Team planning high-risk birth center has 182 collective years of OB experience

Scott Radcliff, of Hasenstab Architects, leads a brainstorming session.

Scott Radcliff, of Hasenstab Architects, leads a brainstorming session.

Last month, Akron Children’s announced that it would dedicate a floor in its new building to high-risk deliveries – a milestone in the hospital’s 123-year history.

This has long been a dream of hospital leaders like President and CEO Bill Considine, as well as the doctors who head up the hospital’s maternal fetal medicine and fetal treatment centers and neonatal intensive care unit.

Now comes the work to make this dream a reality.

Dr. Anand Kantak has long supported the plan to bring high-risk deliveries to Akron Children's as the ideal family-centered care.

Dr. Anand Kantak has long supported the plan to bring high-risk deliveries to Akron Children’s as the ideal family-centered care.

The first steps in planning the new space, which will be on the 4th floor of the medical building already under construction, took place Aug. 5 and 6.

A team of about 20 doctors, nurses, architects, administrators and Lean Six Sigma experts participated in a kaizen (Japanese word for “rapid improvement”) to give key stakeholders a say in how the space is designed.

A high-risk OB patient also participated the first day.

“Delivering babies on our campus may be uncharted territory for us, yet the doctors and nurses in this room have a collective 182 years of experience delivering babies at other hospitals,” said Lisa Aurilio, vice president for patient services and chief nursing officer.

Chief Nursing Officer Lisa Aurilio has also participated in kaizens for the ER and NICU.

Chief Nursing Officer Lisa Aurilio has also participated in kaizens for the ER and NICU.

The plan is to deliver approximately 100 babies per year when prenatal diagnosis determines the baby to be at risk and in need of immediate medical intervention by pediatric surgeons or other specialists upon birth.

This would include babies with congenital heart and neural tube defects, diaphragmatic hernias, and abnormalities that may affect the airway.

The team began by creating a vision statement for the new center. This was done by participants writing responses to prompts like, “I see…”, “I hear…”, “I think…” and “I feel….”

The input of the team members suggest they want to create an environment that's inviting, comfortable and focused on the highest quality of care.

The input of the team members suggest they want to create an environment that’s inviting, comfortable and focused on the highest quality of care.

Each team member was given 5 blue and 5 red dots to place on photos of the interiors of other birthing centers across the country. The exercise indicated the team is partial to soft rather than bright colors.

“They steered away from primary colors and starkness in favor of wood tones, a spa-like feel and interiors that convey home and comfort,” said Sherry Valentine, a project leader for Akron Children’s Mark A. Watson Center for Operations Excellence.

Sherry Valentine, Lean Six Sigma deployment leader, facilitates a group session.

Sherry Valentine, Lean Six Sigma deployment leader, facilitates a group session.

Other activities focused on issues of patient experience and staff work flows.

They looked at the proximity of operating rooms to patient rooms, how many steps doctors and nurses have to walk, storage space, the size and comfort level of the patient rooms, and the various “points of entry” for patients.

While most of these deliveries will be scheduled through maternal fetal medicine, the team also has to plan for the unexpected, including patients arriving via transport, 911 ambulance arrivals, and even the occasional “walk-in” mother-to-be in labor.

Jennie Evans, a registered nurse and medical planner with HKS Architects, offers insight.

Jennie Evans, a registered nurse and medical planner with HKS Architects, offers insight.

The team will make key decisions for the public/shared spaces, such as the waiting rooms, 3 ORs for C-sections, and 6 labor/delivery/recovery/postpartum rooms, which must also flexible enough to become 2 intensive care rooms and an isolation room, if needed.

Several participants talked about how the team “gelled” instantly and how they feel privileged to have a role in a history-making venture for Akron Children’s.

Drs. Melissa Mancuso and Stephen Crane are two of Akron Children's high-risk obstetricians.

Drs. Melissa Mancuso and Stephen Crane are two of Akron Children’s high-risk obstetricians.

“We are all very invested in this,” said Dr. Stephen Crane, director of maternal fetal medicine. “We have dreamed about this for years. It’s the right thing to do for our patients.”

Dr. Melissa Mancuso, co-director of the fetal treatment center, says the ability to perform high-risk deliveries will, over time, enable Akron Children’s to offer new treatment options, such as laser therapy for twin-to-twin transfusion syndrome, ex utero intrapartum treatment (EXIT) procedure, fetal therapy for cardiac conduction abnormalities and in utero release of amniotic bands.

