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
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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
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“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
416.243.3600 ext. 2059