1. Inova Health System
Evidence-Based Design: Inova Fairfax Hospital’s Journey September 16, 2009
Reuven Pasternak, MD
Chief Executive Officer
Inova Fairfax Hospital Campus
Executive Vice President for Academic Affairs
Inova Health System
Falls Church, VA 1 1

2. Evidence-Based Design: Inova Fairfax Hospital’s Journey
Objectives
At the conclusion of the presentation, the participant should be able to describe:
1. At least 3 ways Inova Fairfax Hospital is incorporating evidence-based design elements to enhance patient safety and quality of services delivered.
2. The impact of evidence-based design on clinicians.
3. The role of clinicians in planning the building to reflect evidence-based design. 2 2

3. Inova Fairfax Hospital: Unique Role in the Community
833 licensed beds + COPN for 43 obstetrical beds
Only Level 1 Trauma Center in Northern Virginia
Fourth highest birth rate in the United States
Highest level of neonatal intensive care in Northern Virginia
Only Obstetrics-Gynecology Clinic for disadvantaged expectant mothers in Fairfax County
Only dedicated heart and vascular care hospital in the area
Highest level of critical care, including organ transplants / neurosurgery
Key provider of medical education and research 3 3

4. Inova Fairfax Hospital: Unique Service for the Community
Named a HealthGrades America’s 50 Best Hospital™ for 2009
One of only 6 nationally accredited Primary Stroke Centers in Virginia
Received national Magnet Recognition for Excellence in Nursing Quality for the last 10 years
One of five AA+ rated healthcare organizations in the country 4 4

5. The Need: Impetus to Begin a Journey
Main patient care tower:
over 40 years old
lacks private rooms
inadequate mechanical
and electrical systems
Patient rooms are significantly undersized for current patient and family needs. 5 5

6. The Need: Impetus to Begin a Journey
Unclear wayfinding (locating services)
Women’s services significantly outgrew the current facility capacity 6 6

7. The Need: Population Growth7 7

8. The Need: Aging Population8 8

9. The Need: Demand for Obstetrics9 9

10. What is Evidence-Based Design (EBD)?
Center for Health Design (CHD) defines EBD as:
“The deliberate attempt to base building decisions on the best available research evidence with the goal of improving outcomes and of continuing to monitor the success or failure for subsequent decision-making.”
(Ulrich et. al. 2004) 10 10

11. Inova Health System: Mission, Vision, Beliefs
To improve the health of the diverse community we serve
through excellence in patient care, education and research.
V I S I O N
To be the best health care system in the world.
B E L I E F S
Trust. Respect. Compassion. Empowerment. Integrity. Partnership. Quality. Value.
O U R C O M M I T M E N T S
Innovative Excellence. Caring about People. Community.
Excellence in
health care, education
and research
P A T I E N T C E N T E R E D C A R E
CONTINUOUS QUALITY IMPROVEMENT
VISION ● BELIEFS
MISSION ● COMMITMENTS Q U A L I T Y S E R V C O P G W H M N 11

12. Evidence-Based Design Elements: Linkage to Pillars12 12

13. Inova Fairfax Hospital13 13

14. Evidence-Based Design: The Journey with Eyes Wide Open
Effects of healthcare environmental design on medical outcomes
What does the literature reveal? 14 14

15. Evidence-Based Design Wheel (Geboy, L. , 2007
Evidence-Based Design Wheel (Geboy, L., Healthcare Design 7(2): 41-42) 15 15

16. Single versus double rooms Noise Windows versus no windows
How Strong is the Evidence? Examples of Environmental Properties that Affect Outcomes
Single versus double rooms
Noise
Windows versus no windows 16 16

17. Single vs. Double Rooms: Safety
Single rooms have lower infection rates than semi-private rooms or open bays (Van Enk and Nyirenda)
Fall rate decreases in single rooms (Brandis)
Falls reduced 75% at Clarion Methodist Hospital by changing double rooms to single rooms
Wide bathroom doors prevent falls
Room transfers are associated with increased medical errors
Due to communication discontinuities between staff 17 17

18. Single vs. Double Rooms: Nurses Prefer Single Occupancy Rooms
Nurses favor single-occupancy rooms (Chaudhury, Mahmood, Valente, 2006)
Flexible family accommodation
Suitable for patient exams
Higher patient comfort level
Improved patient recovery rate
Lower rates of medication errors
Less probable diet mix-ups 18 18

