Community open house set for April 26 to celebrate opening of Kay Jewelers Pavilion

Kay Jewelers PavilionHere’s your first chance to step inside Akron’s newest gem and celebrate our community’s most precious jewels – kids.

Patient families, friends and the general public are invited to take their first look inside Akron Children’s Hospital’s new $180 million Kay Jewelers Pavilion at a community open house from 1 to 4 p.m. on Sunday, April 26.

The open house will include:

  • guided tours of our new ER, NICU, GOJO Outpatient Surgery Center and special delivery unit for high-risk newborns
  • kids’ games and activities, including life-size versions of popular board games and a photo booth
  • entertainment, including performances by local kids, puppeteers, costumed characters and a bubble artist
  • Doggie Brigade volunteers

Attendees will also have an opportunity to draw pictures that will become part of a permanent, public artwork at the hospital.

A Look Inside

Kay Jewelers Pavilion lobby

Kay Jewelers Pavilion lobby

The interior of Kay Jewelers Pavilion features a “backyard” theme echoing the joys of childhood and the idea that Akron Children’s has been a treasure in greater Akron’s own backyard since 1890.

“Akron Children’s was founded 125 years ago this year as a day nursery and has grown into a regional health system with the depth and breadth of clinical services that truly enable us to serve all of the children who need us,” said Bill Considine, president and chief executive officer of Akron Children’s. “Every detail of Kay Jewelers Pavilion has been carefully planned with our patient families in mind – and we are thrilled to finally open our doors and invite everyone to see this exciting investment into our children’s well being.”

In following the backyard theme, our new NICU is “The Treehouse” – a soothing, healing environment where families can be comfortable while neonatologists and specially trained nurses care for the youngest and most fragile of infants.

In keeping with the backyard theme of the Kay Jewelers Pavilion, our new ER has a puddle theme

In keeping with the backyard theme of the Kay Jewelers Pavilion, our new ER has a puddle theme

Our ER, nicknamed “The Puddle,” was especially designed to facilitate a more natural flow of admissions.

The GOJO Outpatient Surgery Center, “The Sandbox,” will open with 4 operating rooms equipped for a variety of outpatient procedures, including ENT, ophthalmology, urology, dental and some plastic surgery cases.

Our new labor, delivery and recovery center, known as “The Garden,” is designed for cases when a baby is considered at high risk and in need of pediatric specialists the moment they are born.

New medical building is parent approved

Beth Tenda with her children at the groundbreaking

Beth Tenda with her 3 children at the groundbreaking ceremony for the Kay Jewelers Pavilion.

When Beth Tenda brings one of her children to Akron Children’s new ER, she’ll know every nook and cranny of the space down to the most obscure detail.

That’s because Beth helped design the hospital’s $200 million Kay Jewelers Pavilion as part of the lean project delivery process.

Beth and other parents provide design input to the architects during a focus group in 2012.

Beth and other parents provide design input to the architects during a focus group in 2012.

The process began 2 years ago when doctors, nurses, and other members of the care team met and brainstormed about the ideal ER and trauma bay, neonatal intensive care unit and outpatient surgery center.

Beth and several other parents served as the voice of patient families in the process.

They collected and studied data, looked at pictures of other children’s hospitals, worked with architects and engineers, and built and tested simulated space using cardboard walls.

The goals were to build the best space for patient care, improve efficiency, minimize mistakes and keep the construction on time and under budget.

“Wow, this is just as we had planned it,” said Beth, who was on a tour of the building several months before it opened to the public. “The door spaces, the room spaces are perfectly as I envisioned.”

Adopting children with special needs

After raising 2 sons, Beth still felt that pull to parent and adopted 3 children with special needs. Born prematurely, they are now between the ages of 8 and 10 and require the care of pulmonology, GI, sleep, and neuro-developmental specialists.

Beth estimates she has made more than 50 visits to Akron Children’s ER over the past few years.

“Parents carry stuff – diaper bags, purses, infant carriers, toys. I typically had a stroller or wheelchair and not all of us are petite so, in our meetings, I always questioned door space and room space,” said Beth. “You don’t want to be left in an exam room that feels like closet.”

Beth also got to provide input on the interior design of Kay Jewelers Pavilion at a parent town hall meeting in 2013.

