At HTS, Inc. Transition Planning, we design our processes based on evidenced-based research and experience. We would like to share with you one of our favorite articles on Transition Planning. This article describes the importance of considering the transition of operations and patient care during the design phase. Canfield argues that too often the transition plan becomes a reaction to the design, rather than a part of it, which can lead to critical issues, such as inadequate storage space and overrun budgets. Canfield concludes by saying, “Planning the transition to a new hospital is a long and arduous task. If the planning process begins early with the right personnel leading and participating in the transition planning process, a detailed plan can be assembled that will most likely lead to a successful move into the new facility.”
We hope you enjoy his work as much as we do. Please feel free to leave your comments and questions below.
Hospital Design Begins with the Transition
~by Brian T. Canfield, Academy of Health Sciences, US Army.
October 22, 2010 – Healthcare Development Magazine
A replacement facility by definition is just that. If one expects to execute a flawless transition, then one should consider how this will look before even the first stroke of the schematic design is made.Too often I witness a transition plan that seems to be an afterthought to the design. Architects and Engineers as well as facility directors need to consider just how they plan to facilitate the migration of patients, staff, and families through the new facility in the first few days of the patient move. No matter how many patients are slotted to be relocated, there will need to be staging for clinical engineering, staff entrance, family entrances, and most importantly patient transfer space. With sending coordinators and receiving coordinators fixed on the successful relocation of the patient, they should be comfortable with the process long before they are oriented to the new surroundings.
Case in point – A facility that had planned their opening in haste, in order to “keep up with the Jones”, made several critical errors in the design such as fast-tracking and issuing several packages in order to save time and open within one year of their competitor. This haste brought about increased budget overruns and design/constructability issues that ended up severing the relationship between the owner and architect. During the design phase there was no thought given to how they planned to transfer patients to the new facility and this hospital in particular had planned to consolidate two hospitals in to one. Within two months of opening, and the move looming in the minds of the staff, there was much angst over whether or not this process was going to work and the plan was being revisited on a daily basis with little or no leadership coming from senior management. This brought about heated discussions behind closed doors and no resolution to priority issues was being reached. Even within weeks of the pending relocation there were several issues pertaining to staff access, family waiting and patient transfer entrances as well as staging in areas for IT and Clinical Engineering to perform their safety checks and PC upgrades. Department heads were jockeying for position and one of the most critical decision errors had been made when the dock area was designed at only 2,500 square feet for a 450,000 square foot facility. This attributed to delaying the opening by up to two months as movers, equipment installers, and construction personnel were constantly in each other’s way with such restricted access to the main dock. Small conference rooms, inadequate lobby size for families, and a mile long walk from the ambulance garage to the elevators designated for patient transfer aided in the frustration of staff and consultants.
The move went off without a hitch and quicker than planned due solely on the patient education committee and the skilled nursing
leadership which, combined, made the most out of a seemingly bad situation. Had the architect and senior staff asked themselves “How will we transfer patients and equipment, accommodate families of those patients in route and provide quality healthcare in three different facilities?” there would certainly have been a more profound sense of pride and accomplishment in the days after the last patient was relocated. Instead, there were issues with equipment, training, and orientation as well as areas of the facility that were still under construction due to the lack of planning in the early stages or decisions not made in a timely manner. This transition is considered a success but I am illustrating this to show the kinds of issues that can arise from the lack of planning in the earliest stages of design. In an article published in December of 1998, by the National Pollution Prevention Center for Higher Education, written by Jong-Jin Kim, (Assistant Professor of Architecture) and Brenda Rigdon, (Project Intern) with the College of Architecture and Urban Planning at The University of Michigan they state that:
“In modern society, more than 70% of a person’s lifespan is spent indoors. An essential role of architecture is to provide built environments that sustain occupants’ safety, health, physiological comfort, psychological wellbeing, and productivity.”
While I concede that they are seemingly referring to the need for human comfort while considering environmental impact of design, believe that the statement applies to the topic of this article in the sense that poor design not only affects those employees over time but it is paramount to their psychological well-being in order to provide the “physiological comfort” of the patients during the transition.
In our meetings and presentations we are almost sure to be told that the facility “would like to wait until at least 18 months prior to opening to begin the transition planning.” To those peers that have been through this process, I ask, how many architects did you see in your facilities the day of patient move? personally, I have not witnessed them there to observe how their design affected the transition, to which I ask those planning or about to open a new facility, are you comfortable that your architect is considering or has considered these issues and can maintain a functional design that not only lends itself to the patient/staff satisfaction and clinical processes but also to the process that must occur to move in to the new facility? The answer is that too often the transition plan becomes a reaction to the design rather than a part of it. Three simple questions that, when considered in the design process, can drastically improve the success of a transition.
1) With regard to geographical location, “Will this be a cold weather move?”
a. If so, consider that clinical equipment will need time to acclimate to the environment given the sharp contrast in temperature during the move.
2) If we are at maximum census can we accommodate all of the families at once?
a. Hypothetically speaking, if a patient leaves the abandoned facility every ten minutes and family member are asked to meet their loved one at the new facility rather than prior to transfer there could be upwards of 120 to 200 family members on the receiving side. These families may frequent the cafeteria, lobbies, vending areas, restrooms, and inpatient units as they become curious, hungry, bored, impatient, or making their way to greet the transferred patient. If the answer is no, then staffing concerns will need to be addressed when “spreading out” the transfer of patients is considered. There are companies in this market that can provide temporary clinical and clinical engineering staff to accommodate increased needs with an extra facility in operation for up to a short time.
3) Will we have enough space to accommodate multiple staff orientation activities? Will the orientation process be complete prior to open houses and other public events?
a. Considering that most replacement facilities relocate existing major medical equipment and these relocations, in some cases, occur just days before opening in order to keep the equipment in operation for as long as possible, access to radiology, surgery, laboratories, and food services shouldbe considered and made available outside of the public’s eye. With this said, staff orientation should be complete prior to these events as well or you may find yourself with an obstacle course when trying to tour the public through your beautiful new space and, at the same time, provide access to areas of the hospital that most will never have the chance to see again while staff tours and equipment installations are in process.
Note – by the same token, it IS possible to orient too early, as staff, returning to the previous facility, must concentrate on those processes thus potentially forgetting what was learned. No matter whom a facility chooses to lead the transition effort, that planner is as integral to the design process as the architect. “Planning the transition to a new hospital is a long and arduous task. If the planning process begins early with the right personnel leading and participating in the transition planning process, a detailed plan can be assembled that will most likely lead to a successful move into the new facility.”
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