Healthcare Innovation - The Future of PICU

2018 Innovation | New York Presbyterian’s Pediatric ICU

THE FUTURE OF

DEA 6550 Innovation in Healthcare Research & Design

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COLL ABOR ATORS DEA 6550 Innovation in Healthcare Research & Design Instructor Dr. Rana Zadeh Department of Design and Environmental Analysis, Cornell University Partnering with New York Presbyterian Hospital’s Pediatric Intensive Care Unit

T h e Fu t u re o f Ped i a t r i c I CU Cornell University x NYP Pediatric ICU

Student Innovators Jacqueline Rose Callan, Zachary Andrew-Alfred German, Mio Jia, Adrian Tamerah Jones, Jay Wook Jun, Jeyon Kim, Nicole Shana Levine, Kathy Yin Lin, Elena Nicole Misailedes, Rachael Yehyun Oh, Kishore Rajaram Seetharaman, Hanchun Shao, Justine Stohler, Yuqian Lu, Sung-tsan Yeh, Rebecca Shohet, Cameron McKee, Teresa Mary Bevacqua, Katrina Marie Bamba Sponsors New York Presbyterian Hospital’s Pediatric Intensive Care Unit, Cornell Institute for Healthy Futures and the Department of Design & Environmental

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ACKN OWLE DGE M E NT S This booklet became possible in collaboration with New York Presbyterian Hospital’s team. The following individuals (alphabetically listed) have contributed to this work:

Ana Krieger M.D. MPH, Department of Internal Medicine Bruce M. Greenwald MD, FAAP, FCCM, Professor of Clinical Pediatrics, Executive Vice-Chairman, Department of Pediatrics, Chief, Division of Pediatric Critical Care Medicine.

Courtney Mensing Nataraj, Chair, Komansky Children’s Hospital Family Advisory Council.

Diana Parra, Divisional Administrator, Pediatric Cardiology & Pediatric Critical Care Medicine Erin Clayton, RN, BSN, CCRN, Clinical Manager – Pediatric Intensive Care Unit Elena Mendez-Rico, Pharm D., Clinical Pharmacy Manager – Pediatrics Jean-Marie Cannon, RN, BSN, CIC; Infection Prevention and Control, Department of Pediatrics Gerald Boshi, Department Administrator – Pediatrics Gerald M. Loughlin, M.D. M.S., Nancy Paduano Professor and Chairman, Department of Pediatrics, Weill Cornell Medicine; Pediatrician-in-Chief, New York Presbyterian Phyllis and David Komansky Children’s Hospital, Weill Cornell Medical Center Kimberly LaRose, Advisory Group Leader, Family Advisory Council.

Larissa Elgin, MSN, CCRN, NE-BC; (former) Pediatric ICU & Pediatric Intermediate Care Unit Patient Care Director, Department of Pediatrics Mary Mahoney, RN, BSN, CCRN, Staff Nurse, PICU – Department of Pediatrics Naomi B. Bishop, MD, Assistant Professor, Pediatric Critical Care Medicine, Director, Pediatric Critical Care Medicine, Quality and Performance Improvement Rae-Jean Hemway, MPA, BSN, RNC-NIC, Director of Nursing – Department of Pediatrics Snezana Nena Osorio, M.D. M.S., Associate Professor of Clinical Pediatrics, Vice Chair for Quality and Patient Safety in Pediatrics

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The team would like to thank Naomi Bishop, MD, who championed the inception and development of this project. We would also like to especially thank Snezana Nena Osorio, MD, for her critical support of the project and Bruce M. Greenwald, MD for making this project possible. We thank New York Presbyterian Hospital pediatric ICU’s leadership, staff, and family representatives for welcoming us, presenting us with their valuable experience, and sharing their views for the future of the unit. We particularly acknowledge the valuable input by Nursing Leadership, the Division of Infection Prevention and Control (Jean-Marie Cannon), PICU attendings, fellows, and the Family Advisory Council. We thank Dr. Ana Krieger, Weill Cornell Medicine, for teaching us about the importance of sleep in the PICU. The discussions conducted with these people were invaluable in establishing our final design strategies and giving direction to the final work. We would like our consultants: Craig Zimring, Professor, Georgia Institute of Technology; Elizabeth Capezuti, Professor, Hunter College of CUNY; Mardelle M. Shepley, Professor, and Al George, Professor, Cornell University. They provided us with valued insight and feedback on how to improve the proposed solutions to benefit patients, families, and caregivers.

