Canadian Centre for Healthcare Facilities Conference – December 8, 2014 1

Design Session:From Theory to Practice

Thinking @ Work

Martha HarveyWest Park Healthcare Centre

Cliff HarveyNorth York General Hospital

Canadian Centre for Healthcare Facilities Conference – December 8, 2014 2

Ontario’s Quality Journey

Are we any closer?

Etch A Sketch

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Is it our Definition of Quality?

or

Is it our Process to Arrive at Quality?

Or is it Both???

What is the Issue?

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Quality is an Omnipresence Word

IDEALPolitics- Economics

GOODEthical-Moral

REALAesthetics

TRUEScientific

Quality

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System Thinking

Design Thinking

AbsolveResolveSolveDissolve

Seeking Patterns

ScenarioPlanning

Strategic Foresight

Efficiency

Perform

ance

Innovation

System vs Design Thinking

Canadian Centre for Healthcare Facilities Conference – December 8, 2014 8Mental Model

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Scientific Management

Administrative management

Operational Research

Mental Model

Canadian Centre for Healthcare Facilities Conference – December 8, 2014 10Mental Model

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System Thinking

Design Thinking

Wicked Problems (Rittel & Weber)

Messes(Ackoff)

Complex Adaptive Systems

Efficiency

Perform

ance

Innovation

Wicked Problems

Canadian Centre for Healthcare Facilities Conference – December 8, 2014 12Louis Kahn

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What is the shadow of white light …Black …

I think that it is a time of our sun on trialof all our institutions on trial

I was brought up when the sunlight was yellow,And the shadow was blue

Louis Kahn

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Capitalist Dilemma

$$$

Invest for:

Performance

Efficiency

Innovation

Capital Dilemma

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System Thinking

Design Thinking

VisioningAnalyticsEBD ResearchLEANStandardsUser GroupsMock-ups …

PrototypingDesign ResearchSimulationStory TellingMental ModelsStakeholdersMappingDialogueScenario PlanningForesight …

Efficiency

Perform

ance

Innovation

Thinking Tools

Canadian Centre for Healthcare Facilities Conference – December 8, 2014 18Tim Brown

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Canadian Centre for Healthcare Facilities Conference – December 8, 2014 26Bridging the Gap

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Bridging the Gap BetweenStrategy and Operations

Bridging the Gap

Canadian Centre for Healthcare Facilities Conference – December 8, 2014 28Claude Debussy

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Music is the space between the notes

Claude Debussy

Canadian Centre for Healthcare Facilities Conference – December 8, 2014 30Linear Process

Canadian Centre for Healthcare Facilities Conference – December 8, 2014 31Linear Process

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Complex Adaptive Systems

Learning / EmergingHeterarchical

Nested Systems: Ecology

Complex Adaptive Systems (CAS)

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Nested Systems Design

Social

Organization

Service

Design

Nested Systems

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Quality is an omnipresence word

IDEALPolitics- Economics

GOODEthical-Moral

REALAesthetics

TRUEScientific

Quality

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Map out your Problems

Find the Right Tools

4

3

2

1

Regulations

Policies

Guidelines

Standards

Mapping

Canadian Centre for Healthcare Facilities Conference – December 8, 2014 38Etch A Sketch

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Building an

INTEGRATED CAMPUS OF CARE

DateBuilding an Integrated Campus of Care“Breaking New Ground”

December 8, 2014

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West Park at a Glance Founded in 1904 as a tuberculosis sanatorium

Three programs of care:• Specialized rehabilitation (130 beds)• Complex continuing care (140 beds)• Long-term care (200 beds)

Serving 7,000+ patients per year• 1,400+ inpatient admissions• 57,000+ ambulatory visits

Serving adults of all ages:• >45% of rehab patients are less than 65• >80% of CCC patients are older than 65

Staff:

• 885 employees, 85 physicians, 225 volunteers, residents and students

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West Park’s patients come from all over Ontario:

Province-wide: Tuberculosis and Chronic Assisted Ventilatory Care (CAVC)

Regional: Specialized rehabilitation services – Acquired Brain Injury (ABI), Respiratory, Amputee

Local: Rehabilitation, Complex Continuing Care, and Long Term Care

West Park Services

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Our Challenge Expected service demand growth

- 50% over the next two decades

Primary barrier - outdated facilities and service capacity: 60% of patients are in 4-bed rooms

Only two private rooms per 26-bed unit

Limits ability for: - isolation capacity - optimal infection control - use of modern equipment and technology

Limited space for patient and staff consultations

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RFP Road Map

“Building a Plane While Flying”

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Boeing Dreamliner Collaboration

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“Breaking New Ground”Integrated and Collaborative Model for Planning

Collaborative team to create an integrated project: Consultant continuity between MoHLTC Capital Planning Stages

2 & 3 Functional Programming role fully integrated within the overall

design scope of the PDC Clinical involvement from the start Holistic approach Need strong project vision Greater creativity and innovative thinking when planning

solutions and processes

Canadian Centre for Healthcare Facilities Conference – December 8, 2014 49

“Breaking New Ground”

Pre-functional Programming Toolkit

A set of planning principles based on research, best-practice and evidence-based design

First Ontario hospital to “pilot” a formal process Hand-off of toolkit to PDC team to build on

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Elements of Toolkit

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User Groups

Involved from the start - Lean workshops, Functional Programming, prototyping, etc.

Stakeholders - staff, patients, families, physicians, volunteers, community agencies, etc.

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Lean

Bring value to the patient and reduce waste Operationally efficient Workshops:

• Current State Patient Flow Maps• Future State Patient Flow Maps• Value Stream Mapping• 3P Workshops

Determine extent of Lean – transitional versus transformational

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Prototyping Test workflow, space requirements, placement

of FF&E, etc. Throughout planning and design phases On-site design lab, off-site design lab, 3P

process

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‘Day In The Life’ Tool

Capture the patient experience Validate planning and design from the patient’s

perspective User stories – test for quality of healthcare design

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“Take Aways”

1. Pre-Functional Programming Toolkit• Worth the effort

2. PDC Early Involvement• Enhanced integration and collaboration

3. Early Clinical Integration• Assists with early translation of clinical perspectives

4. User Involvement• Key throughout entire process

5. Lean, Prototyping, Day in the Life• Valuable tools

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(picture: P. Hagan)

THANK YOU

Martha Harvey, RN, BScN, MSc Healthcare Quality, EDAC

Senior Project Manager, Clinical Integration

Campus Development, West Park Healthcare Centre

martha.harvey@westpark.org

416.243.3600 ext. 2059