“The Prentice Story” Prentice Move Phases and Evaluation

1. “The Prentice Story” Prentice Move Phases and Evaluation April 9, 2008

2. “Activation & Readiness Planning”

3. Prentice Women’s HospitalTransition Planning Model Stabilization Patient Move People Commissioning Communications & Events Migration Recruitment Department Readiness Operating Budget Facility Readiness Operations Readiness Building Load Operating Work Flows Technology Readiness Operating Assumptions Building Readiness Program Design Construction FFE Transition Planning Campus Development

4. Feinberg/GalterLessons Learned • Transition took longer than anticipated • Operational and department changes were unclear to staff • Expect and hire for full census • Pilot all new technology and assure staff have adequate training • Assure FFE is delivered to the appropriate department and remains in that department

5. Feinberg/GalterLessons Learned (cont.) • Time between Facility Completion-Grand Opening Events-Move was too short for staff and vendors • Department Readiness • Staff Readiness • Clearly understand the scope of facility transition and the related impact on stabilization post move • Department Readiness • Technology Readiness • Staff Readiness • Assure PAR levels meet new patient demand • Vacated facilities represent operational and cost challenges

6. Prentice Women’s Hospital Unique challenges existed with the Prentice Transition plan • OB & NICU patient move plans would require different clinical assessments • More monitored patients would be moved (L&D and NICU) • More families would want to move with the patient (L&D, NICU and PP) • Opportunity existed to communicate the move plan to patients earlier • Support departments would need to focus on both Feinberg operations as well as Prentice move needs • Complexity and scope of technology had increased dramatically

7. Transition Plan A well defined plan assured smooth activation of the new Prentice. • The Transition Plan extended beyond Prentice Women’s Hospital and involved a majority of the Northwestern Memorial Hospital departments. • Each department/unit established a detailed plan highlighting the move-related activities the year of the move.

8. Transition Plan The move and activation plans were consistent with Northwestern Memorial Hospital’s mission and strategic plan initiatives.

9. Transition Planning Stabilization Patient Move People Commissioning Communications & Events Migration Recruitment Department Readiness Operating Budget Facility Readiness Operations Readiness Building Load Operating Work Flows Technology Readiness Operating Assumptions Building Readiness Program Design Construction FFE Transition Planning Campus Development

10. Prentice Women’s Hospital2007: Move Preparation • Building Readiness • Technology Readiness • Department Readiness • Staff Readiness

11. Prentice Women’s Hospital2007: Move Preparation Equipment Procurement and Pilots Staff and Physician Training Development of Move Plan Move Simulation and Mock Move

12. Organization Structure Transition Planning Team coordinated and facilitated all activities related to the activation and move. Chief Operating Officer Executive Vice President Dennis Murphy Consultant Kerry Shannon Steve Straka Transition Planning Director Kirk McKie IT Project Director Paula Elliott Transition Planning Manager Nick Wojciechowski Transition Planning Manager Roberta Clairmont Transition Planning Manager Sara Hayes/Heather Daas Transition Planning Manager Mary Fran Molitor

13. Transition Plan VP Sponsored Task Forces and Activation Teams addressed the scope of activities required to execute the overall Transition Plan. Prentice AIP Dennis Murphy Kirk McKie • Department • Activation • Teams • Dept VP’s – • MF. Molitor • All TP • Move Logistics • J. Przybylek – • N. Wojciechowski • Building • Readiness • Jim Bicak – • S. Hayes • FF&E • Building Load • G. Fennessy – • N. Wojciechowski • Patient Support • Services • G. Fennessy – • N. Wojciechowski • Information • Technology • T. Zoph – • P. Elliott • Professional • Services • D. Woods – • S. Hayes • Best People • D. Manheimer – • MF Molitor • Communication • & • Events • H. Salls – • R. Clairmont • Activation Teams • geographically focused/ • department specific • assumptions/workflows • Task Forces • assumptions/work flows • that cross department

14. Transition PlanA three year process from planning through execution and stabilization Preliminary Operating Budget Review Recruit 2 Project Managers Recruit 2 Project Managers Opening Patient Move Consultant RFP Planning Support Plan Development Plan, Process & Schedule Budget Review/ Approval Task Force Activity Confirm Charter/ VP Sponsorship Implementation Plan/Assumptions/ Work Flows Validate & Approve Plans/Assumptions/Work Flows Activation Team Activity Confirm Charter/ VP Sponsorship Plan/Assumptions/ Work Flows Implementation Stabilization Homestretch Coordination TP Transfer to Operations 2005 Q3 2005 Q4 2006 Q1 2006 Q2 2006 Q3 2006 Q4 2007 Q1 2007 Q2 2007 Q3 2007 Q4 2008 Q1 2008 Q2

