March 17, 2014 – By Jennifer Kovacs Silvis, Managing Editor – Healthcare Design Magazine – After an 11-month evaluation process, in 2011 Kaiser Permanente chose the winners of its Small Hospital, Big Idea Competition, recognizing Aditazz and M+NLB/Perkins+Will for their combined approach to the challenge of creating a design concept for a small, eco-conscious, high-tech, and patient- and family-friendly hospital.
Three years later, the team behind the winning project and representatives from Kaiser Permanente were on hand at the ASHE PDC Summit in Orlando to share where those big ideas are today in the session "Kaiser's Small Hospital, Big Ideas, Part 2: The Next Generation."
Although the healthcare system is well-known for implementing a design template for its new facilities, Sunil Shah, executive director of the capital projects group at Kaiser, said it also realized the next generation of buildings would need to be "really different," with a focus on flexibility, adaptability, and nimble design. To that end, Kaiser evaluated all submissions to the contest, gaining a wealth of ideas regarding everything from innovation in technology to rethinking healthcare delivery overall.
But it's how the ideas that came out of the experience will be implemented that's been the next chapter of this process.
Between conception and delivery, a lot can be lost in translation, said Ward Vercruysse, co-founder of Aditazz. As a solution, the team has worked toward simulating designs to create models that evaluate staff operations and activities in a space, allowing the team to measure pressure points, like wait time and what's causing it. Working through various scenarios that present a progression in extreme circumstances, the model's effectiveness can be assessed and operations can be optimized.
Once a design has been determined, Michael Bardin, senior associate and senior project manager at Perkins + Will, said the next step is rollout and offered tools to ease that process, too. To start, Bardin said any pilot test begins with communication and instructing the pilot team about what exactly will be analyzed. Next, the project is launched through a "learning phase" that assesses whether the innovation being implemented is working. The key, he said, is "the feedback loop that connects the pilot team to the change management team."
To streamline the feedback process, Perkins + Will created an application that pushes surveys to participants for a quick collection of data that can be collected and translated into a visual analysis of responses to certain interventions, essentially creating a picture of when innovation is adopted or rejected.
Outside of the design of the physical space, the Small Hospital, Big Idea implementation process has also brought with it an analysis of systems and energy use. Walt Vernon, CEO of Mazzetti (formerly M+NLB), said a big piece of that is measuring plug loads, looking specifically at the sliver of consumption that, despite efforts for energy use reduction, remains constant. That constant is generally attributed to medical equipment, and research is digging into consumption and plug load at a micro scale, from department to individual rooms, and how to identify much more specific numbers to input into energy models.
What's collected down to the per-room basis can then be assessed against what manufacturers state as energy requirements on individual pieces of equipment's name plates. The actual use may be much less than what's stated, meaning the energy expected to be provided to a specific room or to a department can also be decreased. However, another piece of the puzzle is how facility staff will operate the equipment. "How do I engineer behavior?" Vernon said. One concept being explored at Kaiser Permanente is a scorecard system to analyze how facility managers are doing and identify how much it's costing their facility if systems aren't running as intended, to make data much more tangible.
Overall, what's in the works right now is what Shah called baby steps toward a huge goal of improvement. After spending the last year figuring out the the right platform for facility design in the future, a path has been forged.
And one thing's for sure: Kaiser will simulate all designs before building anything. And that simulation will cover the spectrum of the patient experience. "It's starting from your home, all the way to the tertiary hospital, and everything in between," he said.