The team expresses our sincere gratitude to our sponsors. This report would have not been possible without the support of the New York Presbyterian Hospital and Cornell’s Institute for Healthy Futures in the College of Human Ecology at Cornell University. This generous funding enabled site visits and in-person meetings and huddles with PICU staff, as well as networking and communication throughout the project, access to consultants, and the reproduction of this report including booklet graphic design, editing and printing.

The Innovation series at DEA was launched in 2013 as a part of the Heath Design Innovations Lab, an Affiliate of the Cornell Institute for Healthy Futures.

The format of this booklet, specifically the categorical structure of topics, objectives,and strategies as a form of translational report was inspired by the City of New York’s 2010 Active Design Guidelines: Promoting Physical Activity and Health in Design, available at: http://centerforactivedesign.org/dl/guidelines.pdf.

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TEAM

We are a consulting team based in Ithaca, NY, that provides design recommendations based on industry best practices and client collaboration. We are an interdisciplinary team of design, policy, and facilities experts committed to helping our clients provide the best care to their patients.

Both physical and social systems have the potential to greatly improve or degrade the quality of patient care. Our goal is to provide the Pediatric Intensive Care Unit at New York Presbyterian Weill Cornell with design and process improvements to increase staff satisfaction, provide empathetic care, and ultimately reduce infection rates for hospital patients.

CO NTE NT

6-1

Translational Design Guidelines 1. Introduction 2. Main Goal: Improve Staff Satisfaction a. Reduce Nurse Burnout b. Promote Positive Socialization Among Nursing Staff c. Improve the Work Environment

6-2

Design Innovation 1. Improve Staff Satisfaction and Reduce Burnout 2. Provide Whole-Person Care to Patient and Family

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Business Cases 1. Low-Cost and High-Impact Solutions for NYP Weill Cornell PICU

Kathy Lin Rachael Oh Sung-Tsan Yeh 192

MHA Candidate, Sloan Program in Health Administration B.S. Candidate, Design and Environmental Analysis M.S. Candidate, Design and Environment Analysis 193

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Te a m 6

SECTION 6-1

Translational Design Guidelines

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Te a m 6 V i s i o n i n g

Goal 01

Improve Staff Satisfaction

OBJECTIVE 1.1: Reduce nurse burnout

I n t ro Patient safety can be assessed through a variety of metrics. Hospital-acquired infections (HAIs) can harm or kill patients while eating up valuable resources through lengthened hospitals stays and high readmission rates.

As a result, controlling HAIs is a top priority for highperforming hospitals. New York Presbyterian Weill Cornell has tasked Agency 6 with redesigning a pediatric intensive care unit that reduces central line-associated bloodstream infection (CLABSI) rates with the hopes of improving patient safety and outcomes, and effectively utilizing resources.

Job-related burnout among medical staff is closely linked to suboptimal medical care and poor patient satisfaction scores. From our research, we have gathered that redesigning physical spaces as well as implementing cultural changes are vital to creating a better work environment that will help yield better patient outcomes. This translational report aims to provide recommendations regarding how Weill Cornell’s pediatric intensive care unit can improve the satisfaction and wellbeing of both employees and patients, both factors which ultimately impact CLABSI rates.

Intensive care units can be stressful environments for nursing staff. High-stress conditions will inevitably impact work performance and can ultimately lead to staff burnout. Specifically, nurse burnout is correlated with infection rates. In order to reduce nurse burnout, we recommend interventions that increase work engagement and reward high-performing staff members.

Strategy 1.1.1.

Implement educational interventions and performance feedback programs Strategies such as educational interventions and performance feedback can be used to manage nursing staff stress and prevent nurse burnout.

Supporting Evidence:

A 2012 study revealed that high levels of burnout and cognitive detachment can lead to inadequate hand hygiene practices and other infection control protocols among registered nurses. Organizational changes such as job engagement programs, educational interventions, and performance feedback systems have proven to be effective in mitigating nurse burnout and preventing infections within acute-care facilities. Encouraging two-way communication between employees and their organization will allow employees to feel valued and heard. Interventions associated with improving nurse satisfaction and alleviating nurse burnout are much less costly than interventions that specifically target hospital-acquired infections (Cimiotti, 2012).

Strategy 1.1.2.

Create nurse recognition programs Nurses who feel appreciated and respected are more likely to remain engaged in their profession and report higher job satisfaction. Nurse burnout can be reduced through the introduction of meaningful staff recognition programs.

