emerging technology and design layouts within a new healthcare facility should take a community mindset. In line with the village advice, healthcare facilities consist of many different groups that must come together, interact positively, and collaborate for the betterment of the goal. To apply the village mindset in a new facility or implementation, various departments in the health system (nursing, IT, security, administrative, etc.) must share their expertise to ensure the facility flourishes and provides a safe environment. The village approach helps understand the direct needs of frontline staff and their patients – which increases the value of the new healthcare facility.

Throughout my career as a registered nurse, IT leader, chief information officer, director of operations, and digital health consultant, I have been given the opportunity to witness first-hand what healthcare professionals and patients want in a healthcare setting. To better understand what our colleagues and patients desire, we must invite them to the table. These individuals, once together, must serve as a sounding board to one another, listening to each other’s concerns and becoming a team when approaching senior leadership.

A recent study with the National Center for Biotechnology Information demonstrates how involving participants with different organizational and clinical backgrounds leads to higher user satisfaction when implementing technology such as electronic health records (EHR). By involving various perspectives when designing shared spaces and tools, there’s a greater chance of employee buy-in, enhanced usability, and improved efficiency and communication. This approach outlines the method personally used when integrating emerging technology and Real-Time Location Systems (RTLS) into a new 400-bed trauma hospital in North Dakota.

Where it all started: Bedside nurse turned IT leader

After a few years as a bedside nurse in the Intensive Care Unit and witnessing first-hand the growing importance of emerging technologies, I felt that I could leverage my knowledge as a nurse to implement technologies that would make a real difference for patients and staff. My goal was to make the clinicians’ lives less stressful and promote better patient care. While I understood it at the time, it’s only become more apparent to me that it is crucial that IT teams have a strong understanding of what clinical personnel do, why they are doing it, the tools used in their day-to-day workflows, and what circumstances health IT aims to solve with the technology we’re implementing.

I joined and remained in an IT role for 25 years, implementing emerging technology and real-time location systems. I found my passion and purpose, demonstrating the positive impact thoughtful technology and workflow design can make for staff and patients. I began training staff with new use cases and highlighting how to apply them in meaningful ways. I’m always aiming to make sure clinicians understand the technology and its purpose. Subsequently, following an acquisition, I was blessed with an opportunity to serve as director of operations for a new state-of-the-art facility and standardize our technologies.

Connecting with “the village” is the first step to developing the plan to implement digital solutions for a new facility or existing department. Aiming for the new hospital to be a space designed for caregivers and patients by caregivers and patients, I connected with all relevant departments to further consider the best technologies for a patient- and caregiver-centric facility.

The importance of working together on a phased assessment

Deciding on the best path forward when implementing new technology involves assessing any challenges within the current facilities and anticipating the overall needs for the next 2-5 years within a new or updated space. I recommend completing the facility analysis through a comprehensive phased approach, which includes stages such as assessment, readiness, and transformation. When stepping into the assessment stage, healthcare decision-makers need to hear input from departments such as equipment distribution, supply chain, IT, and nursing. In my weekly meetings with 100+/- departments during the new hospital development, teams shared updates to reduce siloes and ensure a standardized, purposeful plan moved forward.

Once perspectives are shared in the department manager meetings, teams must gain consensus on the proposed technology use cases to prioritize and develop a strategic roadmap, deployment plan, operational model, and budget summary. This assessment phase enables facilities to take the first step in making impactful changes with emerging technologies. Aiming for a strong ROI and factoring in the needs of the larger “village,” we pursued RTLS; a trusted technology that had been supporting the health system’s overarching goals. For example, we used RTLS data to rightsize equipment needs based on our historical utilization, a key factor when determining the mobile medical assets required to support a new facility. The location technology and sensors powering RTLS platforms use badges, tags, and wearables to provide accurate location information for equipment, patients, residents, and staff. Through an automated workflow system, teams and facility managers maintain synchronized, real-time insights and communication to continuously measure interactions, minimize bottlenecks, monitor patient milestones, evaluate movement patterns for optimal staffing, reduce workplace violence, and increase workflow efficiency throughout the healthcare facility.

Following the assessment period, the operations team should evaluate the readiness of the staff to leverage the technology. When everyone is in a room together during the weekly department meetings, there’s also the opportunity to discuss upcoming training. Following our weekly meetings, 200 Health System leaders offered to assist in department-specific and general training on the new technologies. Through simulations and role-playing, 10,000+ employees received the necessary training. This benefits staff buy-in, creates comradeship, and ensures the relevant team members understand their new devices, equipment, and platforms.

The growing comradeship and support are crucial heading into the next phase: going live and continually monitoring the actionable intelligence from the technology to transform the facility and ensure the desired ROI. Every facility has its own unique challenges as they’re fine-tuning and preparing to go live. When developing a strategic team that incorporates nurses, hospital administrators, and clinic managers as part of the implementation team, challenges can be quickly identified, escalated, and resolved to provide quick time to value for the facility.

Applying director and CIO experience to health IT consulting efforts

Pursuing technology that offers standardized processes provides layers to facilitate caregiver insights – without physically entering the room – and ensures definitive spaces in rooms for patients, staff, and family is crucial when considering patient- and caregiver-centric technology and design. Even so, initial staff support and stakeholder buy-in can present a challenge. The key components for buy-in success when implementing new technology include early transparency, leadership support, and staff education on the technology’s purpose. Successfully deploying location solutions requires incorporating the proper expertise from the healthcare facility’s individual departments and vendor partners.

To enhance the ROI following implementation, leadership should consider pursuing an ongoing staff buy-in campaign. Video education and video learning can be beneficial tools that provide small bites of information, making the information easier to digest. It also helps to continue in the mindset that RTLS and emerging technology programs start at the top, which means leadership should wear their IoT-enabled badges to show their support and belief in the program. Team leadership should also showcase RTLS staff duress tools at daily floor huddles and discuss the purpose behind the location technology.

Staff duress and/or asset management solutions are often the first step for healthcare leaders moving through a journey with RTLS. When health system leadership collaborates with “the village” to assess top pain points, decision-makers typically pursue the need to better monitor the mobile medical equipment (MME) or provide greater support to staff who may experience duress. These scalable implementations can be done step-by-step as they’re beneficial instead of requiring a full system overhaul, ensuring the technology is more accessible to all health systems. Health systems can leverage scalable technology to follow the path that best fits their needs, facility size, location, and 2–5-year plan.

After the initial selection of RTLS, teams can continue to scale the technology with various system add-ons as desired. Since implementing its real-time location system, a hospital in North Carolina has over time successfully implemented over 50 use cases leveraging real-time visibility data and reports more than $10 million in overall benefits. The healthcare facility even continues to collaborate with its RTLS partner for consulting insights to ensure the technology is used to its fullest potential. Through the scalability plan, the hospital experiences savings of more than $900,000 per year simply by deciding to additionally implement an automated temperature monitoring system. Some additional benefits include asset management, which adds a savings of $2 million per year, and an increase in staff productivity, which is valued at over $2 million savings per year for the North Carolina hospital.

Take the time to consider the road ahead

The best way to achieve a substantial increase in value and efficiency across an entire healthcare campus or within a new facility is through a personalized approach that combines a strong patient- and caregiver-focused design with a strategic roadmap that considers the goals for the future. A well-rounded internal “village” team from the health system paired with expert-led consulting and training services can develop the most accurate roadmap to ensure the right technology is implemented to drive greater workflow efficiency, higher safety standards, the ultimate patient and staff experiences, and substantial ROI. By factoring in a range of experienced input, healthcare teams can maximize emerging technologies and RTLS to drive meaningful change throughout their enterprise using practical guidance from within their “village.”

Caryn Hewitt is the Senior Director, Consulting Services at CenTrak, which offers locating, sensing, and security solutions for the healthcare industry. CenTrak has helped more than 2,000 healthcare organizations around the world build a safer, more efficient enterprise. For more information: visit centrak.com.