19. Single vs. Double Rooms: Patient Satisfaction/Costs
Roommate can be source of stress (Ulrich, 2004)
Higher patient satisfaction (Press Ganey)
Confidentiality / Privacy (Pease and Finlay, 2002)
Reduced embarrassment
Opportunity for family members to participate in care
Avoidance of upsetting other patients
Incompatibility among roommates leads to costly room transfers (Pebble Project-Bronson Methodist) 19 19

20. Single vs. Double Rooms: Noise
Noise negatively impacts outcomes
Widespread annoyance among patients and perceived stress in staff (Hilton, Bayo, Garcia and Garcia)
Sleep loss / sleep fragmentation (Yinnon, Hilton, Berg)
Increased blood pressure (Yinnon, Hilton)
Noise level is a greater problem in double rooms
More frequent at higher levels
Noise results from roommate, family of roommate, staff attending roommate
Stressful for patients and caregivers 20 20

21. Florence Nightingale on Light, 1860
“Second only to fresh air… I should be inclined to rank light in importance for the sick. Direct sunlight, not only daylight, is necessary for speedy recovery… I mention from experience, as quite perceptible in promoting recovery, the being able to see out of a window, instead of looking against a dead wall…”
Notes on Nursing.: What It Is and What It Is Not, 1860.
Importance of natural light and the view of nature goes back to the era of Florence Nightingale 21 21

22. Windows Versus No Windows
Absence of windows linked with high anxiety rates and depression (Keep et al., Parker and Hodge)
Lack of windows may aggravate sensory deprivation (Ulrich)
Employees with views of nature report: (Leather et al.)
Less stress
Better health status
Higher job satisfaction (less turnover) 22 22

23. Evidence-Based Design: Staff Involvement
Clinical User Groups provide “Operational Flow”
Involved front-line staff
Involved physicians
Clinical partnership with Global Operations Teams 23 23

24. Patient Room
Configuration
Hill Rom
Room Builder Workshop 24 24

25. Hill Rom Room Builder Workshop25 25 25

26. Private Medical/Surgical Patient Room
STAFF ZONE
PATIENT ZONE
FAMILY ZONE 26 26

27. Critical Care Patient Room
STAFF ZONE
PATIENT ZONE
FAMILY ZONE
Critical Care Patient Room 27 27

28. The Journey: Beyond the Built Environment
Evidence-Based Design: Focus on complexity of work environment, physical space, and technology
How do we enable the provider to spend more time at the bedside? 28 28

29. Leveraging Technology: Impacting the Built Environment
University of Pittsburgh Medical Center Shadyside Smart Room™ technology
Patient involvement (patient education, discharge instructions)
Alerts (time for repositioning, patient on “falls precautions”)
Simulation: experimentation before implementation 29 29

30. Evidence-Based Design: Sustainable Journey
Environmental Mission Statement
Inova Health System is committed to establishing an environmental program that contributes to a safer and healthier environment for our patients, employees and community. We will work diligently to develop a comprehensive environmental program for this healthcare system which is world class with sustainable and measureable outcomes.
Project is registered with United States Green Building Council
LEED certification at Silver level is anticipated 30 30

31. Sustainable (Green) Design Principles
What is “Green” Design?
Design and construction practices that significantly reduce or eliminate the negative impact of buildings on the environment and occupants in six broad areas:
Sustainable Sites
Water Efficiency
Energy and Atmosphere
Materials and Resources
Indoor Environmental Quality
Innovation in Design

32. The Journey: Current State
Economy dictated new footprint
Project redesigned to reflect ability to secure bonds / loans
Previous work to incorporate EBD has proved invaluable
Construction start date is July 2010

33. INOVA Fairfax Hospital - South Patient Tower33

34. Inova Fairfax Hospital South Patient Tower and Women’s Hospital
Inova Fairfax Hospital - South Patient Tower/ Women’s Hospital 34

35. Inova Fairfax Hospital South Patient Tower and Women’s Hospital
Design to achieve LEED Silver certification
Cistern to collect ground water
Solar panels
Green roof
Sustainable patient room materials
Sun control at windows
White roofs
High efficiency mechanical systems
Inova Fairfax Hospital - South Patient Tower & Women’s Hospital
“Green” Concepts 35 35 35 35

36. The Journey: Lessons Learned
Evidence-Based Design principles must be incorporated into the organization’s mission, values, beliefs in order to gain traction
User-input, while time consuming, ensures the organization has sought opinions of those who will provide healthcare.

37. Another Journey: Visit to China
Lessons learned