Restoring Office-Based Surgical Facility Function Post-Hurricane Irma: Lessons Learned From Multiple Facilities.

Hurricane Irma made landfall in Southwest Florida on September 10, 2017, causing significant property damage, flooding, and power outages that lasted days to weeks during high heat and humidity. This created significant challenges for residents and businesses, as well as office-based surgical facilities in the area. Preparations in advance of hurricanes and other natural disasters for businesses should focus on staff, surroundings, space, systems, structure, and service. In the aftermath of a hurricane, assessment of the extent of the damage and the ability to perform restoration and mold remediation postflooding are the immediate goals. With the return of utility services, additional cleanup and assessment of equipment, medications, and sterile supplies with subsequent repair/recertification, replacement and reprocessing, as required, are necessary to bring operations back to normal.

A Study of Relationships Between Content in Documents From Health Service Operational Plans and Documents From the Planning of New Healthcare Environments.

AIM: The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans. BACKGROUND: Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment. METHOD: A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted. RESULTS: The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence. CONCLUSIONS: Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.

Planning Staff and Space Capacity Requirements during Wartime.

Determining staff and space requirements for military medical centers can be challenging. Changing patient populations change the caseload requirements. Deployment and assignment rotations change the experience and education of clinicians and support staff, thereby changing the caseload capacity of a facility. During wartime, planning becomes increasingly more complex. What will the patient mix and caseload volume be by location? What type of clinicians will be available and when? How many beds are needed at each facility to meet caseload demand and match clinician supply? As soon as these factors are known, operations are likely to change and planning factors quickly become inaccurate. Soon, more beds or staff are needed in certain locations to meet caseload demand while other locations retain underutilized staff, waiting for additional caseload fluctuations. This type of complexity challenges the best commanders. As in so many other industries, supply and demand principles apply to military health, but very little is stable about military health capacity planning. Planning analysts build complex statistical forecasting models to predict caseload based on historical patterns. These capacity planning techniques work best in stable repeatable processes where caseload and staffing resources remain constant over a long period of time. Variability must be simplified to predict complex operations. This is counterintuitive to the majority of capacity planners who believe more data drives better answers. When the best predictor of future needs is not historical patterns, traditional capacity planning does not work. Rather, simplified estimation techniques coupled with frequent calibration adjustments to account for environmental changes will create the most accurate and most useful capacity planning and management system. The method presented in this article outlines the capacity planning approach used to actively manage hospital staff and space during Operations Iraqi Freedom and Enduring Freedom.

Decentralizing the Team Station: Simulation before Reality as a Best-Practice Approach.

The purpose of this article is to share the logistical planning requirements and simulation experience of one Canadian hospital as it prepared its staff for the change from a centralized inpatient unit model to the decentralized design planned for its new community hospital. With the commitment and support of senior leadership, project management resources and clinical leads worked collaboratively to design a decentralized prototype in the form of a pod-style environment in the hospital's current setting. Critical success factors included engaging the right stakeholders, providing an opportunity to test new workflows and technology, creating a strong communication plan and building on lessons learned as subsequent pod prototypes are launched.

Health facilities humanisation: design guidelines supported by statistical evidence.

BACKGROUND: Healthcare building humanisation is currently a widely debated issue and the development of patient centered and evidence based design is growing worldwide. Many international health organizations and researchers understand the importance of Patient Centred Design and leading architects incorporate it into the design process. In Italy this design approach is still at an early stage. The article refers to research commissioned by the Italian Health Ministry and carried out by R. Del Nord (Università degli Studi di Firenze) and G. Peretti (Politecnico di Torino) with their collaborators. The scope of the research was the definition of design guidelines for healthcare facilities humanisation. METHOD: The methodology framework adopted is the well established need and performance approach in architectural design. The article deals with the results of statistical investigations for the definition and ranking of users' needs and the consistent expression of their requirements. The investigations were carried out with the cooperation of psychologists of the Università degli Studi di Torino and researchers of the Università degli Studi di Cagliari. The proposed evaluation system allows ranking of health facilities according to the level of humanisation achieved. RESULTS: The statistical investigation evidence collected allowed the definition of humanisation design guidelines for health-care facilities and for the assessment of their specific level of humanisation.

Addressing decisions about new hospitals' siting: a multidimensional evaluation approach.

BACKGROUND: Site selection for urban facilities is a crucial topic in planning decision processes for the several side effects they produce and the multiple criteria involved, especially for healthcare facilities. Nevertheless, the location problem has been ignored by most of the existing evaluation systems. METHODS: Starting from a deep literature review and the analysis of hospitals in 10 European cities, the paper proposes an evaluation system divided into four macro-areas (Functional quality, Location quality, Environmental quality, Economical aspects), each in turn composed by criteria and sub-criteria. RESULTS: The evaluation system has been applied for the site selection of "La Città della Salute" in Milan, Italy. Furthermore, the ShOS (Selection hospitals' Site) Evaluation Tool has been defined, with the aim of assessing the land suitability for new healthcare structures. CONCLUSION: The ShOS evaluation tool improves the transparency and robustness of the decision-making process and it could be broadly applied.

