24 30 bom 0414 coverstory

24

buildingoperatingmanagement APRIL 2014

COVER STORY

through a

Patient’s

EYES New York-Presbyterian Hospital upgrades facility appearance to improve patient experience by sue pi and john d’angelo

W

At New York-Presbyterian, top management supported investments to refurbish areas like patient exam/procedure rooms.

e’ve all done the same thing; we judge a place from the moment we lay eyes on it. Before a service experience even begins, we usually have already decided whether we will be returning to the establishment. As simple as it sounds, understanding the connection between the physical appearance of a facility and patient satisfaction can have a lasting impact on both a hospital’s performance and its ability to provide exceptional community health.

Given the financial resources, most hospital leaders would redo their entrances to create a unique and magnificent first impression.

In fact, so much attention is paid to making the first impression “unique” and “magnificent” that hospital lead-

ers miss the opportunity to create an outstanding lasting impression. Patients spend less than one percent of their hospital time in the lobby, and yet hospitals seem to spend a large percentage of their leadership focus and financial resources there. Spending just a little bit less of both on the lobby will allow an increase in leadership focus and financial support to the other areas where patients spend 99 percent of their time: inpatient rooms, operating rooms, outpatient clinics, exam/procedure rooms, and support areas. In addition, other non-clinical areas like public circulation, elevator banks, check-in and reception counters, and administrative areas contribute to the patient’s perception.

26

buildingoperatingmanagement APRIL 2014

buildingoperatingmanagement APRIL 2014

process provides efficient facilities maintenance mapping.

The assessment process leads to a prioritized work plan for execution of the program by a well-trained, skilled in-house facilities operations workforce. The FACE team tracks the program’s labor and material expenses, which include outside contractors to supplement the in-house workforce.

Specific research was conducted to improve procurement strategies to obtain a higher level of goods and services at competitive bid prices and to ensure a more cost-efficient operation. The process not only provides cost efficient facilities maintenance mapping, but also delivers data for monitoring of space performance, including durability and performance of materials, fixtures, and furniture, to identify opportunities to improve the life cycle and efficiency of New York-Presbyterian’s capital interior assets.

Making the Business Case A new acoustical suspended ceiling system and new LED light fixtures were among the changes that transformed the main public circulation corridor at the Presbyterian Hospital Building at New York-Presbyterian/Columbia University Medical Center.

Top-tier hospitals understand that first impressions set the stage for outstanding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, but the real challenge is to carry those patient experience victories throughout the rest of the stay. For example, a dirty bathroom, scarred and chipped furnishings, and dirty ceiling tiles not only send the message that the hospital cares merely about the front door, but also present infection control risks. Many hospitals don’t know how to address these issues because without true owners, no one prioritizes the funding necessary to correct these problems. At New York Presbyterian, the “FACE” program was designed to proactively improve the interior environment enterprise-wide.

FACE stands for facilities aesthetic condition enhancement. Unlike typical facilities operations programs that maintain a state of good repair, this capital program upgrades an area’s aesthetic appearance in conjunction with preventive maintenance and corrective repairs. FACE methodically bridges the

gap between behind-the-wall infrastructure improvements and the visible environment. The purpose is to restore facilities to the current New York-Presbyterian standard, at a minimum, and establish a uniform appearance for each facility in the system. The program supports excellence in healthcare delivery by ensuring that New York-Presbyterian facilities present the best possible image to patients, visitors, and employees. The program addresses all direct patient impact areas as a first priority, and all employee areas as a second priority, within a four-year cycle of renewal.

The interior renewal process begins with a room-by-room, space-by-space survey and assessment to identify all interior elements requiring attention including: paint, flooring, ceiling, lighting, furniture, cabinetry, wall protection, plumbing fixtures, shower liners, cubicle curtains, and window treatments.

Spatial data is used in prioritizing the scope of work for each interior space.

In combination with New York-Presbyterian’s computerized architectural drawing database, the software-based

The business case for FACE is based on two things: patient experience and employee engagement. With Medicare reimbursements increasingly tied to patient satisfaction, the appearance of a facility is a bottom line issue more than ever. No matter how much a hospital staff cleans a room with dingy finishes and old paint, it will not feel clean to many patients. Refurbishing spaces can improve patient experience and therefore HCAHPS scores. The program improves the patient and family experience by providing a cleaner, up-todate, code-compliant, and aesthetically pleasing environment during their stay at the hospital.

Employee engagement is the other pillar of the business case for FACE. In matters related to patient care, it’s obvious that healthcare employees should not take shortcuts. The same holds for areas not directly related to patient care. One reason that’s true is that engagement tends to carry over from one aspect of a job to another. By ensuring that spaces are attractive, FACE encourages employees to take ownership of the appearance of a facility, which reinforces their ownership in matters related to patient care.

Priorities for FACE are set by a committee made up of senior administrators at the six New York-Presbyterian hospitals plus the vice president of facilities

Follow the Path of Patient Experience

M

any factors are in play when it comes to creating a good impression on patients — including many aspects of the facility. There is the lobby, of course, but before that, there is the neighborhood surrounding the hospital, the boundary of the hospital campus, the wayfinding, the parking or valet experience, and the accuracy of the pre-visit directions. All are important parts of the initial impression.

