Richmond Community Health Access Center (CHAC) Integrated Facility - - PowerPoint PPT Presentation

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Richmond Community Health Access Center (CHAC) Integrated Facility - - PowerPoint PPT Presentation

Oct 18, 2023 483 likes •834 views

Richmond Community Health Access Center (CHAC) Integrated Facility Design Functional Design Event January 15 19, 2018 Date / time Activities Monday Morning Review process & outcome of the week Mini Lean Education

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SLIDE 1

Richmond Community Health Access Center (CHAC)

Integrated Facility Design Functional Design Event January 15 – 19, 2018

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SLIDE 2

Date / time Activities Monday Morning

  • Review process & outcome of the week
  • Mini Lean Education
  • Review guiding principles / decision to date
  • Map 7 flows on proposed floor plan (baseline)
  • Assess and adjust the floor plan

Monday afternoon

  • Elder Roberta blessing
  • Test scenarios in mock up and adjust the design
  • Detail design for selected rooms (if time permits)
  • Physician tour at 5pm

Tuesday morning

  • Plan the tour (develop survey questionnaire and planning)
  • Review functional program (leaders only)

Tuesday afternoon

  • Guest tour
  • Review comments from the tour guests
  • Assess and adjust the design
  • Physician tour at 5pm

Wednesday morning

  • Physician tour at 7:30 am
  • Continue the design adjustments
  • Detailed design for selected staff area (if time permits)
  • Prep for the report out

Wednesday afternoon

  • Report out
  • Document the design / functional program
  • Demolish clinical area / build staff area

Thursday

  • Test scenarios for staff area
  • Assess and adjust 3D
  • Plan and prep for the tour

Friday

  • Guest tour
  • Review comments from the tour guests
  • Assess and Adjust layout
  • Document the design and functional narrative (functional program)
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SLIDE 3

Introduction

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SLIDE 4

Opening and Welcoming Jennifer MacKenzie Chief Operating Officer

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SLIDE 5

Outcomes of the Week

  • Confirmed physical layout of the 3rd

floor

  • Continue to develop functional

narrative (Functional Program)

  • Complete the detailed design for

selected rooms

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SLIDE 6

Integrated Facility Design (IFD) Components & Timelines

Work Design Process & Leader Standard Work Daily Accountability Visual Management Plan for Move In Move in

6

  • 3. Delivery & Implementation Stage

Project Management & Governance Conceptual Design Functional Design Detailed Design

Sept ‘17 – Dec ‘17 Jan ‘18

  • 2. Design & Development Stage

Jul ’17 – Aug ‘17

Orientation & Acclimation Analysis & Evaluation Planning/ Resourcing

  • 1. Evaluation & Planning Stage

Jul ’17 – Sept ‘17 Jul ‘17 Jul ’17 – Sept ‘17 Fall ‘18

Future Service model discussion Future Service model discussion

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SLIDE 7

Lean Education

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SLIDE 8

Methods

  • Waste elimination
  • Standardization
  • Scientific Problem

Solving (A3, STP, Correction Action, PDSA)

What Is Lean / Lean Principles?

Mindset of Continuous Improvement (Focus on maximizing what is of value to the client / patient) Management System

  • Engaging
  • Empowering
  • Aligning all

improvements

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SLIDE 9

Mindset

  • Relentlessly pursue improvements to increase patient/client value
  • Simultaneously improve quality and cost

wastes

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SLIDE 10

8 Types of waste

Any activity that uses resources but creates no value Defects – error in paperwork, product quality or delivery Overproduction – producing more or sooner than customer needs Waiting – long periods of inactivity: people, information, machinery, or material Non-utilized staff – intellectual waste Transportation – Excessive movement of people, information or material Inventory – Excessive storage and delay of information or products Motion – Search for patient charts or supplies Extra processing – Re-tests or re-exams