15. Building Readiness Objective Prepare the physical facility and assure building systems were tested and functioning for the opening of the new Prentice • Environmental • Services • Implement plan for each building clean phase : post-construction, post-load, terminal clean, and patient ready clean • Transition to support building operations • Security • Services • Validate updated security system and procedures • (e.g. Code pink) • Transition to support pre-operating building access and opening operations • Facilities • Management • Transition to support • building operations • (i.e. automation of MEP) • Building commissioning • City requirements • Statement of conditions (JCAHO) • Safety and Infection Control • Training of 2200 employees and vendors of pre-move safety procedures • Environmental testing of facility to ensure air and surface quality meet defined criteria • Service Disruption Team

16. Technology ReadinessObjective To assure that all technology works, and works together in advance of opening the new facility to mitigate risks associated with technology failure, information flow and end-user acceptance. Scope: Infrastructure – 1076 miles of cable Wired Devices – 4727 PC’s, printers & phones Wireless Devices – 550 PC’s & phones Biomedical Equipment – 2650 devices Applications – 76 applications cross referenced to 50 processes Pilots – 6 pilots of new technology

17. Technology Readiness Process • Commissioning • Confirmed commissioning as preferred approach • Focus Commissioning to confirm process and methods • Building load sequenced to support commissioning activities • Created “floor captain” role to facilitate commissioning • Executed • SWAT approach for remediation • Infrastructure • Designed infrastructure with flexibility to accommodate changes in technology for 25 years • Full wireless capabilities, house-wide • Built infrastructure off site, tested, then loaded closets • Application • Conducted workflow sessions • Mapped processes to applications • Piloted new technology in existing facility • Built and tested applications in production environment Activation Teams – Task Forces – Department User Groups

18. Building Load Objective Develop a process and management structure that leverages the organization’s operational strengths to ensure the placement, functionality and retention of all new Prentice Women’s Hospital items in the right place at the right time, in coordination with all pre-occupancy activities. Scope: 45,000 pieces of medical and general equipment 11,000 pieces of furniture 7,500 Information technology devices 703 hours of loading activity

19. Integrated Building Load Project Elements The complexity of the following pre-occupancy elements prompted the need for a fully integrated planning and execution structure. • Construction • Regulatory Inspections • MEP Commissioning • Design-Deferred Construction • Punchlist Construction • Systems Readiness • Cleaning • Training and orientation • Environmental Testing • Technology Commissioning • Equipment installation and testing • Loading • Group 1 Equipment • Group 2 Equipment • Furniture • Artwork and Signage • IT Devices • Supplies, medications and food • Grand Opening Materials • Relocated FF&E and materials

20. Load Sequence (Sample) Each system and piece of equipment required analysis to reveal the dependencies, activation duration and sequence. Video Endoscopy system (8) Ceiling-mounted Flat Panel Display (x24) Camera, Video/Surgical (x5) (new) Cart, Fiberoptic (2 new) Printer (x8) OR Video Integration (new x8) PACS Wall-mounted display (x2) Outside world Gateway Video teleconference Coder/Decoder (x2) OR Conference In-room camera (x2) Conference Center PC (standard charting at documentation station) Delivery Installation Biomedical Certification Technology Commissioning Staff Training First Use

21. Shake Down: Leverage of existing issue reporting system (Sentact) to report track and resolve issues Department Readiness AssessmentObjective Define and Implement process to identify, report, resolve and track issues to assure the planned environment is ready to receive patients and can continue to support patient care following the move • Department Readiness Assessment Validation: Leverage of existing building load database and multidisciplinary support services rounding group to assess environment to validate readiness state • Scope: • 3019 pre-move issues reported • 62% resolved pre-move • 148 move day issues reported • 236 stabilization issues reported – 3 weeks • 95% issues resolved to date Scope: 1000 rooms assessed pre-move 56,000 FFE items validated 16 hours – average assessment time 100% rooms approved to open

22. Shake Down Leverage Sentact To Support Issue Reporting/Prioritization And Issue Resolution Before, During And Immediately Following The Move To The New Prentice Training Issue Entry OR Reports Call 6-8888

23. Department Readiness AssessmentDepartment assessment of loaded and commissioned equipment by department managers utilizing Task Management Tool Deliverables • Report of % of items: • Loaded/installed • Commissioned • Certified • List of open items to begin focused issue resolution inserted within the “add comment” field • Go No-Go Decision