Rethinking Healthcare Facility Designs for Increased Patient- and Family-Centered Care

By: Matt Goche, CEO of Uniguest

When it comes to the patient experience, first impressions are crucial. Healthcare systems seek to develop long-lasting relationships with new and existing healthcare consumers and initial encounters can make or break an experience. New patients, existing patients, and loved ones often take measures to ensure they’re prepared for a visit before stepping into a facility, including confirming directions, parking information, and travel time. I have certainly experienced this mindset when preparing for an appointment or supporting family. Once patients are physically in the healthcare facility, effective visual communications assist in creating a welcoming environment. This is important. The use of digital signage, patient engagement tools, and wayfinding empowers patients and visitors during a time when they may feel a lack of control. Reducing the stress associated with a hospital visit and increasing patient engagement is essential to elevating the overall experience.

As healthcare becomes increasingly competitive, the line between patient and customer blurs. Healthcare facilities must anticipate needs and meet expectations in a timely manner with intuitive solutions and clear communication. Patient expectations are constantly evolving, and leadership, architects, and facilities managers must upgrade designs and technologies to meet these needs while accommodating staff as well. The growing reliance on technology in everyday life is leading to an increase in demand for digital solutions throughout the healthcare journey for all stakeholders. In fact, 84% of healthcare leadership surveyed by HIMSS Research agree that their patients are demanding a “more personalized, holistic digital experience” and the Deloitte 2022 Consumer & Physician Survey revealed that 90% of patients want digital engagement and navigation options. At the same time, Experian Health survey results reveal that 100% of respondents feel staffing shortages have affected patient engagement efforts.

The solution? Thoughtful facility designs and comprehensive engagement systems that help staff reallocate time to patient care. Through this approach, caregivers gain more collaboration with patients to focus on their unique needs and achieve higher-quality outcomes.

Patient Engagement and Family-Centered Care Go Hand-in-Hand

Impactful patient engagement calls for an approach that considers the patient and loved ones at each step of care (planning, delivery, and evaluation) to mutually benefit relationships among patients, providers, and families. It is about better engaging care partners and positioning support around each unique family to drive better outcomes. Increasingly prevalent, the Institute for Patient- and Family-Centered Care says this approach “redefines the relationships in healthcare by placing an emphasis on collaborating” and serves to “promote the health and well-being of individuals and families.”

Leveraging family-centered care allows for a more human experience for everyone and creates greater trust for a smoother care journey. I envision the utilization of the family-centered care model increasing throughout the industry as health system leadership works to implement new technologies within their facility designs. This can be supported in large part at the point of care by implementing a digital engagement strategy that incorporates touchpoints throughout the care journey for improved experiences and outcomes.

Digital Engagement Platforms Guide and Support Patients

Technology is reshaping how consumers access healthcare services and communicate with their providers. From accessing “Doctor Google” to gain insights on what may be ailing us to connecting through a myriad of available digital front doors and making online bill payments, we live in a digital-first, self-service world. Therefore, when patients and families visit facilities for care, the design has to fit this ethos in order to drive engagement, collaboration, and comfort. Patients of all ages are more likely to interact with a system that’s intuitive and familiar. We need to make it easy to ensure the best level of engagement and create a sense of control for patients every step of the way.

Hospitals can be both intimidating and confusing. Some medical centers cover multiple city blocks, causing navigation challenges for first-time and repeat patients alike. Medical campuses often change over time and each new unit or building can disrupt a patient’s previously known path. Navigating the floors and hallways can be equally daunting and add to an already elevated stress level. Consumer-accessible digital wayfinding solutions develop a clear route to guide the user through the navigation process step by step, creating a sense of comfort and control for patients and loved ones at first encounter. Building floorplans are overlaid onto a private, intuitive Google Maps-type interface, allowing users to have a sense of familiarity while gaining contextual information regarding their location and destination. Through interactive maps or directional displays, digital wayfinding solutions foster the independence that is required to manage your health. It’s subtle but it matters.

Once acclimated, a digital engagement platform can guide the family throughout their journey. Large-format video walls welcome arriving patients in a lobby, atrium, and common areas with healing and relaxing imagery that can be placed in rotation with other messaging throughout the day. Common content for signage in common areas includes population health-focused messaging such as reminders to schedule wellness visits, information on getting vaccinations and screenings; seasonally-focused messages such as details on flu shots or managing the heat; and program promotions for at-risk populations that reinforce the system’s commitment to supporting health at all times.

For outpatient visitors, location-specific digital signage solutions in waiting rooms can provide wait times, staff bios, related services, and relevant patient education and discharge content. By proactively providing the answers to the frequently asked questions, stress is reduced while self-efficacy is built. For hospital staff, it is worth noting that each of these endpoints can be easily managed from a central content management system.

Design Health Systems According to Patient Comfort

In the patient room, an Interactive Patient Care System (IPS) transforms the latest smart TV technology into a communication hub for education, empowerment, and, of course, entertainment. Back-end integrations from a range of health information technology (HIT) including the EHR, dietary, engineering, and facilities, allow access to directed patient education, meal ordering, room controls, and service requests conveniently through the device of a patient’s choosing, including a traditional pillow speaker, a hospital provided tablet, or a personal device paired to the system. Again, by providing access through the easy and familiar, system usage increases as families become more comfortable in an unfamiliar environment during an unsettling time.

More advanced IPS systems include additional communication endpoints beyond the TV. The set of HIT integrations can be leveraged to communicate information directly to the patient, family, and staff through a digital whiteboard and to the clinician through a digital door sign. These implementations are designed to build trust and allow each party to remain on the same page throughout the care process. For example, such tools can be set to include the patient’s schedule for the day. This information shows the patient and family what to expect, how to prepare for their daily activities, and where and when key elements are taking place. Through these insights, patients know when they’d like loved ones to be present without the nurse providing a manual rundown.

The IPS also provides advantages for overworked and resource-constrained staff. By automating repetitive tasks such as documenting patient education in the EHR or updating dry-erase boards and offloading non-clinical tasks like adjusting room lighting and heat or ordering a meal, nurses have the opportunity to be more efficient, gain additional time with patients, and practice at the top of their license. More importantly, with less “drudgery,” job satisfaction is increased and employee turnover is decreased.

Digital Engagement Encourages Human-Centered Care

Rising consumerism and increasing competition in healthcare have created a demand for quick access to the information and experiences desired by the patient. Additionally, technological advances have also changed the way providers want to access information and deliver care. Every step of the care journey is essential as healthcare teams strive to deliver high-quality outcomes, reduce avoidable readmissions, and build long-lasting relationships with patients. A comprehensive digital engagement platform incorporated into facility designs helps a healthcare organization stand out as a provider of superior, high-quality, family-centered care.

 

Matt Goche is the Chief Executive Officer of Uniguest. He brings extensive technology and cybersecurity background to Uniguest with a track record of growing revenue and achieving business results. Since Matt joined Uniguest in 2016 as Chief Operating Officer, later as President, and now as Chief Executive Officer, Uniguest has dramatically grown revenue, expanded the employee base, acquired marquee companies, and moved into new markets with new product offerings. Uniguest now has 15 offices across the globe and supports a customer base of over 20,000 customers.

Better Together Like Peanut Butter and Jelly: Delivering High-Impact Functional Programming in Healthcare Design through Collaboration

By: Christopher K. Gargala MSN, RN-BC, CCRN-K, Sheila M. Kelty DHA, MBA, LSSBB and Paul L. Macheske FAIA, FACHA, LEED AP

Crafting the perfect sandwich comes down to ingredient selection, balance of each, and complementary flavors. The peanut butter and jelly sandwich is arguably the most recognized sandwich in the United States, and one that enables people to grow and sustain themselves. Peanut butter provides protein and substance, whereas jelly provides a complementary flavor, texture, and balance. In a similar way, health systems that are focused on growth and sustaining the organization can find complementary, balanced, and joyful outcomes for their projects by bringing together independent teams (ingredients) with specialized experience.

