Innovations in Surgical Environments_Workshop presentation_part 2

CASE STUDIES

SEATTLE CHILDREN’S HOSPITAL

LYNN MARTIN MD, MBA

MARK GESINGER LEED AP BD+C

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

e T d n a

g n i t s

UCLA OUTPATIENT SURGERY AND ONCOLOGY CENTER

n e C

MICHAEL FOLONIS FAIA

CARA TUBBS

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ANII

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

EVOLVING CARE: Facilities as a Force for Positive Change at Seattle Children’s Hospital

Speakers

Lynn Martin MD, MBA

Mark Gesinger LEED AP, BD+C

Medical Director, Continuous Improvement and Innovation Seattle Children’s

Principal ZGF Architects LLP

I. Foundation Bellevue Clinic & Surgery Center Location: Bellevue, Washington Size: 80,000 SF Completion: 2010 Architecture firm: NBBJ

I. Foundation Guiding Principles • Focus on patients and families first – simple, safe, and intuitive • Promote continuous flow for patients and staff (one way in/out) • Create line of sight and visual management • Avoid monuments (flexibility) • Standardization is the foundation of improvement • Maximize natural light • Appeal to all ages (0-21) • Relate to Seattle campus • Be able to replicate at future sites

I. Foundation Integrated Facility Design Adaptation Toyota 3P (Planning, Production, Process) • Shorter development time • Lower start up costs

Multidisciplinary Teams • Architects • Engineers • Clinicians

Sequential Design Process • Project management and governance • Conceptional (Macro) Design (size and key adjacencies) & Mock-ups • Functional (Micro) Design (room details) & Mock-ups • Detail (Operational) Design

I. Foundation – Flow of Patient and Supplies Staff Support Off-Stage Corridor

PACU/Recovery O.R.

Arrival/On-Stage

Prep/Induction

Design Innovation: Generation 1.0 Two Induction Rooms per OR

I. Foundation Outcomes • Seamless new clinical service introduction • Satisfying experience for patients & families (best in the system) • Pleasant and supportive work environment for faculty and staff • Efficient, low-cost ambulatory surgical services • Doubled OR and surgeon productivity • $30M cost avoidance using this process (building size reduction; contingency savings)

II. Evolution: Seattle Children’s Building Care Building Care

Location: Seattle, Washington Size: 310,000 SF Completion: 2022 Architecture firm: ZGF Architects

New Front Door to Campus

II. Evolution: Seattle Children’s Building Care Master Plan Future Campus Build-Outs

Lower Acuity, Specialty, Outpatient

Higher Acuity, Complex, Inpatient

OCEAN GARAGE ASC CLINICAL CENTERS OF EXCELLENCE

NE 45 TH

FOREST Phase 2 D+T

FOREST Phase 1 BEDS

‘Building Care’ PENNY DRIVE

PENNY GARAGE

PENNY ADMIN

STR EET

FOREST GARAGE

FOREST Phase 3 BEDS

NE TH V E 40 A

II. Evolution: Seattle Children’s Building Care Guiding Principles • Innovation is required, comes from anywhere, is iterative, collaborative, disruptive, and essential to change • Optimizing processes and designing right-sized space and capacity to support patient care deliver and employee wellness reduces waste and allows flexibility • Collaboration and co-location of interdisciplinary teams drives better problem solving, communication, consistency, accountability • Standardizing of work processes allows for innovation • Value stream thinking is required for meeting our customer needs effectively • All team members play a role in providing the best patient care • A concurrent care model in a single, continuous flow by the right people in the right place provides the most effective care

II. Evolution: Seattle Children’s Building Care Cross-Functional Representation • Care team • Patient and family • Professional services • Support services • Infection Control • Information Technology, Telemedicine, Epic • Education Communication, Events and Foundation • Facilities • Contractor and trade partners • Consultants • Quality Management/Process Improvement

II. Evolution: Seattle Children’s Building Care Surgery Floor Plan

Arrival / On-Stage

External Setup PACU / Recovery

Operating Room Induction

Staff Support

To ICU

II. Design Iteration: Induction Room 1.1 Camouflaged Induction Room

II. Design Innovation 2.0 – External Set-up Room Induction 1 External Setup

OR #1 Induction 2

OR #2 Clean Core

Scrub Sink Bed Alcove

From Sterile Process

II. Design Innovation: Inspiration • Glass for Daylight and Transparent Process • Standardized Instrument Display • Hands Free Doors, Interlock with OR • No Excess Clutter • One Setup Room / two ORs: Larger, Uninterrupted Space

II. Design Innovation: Inspiration Advantages of External Setup • Faster turnover between cases • Augmentation of patient capacity • Set up of tables without interruption or disruption by creating a calm place to concentrate (thus fewer errors) • No unnecessary door openings or staff traffic while setting up (lower risk of contamination) • Ideal environment to train OR staff for setup

II. Design Innovation: Inspiration (OR Zones) Clemson Research: OR of the Future

Building Care Induction AZ

SZ

Photo: Clemson A+H

Back Tables

OR 2

OR 1 CZ

Nurse / CZ

Clean Care

AZ

II. Design Innovation: Set-Up Visualization

Demonstration of efficiency of external set-up process

II. Design Innovation: Visualization SCH Building Care Operating Room Features • “Camouflaged” induction rooms • Parents remain with children until they are asleep • Reduce patient stress and has the potential to improve patient outcomes • Designed with external instrument setup space • Enhanced throughput

Challenges • Regulatory environment • DOH engagement • New Staffing Model (roles and responsibilities changed dedicated set-up tech vs alternating surgical tech) • Provider and Staff buy-in/trust is key

Summary of Key Points Lessons Learned • Facility design is an ‘obligatory’ opportunity to improve the care model • Care processes and care model must evolve and be aligned with new building design • Architects and clinicians need to work side by side to design the space and care model concurrently • Bring the voice of the external customer (patients, families) and internal customer (care team, administrators) to the process • When contemplating innovations to your care model, stay cognizant of culture, change management implications, and regulatory stakeholder concerns

Images of Ors from Lynn

Q&A

Innovations in Surgical Environments

UCLA Outpatient Surgery Center Santa Monica, California

UCLA Santa Monica Surgery Center

1223 16th Street, Santa Monica,

Cara Tubbs, ANII, MS, BS, RN

Santa Monica, CA 90404 folonisarchitects.com

Service-Disabled Veteran-Owned Small Business (SDVOSB) Disabled Veteran Business Enterprise (DVBE)

Michael Folonis, FAIA

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

DRIVERS & OBJECTIVES

UCLA Outpatient Surgery Center

Michael W. Folonis, FAIA

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

ORGANIZATION & BUILDING LAYOUT

UCLA Outpatient Surgery Center

Michael W. Folonis, FAIA

FIRST FLOOR PLAN Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

SECOND FLOOR PLAN Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

THIRD FLOOR PLAN Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

PATIENT POPULATION & PLANNING CONSIDERATIONS UCLA Outpatient Surgery Center

Cara Tubbs, ANII, MS, BS, RN

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

KEY DESIGN FEATURES

UCLA Outpatient Surgery Center

Michael W. Folonis, FAIA

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

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Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

20 FT.

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects

OUTCOMES, LESSONS LEARNED & NEXT STEPS UCLA Outpatient Surgery Center

Cara Tubbs, ANII, MS, BS, RN

Cara Tubbs, ANII, MS, BS, RN

UCLA Santa Monica Surgery Center

Michael W. Folonis, FAIA Michael W. Folonis Architects