Reimagining the NICU: a human-centered design approach to healthcare innovation.

Design charettes have been utilized in architectural and design practice to generate innovative ideas. The Reimagining Workshop is a version that combines practical and blue-sky thinking to improve healthcare facility design. The workshop engages diverse stakeholders who follow a human-centered design framework. The Reimagining the Neonatal Intensive Care Unit workshop sought to generate ideas for the future, optimal NICU without specific site or client constraints. Key themes include family-centered care, technology-enabled care, neighborhood and village design and investing in the care team. Recommendations include a supportive physical environment, celebrating milestones, complementary and alternative medicine, enhancing the transition of care, aiding the transition period, and leveraging technology. The workshop showcased the potential for transformative change in NICU design and provided a roadmap for future advancements. These findings can inform regulatory standards for NICU design and drive improvements in family-centered care, patient experiences, and outcomes within the NICU environment.

Reimagining Workshops.

Design charettes have been a mainstay in architectural and design practice. Although they are relatively common, research studies on their effectiveness and methods are rare. Recently, an approach has been introduced in the format of Reimagining Workshops (RWs), a charette characterized by both practical and blue-sky thinking, training in empathy, and multi-stakeholder input. In spring of 2021, two RWs were held to explore ideal neonatal intensive care environments. The RWs were born out of a desire to provide a source of information for the Facility Guidelines Institute Guidelines. To date, there have been four RWs: Reimagining the ED, Reimagining Childbirth Facilities, Reimagining Critical Care, and Reimagining the NICU (virtual). This experience enables participants to operate outside of their comfort zone, an important step toward achieving innovation. They are unique in the following ways: (1) the assignments are broad, (2) participants are encouraged to think radically, (3) there are no constraints, (4) participants receive empathy training, and (5) multiple facilities and stakeholders are brought together rather than focusing on a single facility. This article describes the history of design charettes, the history of the RWs, the methodology associated with RWs, and the specific findings from the NICU and the other workshop events.

A partnership model of early intervention in psychosis programme--a Canadian experience.

AIM: To describe how a new partnership model of early intervention in psychosis, early intervention in psychosis (EIP) programme delivery in Canada attracted the interest of the community and acquired government funding. METHODS: The process by which a few individuals used a conceptual framework of integrated, collaborative, flexible and recovery focused principles to engage community partners and attract government funding is described. RESULTS: The establishment of a small EIP programme and its expansion to a regional programme serving an area of 20,000 square kilometers and a population of approximately 500,000 people were achieved. A programme specific logic prototype was developed. A synergy of public, private and academic services emerged with an infrastructure for ongoing cohesiveness and productivity. Annual clinic visits increased from 641 in 2002 to 1904 in 2007 and annual new patients enrollments grew from 46 to 128 within the same period. Staffing grew from an interdisciplinary staff of 1.5 full-time equivalent (FTE) to the current 10.0 FTE. CONCLUSIONS: A carefully orchestrated programme organization that is inclusive rather than exclusive can produce a balance of evidence-based best practices in client focused service, community mental health integration and academic productivity.

Relationship between assault frequency and length of hospitalization in older patients with dementia--determining the maximum benefit of inpatient treatment.

In this quantitative study, the author examined the relationship between duration of hospitalization and frequency of assaultive behavior in 42 older long-term patients with dementia in a Canadian psychiatric hospital. The study instrument used for data collection was existing incident reporting forms routinely completed in Canadian regional psychiatric hospitals. A secondary analysis was conducted using data previously collected on a regular basis by the psychiatric hospital serving as the study site. A significant negative correlation was found between the number of assaults committed and the number of months spent in the hospital, with significantly fewer assaults occurring in the second year of hospitalization compared with the first year. Male patients were observed to be significantly more assaultive than female patients. Findings suggest that the maximum benefit for patients hospitalized for assaultive behavior is obtained during the first 2 years of inpatient treatment and that patients within this population who are no longer assaultive may be more appropriately cared for in nursing homes. Based on these findings, resources should be allocated to assist with the transition of formerly assaultive patients with dementia from a psychiatric hospital to a nursing home. This scenario forecasts the development of a challenging new role for nurses.

Decreasing assault occurrence on a psychogeriatric ward: an agitation management model.

An agitation management model providing staff education, quantitative assessment of agitation, and emphasized psychosocial interventions was introduced on a geriatric psychiatry ward for male patients. A within-subjects comparison was made of Cohen-Mansfield Agitation Inventory (CMAI) scores and frequency of committing assault under pre- and post-intervention conditions. Among participants (N = 8) who finished the 72-week study, CMAI scores did not differ significantly under either of the study conditions (p > .05, two-tailed t test). Twenty-nine assaults occurred during the pre-intervention time period and six assaults occurred during the post-intervention time period. According to analysis with the Wilcoxon signed ranks test, the distribution of assaults differed significantly between the two time periods (p < .05, two-tailed). Among individuals who were excluded from the intervention because of lack of consent, assaults increased over the same two time periods. Psychosocial interventions intended to reduce agitation among elderly men with dementia may not necessarily serve to decrease agitation, but may serve to decrease assault occurrence.