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Virtua Health Process Driven Design

Pebble Conference March 21, 2007

Mike Kotzen, COO, Voorhees HospitalTejas Gandi, Director Management Engineering

Stephanie Fendrick, Greenfield PM

Agenda• Introduction to Virtua Health

– Relationship with GE– History with Six Sigma

• Vision for New Campus• Architect Selection Process• Future State Planning Process• Master Site Planning Process• Management Engineering Role

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Virtua Health….Today• Four hospital system in Southern New Jersey• Two Long Term Care Facilities• Two Home Health Agencies• Two Free Standing Surgical Centers• Ambulatory Care - Camden• Fitness Center• 7000 employees + 1700 physicians• 7,500 deliveries• $840 million in revenues• STAR Culture

Virtua Health: Where We Were?• 1999: Merged corporate departments;

integrated governance and management structures---Average performance.

• 01/01: CEO “We don’t want to be average…We want to be outstanding.”

• 03/01: Created a system wide cultural transformation: The STAR Initiative

• 10/01: Began the use of the GE Tool Kit to support cultural change

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Excellent service

Best people

Caring culture

Highest clinical quality

Resourcestewardship

Outstanding Patient

Experience

StrategyStrategy

Mission and

Mission and

ValuesValues

Performance

Performance

The VirtuaThe Virtua

Current State: STAR

Commitment

Desired State: STAR

Performance

It’s Great to Have a Philosophy . . . But We Need a Strategy !!

Six Sigma is part of our strategy on our journey through the mazeSix Sigma is part of our strategy on our journey through the maze

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The Virtua Tool Kit

Paths to Change•Strategic Decision

•Operational issue Requiring a Decision

•“Wisdom of the Group”Problem

•Eliminate Delay/Waste

•Eliminate Defects

Change Acceleration

WorkOut

Lean

Six Sigma

Virtua Strategy Development Timeline

Ambulatory Strategy2005

Strategic campus planning2006

POE Technology assessments and 10 year volume assessmentsGreenfield Guiding Principles

2004

Branding Strategy & Bridge Plans2003

Comprehensive market assessment and infrastructure/facility recommendations

2002

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Overview of Current Voorhees Hospital

• 293 beds• 24,000 Admissions• 50,000 ED visits• 5500 births• 90%+ Typical

Occupancy Levels

Drivers for new campus• Replacement Hospital for Voorhees

Hospital – No capacity– Inefficient and costly hospital infrastructure– Landlocked site – Consumer preferences– Digital Hospital infrastructure needs– New technology for diagnosis and treatment

• Implement Ambulatory strategy – Capture shift of IP to OP– Patient convenience

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Campus Guiding Principles• Provide a digital model to reduce errors, improve communication of

vital information and drive efficiency.• Develop a campus that is flexible and versatile with ability to

maintain appropriate adjacencies with future expansion. Plan for long-term consolidation.

• Create a feeling of destination upon arrival to the campus.• Create high touch/high tech facilities and services that

integrate technology with the delivery of world class level service.• Provide a full compliment of “one-stop” services.• Create and maintain the identity of specialty hospital or

centers (Women’s and Children’s Pavilion; Cancer Center) • Provide clear separation of outpatient and inpatient

services.• Provide clear definition between public vs. private spaces.• Provide a healing, family centered environment.• Maximize operational efficiency throughout.

Payor

Physician

Nurse

Hospital

Patient

Digital Transformation – 3 Themes1. Information access

everywhere – scope, documentation expand, leads to…

2. Streamline processes for efficiency

3. Establish new levels of processeffectiveness, robustness for better outcomes

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With 3 Enablers to Safety, Quality

Paperless Filmless Wireless

Architect Selection ProcessEarly 2005

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Architect Selection

• RFP process• Criteria evaluated• Scenario analysis

– GE assessment• Interview process• Site Visits• Final Selection

Lean workflow challenge presented to A/E candidates as screening criteria…

Cardiology

IP (40%)

OP (48%)

EP (12%)ALOS : 4.9 days (2004)