For urban hospitals, there is not a lot that can be done about the surrounding neighborhood. If that neighborhood is viewed as unsafe, it can affect the patient’s selection of their healthcare facility. At a minimum, these hospitals can create an oasis of safety and a clear line of demarcation for patients entering their campus.

Each circumstance is different but establishing campus boundaries with green space and focused lighting instead of fences and barbed wire can reinforce how safe the hospital is as opposed to reinforcing how unsafe the surrounding neighborhood may be. These hospitals can work with their host communities through clinical outreach, planning, and zoning, and they can focus their real estate strategy on creating a safe corridor to their entrance.

A patient’s or visitor’s first impression of a hospital starts before they come in the front door. Safety and parking are essential to a positive experience.

Patients need to be clearly told what building they will report to, where to park, how best to approach the campus from their neighborhood, and who they can call for additional help. Arriving patients are often anxious. In the digital age there is an app for that. New York-Presbyterian has launched the “FindNYP” app, a mobile guide to the main campuses. The app provides locations and directions to inpatient units, the emergency department, waiting rooms, and other services, as well as restrooms, elevators, places to eat, and more.

Even with the app, clear signage and graphics are essential.

Directional and building signage should have the same names as the pre-visit communications — imagine the confusion for a new visitor when their appointment card says to park in “Garage A,” but the campus signage points it out as “7th Avenue Garage” and the hospital employees know it as the “East Garage.”

Hospital leaders should approach the campus as would a patient, both by car and public transportation, to ensure what they see exactly matches what is given in the pre-visit communication.

For most patients, the parking attendant is the first and the last person that they will meet at the hospital. Of all of the caregivers they encounter, this is the one that sets the initial impression upon arrival and locks in the final impression upon departure. Engaged employees are good, but employees that engage the patients and visitors are better. Unfortunately this is an area of the hospital that few leaders visit as they often do not understand how important it is to patient experience. Worse yet, many leaders seek to automate their parking experience. No matter how efficient automation may be, it is rarely welcoming.

Pay attention to the route patients follow from the parking garage to the lobby. Patient safety and patient experience are directly pro-

portional — an increase in one improves the other. Ensure that it feels safe at all times of the day and night, that the signage is correct, that it offers places to rest. Reinforce the oasis of safety through appropriate lighting levels and visible security presence when applicable. Provide cover from exposure to weather when and where appropriate and pay careful attention to trip hazards and chokepoints.

Sidewalks should be at least wide enough to allow two wheelchairs to pass even if wheelchairs aren’t normally allowed to follow that route — someone will find a way. Any encroachment into the sidewalk by plantings should be addressed; pedestrians should not feel like they have to walk in the street or even too close to the street. The path should be as level as the terrain will permit and any potholes, uplifting, or cracks should be addressed immediately as they can have negative impacts on patients with walkers.

Upon arriving in the lobby, the first thing every patient and visitor should see is a smile. Too many hospitals spend millions of dollars on their lobby during initial construction and not enough on their lobby staffing or maintenance. A warm smile in a clean and inviting space will be remembered longer and more fondly than marble finishes.

This is also the point where most patients start to notice inconsistencies in the hospital’s message. Wayfinding often takes a back seat to the lobby decorations, surfaces chosen for architectural appeal are often hardest to maintain or the easiest to become root causes for slips, and very little thought is often given to how surfaces perform in different seasons.

Although most patients and visitors pass straight through the lobby, ensure sufficient thought goes into the comfort of any that may have to spend time there waiting on their transportation or as a getaway for visitors who need a place they can refresh and recharge apart from their sick loved ones. Having retail space adjacent to the lobby is important if these services are not offered within walking distance of the hospital, and these spaces provide a distraction to those that need it. Above all, have a central focus of the lobby be an information desk where patients and visitors can get help in finding their destination.

— Sue Pi and John D’Angelo

Facility managers should be familiar with the route patients will take if they arrive by public transportation, to ensure that directions to the hospital are clear.

27

28

buildingoperatingmanagement APRIL 2014

buildingoperatingmanagement APRIL 2014

operations. The program reports to the real estate board of the New York-Presbyterian board of directors; there are quarterly meetings to report progress, and the senior administrators and vice president of facilities are at the meetings.

Key Considerations

As part of the New York-Presbyterian FACE program to refurbish interior spaces, custom casework and multifunctional patient/clinician LED lighting fixtures were installed in patient rooms at Weill Cornell Medical Center.