Beth also got to provide input on the interior design of Kay Jewelers Pavilion at a parent town hall meeting in 2013.

Beth also recommended family restrooms, glass doors in the ER (where patients are less likely to feel forgotten) and a larger security presence in the ER waiting room.

Beth Tenda with Dr. Emily Scott at a design workshop for the ER

Beth and Dr. Emily Scott at an ER design workshop

“Two years ago, I would guess I made an ER visit at least every other month so I know it well,” she said. “I’ve been there when it was standing room only. So I am very excited to see the new ER in action. It’s all about flow, triaging the patients based on symptoms, and getting them treated sooner. Registration will take place in the exam room, so that means one less stop.”

Beth contributed about 100 hours to the project, attending town hall meetings in the evenings, at least 4 all-day design workshops at a warehouse, and many other sessions.

Beth participates in a simulation workshop for the outpatient surgery center

Beth participates in a simulation workshop for the outpatient surgery center

“You see different ideas and I learned so much about how all of these people interact to provide care to keep kids healthy. It was an eye opener,” she said. “There is so much that goes on behind the scenes to make the typical ER visit or the typical medical appointment happen.”

Beth’s experience as a member of the design team has impacted how she views her day-to-day life.

“I look at things differently now,” she said. “Whether I am shopping or on a doctor’s appointment myself, I get annoyed if processes are not consumer friendly. Getting my kids ready for bed is now clockwork.”

Beth at the NICU town hall meeting in 2012

Beth at the NICU town hall meeting in 2012

Beth continues to volunteer as a parent advisor at the hospital, providing input on various hospital committees and performance improvement projects.

“In many places and in many ways, parents are given the opportunity to have a voice in their children’s medical care or education and we need to use those opportunities,” Beth said. “Whenever I walk into that new building, I think I will want to pat myself on the back and say, ‘I did this!’”

Where the familiar things are

Abstract design features in the future lobby play into the "things familiar" and backyard ideas. The blue wall represents an abstract fence. The design team is also working on large tree sculptures and a ceiling sculpture element to symbolize a tree canopy of leaves.

Abstract design features in the future lobby play into the “things familiar” and backyard ideas. The blue wall represents an abstract fence. The design team is also working on large tree sculptures and a ceiling sculpture element to symbolize a tree canopy of leaves.

Where does a child’s adventure begin?

The answer: In the child’s backyard.

That answer led to the theme for Akron Children’s new medical tower – “things familiar.”

The idea was to inspire imagination while being comfortable and safe at the same time – like in a child’s backyard.

The theme was a result of a visioning process between HKS Architects and hospital leadership.

The theme meets hospital leadership’s desire to create a place that’s distinctive and serves as a beacon to the community. It also conveys a connection to the natural environment, and inspires creativity and hope.

“A child’s imagination is the most powerful tool we have,” said Becky Baumer, an interior designer at HKS Architects.  “It transports them into another time, another place. It takes them out of their current state and into their perfect future state.  It holds their dreams. It is healing. It is comforting. It is calming. It is playful.  It turns things familiar into magical retreats.”

Each department in the new building will feature a backyard-related design that drives the building’s interior look and feel.

These themes will be reflected in abstract design features appropriate to the departments, and each floor will have an assigned a color, signage and accent walls that fit the themes.

  • ED is “the puddle.” This theme was chosen because water has a calming effect for this high-stress environment. The first floor ED will be blue.
  • The outpatient surgery center is “the sandbox.” Located on the new building’s 3rd floor, outpatient surgery will have a more energetic orange color scheme, reflected in color, texture and pattern.
  • The high-risk delivery area, located on the 4th and 5th floors, will be “a garden,” which is appropriate and restful for this adult audience.
  • The NICU, also occupying two floors (the 6th and 7th), will create the feeling of “a treehouse.”  One floor will be the treehouse at night, using the color magenta and setting the scene for a camp-out or sleep-over. The 2nd floor will be green, to reflect the feeling of spending the day in the tree tops.

“The hope,” Baumer said, “is that as the campus grows and areas are refurbished, this type of theming can be continued.”

How will healthcare look in 20 years? That would be nice to know as we build now

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.

No kid wants surgery, but here’s to making the process the best it can be

How do we build a same-day surgery center that satisfies the needs and desire of everyone – patients, patient families, doctors, anesthesiologists, nurses and surgical support teams?