Cardiology

IP (40%)

OP (48%)

EP (12%)ALOS : 4.9 days (2004)

2000 IP /yr

Pulmonary

IP (15%)

OP (68%)

EP (17%)ALOS : 4.9 days (2004)

Pulmonary

IP (15%)

OP (68%)

EP (17%)ALOS : 4.9 days (2004)

1000 /yr

Induction (65%)

C-S (35%)(Scheduled 33%)

Nonscheduling (67%) ALOS : 3.1 days

OB total 2400 /yr

Firm 1 10.8 Million Feet

+ 3 distinct options, option C best

Firm 2 6.6 Million Feet

+ Best overall solution

Firm 3 12 Million Feet

- duplicate use of space issue

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Fee

Reputation

Overall perceived strength, capability, and experience

Overall perceived strength, capability, and style – Exterior and Interior Design

Design within tight budgets

Energy Management experience (LEED project experience)

Design from the inside out

Understanding operating differences between inpatient and ambulatory services

Cutting edge healthcare assignment example

Collaborate with other professionals in a non traditional designapproach

Design the best patient centered care environment

Design to optimize mix and co-location of business ("B") and institutional ("I") occupancies

Enhance standard design process with clinical workflow analysis

Digital healthcare environment understanding & experience

Design experience with Women’s / Children’s services

Experience

Design & management team

321

HighMedium Low

AE Selection Criteria

Relative Importance

Future State Planning for the Future State Planning for the Greenfield campusGreenfield campus

Stephanie FendrickStephanie Fendrick

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Goal: Process driven designRecommended Process:• Research based:

– Observation– Hypotheses– Testing & validation

• Emphasis on:– Optimal clinical pathways– Patient & family experience– Leveraging technology

Timeline for Future State Planning

Space ProgrammingJan 2006

Planning StepMonth

System Capital Plan ApprovedMarch 2006

Demand AnalysisFebruary

Future State Planning SessionsNov – Jan

Future State Operating Models – Research effort

Oct

Study patient and staff experience, current state mapping, technology roadmaps

June-Sept

Determine planning processApril - May

HGA on boardMarch 2005

1 year

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IntegrationSite Visits Leading

Practice Research

Peer to Peer Surveys

Photo Journaling

Technology Roadmaps

From-to Adjacency

High LevelFlow

ARENASimulation

IT Enablers

Evidence Based Design

Patient Experience

Des

ign

Des

ign

FutureState

FutureState

TransformationTransformation

DesignIntelligence

Mov

e In

Mov

e In

SafetyChecklists

Greenfield Workflow – A/E Input Deck5569

4073

3699

2593

2378

2214

0 1000 2000 3000 4000 5000 6000

Cardiac PacemakerCardiac-OpenHeart

CardiologyDermatology

EndocrinologyGastroenterologyGeneral MedicineGeneral Surgery

Infectious DisNephrologyNeurology

NeurosurgeryOncology Hem/MedOncology Surgical

OphthalmologyOral Surgery

Orthopedic SurgerOtolaryngologyPlastic Surgery

PsychiatryPulmonary MedicinSubstance AbuseThoracic Surgery

UrologyVascular SurgeryW&C Gynecology

W&C NeonatalW&C Newborn

W&C Obstetrics

Serv

ice

Line

Discharges

Pareto High Volume Pathways

Adjust for Tech Roadmap

Procedures / MixCycle Times / Value Stream mapFlow Patterns/Spaghetti

Architectural Concepts

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OB: ScheduledInduction (65%)

C-S (35%)(Scheduled 33%)

Nonscheduling (67%)

