Products & Services

Taking over makeovers
Common sense, computer simulations drive design configurations

by Rick Dana Barlow

With all the home improvement and makeover shows growing in popularity on cable and network television you might think it would be a cinch – if not mildly entertaining – to tickle your inner Ty Pennington, Martha Stewart or anyone in between to spruce up your facility’s patient rooms or surgical suites. You’d be wrong, of course. That’s because hospitals and other healthcare facilities don’t furnish and improve themselves on aesthetics or convenience alone. They also must account for efficiency, ergonomics, infection prevention and productivity just to name a few.

And although those factors may not get you a spot on "Oprah," they’ll go a long way toward preventing "60 Minutes" from knocking on your door.

So what’s so challenging about furnishing a healthcare facility?

Whether you’re dealing with new construction or renovation, filling those empty rooms or merely redesigning and upgrading what’s there can be both a blessing and a curse if you don’t know how to plan for what you need and where you need to place it.

KI’s Soltíce collection of healthcare furniture
supports a patient-centered environment.

Recruiting artistic and craftsman expertise may be a nice touch as a finishing strategy, but it may not be practical enough as a furnishing strategy, thanks to the specific needs of healthcare facilities.

So what are those needs and why is furnishing healthcare facilities so challenging?

"Furnishing a healthcare facility is complex because patients, families and staff each have unique needs that must be met," said Debbie Breunig, R.N., vice president, healthcare market at KI, Green Bay, WI. "Adding another level of complexity, healthcare design must take into consideration a number of patient care, business and demographic issues. For example, the way an acute care facility is furnished and equipped often must support a healing environment, serve as a competitive differentiator and meet the needs of an increasingly obese population."

But financial and operational concerns must be addressed, too, according to Rebecca Gayden, capital equipment manager at Novation, Irving, TX. "Functionality, efficiency, and life cycle costs are all significant things to consider when equipping a healthcare facility," Gayden noted. "Operation efficiencyand patient flow are key to the success of a healthcare facility, while life cycle costs are imperative to evaluate on the front end to ensure a greater ROI for capital equipment expenditures."

That’s why creating a strategic business plan is paramount, whether a facility is furnishing and equipping a patient room, a waiting room, a surgical suite, a lab or an administrative office, advised Jasemin Yigit, project manager for Olympus Medical Systems Group’s EndoSite Consulting Service. Such a plan should include "extensive data on growth, new technology, real estate availability and reimbursement," Yigit noted. Furthermore, it should cover a five-year projection and incorporate an extensive level of detail and risk.

As the organization formulates its strategic plan for furnishing and equipping a facility, it simultaneously must research design and construction standards. "Typically, state and local governments issue construction regulations for items such as parking requirements, ventilation, and emergency power systems – things that could otherwise be overlooked," Yigit said. "The federal government also issues physical environment regulations centering on unit safety. Lastly, accreditation bodies like JCAHO and AAAHC have created environment checklists for facilities that intend on becoming accredited."

Before any product selection begins,
Yigit urged facilities to perform a detailed space analysis for any and all areas that will be furnished or equipped with technology. Waiting rooms, business offices (including an area for patient private discussion) have different requirements than preparation area, recovery area, procedure area, endoscope storage and support areas such as a nursing station and staff toilet.

Incorporating comfort
in the clinical

Healthcare facilities embarking on any kinds of updates or upgrades of clinical, patient or public areas absolutely have to focus on aesthetics to a certain degree because that tends to improve outcomes, as well as performance. "Administrators should seek furniture that enhances the experiences of the patient, family and staff," Breunig said. With a patient-centered focus facilities should turn to furniture that creates "a supportive environment that is comfortable, not clinical," she added. "This typically means furniture with a residential aesthetic that reminds patients of home. At the same time, furniture must have the durability to withstand the high usage that is common in healthcare facilities.