24. Department Readiness Assessment EOC ReviewMultidisciplinary support services rounds accompanied by department manager to validate department’s environment is ready to accept patients Deliverables • Sentact Shake Down report of all identified issues • Report of % of EOC rounds completed • Go No-Go Decision • Team Members • Safety • Bio Medical Engineering • EVS • Materials Management • Facilities • Pharmacy • Construction/Renovation • Infection Control

25. Migration Project Elements Many project resources and organizational structures were leveraged to streamline the migration process. • Implementation Planning • Activation Teams Identified Dependencies and Items Needed for First Day of Operations • Department Assessment Conducted to Label All Migrating Assets • Bid and awarded commercial mover contract • Move • Labels Distributed to Departments for Box Identification and Relocation • Vendors Engaged to Assist with Complicated Migration Items • Master Migration Plan Established • Planning • FF&E Group Established New Asset Master List • Gap Analysis Completed; Migration List Created • Migration Guiding Principles Established and Distributed • Activation Teams Validated Migration List and Established the Migration and Commissioning Plan

26. Sample Migration Plan Breast Imaging MOVE Screening Center in 676 Closes Screening Center Equipment to New Prentice for Installation and Commissioning Galter 13 Operates at Half Capacity Move Half of the Mammo Units from Galter 13 to New Prentice for Installation and Commissioning Galter 13 Closes Move remaining Mammo Units from Galter 13 to New Prentice for Installation and Commissioning New Prentice Opens with 3 Diagnostic Pods and a Screening Pod Operate at Full Capacity Oct 1 Oct 8 Oct 29 Sept 24 Oct 15 Oct 22 Nov 5 Nov 12

27. Operating Program - Assumptions - Work FlowObjectives Activation Teams To develop geographically focused/department specific operating assumptions and Workflows – e.g. NICU. Task Forces To develop operating assumptions and workflows that cross departments in Prentice – e.g. Pharmacy. Scope: 8 Task Forces 160 Staff & Physicians Scope: 16 Activation Teams 300 Staff & Physicians

28. Operating Program - Assumptions - Work FlowStructure Task Forces • Building Readiness • Technology Readiness • Patient Support Services • Professional Services VP Sponsor Director Oversight Selection Of Membership Kick – Off Monthly Meetings Formal Minutes • Activation Teams • Inpatient • Labor & Delivery • Ante/Post Partum • NICU • Women’s Care Unit • Hematology Oncology • Diagnostic & Therapeutics • Radiology • Breast Imaging • Ultrasound • Surgery • Support Services • Professional Services

29. Operating Program - Assumptions - Work FlowProcess • Projected Volume • Facility Design & Size • New Programs • Service Enhancements • Regulatory Requirements Provide Input to Technology Device & Application Plans Provide Input to Training Plans Develop Operating Assumptions & Workflows Review Department Specific Program Participate in the Development of the Move Plan Validate Staffing Models Key Factors

30. Work Flow Sample OB Triage • Swipe Employee Badge at Kronos Station on floor which staff is assigned. • Keycard Reader Access to the Staff Lounge. Place personal belongings/purse in purse locker within the Staff Lounge • Staff will then participate in Assignments/Report on a one to one basis in the conference area adjacent to the private patient care workstation • Wireless devices will be stored in the private patient care workstation area and will be picked up there at the beginning of the shift. • Paper charts will be stored at the patient care workstation • The Clinical Coordinator will use their shared office on “office days” and be at the patient care station other times. • The unit secretary will work in the Patient Care station at the PC closest to the Nurse Call master station. • Purse lockers will have keys – Staff will use locker only during shift returning key and emptying purse locker at the end of shift • After report the receiving nurse will sign in the the Rauland Nurse Call System PatientCareStation Keycard Reader Reception Desk Report Conference Kronos Lounge

31. People Commissioning Objective Working with organizational resources to ensure that all staff and Physicians have novice competency to work effectively and safely with the New Prentice building, equipment, systems and workflows and to verify same to senior management. Practically this means the ability to locate, access, retrieve and use spaces, systems, equipment and supplies with no delays, no adverse events and with minimal assistance in urgent situations. Note: Clinical competence is outside the scope of this charter. Scope: 16 Staff and contractors 7124 Total participants (2514 unique individuals) 474 Physicians 18,537 Training Hours Delivered 102.5 Training Hours Developed

32. New Prentice Women’s Hospital 100% of employees completed mandatory training 600 training sessions held in September and October Training scheduled 6 days/week, 15 hours/day 138 trainers participated (primarily patient care staff) Over 1300 employees completed 4-18 hours of training Electronic Learning Management System used to track enrollment and completion in real time Training: Our Staff