Entrance Registration2nd Floor L&D

Discharged

5-10 min

Nurse Station Triage

C SectionPACU3/4 Fl Bed

5 min 1hr

1hr1hr96 hr

Scheduled – C Section

Entrance Registration 2nd Floor L&D

Labor room

C Section PACU 3/4 Fl Bed

Discharged5-10 min

8-10 hrs2nd Floor

Antepartum

2-24 hrs75%

25%

60-90 min 96 hrs

3/4 Floor Bed

48 hrs

1hr

Scheduled - Induction

ALOS : 3.1 days

2.4

4.6

2.4 0.4 6

4.4

4.4

5.4

4.2

3 1 0.5 0.5 0.4

0.4 6 4.4

POE/Technology StrategySummer 2004 – Virtua works with Sg2 to:• Review current market assessment• Conduct technology assessment and adoption

profiles specific to each POE– Technology adoption curve

• Discuss inpatient and outpatient forecasts• Project 10 year volume assessment by POE for

system based upon:– Demographics– Consumerism– Payment and Economics– Technology and Care Delivery shift

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Organizations Adopt Technologies at Different Rates

InnovatorsEarly

AdoptersConsensus

AdoptersCautiousAdopters

LateAdopters

Adopt new technologies

Research/develop new technologies

Have outdated technologies/systems

Lag in adoption of mature technologies

Adopt generally accepted technologies

1 2 3 4 5

Operational

Environmental

20092008200720062005

Surgery

Lab-Based Diagnostics

Imaging/Technology

2010

Women’s POE Technology 2005-2010

Vol. increases: Expand regional market by MFM,RPC, recruiting practices, inc # high-risk preg

EMR & CPOE

Continue adoption of high-tech imaging (U/S)

Biocept- Noninvasive fetal tissue sampling

C/S rate 50%

Fetal surgery

Need to address Private PP room capacity; #LDR’s, efficiency issues etc

Ambulatory fibroid program

Growth in dx Fetal MRI

Less invasive MFM testing; more consultative

Remote monitoring PACS- /MFM &OB’s

IGFU Growth: address re-imbursementAA and Breast clinical trial

Preimplantation Genetic Diagnosis

LOS impact

Robotic (DaVinci) lap

PCR based Strep/Rapid HIV-1

Lap pelvic floor reconstruction

Increasing C/S rate; decreasing VBAC rate

Upgraded EFM system,surrveillance, archiving, documentation

Malpractice crisis

ECMO

HBV vaccine

Growth in MIS

GYN Oncologist recruited. GYN Oncology utilization will increase; See Oncology POE Technology Plan

Remote Physiology Monitoring

SAMPLE

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Photo journaling

• Staff perspective • Patient perspective

Summer 2005

Major Themes expressed in photo journals

• Lack of storage• Lack of privacy• Lack of personal space for staff• Poor waiting spaces• Public and private spaces mixed• Unscenic views for patients and staff• Poor work spaces

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No place for staff personal belongings

No public vs. private separation of space

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Rooms with a View . . .

Future State Facility Operating Models

• Specimen Collection and Processing

• Medication Administration

• IP/OP Diagnostic Svcs

• Acuity Adaptable Rooms

• Food Services Delivery

• Patient Registration• Equipment

Management• Digital Environment• Central Sterile

Supply• Remote Monitoring• Medical Library

Fall 2005

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Future State Planning Sessions with HGA

3 rounds with 10 key areas to:• Sharing observations• Site visits/Research efforts around

new facility designs• Define future state flows

– Directly impacted key information on space needs, key adjacencies, patient flows

– Later tested with MELate Fall/Early Winter

Multiple Site Visits• The Woodlands, Houston,

Texas• St. Clare’s, Weston, WI• Northside Hospital, Atlanta,

Georgia• Baptist Memorial Hospital for

Women, Memphis, TN• Magee Women’s,

Pittsburgh, PA• Hackensack University

Medical Center, Hackensack, NJ

• Morgan Stanley Children’s Hospital, NY, NY

• Mary Washington, VA• MRMC, VA• CentraCare, St. Cloud,

MN• St. Joseph’s, West Bend,

WI• Lancaster General,

Lancaster, PA• Good Samaritan

Hospital, Reading, PA• ChristianaCare, Newark,

DE• Lehigh Valley Hospital,

city, PA

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Community based Focus Groups

• Use of backwards imaging• Recommendations• Mock up evaluations• Update sessions