Synergy of Collaboration

Healthcare organizations engaging in building projects desire a facility with both form and function – a building’s peanut butter and jelly. They are looking for a building that delights the senses, inspires hope, welcomes patients and family members upon arrival, and enables the orchestration of efficient workflows for caregivers, physicians, and staff. Traditionally, a healthcare organization may use their architect firm as the sole vendor for the functional programming phase of design. This methodology inadvertently creates gaps that often must be addressed by the organization later in the project. Utilizing a functional programming planner with healthcare experience including clinical, ancillary, and support operations as well as executive leadership experience enhances the expertise the architect brings to the project by invoking user groups to translate their needs to individuals that are their peers and who have the experience of mastering built projects. Including a multidisciplinary team from the healthcare organization at the onset provides insight into the culture of the organization. Each of these groups has their own expertise and although they are knowledgeable about some areas that overlap, many would benefit from the expertise of those who can help to translate their operational skillset into rooms, space, and buildings. We will explore more about each of these groups— AHCA Board Certified Architects, Healthcare Operations Consultants, and Healthcare Organizations—and their expertise and the gaps in their ability related to the functional programming phase of a new building project.

AHCA Board Certified Architects

Expertise

The architect is a vital part of the project from beginning to end; one who brings tactile definition to the project framed by the client’s vision and goals, while holding the liability to comply with complex codes and life safety regulations and incorporate best practices as licensed professionals. Architects who specialize in healthcare are board certified by the American College of Healthcare Architects (ACHA) and have demonstrated expertise.[1] Similar to medical professionals who obtain board certifications for Neurosurgery or Cardiology, ACHA Board Certified Healthcare Architects meet or exceed high thresholds in experience and testing and thereby are credentialed by their organization, lead development of best practices and approaches, meet rigorous standards, and demonstrate competence in a highly complex field. Just as you would not consider receiving brain surgery by a non-board-certified neurosurgeon, hospitals should seek healthcare architects that are ACHA certified. Healthcare Architects recognize the challenges that healthcare systems face, from declining reimbursements to higher operational costs. Instituting innovative technology in building materials can help your building be more sustainable, lower your energy costs, and reduce your carbon footprint. Healthcare Architects utilize renderings, departmental and room use floor plans, and other deliverables to obtain user approval at design phase milestones.

Gaps

Not all architects who offer design services are ACHA Board Certified Healthcare Architects and many architects do not have boots-on-the-ground experience in hospital operations. Generally, their experiences do not include caring for patients nor family members in a healthcare setting. Understandably, most practicing architects have not personally experienced the daily staffing of a clinical unit with a declining workforce and excessive cost of travelers and locums and can benefit by the balance of jelly to the peanut butter they provide.

Healthcare Operations Consultants Expertise

The Healthcare Operations Consultants balances patient focus, employee focus, and operational throughput based on real-life healthcare experience. Building projects are not the primary focus of healthcare organizations. The organization may have a small team of people who have roles in building and construction, but healthcare operations team members are not released from their clinical role to plan, develop, and build buildings over what is sure to be an extensive period.

Healthcare Operations Consultants with deep, personal experience working in the healthcare sector have worked with—and have had their organizations impacted by—state department of health requirements and accreditation requirements. They have faced the challenges of staffing and operational budgets. Healthcare Operations Consultants have often had the privilege of working in or with numerous healthcare organizations and have had a hand in building projects of all sizes and budgets. The consultants also have access to evidence-based best practices and a diversity of experience in Lean processes. Utilizing this experience in conjunction with the healthcare architect can help the healthcare client identify risks and potential workflow issues in the initial stages of programming, thus shortening future design phases. Their vast personal experience, membership in professional organizations, and deep understanding of healthcare processes are paramount to the role and value they bring to functional programming. And just like the many potential flavors of jelly that can complement peanut butter, Healthcare Operations Consultants come with a wide variety of credentials from registered nurses, physicians, imaging technicians, and therapists to non-clinical backgrounds such as patient access, financial services, administration, and other ancillary and support areas.

Gaps

Healthcare Operations Consultants are not architects. They do not have the level of design experience that the architect is contractually bound to uphold. Although they participate in building projects in many cities and states, their knowledge of building codes may not be current or may not pertain to the geographic location of the client. They have myriad experience in many healthcare organizations, but still need to understand the culture, vision, and patient base of the client to support programming.

Healthcare Organizations (Client) Expertise

Many times, functional programming efforts include executive management but lack involvement from direct care staff members. Incorporating the hands-on staff from the beginning of the functional programming process allows the programming team to ascertain what is going well and should be replicated in the new build. Doing so also allows the team to determine operational areas and processes that do not work well in the existing facility and need to be reimagined for the new facility. Listening carefully to the current staff during programming helps bring the complete operational picture into focus and reduces the risk of change orders later in the process. The hands-on or front-line staff from the client organization can be likened to the bread that is the main ingredient in the peanut butter and jelly sandwich.  Without the bread, there is no sandwich.

Gaps

The healthcare organization leaders may have functional programming duties for the project without removing any of their current workload, which adds to their day and presents competing priorities. Their primary focus remains the day-to-day clinical focus for their patients. Similarly, they may be siloed in their view of the care or service they provide. Or, when asked by the architect what their needs are to inform the design of a new facility, the default may be to replicate what they have grown accustomed to within current space. Unintentionally, representatives of a particular service or care area may prioritize their portion of the continuum of care over other services. The information provided by each service areas’ team members must be addressed holistically in programming to align with the operational requirements of other departments and services lines.

Collaboration creates a complete package

Constructive collaboration between a Healthcare Operations Consultant, an AHCA Board Certified Healthcare Architect, and representatives of the Healthcare Organization that begins in the earliest stages of the project allows for a 360-degree view of the healthcare organization’s needs. This collaboration allows for simultaneous review and updates to processes that result in the infrastructure to develop service lines, departmental space designs, and overall building designs meeting the needs of the healthcare organization. A workshop-based process allows teams to work both separately and collaboratively throughout functional programming.

Workshops and Communication

The modern healthcare environment provides opportunities for Healthcare Organizations to partner with entities who are geographically distant through virtual synchronous and asynchronous means such as virtual meetings and cloud file sharing. While virtual synchronous and asynchronous collaboration offers extraordinary benefits for communication and collaboration, the programming process requires an elevated level of engagement that benefits from face-to-face meetings. Architects, Healthcare Operations Consultants, and Healthcare Organizations achieve great benefit with primarily in-person collaboration augmented by virtual modalities.

A collaborative workshop approach assists the functional programming process. Initial workshops should focus on building a cohesive project team, establishing guiding principles, and gaining executive leadership buy-in and support. Subsequent workshops should be service-line specific and include key front-line staff members and appropriate decision makers. Service-line specific workshops should include a current state analysis (including opportunities to improve) to create a thorough understanding. The remainder of the functional programming process should then focus on future state space needs and wants as related to staffing, departmental spaces, technologies, and equipment. Though the Healthcare Operations Consultants lead these workshops, it is crucial that the Architects are engaged in an active listening and analysis mode. Real-time input and space program editing can occur from an architectural perspective. Furthermore, engaging dialogue often surfaces the most collaborative solutions to the most complex problems.

Communication is a challenge waiting for an optimized solution with every project; functional programming is no exception. Not only is leveraging collaborative project management tools (synchronous and asynchronous) imperative to a successful functional program, but it is also crucial to minimize the number of tools in use. At the beginning of the engagement, there should be clear expectations about which tools the team will utilize, and in which instances they will use each tool. The Healthcare Organization should be a part of this vital conversation; doing so will streamline processes and reduce rework in the future.

Final Product

The Healthcare Operations Consultants and the Architects have distinct responsibilities for the final functional programming deliverable. Generally, Architects define the space program and, in some cases, draw bubble (adjacency) diagrams with concurrent and collaborative input from Healthcare Operations Consultants. Healthcare Operations Consultants, on the other hand, write the functional program document, which is an owner-required deliverable under the FGI Guidelines for the Design of Healthcare Facilities[2]. The Healthcare Operations Consultants synthesize the relevant information from all the preceding workshops and present it in a compelling, comprehensive way that meets the needs and vision of the Healthcare Organization. The Healthcare Organization’s needs, vision, and service to patients must be at the center of all discussions and decisions related to the functional program. Given that design and construction is not the primary daily focus of healthcare systems, concurrent collaboration utilizing the skills and expertise of both the Architect and the Healthcare Operations Consultant allows for the creation of a well-rounded and effective functional program.

