Positive distractions such as music and patient choice of artwork in the room were considered part of the treatment. Spaces for resource centers and family accommodations were add- ed, including kitchens where family members could prepare a favorite meal or learn to cook for healthy postdischarge diets. The extraordinary transformation associated with the Planetree care model required both culture change and facility change. This small organization, conceived by consumer activists in California, is now an international alliance of more than 90 affiliates dedicated to the de- livery of patient-centered care based on the Planetree philosophy Orr, The Intermountain Healthcare IH system faced a facility challenge in the s.
A decision to replace or close the Valley View Medical Center in Cedar City, UT, was forced because the largely obsolete facility did not meet the seismic protection standards for earth- quake risk. The challenge came because the margin at the small, rural hospital was so thin that the capital cost of a replacement could not be supported unless there was a dramatic improvement in financial performance.
The facility planning thus required very tight space programming, a frugal capital budget for construction and equipment, shared services within new departmental combinations, and extreme efficiency. Operation of this efficient facility design was not possible within the framework of the existing organizational structure. Thirty-five departments became 12 departments or multimodality centers. Change of such magnitude could not have been accomplished in the old building; modern facilities were required to make it possible.
A new model of care delivery based on private rooms, technology investments, and decentralized staff locations resulted from the physical changes. An overarching culture of efficiency was required to deliver the updated model of care in the new setting, and IH was rewarded by a The coordinated efforts of organizational restructuring that required facility change and led to inevitable culture change, produced dramatic results that transformed a losing operation into one of the top financial performers in the IH system based on operating margin.
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More recently, the board and CEO of St. Leadership invited an interdisciplinary group of national safety experts to analyze hospital safety. The group produced 10 recommendations for ways in which design might enhance safety and introduced the hospital to failure modes and effects analysis FMEA methods used by high-reliability organizations. The staff used the FMEA process as part of its shift to a culture of safety and coordinated with the design team as it reviewed proposed plans. The facility innovations, among many, included hypotheses that safety would be improved by standardization of patient rooms including elimination of the typical back-to-back configurations making all rooms single-handed and placement of the patient toilet on the headwall instead of across the room so that there would be a continuous handrail from the bed to the toilet.
They were successful at creating a learning culture that encouraged reporting and feedback used to continuously improve processes and facilities Reiling, In each of these examples from the past three decades, executive leadership engaged in collaborative efforts to coordinate facility design and construction with organizational and culture change.
Each demonstrates that the combination can produce transformative results. The examples above produced positive results in market share, patient and employee satisfaction, staff morale and turnover, and, importantly, financial performance. Data remains to be collected that will confirm additional positive clinical and safety outcomes.
Sadler, Jennifer R. DuBose, Eileen B.
Malone, and Craig M. Healthcare organizations are investing in strategies to reform a complex web of variables that impact the quality and business of care delivery. As organizations respond, they engage with a variety of partners. If, for example, there is an initiative to address new services, image, or capacity, the organization might contract separately with care delivery experts, culture-change consultants, and facility design firms. This paper addresses the moment in time when an organization has decided to intentionally engage in either or both facility and culture change.
We argue there is an intrinsic link between the physical and social environment that actively enables or constrains the effectiveness of either. Planned change is in itself a risky, unpredictable process. The joint optimization model presented here is offered as a route to optimizing the effectiveness of both facility and culture change efforts, as well as to increase the likelihood of sustained change.
Ulrich et al. However, the advantage of linking facility design and culture-change processes has remained largely unrecognized. A comprehensive, compatible marriage in the planning and implementation of evidence-based design and cultural initiatives is not only an opportunity, but can be a risk if left unattended. The opportunity to jointly optimize the work of design and culture teams starts with recognizing the obvious intersections. We have identified four of many possible situations that commonly trigger transformation initiatives. Independently, facility design teams and culture-change consultants might evaluate these opportunities and create reasonable solutions based upon their particular expertise.
However, each would start with assumptions about the other that may unnecessarily limit the alternative designs and interventions. For example, if culture-change efforts initiate policy changes aimed at family involvement, the architectural firm may be unaware of the policy changes leading to design decisions based on outdated assumptions. If the two teams work together during the design process, they can broaden the possibilities. Efforts to improve the patient experience and care de- livery model are examples of the intersection of culture and facility design.
We can see this from three perspectives. From a provider perspective, the location of workstations and supplies impact the daily routine of the frontline provider. Introducing decentralized nursing positions might look like a good idea from a design or workflow perspective, but might be underutilized if it is inconsistent with the social aspects of the culture.
From a patient perspective, a new care model might call for patient education. Successful patient education requires it to be a priority in the culture and that an appropriate location be available for materials and counseling.
From a family perspective, the benefit of single-patient room design with physical accommodations can only be helpful if the visiting hours and staff culture also accommodate inclusion of the family. As demographics shift and the care utilization of a population evolves, hospitals have an opportunity to reevaluate physical locations and services offered. As plans developed for expanding the facility in new construction, it engaged the community through focus groups. The LDRP required a shift in the routines and culture of the care providers as well as facility changes.
The common vision of theLDRP enabled collaboration between the necessary culture-change efforts and facility design. Technologies and innovations to improve patient care are now a part of the continuous change in hospitals. It is clear that the successful implementation of these innovations depends on contextual factors, including culture and physical environment Kitson et al.