NICU –A Case Study• Photo journals illustrating concerns with

current layout• Focus group on past experience• Future State mtgs discussed ways to

organize unit – open, pods, single rooms• Single Rooms “This will never work”• Research on new level III NICU designs

– Site visits- “I could not believe it until I saw it!”• Focus Group input – privacy vs. security

balance

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MASTER SITE PLANNINGMASTER SITE PLANNING

Mike KotzenMike Kotzen

The Original Models

MODEL A B C

MODEL D E F

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Model Evaluator Matrix

MODEL A

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MODEL E

Master Site Plan Drivers• Two campus layout

– Inpatient (north)– Outpatient (south)

• Integrated physician offices in the center• Image of two inpatient hospital buildings

– Women’s and Children’s– Adult– Separate identities & separate visitor entrances

• Efficiency of one hospital - one campus– Service and Patient Spine

• Outpatient / ambulatory patient convenience• Flexibility for future growth

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Blocking and Stacking Drivers• Emergent Platform

– Adult ED, Pediatric ED, OB Triage, & Dedicated Imaging

• Flexible Factory Space– Surgical / Interventional Platform– Separate LDR / NICU Floor

• Short-stay Hotel– Prep and Long-term Recovery, Observation

Patients– Ambulatory Diagnostics

• Longer stay “condo” spaces – Separate and distinct bed towers– Orientation to wetlands

• Public vs. private spaces and flows

Hybrid Master Site Plan Model

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ROLE OF MANAGEMENT ROLE OF MANAGEMENT ENGINEERINGENGINEERINGTejas GandhiTejas Gandhi

Role of Management Engineering

• Modeling for demand analysis• MSP quantitative analysis• Blocking and stacking

recommendations• Schematic design – application of

LEAN

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Sizing and Capacity Determination

• Traditional

– Volume uniformly distributed

– LOS - average

– Capacity Needs: Product line (A+B+C+……….)

• Virtua Health Approach

– Consider seasonal patterns (anticipate peaks and valleys)

– LOS – stochastic

– Capacity Needs: Product line (A U B U C U……)

– Simulation Approach

Arrivals (Admissions) by Month

170

147

181

140

161155

118

144

122

156

128 126

101

74

99 10092 91

87

98 100

8882

71

51 54

43 41

6054 54

58

44 45 46 47

2318

13 1623

1219 21

1520 22 2324

4436

32 33 3137 37

49

37

2631

0

20

40

60

80

100

120

140

160

180

200

1 2 3 4 5 6 7 8 9 10 11 12

2005

CardiologyGeneral SurgeryNeurologyOncology Hem/MedOrthopedic Surger

Count of Volume

Admission YR (A) Admission Month

Product Line

Seasonal Trends in Patient Admissions

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2012 Utilization Rates Using Current Bed Capacities

0102030405060708090

100

Antepa

rtum

Postpa

rtum

Mother

Baby

WH Med

/Surg

Med/Surg

/Onc Te

le ICUNICU

Nursery PCU

Peds

PICU

Utliz

atio

n (%

)

Sensitivity Analysis– Answer the question: what mix of IP beds is most suitable to

meet new demand

Current capacity cannot meet forecasted demand (high utilization rates result in exploding queues)

No. runs: 30

Run length: 365 days

2012 Utilization Rates with Adjusted Bed Capacities

0102030405060708090

100

Antepa

rtum

Postpa

rtum

Mother

Baby

WH Med

/Surg

Pediat

rics

NICU

PICU

Med/S

urg/O

ncTele PCU IC

U

Utli

zatio

n (%

)

Analysis [cont’d]• Utilization of IP Units

Forecasted patient volume growth results in a low utilization rate given bed capacities

Desired Utilization

85%75%

No. runs: 30

Run length: 365 days

85%75%

W&C Adult Care

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Application of Quantitative Analysis to MSP

Where to Look• The Pareto principle is used to prioritize tasks.