“Of course the best reason for doing this is it keeps moms with their babies and keeps families together under one [hospital] roof. You can’t put a value on that,” said Dr. Mancuso.

That’s not to say the process will be easy.

“The most challenging aspect of this for our hospital is thinking beyond babies and children as patients,” said Aurilio. “Now mothers will be our patients as well, and that has implications for everything we do from insurance contracts to medical coding to laboratory procedures.”

And the award goes to… (Photo gallery)

Trent Jezwinski, director of healthcare construction for Welty/Boldt, took home the Bright Idea Award for recalling information from a training that took place over six years ago, which resulted in a potential six-figure savings for the project.

Trent Jezwinski, director of healthcare construction for Welty/Boldt, took home the Bright Idea Award for recalling information from a training that took place over 6 years ago, which resulted in a potential 6-figure savings for the project.

The seven teams working on Akron Children’s Hospital’s new building can get pretty tired at the end of a work week, especially when there are multiple companies working together for the first time and they’re challenged to change the status quo.

So Bernita Beikmann, of HKS, and Nick Loughrin and Will Lichtig, of Welty/Boldt, put their heads together and came up with a way to energize the teams.

“Our first thought was a monetary reward, but that meant assigning dollar values to specific tasks,” said Beikmann. “And, at some point, the money runs out and future tasks don’t look as important unless dollars are assigned to them.”

Taking a page from the children we serve, they ended up with this fun and lighthearted award system:

  • Super Star with the Sticky Notes – The team or person who made the most strides in improving communication and collaboration.
  • Bright Idea – Any person or team with a new, innovative idea to share.
  • Purple Heart – A team or team member who overcame personal or professional struggles during the week or did something on behalf of another team.
  • Super Spice – The team that brought the highest energy to the project.
  • Raising the Bar – The team whose projected innovation savings surpassed their savings goal.
  • Katniss Everdeen Award – The team that reached their target cost.
  • Down the Rabbit Hole – The team member who helped prevent a task or conversation from going down the wrong path.
  • Energizer Bunny – The team that reached its target cost, but still kept adding innovative ideas.
 Rob Ford, estimator at Baker Concrete Construction, and Pam Best, director of pre-construction services at MMC Contractors, accepted the Purple Heart and Raising the Bar Awards on behalf of the team members working at the site to solve problems and ensure a safe environment.

Rob Ford, estimator at Baker Concrete Construction, and Pam Best, director of pre-construction services at MMC Contractors, accepted the Purple Heart and Raising the Bar Awards on behalf of the team members working at the site to solve problems and ensure a safe environment.

“Despite the silliness of their names, the intention of the awards is to motivate everyone to excel,” Beikmann said.

The “trophies” can be as silly as their titles – a stuffed toy rabbit in a tumbler, a light bulb, a doll or a photo of the Spice Girls.

Anyone can nominate a team or individual, and the winners are chosen by the group at the end of the week.

“It was a little scary in the beginning, not knowing how receptive the teams would be to the idea, but the response has been overwhelmingly positive, with teams even competing for awards,” Beikmann said.

The Mechanical, Electrical, Plumbing and Fire Protection Innovation Team even rapped out one of their presentations to win the Super Spice Award.

The Purple Heart Award has been given out to a few team members who have gone above and beyond.

“One recipient gave birth the day after a meeting, another worked until the day before her wedding day, and another member ended up in the ER during the week,” Beikmann said.

And, of course, Akron Children’s received the Katniss Everdeen Award, named after the heroine of The Hunger Games, for its decision to include high-risk OB in the new building.

“In keeping with the book’s story line, the winner of the award reached the target without being set on fire, starving to death, or being killed by another team member,” Beikmann laughed.

For the construction workers at the site, a separate recognition program has been developed with hard hat stickers.

“Construction crew members work as a team and help each other to the benefit of the hospital and the community-at-large,” Beikmann said. “This includes actions like improving the walking paths around the site, cleaning up trash regardless of how it got there, and reducing noise pollution.”

Creating new building model is a snap (Photo gallery)

(L-R) Volunteer architects Dan Gilbert and Jonathan Morschl and associate development officer Brian Hollingsworth were instrumental in building the LEGO model.