Supporting Evidence:

Organizational and job-related factors can increase the occupational stress experienced by many nurses in intensive care units. Studies have shown that an imbalance between efforts and rewards can greatly contribute to job dissatisfaction and emotional exhaustion (Fortunatti & Palmeiro-Silva, 2017). Nurse recognition programs can enhance staff members’ personal sense of accomplishment. Through meaningful recognition, nurses are acknowledged for their hard work and are empowered with a sense of having a real impact on the lives they touch, and as one nurse leader states, such programs provide a reminder of “the reason we all became nurses”. Obtaining feedback from patients, families, and even colleagues will make nurses feel valued by the organization and improve job satisfaction (Lefton, 2012).

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OBJECTIVE 1.2: Promote positive socialization among nursing staff Nurses carry a wealth of information and can benefit from learning from each other. This topic relates to the socialization and reinforcement of positive behavior among nursing staff. Social support initiatives can be improved by pairing nurses up and establishing positive role models. Perpetuating good behavior and creating a good support system can greatly improve staff satisfaction.

One nurse role model states: “In the stressful environment of a nursing unit, people really want to know that what they are doing is valued and appreciated. This was something that as a bedside nurse myself, would be the one thing I would really want to hear, especially on the days where stress rang supreme. Once I started taking on more leadership roles with teaching within the unit, I realized that giving someone that little bit of positive feedback was the best strategy to build confidence and make someone feel that they were an invaluable member to the team (Perry, 2008).”

OBJECTIVE 1.3: To improve the work environment Strategy 1.2.1.

Use nurse pairs during catheter insertion

Corresponding strategies include reducing shift lengths, introducing positive distraction in the PICU, implementing a red light system, and creating an employee respite area.

Establishing a “buddy system” during catheter insertion can facilitate better care and facilitate knowledge transfer among nursing staff.

Strategy 1.3.1.

Supporting Evidence:

Increasing the amount of social support among coworkers can enhance job performance and reduce occupational stress (AbuAlRub, 2004). Additionally, according to a catheter insertion study, the implementation of a buddy system or using team-based catheter care, in which one nurse inserts a catheter and another observes for breaks and assists when needed, has helped medical staff learn from one another and has reduced instances of complications (Schulman, Stricof, Stevens, et al., 2009).

Strategy 1.2.2.

Establish positive role models Establishing positive role models among nursing staff can prevent negative socialization and emphasize good practices.

Minimize nursing shifts that exceed twelve hours Corresponding strategies include reducing shift lengths, introducing positive distraction in the PICU, implementing a red-light system, and creating an employee respite area.

Supporting Evidence:

Rogers and her colleagues collected data on 5,317 nurse work shifts which revealed that work duration, overtime, and the number of hours worked per week significantly contributed to the amount of nursing staff medical errors. The likelihood of errors and near errors was three times higher when nurses worked shifts lasting 12.5 hours of more (Rogers et al, 2004). Moreover, nurses who work shifts longer than 12.5 hours are significantly more likely to report difficulties remaining alert than nurses working fewer hours per day (Rogers, 2008). Fatigue and absenteeism greatly contribute to job dissatisfaction among nurses. The unfavorable working conditions among nursing staff can greatly threaten patient safety. Evidence supports the idea that nurse performance and satisfaction can be enhanced by minimizing the number of nursing shifts that exceed twelve hours.

Supporting Evidence:

Research supports the use of positive role models and positive social norms within an organization to help perpetuate good practices among nurses while preventing negative socialization (Kingston, Slevin, O’Connell, Dunne, 2017). Role modeling is a common tool used by exemplary practice clinical nurses to share their skills and pass down “craft knowledge” to novice nurses. Many of the intricacies of truly outstanding nursing care cannot learned in a textbook. Additionally, role models can be used to encourage and assist younger nurses who may be struggling to adjust into their new roles. The most effective role models affirm novice nurses by recognizing their potential and taking opportunities to let others know that they were succeeding.

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Strategy 1.3.2.

Introduce positive distraction through nature Artificial greenery in the PICU can improve aesthetics and acoustic buffering while enhancing biophilic design. This kind of intervention will not only reduce staff stress but also help create a more satisfying healthcare environment.

Supporting Evidence:

Many studies have shown that the presence of plants within a hospital setting has been shown to reduce patient stress and pain while providing a more satisfying healthcare environment for both patients and staff medical workers. Live and artificial plants are associated with higher environment assessment and room satisfaction ratings. As a result, the addition of real or artificial foliage provides a cost-effective and safe method to improve hospital setting experiences (Fulton, 2014).