The final functional program serves as a starting point for the remainder of the construction project. It is a living document that when consulted, should point the client and project team toward their desired future state. This lengthy document could collect dust on the COO’s bookshelf, but we would caution against that. Instead, it should operate as a go-to resource for the entirety of the project. A well-crafted, and often-referenced, functional program will help clients shorten future design phases, ensure front-line voices were heard, identify risks and decisions early, reduce the propensity of change orders, and, ultimately, deliver the best peanut butter and jelly sandwich: a healthcare facility that attracts top talent and changes a community for future generations.

[1] About ACHA. ACHA. (2023, April 17). https://healtharchitects.org/about/

[2] Facility Guidelines Institute. (n.d.). https://fgiguidelines.org/

 

Rethinking Healthcare Design to Appeal the Workforce Shortage

By Julian Lopez, NCIDQ, IIDA, Senior Project Designer at HMC Architects.

When it comes to healthcare design, the vernacular among architects and designers must revolve around the patient experience, healing environments, and promoting healthier local communities. This common verse among healthcare professionals has not only been mastered, but it has also, from time-and-time again, been regurgitated by the formulations of evidence-based design, positioning architect and design firms to create the next best healthcare facility. Then came Covid-19 and, healthcare facilities have had to reinvent themselves multiple times over the course of the pandemic. How times have changed.

As Covid-19 emerged, not only were entities forced to shut down elective services, but they became the imminent forefront for humanity. Quickly, they found themselves in survival mode for their operating budgets and the lives of their own professionals.
The world has not been the same, and neither has the healthcare workforce after the exhaustion and burnout of facing Covid-19 head-on since early 2020. As a result, the healthcare workforce crisis continues to threaten organizations while hospital employment continues to decline.

“Prioritizing design around the patient experience is no longer the only priority,” said CEO of Alta Hospitals, Hector Hernandez, MD, MBA. “For the first time in my 30 years in healthcare administration, I have had to become extra creative by finding ways to retain nursing and clinical ancillary staff. This has included providing additional break rooms, Zen-type meditation rooms, spaces to provide pet therapy for employees and physicians, while enhancing cafeteria services that operate 24/7, not to mention increasing morgue capacity and providing accommodations for those not wanting to go home due to fear of getting their family sick. Design cannot be ignored because now it accounts for what nurses and staff are looking for when making a decision to join Alta Hospitals.”

What does this ultimately mean for healthcare designers?
More than ever, designing those support areas for healthcare providers such as staff lounges, staff dining facilities and physician on-call rooms, among other spaces, must be closely analyzed and programmatically defined to account for the healthcare workforce incentive factor.
The design-build team of Hensel Phelps | HMC Architects | CO Architects is leading the design and construction of Harbor UCLA Medical Center Replacement Program, one of HMC Architects’ largest healthcare projects. The new 468,000 SF inpatient care tower with 346 beds, as well as a 403,000 SF outpatient treatment center and support building is not only looking closely at what the design means for patient care, the project is analyzing how the design also supports those who care for the patients.
While staff safety has always been crucial for HMC, taking a closer look at what this means coming out of a pandemic has reactivated design efforts into actual checklist of items. At Harbor-UCLA, patient-and-staff interaction hubs such as check-in and registration areas are being designed with aesthetic precaution. Desking must include privacy panels while other areas are divided with transaction glass windows where color and graphics help soothe environments. Taming design to not only care for patient privacy but to now account for enhanced staff protection has meant rethinking space planning layouts where social distance is layered and preferred. Waiting areas where tandem seating once allowed for maximizing occupancy loads are now becoming dispersed and accounting for safety versus overcrowding.
While HMC continues to design in support of enhanced patient care, and operational and sustainable efficiency, the design-build team’s efforts with Harbor-UCLA are consequently addressing the importance for employee mental health as well.

The project is aiming for LEED Gold Certification. Ensuring sustainability goals are met throughout the entire campus program results in strong design efforts that support employee wellness and reducing burnout and turnover.

Aesthetically, the design incorporates the surrounding environment. Local textures and colors of the harbor and calm local South Bay are reminiscent through material textures and curved finishes. Biophilic design concepts are used throughout; expanded visibility of the native landscape and natural light that seeps into the main lobby and other employee and patient areas provide staff and visitors the opportunity to mentally reset and restore.

Hernandez, CEO of three Alta Hospitals in Southern California not only recommends focusing on spaces dictated by our local labor force and younger generations, but emphasized on how we must also address diversity, equity and inclusion for the thousands of nurses and healthcare professional coming from countries such as the Philippines, India, Canada, and Mexico, among others. Their cultural differences must be addressed for their better adaptation and cultural transgression issues related to their relocation to the United States.
According to YM Careers Network, one of many recruiting organizations connecting Millennials and Gen Z healthcare talent with healthcare systems, it is important to have modern, tech-friendly systems in place to attract today’s candidates. It’s important to design for technology systems that support staff communication and efficiency such as remote interview areas, intentional kiosk locations within hospitals, and mobile-friendly interfaces and communication, all of which serve as part of the recipe for a tech-friendly recruitment approach.

For designers, this means having to heighten our knowledge on how we view and design around technology and cultural barriers. Design for the healthcare professional coming from another country and cultural background, must account for religion, gender identification and ethnicity to make them feel welcomed and diminish possible barriers.
At Harbor-UCLA, designing around technology to support staff communication and operating efficiencies means keeping an outlook for future technological needs and not ignoring how future healthcare talent will approach technology. This means not designing wall niches for queuing monitors or a television in public waiting areas, as we are used to doing because we don’t know what the future holds for queuing system technologies or if a television of a specific display size will continue to serve an entire waiting area.
So, what does this all mean for healthcare designers and architects acclimating to this new healthcare era?
The answer is simple. Designing in post-pandemic times requires that we address not only the immediate urgencies that will mitigate a dwindled workforce but that we continue to design for future generations while not overlooking to tune up the true healthcare engine—the healthcare workforce, a locomotive force that served us when we needed them most.

Building the future of healthcare facilities with a concierge luxury approach

By:Joel George MBA, MSN, RN, PhD candidate, Executive Director of Retail Services l Health Parks, AdventHealth

The hospitality industry currently accounts for 11% of the US GDP and is valued at around 3953 billion dollars. Hospitality is one of the world’s largest and fastest-growing industries, as it covers more than 25 sectors, from hotels and resorts to restaurants, event planning, theme parks, and tourism. With the amount of attention to detail the hospitality industry places on their products, why is healthcare not reaching this consumer base by implementing consumer-centric personalized experiential moments in a similar way?

Over the years, I have wondered why healthcare has suffered a negative connotation of being looked at as dark, sterile environments where patients go for reactive care. It is time to change that approach as the new generation of consumers are searching for personalized exclusivity in healthcare. Three years ago, I set a goal to figure out what consumers truly want to see in an ideal healthcare setting. My motto has always been, if we want to know what consumers want, ask them! Starting as a registered nurse and witnessing firsthand what patients actually experience by walking into a dark, sterile environment propelled me to focus on a new vision of consumer centricity and how patients would ideally want to experience a healing environment. I was blessed with an opportunity to serve as director of radiology for a AdventHealth after practicing as an ER nurse for 4 years. The moment I stepped foot into the radiology department, I wanted to transform the patient experience by taking their mind off of the imaging exam they were coming in for and putting them at ease. The entire department was beachside themed with sandcastles covering the MRI machine, cabana areas as dressing rooms, and ocean sounds playing while patients were drinking their contrast media. My goal was to embed the newest innovative technology within the department. We were able to pilot a front desk concierge digital experience to keep family members informed in the lobby as their loved ones were having a procedure or scan done. We saw that through these meaningful enhancements within the environment and use of technology, the administration of sedatives prior and during exams decreased by 2.5%, which helped with overall departmental cost savings.