– 20% of patient types, activities, problems, etc. make up 80% of the work effort, volume, or breakdowns

– Identify the “Critical Few” that make up the lotAll Products - SKU Distribut ion

Two Turns Per Month

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

22.0

24.0

26.0

28.0

30.0

32.0

34.0

36.0

38.0

40.0

SKU

84" P

alle

t Qua

ntity

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Pallets/ Turn % of Total

80% of space consumed by 24% of varieties

25% of space consumed by 3% of varieties

Freschetta 12" 4 CheeseRB Classic 12" 4 CheeseTony's OC 10.5" PeppTony's OC 10.5" Cheese

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Virtua Reality

• Women’s and Children’s Services – 50%– Obstetrics (30%)– Women’s Health (15%) – Children’s (5%)

• All Others – 50%– Endo– Cardiac– Pulmonary– General Medicine– Geriatrics– Oncology– General Surgical– Neurology / Stroke

Math Works• If we are to eliminate waste in

transportation and motion, our master plans must consider– Staff cost

• Direct patient needs• Indirect rounding • Milk Runs

– Patient experience cost• To and from service

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Valuing Proximity• To evaluate the value of proximity

we have seven key variables– Home base– Frequency of event– Services needed– Transportation type– Staff involved in transportation– Distance traveled to and from service– Speed of transport– Intangibles

LegendsTransportation Weights

6x

3x

4x

2x

1x

Red - PatientBlue - Staff

From/To Calculation Box

96.00% Branch Percent94.00% Aggregate Percent

4,794 Patient Volume3 Transportation Type

14,382 Total Traffic

Critical Path Volumes

Greater than 10,000

Greater than 5,000

Less than 5,000

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W&C ObstetricsPortal / Home Base Relationships 58.00% Ancillary Relationships

52.41%Input Volume 3,459 92.62% Labor and Delivery

3 Trv Pct Freq Total6,600 87.10% 10,377 Lab 0 89% 5,440 0

85.10% Pharm 0 90% 5,502 05,616 OR 4 28% 1,712 6,846

15,616 30.00% 23.80% Ante Partum

25.53% 52.41% Trv Pct Freq Total1,685 3,459 Lab 0 81% 4,951 0

97.70% 3 3 Pharm 0 83% 5,074 05,055 10,377 OR 4 6% 367 1,467

12% 40.00% 62.00% Post PartumTransportation Weights 10.21% 5.15% Trv Pct Freq Total

12.10% 674 340 Lab 0 85% 5,196 011.82% 3 3 25.53% Pharm 0 91% 5,563 0

780 2,022 1,019 1,6853 3 30.00% Mother Baby

2,341 5,055 Trv Pct Freq TotalLab 0 93% 5,685 0Pharm 0 90% 5,502 0

5%0.12%

83 53.00%

23 12.23%807

45.50% 3 1.30%1.05% 2,422 0.03% 5,953

69 23 0

207 0

2.30%

21.40%0.49%

323

97

EDPortal

DirectPortal

Ante Partum

Labor and Delivery

Post Partum

W&C

Discharge

Partum 2Mother Baby

6x

3x

4x

2x

1xRed - PatientBlue - Staff

Diagnostic Relationships

CT

L&D

..

..ED

ICU

PCU

MS

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Blocking and Stacking Drivers

• Management Engineering Analysis:– Travel distances– Ancillary deployment– New models – Equipment Depot

• Cost and Space Programming– Best fit scenarios– I to B

Schematic Design

• Application of LEAN:• Updating process maps• Spaghetti diagrams – current state• Evaluation of alternatives

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Using Lean to improve a process …Start Time: End Time: Total Cycle Time: 0:00

TAKT 22.65 min Observer: Sylvia Konopka Date: 12/7/04 Mark:Step Description Time (secs.) Dist.(Ft.) VA VE Wait Travel Inspect NVA-Other

Same Day Surgery AdmissionPre-Surgical Screening (One-Week Prior to Surgery)

