PENN MEDICINE CHESTER COUNTY HOSPITAL | LASKO TOWER
POST OCCUPANCY EVALUATION
EXECUTIVE SUMMARY The new Lasko Tower at Chester County Hospital continues the hospital’s commitment to delivering patient-centric care for its rapidly growing community. The 93,000 SF, four-story building adds 72 new private patient rooms for telemetry, surgical care, and maternity units, as well as a stateof-the-art radiation oncology treatment suite. Space and light are key components of this expansion. Spacious, but right sized, patient rooms allow the comfortable coexistence of clinicians, patients and families during the treatment and healing processes. The placement of the caregiver stations and touchdowns within the 24-bed floor plan decreases the distance between work space and patient, allowing the caregivers to spend more time at the bedside. Large windows bring natural light and outdoor views to waiting areas, patient rooms, interior family lounges, staff lounges and conference rooms. Ballinger conducted a Post Occupancy Evaluation in the Summer of 2016, which was +/-12 months after the last floor of the building was completed and occupied. Because of the sequential openings of each of the patient floors, while the 2nd floor had been occupied for only 12 months, the 3rd floor 18 months and the 4th floor close to 3 years. The objective of the evaluation is to understand which planning and design interventions have been most successfully realized. Because these floors were built consecutively, the team compared where the staff requested design changes based on clinical needs, and what affect if any these changes had on staff and patients across the units. It is a unique opportunity to compare not only how the slight differences over the 3 floors altered the patient and staff perceptions, but also the baseline data from the Ground West. Further data and survey from the Ground West existing building and unit are used as a baseline comparison, since these patients and staff had relocated to Lasko 3.
LASKO TOWER POST OCCUPANCY EVALUATION
METHODOLOGY Data was collected through anonymous electronic survey of staff. Patients who were on the unit were offered the opportunity to participate in an online survey or to fill out the paper copy of the survey which the team would then input into the final survey report. Additional patient interviews were complete by the staff and compiled.
ONLINE + WRITTEN SURVEYS FOR PATIENTS AND STAFF
REPORT LEGEND
ONSITE OBSERVATIONS
STAFF RESPONSES
PATIENT RESPONSES
LASKO 4: TELEMETRY
LASKO 3: ORTHO
LASKO 2: OB
GROUND WEST: ORTHO
ONSITE INTERVIEWS WITH STAFF
PROJECT SCHEDULE 2010
2011
2012
2013
2014
2015
2016 POST OCCUPANCY EVALUATION
DESIGN
CORE + SHELL L4: TELEMETRY
L3: ORTHO
L2: OB
2
PENN MEDICINE CHESTER COUNTY HOSPITAL
KEY FINDINGS OF THE POST-OCCUPANCY EVALUATION Decentralized stations matter as much or more to patients than to the staff. 66% of the staff felt that decentralized stations improved their ability to deliver quality patient care, while 91% of patients said that the stations improved the way they felt cared for in the new building.
66%
STAFF FEELTHE DECENTRALIZED STATIONS IMPROVE PATIENT CARE
Because patients admittedly felt more cared for in the new units, the decentralized station can likely be seen as a contributing component to the the double digit increases in the HCAPHS scores for the new units.
91%
PATIENTS SAY THE DECENTRALIZED STATIONS IMPROVE THE WAY THEY FEEL CARED FOR
Additional investigation into the travel distances of staff, their time spent with patients, and the impact of whether staff were sitting at the central nurses station or utilizing the decentralized stations uncovered a direct relationship to more time providing patient care. L2 spent a reported 71% more time at the decentralized stations than their counterparts on L4. By investigating the travel distances to from the decentralized station to supplies and patients, it was determined to fetch the same items compared to staff on L3 who utilized the central station more, staff would walk 41% less.
L2 SAW OVERALL
41%
REDUCTION IN TRAVEL DISTANCES BY SITTING AT THE DECENTRALIZED STATIONS
This time and effort savings was corroborated by the staff on L2 reporting that they spent 16% more time providing direct patient care than their counterparts on L3 or L4.
