Building Healthcare

The surgical masks, bright lights and machines that buzz and beep are all hospital greetings that can easily put our nerves on edge. These medical visits are often unexpected, in environments that are unfamiliar, which adds stress to an already tense situation. For healthcare’s youngest patients, fear of the unknown can make a hospital visit feel like a monster under the bed.

This is where Detroit Medical Center, and the new Children’s Hospital of Michigan Troy (which opened their doors a little more than a year ago), decided to put comfort first. Through lean process improvement, staff, clinicians, designers and The Christman Company were able to formulate a better patient experience. One that included more parent time, fewer people transfers and efficient hospital processes.

Thankfully, lean wasn’t a new concept to the DMC system, as each of their locations employs lean practices to improve operations and satisfaction while reducing cost.

Building Lean
This pediatric hospital’s lean process got started based on feedback from parents on the Patient Advisory Council and directly from kids themselves. It showed that anxiety and stress increased at each patient hand-off. With more people handling the child’s care came more dread as “little one’s” moved from room to room and provider to provider, sometimes without mom and dad.

The Children’s Hospital of Michigan Troy set their priority at patient satisfaction. Achieving this goal through lean construction methods allowed exploration of other benefits, such as saving money and creating more efficient workflows for patients and staff alike.

Solutions to Reduce Time and Costs
The DMC team engaged in rigorous user immersion. Ideas were identified to create a single patient contact for those needing surgical services. Nurses would now manage reception activities, x-ray, weighing patients, transportation and more. By staying at a youngster’s side, they build trust and a sense of security. The hospital also decided to administer anesthesia in the induction room, allowing children to avoid the stress of consciously entering the OR.

To provide services in this manner, the construction and design team needed to formulate a solution that saved time on tasks, reduced distances walked by staff and lowered processing time. This came about by means of lean improvement techniques.

Several methods to measure baseline stats were employed, such as Swim Lanes, Leader Standard Work, Takt Time Charts and Value Added Analysis. These calculated time and/or distance for measuring nurse’s footsteps and often repetitive tasks. The goal was to find design solutions that relocated storage, reception and room-layout triggering better productivity. Nurses were able to dedicate more time to the patient once this was complete.

Another approach was the creation of “cardboard city” where entire floors were created with cardboard. Using a sporting arena, teams developed a full-scale model of patient rooms, hallways and reception areas. Users were able to “walk the halls” and enter patient exam rooms, operating rooms and every single ancillary space. They identified improvements and alternate design solutions that would have been much more costly to implement during construction in progress. Major efficiencies were gained by early relocation of storage cabinets, outlets and gas connections.

The Results
It’s clear that the patients are happier. Children and parents alike appreciate the reduced stress. This is highlighted in their lower ratio of patients who leave without being seen, which shrunk from four percent to less than one percent.

The modular/multi-functional rooms also helped the hospital see more patients, faster. Yet the Children’s Hospital of Michigan Troy has less total square footage than the original design identified, all thanks to a focus on cost savings through keeping the building lean.

Don’t Step Off the Gas
When asked what the biggest challenge was of implementing lean processes to a new facility, Ronald Henry, SVP and Chief Facilities Engineering and Construction Officer stated, “Keeping your foot on the gas.” He believes that while the changes improved patient satisfaction and work efficiency, human nature has a way of taking hold. If you lose your focus on the reasons you initiated a lean process, habits creep in that trigger working the “old way.”

To combat a return to the past the team holds daily huddles to discuss operations. Leaders also have active conversations with teams about the process for identifying lean strategies, and why they made their choices early in construction planning. By opening a dialog everyone becomes part of the solution.

Where to Begin?
To begin or amp up use of lean methods at your facility, start by focusing on processes that involve materials, time and money. By working with an architect, construction manager and internal team (even if they are unfamiliar with lean methods) on the front end, you will ultimately enjoy increased efficiency and higher patient satisfaction.

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To say that hospitals and healthcare facilities are at a critical crossroads would be an understatement. Current national debate puts healthcare reform, and the inevitable reimbursement changes, at the top of organizational agendas. So when facility renovations and new construction are the topic, construction management firms should be ready with innovative ideas and solutions.

