What We Do
When it comes to designing new health system models, while it's important to research innovative ideas being developed in health systems around the world, it's even more crucial l to ask your own staff how they think things could be done differently or better.That's the philosophy that underpins the User Group engagement in the planning of the new Christchurch and Burwood health campuses. "Innovation is about ideas," says CDHB CEO David Meates. "By listening to the people who actually work in the environment it means we can design buildings that improve processes and services."It's easy to build the wrong thing. The hard work is the planning in the beginning and that's why we need staff to keep themselves informed and to contribute when they have th e opportunity."Seven User Groups were set up for Burwood and 11 groups, growing to 14, were formed at Christchurch Hospital. These groups have been meeting every two weeks with the teams from the different health planners and architects, Klein at Burwood and Katoa Health Design at Christchurch, to inform the new hospital design.
The process, in some cases, started years ago. User Groups were first established by CDHB four years ago when the 2010 Business Case was written. Health Planners and User Groups met to establish the physical environment they needed to deliver their respective models of care that would fit CDHB's Health Services Plan & Vision 2020. These early discussions involved everything from, do you need a photocopier and shredder, can lounge space be shared between different patient groups, to how many beds do you need. Health planners create a Schedule of Accommodation (SoA), which is a list of room types, sizes and numbers required. They then create a Functional Design Brief (FDB) document that describes how a service works and explains the spaces listed in the SoA. This is passed on to the architect who creates a set of drawings that reflects the brief.
The Australasian Health Facility Guidelines provide a set of guidelines for planners in terms of specific requirements that different units need. For instance, an After Hours Blood fridge needs 3m2, a standard 1 bed room that will accommodate 1 patient, 1-2 staff and 1-2 visitors needs 15m2 and 4m2 has to be allocated for bays for holding meal trolleys and wheel chairs.These guidelines are reviewed and benchmarked every few years to ensure they are current.There are also constraints that come from the New Zealand Ministry of Health who determine certain elements, such as the number of beds in the hospital.
Robust discussion – is the simple answer. The first step in all the meetings is to outline the scope and process of the group, define the current situation and then develop discussion points. The User Group represents people who are working with our patients and in the environments that we want to improve. Whether it's the time different categories of patients spend in the unit or the length of a pacing circuit, they know what the patients prefer and also what is most efficient for them. Initially discussions revolve around reviewing the SoA and FDB, and creating mud maps of spaces and functions and how they relate to each other.At the meetings the drawings are projected onto a whiteboard and User Group members, the health planner and architect talk through the ideas, any changes that have been suggested and the flow of the unit. The regular meetings are a chance to flag any concerns about the design as it develops and to voice opinions about what they like and/or don't want changed. It is not unusual at this stage for many versions of the plans to be developed and discarded.Decision making revolves around which way do doors open, where do you put nurse stations so they have oversight over the ward but also sub-waiting rooms for families, and what equipment do you ne ed that is specific to an area, such as special lights, or general such as purge valves to deal with odours. Radiology, for instance, is screening 1,200 patients a week so how do you fit everything together so there are no log-jams?
Each area being designed needs a user group familiar with the needs of that service, and patient group. So for each area there is a user group established. The user groups are made up of varied representatives of the care team – nursing, medical, allied health, administration, technical and at times representatives from other areas such as security, other clinical teams etc. Consumer representation is also important and user groups have adopted various methods for ensuring con sumer participation.The Family Advisory council has had input from the perspective of parents and guardians of children who need hospital care. Radiology are dealing with issues such as where do you put the MRI scanner in Christchurch's new acute medical s ervices building so that it is not affected by trucks passing nearby and so that it will not adversely impact on nearby patients?For the Emergency Department User Group the issue of access to a CT scanner for resuscitation patients is one of the many items that is key to making their space work for them. In Paediatrics, they would like sound proofed cubicles so children can't hear if another child is crying.
Users of the system are seen as a key stakeholder in informing the design of the new hospitals so it is vital they are involved in generating and co-producing ideas. User Groups are driven to ensure they get the best design for their area but whilst acknowledging the obvious constraints of size and funding and the 'bigger picture' of making their area fit in a wider facility.
They talk more. There are elements of the build that can continue in parallel to the User Group meetings, so if something is unresolved, the planners head back to the drawing board and rework the design. If everyone is mostly happy with the design with just a few issues to still resolve the design is signed off with caveats. "Many caveats are only because the plan needs to mature in future stages. It needs more detail or there has been a hiccup in the flow of information," says Project Manager Christine Corin. "It can be a matter of playing catch up as that information comes through."
User Group approved plans are presented to the Clinical Leaders Group (CLG) for approval. A representative from the User Group attends Clinical Leaders Group meetings and presents the thinking and journey to date that has resulted in the plan being approved. They outline key flow and operational items and also caveats that are waiting to be resolved in the next stage of planning. CLG then either approve or reject the plan and may include additional caveats of their own. Approved plans proceed to the next stage of design. During this process the project team ensure the plans and their progress are shared with governance team members (CEO, Executive Director of Nursing, Executive Director of Allied Health) so that when CLG approves a plan it is also generally endorsed by the Governance group.
The User Groups are made up of members that represent their particular units. It's their role to be the voice for the unit. After each User Group meeting, the health planner and architect take what was discussed, rework the drawings and send these back to the User Group members. The members are required to take the new designs back to their respective units and share them with staff. They collect the feedback and ideas, which they bring to the next round of User Group meetings. Once everyone is happy with the design, the User Group members sign it off. Throughout the design process regular presentations on planning by each user group are made to the Clinical Leaders Group, who also sign off on the plans.
Several years ago, CDHB determined it would be beneficial for all parties to set up a Clinical Leaders Group that would bring clinical leadership and governance across the DHB. The idea is that doctors, nurses and other health professionals are best placed to encourage performance improvement amongst peers and should be involved in leadership. The Clinical Leaders Group that is involved in the development of the Christchurch Hospital, Burwood Health campus and CERA's health precinct comprises Chiefs and Chairs of services, Directors of Nursing, Allied Health leaders and Executive Management Team Leaders.