Supporting Evidence:

Insufficient sleep has adverse effects on cognition, mood, and performance. Data from clinical trials and meta-analyses provide strong evidence for short naps and their ability to not only greatly improve night-shift alertness but also prolong periods of wakefulness. Day-time naps have been shown to improve nurse alertness in the afternoon. Evidence supports the idea that nurses who start their shift at 11pm or midnight should consider napping prior to the start of their shift as these nurses have the strongest sleep tendency. Nurses should be allowed to nap during their break and meal periods. These naps should be short (less than 45 minutes) in order to reduce the likelihood of sleep inertia (Rogers, 2008).

Strategy 1.3.3.

Improve nurse productivity by introducing red lights Red lights in a hospital setting have the potential to improve nurse alertness at night without disrupting circadian patterns.

Supporting Evidence:

Staff burnout is significantly associated with impaired sleep quality that can result from working at night as rotating-shift workers. Nurses working at night are likely to experience daytime dysfunction, decreased productivity, and impaired safety while on the job. Many studies have shown that light at night can greatly reduce sleepiness and improve performance. However, light also has been shown to suppress melatonin and disrupt nurse circadian rhythms, both of which are linked to long term health risks. A nighttime laboratory study revealed that the introduction of red light can greatly help nurses working rotating shift maintain nighttime alertness without the harmful side effects of suppressing melatonin or changing circadian rhythms (Figueiro,Sahin, Wood, & Plitnick, 2016).

Strategy 1.3.4.

Improve nurses’ sleep quality by providing a relaxation room Providing a relaxation room for nursing staff will improve staff access to rest and sleep. Because fatigue among nursing staff is extremely high and can contribute to nursing staff burnout, fatigue countermeasures such as napping can provide temporary relief and improve both nurse alertness and acuity.

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REFERENCE AbuAlRub, R. F. (2004). Job stress, job performance, and social support among hospital nurses. Journal of Nursing Scholarship, 36(1), 73–78. https://doi.org/10.1111/j.1547-5069.2004.04016.x Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40(6), 486–490. https://doi.org/10.1016/j.ajic.2012.02.029 Fortunatti, C. P., & Palmeiro-Silva, Y. K. (2017). Effort–Reward Imbalance and Burnout Among ICU Nursing Staff: A Cross-Sectional Study. Nursing research, 66(5), 410-416.

Fulton, Cindy, (2014). “The Impact of Real and Artificial Plants on the Patient Experience in the Hospital Setting”.

School of Physician Assistant Studies. Paper 502.

Kingston, L., Slevin, B., O’Connell, N., & Dunne, C. (2017). Hand hygiene: Attitudes and practices of nurses, a comparison between 2007 and 2015. AJIC: American Journal of Infection Control, 45(12), 1300-1307.

Lefton, C. (2012). Strengthening the workforce through meaningful recognition. Nursing Economics, 30(6), 331.

Perry, R. B. (2009). Role modeling excellence in clinical nursing practice. Nurse Education in Practice, 9(1), 36-44.

Rogers, A.E., (2008). The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US). Hughes RG ed. Chapter 40. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK2645/ Rogers, A., Hwang, W., Scott, L., Aiken, L. H., & Dingers, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs , 23 (4), 202-212.

Schulman, J., Stricof, R., Stevens, T., et al. (2009). Development of a statewide collaborative to decrease NICU central line-associated bloodstream infections. Journal of Perinatology : Official Journal of the California Perinatal Association, 29(9), 591-9.

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Te a m 6 D e s i g n

SECTION 6-2

Design Innovation

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Te a m 6 D e s i g n

DESIGN GOAL 01

Improve Staff Satisfaction and Reduce Burnout

Design Solution 1.1: Improve staff satisfaction through an employee recognition program Research has shown that nurses who feel valued, appreciated, and respected—and who enjoy professional communication and working relationships—will stay at an organization and remain engaged in their profession. Our employee recognition program is designed to allow hospital leadership to acknowledge and congratulate staff members in a meaningful way.

D E S I GN I N N OVAT I O N G OAL S 1. Improve staff satisfaction and reduce burnout

Employee Recognition Card

2. Provide whole-person care to patient and family

back side of the recognition card gives opportunity to nominate employees -- it is important to solicit specific feedback from patients, family, and even other colleagues as to why the nominated staff member’s actions were personally meaningful to serve as an inspiration to other nursing staff and also empowers nominated staff members with a sense of having a real impact on the lives they touch.

front side of the recognition card features encouraging messages for the staff.

