Inova Health System

1. Inova Health System Evidence-Based Design: Inova Fairfax Hospital’s JourneySeptember 16, 2009 Reuven Pasternak, MD Chief Executive Officer Inova Fairfax Hospital Campus Executive Vice President for Academic Affairs Inova Health System Falls Church, VA • 1

2. Evidence-Based Design: Inova Fairfax Hospital’s Journey • Objectives • At the conclusion of the presentation, the participant should be able to describe: 1. At least 3 ways Inova Fairfax Hospital is incorporating evidence-based design elements to enhance patient safety and quality of services delivered. 2. The impact of evidence-based design on clinicians. 3. The role of clinicians in planning the building to reflect evidence-based design. • 2

3. Inova Fairfax Hospital: Unique Role in the Community 833 licensed beds + COPN for 43 obstetrical beds Only Level 1 Trauma Center in Northern Virginia Fourth highest birth rate in the United States Highest level of neonatal intensive care in Northern Virginia Only Obstetrics-Gynecology Clinic for disadvantaged expectant mothers in Fairfax County Only dedicated heart and vascular care hospital in the area Highest level of critical care, including organ transplants / neurosurgery Key provider of medical education and research • 3

4. Inova Fairfax Hospital: Unique Service for the Community Named a HealthGrades America’s 50 Best Hospital™ for 2009 One of only 6 nationally accredited Primary Stroke Centers in Virginia Received national Magnet Recognition for Excellence in Nursing Quality for the last 10 years One of five AA+ rated healthcare organizations in the country • 4

5. Main patient care tower: over 40 years old lacks private rooms inadequate mechanical and electrical systems Patient rooms are significantly undersized for current patient and family needs. The Need: Impetus to Begin a Journey • 5

6. The Need: Impetus to Begin a Journey Unclear wayfinding (locating services) Women’s services significantly outgrew the current facility capacity • 6

7. The Need: Population Growth • 7

8. The Need: Aging Population • 8

9. The Need: Demand for Obstetrics • 9

10. What is Evidence-Based Design (EBD)? Center for Health Design (CHD) defines EBD as: “The deliberate attempt to base building decisionson the best available research evidence with the goal of improving outcomes and of continuing to monitor the success or failure for subsequent decision-making.” (Ulrich et. al. 2004) • 10

11. Excellence in health care, education and research P A T I E N T C E N T E R E D C A R E Q U A L I T Y S E R V I C E C O S T P E O P L E G R O W T H C O M M U N I T Y CONTINUOUS QUALITY IMPROVEMENT M I S S I O N To improve the health of the diverse community we serve through excellence in patient care, education and research. V I S I O N To be the best health care system in the world. B E L I E F S Trust. Respect. Compassion. Empowerment. Integrity. Partnership. Quality. Value. O U R C O M M I T M E N T S Innovative Excellence. Caring about People. Community. VISION ● BELIEFS MISSION ● COMMITMENTS Inova Health System: Mission, Vision, Beliefs

12. Evidence-Based Design Elements: Linkage to Pillars • 12

13. Inova Fairfax Hospital • 13

14. Evidence-Based Design: The Journey with Eyes Wide Open • Effects of healthcare environmental design on medical outcomes • What does the literature reveal? • 14

15. Evidence-Based Design Wheel(Geboy, L., 2007. Healthcare Design 7(2): 41-42) • 15

16. How Strong is the Evidence? Examples of Environmental Properties that Affect Outcomes Single versus double rooms Noise Windows versus no windows • 16

17. Single vs. Double Rooms: Safety • Single rooms have lower infection rates than semi-private rooms or open bays (Van Enk and Nyirenda) • Fall rate decreases in single rooms (Brandis) • Falls reduced 75% at Clarion Methodist Hospital by changing double rooms to single rooms • Wide bathroom doors prevent falls • Room transfers are associated with increased medical errors • Due to communication discontinuities between staff • 17

18. Single vs. Double Rooms: Nurses Prefer Single Occupancy Rooms • Nurses favor single-occupancy rooms (Chaudhury, Mahmood, Valente, 2006) • Flexible family accommodation • Suitable for patient exams • Higher patient comfort level • Improved patient recovery rate • Lower rates of medication errors • Less probable diet mix-ups • 18