Shared Experience
With a desire to enhance the understanding of our healthcare customers' outlook, respond knowledgeably to market conditions, and see the world of healthcare from the perspective of a facility's end users, we recruited an expert who experienced it for more than 30 years.

Jeff Gielniak is a licensed architect who developed his healthcare career overseeing real estate, master planning, programming and project delivery at a major Michigan Healthcare System. His facilities management spanned eight hospitals with more than 3,000 beds. He has experience with ambulatory, post-acute and support sites containing 13.5 million square feet and covering nearly 900 acres of property.

Healthcare Trifecta: A Great Investment
Jeff is bringing his talents to the forefront at a rapid pace.

• As a trained architect, he is providing insights into techniques, such as Lean Design, which meets organizational goals for speed and cost.

• His experience has immediate benefits from the angle of a construction manager, as he enables Christman to quickly understand and apply your priorities.

• But, most important, he lived the world of the “owner” and balances patient experience, business objectives and critical schedules into his Christman projects.

A Man with Purpose
Jeff’s passion for working in hospitals grew from the opportunity to watch “lives being saved.” There is a deep satisfaction in watching people become healthier, looking forward to their future. While the nature of healthcare has its uncertainty, more and more people benefit from new technologies and treatment options.

This is why Jeff is eager to continue advancing healthcare on an even broader scale at Christman. As a seasoned executive, with a knack for planning and organizing facility growth, Jeff hopes to guide design solutions and craft successful growth strategies for Christman and its healthcare customers. As Jeff puts it, “Being part of the Christman team provides a whole new aspect to the healthcare industry to explore with its own unique attributes that put all of the pieces together.”

As a man who takes pride in his work he is dedicated to earning your trust, improving your experience and keeping costs and schedules on target. Welcome to Christman, Jeff.

To contact Jeff about your project or simply wish him a warm welcome, email him at jeff.gielniak@christmanco.com.

Healthcare professionals are already familiar with Michigan’s 2007 Minimum Design Standards which set the stage for infection control requirements during major renovations or new construction. For facility planning, design and construction, the particular perils inherent on an occupied healthcare campus cannot be understated. These threats set in motion the infection control risk assessment (ICRA) process.

Planning Phase Determinations
The onsite construction team provides documentation on risk assessments and mitigations for each phase of the project project to reduce the risk of air and waterborne contaminants that could compromise patient safety. It is extremely important that this planning occurs ahead of the project.

Working in partnership with healthcare facilities across the state, Christman provides guidance on strategies that meet and exceed state requirements. We do this up-front, conscious of the ever present issues.

Key to Success
What makes a good ICRA plan? It is one that takes into account infection control, life safety, excessive noise/vibration and protection of patients. These factors can have a negative effect on patients and therefore reduce patient satisfaction.

The solution is bringing teams together. When healthcare professionals, construction managers and operational staff collaborate we create a comprehensive understanding of risks.

We’ve Done It
Healthcare demands are increasing along with population and regional growth. Facilities are responding with expansion plans and new construction.

One such project is in an emergency department which is adding exam and trauma rooms. The need for emergency services continues during construction. This made a strategic approach to ICRA essential to ongoing operations as vulnerable patients are delivered to an active construction site.

We use several techniques help maintain quality care:

• Daily checklists ensure tight adherence to safety measures. Weekly reviews add redundancy which allows continual modifications to the plans and look-ahead conversations.

• Negative air pressure monitoring through a “ball-in-the-wall” system allows continual measurements and visual alarm notifications.

• Hospital schedules get top priority.
  • Vibration threats are removed on days physicians schedule eye surgery.
  • Utility tie-ins and shut-down are planned weeks in advance and strictly managed.
  • Mechanical system shut-down and coordination includes heightened cooperation with facility managers.

• Patient access and flow is prioritized so construction materials, manpower and equipment access follows alternate routes to the worksite.

• Contaminant control is enhanced through tracking mats and readily available cleaning supplies at each entrance.
  
  
• Bold and clear patient signage provides security and separation from work areas.

Check It Out
Our dedication to supporting ICRA requirements extends to each project we manage. The images below show a few of our most recent examples. Working with a construction manager that values and prioritizes safety can directly translate to higher patient satisfaction scores and a safer, more productive work environment for your staff. 

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