Enhancing Patient-Centered Care: Evidence-Based Design Approach

1. Creating a Patient-Centered Care Environment on a Medical-Surgical Nursing Unit Using Evidence-Based Design Debbie Hunt MSN RN CNOR NE, B/C DNP (candidate) Academic Advisor: Olivia May, DNP, CRNP Clinical Advisor: Terri Joiner, FNP-BC June 1, 2014

2. Objectives • Discuss the background of the project • Define patient-centered care • Discuss the process • Discuss the results • Discuss implications

3. Why replace the current hospital? • Space, fire, and life safety issues • Floor to floor heights • Distance between structural columns • 200,000 sq/ft short of space needed for workload • Current infrastructure does not allow renovation to accommodate current and future health care design criteria

4. Background • 2004 - Capital Assets Realignment for Enhanced Services (CARES) commission • 2006 – Secretary for Veterans Affairs accepts recommendation • 2012 – Site selected and purchased • 2012 – Core Activations team established • 2013 – Focus Groups and Schematic Design 1 • 2014 – Schematic Design 1 completed

5. VAMC Louisville Replacement Medical Center Timeline Site Selection SecVA announced the Brownsboro site as the location for the new Robley Rex VA Medical Center Construction Award late 2015 Estimated completion, 3-4 years Begin stakeholder focus groups Aug 2013 Master Planning Completed 22 Nov 2012 2019-2020 June 2012 July 2012 Nov 2012 May 2014 Aug 2013 Schematic Design Initiated Aug 2013. Activation Team Hired Site Purchase The Brownsboro site purchased 12 July 2012 Schematic Design Completion May, 2014 Projected Completion

6. Defining Patient-Centered Care • Referenced as far back as the 1950’s but not prioritized (Cliff, 2012) • Other priorities including patient safety, delivery of quality care and operating budgets. • 2001 – Institute of Medicine report Crossing the Quality Chasm: A New Health System for the 21st Century • Institute for Healthcare Improvement definition • Patient-centered care moves to the forefront

7. Institute for Healthcare Improvement • Independent not-for-profit organization founded 25 years ago • Partners with visionaries, leaders, and front-line practitioners around the globe • IHI Patient-Centered Care definition

8. The Planetree Organization • Founded in 1978 • Mission – patient-centered focus Sticher, 2011

9. Nine Elements • Human interaction • Patient education and information • Healing partnership with family and friends • Healing nutrition • Spirituality and personal healing resources Sticher, 2011 • Human touch • Healing Arts • Alternative and complementary care • Healing environments.

10. Process • Defining the Vision • Space planning • Stakeholder management • Site visits

11. Defining the vision • Why is this important? • Provide a foundation for decision making • Department of Veterans Affairs • Vision for care deliver • Guiding principles

12. VA Office of Construction & Facilities Management • VA and patient-centered care • Developing and integrating a care delivery model focused on patient centered care specifically as it applies to Veterans (Design Guide, 2011, p. 7). • VA and Planetree • Partnering with Planetree

13. Veteran Centered Care Core Principles • Honor the veteran’s expectations of safe, high quality, accessible care • Enhance the quality of human interactions and therapeutic alliances • Solicit and respect the veteran’s values, preferences, and needs • Systematize the coordination, continuity, and integration of care • Empower veterans through information and education • Incorporate the nutritional, cultural and nurturing aspects of food

14. Provide for physical comfort and pain management • Ensure emotional and spiritual support • Encourage involvement of family and friends • Ensure that architectural layout and design are conducive to health and healing • Introduce creative arts into the healing environment • Support and sustain an engaged work force as key to providing veteran centered care (Design Guide, 2011, p. 7)

15. Space planning • Multidisciplinary, integrated activity • Activations team • Leadership • Architect and Engineer firm • Department leadership • Central Facilities Management (CFM) • Veterans Integrated Services Network (VISN)

16. Stakeholder Management • What is stakeholder management? “a process of enabling stakeholders to identify, negotiate and achieve their objectives, such as social, environmental or economic, through active participation in the project process” (Rowlinson and Cheung, 2008, p. 611 as cited in Brammer and Millington, 2004, and Palunen, 2006)

17. Institute for Patient and Family Centered Care (IPFCC) patient and family-centered care concept • “Patient- and family-centered care is an approach to health care that shapes policies, programs, facility design, and staff day-to-day interactions. It leads to better health outcomes and wiser allocation of resources, and greater patient and family satisfaction (2014, para. 1).