87%
93%
HCAHPS
13%
HCAHPS
19%
L4
L3
L2
AVERAGE INCREASE OF THOSE WHO RATE HOSPITAL 9-10
LASKO TOWER POST OCCUPANCY EVALUATION
L4
L3
L2
AVERAGE INCREASE OF THOSE WHO WOULD RECOMMEND THE HOSPITAL
L2 SPENT
16% MORE TIME
PROVIDING PATIENT CARE THAN L3 AND L4 L2 SPENT
71% MORE TIME AT THE DECENTRALIZED STATIONS THAN L4
ACKNOWLEDGEMENTS This Post Occupancy Evaluation was performed as part of a research endeavor between PennMedicine Chester County and Ballinger to assess the efficacy and design iterations between 3 successive patient bed floor projects. The information was used to adjust the previous Lasko bed floor template and begin an investigation on a new bed tower expansion. The new tower will also expand the ICU capabilities of the hospital. A special thanks to Cathy Weidman, MPA, BSN, RN CNML and Director of Medical Surgical Services at PennMedicine Chester County Hospital who generously participated both in the research and production of the POE, but also in its presentation as part of the 2016 ASHE PDC Summit in San Diego. PENN MEDICINE CHESTER COUNTY HOSPITAL
BALLINGER
Michael D. Barber Chief Operating Officer
Louis Meilink, Jr., AIA, ACHA, ACHE Principal
Angela R. Coladonato, DNP, RN, NEA-BC Senior Vice President/Chief Nursing Officer
Christina Grimes, AIA, LEED AP BD+C, EDAC Senior Associate, Healthcare Planner
Tina Maher, BSN, MA, RN, NE-BC Director, Telemetry Services
Debbie Phillips, AIA, ACHA, EDAC Senior Healthcare Planner
Cathy Weidman MPA, BSN, RN CNML Director of Medical Surgical Services
Whitney Wexler Associate, Communication Design
Frances Doyle, MSN,RN,CNML Director, Maternal Child Services
4
PENN MEDICINE CHESTER COUNTY HOSPITAL
CONTENTS 1.0
PROJECT OVERVIEW
2.0
POST OCCUPANCY EVALUATION Respondent Profile Satisfaction Patient Safety Decentralized Stations
LASKO TOWER POST OCCUPANCY EVALUATION
PROJECT OVERVIEW In a project completed in 2015, Ballinger architects designed a hospital addition at Penn Medicine Chester County Hospital. Spanning three floors and 72 patient beds, the addition included three medical/surgical patient care units with decentralized caregiver stations between each pair of patient rooms. The 3 floors were conceptualized as an expansion of bed capacity in order to decant many of the existing double patient rooms to single beds, and
LASKO TOWER POST OCCUPANCY EVALUATION
provide 72 new all private rooms to the campus. Because further additions were planned, these patient units were to take advantage of the existing entry sequence, public and patient/staff elevators and leave in place the opportunity for the next phase of expansion. As the first major step to an all private room model, the decisions and investigations in the 3 patient floors worked to define a new standard and flexible template for all future patient rooms.
The team investigated the patients and staff on the Ground West unit (constructed in 1962, with a cosmetic renovation in 1998) for a baseline. Ground West was also the location of the same orthopedic patients and staff patients who transferred over to the third floor of the new Lasko Tower building. The Ground West unit was built as a double loaded corridor of rooms with a single caregiver station, no decentralized station, and limited support space for staff, compared to the new Lasko Tower units that featured a central work core. By isolating the staff and patient populations, the team could more closely link correlations to the physical changes in the new unit.
WEST BUILDING (GROUND WEST) • 13,295 UNIT SF • 20 BEDS • 210 SF / ROOM • BUILT 1962, RENOVATED 1998 • 1 CENTRAL CAREGIVER STATION
LASKO TOWER • 23,300 UNIT SF • 24 BEDS
75%
• 320 SF / ROOM • BUILT 2013
INCREASE IN SPACE FROM GW TO LASKO
• 2 SMALL CAREGIVER STATIONS (L2) • 2 CENTRAL CAREGIVER STATIONS (L3 + L4) • 12 DECENTRALIZED STATIONS (ALL)
ONLY
20% MORE BEDS
GW: ORTHO
8
4 3 2 1 G
L4: TELEMETRY L3: ORTHO L2: OB
PENN MEDICINE CHESTER COUNTY HOSPITAL
The new Lasko Tower units used decentralized stations between every pair of patient rooms, two large stations for collaborative care discussion, and a physician dictation room on the fourth floor for six additional staff members. The second floor post-partum unit required a 16-bed nursery, which displaced some of the clinical staff and created smaller opportunities for caregiver stations within the core. Â The fourth floor had a total of 30 seats within the central core for a telemetry unit, 24 seats on the third floor for an orthopedic unit, and 12 seats on the second floor for a post-partum unit. The reduction in seats available on the successive units likely encourages caregivers to use the decentralized stations more. The interviews with staff also suggested that on the fourth floor, which has three locations for staff within the core, there were increased problems with locating physicians, who could be at either of the two stations or in the small dictation room.