The most dangerous kind of waste is the waste we do not recognize

Shigeo Shingo

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SLIDE 11

Process Complexity

Pick up mail Open & date stamp Triage
  • Type 1 contact
  • Detox
  • Children
  • Symptomatic
X-ray Report? Request abnormal X-ray report All documents received Yes No Hold unmatched Enter Radiology report No Yes X-ray or CD? X-ray Check CD
  • name
  • report
CD Onsite or Offsite Pull previous record Request offsite record Enter into iPHIS Check iPHIS for previous record X-ray or CD? Radiologist Review X-ray Review by Dr. Elwood Yes No Yes Normal / Abnormal File X-ray 939 & Normal report 939 939 & abnormal X-ray Normal Abnormal CD Batch CDs, read in Reading room Normal / Abnornal Dictation Check “No Evidence” Box Normal Abnormal Separate Field Ops & Vancouver X-rays File copy return Normal / Abnormal 939 & Tape Transcribe into iPHIS Enter “No Evidence” into iPHIS Normal Abnormal Dictated 939s Send Referral in iPHIS Generate Validation Sheet Enter treatment required into iPHIS Outbox to Pharmacy Enter end date into iPHIS Send pick & yellow copies to Health Units Outstanding referrals iPHIS Previous Files? Request Discharge Summary Proof narratives Discard extra copies Create small envelop & withdraw card File 939 Validate printed report Upd? Update iPHIS report Print narratives Yes Print upd report Separate
  • health units
  • physicians
Pre-addressed, pre-stamped envelop  Mail Withdraw envelop & mail CD Match CD & 939 To VGH for Radiology Radiologist review Date stamp upon arrival Enter Radiology report into iPHIS To Dr. Elwood for review More dictations? File CD File 939 Initial comments No Yes Incoming mail Complete/ Incomplete? Enter skin test result Hold for 5 days Are they important? Return to Sender Complete Incomplete No Receive complete documents X-rays Radiologist to review
  • Dr. Elwood
reviews X-ray / CD X-ray CD Dictation Transcribe into iPHIS Enter Radiology Report Print 2 validation sheets
  • Angela
  • Dr. Elwood
Validate printed report Send report to Angela Enter “No Evidence” Separate pink & yellow 939 CD? CD & white 939 to Maria File white 939 No Yes CD Send to Radiology Radiology to read Enter Radiology Report File

Resulting system performance

  • Increased reliability
  • Probably also faster and lower cost

Reliability: 0.99 Probability of Success of the system: 52% Probability of Success of the system: 79%

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SLIDE 12

Mindset

  • Andon - never pass along known defects or incomplete work to downstream. Inspection

at the end of the process is too late and is the least effective methods to assure quality.

  • Plan-Do-Study-Adjust (PDSA) to achieve the perfection - Learn from failures more than

success and be not afraid of making mistake!

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SLIDE 13

Basic Lean Principles

  • Make the process flow

7 flows of medicine – Patient / Client flow – Family flow – Provider flow – Information flow – Medication flow – Equipment flow – Supply flow

  • Pull processing to minimize blocked

and congested flow through a facility

  • r process
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SLIDE 14

Methods

  • Standard Work

– the most effective of performing work – the simplest way therefore the fastest way – has 4 components: Content, Sequent, Outcome, Time

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SLIDE 15

Methods

  • Visual management of signals for move or produce is essential for

synchronized rapid response

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SLIDE 16

Methods

  • Work is performed in a single piece, just in time, continuous flow

manner.

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SLIDE 17

Management

  • Lean management system (LMS) - Three elements
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SLIDE 18

Management

  • Daily management system (DMS)

– Provide direction and purpose for the day – Engage, coach and mentor frontline staff in problem solving – Focus on daily process to monitor, maintain, and continuously improve their work

 Everyone has two jobs

  • For leaders: to lead and to develop leaders
  • For staff: do work and improve work
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SLIDE 19

Lean Facility Design Principles

  • Design around flow (patient streams) not

departments or provider groups

  • Create multiple simple flows rather than

single complex flows – Simple flows are more reliable, easier to control and nevigate

  • Link process steps together without inter-

process waiting. Waiting can be reduced by increasing department flexibility

  • Focus on the process within, make the

building flexible (build camping tents, not castles)

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SLIDE 20
  • Create Line-of-Sight

Improves safety, communication, ability to level-load

  • Separate Front-of-House from Back-of-House

Benefits patient experience and efficiency of support functions

  • Make Work Areas “narrow-and-deep” not “wide-and-shallow”

Reduces travel and improves communication

  • Avoid too much space

Increases travel, encourages clutter, conceals waste

Lean Facility Design Principles

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SLIDE 21
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SLIDE 22

VCH-Richmond Community Health Access Center IFD Event

January 15-19

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SLIDE 23

Guiding Principles

  • Centered on clients, families and caregivers
  • Be evidence informed
  • Focus on transformation - not be limited by current models or systems/processes
  • Integration and coordination driven by client need, outcomes and ease of access
  • Optimize a continuous pathway of care for patients between all services and

providers

  • Service delivery will be in the location best suited for the client, i.e. clinic based or
  • utreach based
  • Model of Care will be based on the Triple Aim