Three years ago, I was asked to work on a special project focused on dreaming up ideas for the future of health care. The goal was to understand consumer behaviors and understand what patients would like to see in an ideal healthcare setting. The CEO asked eight specialized innovators, including myself to travel to New York and work with a creative agency on ideas that would be consumer-focused and push innovation forward. While there, ideas circled around creating a one-stop shop facility called Health Parks across our healthcare system. We wanted to focus on developing these buildings to have an elevated concierge approach along with a luxury feel. We went directly to the consumer through the implementation of a survey and asked what they wanted to see and experience in a fully immersive medical office building. The themes that were important to them were; a clean environment, one-bill, access (extended hours), and a seamlessly connected experience with a single EMR.

With this feedback, we worked with a team to build out our first “Health Park” in our healthcare system in 2020. The services in the building included lab, imaging, physical therapy, primary care, and specialty medical practices creating a true one-stop facility. It was important to ensure we had natural light in the building with a transparent frontage, along with modern high-end luxury furniture. We also took lessons from major brands such as Apple in creating a genius bar concept front desk registration experience. The hallmark characteristics of these facilities centered around a centralized check-in experience without multiple front desks, partnering with local coffee shops and bringing them into the facility, and training each staff member on a true hospitality approach to healthcare with learnings from major brands like the Ritz Carlton and Chick-fil-A. We also created a connected experience by integrating a corridor that attached all specialty services and primary care together in a free-flowing open layout. This was intentionally built so that each practice could easily refer and transition patients on the same day. One out of three patients continue to receive multiple services on the same day. We solved the problem of healthcare access by expanding hours of operations to 7a- 10p Monday through Friday and weekend appointment availability. Over 30% of our appointments are booked after 5p Monday through Friday and on weekends, showing the need for flexible hours of operations meeting the consumer on their time. Every interaction in the health parks is a hospitality-centric experience. All of the “Engagement Specialists” (front desk associates) have been concierge trained to make sure patients receive everything they need before departing. We implemented a lifestyle program focusing on free yoga, cooking classes, and mental health talks to truly create a partnership with our patients.

My vision has always been evident in ensuring we create lifetime partnerships with our patients. I am proud to say our health parks are the highest Google-rated facilities in our system. Being a visionary who is obsessed with experience, I truly believe that the only way to retain future consumers is to create personalized, humanistic, convenient, and memorable moments for them. The future of healthcare is undoubtedly focused on personalized care, and we have found the secret sauce in truly creating a one-stop connected experience and making our patients lifetime partners at our facilities. The future of healthcare is ripe for disruption, and a consumer-centric approach is crucial to stay viable in the current healthcare environment. We must learn from luxury brands what keeps their consumers obsessed with their brands and make sure healthcare follows suit in understanding learned behaviors and anticipating needs before consumers walk through our doors.

Benefits of Electronic Bidet Seats in Assisted Living

By: Steve Grande, LIXIL Americas

As we age, even the simplest tasks can become difficult to manage. For seniors residing in assisted living facilities or retirement communities, maintaining personal hygiene is a challenge that can lead to embarrassment and discomfort. This difficulty can affect their overall health and quality of life, which is why senior living residences are always looking for ways to improve the daily living experience of their residents. Fortunately, technology has provided a solution to this problem in the form of electronic bidet seats. These seats have revolutionized the way we use the bathroom, and for seniors, they offer numerous benefits that make daily life much more comfortable.

Electronic bidet seats, which originated in Japan, have become increasingly popular in the United States in recent years, are toilet seats with integrated bidet functions. They come equipped with a control panel that allows users to customize the temperature, pressure, and position of the water spray for maximum comfort and cleanliness. Some seats also includes a warm air dryer and odor neutralizer, making the experience as seamless and pleasant as possible.

One of the most significant benefits of electronic bidet seats for seniors is improved hygiene. Many seniors struggle with hygiene issues due to limited mobility or other health issues, which can lead to infections, skin irritations, and other problems. Electronic bidet seats provide a more thorough cleaning than traditional toilet paper, which can leave behind bacteria and other contaminants. This thorough cleaning can help prevent infections and other health issues, making seniors feel more comfortable and confident in their hygiene.

Another benefit of electronic bidet seats is increased comfort. Seniors who struggle with mobility or arthritis may find it challenging to clean themselves the traditional way, which can cause pain and discomfort. Electronic bidet seats eliminate the need for wiping, which can help alleviate this discomfort and help increase the user’s dignity by not needing help in the restroom to clean up. Additionally, many electronic bidet seats feature heated seats, which can be particularly beneficial for seniors who are sensitive to sudden temperature changes.

In addition to these practical benefits, electronic bidet seats also offer a level of luxury that is often associated with high-end hotels and spas. For seniors who may have limited mobility or live with chronic pain, the warm water and heated seat can provide a soothing and therapeutic experience that is unmatched by traditional toilets.

Perhaps the most significant benefit of electronic bidet seats in senior living residences is increased independence. Many seniors struggle with tasks that were once simple, such as using the toilet. This loss of independence can be frustrating and embarrassing, particularly for seniors who value their privacy. Electronic bidet seats can help seniors maintain their independence by providing them with a tool that makes using the toilet easier and more hygienic. This increased independence can help seniors maintain their dignity and self-esteem, which can have a positive impact on their overall well-being.

While we have discussed these very human benefits, electronic bidet seats can also save senior living residences money. Traditional toilet paper can be expensive, particularly if residents require specialized or medical-grade paper. Electronic bidet seats eliminate the need for toilet paper, which can significantly reduce a residence’s annual budget. Additionally, electronic bidet seats can help prevent plumbing issues caused by flushing toilet paper, which can be particularly problematic in older buildings.

Of course, as with any new technology, there are some potential downsides to electronic bidet seats. For example, some seniors may be resistant to using a bidet seat, particularly if they are unfamiliar with the technology. Additionally, electronic bidet seats can be costly, particularly if they are not covered by insurance. With their popularity in the western world growing, we have seen prices drop considerably on electronic bidet seats from even a few years ago. However, many senior living residences have found that the benefits of electronic bidet seats outweigh the potential downsides, particularly when it comes to improving residents’ overall health and well-being. It costs very little to include power outlets at the toilet area in the design and build stage of these projects and retro-fitting existing projects can be done with a simple inspection by a plumber or electrician.

In conclusion, electronic bidet seats are an innovative and beneficial technology for senior living residences. These seats provide numerous benefits, including improved hygiene, increased comfort, and increased independence for seniors. Additionally, electronic bidet seats can save residences money and prevent plumbing issues caused by traditional toilet paper. While there may be some downsides to using electronic bidet seats, many senior living residences have found that the benefits to their residents outweigh the potential drawbacks. Overall, electronic bidet seats are a valuable tool for improving the daily living experience of seniors in senior living residences.

Hospitals Are Complicated. Let Digital Wayfinding Reduce Anxiety For Patients & Visitors

By: Todd J. Fisher, Founder and Chairman of Intraprise Solutions (Eyedog.US is a Division of Intraprise Solutions, Inc.)

At the end of January, a close family member of mine began to experience heart failure while we were sitting on the couch watching the news. With a jolt of adrenaline, I drove her to the ER, helped her register, and answered questions from clinical staff as they measured her vital signs, performed diagnostic tests, and provided preliminary treatment. Like it is for so many people in hospitals across the US, every single day, the experience was stressful, overwhelming, and emotionally draining.

 

And, over the next two weeks while she remained in inpatient care, having several tests and multiple procedures, I returned back to the hospital to visit, learn, and serve as an advocate. I was reminded of something I already knew, but had not felt so viscerally before: family members of patients spend a great deal of cognitive energy while supporting their loved ones, often over long periods of time, while hungry, thirsty, and sleep deprived.