Bariatric setup from Novation

"Furniture must serve family members who want to spend as much time as possible with loved ones," Breunig continued. "Seating that converts into a sleeper is an example of an effective solution for accommodating visitors in a patient’s room."

Ergonomics, infection control and safety also play a key role – particularly for healthcare staff members. "For instance, height-adjustable desks make it easy for workers to sit or stand at comfortable levels by selecting the work surface height that is most comfortable for their dimensions," he said. Healthcare facilities also need to consider antimicrobial fabrics that help to reduce the number of infections. These fabrics prevent bacteria from surviving or growing on specially manufactured textiles used for seating and other surfaces."

Gayden, who has equipment planning in her background, advised that those facilities contemplating any kind of makeover to consider physician preference, facility standardization and group purchasing organization affiliation among the key contributing factors.

Renovating any space in a facility must incorporate productivity, patient flow and workflow into the mix, Yigit noted. "Poor design and workflow not only affect cost, but also staffing needs," she said. "Each specialty has its own needs, and a ‘one for-all’ approach is typically not the best way to build for optimal efficiency and profitability."

Novation’s Standard Room Configuration tool.

As a result, Olympus uses clinical reviews of the architectural space to validate workflow and design, Yigit continued. The company also found that a unidirectional flow dominates the most efficient units. "If a patient is admitted in one area, but discharged through a separate location while maintaining a one-way course throughout the unit, congestion can be reduced," she said. "Designing preparation and recovery areas interchangeably allows for greater patient and staff efficiency. For example, more staff and preparation areas are needed in the morning while the opposite is true at the end of the day."

Yigit argued that one rule of thumb that should be near the top of everyone’s redesign list is this: "Don’t neglect toilets. A commonly accepted formula is one toilet for every three-preparation/recovery area."

Furthermore, when planning the endoscope cleaning room, design for a dirty-to-clean flow, she said. "Allow space on the dirty side for endoscope transport containers and build a separate area for storing patient-ready endoscopes. Endoscope storage should also encourage even distribution and use of each endoscope."

While aesthetics play an important role in the design and furnishing of patient and public areas, it doesn’t garner as much emphasis in the surgical areas as ergonomics, productivity, safety and work flow.

Relatively recent trends in the surgical suites includes moving devices and equipment onto ceiling- or floor-mounted booms and towers, festooned with technology-laden articulating arms. This virtually eliminates much of the clutter as well as the rivers of power cords snaking along the floor.

Granted, this strategy does offer an aesthetically pleasing look as a byproduct but "the cost for the additional structural support must be added into the decision-making process," said Marc Shapiro, Olympus Medical’s integration consulting director.

Currently, there is an emphasis to take video output and observation cameras and route video into the procedure room, as well as other areas, such as the nurses’ station, auditorium and conference rooms," Shapiro said. "Routing endoscopic video proves especially helpful for clinical consultation and conferences, while room display routed to a nurse station drives efficiency in staff preparing for the next case."

KI’s collection of antimicrobial fabrics
can help healthcare facilities reduce
the number of infections.

When equipment and functional integration is a central tenet of a redesign strategy people usually "envision a state-of-the-art deluxe O.R. system," he continued. But it doesn’t have to be that way. "Integration of a GI Suite can be something as simple as having flat panel monitors and routing video to a conference room," he added. "Think of this as building blocks."

Virtual tools for visual effects

Thanks to vast improvements in computer technology, in addition to electronic gaming capabilities being transferred to the more serious business world, a growing number of vendors are using two- and three-dimensional room configuration programs or computer simulations to varying degrees to help healthcare facilities physically visualize how furniture and equipment placement impacts patient care and workflow.

While these simulation technologies may not impress Disney/Pixar or DreamWorks animators, they represent visualization tools that are escalating equipment and furniture layout and design light years ahead of where they were a decade ago.

In fact, you should be disappointed if a vendor in the surgical equipment segment actually didn’t offer simulation programs, such as ones used by Novation, Olympus Medical, Getinge and Skytron, for customers to reconfigure placement of booms, tables and work stations.

