By Rebecca Hathaway RN, MSN, EDAC
Sr. Operations Executive, Temecula Valley Hospital
(Formerly Sr. Vice President, Healthcare, at HMC Architects)
Virtually every healthcare facility is faced with the need to rethink high-traffic areas where efficiency can literally mean life or death. Will a simple remodel do the trick? Are new exam rooms necessary to deliver better care? Does the hospital require additional exam rooms in the emergency department, or are additional inpatient beds needed to accommodate the current ED volume? And of course, budget constraints underlie all of these decisions.
In the current economic climate, technology is increasingly at the forefront as a tool to help decision makers find the right choices for their patients and their staff without making costly physical changes that may not produce the desired results. A recent IT solution being used in the architecture field – and one that is proving to save both time and money – is simulation modeling.
Even if a facility has not gotten to the stage where they engage an architecture or interior design consultant, staff and administrators will likely detect inefficiencies in the physical environment, particularly in areas where time is of the essence and patient volumes and needs are difficult to predict (such as emergency rooms or surgical suites). They may decide to compensate by adding more physicians or nurses, or by repurposing rooms or building hasty add-on space, without examining the underlying inefficiencies that have, in effect, created logjams.
“If you push the balloon, it often pops out in areas you don’t anticipate,” says Jerry Eich, senior medical planner and healthcare practice leader at HMC Architects. “Wherever possible, you need to be able to assess the necessary flow of services and model the actual delivery of care. And often, you can’t do that using spreadsheets. You have to be able to demonstrate it visually.” The ability to add variables such as volume surges, for example, enable visualization of their impact throughout all the steps in the care delivery process.
This is where simulation modeling takes center stage. New software, now available from a variety of vendors, allows designers to depict the critical relationships between medical departments and to identify where the delivery of care may be suboptimal. These simulations can assist hospital executives in determining priorities for physical changes before a single wall is moved or demolished. In easy-to-read depictions of floorplans and staff/patient clustering, simulation modeling helps both designers and their clients to see where inefficiencies exist – and then work together to correct them. It brings project management tools to the drawing-board in a way that is effective for client and planner alike. In some cases, the software indicates that process changes can be made without making a capital investment for design or construction – allowing architects to act as clients’ business partners with or without architecture.
In Southern California’s Temecula Valley Hospital, simulation modeling and systems analysis are being employed by HMC Architects and Empirical Solutions Corporation to provide an estimate 30 percent improvement in patient care and process efficiency. The simulation modeling approach acquires and assesses circulation flows up to peak hours, in both intra- and inter-departmental scenarios. It then will make recommendations based on client-identified priorities, competitor benchmarking, and projected future needs or growth.
“The real benefit of simulation modeling is that it allows [hospitals and designers] to work things out in a virtual way before money is being spent on physical changes that may end up to be either counterproductive or unnecessary,” says Tara Laski, regional project manager for United Healthcare Services, Temecula Valley Hospital’s owner. “As far as determining the throughput from one healthcare department to another, I have found it to be an essential tool.” As a case in point, she adds, “Even the most effective emergency department doesn’t exist in a vacuum. It still needs to be able to interact quickly with the rest of the healthcare facility, and simulation modeling helps to determine optimal ways for that to happen.” An example is the impact on the imaging department, or the time it takes to transfer a patient from the emergency department to an inpatient bed.
From the point of view of the hospital administrator who is faced with difficult decisions on how to optimize his or her budget, Laski observes, “You save money by investing in using technology to model the design before any construction drawings are created. Simulation modeling allows you to test the design before paying for any building or remodeling. It really makes the process of improving efficiency at your hospital much more intuitive for everyone concerned – including the designers or architects.”
As part of a $360-million effort to reinvigorate the campus of the Martin Luther King Jr. (MLK) Medical Center in Los Angeles County, HMC Architects designed the renovation of an existing tower and a new multi-service ambulatory care center, both slated to open in 2012. Because operational shifts had spurred HMC’s client to seek the architects’ help, one of the first steps was simulation modeling. In addition to other data, figures on bed capacity, patient arrival patterns, lengths of stay, and wait times were collected and used to forecast areas where the hospital’s program would best benefit from expansion or redesign to alleviate overcrowding. HMC was then able to create a set of variables representing physical changes that could be manipulated to demonstrate the effectiveness of particular design options.
“Instead of lines on paper, you’re showing the client shapes that relate to the actual environment that they experience on the ground,” says Donna Nagaoka, project manager for the MLK Hospital. “If you want to see the potential benefits of one option as opposed to another, you can use simulation modeling to do that in a way that is visual, easy to understand, and based on the facts that pertain to each facility’s unique situation.”
Even hospitals that are not planning renovation, remodeling, or new construction can benefit from simulation modeling. “What operational issues are you trying to solve?” is the question that Nagaoka recommends asking. If a hospital’s systems and processes are not performing up to expectations, the trouble may not be the amount of space or the architecture per se – yet, by converting hard data into easy-to-understand visuals, simulation modeling can still help. And in the ever-evolving world of healthcare provision, it is never a bad idea to begin building a body of knowledge that will help to keep a facility on par with the curve when renovations, remodeling, or expansion eventually become necessary.
The old adage “measure twice, cut once” is especially apt when it comes to design and planning decisions that affect not just a hospital’s bottom line, but its patients’ quality of care. Simulation modeling may well be the new yardstick that enables the most accurate – and ultimately, cost-effective – measurements.