33. Over 300 providers from multiple specialties completed building orientation Building tours tailored to individual provider’s specialty and focused on navigating new environment L&D and NICU: Multidisciplinary simulation exercises conducted to practice emergency responses in new environment New Prentice Women’s Hospital Training: Our Attending and Resident Physicians

34. People Commissioning Process Evaluation Follow-Up Remediation • Plan Development • Administration • Development Process Scope Validation Needs Assessment Strategy Budget Implementation On-Line Training General Orientation Department Training

35. Identify & Prioritize Training Needs Develop Training Approach Conduct Needs Analysis Unit & General Develop Scenarios Identify Subject Matter Experts (SMEs) Develop Evaluation Plan NPWH: Process for Training Development Evaluation & Follow-Up Develop Training Materials Certification Process Finalize & Communicate Schedule Quality Checks Conduct Training Identify & Prepare Trainers Process for DevelopingUnit Specific Transition Training

36. “Patient Move”

37. Move Logistics Objective Develop and implement a move plan that takes occupancy of the new Prentice in the most efficient, safe and cost effective manner for the patients, visitors, staff and physicians. Scope: 208 total patients 8 laboring mothers 49 critical care neonates Duration: 5 hours

38. Prentice Women’s HospitalThe Move: October 20, 2007 Move Statistics • Move start –7:43 am • Average trip –12 minutes • Patient moved every 2 minutes • 208 adults and infants moved, including 49 NICU Infants • Move duration: 5 hours, 1 minute All patients moved safely with no untoward incidents

39. Patient Move – ResourcesOver 500 staff and volunteers supported the move Patient Movement Materials Movement Move Route Security & Facilities Care Stations Diagnostics & Therapeutics Communications & Media Relations Visitor Management Concierge (Orientation to Patient Room & Technology) Patient Move Gift Distribution Ongoing Operational Support Data Management

40. The Move Plan: Move Sequence Simulated Duration – 5 Hours, 44 minutes 13:30P 12:30P 7:30A 8:00A 8:30A 9:00A 9:30A 10:00P 10:30A 11:00A 11:30A 12:00P 13:00P Close Current LDOU 12:00AM (All patients to L&D) Neonatal Intensive Care Unit Open New L&D and OB Triage (Point of entry all OB pts. during the move) Close Current L&D Transfer early labor patients from current L&D to new PWH L&D Deliver and recover remaining patients at current PWH Post Partum Admissions – 9 New Prentice (Admitting Unit for deliveries occurring in current/new L&D during the move) Move Final Antepartum (15) est. 9-10 pts. NICU PP Mothers Hematology/Oncology Units (15E, 15W then 16E) Women’s Care Unit Post Partum Units (12, 11 then 9)

41. New PWH – Patient Move Route ChicagoAvenue - Minor Care Stations - Major Care Stations N - Patient Move Route New PWH - Doorways (requiring support) - Privacy Curtains - Return Route PWH Return Route Superior Street Olson Pavilion PWH L&D Feinberg return Route Elevator to basement level NICU Across drive under tent Elevator to ground level Lurie Research (Note: Incline of Lurie Bridge) Huron Street - Bridges and 2/3 floor corridors Feinberg/Galter Pavilions -Tunnels & Lower Concourse Corridors - Elevators

42. New Prentice Women’s HospitalMock Move: August 2007Coordination of resources to validate the department move plans, move sequence - timing and move route Mock Move Roles Patients Family Members Patient Care Staff - RN’s/PCT’s Physicians Unit Secretaries Patient Escort Volunteers - Movement of Personal Belongings EVS - Equipment Cleaning Elevator Operators ADT/Navicare Data Input Move Leads Command Center Members

43. New Prentice Women’s HospitalMock Move Successfully completed the move of 34 patients ahead of schedule!!!

44. New Prentice Women’s HospitalMock Move: Lessons Learned • Allow unit managers control and flexibility for patient move sequence • Provide route signage and move staff identifiers

45. New Prentice Women’s HospitalMock Move: Lessons Learned • Scripting of messages to patients/families • Keep infants in view of Mother • Separate return route for resources & equipment

46. New Prentice Women’s HospitalMock Move: Lessons Learned Transporter fatigue – maintain consistent pace and provide breaks Coordination of transportation equipment • Care Station strategy & locations • Major versus Minor • Distance between stations • Emergency Response within Tunnel

47. Patient Move Simulation The Simul8 application allowed for the definition of resource requirements and the implications of assumption adjustments

48. The Last Baby Born at Old Prentice Born: 11:43 AM It’s a boy!

49. The First Baby Born in New Prentice • Born: 11:48 AM • It’s a girl!

50. “Stabilization”