– Improve health and wellness of all population holistically (physical, emotional, social and spiritual) – Improve client, family, caregiver, provider and support staff’s experience of care – Improve per capital cost of care without compromising quality effectiveness and appropriateness

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SLIDE 24

Decisions to Date

  • Population-Focused Care and Service Delivery Approach

– Child-bearing families; Youth; Adults/Older Adults

  • Designate key service hubs for these populations
  • Enhance reach and access

– serve more people through technology; face-to-face; out in the community; at home; in clinics; in groups

  • Integrated and coordinated model of care – one care plan per client
  • 2018 –

– Alderbridge: Adults/Older Adults – Foundry Development: Youth

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SLIDE 25

Vision for Community Model of Care

  • From Patchwork of services and locations to Population-based Integrated Hubs of

Care

– Client and family-centered care – Integrated and coordinated care delivery – Built on a foundation of Primary Care Service Delivery – Single point of access to Adult and Older Adult services and resources – “Every Door is the Right Door” – “Single Coordinated Care Plan” for the same client – Integrated Chronic Disease Strategy – Evidence and best practice informed services – Sustainable model of care into the future – Retain responsibility for client – through transitions of care; throughout acute stay and discharge care planning – Avoidance of facility admission – Proactive, preventive, continuity of care – reduce/avoid need for ED and acute care 25

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SLIDE 26

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Alderbridge - Adult/Older Adult services

Wellness & Chronic Disease Management Adult Mental Health Substance Use High Needs Older Adults Diabetes Education Adult Mental Health Team Home Health - CM, RN, Rehab Fall Prevention Ann Vogel QRT Tobacco Reduction

ACT

Frail Elder NP Respiratory Program Community Geriatrician Chronic Disease Management Nurses Community Care Clinic OASIS GAP Cardiac Rehab Primary Care Clinicians Bariatric Priority Access Outpatient Rehab (Arthritis, Hand Therapy and PT) Older Adult Mental Health Gilwest Palliative Program and Palliative Pain and Symptom Management Clinic Continence Counselling General Internal Medicine Foot clinic Pain clinic

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SLIDE 27

Available Space Allocation

Alderbridge – Access, assessment, care coordination and service delivery (short and long- term) targeting Adults and Older Adults Accessing Space at Garratt Wellness Center – Education, wellness promotion center

  • Group interventions
  • Gym
  • Community partnership and engagement

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SLIDE 28

7671 Alderbridge: Community Health Access Centre

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SLIDE 29

Base building:

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SLIDE 30

Base building:

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SLIDE 31
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Space Planning

  • Focus on space use for patient and staff flows (and) with key adjacencies
  • Space has been determined through LMFM planning (incl.VCH and CSA standards)
  • Shared spaces for similar service delivery functions
  • Guided by the Vision for Community Model of Care
  • Space use intended to facilitate interdisciplinary care and integration of care
  • Incorporate Lean Principles
  • Flexible, multi-use spaces
  • Building envelope/exterior walls cannot be modified
  • Large elevators: main client/public access
  • One reception area for the 3rd floor
  • Once build is complete (walls, plumbing, etc.) further change is problematic and

expensive

  • Part time staff will share workspaces

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SLIDE 33

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SLIDE 34

Norm & Behavior

What we will do

  • Leave our hat at the door
  • Participate and invite participation
  • Be curious, creative, inventive
  • Listen and learn
  • Be champion of the principles – client/family =

1st priority

  • Unafraid of conflict
  • Respectful challenge / criticism
  • Imagine and be open to all ideas
  • Will take risk
  • Have fun

What we won’t do

  • Talk over others
  • Make own assumptions
  • Over-protective of our own programs
  • Fight
  • Walk away from discomfort
  • Undermine the process
  • Use acronyms/abbreviations, jargon
  • Keep ideas to self
  • Will not feed the “white elephant”
  • Be negative
  • Hold on to the past

How we will behave

  • Be open minded
  • Be respectful
  • Have a sense of humour
  • Be supportive of risk
  • Seek knowledge
  • Create a culture of enquiry and a safe

environment for critical enquiry

  • Be present
  • Enable issue awareness
  • Ensure everyone has a chance to be heard
  • Self manage own “airtime”

How we won’t behave

  • Defensive
  • On our devices
  • Dismissive
  • Judgemental
  • Complain
  • Be provider centric
  • Self-interested
  • Rude
  • Reserved