18. Primary Stakeholders for Medical-Surgical Unit • Deputy Nurse Executive • Nursing unit staff • Pharmacy • Discharge Planners • Food and nutrition • Environmental management services • Healthcare providers • Veterans and families

19. Presentations • Staff meeting presentations • Multiple meetings on all shifts • Defining patient-centered care • Review of renderings • Brainstorming • Veteran Service Organizations (VSO) presentations • Monthly meetings • Defining patient-centered care (different from veteran-centered care?) • Review of renderings • Brainstorming

20. Schematic Design User Group Meetings • Schematic Design 1 – further develops concept plan to a level of detail that includes functional and adjacency requirements and establishes the aesthetics of the design (A/E submission Requirements, 2013, p. 16). • On-site user group meetings • Subject matter experts (SMEs) • Deputy Nurse Executive • Associate Chief Nurses • Nurse Managers • Patient Safety Officer • Infection Control Coordinator

21. Schematic Design User Group Meetings • Schematic Design 2 – further refine the solution developed in SD1 and to validate that project goals and parameters are reflected in the design, which is further developed at a room-by-room level of detail • On-site user group meetings • Subject matter experts (SMEs) • Deputy Nurse Executive • Associate Chief Nurses • Nurse Managers • Front line staff • Patient Safety Officer • Infection Control Coordinator

22. Site visits • Trend toward evidence-based design • Examples of evidence-based design • Best practices • Planetree

23. Site Visits • Norton Brownsboro • Jewish Hospital Medical Center East • University of Louisville Hospital • University of Kentucky Hospital • Las Vegas VA • Orlando VA • Palo Alto VA

24. Discussion • Implications • Improve patient outcomes • Improve staff morale • Improve patient/family satisfaction • 10 designated Planetree hospitals “exceed the Centers for Medicare and Medicaid Services (CMS) national averages on several core measures (Frampton and Guastello, 2010, p. 52)

25. Sharp Coronado Hospital Study • Retrospective study examining data from two medical-surgical units over five years. • One unit had implemented Planetree and one had not • Planetree unit demonstrated: • Shorter average lengths of say • Statistically significant lower costs per case • Higher average overall patient satisfaction scores (Frampton &Guastello, 2010)

26. Conclusion – So What? • VA mission to create a patient-centered care environments that are Veteran centric • Exciting time for Veterans and those involved

27. References A/E Submission Requirements for VA Medical Center Major New Facilities, Additions & Renovations. Retrieved from http://www.cfm.va.gov/til/ae/aeSubMaj.pdf. Cliff, B. (2012). Patient-centered care: The role of healthcare leadership. Journal of Healthcare Management / American College of Healthcare Executives, 57(6), 381-383. Design Guide. (2011) Department of Veterans Affairs Office of Construction & Facilities Management design guide November 29, 2011. Retrieved from http://www.cfm.va.gov/til/dGuide/dgInpatientNU.pdf Frampton, S., and Charmel, P. (2009) Putting Patients First: Best Practices in Patient-Centered Care, 2nd ed. San Francisco: Jossey-Bass.

28. Frampton, S. B., and Guastello, S. (2010). Patient-centered care: More than the sum of its parts. The American Journal of Nursing, 110(9), 49-53. Garon, S. (2006). Space project management lessons learned: a powerful tool for success. Journal of Knowledge Management, 10(2), 103-112. Institute for Healthcare Improvement (2014). About IHI. Retrieved from http://www.ihi.org/about/Pages/default.aspx Institute for Healthcare Improvement (2014). Person- and Family-Centered Care. Retrieved from http://www.ihi.org/Topics/PFCC/Pages/Overview.aspx

29. IPFCC Frequently Asked Questions (2014). What is patient- and family-centered health care? Retrieved from http://www.ipfcc.org/faq.html Rowlinson, S., & Yan Ki Fiona, C. (2008). Stakeholder management through empowerment: modelling project success. Construction Management & Economics, 26(6), 611-623. doi:10.1080/01446190802071182 Stichler, J.F. (2011). Patient-Centered Healthcare Design. Health Facility Design, 41(12), 503-506. VA Executive Summary 2008 (n.a.) Retrieved from Louisville Replacement Hospital SharePoint.

30. VA Space and Equipment Planning System (2014). Office of Construction & Facilities management. Retrieved from http://www.cfm.va.gov/TIL/planning.asp