LASKO 4: TELEMETRY
By posing the same questions for patients in Ground West and Lasko floor three, the investigators were able to identify differences based solely on the infrastructure and facilities changes, as the patient population and nursing staff were consistent before and after the move. The subtle differences in the nursing layouts over the floors and similar finishes on floors three and four of the Lasko Tower allow for comparison between standard units and varied patient needs. Lasko second floor and its contrasting layout of caregiver station within the core, as well as the shift to only 12 centralized seats, creates another level of detail for comparison while maintaining a control for finishes and aesthetics.
LASKO 3: ORTHO
LASKO 2: OB
GROUND WEST: ORTHO
LASKO TOWER POST OCCUPANCY EVALUATION
STAFF
PATIENT
L4
L3
L2
GW
10
PENN MEDICINE CHESTER COUNTY HOSPITAL
ALL PRIVATE ROOMS MIRRORED IDENTICAL CARE GIVING
DECENTRALIZED CARE STATIONS BETWEEN EVERY 2 ROOMS
PATIENT / FAMILY AMENITIES IN ROOM
OUTBOARD TOILETS
TEMPLATE DESIGN FOR M/S, IMU AND ICU CAPABLE WITH RENOVATION
The patient rooms across all 3 floors of the Lasko tower maintained the same new standard and flexible template. While Lasko only included Medical/Surgical patients the template was design to accommodate an ICU footprint as well, with minor adjustments. All rooms were mirrored with outboard toilets and had increased amenities in the room for family or care givers to sleep over with the patients.
LASKO TOWER POST OCCUPANCY EVALUATION
The decentralized stations between each pair of patient rooms allowed space for 1 staff member to sit and access the electronic medical record of any patient. Each room also had a wall mounted computer within the room as well. While all 3 floors had the same patient rooms, variations and adaptations were accommodated within the support core. These differences did impact some of the findings between the units.
12
PENN MEDICINE CHESTER COUNTY HOSPITAL
POST OCCUPANCY EVALUATION To begin the evaluation, the team was comprised of both members of the original design team, and members who had not worked on the initial project to bring a level of unbiased opinion to the research. The team gathered both qualitative and quantitative data regarding the project from a diverse group within the building. Three methods for information gathering were selected: An on-line survey for the patients and staff, on-site interviews with staff, and on-site observations by the team. These varied collection points allowed the evaluation team to triangulate those issues which permeated the discussions from a variety of vantage points.
ONLINE + WRITTEN SURVEYS FOR PATIENTS AND STAFF
The results have been evaluated in 4 categories. • RESPONDENT PROFILE: Breakdown of staff and patient respondents by floor, experience, and age.
ONSITE OBESERVATIONS
• OVERALL SATISFACTION & HCAPHS IMPACT: Evaluations of patient and staff reported levels of satisfaction regarding the unit and patient room design, planning decision, amenities within the unit and how the self reported scores and the HCAHPS scores were impacted across the patient floors. • PATIENT SAFETY IMPACTS: Understanding of both the self reported patient and staff information combined with data analysis of Pre-Occupancy fall rates and infection control rates for the same patient and staff populations were analyzed to determine the affects on these safety metrics within the new units.
ONSITE INTERVIEWS WITH STAFF
• DECENTRALIZED STATION: Noting both staff and patients reported information and combining these results with analytical information and travel distances based on the variations of the floor plans across the units, the investigation assesses the locations at which staff are charting, the proximity to supplies, and time spent on patient care.