For example, in order for infections to be reduced by hand washing, both the physical presence of alcohol-gel dispensers and the use of the dispensers need to be taken seriously. Strategic location of sinks and marking of alcohol dispensers make it possible for the patients to observe staff members washing their hands and also allow visiting family members to participate in the process of infection control. Medication error is another important target of current patient-safety initiatives.
However, this change also meant the nursing staff had to adjust to having both critical-care and step-down patients on the same unit, and effort was required to resolve the issues raised by the need for a new culture. Malkin reported the initial success was not sustained, illustrating how new facility accommodations do not guarantee a shift in care routines that require dramatic changes by staff members.
Improvement to the work environment is a winning strategy for attracting talent and employee satisfaction. The social and cultural aspects of the work environment are part of a successful hiring and retention strategy. Their hard work to intentionally plan the supportive organizational culture, create a warm and attractive design, and leverage the assets of the natural environment was rewarded with a flood of applicants. While other Minneapolis-area hospitals were experiencing notable shortages, Woodwinds had so many applicants that it was able to work with the University of Chicago to develop an interview instrument to screen for the more caring candidates.
In summary, regardless of the situation that triggers the change initiative, social structures and physical structures are intimately interdependent. Given the influence that the built environment and cultural elements have on each other, it is imperative that planned changes in either prompt an evaluation of the other. Sociotechnical theory focuses on the interface of the worker and the technology of the work. In its simplest form, it states that joint optimization of the social and technical aspects of the organization will produce better results than if either is separately optimized.
Design: Models of Change by Ken Baynes Published by Loughborough Design Press
There is synergy available in the collaborative and cooperative process. Appelbaum further explains that:. The key issue is to design work so that the two parts yield positive outcomes; this is called joint optimization. Achieving joint optimization is complicated, due to the simultaneous need to address multiple systems within the organization, and delicate, due to the dynamic interrelationship of these systems Appelbaum, Despite the challenges, achieving joint optimization is important.
Joint optimization offers the organization more robust interventions that have higher probabilities of success. Further, change supported by efforts in both the social and technical aspects of work seems more likely to be sustained Appelbaum, In this paper, we consider the tangible physical attributes of the facility, including its architecture, interior design, equipment, logistic systems, communications infrastructure, and information systems to be an integral part of the work technology. The intangible social aspects of the organization include the social roles of humans as they interact with work technology, as well as the organizational culture, norms, structure, governance, team- work, policies and procedures, along with reward systems.
Norms associated with working teams of care providers will powerfully influence performance. The joint optimization model we propose goes beyond compatibility to explore the opportunities for potential synergy when joint optimization is a priority in the design process. In the following section we introduce the model for intentional integration of these Planning processes. Figure 1 see PDF version illustrates a conceptual model for joint optimization. The left and right columns are intended to reflect the traditional processes for culture-change and facility design initiatives.
The focus of the joint optimization model is on the center column. The central actions are not intended to be precise or totally linear. Rather, they illustrate productive points of interaction where the two traditional processes may find synergy through collaboration. What follows are some key considerations when implementing an integrated joint optimization approach.
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There are many issues and areas to cover when engaging in any change effort or major project—these are some of the basic activities and issues to illustrate the intersections where optimization occurs and the intentions of the joint optimization model. It is highly recommended that an honest assessment of the existing culture take place at the beginning of the process. Research has shown that executives and leaders may assume they understand their culture s , but when honest and direct dialog occurs throughout an organization, misperceptions are revealed Huw, Just as an executive may lack understanding of specific methods and procedures within a portion of the organization, leadership may miss the unstated currents of opinion and assumptions shared by many members of the organization.
However, the data should be used to prompt engagement in serious discussions and reflection.
In addition to standard surveys, listening tours, focus groups, and one-on-one discussions can inform honest and direct conversations required to understand the underlying culture s in an organization. Benchmarking visits to other organizations by multidisciplinary teams can allow them to see firsthand how others have approached facility change and culture change.
Observations of the culture, alternative care delivery models, operational patterns, facilities, equipment, and technology of other organizations can lead to valuable insights.
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The benchmarking team should have a clear agenda and immediately debrief the visit to maximize learning from the experience and uncover specific new applications. Nonhealthcare organizations can provide insights into areas such as process improvement and maintaining a strong culture.
Social sciences. Niedderer, S. Ludden Eds. Routledge, Taylor and Francis. Routledge, Taylor and Francis, Routledge, Taylor and Francis, pp. Access to Document Link to publication in Scopus. The 5 chapter headings are:. Within these chapters Ken is seeking to answer questions such as: How do designers do what they do? How do architects, engineers, industrial, fashion and graphic designers think? What is it that goes on in their minds that enables them to shape the things that people buy, use and inhabit? And how far do they share their mental abilities with people at large?
Is it true that everyone is a designer in their own way? He uses the latest findings from neuroscience and evolutionary biology but also traces the story of designerly thinking back to the early days of homo sapiens sapiens and such momentous changes as the invention of cooking, the Enlightenment and the industrial revolution. Essentially the ability to design depends on the capacity of the human mind to make coherent causal models of our experience and the world.
Using these cognitive models we remember the past, interact with the present and imagine the possibility of alternative futures. Design focuses on the future of material culture and so sets out to provide a favourable environment for the evolution of human society. So far so positive.