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How It Works

Cards will be reviewed by senior leadership and placed on public display, biweekly

Design Solution 1.2: Positive distraction through nature Artificial plantation wall in staff area is able to enhance aesthetics, increase acoustic buffering and increase biophilic design to reduce stress level. However, according to the New York construction code, the PICU is not allowed to use real foliage. Studies have shown that artificial plants have similar healing effects on patients and staff members. Therefore, we suggest using artificial green walls or creating a garden landscape with glass partitions to increase visual accessibility and minimize concerns regarding physical contact. The introduction of artificial plants in the PICU provides a cost-effective and safe way to enhance the hospital experience.

Artificial Green Walls

Blank cards are placed on countertops or mounted on walls in areas such as reception, patient rooms, waiting areas, nurse stations, and staff break rooms for easy access, and completed cards can be turned in to clear boxes.

green walls not only provide therapeutic effects, but also features and acoustic buffering and pleasant aesthetics 208

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Artificial Garden Landscape

Artificial tree or other greenery is placed in view of the patient to create a stress- and painreducing environment.

Design Solution 1.3: Employee lounge area Studies have shown that sleep quality has a strong correlation with work efficiency and performance. A relaxation area, including a staff lounge and relaxation room, allows staff to take a breath and recharge.

Staff Area

relaxation room

locker room restroom

relaxation room

lounge room

Employee Area

staff locker room with 55 lockers

The glass partition safely avoids physical contact with patient to adhere to the New York construction code while maximizing visibility.

staff nap rooms 210

staff lounge area

staff restroom 211

Staff Lounge Room

Mural depiction of nature also promotes positive distraction through art

Materials such as wood, fabric, and carpet, as well as the color selection, combine to create a home-like feeling.

Relaxation Room

unk beds give staff an opportunity for restful naps without being disturbed.

Design Solution 1.4: Create new nurse staffing protocols that minimize the use of shifts that exceed 12.5 hours Evidence-based practice recommendations related to shift duration and number of work hours during a week:

Recommendation

Practice Implication

Schedules that involve working 48 or 60 hours per week, or working 7 consecutive 12-hour shifts in one week in order to have 7 consecutive days off the next week are unacceptably risky, and should be prohibited.

Do not work any more than 48 hours in a 7-day period.

The continued use of 12-hour shifts cannot be recommended given the current working conditions, including the almost daily need for nurses to stay beyond the end of their scheduled shift, the frequent absence of breaks during the workday, and the higher risk of errors associated with 12-hour shifts.

Nurse managers should not schedule nurses for 12-hour shifts and nurses should not request 12-hours shifts.

If nurses insist on continuing to work 12-hour shifts, several measures should be taken to reduce the risks to patients and nurses. These steps include reducing the number of consecutive shifts to no more than three, providing adequate meal and rest breaks, revising schedules to ensure that nurses have at least 10–12 hours off between work shifts so that they have adequate time for sleep, commuting, and completing their domestic responsibilities, and requiring that nurses use their off-duty time to get sufficient sleep.

If you are scheduled to work a 12hour shift, (1) do not work more than three shifts without a day off; (2) insist that provisions are made for sufficient staffing to ensure that you are able to be free of patient care responsibilities for 10 minutes every 2 hours and for 30 minutes to eat a meal; and (3) insist that you have at least 10–12 hours off between shifts so that you can obtain sufficient sleep.

Adopted from Rogers, AE., (2008). The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 40. Hughes RG edit. Rockville (MD): Agency for Healthcare Research and Quality (US); Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK2645/ 212

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DESIGN GOAL 02

Provide Whole-Person Care to Patient and Family

Family Consultation Room

Mural depiction of nature also promotes positive distraction through art for families.

Design Solution: Family lounge and talk room Research has shown that caregivers play a critical role for patient recovery. Caregiver burnout is also a critical issue. By offering a family lounge and a private room to talk, the unit gives patients’ families a breathing space. The space can be used as a consultation room that enhances privacy and communication quality.

Family members have access to a bathroom to avoid unnecessary visits to other floors.

Family Lounge Room

Orientation of desk and chairs allows for privacy for the patient’s family, if needed.

Family Area consultation room

restroom

Use of color and materials such as wood and fabric combines to add homeyness for family members.

