Sponsor:U.S. Military Health System
PI: Craig Zimring
Introduction: This project covered many different aspects of healthcare facility design, including the following:
- Post-occupancy evaluation system
- Innovation center
- Evidence Based Design (EBD) checklist
- Healthcare Environments-Baseline Assessment of Safety and Quality (HE-BASQ)
- Refereed publications
This research will support the Military Health System's $11 billion hospital modernization program and contributes to policy and practices that will impact the system's 59 hospitals, 800 medical and dental clinics and 10.4 million people served.
The Military Health System (MHS) leadership acknowledges in the 2008-2010 Strategic Plan the honor and responsibility that the MHS has in caring for our troops, their families, and those who have previously served our country. More than nine million beneficiaries are eligible for services provided by the MHS, a health care system with underpinnings of "innovation, service to others, and unrelenting persistence to achieve excellence." The MHS is challenged to deliver high-quality healthcare and construct and operate high-value healthcare facilities in an environment of multiple converging factors during a time of increased Congressional scrutiny of the MHS budget. These factors include escalating costs and the rapid advancements in medical science, Health Information Technology (HIT), and environmentally-oriented construction practices. All must be integrated into the care delivery and facility planning process.
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A viable solution for addressing the challenges at hand is for the MHS to stand-up a formal innovation program; in this context, innovation is "defined as the successful implementation of a novel idea in a way that creates compelling value for some or all of the stakeholders." The short term goal is to optimize healthcare delivery within the MHS, with the more long-term goal of evolving as a leader in health innovation with application for public and private sector entities nationally and world-wide. With a six billion dollar portfolio of healthcare facilities projects planned over the next five years, the MHS is well positioned, and well advised, to begin the process of implementing a formal innovation program. Through strategic partnerships with existing innovation centers and organizations, the MHS can rapidly stand up a program and quickly realize the benefits of innovation.
As a component of a special studies task related to military facilities, TRICARE Management Activity (TMA) requested of Noblis and the Georgia Institute of Technology (Georgia Tech) to submit recommendations related to the feasibility of standing-up an MHS innovation center. In the course of the research and briefings to TMA management, the request was made to alter the task scope to a more expansive view of an innovation program inclusive of a network of potential strategic partners. Therefore, the report encompasses a review of programs internal and external to the MHS, lessons learned, partnership opportunities and overarching recommendations for creating an MHS Innovation Program.
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Evidence-Based Design (EBD) is recognized by most as a good idea (in fact, as "the right thing to do"), but it is hard to implement. Health facility leaders are rarely well-versed in EBD, and Design Architects are generally not inclined to use "cookbook" (template) designs. The EBD Checklist strives to create a balance between giving enough education and advice to move an inexperienced project team forward and providing guidance without "prescribing" certain facility solutions, therefore maintaining the opportunity for the designers to invent creative and/or innovative solutions to meet the patient-centered goals of the MHS.
The EBD Checklist is a tool that is expected to:
- Promote evidence-based design strategies throughout the facility lifecycle to minimize the risk that EBD features, and therefore their benefits, are missed.
- Guide visioning for the facility: clearly identify and place the key principles (design drivers) of EBD in front of the leaders and planners.
- Present design strategies (e.g., install patient lifts in patient rooms) that should be considered to address the design drivers (e.g., reduce patient falls and staff injuries).
- Capture new design strategies as they are recommended from the field and investigate these through the MHS Innovation Program for potential inclusion in future designs and versions of the EBD Checklist.
- Build evidence for the effectiveness of design strategies- Help to guide the collection of baseline data on existing key outcomes and processes that can be compared with the new facility during the Post-Occupancy Evaluation (POE). Once measured, the next step is to develop a library of examples (both successful and unsuccessful).
A governance structure is offered to make the EBD Checklist a standard part of all projects- building it into the Architects' contract for services and having a process/review infrastructure that ensures that Checklists are applied at the right time and a feedback loop is provided. The primary user of the EBD Checklist should be the facility project team, including an identified EBD champion who takes responsibility for utilizing the Checklist.
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Healthcare Environments-Baseline Assessment of Safety and Quality (HE-BASQ):
The Portfolio and Planning Management Division, Office of the Assistant Secretary of Defense, Health Affairs funded a baseline study investigating links between design and outcomes in the existing four National Capital Region (NCR) military treatment facilities (Walter Reed Army Medical Center, National Naval Medical Center - Bethesda, Malcolm Grow Medical Center at Andrews AFB and Fort Belvoir's DeWitt Army Community Hospital) and non-military hospitals including Dublin Methodist Hospital in Ohio.
The overall goals of this study were to:
- Provide a baseline assessment to compare with the new facilities (due to open in 2011) and to
assess to what extent they provide the world-class outcomes that were targeted in the design
- Gather evidence now that can be used to improve design and outcomes in the large group of
treatment facilities that will be planned and designed over the next few years;
- Identify opportunities for improvement of existing policies, processes and guidance documents.
This was a joint effort including: teams from each facility, the Department of Defense (DoD) Patient Safety Analysis Center, the US Army Public Health Command (provisional) Ergonomics Group, Noblis and Georgia Tech. Craig Zimring was overall Principal Investigator (PI), Julie Mann-Dooks was co-PI and Noblis lead, and Erin Lawler was the DoD Patient Safety Analysis Center (PSAC) lead. Each DoD facility had a local PI; Colonel Petra Goodman (Walter Reed Army Medical Center), Colonel Margaret M. McNeill (Malcolm Grow Medical Center), Colonel Kathleen Ford and Claudia Moses (DeWitt Health Care Network), and Commander Michele Kane (Navy National Medical Center). A larger team of clinicians, methodologists and researchers made substantial contributions as well.
Research studies have been developed in six areas: patient falls, hospital noise, staff injuries due to patient handling, in-hospital patient transfer and transport, satisfaction, and hospital-acquired infection.
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Publications related to Military Healthcare System Research:
- Ossmann, M., Boenecke, C., and Dellinger, B. A. (2008). Healing Environment for America's Heroes. Healthcare Design, 28-38.
- Casscells, S., Kurmel, C., and Ponatoski, E. (2009). Creating healing environments in support of the us Military: a commitment to quality through the built environment. HERD, 2(2), 134.