1. Is There Another Way? Question inclusion of Cobequid
Department of Transportation and Infrastructure Renewal
Healthcare Project Services
Is There Another Way?
Question inclusion of Cobequid
Organizing community based services by postal code
April 15, 2016

2. Share a philosophic approach to Health Care Facilities in Nova Scotia
We cannot afford to continue to do what we have been doing
Is there another way? 1

3. We will provide a background to the problem
We will share an approach that is being developed
Share a project underway using this approach
Wrap it all up with what is expected for results 2

4. Average age of a resident in Nova Scotia: 44.3 years
Average age of hospitals in Nova Scotia:
47.6 years
Hospitals are in use 24 hours per day / seven days per week / 52 weeks per year: No down time 3

5. 4 106 buildings located over 43 campuses
Importance of hospitals to communities
Do we really need this many? 4

6. One Tertiary Hospital site in the province for specialized surgery
Nine Regional Hospitals which are capable of handling secondary surgeries
Community Hospitals which provide local health care 5

7. Primary Care Facilities:
Take non-emergency patients away from Emergency Department
Ambulatory Care Facilities:
Realign non-specialized outpatient care to the community and take pressure off clinics inside the hospital
Hospitals:
Can focus on the highest acuity patients at a lower cost 6

8. Primary Care Facilities: $250 – 375 / sq. ft.
Cost of Facilities:
Primary Care Facilities: $250 – 375 / sq. ft.
Ambulatory Care Facilities: $350 – 425 / sq. ft.
Acute Care Facilities: $750 – 975 / sq. ft. 7

9. Integrated Planning Team
Do we measure the right things when we build facilities?
Tactical success vs. Strategic success
Tactical
Strategic 
Strategic Success
Safe
Efficient
Flexible
Generative
Restorative
Sustainable
Tactical Success
On Program
On Schedule
On Budget 8

10. Smallest footprint possible Lean, efficient design
Result:
Smallest footprint possible
Lean, efficient design
Buy-in from Clinical Team 9

11. Vision for clinical services Doing it Another Way!10

12. Total Surgeries Performed at VG 15,871/Year
Current Situation
Total Surgeries Performed at VG 15,871/Year
Some of the most complicated and specialized services are delivered at the Centennial and Victoria Buildings in less than adequate environments
Numerous infrastructure issues
Over the past decade, numerous attempts have been made to keep services going by patching areas such as floors, walls, plumbing, etc.
Karen 11

13. Current Inpatient Services at the Centennial Building (Approximately 215 Beds)
General Surgery
Hematology/Blood & Marrow Transplant (BMT)
Medical Oncology
Palliative Care
Multi-Organ Transplant (Liver/Kidney/Pancreas)
Thoracic Surgery
Radiation Oncology
Gynecologic Oncology
Urology
Nephrology
Hepatology (Liver)
Ophthalmology
Community Transitions Unit
Ear Nose & Throat/Head & Neck Cancer
Oral Maxillofacial
Critical Care 12

14. Current Outpatient Services at Victoria / Centennial / Dickson Buildings
Gastrointestinal
Endoscopy Unit
Termination Pregnancy Unit
General Surgery/Trauma Surgery
Dermatology
Oncology Clinics (Hematology/NS Cancer Centre)
Gynecology Colposcopy
Radiation Therapy
Outpatient Systemic Therapy
Palliative Care
Immunology
General Medicine
Endocrinology
Multi-Organ Transplant
Nephrology
Ear Nose & Throat
Ophthalmology
Oral Maxillofacial
Acute Dialysis
Chronic Pain
Bariatric
Infectious Disease
Hearing & Speech
Ambulatory Square Footage Totals:
Victoria = 46,808
Centennial = 37,669
Dickson = 132,597
For a total net square footage of 217,075 net sqft.  13

15. Government Coordinating Committee
Governance Structure
Government Coordinating Committee
QEII/DGH Facility Renewal
Transportation and Infrastructure Renewal
Department of Health and Wellness
Finance
Premier’s Office
Nova Scotia Health Authority
QEII Steering Committee
Co-Chairs
Dr. Kirkpatrick
Karen Mumford
Dartmouth General Hospital Steering Committee
Co-Chairs
Dr. Howlett
Heather Francis 14

16. What This Means For The People of Nova Scotia
Improved Confidence in Health Care: Patients and visitors to the VG Site have cited poor infrastructure as a major concern. The new facilities and decommissioning of the Centennial and Victoria Buildings will enhance confidence.
Enhanced, Specialized Care for the Maritimes: The most specialized care in Atlantic Canada will all be delivered at the Halifax Infirmary Site where care teams will work in collaboration with academics & research.
Increased Coordination of Care and Access: Improve patient experience by decreasing fragmentation in patient services and enable better co-ordination and continuity in care.
Starting Now: Using a phased approach which begins with the DGH renovations and expansion means Nova Scotians will see immediate work being done to make health care better.
A Legacy for the Province:  As the provincial centre of the most sophisticated care, the QEII redevelopment will provide health services for all Nova Scotians to meet their needs now, but also well into the future for generations. 18

17. Dartmouth General Hospital
Is There Another Way?
Dartmouth General Hospital
137 Bed Regional Facility
Providing Secondary Care 19

18. Dartmouth General Hospital
Is There Another Way?
Dartmouth General Hospital
Double the OR’s & Associate Support Services
Increase Bed Capacity by 50
Increase Ambulatory Capacity 20

19. Is There Another Way? Readiness For Change
Facility
Clinical Team
Support Teams
Community 21

20. Is There Another Way? How We Did It Functional Teams
Inpatient
Endoscopy
Perioperative
Diagnostic Imaging
ICU
Pharmacy
Ambulatory 22

21. Is There Another Way? Guiding Principals Center of Quality
Patient and Family Centered
Staff Morale and Motivation
Way-Finding and Orientation
Future Proofing
Technology
Education and Research
Infection Control
Patient Confidentiality 23

22. Is There Another Way? Design Camps
Iterative Process
End User Driven
Community Involvement
Lean Design
Vertical Involvement
Very Tight Timelines 24

23. Is There Another Way? TCC New Med Gas Isolation Valves
New Equipment/Hand Sink Alcove
Soiled Utility Room 25

24. Is There Another Way? Results
Project taking a different shape
Repurposing of many smaller facilities
The right level of care
The right place
At the right cost 26