"While planning a facility, it is sometimes easier for the end user to see a ‘virtual reality’ that their space could conceivably look like," Gayden said. "It is sometimes difficult for people to envision what the end result will look like on paper, while discussing adjacencies of clean rooms to surgical suites on blueprints might be abstract. Tools that allow the end users to envision what their space will look like enables them to make more informed decisions."

Olympus’ 2-D and 3-D renderings showcase the company’s simulation software and ability as a design consultant.

Using Novation’s interactive Web-based "Standard Room Configuration" tool, clinicians can identify what a specific room typically requires, in addition to identifying products currently on contract for more controlled expense management, she added.

"Novation’s Standard Room Configuration tool can really make a difference, by not only identifying what equipment is on contract, but also by eliminating excess spend on ‘wish list’ items," she noted. "The tools provide clinicians with the typical equipment needed per space allowing them to make an informed decision on purchases."

"Novation’s tool allows customers to view a variety of hospital rooms, suites and units that offer design suggestions and include information about each piece of equipment in the room, including anesthesia machines, blood pressure cuffs, O.R. tables, monitors, IV pumps, andelectrosurgical equipment. All items have point-and-click links for users to access and print information about the equipment and provide information about the associated Novation contracts.

Olympus developed a proprietary computer simulation model that systematically replicates patient flow. The EndoEfficiencies Simulation & Predictive Outcomes software model "accurately recreates patient throughput based on existing protocols, resource requirements and variables specific to the customer’s facility that has been identified to impact flow," Yigit said. Variables include staff mix, skills and schedules, patient arrival habits, physician endoscope preferences, patient travel protocols, number of procedure rooms, number of prep and recovery bays, registration processes, patient flow tasks and times.

EndoEfficiencies flags any variables that contribute to patient flow bottlenecks, she noted. ""Utilizing the predictive analysis capabilities built into the EndoEfficiencies model, an [Olympus] EndoSite advisor can modify the input variables – one-by-one, or all at the same time – to statistically calculate the predicted impact of any future change to the facility’s bottom line."

EndoEfficiencies simulations either construct a generic layout that allows for customer-specific adjustments or it relies on the importing of an actual computer-aided design (CAD) drawing of the customer’s facility into the model to create a 3-D rendering that facilitates complete visualization of patient flow, according to Yigit.

"While simple decision criteria may be calculated utilizing old fashioned methods, such as a calculator, computer simulation and Web-based strategic planning tools provide the ability to model complex decision criteria and their interdependencies," Yigit said. "Changes to any one variable can easily be calculated manually, but accurately predicting the impact of that change on all of the other variables, and ultimately on the facility’s bottom line, can only be calculated by utilizing predictive statistical analysis available through sophisticated computer simulation tools. Only computer modeling can provide the ability to change multiple variables, one at a time or simultaneously, to simulate their interdependencies and the predicted impact of those changes on the bottom line."

New from Getinge, MAQUET’s 3-D Dynamic Configurator lets planners build and view a customized, virtual, surgical workplace complete with tables, lighting, ceiling service units, power outlets and other equipment/accessories that are dimensionally accurate based on actual manufacturer specifications. Room size and ceiling height are dimensionally accurate as well.

The 3-D Dynamic Configurator also has the ability to calculate the remaining payload capacity of a ceiling service unit or assist in specifying O.R. tables with accessories that meet a facility’s individual requirements. A choice of user "views," including a surgeon’s perspective, can factor in the height of staff members to determine optimal equipment elevations.

Companies like KI offer similar interactive Web-based tools that enable customers to design and furnish non-surgical areas.At KIHealthcare.com users can access design tools that help them specify projects and navigate through an extensive product catalog with specification details. For example, KI’s "See It… Spec It" swatching tool lets users choose fabric and finish options on select pieces from the KI healthcare line in real time and zoom in on photos to spot details like seams, texture and weaves. HPN