Francis Family Liver Clinic Check-In Reception Area Consolidation Case Study
Affiliation
University Health Network (UHN), 13 NU
Case Study Duration
3 months
Site
Norman Urquhart (NU) Building at Toronto General Hospital
Role
Project Coordinator, UHN’s FM-PRO Redevelopment Team
MY ROLE
Interviewer
Facilitator
Visual Designer
User Research
TOOLS
Behaviour Mapping
Engagement Tool
Patient Journey - Processes Mapping
METHOD
Field Research
Case Study
Interdisciplinary Rounds
Co-creation Facilitation
Project Background
Francis Family Liver Clinic is an integrated clinic located in the Norman Urquhart (NU) Building at the Toronto General Hospital. In 2017, the clinical team finalized the decision to amalgamate the remainder of the team to the same ward to unify the teams.
There are currently other inpatients units that share the space with Liver Clinics, including Tropical Disease Unit and Immunodeficiency Unit.
With the amalgamation of the Liver Clinic teams, the Liver Clinic team currently situated on the 10th floor (10NU) will be joining the rest of the team on the 13th floor (13NU). The three clinical departments on 13NU expect that increased patient traffic and volume will directly affect the overall patient volume and flow in the shared space.
In June 2019, due to a network-wide clinical department change at University Health Network (UHN), this project ultimately was appointed to a new Clinical Director's portfolio.
The Clinical Director engaged our project team to revisit the project scope. We conducted a case study of consolidating the three department’s check-in reception areas into one shared reception space. To ensure the integrity of the current patient flow and volumes for all three clinical departments on 13NU is achieve.
Challenge
Due to the amalgamation of the Liver Clinic teams, it is expected that patient volume would increase and will impact the Tropical Diseases and Immunodeficiency (HIV) units’ functionalities and patient experience.
How might a consolidated check-in reception space maintain or improve the integrity of the current patient flow and volumes on 13NU?
Outcome
Project team facilitated interdisciplinary round discussions with end-users and impacted hospital stakeholders to revisit proposed scope of work to develop a consensus on a shared check-in reception space for the upcoming amalgamation.
Discovery & Understand
Project Scope
The project was in the design development stage of the project architectural design process as of June 2019. At this stage, the previous project team has worked with design consultants to incorporate the preliminary rounds of end-users’ comments and needs.
The proposed scope of work included plans to implement three new examination rooms, shared amongst both the Liver Clinic and Tropical Disease teams, a dedicated Liver clinic check-out space, and additional workstations in an existing alcove.
Stakeholder Map
We began the case study by on-boarding the Clinical Director with the stakeholder engagement map, which identified whom the project will affect and the level of engagement the project required for each stakeholder group.
Our project team used this tool to engage with the appropriate groups and effectively plan and execute interdisciplinary rounds.
Field Study
Our team revisited the site with the Clinical Director to establish a basic understanding of the current layout of the ward. From our observations, there are three separate check-in spaces, which served as the patients’ initial touchpoint for each department.
After our initial site exploration, we extended our survey on the floor below. A recent 5,300 square foot interior renovation in the Diabetic Centre on 12NU was completed, and one of the implementations includes a consolidated check-in reception area. The consolidated check-in area is shared amongst both the Endocrinology and Nephrology clinical departments.
Early Concepts
From the site visits, the Clinical Director proposed two check-in consolidation options for 13NU with the goal in mind: To maintain the integrity of the current patient flow and volumes with the amalgamation of the liver clinic teams.
Our team used these proposals to facilitate the interdisciplinary round discussions with the impacted end-users.
Patient Flow & Patient Journey
To better understand the feasibility of consolidating the reception spaces on 13NU, we spent the following days to observe the patient and staff in action and conducted interviews with Administrative Coordinators, and the Reception and Administrative Support teams from each department. From these exercises, our team learned firsthand from the front line staff members and developed a deeper understanding of the current patient flow and patient journey in the ward.
