Dr. David Chand talks with Dr. Emily Scott, a pediatric ED attending physician, during the August kaizen to design the new ER.
As Akron Children’s Hospital moves forward with its $200 million campus expansion, a crystal ball would come in handy.
With health care reform, changing demographics, and other uncertainties, our goal is to build flexibility into our design in every way possible. We can make educated guesses regarding future patient volumes and acuity, reimbursement levels, the always-changing technology and best practices for care, but they are just that – educated guesses.
The kaizen process is a group effort.
The first phase of the plan includes a critical care tower to be built on Locust Street, west of our main hospital. The tower will include a new emergency department, neonatal intensive care unit and outpatient surgical suites. A new parking deck, which will connect to the tower, is already under construction. Later projects include an expansion of the Ronald McDonald House of Akron and additional space for clinical programs.
Akron Children’s is using a forward-thinking design process called Integrated Lean Project Delivery (ILPD), which has brought all stakeholders – physicians, nurses, parents, and staff – together with the architects and engineers to design the new space efficiently and with the best possible patient experience in mind. The guiding principles echo back to the hospital’s original promises of:
- Treating each child as if our own,
- Treating others as we would want to be treated, and
- Turning no child away regardless of ability to pay.
Using this process is a natural evolution for Akron Children’s, which began to embrace the Lean Six Sigma process improvement principles when it created the Mark A. Watson Center for Operations Excellence in 2008.
I have been most closely involved with the team designing the emergency department, which was built to serve 45,000 patients annually but has been serving closer to 60,000 in recent years.
Moving through the design process, we held several architect-led meetings, including a week-long “kaizen” in a local warehouse. Using sturdy cardboard for walls, we were able to test true-to-size floor designs and the functionality of the space by wheeling a patient down a hallway, measuring the time needed to get an x-ray, and counting the steps a nurse takes when reaching for supplies.
We have tested various ED scenarios, including a common case of asthma, a trauma, and a teen having a mental health crisis. A pediatric ED is a busy place and we have sought the input of other hospital professionals who provide services there, including our social workers, dietitians, chaplains, transport team members, pharmacists, lab and radiology technicians, and security and housekeeping staff.
Testing patient care flow during a kaizen to design the new ER.
We studied data, such as our average daily census and length of stay, and created “current state” and “future state” value-stream maps, which quantify all the employees, functions, time and costs that follow a patient from arrival to discharge.
Some surprisingly low-tech supplies such as Post-It Notes, yarn, masking tape, and paper cut-outs have been employed to capture ideas and study work flow.
The goal is to catch design flaws early, reduce the number of change orders and, of course, solve problems before it is too late to make changes.
We learned a few things early on. We want separate ED entrances for ambulances and families bringing children on their own. We want as much standardization as possible to reduce the risk of error. And we want rooms to be universal – able to change in function by simply moving equipment in and out.
The parents on our team told us they hope for improved way-finding and easy check-in. A good sense of safety and security is also a top priority. We were reminded that they often come to the hospital with baby carriers, diaper bags, strollers and siblings in tow and few pediatric ED visits are ever planned. The input they have given us has been invaluable.
Construction will begin this spring, with completion scheduled for 2015. We can only wonder what changes we will see in health care by the time the doors of our new critical care tower officially open.
Dr. David Chand is a pediatric hospitalist and member of Akron Children’s Hospital’s Mark A. Watson Center for Operations Excellence.