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Kitchenette features basic amenities where families can spend needed time to rest and recharge.

lounge room

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Te a m 6

SECTION 6-3

Business Cases

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Te a m 6 V i s i o n i n g

BUSINESS CASE 01

Low-Cost and High-Impact Solutions for NYP Weill Cornell PICU

Feasible for Immediate Implementation

BU S I N E S S CA S E 1. Low cost and high impact solutions for NYP Weill Cornell PICU

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According to Uchida et al. (2016), the annual replacement cost per RN in hospitals is estimated to be over $96,969 in 2012 dollars). Adjusting for inflation, this figure would be $98,694 in 2018 dollars. NYP Weill Cornell’s PICU lost five nurses last year, which implies a replacement cost of approximately $493,470 last year. To provide a conservative estimate, we assume that, with our interventions, NYP Weill Cornell’s PICU would only lose two nurses each year. We can estimate a total discounted savings of $1,174,395.30 over the first five years of implementation.

Our team aims to deliver low-cost, high-impact solutions that are currently feasible for NYP Weill Cornell PICU and can be immediately implemented. Nursing turnover can cost as much as 6% of a hospital’s operating budget. As a result, the greatest cost savings can be realized by addressing nurse retention rates. Our solutions—such as creating a new staffing protocol, recognition cards, and lounge area—can achieve these goals.

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EBD Implementation Investment Employee Recognition Cards (500 cards per year) Artificial Plants Nurse Beds and Couches Redesigned Lockers Lounge + Kitchenette Furniture/ Renovation Door Installation Create new nurse staffing protocols Total Annual Investment Cost Present Value Factor Total Discounted Annual Investment Costs Savings from EBD Implementation Estimated Cost Savings from Staff Retention Total Annual Savings Present Value Factor Total Discounted Annual Savings Return on Investment (ROI) Summary Undiscounted Annual Net Cash Flows Discounted Annual Net Cash Flows Cumulative ROI Net Present Value Internal Rate of Return

Initial Cost $ 200.00 $ 300.00 $ 5,000.00 $ 5,000.00 $ 9,000.00 $ 35,000.00 $ 10,000.00 $ 64,500.00 1.00 $ 64,500.00

1 80.00 100.00 100.00 100.00 180.00 700.00 200.00 1,460.00 0.91 1,327.27

$ $ $ $ $ $ $ $

$ $

$

296,082.00 296,082.00 0.91 269,165.19

$ (64,500.00) $ $ (64,500.00) $ 0

294,622.00 267,837.91 4.07

1.00

$ $ $ $ $ $ $ $ $ $ $

Year 3

2

$

$ $ $

82.00 102.50 102.50 102.50 184.50 717.50 205.00 1,496.50 0.83 1,236.78

$ $ $ $ $ $ $ $

303,484.05 303,484.05 0.83 250,814.39

$ $

301,987.55 249,577.61 7.72

$

$ $ $

4

84.05 105.06 105.06 105.06 189.11 735.44 210.13 1,533.91 0.75 1,152.44

$ $ $ $ $ $ $ $

311,071.15 311,071.15 0.75 233,710.87

$ $

309,537.24 232,558.42 10.99

$ $

$

$

Total (All Years

5 86.15 107.69 107.69 107.69 193.84 753.82 215.38 1,572.26 0.68 1,073.87

$ $ $ $ $ $ $ $

318,847.93 318,847.93 0.68 217,776.32

$ $

317,275.67 216,702.46 13.95

$

$ $ $

88.31 110.38 110.38 110.38 198.69 772.67 220.76 1,611.57 0.62 1,000.65

$ $ $ $ $ $ $ $

620.51 825.63 5,525.63 5,525.63 9,946.14 38,679.43 11,051.27 72,174.24

$

70,291.02

326,819.13 326,819.13 0.62 202,928.53

$ $

1,556,304.26 1,556,304.26

$

1,174,395.30

325,207.56 201,927.88 16.63

$ $

1,484,130.02 1,104,104.28 15.71 $1,556,237.53 408%

Additionally, our proposal for a new employee lounge area is also relatively low cost as it uses the existing PICU floor plan and does not involve major renovations. The proposed employee lounge merely involves repurposing rooms and some interior design recommendations.

Although the lounge area costs the most of our proposed solutions and takes time, it is also the most influential. A respite area allows staff members to take a breath when needed and can effectively help avoid burnout. In the long run, with a rough calculation, a return on investment of 15.71 and an internal rate of return of 408% show that these interventions would be a good investment.

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THANK YOU By the students of DEA 6550 | Cornell University

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Published on May 2018 By the students of DEA 6550 Innovation in Healthcare Research & Design Cornell University