An approach to plan and evaluate the location of radiotherapy services and its application in the New South Wales, Australia.

This paper proposes an integrated modelling approach for location planning of radiotherapy treatment services based on cancer incidence and road network-based accessibility. Previous research efforts have established travel distance/time barriers as a key factor affecting access to cancer treatment services, as well as epidemiological studies have shown that cancer incidence rates vary with population demography. Our study is built on the evidence that the travel distances to treatment centres and demographic profiles of the accessible regions greatly influence the uptake of cancer radiotherapy (RT) services. An integrated service planning approach that combines spatially-explicit cancer incidence projections, and the placement of new RT services based on road network based accessibility measures have never been attempted. This research presents a novel approach for the location planning of RT services, and demonstrates its viability by modelling cancer incidence rates for different age-sex groups in New South Wales, Australia based on observed cancer incidence trends; and estimations of the road network-based access to current NSW treatment centres. Using three indices (General Efficiency, Service Availability and Equity), we show how the best location for a new RT centre may be chosen when there are multiple competing locations.

Health care facilities resilient to climate change impacts.

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator's guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change.

A conceptual model for healthcare facility design.

A conceptual model for healthcare facility design provides nurse leaders a framework for measuring the effect of specific or more global design features on patient, provider, and organizational outcomes. The model can help to explain relationships among variables of interest in facility design and be used to guide research studies or measures of change or improvement.

Health systems engineering as an improvement strategy: a case example using location-allocation modeling.

Finding the optimal geographic location for a medical service is a common challenge for healthcare organizations. However, there is limited use or description of methods to determine the optimal location of a medical service. We describe a case study of how location-allocation techniques used by industrial engineers assisted a regional healthcare network develop a plan for optimal location of sleep medicine services within its network.

How to move a psychiatric facility.

A special challenge for the transition of Menninger/Kansas to Menninger/Texas was the preparation of suitable facilities for the relocated operations in Houston. The vice president of Facilities & Property Management recounts the tasks that were his responsibility and the process he went through to assure a successful move not only to Houston, but also within Houston planning for two major moves in less than a decade, an unprecedented challenge.

Finding evidence to support facility design decisions.

Nearly $200 billion of healthcare construction is expected by the year 2015, and nurse leaders must expand their knowledge and capabilities in healthcare design. The goal of this bimonthly department is to prepare the nurse leader in using the evidence-based design process to ensure that new, expanded, and renovated hospitals facilitate optimal patient outcomes, enhance the work environment for healthcare providers, and improve organizational performance. In this article, the author provides nurse leaders with examples of where to find data to guide decisions about the efficacy of specific design features in achieving desired outcomes.

Health facilities planning: determining infrastructure requirements for form and function from clinical and operational capabilities.

This article describes the practical application of documenting the operational concept and scope of services for military combat hospitals providing joint health service support during Operation Iraqi Freedom. Due to the rapid changes that take place in healthcare in general, and, in particular, in a large, rapidly maturing military theater of operations, a clear operational concept and accurate scope of services is essential for hospital commanders and medical planners. A highly structured, yet flexible collaborative approach to health facility requirements development begins with a clinical concept of operations (CONOPS). Initial, up-front investment of time in the requirements process, and subsequent reviews and revisions result in a definitive description of the clinical and operational requirements. Those requirements in turn become the authoritative source for space, building systems, equipment, functional arrangements, and financial justification. A recent case study highlights the utility of the CONOPS document in translating the necessary clinical capabilities and capacities into facility space and building systems required to support them in a very tight schedule driven process normally not associated with the military construction program and in particular medical projects.

Controlled chaos: managing your access control system for future success.

How a medical center's protective services department is keeping pace with and planning for future changes in the face of unprecedented rapid growth.

Design and ergonomic considerations for the filmless environment.

Planning and executing the redesign of a traditional institutional radiology reading room to conform to the radically different requirements of digital imaging are reviewed, with examples drawn from the authors' experience and from the growing body of literature on this subject. Included are best-practice recommendations and real-life examples on initial design and planning, stakeholder involvement, identifying and hiring consultants, architectural planning, the designation of a radiology point person, rethinking room and workstation design, the selection of ergonomic furniture and fittings, identifying optimal environmental elements, fine tuning and lessons learned, and going digital.

Using data to make decisions and drive results: a LEAN implementation strategy.

During the process of facility planning, Fairview Laboratory Services utilized LEAN manufacturing to maximize efficiency, simplify processes, and improve laboratory support of patient care services. By incorporating the LEAN program's concepts in our pilot program, we were able to reduce turnaround time by 50%, improve productivity by greater than 40%, reduce costs by 31%, save more than 440 square feet of space, standardize work practices, reduce errors and error potential, continuously measure performance, eliminate excess unused inventory and visual noise, and cross-train 100% of staff in the core laboratory. In addition, we trained a core team of people that is available to coordinate future LEAN projects in the laboratory and other areas of the organization.