LASKO TOWER POST OCCUPANCY EVALUATION
STAFF
PATIENT
L4
L3
L2
GW
RESPONDENT PROFILE Patients and staff were both well represented from from each of the 4 floors surveyed. The majority of staff were nursing staff, the largest group were those on Lakso 3. Staff also came relatively equally split among the Boomer, GenX and Millennial Generations, with a slightly larger group of Millennial respondents. The Patient’s also included members of the Silent Generation and were typically much older than the caregivers on the units.
88%
OF RESPONDENTS ARE NURSING STAFF
Many of the staff were seasoned professionals, and had worked at other facilities, giving them not only comparison among these 4 patient units, but a comparison to other institutions as well as a basis for their considerations.
12%
ADMINISTRATION
10%
10%
L4: TELEMETRY
OTHER
28%
L4: TELEMETRY
10%
GW: ORTHO
31%
GW: ORTHO
50 PATIENT RESPONDENTS
117 STAFF RESPONDENTS
35%
L3: ORTHO
23%
L2: OB
30%
L3: ORTHO
14
24%
L2: OB
PENN MEDICINE CHESTER COUNTY HOSPITAL
RESPONDENTS BY GENERATION 1945 – 1965
2-4 VISITS
1982+
31%
28%
60%
41%
5+VISITS
8%
1 VISIT
32%
20%
35%
22%
24%
VISITS TO PMCCH BORN PRIOR TO 1945
1966 – 1981
18%
0-4 YEARS
30%
46%
5-14 YEARS
52%
13%
15-24 YEARS
8%
24%
25+ YEARS
11%
TIME IN HEALTHCARE INDUSTRY
LASKO TOWER POST OCCUPANCY EVALUATION
NO OTHERS
37% 5+ FACILITIES
TIME AT PMCCH
STAFF
PATIENT
L4
L3
L2
OF STAFF HAVE WORKED IN 1-2 OTHER FACILITIES
3-4 FACILITIES
GW
SATISFACTION Overall the satisfaction scores at 94% & 96% were remarkably high for the the 3 patient units. The Ground West Unit was the previous home for the L3 units patient and staff prior to the opening of the new tower. With a reported increase of 113% from the same patient cohorts from Ground West, to those on L3, the increase of the patient satisfaction is even more apparent.
L4
94%
As seen in the word cloud on the adjacent page, the main staff comments for Lasko focused the improved light and beauty of the new unit, along with the ability to do their electronic charting at the computers throughout, and the space and amenities for their patients. While Ground West staff did focus on the small patient rooms and the lack of computer access they did comment frequently on some of the less tangible items such as their co-workers which maybe encouraged by the central caregiver station for collaboration. Patients in the Lasko Tower focused both on the size of the patient rooms and the amenities throughout the unit, as well as how the staff improved their stay.
GW
45%
L3
94%
L2
96% 16
PENN MEDICINE CHESTER COUNTY HOSPITAL
NEW AND CLEAN
ROOM FOR FAMILIES
SIZE OF ROOMS
CENTRAL NURSES STATION
SPACIOUS ROOMS
PRIVATE ROOMS
COMPUTERS AT BEDSIDE
BRIGHT NATURAL LIGHT
LARGE BATHROOMS ARE EASIER FOR PATIENTS
ABILITY TO HAVE NATURAL LIGHT
ABILITY TO STEP OUTSIDE
LOTS OF COMPUTER ACCESS BEAUTIFUL PLACE TO WORK STAFF IS THE BEST MED ROOM IS LARGE BRIGHT + CLEAN LOVED THE SHOWERS
SPACIOUS ROOMS
PRIVATE ROOMS
THE NURSES ARE GREAT
PLENTY OF COMPUTER WORK AREAS
COMPUTERS TO LOG ON ANYWHERE
DECENTRALIZED STATIONS
REALLY GREAT COWORKERS LARGE ROOMS
SPACE FOR FAMILY
PLENTY OF COMPUTERS
SNACKS FOR FAMILY
THE BATHROOMS ARE VERY VERY NICE!
