Overcoming Design Challenges at a Medical/Surgical Shell Space via Validation and Staff Participation
SCL Health’s Platte Valley Medical Center in Brighton, Colorado was seeking to fit out its medical/surgical shell space to offer care to its growing population as well as that of surrounding communities. To achieve this, they partnered with Boulder Associates Architects (BA) to seek out design opportunities and innovations using an inclusive, collaborative process that included staff, former patients, community members, and patient advocates.
The building’s atypical, fish-like footprint presented the team with a design challenge to fit all the components of the 28-bed program efficiently in such a way which optimized patient and staff outcomes.
The BA team recommended a validation phase—a pre-design study of the existing second-floor medical/surgical unit that would allow for the deeper understanding of what was working and what wasn’t. To start, BA Science researcher, Meredith Banasiak, and lean practitioner, Bill Keen, gathered data from the existing second-floor operation to set performance goals for the third-floor unit. These would focus on patient safety, patient experience, clinician effectiveness, and clinician experience and health.
They analyzed nurse call-light response times and performed observations at nurse stations, patient rooms and corridors, to better understand staff workflows, communication, visibility, and processes, stress, fatigue, and satisfaction, accessibility to supplies and equipment. They measured light and decibel levels, evaluated patient privacy, and risk of injury, among other outcomes to compare against scholarly and industry benchmarks and propose new strategies which would facilitate a better environment for both staff and patients on the new third floor.
The validation provided benchmark data and optimization targets for the new third floor allowing the team to solve problems in a way that wouldn’t just repeat what was on the floor below. As a result, the team ended up totally reworking the core.
The challenge again: to stick with the unique shape and keep it at 28 beds. Designers looked at patient rooms, nursing stations, how to create a flow in the unique, long curved halls and bring in external light. For the actual layout of the space, they asked the experts who were most familiar: the staff.
Stacey Root from BA Science held a Paper Doll design workshop for the central core, and a Cardboard Mockup Workshop for patient rooms. This involved bringing in a diverse group including the design team, but more importantly a range of the clinical staff, including the CNO, the medical/surgical unit director and her key nursing and clinical personnel.
The groups were split and separately did two sets of paper dolls to try and solve their problems. They were given a copy of the plan, and squares of paper to sort out locations for their desired layout from everything as minor as lockers and breakroom locations to the PT gym and nursing stations. They learned they had to deal with columns, mechanical shafts, elevators, plumbing, stairways—they began to understand design constraints, which led to some real “aha” moments.
Ultimately three options from each group were presented to the entire workshop group. Two of those options were then picked for the BA design team to refine and design further, then brought back to the Platte Valley team for their final approval before beginning the traditional design process. Among the key changes common to both schemes involved sizing and layout of medication rooms to facilitate drug safety and staff efficiency, main nursing stations located in a central location supported by satellites, and flexible seating options for visiting families. The research team evaluated the two design concepts across the projects evidence-based performance goals by conducting a sightline and nurse travel distance analyses.
During finish selection, the research and interiors team conducted a flooring evaluation to compare potential flooring types across the project’s evidence-based performance goals.
Because the third-floor space was shelled, the design team took the opportunity to mimic second-floor rooms with in-place cardboard mockups to identify specific areas for improvements. Two mockups were created, one of an existing patient room and one as a “blank slate.” The team evaluated the current room to see what worked and what didn’t. Staff findings and suggestions included locations of nursing charting stations, sink locations, as well as input on lighting, finishes, door swings, and space saving alternatives for the family area.
With this validation, BA’s team then made those strategic changes to the patient room. Since the third floor was basically half occupied at the time, the shell space allowed them to actually mock up live in the space. They then had former patients, staff, community members, and patient advocates come in give us further input. The design team took that feedback and immediately implemented it into the drawings.
By doing more of an assessment, utilizing lean tools, and getting interactive user feedback early in the project, you are checking all of the boxes beforehand to ensure you get positive results.
Through their participation and input, working through the design challenge, the staff became the creators of their new space, which gives them a sense of ownership.