Minimizing Built-in Waste in Michigan Medicine’s New Clinical Inpatient Tower Final Presentation Presented By: IOE 481 Team #3 Sarthak Jain Mary Owczarczak Katherine Sell Jennifer Wenger April 19, 2017

Overview Introduction Key Issues Goals and Objectives Project Scope Methods Findings and Conclusions Recommendations Expected Impact

“Best Hospitals in Michigan” Introduction “Best Hospitals in Michigan” -U.S. News and World Report Improve colocation of similar services and patients Facilitate the overall growth of adult services Create an optimal patient experience

Introduction Current capacity constraints New Clinical Inpatient Tower Michigan Medicine’s Ann Arbor Location New Clinical Inpatient Tower

Key Issues Key issues driving the need for this project: Care providers walk long distances during shifts Time at the bedside is constrained due to motion and transporting activities Key resources and destinations are not efficiently placed in current facility layouts

Goals and Objectives Minimize built-in waste in the design of Michigan Medicine’s new Clinical Inpatient Tower The team analyzed the: Total distance traveled during a care provider’s shift Mean distance traveled per hour of the shift Destinations visited most frequently by care providers

Project Scope Includes Excludes Doctors, nurses, technicians, pharmacists, and residents University Hospital Inpatient Units 4A, 4C, 4D Pre-Op, PACU, Anesthesiology, Adult ED All shifts during week days Excludes Employees with no patient interaction All other Michigan Medicine buildings

Methods

Literature Search The Effect of Hospital Unit Layout on Nurse Walking Behavior Lean-Led Hospital Design: Creating the Efficient Hospital of the Future A 36-Hospital Time and Motion Study: How do Medical-Surgical Nurses Spend Their Time?

Observations and Interviews University Hospital: Pre-Op, PACU, Unit 4A, and Unit 4D 12 hours per team member Deeper understanding of current flow and destinations frequently visited

RFID Tag Study - Data Collection Tagged participants during work week Surveyed participants after tagging

RFID Tag Study - Data Analysis Software created visual of RFID pings String method used to analyze data

RFID Tag Study- Data Analysis Key Metrics: Total distance traveled per shift Mean distance traveled per hour Epicenter and the most frequently visited destinations Distances from the epicenter to these destinations

Time Studies Timed walk paths to key destinations using stopwatch Used MODAPTS to convert between distance, steps, and time

Findings & Conclusions

Distances Traveled

Department Epicenters Epicenter: Location visited most frequently per department

Unit 4A Findings and Conclusions

Walking Paths from Epicenter (Unit 4A) Unit

Distances and Trip Percentages (Unit 4A) Unit Data collected with RFID tags from 2/20/17 - 3/28/17, n = 5 people Percentage of Trips → Patient rooms are most frequented location and have the longest distance from epicenter

Times Studies and MODAPTS (Unit 4A) Unit

Unit 4A Subjects: Walking Paths Unit Ping Rate = 1 minute

Unit 4C Findings and Conclusions

Walking Paths from Epicenter (Unit 4C) Unit

Distances and Trip Percentages (Unit 4C) Unit Data collected with RFID tags from 2/20/17 - 3/28/17, n = 6 people Percentage of Trips → Patient rooms are most frequented location and have the longest distance from epicenter

Time Studies and MODAPTS (Unit 4C) Unit

Unit 4C Subjects: Walking Paths Unit Ping Rate = 1 minute

Unit 4D Findings and Conclusions

Walking Paths from Epicenter (Unit 4D) Unit

Distances and Trip Percentages (Unit 4D) Unit Data collected with RFID tags from 2/20/17 - 3/28/17, n = 5 people Percentage of Trips → Computer area is most frequented location and has the longest distance from epicenter

Time Studies and MODAPTS (Unit 4D) Unit

Unit 4D Subjects: Walking Paths Unit Ping Rate = 1 minute

Pre-Op Findings and Conclusions

Walking Paths from Epicenter (Pre-Op) Unit

Distances and Trip Percentages (Pre-Op) Unit Data collected with RFID tags from 2/20/17 - 3/28/17, n = 4 people Percentage of Trips → Bay stations are most frequented location

Time Studies and MODAPTS (Pre-Op) Unit

Pre-Op Subjects: Walking Paths Unit Ping Rate = 5 minute

PACU Findings and Conclusions

Walking Paths from Epicenter (PACU) Unit

Distances and Trip Percentages (PACU) Unit Data collected with RFID tags from 2/20/17 - 3/28/17, n = 4 people Percentage of Trips → Bay stations are most frequented location and have the longest distance from epicenter

Time Studies and MODAPTS (PACU) Unit

PACU Subjects: Walking Paths Unit Ping Rate = 5 minute

Anesthesiology Findings and Conclusions

Walking Paths from Epicenter (Anesthesiology) Unit

Distances and Trip Percentages (Anesthesiology) Unit Data collected with RFID tags from 2/20/17 - 3/28/17, n = 5 people Percentage of Trips → PACU is most frequented location

Time Studies and MODAPTS (Anesthesiology) Unit

Anesthesiology Subjects: Walking Paths Unit Ping Rate = 5 minute

Adult ED Findings and Conclusions

Walking Paths from Epicenter (Adult ED) Unit

Distances and Trip Percentages (Adult ED) Unit Data collected with RFID tags from 2/20/17 - 3/28/17, n = 5 people Percentage of Trips → Patient rooms are most frequented location and have the shortest distance from epicenter

Time Studies and MODAPTS (Adult ED) Unit

Adult ED Subjects: Walking Paths Unit Ping Rate = 1 minute

Recommendations Unit Patient rooms: placed as close to department epicenter as possible Distance savings: Up to 54 feet per trip Time savings: Up to 12 seconds per trip Anesthesiologists’ offices: placed between the Pre-op and PACU departments Distance savings: 180 feet per trip Time savings: 39 seconds per trip Pre-op department: include break room for department Distance savings: Up to 195 feet per trip Time savings: Up to 42 seconds per trip

Recommendations: Adjacencies Department Epicenter Primary Adjacencies Secondary Adjacencies Unit 4A: Charge Station Conference Room Computer Room Med Room Equipment Room Unit 4C: Charge Station Team Room / Computers Computer Desk Clean & Sterile Supply Room Unit 4D: Charge Station Computer Area Staff Room Clean Holding Room Soiled Holding Room

Recommendations: Adjacencies Department Epicenter Primary Adjacencies Secondary Adjacencies Pre-Op: Charge Station Computer Area Clean Room Break Room PACU: Charge Station Supply Room Anesthesiology Department: Office Region H PACU Equipment Room Operating Room Conference Room Logistics Room Pre-Op Adult Emergency Department: Computer Area Equipment Hallway EMS Linens Room Computers

Innovative Recommendations Two computer areas: one on each end of inpatient unit Moderate spacing between med rooms and patient rooms Saves up to 60 feet and 13 seconds per trip Saves a minimum of 12 feet and 3 seconds per trip

Innovative Recommendations Two-way access for frequented locations Improves department flow Saves up to 70 feet and 15 seconds per trip

Innovative Recommendation

Recommended Future Studies Additional analysis of walking distances of Michigan Medicine’s care providers Pedometer as additional measurement tool

Expected Impact Decrease distance traveled by care providers per shift/hour Increase time at the bedside Increase employee morale Decrease square footage of inpatient tower Increase Michigan Medicine’s operational efficiency

Questions?