CASE STUDIES
SEATTLE CHILDREN’S HOSPITAL
LYNN MARTIN MD, MBA
MARK GESINGER LEED AP BD+C
n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f
e T d n a
g n i t s
UCLA OUTPATIENT SURGERY AND ONCOLOGY CENTER
n e C
MICHAEL FOLONIS FAIA
CARA TUBBS
r te
ANII
INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019
EVOLVING CARE: Facilities as a Force for Positive Change at Seattle Children’s Hospital
Speakers
Lynn Martin MD, MBA
Mark Gesinger LEED AP, BD+C
Medical Director, Continuous Improvement and Innovation Seattle Children’s
Principal ZGF Architects LLP
I. Foundation Bellevue Clinic & Surgery Center Location: Bellevue, Washington Size: 80,000 SF Completion: 2010 Architecture firm: NBBJ
I. Foundation Guiding Principles • Focus on patients and families first – simple, safe, and intuitive • Promote continuous flow for patients and staff (one way in/out) • Create line of sight and visual management • Avoid monuments (flexibility) • Standardization is the foundation of improvement • Maximize natural light • Appeal to all ages (0-21) • Relate to Seattle campus • Be able to replicate at future sites
I. Foundation Integrated Facility Design Adaptation Toyota 3P (Planning, Production, Process) • Shorter development time • Lower start up costs
Multidisciplinary Teams • Architects • Engineers • Clinicians
Sequential Design Process • Project management and governance • Conceptional (Macro) Design (size and key adjacencies) & Mock-ups • Functional (Micro) Design (room details) & Mock-ups • Detail (Operational) Design
I. Foundation – Flow of Patient and Supplies Staff Support Off-Stage Corridor
PACU/Recovery O.R.
Arrival/On-Stage
Prep/Induction
Design Innovation: Generation 1.0 Two Induction Rooms per OR
I. Foundation Outcomes • Seamless new clinical service introduction • Satisfying experience for patients & families (best in the system) • Pleasant and supportive work environment for faculty and staff • Efficient, low-cost ambulatory surgical services • Doubled OR and surgeon productivity • $30M cost avoidance using this process (building size reduction; contingency savings)
II. Evolution: Seattle Children’s Building Care Building Care
Location: Seattle, Washington Size: 310,000 SF Completion: 2022 Architecture firm: ZGF Architects
New Front Door to Campus
II. Evolution: Seattle Children’s Building Care Master Plan Future Campus Build-Outs
Lower Acuity, Specialty, Outpatient
Higher Acuity, Complex, Inpatient
OCEAN GARAGE ASC CLINICAL CENTERS OF EXCELLENCE
NE 45 TH
FOREST Phase 2 D+T
FOREST Phase 1 BEDS
‘Building Care’ PENNY DRIVE
PENNY GARAGE
PENNY ADMIN
STR EET
FOREST GARAGE
FOREST Phase 3 BEDS
NE TH V E 40 A
II. Evolution: Seattle Children’s Building Care Guiding Principles • Innovation is required, comes from anywhere, is iterative, collaborative, disruptive, and essential to change • Optimizing processes and designing right-sized space and capacity to support patient care deliver and employee wellness reduces waste and allows flexibility • Collaboration and co-location of interdisciplinary teams drives better problem solving, communication, consistency, accountability • Standardizing of work processes allows for innovation • Value stream thinking is required for meeting our customer needs effectively • All team members play a role in providing the best patient care • A concurrent care model in a single, continuous flow by the right people in the right place provides the most effective care
II. Evolution: Seattle Children’s Building Care Cross-Functional Representation • Care team • Patient and family • Professional services • Support services • Infection Control • Information Technology, Telemedicine, Epic • Education Communication, Events and Foundation • Facilities • Contractor and trade partners • Consultants • Quality Management/Process Improvement
II. Evolution: Seattle Children’s Building Care Surgery Floor Plan
Arrival / On-Stage
External Setup PACU / Recovery
Operating Room Induction
Staff Support
To ICU
II. Design Iteration: Induction Room 1.1 Camouflaged Induction Room
II. Design Innovation 2.0 – External Set-up Room Induction 1 External Setup
OR #1 Induction 2
OR #2 Clean Core
Scrub Sink Bed Alcove
From Sterile Process
II. Design Innovation: Inspiration • Glass for Daylight and Transparent Process • Standardized Instrument Display • Hands Free Doors, Interlock with OR • No Excess Clutter • One Setup Room / two ORs: Larger, Uninterrupted Space
II. Design Innovation: Inspiration Advantages of External Setup • Faster turnover between cases • Augmentation of patient capacity • Set up of tables without interruption or disruption by creating a calm place to concentrate (thus fewer errors) • No unnecessary door openings or staff traffic while setting up (lower risk of contamination) • Ideal environment to train OR staff for setup
II. Design Innovation: Inspiration (OR Zones) Clemson Research: OR of the Future
Building Care Induction AZ
SZ
Photo: Clemson A+H
Back Tables
OR 2
OR 1 CZ
Nurse / CZ
Clean Care
AZ
II. Design Innovation: Set-Up Visualization
Demonstration of efficiency of external set-up process
II. Design Innovation: Visualization SCH Building Care Operating Room Features • “Camouflaged” induction rooms • Parents remain with children until they are asleep • Reduce patient stress and has the potential to improve patient outcomes • Designed with external instrument setup space • Enhanced throughput
Challenges • Regulatory environment • DOH engagement • New Staffing Model (roles and responsibilities changed dedicated set-up tech vs alternating surgical tech) • Provider and Staff buy-in/trust is key
Summary of Key Points Lessons Learned • Facility design is an ‘obligatory’ opportunity to improve the care model • Care processes and care model must evolve and be aligned with new building design • Architects and clinicians need to work side by side to design the space and care model concurrently • Bring the voice of the external customer (patients, families) and internal customer (care team, administrators) to the process • When contemplating innovations to your care model, stay cognizant of culture, change management implications, and regulatory stakeholder concerns
Images of Ors from Lynn
Q&A
Innovations in Surgical Environments
UCLA Outpatient Surgery Center Santa Monica, California
UCLA Santa Monica Surgery Center
1223 16th Street, Santa Monica,
Cara Tubbs, ANII, MS, BS, RN
Santa Monica, CA 90404 folonisarchitects.com
Service-Disabled Veteran-Owned Small Business (SDVOSB) Disabled Veteran Business Enterprise (DVBE)
Michael Folonis, FAIA
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
DRIVERS & OBJECTIVES
UCLA Outpatient Surgery Center
Michael W. Folonis, FAIA
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
ORGANIZATION & BUILDING LAYOUT
UCLA Outpatient Surgery Center
Michael W. Folonis, FAIA
FIRST FLOOR PLAN Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
SECOND FLOOR PLAN Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
THIRD FLOOR PLAN Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
PATIENT POPULATION & PLANNING CONSIDERATIONS UCLA Outpatient Surgery Center
Cara Tubbs, ANII, MS, BS, RN
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
KEY DESIGN FEATURES
UCLA Outpatient Surgery Center
Michael W. Folonis, FAIA
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
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Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
20 FT.
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects
OUTCOMES, LESSONS LEARNED & NEXT STEPS UCLA Outpatient Surgery Center
Cara Tubbs, ANII, MS, BS, RN
Cara Tubbs, ANII, MS, BS, RN
UCLA Santa Monica Surgery Center
Michael W. Folonis, FAIA Michael W. Folonis Architects