TELEVISION
WE HAVE ROOM FOR ALL THE EQUIPMENT WE NEED LASKO TOWER POST OCCUPANCY EVALUATION
STAFF
PATIENT
L4
L3
L2
GW
PATIENT SATISFACTION Beyond just reporting high levels of patient satisfaction within the PostOccupancy questions, the hospital has received a significant increase in their reported HCAPHS scores through the Centers for Medicare and Medicaid Services. The Value Based Purchasing program withholds a percentage of money (1.75%) with the incentive to earn back the money based on performance in four areas: efficiency, patient satisfaction, patient safety and clinical outcomes. The HCAPHS scores are used to determine whether an institution receives this incentive.
caregiver station, no decentralized station, and limited support space for staff. Though it is difficult to contribute all of the increase to the inclusion of the decentralized station, it should be noted that through the survey and interview process, both patients and staff consistently included mention of the decentralized station in their remarks related to satisfaction, perception of care, and work-flow improvements.
Across all units, the hospital had a dramatic increase in their HCAHPS scores for groups before the move to after the move into Lasko Tower, with average increases of 13–18 percent over their pre-move units. All of the units in the existing conditions were similar to the Ground West in that they were built as a double loaded corridor of rooms with a single
• The size of the private patient room and toilet room
87%
In addition to the decentralized stations, the patients repeatedly reported the following item contributed to their satisfaction: • The light and views throughout the unit • The quietness of the rooms • The space and amenities for family
93%
HCAHPS
13%
HCAHPS
19% 18
L4
L3
L2
L4
L3
L2
AVERAGE INCREASE OF THOSE WHO WOULD RECOMMEND THE HOSPITAL
AVERAGE INCREASE OF THOSE WHO RATE HOSPITAL 9-10
PENN MEDICINE CHESTER COUNTY HOSPITAL
Since the landmark study “View Through a Window May Influence Recovery from Surgery� Roger S. Ulrich, the design community has invested in the views to nature and light as a healing element. Using the Ground West unit as a base line, the data controls for both staff and patient population. This limits the affect on the data to the physical configurations and material choices employed within the Lasko Tower. With a 390% staff increase in the reported therapeutic feel of the patient room, compounded with a 213% staff increase in the views to nature the data points to a dramatic improvement based on the design of the Lasko Tower. The patients in general were more complimentary across all questions, but for the color palette selection noted a 223% increase satisfaction.In general the look and feel of the unit was well received and impactful for both patients and staff. 98% 100% 20% 64% THERAPEUTIC FEEL OF ROOMS 94% 100% 30% 87% VIEWS TO NATURE 96% 100% 30% 100% ACCESS TO DAYLIGHT 95% 100% 40% 31% COLOR PALETTE LASKO TOWER POST OCCUPANCY EVALUATION
STAFF
PATIENT
L4
L3
L2
GW
The new rooms within the Lasko tower were all +/- 320 SF with a decentralized station between every pair of rooms. The additional 110 SF in each room is a 52% increase over the existing patient rooms in the Ground West building. The Design layout and the over all space allows for the care giver zone, the patient zone and the family zone, the rooms patient rooms were right sized to provide adequate space for the delivery of care.
DESIGN / LAYOUT TV
ROOM SIZE / BATHROOMS
FAMILY AMENITIES
GROUND WEST
HIGHEST SATISFACTION: PRIVATE ROOMS
The patient toilet rooms were all designed to be ADA compliant, have a rain shower head, and a frosted window to provide natural light. These rooms are large enough for care givers to assist patients, and also contributed to the reported satisfaction at 35% of patients ranking the size of the toilet rooms as the most impactful.
60%
GROUND WEST: 210 SF
HIGHEST SATISFACTION: ROOM SIZE / BATHROOMS
DESIGN / LAYOUT
35% LASK0 TOWER AVERAGE
TV
FAMILY AMENITIES
PRIVATE ROOMS
LASKO AVERAGE: 320 SF
20
PENN MEDICINE CHESTER COUNTY HOSPITAL
In addition to the traditional waiting rooms off the units on each level, all 3 floors also included a smaller gathering area within the unit. Both L2 and L3 reported that many family members utilized this additional amenity. L4 had a dramatically different usage, which maybe attributed to its use as a telemetry unit. If patients are unable to use the area with their family member, they may spend more time together in the patient room. As part of the Obstetrics program on L2 an additional nourishment station was included and open to the families and patients for use during their stay. Families had access to the snacks and coffee 24hours a day within the unit.