(L-R) Volunteer architects Dan Gilbert and Jonathan Morschl and associate development officer Brian Hollingsworth were instrumental in building the LEGO model.

With a little more than a month for planning and construction, a team of 30 volunteers set out to achieve the unthinkable – construction of the new building at the Akron campus.

Under the architectural direction of Jonathan Morschl of Four Points Architectural Services, Inc. and Dan Gilbert of DLZ, the team produced the necessary designs, procured the right materials, deployed a loyal and skilled group of building experts, and completed the project on time.

Did we mention they built the building using LEGO®?

“We wanted to do something special for the groundbreaking,” said Brian Hollingsworth, associate development officer for the Akron Children’s Hospital Foundation. “We wanted a piece that would show people a visual representation of what the building is going to look like.”

Airbear, Akron Children's dedicated pediatric transport helicopter, will have a new helipad when the critical care tower opens

Airbear, Akron Children’s dedicated pediatric transport helicopter, will have a new helipad when the critical care tower opens

After some brainstorming within the Foundation, Gretchen Jones, the Director of Principal Giving, suggested a LEGO creation that would serve as a
centerpiece for the recent groundbreaking festivities.

Hollingsworth turned to social media to get ideas about how to replicate the building using LEGO and to recruit volunteers to build it.

After a simple Facebook post, the project took off, he said.

“We received just an amazing response,” Hollingsworth said. “People were liking it, commenting on it, and sharing it on their own pages. I received so many messages from people saying ‘I’m a Lego maniac’ or ‘I have a husband or a child who wants to do this.’”

Morschl and Gilbert helped plan the LEGO model so it would stand as a true representation of the new building when the real structure is complete.

They helped determine what types and quantities of Lego pieces would be necessary to build the model to scale with as much authentic detail as possible.

Assembly was challenging, but finding the materials was more difficult, said Hollingsworth. “It was hair-raising at times waiting for the mail to arrive to bring more essential LEGO bricks,” he said.

Ultimately, the model required several dozen different types of LEGO bricks, more than 12,000 pieces in all, and about 120 volunteer hours to construct. It stands 13 inches tall and 2 feet, 10 inches across, resting on a 4-foot-square platform.

The model may eventually find a home on display in the new building when it’s completed in 2015.

“It was a much bigger project than we thought at first,” said Hollingsworth. “It took a lot of volunteers to make it happen.”

Final design workshop for NICU likened to “speed dating” [Photo Gallery]

Mary Beth Frye, Megan Pollock and nurse Sofiya Lizhnyak participate in NICU simulation

NICU family care coordinator Mary Beth Frye, Megan Pollock and nurse Sofiya Lizhnyak participate in a NICU simulation to test the new design space.

Akron Children’s Hospital’s NICU team began its final design kaizen with an approach that could be compared to speed dating.

The team broke into three small groups that rotated around full-sized cardboard mock-ups that represented patient rooms, medication rooms, team rooms, family and staff quiet rooms, supply and equipment rooms, pod work stations, and remote networking or “touchdown” rooms.

Each group had 45 minutes to review and discuss where every stationary and portable item should be placed in each room.

During a simulation scenario, Dr. Jen Grow and mock patient family test out the design of the new patient rooms

During a simulation scenario, Dr. Jen Grow and Megan Pollock test out the design of the new patient rooms.

The teams took the needs of NICU families into consideration – everything from how to provide coffee and tea service most economically and efficiently to the need for recliners in the quiet room for parents to hold their end-of-life babies.

“It’s been great to be able to give input on everything from the chair position in the patient room to the counter space and cabinets in the bathroom,” said Megan Pollock, a former NICU parent.

In all the rooms, the team discussed the smallest details:

  • How many and what types of seating are required?
  • How many phones and chargers for communication devices are needed?
  • What types of storage work most efficiently in different rooms?
  • Would white and cork boards be useful or compromise patient privacy?
  • What size windows provide the best compromise between visibility, privacy and cost?
  • What’s the best location for the breast milk and formula refrigerator and the meds refrigerator in the medication room?
  • Could crash carts be stored in the medication room?
  • Where is the best place to locate sinks to avoid splashing and possible contamination?
  • Are clutter free counters with storage shelves above the best approach?
  • Who will be responsible for cleaning and stocking items?

After the NICU team agreed on changes, they used simulation scenarios to confirm that they knew where to find what they needed and make sure the newly designed spaces work as planned.