As Akron Children’s Hospital moves forward with its plans to build a $200 million critical care tower, teams continue to meet, brainstorm and test out architectural designs in a true-to-scale setting during weeklong Kaizens. Kaizen is a Lean term that refers to improving processes continually by making incremental changes.

Parents Beth Tenda and Judy Doyle participate in the Kaizen to design the new outpatient surgery space.

In September, a team representing outpatient surgery gathered in a warehouse, where cardboard-like walls defined surgical suites, recovery rooms, pre-op areas and other spaces and allowed doctors, nurses and patients to move through their typical day.

As the Kaizen began, several issues were front and center:

  • The need to create the ideal number of surgical suites based on current patient volumes as well as future growth.
  • The need to keep the ORs running as efficiently as possible, taking into consideration the ebb and flow of higher and lower volume procedures, as well as planned and emergency cases.
  • Focus on flow – How much walking will be required for patient families, as well as the doctors and nurses?
  • Movement of supplies in and out of the ORs. Surgical instruments come into the room sterile and the proper equipment must be assembled for each case, whether it’s an ENT procedure, an eye surgery or an orthopedic case.
  • Providing a calm environment that promotes privacy.

As the week began, it felt like this was an impossible task to come up with a floor plan that addressed all of these concerns and made everyone – from the anesthesiologists to the surgeons and the surgical support team – happy.

We were reminded again that Akron Children’s is a dedicated pediatric hospital and that children are not “just small adults.” The team worked to ensure excellent sight lines of patients in the recovery unit design to enhance patient safety.

“Unlike an adult hospital, children in the recovery unit don’t necessarily stay in bed,” said clinical coordinator Tina Sanzone, RN, BSN. “We need to have patients in view to ensure patient safety.”

The team went through phases of anticipation, discouragement and hope as each day welcomed success, frustration and new architectural drawings of the space. Each layout, when constructed three-dimensionally, generated dissatisfaction that the ideal plan still had not been developed.

Until Day Four.

When the exhausted team found their architectural team had worked overnight to meld the best ideas from two of the previous designs, they realized they finally had a winner.

The last design greatly improved patient flow. It offered easy access to storage. Doctors and nurses were not wasting extra steps within surgical suites or between them and other key spaces. The plan built in flexibility for growth and change down the road.

“The translation of design from paper to three dimensions can be eye opening,” said Beth Carr, MSN, MBA, RN, director of Nursing for Surgical Services. “When you see a design on paper, you envision it to work correctly. It’s not until you are actually in the space, and moving within it, that you realize it may not be ideal. The process takes time and patience. When you think there are no options, options present themselves.”

Using our senses to describe the ideal emergency department

Megs knows just where she is going to place her stickers.

I know I’ve said it before, but we are privileged to have a hospital that cares to ask its employees and parents for input on how to create the best hospital around.

The second town hall meeting consisted of a few parents from the previous meeting as well as new faces and employees. Again, we were asked what we liked and disliked about the hospital and what we would like to see in the future. We described what our senses tell us – how we feel and what we see and hear.

Some parents suggested activities for the families to engage in during the waiting process. I love this concept. My feeling is, “How long can you stare at fish or pictures?” Engagement helps pass the time. Emergency departments aren’t necessarily known as in-and-out experiences. There may be testing to be completed, specialists to be contacted or materials to be gathered. One of the attendees suggested having a video game console or iPad in the rooms.

Activities or internet access in the surgery waiting areas would also be helpful. One of the team members approached Randy and I about placing our belongings in a locker. I love this idea. When you have surgery in the winter or have extra bags it’s hard to gather them up when you need to move around the waiting area, speak to the surgical staff, or leave to get something to eat. If there were lockers it would be one less item you need to be concerned with that day.

Some other concerns were not having cell phone service in the Emergency department and having to repeat your history to each medical professional who enters. It may seem small, but sometimes it feels like a waste of time. Now that the hospital has switched to electronic health records, communication between team members is improving.

We also discussed locating the mental health area in a separate section toward the back of the Emergency department, shorter waiting times, and being placed in a private room sooner. There were attendees who have first-hand experience in the current emergency department, and they had great points. The staff said that not only is there a new building, but there will be a new process for how the department will operate as well.

