Staff members went through the step-by-step process of how they would take care of patients to get a sense of the layout.
Staff members went through the step-by-step process of how they would take care of patients to get a sense of the layout. This photo shows a mock-up of a patient procedure room. Photo courtesy Cone Health.

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<p>Physicians, architects and hospital administrators are using life-size cardboard models of operating rooms to redesign and improve patient care at a hospital in Greensboro.

By Minali Nigam

Before a shovel breaks ground, architects use blueprints and sketches to plan construction.

But last October, administrators at Greensboro’s Cone Health worked with architects on a different type of model to design hospital operating rooms: A life-size cardboard replica. The temporary structure was built inside a warehouse in Greensboro and consisted of 10 mock-up operating rooms, a total of 38,000 square feet.

The cardboard “hospital” contained ten life-size operating rooms, covering 38,000 square feet. Photo courtesy Cone Health.

Physicians, nurses, biomedical engineers, technicians and other hospital staff walked through the cardboard warren and simulated their work in the space. They then consulted with architects to improve the layout for an addition and renovation at Wesley Long Hospital on the west side of town.

Instead of fitting patients into a constructed building, Karin Henderson, executive director of strategic management for Cone Health, said they created the floor plan after identifying “optimal patient experience.”

“The traditional approach to building a new wing or new department is to get some minimal interviews from maybe not a wide array of stakeholders,” she said. “This process brought everyone together at the same time.”

Going Lean

“In the past you didn’t have that group, multidisciplinary interaction. You had a couple of people come up with ideas, the architects would go back and make the redesign and then you’d come back and talk about it,” said Sharon McCarter, Cone Health’s co-executive of operative services.

One change was moving the push plate (mechanism to remotely open a door) required to get into secure areas within reach of staff who carry patients on a stretcher, said Wayne McFatter. Photo courtesy Cone Health.

Instead, with everyone at the table, the architects drew up changes on paper, and then moved the corresponding cardboard parts.

There were three design phases, with over 75 staff and physicians involved regularly. Some staff members acted as patients.

“[We followed] the patient from the front door, through pre-op, operative services and post-op to understand what the patient flow looked like,” Henderson said.

This patient-centered design, she said, is part of Cone Health’s effort to explore and understand Lean methodology, which is being widely adopted in hospitals nationwide.

Lean management, which was originally developed in Toyota car manufacturing plants, means “using less to do more,” according to a report for the Institute for Healthcare Improvement, a health policy think tank. In hospitals, Lean management helps reduce wasted time, energy and money while making the patients’ needs a primary focus.

“[It’s] also having a more efficient experience for the clinicians, while supporting our quality and cost initiative,” said Henderson.

‘Simple’ changes

Several changes were made to the operating rooms between October and April, when the cardboard city was taken down, said Wayne McFatter, Cone Health’s executive director for perioperative services.

Suzi Brewer, a nurse, and Johynni Burkett, a clinical technician, look at the blueprint while walking through the cardboard city. Photo courtesy Cone Health

“The locker room space and physician lounge were on complete opposite sides of where we had initially thought we needed them to be,” he said. “That was a big ‘Ah-ha’ moment.”

A post-operative recovery room was also moved from a central location.

“We only used that room about twenty-five times a year,” said McCarter. “So it really was not value-added to have it in prime space. We actually redesigned that with the help our surgeons and [recovery] staff and moved it to a side location.”

In the process, Henderson said, staff were attentive to details such as where the television and telephone would be placed in relation to a patient’s bed.

The system ensures that things as simple as hand washing sinks are in the right place for the right time in the patient care experience,” she said.

Cone Health isn’t alone in using Lean principles to redesign workflow. A couple of years ago, a rural hospital in Anson County also built a life-size cardboard model before construction.

“Lean methodology is an emerging trend, not just across North Carolina, but across the nation,” said Henderson. “The new standard is to deliver excellent care at optimal costs.”

Cone Health staff anticipate it will take a year to build the actual operating rooms. Construction is set to begin at Wesley Long Hospital in October.

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