 

In an already emotionally charged, stressful moment, the physical environment of a hospital can exacerbate feelings of anxiety: hospitals are, for a handful of reasons, inherently difficult to navigate. Hospitals often have hundreds of destinations that need to be accessible from any given starting point within and outside the hospital. Large hospitals, on sprawling, multi-building campuses – sometimes merging old and new structures – make navigation less than intuitive. Pedestrians navigating these spaces are often in an emotionally vulnerable state: visiting a hospital as a patient, or as a loved one of a patient, is stressful to begin, and makes navigating an unfamiliar or confusing space feel impossible.

 

 

Photo Landmark Navigation: More than Maps

 

Actually, navigating indoors is tricky even at an emotionally neutral state, especially when using digital wayfinding applications as a resource aimed at ‘simplifying’ the navigation process. We are all familiar with digital navigation systems while driving – in-dash navigation, Google Maps, and Waze have revolutionized the way we find our way while driving.  We don’t think much about how it works, we’re just grateful for the huge improvement over printing out maps, following road signs, tracking mile markers, or heaven forbid, pulling over to ask another human for directions.

 

As we consider the application of this navigation paradigm to solve a different challenge – finding our way as we move inside large complex buildings – we are quickly reminded that the real feat of Google Maps isn’t so much the tech that makes it all possible, but the simplicity and clarity with which Google communicates directions in cadence with the movement of our navigation. When we can visually match our current location with our surroundings, it becomes easy to see where to go next.

 

However, when we try to apply this GPS concept to pedestrian indoor navigation, we realize the tech that works wonderfully for navigating in open space while moving at 60mph may not serve us as well in confined spaces at low speed, where our view of the navigation landscape is obstructed by walls and ceilings. What we need is a method that converges with users’ natural way of thinking and effectively accommodates indoor navigation nuances without confusing or frustrating the user.

 

Thankfully, the scientific community has produced a stable of research regarding how humans think when it comes to matters of spatial awareness. Their key takeaway is our need for visual landmarks, as they are the most efficient way to communicate wayfinding instructions, especially in circumstances such as hospital navigation, where anxiety is high, users are distracted, and cognitive capacity is compromised.

 

Landmarks allow for fast reasoning because they align with humans’ natural cognitive navigation process. So, how do we incorporate visual landmarks into mobile wayfinding applications? Simple: we use photos!

 

A method called Photo Landmark Navigation is a more effective technique for indoor mobile wayfinding. Like GPS navigation, it leverages graphing algorithms to generate optimized pathways from one point of interest to the next – think “main entrance to NICU.” The user is presented a narrative sequence of photos showing their surrounding building hallways, rich with design features that serve as visual landmarks. As users reach each new visual landmark, they simply swipe or scroll to the next picture, revealing the next set of landmarks to walk toward.

 

Unique Hospital Design Means Better Digital Wayfinding

 

This is where the physical environment of a healthcare campus impacts digital wayfinding, and vice versa. A healthcare facility rich with visual landmarks, unique design features, and noteworthy points of interest makes a great candidate for a wayfinding solution like Photo Landmark Navigation. There are ample visual markers to help users clearly see where they are, and where they are headed. We’ve all visited healthcare facilities with the same paint color lining the multi-floor, multi-building, large campus walls – it’s hard to tell where you are or where to go. With well designed facilities, though, Photo Landmark Navigation works best, because it draws on the natural human instinct to use distinctive physical landmarks to navigate. Seeing those landmark photos on a smartphone screen signals that the user is on the right path. And, in older hospitals with updated designs, periodic additions, and tricky intersections, the same is true: Photo Landmark Navigation solves for wayfinding pain points no matter the setting, because it utilizes existing landmarks as an effective tool for navigation.

 

At Vail Health Hospital, in Vail Colorado, patients, visitors, and staff have access to a digital wayfinding solution called Eyedog, which uses Photo Landmark Navigation to deliver clear pedestrian directions to users. The solution, designed to eliminate common (and often overlooked) challenges around indoor navigation, enhances the patient experience by providing intuitive walking directions that resolve problems that often cause stress for the entire community, before they arise.

 

Great digital wayfinding meets consumers where they are, both physically and technologically. At Vail Health Hospital, the Eyedog digital wayfinding solution provides intuitive pedestrian directions that acknowledge the fact that our digital and physical environments have merged. This specific initiative provides effective and efficient digital wayfinding, because it utilizes familiar digital elements that fit seamlessly into the patient experience, ensuring that patients, visitors, and staff can focus on the task at hand, rather than the logistics of finding their way. The Eyedog solution works well at Vail Health Hospital because it eliminates concerns about the fail-points that commonly accompany other types of digital wayfinding, with third party dependencies.

 

An example of how Photo Landmark Navigation can resolve common challenges associated with digital wayfinding in the healthcare setting, Vail Health Hospital effectively utilizes unique hospital design features as the groundwork for great pedestrian directions via Eyedog Photo Landmark Navigation, merging the physical design elements with an empathetic technology solution.

 

Changes to the Physical Environment Can Create Confusion

 

Frequent changes and updates to the physical environment of healthcare facilities are inevitable; updates are a necessary and exciting part of keeping the hospital relevant, competitive, and well-fit to serve the needs of its community. But, those design changes introduce the potential for hidden difficulties for staff and patients, particularly those who are returning patients experiencing the changes in a facility they have visited before: changes to the environment can cause unexpected obstacles in an already turbulent experience. Change is difficult, and clear communication is a key way to reduce the impact of such change. Amid changes in a healthcare facility, Photo Landmark Navigation provides clear communications that extend beyond basic walking directions. Because of the frictionless and intuitive nature of such directions, they can drastically reduce the stress and anxiety felt while navigating confusing healthcare facilities.

 

Because of the nature of hospital growth, many facilities opt to add or grow in phases. Adding to existing, often older buildings can create confusing, difficult-to-navigate building landscapes; signage is just one piece of a complex puzzle required to effectively provide directions. Staff, who are also learning to navigate a new facility, often find themselves responsible for helping patients to navigate, as well, taking their time and attention from other duties and responsibilities to provide directions. With renovation comes confusion and stress for those working to navigate unfamiliar facilities.

 

And, for brand new patients, there is an inherent feeling of stress that accompanies navigating an unfamiliar facility. Photo Landmark Navigation is so effective and efficient in all of these settings because it combines high resolution photos of the campus with directional arrows and written directions, designed to help users navigate, regardless of their familiarity with the campus. Because users see on their smartphone screen their exact, current surroundings, a building’s confusing landscape, or out-of-date signage does not negatively impact the effectiveness of the directions.

 

Attention is Valuable

Photo Landmark Navigation gives patients and visitors intuitive access to effective indoor wayfinding that does not require a lot of attention to use; there are few barriers to entry, enabling successful wayfinding that can reduce the stress and anxiety commonly associated with navigating a new (or changing) healthcare facility. With the option to view a personalized photo route ahead of an appointment, users find a sense of control within their clinical experience.

 

Enhancing existing wayfinding systems, Photo Landmark Navigation works without requiring any hardware, making it quick to deploy and affordable to maintain. Photos obviate the need for indoor positioning, thereby removing the need for beacons, which are expensive to install and maintain. Such a digital wayfinding solution allows healthcare systems to capitalize on the opportunities afforded by offering an app-less mobile wayfinding solution, dramatically increasing the likelihood of usage and adoption. Instead of only appealing to those users who have taken the time and attention to download an app (likely a tiny percentage of all visitors), you can now offer mobile wayfinding to any visitor with a smartphone. Photo Landmark Navigation technology is unique in that it is complex behind the scenes, but incredibly simple for healthcare systems and their patients, making it manageable and maintainable for everyone involved.

 

And, we can’t forget that Photo Landmark Navigation is designed to be an addition to traditional wayfinding methods. Effective indoor wayfinding is multifaceted; Photo Landmark Navigation presents directions that use digital technology, but also leans on effective signage, healthcare design, volunteer & staff participation, and community engagement to successfully improve indoor wayfinding woes.