“Participating in the simulations was awesome,” Megan said. “The newborn mannequin made the whole experience feel so real. When I practiced kangaroo care with it, I could feel the heart beat.”

The NICU team will now embark on two years of process refinement during the Critical Care Tower construction, culminating in the move to their new space in 2015.

Simulations help team design most efficient ER

Dr. Gregg DiGiulio examines a mannequin during a simulation to help design the new ER.

A 15-month-old lies in an ER trauma room after being transported by EMS from an adult hospital. Lab results indicate possible kidney failure.

A 6-month-old suffering seizures is being treated in an ER patient room.

A baby has been found not breathing in a bassinette by a babysitter and has been brought to the ER by EMS.

A normal day in Akron Children’s Hospital’s ER?  Not today.

These are 30-minute simulations being played out at the warehouse in Green Township. They’re helping the ER team in its continuing effort to design the most efficient ER, which will be part of the hospital’s new Critical Care Tower.

In previous sessions, the ER team defined equipment needs, room sizes, basic layouts, and the location of support services.

Dr. Mary Patterson is part of the team helping design the new ER and trauma space in the new critical care tower.

This week, ER team members are enacting simulation scenarios created by Dr. Mary Patterson and her staff in the simulation center, to refine the details of the space and determine how it actually works in practice with a patient.

This means fine tuning what’s in the rooms and where everything is placed. Is equipment easily accessed or in the way of staff providing patient care?

ER staff members are assigned roles to play – residents, attending physicians, medical nurses, procedure nurses, recording nurses, respiratory therapists, x-ray techs, anesthesia assistants, observing students, child life specialists, even distraught parents – to evaluate how well the space and equipment work for each member of the team.

The team surrounds the “patients” – mannequins with pulses, eyes that react to light, and breathing and heart sounds – to test the placement and functionality of equipment.

These simulations are videotaped, and with Dr. Patterson leading the debriefing sessions that immediately follow the simulations, team members watch the videos and talk about their own experiences to identify what’s working and what needs to be changed.

As the week progresses and equipment and cart placements are decided, slow-motion simulations will be used to confirm that medications and critical equipment are within the reach of all members of the team, from the tallest to the shortest.  Simulations will also capture patient care at and from ambulance bays.

All of these workshops taking place at the warehouse are part of what’s called a Kaizen, a rapid process improvement event. This will be the last Kaizen meeting for the ER team. Refinements made in this session will be reflected in the completed architectural drawings due by March 8.

How the ER team will boost efficiency and reduce costs in new space

Akron Children’s ER design team runs through patient scenarios to find ways to create the most value in the design of our new ER.

As our teams assemble to discuss and collaborate on best practices and design of Akron Children’s Hospital’s new $200 million critical care tower, participants continue to experience “Ah, ha!” moments.

This week, the ER team ran through patient scenarios, using mannequins and equipment, to test how effectively the staff can move throughout the current design space.

What they realized was that exploring all options – even if there are some that will be ruled out – helps identify new, unexplored possibilities.

Throughout the integrated project delivery (IPD) process, design teams have been challenged to find ways to maximize efficiency and reduce space, creating the most value in the design.

The ER team realized that they could save money and increase flexibility within the space by reducing the amount of built-in storage and using a cart system to store and move supplies around.

They brainstormed possible cart combinations and then discussed how those carts could be used and stored. By not having identical medical equipment housed in each room, we save space and money.

In the future, if equipment needs updated, there will be fewer units to update, reducing expenses.

In addition, carts provide flexibility because the staff can customize the room to the patient’s situation by bringing in only the equipment they need.

This group also talked a lot about doors – their size, hardware function and open/close timing. In January, they’ll return to the warehouse for patient simulations using sample doors from manufacturers.

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.”

Video: Child life specialists weigh in on Akron Children’s new critical care tower

Our child life specialists play a critical role in helping to reduce stress and anxiety for children and families before, during and after medical procedures. It’s a perspective they’re sharing with the team planning and building the new $200-million critical care tower at Akron Children’s Hospital.

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 jdoyle@chmca.org. Space is limited.

Check out the August family focus group.

Getting the parents’ perspective for new building

Feedback from families has played a key role in the design phase of a new critical care tower at Akron Children’s Hospital’s downtown campus.

During the process, parents were able to interact with full-scale floor models of the new patient care areas and were joined by their children for a focus group.