0 Patient Arrives 0 01 Person at desks notifies Corrinne (screening person) 8 28 12 Corrinne walks to desk and checks off pt on sign in sheet 11 30 1 13 Corrine walks toward patient in waiting area to introduce herself 6 18 14 Corrine introduces herself to patient 1 0 15 Corrinne takes patient back to room 11 30 16 Patient Signs Paperwork 89 0 17 Corrine walks patient to per-surgical screening 84 137 18 Patient waits in pre-surgical surgical screening 577 0 19 Nurse takes patient into exam room B 20 28 1

10 Nurse asks questions/has pt sign papers 1670 0 111 Nurse takes blood pressure 168 0 112 Nurse takes temperature 14 0 113 Nurse draws blood 178 0 114 Nurse completes assessment 350 0 115 Nurse walks to phone to call anesthesia to come down 5 13 116 Nurse calls anesthesia 82 017 Patient waits for anesthesia, respiratory, and house doctor 108 0 118 House doctor arrives to do assessment 0 019 Respiratory arrives 0 020 Respiratory stamps forms, grabs pt bag, and leaves to come back later 128 23 121 Anesthesia enters room 0 022 Anesthesia completes assessment 313 0 123 House doctor completes assessment 596 0 124 Pt waits for respiratory to return 80 0 125 Pt is moved from exam room B to exam room A 17 20 126 Respiratory returns 1045 0 127 Respiratory completes assessment/instructions 109 0 128 Patient leaves building 138 147 1

Patient Wait to Pre-Op Holding29 Arrive in reg and get in line 6 36.6 130 wait in line 65 6 131 talk with ladies at front desk 15 0 132 sit down 13 20 133 wait in line 10 0 134 person at front desk walk to pt 5 0 135 lady at front desk with pt 20 0 136 Walk from Reg to OR Wait Rm Desk 59 172 137 Wait for clerk to show up to OR Wait Rm Desk 360 0 138 Check in at OR desk 0 0 139 OR desk to waiting area 0 73.0 140 Wait to be called to front desk for consult 365 0 141 Walk to front desk 8 73.0 142 Walk to consult room (1 or 2) 5 20.0 143 Clerk walks from desk to consult rm 1 or 2 87 16.0 144 Consult 108 0 145 Pt walks to seat in wait area 10 93.0 146 Clerk walks to desk 0 16.0 147 Wait until staff calls pt for bloodwork (if necc) 0 0 148 Pt walks from wait area to OR desk (if necc) 0 0 149 Pt and phlebotomist walk from OR desk to bloodwork area in pre-op room (if necc) 0 0 150 Bloodwork (if necc) 0 0 151 Pt walks from bloodwork area back to waiting area (if necc) 0 0 152 Wait until staff calls pt for pre-op 2767 0 153 Pt gets up 0 0 154 Pt walks from seat to pre-op door 15 30 1

STREAM: Same Day Surgery AdmissionValue Stream Map

1.0 Detailed process observations

2.0 Validated process map

Day of Surgery:

Distance = 4127.6 ft. Patient

Nurse

3.0 Spaghetti analysis

5.0 Process improvement plan

4.0 Value analysis and improvement opportunity

Lean: Making the Very Best use of the Resources We Have

Only the right work…. Only the right way….

Everywhere.…All of the Time!

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Lean: Schematic Design• Pre-Schematic Session Work

– Integration of any previous work– Shadow map high quantity tasks by staff

• Activity description• Location accessed• Distance in motion

– Swim Lanes– Space Relationships– Spaghetti Diagrams– Identify Lean concepts and opportunities in existing

designs– Recommend ways to reduce waste in the system

from people, process, technology and space perspective

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NICU – Space Relationships

NICU

PYXIS / I-NICU 2

RESPIRATORYROOM

FORMULA ROOM

NURSE STATION /

OFFICE

SUPPLIES

I-NICU1

26 - 4011- 250 - 10

Frequencies of movement are per Nurse per shift: 7 am to 7 pm[Observed 06/21]