93% 94%
ARE SATISFIED WITH OVERALL FAMILY AMENITIES ON THE UNIT
FAMILY MEMBERS UTILIZE UNIT AMENITIES
L4
20%
LASKO TOWER POST OCCUPANCY EVALUATION
STAFF
PATIENT
L4
L3
L2
L3
100%
GW
L2
100%
PATIENT SAFETY Design and construction of new patient units has been increasingly linked to patient safety for slip and falls and Healthcare Associated Infections (HAIs). The research focused on both the material selections and the design layout of the patient rooms and patient toilet rooms to understand any correlations. The initial investigation included looking at all infections across the units pre-and post move into the Lasko Tower, and also looking at C Diff and Pneumonia separately as those are some of the most common and difficult HAIs. The 52% decrease was for all infections from the calendar year prior to the move compared to the calendar year after for Lasko 3.
HAIs HAVE DECREASED
52%
In addition to including a hand washing station at the entry to every patient room, a Hand sanitizer dispenser was located both directly inside the door and outside the door for each patient room. Material selection such as Solid Surface counters and integral flooring products are also potential contributors to this decrease.
SINCE THE MOVE
79%
ARE SATISFIED WITH SELECTION OF MATERIALS AND HOW THEY HAVE HELD UP
90%
HCAHPS
28%
97%
SATISFIED WITH STANDARDIZATION OF HEADWALLS
22
L4
L3
L2
AVERAGE INCREASE IN SATISFACTION WITH CLEANLINESS PENN MEDICINE CHESTER COUNTY HOSPITAL
CCH FALL RATES DROPPED
28%
AFTER CONVERSION STATE AVERAGE FELL 3.31% DURING SAME TIME
82%
STAFF ARE SATISFIED WITH THE LAYOUT + DESIGN OF PATIENT CARE AREAS TO PROMOTE SAFETY
PATIENT COMMENT
The addition of the decentralized caregiver station was also a potential contributing factor to the reduction of falls, as staff could see if a patient was exiting their bed unassisted.
“I FEEL SAFE IN THIS ROOM”
LASKO TOWER POST OCCUPANCY EVALUATION
STAFF
PATIENT
L4
L3
L2
Many of the patient falls occur when patients attempt to use the restroom un-assisted or within the shower. The hospital and the design team used an integral poured flooring product within the patient toilet room to decrease any level changes or grout, provided handrails throughout the toilet room and at the exterior door to the toilet room, and included a recessed shower shelf to reduce the risk of falls.
GW
ACOUSTIC PRIVACY Acoustic privacy has become an important issue for patients and staff, driven in part by the Health Insurance Portability and Accountability Act (HIPPA) which mandates the standards for privacy of individually identifiable health information. This mandate has driven changes in STC ratings for construction, variations in locations for private patient conversation, and is included in the HCAPHS questions. Only 19% of patients felt the Ground West Unit provided adequate sound control within the patient rooms. The Lasko Tower showed 410% increase in the patient satisfaction with the sound control, which was likely impacted by the race track design, higher STC rated wall construction, limiting conversation/gathering at a central caregiver station, and increased performance in the ceiling tiles.
SATISFACTION WITH SOUND CONTROL
77% 45%
80% 64%
91% 36%
AT NURSE STATION
IN CORRIDORS
IN PATIENT ROOMS
100% 25%
94% 31%
97% 19%
24
89%
HCAHPS
34%
L4
L3
L2
AVERAGE INCREASE IN SATISFACTION WITH QUIETNESS
87% 97%
ARE SATISFIED WITH SPACES FOR PRIVATE CONVERSATION
PENN MEDICINE CHESTER COUNTY HOSPITAL
DECENTRALIZED STATION
L2 SPENT
The new Lasko Tower units use decentralized stations between every pair of patient rooms, two large stations for collaborative care discussion, and a physician dictation room on the fourth floor for six additional staff members. The second floor post-partum unit required a 16-bed nursery, which displaced some of the clinical staff and created smaller opportunities for caregiver stations within the core.