 

Put simply, Photo Landmark Navigation alleviates the challenges often associated with indoor digital navigation, while spotlighting the unique and beautiful design of a healthcare facility, saving on costs, and improving the patient experience. A creative twist on the driving navigation we all know, love, and rely on, Photo Landmark Navigation is the simple, frictionless, intuitive solution for navigating within complex healthcare facilities. Together with signage, design, and digital wayfinding, healthcare systems can take their digital transformation and patient engagement strategies to the next level, leaning on healthcare design to promise an improved experience for the entire healthcare community.

 

About Eyedog.US

Eyedog.US offers the world’s leading indoor and campus-based pedestrian wayfinding solution. Using photo landmark navigation technologies, Eyedog.US offers a human-centered wayfinding approach that promises to reduce stress and anxiety associated with navigating a complex campus. Learn more at https://eyedog.us/

Don’t be Caught Red Handed – 2023 Healthcare Regulatory Hot Topics

By: Christina Olivarria, MSPM, PMP, LBBP, HACP, Director of Business Development and Communications, Yellow Brick Consulting Inc

I think it’s fair to say the lion’s share of us working in healthcare did not get into this field to learn about regulations, compliance, and accreditation. In fact, some of you may even cringe at the thought of developing policies, reviewing scopes of services, or verifying that staff files are up-to-date and inspection ready. Let’s face it, as much as we may dislike the headache they often bring, healthcare regulations are a necessary component to maintaining our healthcare system. As healthcare professionals, we are responsible for keeping abreast of the latest regulatory trends so that we always bring our best, most informed self to whatever setting may need that information.

As a non-clinician, I have challenged myself to become more educated about the various aspects of regulatory compliance. When activating a new healthcare facility, surveys and site inspections are often the final hurdles project teams must overcome before Day 1 Activation. Each year, as part of my regulatory education, I work with our Regulatory Specialist, ask probing questions, attend webinars, and do lots of reading. Below is a summary of prevalent regulatory hot topics across the country.

Behavioral Health Patient Risk Assessments

The CMS Hospital Condition of Participation, “Patient’s Rights” (42 C.F.R. §482.13(c)(2)) establishes the rights of all patients to receive care in a safe setting and is intended to provide protection for a patient’s emotional health and safety as well as his or her physical safety.

The Joint Commission identified patient safety risks as one of the goals listed in the 2023 National Patient Safety Goals. Specifically, reducing the risk of suicide through thorough environmental risk assessments is a top priority of the TJC and CMS, and many healthcare organizations, particularly as Behavioral Health, becomes a more prevalent topic. Evaluating ligature risks within healthcare settings where high-risk patient populations are cared for should be a top priority of healthcare leaders to mitigate the risk of self-harm. Currently, only psychiatric hospitals and hospitals psychiatric units are mandated to be designed to be ligature resistant. Those of us in healthcare understand behavioral health patients are treated in almost every type of healthcare environment, so it is important to be aware of potential risks and have the plan to minimize them.

Some recommendations include:

  • Evaluation of the physical environment through a standardized risk assessment tool
  • Ensure all patients are being screened for suicidal ideation
  • Develop and maintain policies and procedures should a patient be identified at risk for suicide, including continuous monitoring and staff safety
  • Develop and provide training to staff
  • Follow policies and procedures related to discharge counseling and follow-up care

Workplace Violence Prevention

The data paints a bleak picture.

  • Healthcare and Social Services workers are five times more likely to experience workplace violence
  • Workplace violence comprises 73% of all nonfatal workplace injuries
  • 80% of serious violent incidents reported in healthcare settings were caused by interactions with patients
  • The “healthcare and social assistance” sector had 7.8 cases of serious workplace violence per 10,000 full-time employees compared to other large sectors that all had fewer than two cases per 10,000 full-time employees

As a result of this problem riddling our healthcare teams, the Joint Commission issued new and revised workplace violence prevention standards on January 1, 2022. The Occupational Safety and Health Administration (OSHA) plans for a Small Business Regulatory Enforcement Fairness Act (SBREFA) review of rulemaking for workplace violence prevention in health care and social assistance to ensure all healthcare providers are compliant.

The Joint Commission’s glossary defines workplace violence as “An act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors.” Healthcare leaders are now faced with the arduous task of incorporating these new standards into existing policies and procedures.

The new prevention standards are comprised of the following components:

  • Management of safety and security risks – Conduct an annual analysis of the effectiveness of the workplace prevention program.
  • Collection of information to monitor environmental conditions – Establish a process to monitor, investigate, and report incidents, including but not limited to injuries to patients and staff, occupational illnesses, safety and security risks, hazardous materials and waste spills, and utility system problems/failures
  • Coordination of ongoing staff education and training – Establish training modules and content for various staff types, including at the time of hire and on an annual/as-needed basis. Content should include roles and responsibilities, de-escalation techniques, and reporting methods.
  • Maintenance of a culture of safety and quality – Develop policies and procedures that address workplace violence. Evaluate key performance indicators that can be established to monitor incidents. Ensure support resources are available to staff.

Although this regulatory requirement has left many organizations scrambling, there are several incentives to adopting policies and procedures addressing workplace violence, including staff-burnout prevention, minimizing workers’ compensation claims, and reducing the need to backfill staff who are out due to injury. To access the Joint Commission resource toolkit, click here.

Disaster and Emergency Preparedness

The Emergency Preparedness CoP at §482.15(d)(1) contains requirements for hospitals to train staff and to have policies and procedures aimed at protecting both their workforce and their patients.

In the wake of the Covid-19 pandemic and its impacts still reverberating through the healthcare system, it is unsurprising to see increased scrutiny on emergency preparedness. The Joint Commission has highlighted Emergency Management as key safety topic, focusing on four main areas – preparedness, response, recovery, and mitigation.

Preparedness – Conduct a hazard vulnerability analysis utilizing an all-hazards approach, considering internal and external threats to the organization. Develop an Emergency Operations Plan that addresses identified threats. Validate systems required to support critical services and develop plan to maintain in the event of an emergency.

Response – Develop policies and procedures to support an Emergency Action Plan. Conduct staff training to support outlined policies and procedures to ensure teams respond as planned. Ensure communication and roles and responsibilities are outlined.

Recovery –  Address how and when the hospital will return to full functionality after an emergency or disaster. Consider family reunification and patient identification procedures for unidentified adults and unaccompanied children.

Mitigation – Conduct exercises to test emergency response, including fire evacuation drills, active shooter exercises, mass casualty events, and technology ransomware attacks. Evaluate responses and identify areas of opportunity and gaps in planned responses.

Hospitals must ensure that emergency services will be available when the next disaster occurs while prioritizing investments that will build the healthcare delivery system of tomorrow. For more information, please click here for the Joint Commission R3 Report.

End of the COVID-19 National Emergency and Public Health Emergency (PHE)

Throughout the pandemic emergency, declarations allowed extra funding to be utilized to maintain Medicaid coverage for millions of Americans. With this funding being pulled this year, it is unclear how this unwinding will impact the healthcare system and the millions of Americans who may lose access to insurance come May 2023. Emergency declarations enacted during the Covid-19 pandemic will end, which may result in adjusting ratios, retraining staff onboarded during this period, and adjusting billing for services currently covered under the national emergency declarations.

Organizations should conduct an internal analysis of practices and procedures to prepare for this unwinding period to prioritize the next steps. Communication and coordination with community resources are recommended to ensure patients have the most up-to-date information regarding available benefits and resources.

Although not the most exciting of healthcare topics, regulatory and healthcare compliance education should be a goal of every healthcare professional. What I have found most helpful is understanding what I need to know to be successful in my role and also who my subject matter experts are in the event that I need to consult with them on a topic outside my realm of expertise. Plenty of free webinars and articles are available on the various regulatory agency websites. Should you encounter a situation in which you need consultation, reach out to a consultant that specializes in healthcare. Many are happy to point folks in the right direction. Best of luck on your regulatory educational journey, and be sure to keep these hot topics on your radar in 2023.