40

65

6

8

10 10

10 4

OVERALL FREQUENCIES

10

1

Frequencies of Travel

13

1

617

35

0

10

20

30

4050

60

70

Nurse Station Pyxis Supplies I-NICU FormulaRoom

Travel from NICU to Modalities

Freq

uenc

y of

Tra

vel

High Frequency Tasks carried-out by a Clinician during a regular shift

NursesTotal distance traveled by a Nurse is 2451 ft. per day per shift which is approximately 170 Miles per year, the same as walking from Philadelphia, PA to Long Island, NY

Nurse AidesTotal distance traveled by Nurse Aide is 5410 ft. per day per shift which is approx. equal to 340 Miles per year, the same as walking from Philadelphia, PA to Pittsburgh, PA

NICU – SpaghettiDiagrams

&ADMISSIONS

ENTRY

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Schematic Design: Evaluation• Process defines space not space defining process• Evaluate the activity

– Is it value added?– Will technology enable, eliminate or improve the activity?– Can you change the sequence or route to complete the

activity to reduce motion?– Can you bring the essentials tools and information within

reach or closer to the care giver to reduce motion?

• Evaluate the alternative designs– Map future state– Spaghetti map flows– Recommend pros and cons of design

Clinician

Nursing Aide

Clinician & Aide Travel Pathways

NICU – Future State Spaghettis

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Clinician

Nursing Aide

Clinician & Aide Travel Pathways

RecommendationsNursing Station Location

Flip location of Nursing Station & Staff Toilet

Staff Toilet could be used my NICU moms? Possible to rename as Patient Toilet?

Staff ToiletLocate near Staff Lounge

Could the current location be used as scrubbing areas for families?

NICU – Future State Layout

NURSINGSTATION

STFTLT

DEPLOYMENT• Information• Supplies• Staff• Services

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Concluding images

Sedimentary materials anchor building to the ground.•Lighter materials above express structure and technology.

Glass facades reflect sky & landscape and maximize patient views.

Strong horizontals minimize building’s impact on site.

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Landscape flows through campus creating a variety of vistas for positive health and healing.

Intermittent courtyards aid patients in way-finding and a feeling of release.

The building acts as a filter and link between adjacent wet lands.

The building takes advantage of indirect light from the north while restricting the harsh southern sun.

The campus creates an intimate sensation through creation of plazas and gardens.

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Glass lanterns at ends of bed tower mark entries and family waiting areas.

Canopy & signage extend from the building and grab the ring road to direct patients to the entrance.

Courtyards orient patients as they travel through building.

Views are directed toward gardens and limit views onto adjacent parking lots.

Images of successful patients illustrate the importance of human interaction in Virtua’s process.

Purposefully human scaled environment instills a sense of calm.

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Captivates the senses through sight, scent, touch, and sound.

The curve of the bed tower embraces the landscape.

The postpartum is expressed with the accent material.

Emergency Department is separated from ambulance drop off through landscaping.

Thoughtful and engaging through concealing and revealing.

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Potential Pebble ProjectsAccess to Natural Light and Nature

Way finding with multiple entrances, distributed parking, separate visitor experiences.

Observation unit in ambulatory setting and impact on LOS

Single Room NICU

Inpatient unit design with decentralized charting stations, decentralized support areas,

Impact of floor design on travel distances – reduced walking and improved workflow – reduce time hunting and gathering

Private patient rooms with a patient controlled environment, family centered care environment, hospitality like setting, safety

Team hub design to promote care team environment. Impact of decisions with regarding to lighting and acoustics in this area.

Medication distribution process and impact on med errors with pharmacy deployed near patients and decentralized medication room and new technologies

Equipment Depot and impact on service response time& nursing efficiency

Work Process StudyInpatient Unit Design

• Decentralized Charting Stations• Decentralized Support• New Technologies• Strategically Located Hand-washing Stations

• Measurable Outcomes– Increase in patient safety / observation– Decrease in time “hunting & gathering”– Decrease in staff fatigue / errors– Decrease in “sneaker time”– Increase in communication – Increase in infection control ratings

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Questions?

Thank you.