16% MORE TIME
PROVIDING PATIENT CARE THAN L3 AND L4
The fourth floor had a total of 30 seats within the central core for a telemetry unit, 24 seats on the third floor for an orthopedic unit, and 12 seats on the second floor for a post-partum unit. The reduction in seats available on the successive units likely encourages caregivers to use the decentralized stations more. The interviews with staff also suggested that on the fourth floor, which has three locations for staff within the core, there were increased problems with locating physicians, who could be at either of the two stations or in the small dictation room.
PHYSICIAN DICATION STATION
LASKO TOWER POST OCCUPANCY EVALUATION
THAN L4
STAFF REPORTED THEY WILL USE ANY AVAILABLE WORKSPACE
24 CENTRAL SEATS
2 LARGE STATIONS
LASKO 4: TELEMETRY:
71% MORE TIME AT THE DECENTRALIZED STATIONS
76%
“It is ALMOST IMPOSSIBLE TO KNOW IF SOMEONE IS IN ANOTHER NURSING STATION if you are in the other. A LOT OF WALKING BACK AND FORTH”
30 CENTRAL SEATS
L2 SPENT
12 CENTRAL SEATS
2 LARGE STATIONS
2 SMALLER STATIONS
LASKO 3: ORTHO
STAFF
LASKO 2: OB
PATIENT
L4
L3
L2
GW
The staff of Lasko floor three had six fewer seats than Lasko floor four staff, which resulted in an additional reported increase of 31 percent more time spent at the decentralized station. Lasko second floor staff had18 fewer seats on their unit and reported an additional 71 percent increase in time spent at the decentralized station and a 16 percent increase in time spent at the patient bedside over Lasko floor four.
66%
STAFF FEELTHE DECENTRALIZED STATIONS IMPROVE PATIENT CARE
With 91 percent of patients reporting increased satisfaction in the care they receive with decentralized stations and staff reporting a 16 percent rise in time spent providing patient care, the decentralized station proves to be a valuable addition regardless of the patients’ care level. The additional increase in the HCAPHS scores shows that patients in these units appreciate the care being delivered, which translates to financial incentives for the institutions.
91%
PATIENTS SAY THE DECENTRALIZED STATIONS IMPROVE THE WAY THEY FEEL CARED FOR
L4 staff reported spending 38% more time at the central station than the decentralized station, which created longer walking distances to the support spaces and to the patient rooms, and left them less time in their day for patient care than either L3 or L2 where staff elected to use the decentralized stations more often.
8% DECENTRALIZED STATION
36% PROVIDING PATIENT CARE
26% CENTRALIZED STATION
L4
TELEMETRY
13% FETCHING ITEMS FOR PATIENT CARE
26
13% COMPUTER IN PATIENT ROOM
11% DECENTRALIZED STATION
38% PROVIDING PATIENT CARE
22% CENTRALIZED STATION
L3
43% PROVIDING PATIENT CARE
13% CENTRALIZED STATION
L2
ORTHO
12% FETCHING ITEMS FOR PATIENT CARE
14% DECENTRALIZED STATION
OB
14% COMPUTER IN PATIENT ROOM
16% FETCHING ITEMS FOR PATIENT CARE
8% COMPUTER IN PATIENT ROOM
PENN MEDICINE CHESTER COUNTY HOSPITAL
LASKO TOWER POST OCCUPANCY EVALUATION
STAFF
PATIENT
L4
L3
L2
GW
SATISFACTION: BETWEEN STAFF WORK AREAS
78% 62% 34%
VISIBILITY
L4: TELEMETRY 30 CENTRAL SEATS
53% L3: ORTHO 24 CENTRAL SEATS
To isolate whether it was a visibility issue or a proximity issue related to staff being able to find each other on the unit, the team looked at the satisfaction levels of the staff with both metrics.
With staff embracing the decentralized model they were able to located their coworkers more easily, and could view them down the length of the corridor
For the staff to staff visibility, L2 which has the most remote workspaces had the highest level of staff satisfaction related to being able to see each other. This is likely because the staff on L2 were 72% more likely to sit at the decentralized stations.
L4 had the lowest level of satisfaction with the physical travel distance between the 3 centralized staff work areas, but also the least physical distance of all the units.
