Susan Smyth: We took about a year to design the cardiovascular floor. It was an intense
process that involved a number of providers, staff, folks from facilities, because what
we were trying to design was a space in which we could provide uplifting, healing cardiovascular
care. And so as we were designing, it became very important for us to study what we were
doing, to develop metrics, and ways in which we could continue to improve the care delivery process.
Kathy Isaacs: We had this brand new building, and when we were moving units over, we were
hearing a lot of feedback from the nursing staff about the changes in their workflow,
and how that impacted their daily work and to be able to deliver care to our patients.
At the same time, Lindsey and Allison and a few others had just completed their research
in the Emergency Department and did a post-occupancy evaluation. In talking with Lindsey and collaborating
with them, it became much bigger. We were able to really expand the data that we collected
and the goals that we had.
Lindsey Fay: It’s been a truly collaborative project with interdisciplinary partners from
the UK College of Design, College of Communication and Information, UK Healthcare, Pharmacy,
and then of course, having our students involved. In the fall of 2014, we initiated the research
process, and we went into the old hospital, and examined how they were working in this
space. About 6 months after the move to the new environment, we then went back to examine
again, through the same methods, how the design was contributing
to patient safety, to caregiver satisfaction.
Kathy Isaacs: The perspective that we came from, was, to find out more about the daily
workflow, to follow nurses through every footstep they took. To be able to see where they walking
the most, where were they spending the most time, and how could we ensure that they had
the time at the bedside with their patients, which is where we know nurses are most happy.
Lindsey Fay: The move to the 8th floor marked an important change for UK HealthCare, in
that they moved from a centralized unit design to a decentralized unit design.
Susan Smyth: In the new floor, the nurses are actually located immediately outside the
patients’ rooms. The decentralized model really puts the nursing care right at the
bedside, where the patients and the family are, where they need nursing-level care.
Kathy Isaacs: And so, the pedometer data was very valuable, because it allowed us to
compare the old unit with the current unit. The nurses said that they were walking much
more. Well, what did that actually look like? We also did survey data, and that was to collect
broad range data about the old environment versus the new. We did observation, which
was a big part of the students’ involvement. So, having a third party watch where they’re
going. It was really nice to have the data from the students, to see, where they’re
walking, where these communication circles were, because we wanted to see, in a space
that was much larger, where are those conversations taking place, that are so critical.
Marissa Wilson: My favorite part of the project was really getting to understand how a health
care environment works, and seeing how the nurses, physicians, and staff work in the
cardiovascular unit. I was a part of the behavioral mapping observations. I entered a lot of the
data, the observational mapping, and then surveys into the computer, and then after
that, it was sent to the statistician, where he analyzed it. And then I took that data,
and I created graphics to show it in a more simplistic way, so it is easier for the reader
to see. So, being involved in research like this, I think, is really important, because
a lot of the design firms are doing pre- and post-occupancy evaluations with their design
projects. And, so it teaches you how to do those things, and then also, it gives you
kind of more experience on the research side, and understanding why it is important to do
research when you are designing a space. Because as designers, we’re designing
for the people. So, it’s important for us to understand how they work and operate in
the environment that we’re designing.
Lindsey Fay: So, we had a lot of positive responses to the new environment. Overwhelmingly,
people were enthusiastic about the great views from the 8th floor.
Kathy Isaacs: That daylight infusing in on patients was good for patients, to be able
to see what was going on in the outside world. There was good ability to move the patients
around that environment, if the patient was in a wheelchair or had crutches, the threshold
to the bathroom was large enough to be able to sort of navigate that. This was a cardiology
unit, so they had the ability to pull up certain EKG monitoring on their computers that they
were sitting at, just in real time. And, to be right there with their patients, right
outside of the room, also made them feel very good.
Lindsey Fay: One of the things that we did with our outcomes, was make short- and long-term
suggestions for improvement.
Kathy Isaacs: Some of the shorter term goals: could we put in monitors where they had identified
monitors were needed. We needed to come up with some type of lighting right at their
desk outside of the patient’s room, that would allow them to be able to see their paperwork
but still being right there by the patients. Sort of longer term things that we want to
look at, do we have enough unlicensed staff, so our nursing care techs, in the environment,
to be able to go and get the supplies and the equipment, to keep the nurse at the bedside
with the patient. Stratifying what is the easy “win” that we can get out there now,
like the lighting at the computers, and then, what will take just a little bit more time,
and thinking about that.
Susan Smyth: To be able to collect data on metrics in terms of, how effective this care
delivery model is, how active the nurses are on the floor, how this has impacted care,
really will of be of critical value as we roll out new floors, and as we try to tweak
what we’re doing on a day-to-day basis.