The Opportunity for Continuous Improvement in Activation and Transition Planning

BY: Rich Clough and Stefan LaBere, ECG Management Consultants

In Brief: When the excitement of moving into a new facility fades, will your organization fall back on old processes or continue to pursue new efficiencies?

Transitioning to a new and upgraded space presents an opportunity for healthcare organizations to reset and “reinvent” operations to realize new efficiencies. But a new facility alone won’t improve a department’s processes or change its culture. The excitement and optimism that accompany a move to a new space are fleeting; leaders need to promote a culture of continuous improvement to ensure that the advantages of a new space aren’t squandered by a gradual return to the old way of doing things.

The seeds for that culture are planted at the beginning of an activation and transition planning (ATP) project by defining the vision and setting guiding principles for operational excellence. These elements serve as the North Star for all planning activities—they are integrated into project materials, reviewed at key meetings, and championed by executives.

Creating the new facility’s vision and guiding principles demonstrates the organization’s willingness to embrace change and support frontline staff, which in turn encourages department leaders to adopt a continuous improvement mindset during operations planning activities. When done successfully, this enables departmental staff involved in operations planning activities to get creative and reevaluate how their processes can and should change.

Maintaining Momentum

As the opening date of the new facility comes to pass, it is always accompanied by a flurry of excitement and various activities to welcome patients to the new care setting. It can be easy for staff to return to their old habits and processes once operations in the new space reach the new steady state, and the activities completed and ideas shared during operations planning can be at risk of being forgotten.

Often, workarounds and other deviations from the agreed-upon plans prior to opening can become permanent fixtures, which is less than ideal. It is crucial that new or refined processes developed during operations planning, as well as the defined vision and guiding principles, are continually reinforced through training—not only prior to the first patient, but routinely and consistently. This can be achieved through a combination of simulation exercises or in-person training activities to maintain standard workflows and protocols; perhaps more importantly, this can enable the continuous improvement mindset to persist.

Organizational leadership must encourage and enable departmental leaders and frontline staff to utilize existing forums (e.g., daily huddles, regular staff meetings) to reinforce these principles and best practices. Additionally, maintaining select committees established during operations planning (e.g., Opening Readiness Committee) for three to six months after opening day—the stabilization period—can further supplement these efforts.

Sustaining the Mindset

ATP projects typically involve the transition or expansion of existing departments into new spaces. It can often be difficult to capture and sustain process improvements in legacy spaces, so transitioning into a new facility presents a significant opportunity for service lines to “do things the right way.” Reinforcing the new facility’s guiding principles through training and maintaining forums established during operations planning are effective means of sustaining a mindset of continuous improvement. However, it is crucial that these elements are not targeted at one or a few select services in the new facility—these must be broadly applicable to all services and ingrained in the fabric of the entire building. All stakeholders must not only have the ability to contribute, but also feel empowered to do so.

As such, it is incumbent upon organizational and service line leadership to adapt to change and identify new methods for encouraging the adoption of a continuous improvement mindset. How this can be achieved will vary between organizations, but establishing some ongoing structure or process to sustain this cultural change (e.g., creating formal committees comprised of facility service line leaders, conducting facility town hall events) is essential to realize long-term results. Ultimately, organizational leadership must want staff to adopt this mindset, and identify and capitalize on the opportunities available to do so.

Accelerating Innovation in Healthcare Design…

by Dr. Wayne Ruga

Innovation is integral with healthcare – throughout the history of healthcare, it has continuously evolved in its effectiveness through progressive innovation.  What is the source of this innovation, who does it, where does it come from, and – perhaps you find yourself wondering, at times – what can I do to contribute my own innovation to healthcare?  If you do wonder this, please keep reading.

The Symposium has been the leading vanguard for innovation in healthcare design since its very beginning.  In fact, Sara Marberry edited a book called Innovations in Healthcare Design that draws from the most innovative presentations during the first five Symposia.  If you read the ‘Table of Contents’ (posted on Amazon), you will appreciate that many of these select presentations are as innovative today – and impactful in their design influence – as they were more than three decades ago.

Now, thirty-six years after the First Symposium, healthcare design innovation is no less important, now, than it was then.  With the current challenges in our world, for example – shifting and aging populations, environmental concerns, new strains and variants of resistant pathogens, rising energy costs, supply chain breakdowns, and shortages of qualified available labor – the urgent need for accelerated healthcare design innovation is probably even more important, today, than it ever was before.

What – precisely – is ‘innovation’, and how can it be distinguished from other types of advances in healthcare?  From my own personal point of view – being a serial innovator – an innovation must fulfil two requirements.  First, it must make a systemic improvement – this means that it introduces something new, something that never existed before, something that changes the status quo and introduces a new way.

The second requirement is that it must be sustainable – by this, I mean that the improvement is not a flash-in-the-pan, flavor-of-the-month trend, fad, or fashion.  Rather, by sustainable, I mean that the improvement continues to improve over time.

The Symposium is an ideal example of an innovation – nothing like it ever existed before – it changed the pattern.  And, it has sustained the test of time, with tens of thousands of attendees participating in it from across the US and every corner of the globe – carrying its pattern-changing messages back into their own communities in support of making their own local improvements.

As the stories about innovation are told – including even many of the presentations we hear at the Symposium – they tell us about the ‘what’.  Most often, these stories describe ‘what’ the innovation is, or ‘what’ it does.  Rarely, if ever, does the story tell us about the ‘how’ – what was the source of this new idea, and how did it come into the awareness of the innovator?

In keeping with the original inspiration that led to the creation of the Symposium – that is, to initiate an intervention that is an ongoing and ever-expanding quest into the inquiry of ‘how can we design the environment to improve lives?’ – this year’s Pre-Conference Workshop is a candid, truth-telling exploration into the sources of innovation from acclaimed pioneers of innovation – each having made recognized improvements to the healthcare status quo that are both systemic and sustainable.

The ‘what’ story that each one of these innovators will present is breath-taking…but – even more importantly – each innovator will also explain ‘how’ their innovation came into their awareness, and how they each gave their innovation the breath of life, to live on in the world and make a sustainable improvement.  The purpose of this unconcealing of the ‘how’ is to provide workshop attendees with the opportunity to look at the wide range range of these ‘how’ stories, to demystify them, and to introduce ways of knowing that attendees can use to make their own discoveries with.

Every innovator goes on a unique journey of exploration and discovery.  Sometimes much of this journey is extremely unproductive – sometimes it might even take years to arrive at a clear discovery – other times, this journey can occur in a fraction of a nanosecond, with vivid and compelling clarity.  It’s impossible to predict, in advance, what the journey will be like – or, even whether or not it will be a productive journey.

The good news, though, is that there are some common characteristics of how we can prepare ourselves to make innovative new discoveries.  The purpose of the Pre-Conference Workshop, at this year’s Symposium, is to enable ourselves to become acquainted with these characteristics, and to clearly articulate them, with the goal of priming the pump and accelerating a new generation of Symposium inspired innovators.  Appropriately, then, this year’s Pre-Conference Workshop has the title of Breakthrough Innovation: Exploring and Learning ‘HOW I CAN DO IT, TOO’.

The structure of the Pre-Conference Workshop has been designed to cultivate the conditions for learning ‘how’ to innovate.  These conditions include:

  1. Specific presentations by accomplished innovators that focus on explaining their ‘how’;
  2. Breakout sessions that enable small discussion groups with attendee-selected presenters;
  3. A ‘speed-dating’ format of the breakout sessions to provide opportunities to have small group discussions with more than one presenter; and
  4. A closing Networking Reception to enable informal one-on-one conversations.

Registration is currently open for this unique Symposium event. This one-time event is a special opportunity for you to have a direct learning experience from those leading pioneers who have already achieved acclaim for their contributions to healthcare, and put your foot on the path that begins your own personal journey of discovery.  Seats are limited, and are available on a first-come, first-served basis.  I encourage you to register quickly – and – I am looking forward to our time together, then.

If you have questions or concerns about this workshop, please feel welcome to be in touch.  I can be reached at:  [email protected] .