We discovered that each department’s functions widely differ from each other. For example, Immunodeficiency Clinic has many patient touchpoints in potentially six physical spaces on the west wing of the ward. With these further investigations, our team used these findings to facilitate the interdisciplinary rounds of discussions.
Interdisciplinary Rounds
Interdisciplinary Round One
In the first interdisciplinary round discussion, we invited Clinical Staff, Administrative Support Staff and the project’s Clinical Director. They collaborated with our project team to discuss the feasibility of the two options of consolidating the reception areas.
From the discussion, the end-users shared their daily workflow, which added more narrative to the patient journey map. The most important thing we learned was the physicians’ concerns about a shared reception space, as it may create a more susceptible environment for the potential spread of communicable diseases. Having to learn about the potential risks to patient health and safety, our project team, including the Clinical Director, realized the reception consolidation options might not be feasible.
Furthermore, our project team included the UHN’s internal Infection Prevention and Control (IPAC) team in the discussion. As a result, the IPAC team endorsed a shared reception desk provided that the seating area has separation and designation for patients.
Interdisciplinary Round Two
We facilitated the second interdisciplinary with the direct point of contact from each clinical department, Clinical Director and the Architect.
Having the current patient journey map, and perspectives from all of the stakeholders leading up to the second round of discussion, it allowed the interdisciplinary teams to revisit all options collaboratively. We facilitated an open discussion round to encourage all parties to review the original proposed scope of work, including the possibilities of consolidating the reception area as an additional scope of work. As a result, combining all conversations and findings, the stakeholders congregated to a final decision to not consolidate the reception area.
However, the question remains: How might we ensure to maintain or improve patient flow in the ward with the Liver Clinic amalgamation?
During the round, the Liver Clinic staff states that the original proposed scope of work in the Liver Clinic area would not change the current patient flow. As it will still encourage patients to enter and exit from the same doorway.
Challenge Redefined
Due to the amalgamation of the Liver Clinic teams, it is expected that patient volume would increase and will impact the Tropical Diseases and Immunodeficiency (HIV) units’ functionalities and patient experience.
How might we create a space that encourages a more intuitive patient flow and ultimately enhance patient experience in the ward with the Liver Clinic amalgamation?
We directed our focus on the Liver Clinic’s patient flow. Our project team facilitated a co-creation session with the end-users, Clinical Director, and the Architect to refine the Liver Clinic’s check-out space. During the co-creation, the participants listened to each other and suggested different options to rework the liver clinic check-out space. As a result, we collectively revised the Liver Clinic check-out area, and the architect was able to propose a separate exit-way. This implementation will encourage patients to exit the space after their examination with reduced square footage in the administration space as a trade-off.
Lessons Learned & Fundamentals to Success
Lessons Learned
The challenge proposed by the newly appointed director was a blessing in disguise. It allowed our entire team to revisit and refine the Liver Clinic’s new check-out area, in the hope to create a better patient and end-users' experiences. Before, the project was well underway for the tender stage. Our project team inherited the project during the initial stages of design development, whereas the stage best suited for iterations was during the schematic phase of the project.
"Jennifer was able to appreciate the need to align with established site, program and organizational standards. Collaborating with the group and developing positive relationships, as well as providing advice and guidance using graphics and presenting concept designs was instrumental in helping us finalize our plans for the project."
Sandra Grgas
Clinical Director, UHN
Fundamentals to Success
Importance of Co-Creation. As a collective, we all learned how essential it is to involve crucial individuals as part of the planning and design process. This project significantly relied on constant input from UHN’s internal stakeholders and especially the end-users.
“Guidance, oversight, and transparency are essential to fostering trust and confidence”. When the proposed implementations do not match participants' expectations or visions, the project team should invest the time to illustrate the reasons, project constraints, and, most importantly, the trade-offs. It will ensure all parties to obtain a better understanding of why a specific component of the project gets implemented the way it does. Ultimately, build trust amongst all parties.
Next Steps
The project is well underway and our project team have completed contract document phase of the project and will be proceeding out for tender in 2020 with the construction to be completed in summer 2020.