I also had the pleasure of meeting a child life specialist who works in the current Emergency department. I love the goal of having more child life specialists, and I feel that these professionals are the glue of the team. They are the link to our common language, to show and explain what is happening, create a sense of calm in crisis, and add an extra smile in our time of need.

We are so excited to see where these plans go to create one of the best hospitals in the nation.

Help us build a better hospital

Akron Children’s Hospital hosted its first family focus group in August to help design its new critical care tower.

Akron Children’s Hospital is seeking families to share their vision for a new ER and outpatient surgery center during the second in a series of family focus groups on Tuesday, Sept. 25, 5:30-7:30 p.m.

Our new critical care tower will be designed to enhance the quality, family-centered care we’ve been providing for more than 120 years.

Patient families offer an important perspective in the planning process.

“Your input will help us ensure the space is created as a healing environment for patients and families,” said Judy Doyle, parent advisor coordinator at Akron Children’s Hospital.

Parents are encouraged to bring their children ages 9 and older because we’d like their opinions too.

To attend or for more information, contact Judy at 330-543-3072 or Space is limited.

Check out the August family focus group.

How to build a better ED: Learning from Seattle Children’s

Akron Children’s Hospital, firmly rooted in northeast Ohio and the Midwest since 1890, is looking to a West Coast children’s hospital for guidance as it begins a $200 million expansion of its main campus.

As the hospital undertakes a year-long process to design a new medical tower that will include a new emergency department, neonatal intensive care unit, outpatient surgery center and expanded clinical space, it borrows greatly from the experienced learned at Seattle Children’s Hospital in the early 2000s.

Working closely with Joan Wellman & Associates, Seattle Children’s followed a process called Integrated Facility Design to expand its campus, adding a universal clinic, outpatient surgery center, imaging center, lab and pharmacy.

Early estimates indicated the Seattle project would span 110,000 square feet and cost $100 million. The hospital board approved a $70 million total cost. In the end, the 80,000 square foot (a 30 percent reduction) facility ran under the allocated budget by $3 million and opened a month early.

The secret was turning to the Lean Six Sigma principles perfected by Toyota and other Japanese manufacturers that focus on eliminating waste, improving efficiency and focusing on customer satisfaction.

CNO Lisa Aurilio

A team from Akron Children’s has visited Seattle Children’s. The hospital created the Mark A.Watson Center for Operations Excellence in 2009 and this staff has been tackling problems big and small for the hospital. Successes range from improving the efficiency of the hospital sterile process department (essential to meeting the demand for more surgeries) to improving the scheduling of MRIs.

The approach to building design essentially flipped the traditional method.

“Right now we have everyone working together from the very start,” said Magnus Nilsson, a senior consultant for the KLMK Group, a key player in the project. “Typically, an owner works with an architect for a year and then they bring in the mechanical, electrical, structural and civil engineers and the construction team. The goal here is to have a seamless communication process.”

Nilsson said the goal of having zero change orders – costly changes in the plan once construction starts – is a realistic goal.

Lisa Aurilio, chief nursing officer for Akron Children’s Hospital, said she remembers earlier in her nursing career pushing a patient on a stretcher in a hospital that had just opened. But as they approached the treatment room, she couldn’t get the patient into the room – the door width was too narrow.

“As nurses, we known how to give really good patient care, but we don’t know how to read blueprints,” Aurilio said. “This process [including using life-size mock-ups of an ED or NICU] lets us avoid those mistakes. It allows us to get the patient’s voice in the process. After all, it’s about them.”

Doug Dulin

Doug Dulin, senior director of the Mark A.Watson Center for Operations Excellence, said the process so far has reduced Akron Children’s new medical tower from 360,000 to 330,000 square feet.

According to Dulin, in Lean Six Sigma language, patient/customer flow is often compared to a river. Good building design will keep patients moving along “downstream.” Bad design will cause waits, confusion and bad experiences.

“We want patients to come into the ED, get registered, see a provider, get the care they need and then go home as quickly as possible,” Dulin said.

Learn more about Akron Children’s building expansion project, called “Building on the Promise.”

Credit: “Leading the Lean Healthcare Journey; Driving Culture Change to Increase Value”  by Joan Wellman, Howard Jeffries and Pat Hagen.  This book was published by CRC Press, a Taylor and Francis Company.