Inpatient Psychiatry Redesign

1. Inpatient Psychiatry Redesign Project Update

2. Galter Project Guiding Principles • Provide an environment of safety and quality excellence through the physical design, operational processes and technologies • Enhance the patient experience by creating an environment that recognizes the patients individual physical needs as well as their emotional and spiritual needs • Provide an environment that supports operational excellence • Advance the art and science of healthcare delivered by: • Incorporating the successes/lessons learned from previous NMH projects • Integrating evidenced based innovations from benchmark organizations • Creating new design/operating/technology innovations (becoming the benchmark – best practice) • Provide flexible/adaptable spaces and infrastructure to accommodate the dynamic nature of healthcare delivery • Provide an environment that positions NMH as the hospital of choice for staff and physicians

3. Contemporary Behavioral Health Design Elements • “Mall treatment” and neighborhood concept • On-stage, off-stage design • Access to natural light • Light, airy environment that calms • Maximized patient visibility

4. Key Design Components • Due to existing physical properties, the structure does not allow for patient rooms in either north corner due to safety concerns • Chose inboard bathrooms to preserve windows and natural light for patients • 29 beds • 2 rooms are semi-private to accommodate patients that would clinically benefit from a roommate

5. Key Design Components • Rooms are smaller than normal med-surg rooms due to the specialty treatment requirements for psychiatry • Maintain code requirements • Majority of treatment for psychiatry patients is in group and milieu rooms; time in room is limited except for sleeping • Appropriate ratio of ADA compliant rooms are maintained – 2 singles and 2 doubles (2 double rooms are quite large due to existing structures and can accommodate ADA facilities easily)

6. Key Design Components • On-stage off-stage concept and improved staff flow • Address life-safety divisions (fire doors) to remove need for additional secure doors in treatment mall • Enhanced operational efficiency and patient safety • Northeast corner is hidden between mechanical shafts and elevators and is not a viable option for any patient activity • Moved internal conference room to the corner, freeing up space closest to nursing stations for support activity such as report room, patient belonging storage • Allows off-shift/evening hours use for external/community entities, such as NAMI and/or AA

7. Psychiatry Update Presented at Stone Institute of Psychiatry Employee Open Forums November 8, 2007 By Maureen Slade and Ronald Krasner, MD

8. Agenda • Welcome • New Chairman – Department of Psychiatry • Inpatient Psychiatric Services • Enhanced Outpatient Services • Questions and Answers

9. Chairman Selection • John G. Csernansky, MD • Washington University School of Medicine, St. Louis Missouri • Gregory B. Couch Professor of Psychiatry, Professor of Neurobiology, Department of Anatomy and Neurobiology • Director, Silvio Conte Center for the Neuroscience of Mental Disorders • Site Principal Investigator, Treatment Units for research on Neurocognition and Schizophrenia (TURNS) • Chicago Native • Northwestern Graduate (BA, Chemistry) • Likely to start February or March of 2008

10. Inpatient Psychiatric Services • Galter Pavilion, Floor 13 • 30 Inpatient Beds • Estimated move Spring 2010 • Beautiful, state-of-the-art, healing environment for psychiatric patients

11. Enhanced Outpatient Services • Offer a short stay unit in the ED to more appropriately diagnose and link ED patients to the best treatment options • Provide Intensive Case Management to our most at risk patients to support a seamless transition to treatment • Develop step-down services through a Partial Hospital Program that serves acute patients • Improved Access to Outpatient Treatment • Expanded Emergency Housing Programs and actively link patients to housing options

12. Psych ED DMAIC Project • Goal – Care of the Psychiatric patient in the ED is timely, safe and effective • LOS varies between 9 and 15 hours based on disposition type • Implemented the project in July 2007 • Staff highly involved in defining issues and data collection which completed in Oct 2007 • Important take away – 69% of Psych patient in the ED are medically complex therefore 31% of the patients may be amenable to a fast track for medical clearance

13. Overview of Initial Process • Director held meetings with inpatient managers, systems coordinator, clinical coordinators, and staff educator to explore existing space, discuss what does not work and ideas to improve care • Group held smaller meetings with frontline staff and reported back findings • Began meetings with architects in September 2007 and started discussions with functional and space programming • 2 site visits – Evansville State Hospital, Evansville, IN and Avera-McKennan Behavioral Health, Sioux Falls, SD

14. Overview of Design Process • Knowledge gleaned from site visits used to begin adjacency/concept designs with architects in early November 2007 • Schematic design process began and nearly finished in December, 2007 • Brought in physician leadership and Residency Training Director for further feedback and refinement • Process slowed by issues with shafts • Asked to test-fit a Psych ED within the floor