19. Single vs. Double Rooms: Patient Satisfaction/Costs • Roommate can be source of stress (Ulrich, 2004) • Higher patient satisfaction (Press Ganey) • Confidentiality / Privacy (Pease and Finlay, 2002) • Reduced embarrassment • Opportunity for family members to participate in care • Avoidance of upsetting other patients • Incompatibility among roommates leads to costly room transfers (Pebble Project-Bronson Methodist) • 19

20. Single vs. Double Rooms: Noise Noise negatively impacts outcomes Widespread annoyance among patients and perceived stress in staff (Hilton, Bayo, Garcia and Garcia) Sleep loss / sleep fragmentation (Yinnon, Hilton, Berg) Increased blood pressure (Yinnon, Hilton) Noise level is a greater problem in double rooms More frequent at higher levels Noise results from roommate, family of roommate, staff attending roommate Stressful for patients and caregivers • 20

21. Florence Nightingale on Light, 1860 “Second only to fresh air… I should be inclined to rank light in importance for the sick. Direct sunlight, not only daylight, is necessary for speedy recovery… I mention from experience, as quite perceptible in promoting recovery, the being able to see out of a window, instead of looking against a dead wall…” • Notes on Nursing.: What It Is and What It Is Not, 1860. • 21

22. Windows Versus No Windows Absence of windows linked with high anxiety rates and depression (Keep et al., Parker and Hodge) Lack of windows may aggravate sensory deprivation (Ulrich) Employees with views of nature report: (Leather et al.) Less stress Better health status Higher job satisfaction (less turnover) • 22

23. Evidence-Based Design: Staff Involvement • Clinical User Groups provide “Operational Flow” • Involved front-line staff • Involved physicians • Clinical partnership with Global Operations Teams • 23

24. Patient Room • Configuration • Hill Rom • Room Builder Workshop • 24

25. Hill Rom Room Builder Workshop • 25

26. Private Medical/Surgical Patient Room • STAFF ZONE • PATIENT ZONE • FAMILY ZONE • 26

27. Critical Care Patient Room • STAFF ZONE • PATIENT ZONE • FAMILY ZONE • 27

28. The Journey: Beyond the Built Environment • Evidence-Based Design: Focus on complexity of work environment, physical space, and technology • How do we enable the provider to spend more time at the bedside? • 28

29. Leveraging Technology: Impacting the Built Environment University of Pittsburgh Medical Center ShadysideSmart Room™ technology Patient involvement (patient education, discharge instructions) Alerts (time for repositioning, patient on “falls precautions”) Simulation: experimentation before implementation • 29

30. Evidence-Based Design: Sustainable Journey Environmental Mission Statement Inova Health System is committed to establishing an environmental program that contributes to a safer and healthier environment for our patients, employees and community. We will work diligently to develop a comprehensive environmental program for this healthcare system which is world class with sustainable and measureable outcomes. Project is registered with United States Green Building Council LEED certification at Silver level is anticipated • 30

31. Sustainable (Green) Design Principles What is “Green” Design? • Design and construction practices that significantly reduce or eliminate the negative impact of buildings on the environment and occupants in six broad areas: • Sustainable Sites • Water Efficiency • Energy and Atmosphere • Materials and Resources • Indoor Environmental Quality • Innovation in Design

32. The Journey: Current State • Economy dictated new footprint • Project redesigned to reflect ability to secure bonds / loans • Previous work to incorporate EBD has proved invaluable • Construction start date is July 2010

33. INOVA Fairfax Hospital - South Patient Tower • 33

34. Inova Fairfax Hospital South Patient Tower and Women’s Hospital Inova Fairfax Hospital - South Patient Tower/ Women’s Hospital • 34

35. Inova Fairfax Hospital South Patient Tower and Women’s Hospital Inova Fairfax Hospital - South Patient Tower & Women’s Hospital “Green” Concepts • 35 • 35

36. The Journey: Lessons Learned • Evidence-Based Design principles must be incorporated into the organization’s mission, values, beliefs in order to gain traction • User-input, while time consuming, ensures the organization has sought opinions of those who will provide healthcare.

37. Another Journey: Visit to China • Lessons learned