28
Staff also reported loosing each other as they went from one station to the other looking for
85% 63%
L2: ORTHO 12 CENTRAL SEATS
staff. Some comments suggested that the private dictation room and its additional 6 seats was also a hindrance to locating each other. This room had solid walls and a door, which while increasing privacy appears to affected the staff access to one another. L2 had an additional 60’ of physical travel distance between their central staff work areas. To reconcile the physical differences, the team recognized that additional factors were at work to beyond the locations of the central stations.
PENN MEDICINE CHESTER COUNTY HOSPITAL
SATISFACTION: BETWEEN STAFF WORK + PATIENT CARE AREAS
78%
76% 41%
86%
93%
85%
VISIBILITY
L4: TELEMETRY 30 CENTRAL SEATS
L3: ORTHO 24 CENTRAL SEATS
L2: ORTHO 12 CENTRAL SEATS
The metrics for staff to patient visibility and proximity all tended higher than the staff to staff metrics, which began to reinforce the role that the decentralized station might have in the data.
The team began to investigate the impact of staff on L2 reporting a they 72% more likely to sit at the decentralized stations.
THERE WAS AN 85% INCREASE IN VISIBILITY SATISFACTION DESPITE 18 LESS SEATS AND AN ADDITIONAL 60 FEET BETWEEN THE CENTRAL STATIONS ON L2
All three units had equal access to the decentralized stations, but L2 had consistently rated their visibility and proximity to each other and patients the highest. This is despite a 60% decrease in the number of centralized staff work seats, and an 66% increase in the distance between the centralized staff work areas. LASKO TOWER POST OCCUPANCY EVALUATION
STAFF
PATIENT
L4
L3
L2
GW
DECENTRALIZED STATION EFFECT ON SATISFACTION After noticing the staff satisfaction scores, and the 16 percent rise in time spent providing patient care, the team investigated possible drivers in how this additional time could be found during the busy shift of the caregivers. By looking at the floor plans of the three floors, the investigators created a Proximity Index. The team evaluated the fetching distances of staff who were presumably starting their trip from the central station compared to that of staff with a similar roundtrip beginning from a decentralized station. The team then compared each of the sets across the three floors of new construction.
0
20
40
60
80
100 120 140 160 180 200 220 240 260 280 300 320
DISTANCE (IN FEET)
CENTRAL STATION
For Lasko floor four, a model with the soiled, clean, meds, or equipment storage ran typically from one corridor to the other corridor through the core, with access employed from both corridors into the rooms. In this model, a single soiled room and single equipment rooms showed the longest travel distances for both trips from the central station or from the decentralized stations. Both the clean holding room and the meds rooms were duplicated on the units and showed consistently shorter travel distances. Â
DECENTRALIZED STATION L4 SAW OVERALL
26%
REDUCTION IN TRAVEL DISTANCES BY SITTING AT THE DECENTRALIZED STATIONS
L4: TELEMETRY
30
PENN MEDICINE CHESTER COUNTY HOSPITAL
For Lasko floor two, a model with a cross-corridor through the core and the rooms opening off this corridor was used in a blended model where these frequently accessed rooms were decentralized. Two soiled rooms and two meds rooms were both off the cross corridor. Two additional clean supply rooms used the coast to coast model, and a single storage room was located near the far end of the unit. Â For post-partum patients, the largest needs expressed by the clinicians were centered on the meds, soiled, and clean supply rooms, with little use of equipment. This drove the shift in the core design and contributed to the request of an additional soiled utility room. Lasko floor two shows significantly longer travel distances to the storage room, and this was discussed as a trade-off for this floor. In exchange, the travel distances to the soiled rooms is much shorter than those on Lasko floor four. 0
20
40
60
80
100 120 140 160 180 200 220 240 260 280 300 320
CENTRAL STATION
DECENTRALIZED STATION
L2 SAW OVERALL
41%
REDUCTION IN TRAVEL DISTANCES BY SITTING AT THE DECENTRALIZED STATIONS
LASKO TOWER POST OCCUPANCY EVALUATION
L2: OB
STAFF
PATIENT
L4
L3
L2
GW
32
PENN MEDICINE CHESTER COUNTY HOSPITAL