Implementing an interior appearance enhancement program should be coordinated with a specific interior guideline — a design standard for interior finishes, fixtures, and furniture. These guidelines can be structurally packaged and duplicated as a renovation formula that incorporates interior finishes, temperature comfort, proper acoustics, indoor air quality, furniture ergonomics, technology, life safety, ADA accessibility, energy efficiency, environmental safety, and maintainability. The standardized image, function, and performance guidelines provide benefits beyond renewal: Guidelines ensure that any major renovation contributes to the hospital’s branding goal and provides spaces conducive to improving healthcare services

Program Implementation

29

FACE Program: Anticipated 4-Year Cycle of Renewal » Fully utilized software assessment tool » Completed the hiring and training of workforce » Accomplished 60 percent of eligible patient room refurbishment. (Target was 70 percent; 10 percent

postponed due to scope change) » Continued implementation of interior guidelines » Executed 2011 high priority special projects » Upgraded furniture

2012

» Accomplished 75 percent of eligible patient room refurbishment. (Target was 80 percent; 5 percent postponed due to high patient census)

» Begin refurbishment of other patient support areas » Execute 2012 high priority special projects » Re-assess patient rooms only

2013

» Accomplished 100 percent of eligible patient room refurbishment » Accomplished 50 percent of other eligible patient support area refurbishment (target: 50 percent)

» Begin refurbishment of administrative areas » Execute 2013 high priority special projects » Re-assess all facilities

2014

» Anticipate 100 percent completion of all remaining areas of hospital refurbishment » Execute 2014 high priority special projects

» Re-assess patient rooms only » Prepare FACE program cycle no. 2

2011 YEAR 1

YEAR 2

YEAR 3

YEAR 4

2015 Cycle 2 Year 1

» Future program planning » Patient room refurbishment cycle no. 2 starts

The hydrostatic-drive Bobcat® 3650, with its front-mounted, PTOdriven attachment capability, gives you a fast and powerful option for mowing, sweeping, clearing snow and much more. Step inside an air-conditioned, heated cab and comfortably do tough jobs all year.

Text UTV6 to 24587 for an online video that shows how versatile Bobcat utility vehicles can be.

Standard message and data rates apply. Bobcat will not share your mobile number. To unsubscribe at any time, text STOP to 24587.

Bobcat.com/mowtosnow6 1.877.745.7813 Bobcat ® and the Bobcat logo are registered trademarks of Bobcat Company in the United States and various other countries. ©2014 Bobcat Company. All Rights Reserved. | 1257C-0

30

buildingoperatingmanagement APRIL 2014

while at the same time dealing with the existing constraints of the buildings.

The optimal design and build templates should provide guidance for the design and construction of both new and existing buildings.

The ultimate goal is to unify new and existing facilities while offering environmental and social elements that benefit not only the building occupants, but also the general public and surrounding community. The interior enhancement

to keep the patient experience positive, a strong “last impression” is also part of the equation. The entire patient travel path should appear well-kept and professional, and all furnishings should be aesthetically compatible. Patients will think more highly of facilities if these positives are in place. The reality is that the majority of healthcare facilities have to deal with aging facilities that are near the end of their life cycles. Refurbishing these outdated and stressed interior en-

The physical environment can have a substantial impact on the well-being of patients. An effective healthcare facilities improvement plan is necessary to offer the healthiest environment. implementation strategy is to work in collaboration with other network-wide departments and programs in order to ensure the optimal patient care process with comfort, accessibility, and legibility of signage.

Clearly, building from the ground up with advanced technology, high-end finishes, vast open spaces, and high-ceiling lobbies is the most effective way to achieve a strong first impression. However, to make that impression last, and

vironments requires work to provide a visually pleasing space, and durable materials to extend much needed wear and tear to meet today’s economic climate.

Evidence-based-design research demonstrates that the physical environment can have a substantial impact on the performance of the caregiver and the wellbeing of the patient. To maximize the impact, an effective healthcare facilities improvement plan is essential. The underlying goal of all healthcare business

The upgrade to this operating room in the Greenberg Pavilion at the New YorkPresbyterian Weill Cornell Medical Center included installation of anti-fatigue rubber sheet flooring.

practice is to ensure benefit to both the patient service mission and the strategic goals of the network or enterprise. Focus and discipline are required to initiate the refurbishment program, with recalibration and continuous improvement following a structured execution methodology. However, the needs of the environment of care and patient population will not remain static as new initiatives are rolled out. Flexibility and refinement are just as important, but there must be balance — an organization must first establish a baseline and then move forward in achievable incremental phases.

The FACE program has taught valuable lessons. Actual experience is used in future planning and implementation for a more efficient delivery of a superior healing environment. This type of renewal provides measurable results that help New York-Presbyterian Hospital to remain among the top academic medical centers in the nation.

A well maintained and attractive facility improves the hospital’s overall quality while establishing branding among all campuses and buildings. It attracts not only patients, but also top-rated medical providers and strengthens employee morale. When combined with other factors as important and personal to medical care seekers such as staff friendliness, facility image and cleanliness, it will greatly influence whether the patients and caregivers choose your facilities as “their hospital.” ■ Sue Pi, LEED AP, is the interior infrastructure program leader for facilities operations at New York-Presbyterian Hospital. She is responsible for leading, planning, and executing FACE, the facilities aesthetic condition enhancement program.

John D’Angelo, PE, CHFM, CHEP, is the vice president of facilities operations at New York-Presbyterian Hospital. He is responsible for maintaining safe and compliant facilities and infrastructure across all campuses and overseeing business operations, energy policies, strategic engineering planning, and regulatory compliance. He also has an integral role in the implementation of the eight-year capital plan.

Email comments and questions to edward.sullivan@tradepress.com.