Blog Contribution by NIHD Secretary Lynn Aguilera, D.M., MSNEd, RN, PMP, EDAC.
Using mock-ups during the design development phase of a project provides a unique opportunity to allow frontline staff to envision their future space and move through it according to their anticipated workflows. Despite the benefits of mock-ups, they are sometimes limited in providing opportunities for staff to fully visualize the space in which they will be providing patient care. This is where the addition of full-scale simulations come in. Full-scale simulations for common and high-risk events help staff imagine their future and understand the physical changes proposed in the new design that may impact their workflow. This experience allows them to recommend changes during design to support smooth operations, identify any regulatory concerns, and minimize future change order requests.
The mock-up spaces should be built so staff understand where the walls, windows and doors will be and give them the freedom to move items around, within determined constraints, to support their workflow. When planning full-scale simulations in the mock-up space, the planning team should engage simulation experts (if available) or educators and bring in as much real equipment and supplies as possible, including mannequins or dolls. If mannequins are not available, volunteer patients can be used. For those items that cannot be brought to the mock-ups, such as headwalls and ceiling mounted equipment, the use of cardboard replicas or printed images of those items to scale, will help create a more realistic experience. When staff perform tasks using real equipment and supplies, and visualize a person in the care space, they are more engaged and perform more realistically than they would when only using cardboard replicas or artificial mock-ups items.
Other important elements the planning team should consider are the use of pre-planned scenarios and seasoned facilitators. The scenarios should include common and high-risk workflows for the staff to practice. These aid in ensuring vital workflows are performed in the space so that key design features are vetted in the simulated environment. Using a experienced facilitator also helps keep the team focused on the goal of reviewing the space, rather than on clinical practice.
As the staff go through the scenarios, the planning team should encourage them to simulate their workflows and physically test where items should be and have them move anything within the design constraints that would improve workflows. Examples of items that may be moveable include headwall placement, outlets, cart alcoves, label printers, nurse call stations, and computers.
The use of debrief meetings following the simulations are an effective way to gather feedback from the participants and validate decisions. Documenting the final validated set-up through photographs is also recommended. The debrief should be facilitated by a planning team member who is prepared with a list of questions to keep everyone focused and on-track. Recording the session is helpful so that the teams can go back and review for lessons learned, best practices, and any final decisions.
Although full-scale simulations require a lot of planning and preparation, they are highly effective in testing the space in a realistic environment before the final design is signed-off.
Blog Contribution by NIHD Secretary Lynn Aguilera, D.M., MSNEd, RN, PMP, EDAC.
Lynn serves as the Executive Director of Strategic Space Planning and Transition Strategy at Stanford Medicine Children's Health, overseeing a multitude of hospital and off-campus projects.