Hospital renewal planning in the first stages

Jodi Schellenberg
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During the provincial government budget process, $2 million was promised for the renewal of the Victoria Hospital.

This week, the 3P planning process for the renewal was started, with about 40 volunteers, patient representatives and hospital employees working together.

“We have been really focused on planning for the redevelopment of the Victoria Hospital,” said Cecile Hunt, Prince Albert Parkland Health Region CEO. “It is called a 3P process and it is very much a new way of thinking about the service that we deliver, focused on our patients and supportive of our staff and communities.”

The three Ps are production, process and people, Hunt said.

“We have looked at how all of those flows interact and come together,” Hunt said.

Those working on the process were focused on four specific areas -- the front entrance of the hospital, the emergency room, the operating room and diagnostic imaging.

“I think we have had lots of hard work, coming together really trying to look at the seven flows of medicine,” Hunt said. “I think one of our major improvements is around patient access, just making sure patients will know where to go, how to find their way, trying to ensure it is very supportive also to our families who come with patients in an appropriate and culturally sensitive way.”

She said another challenge has been to make sure they are planning for the future and around new technology.

“What we have today may not be what we have tomorrow and we need to make the space flexible enough for the future, for the people we serve and for the technology we may have available to us in the future,” Hunt said.

The process started in a two-dimensional state, drawing diagrams on paper of different design layouts for the hospital, Hunt said. Once they chose the best diagrams, the teams went on to form small, but to scale, three-dimensional models.

The teams eventually took a few rooms out of their small models and built full-scale models to see if the size and space would work.

“We tested different strategies to make sure the flow was better and until you actually see it full scale, what you think works on paper in two-dimensional is very different from the full scale model,” Hunt said.

One of the most important aspects was involving the patient representatives, who gave a different point of view.

“Often I think in the past buildings may have been built to ensure good provider flow and support,” Hunt said. “Sometimes I think in the past, we believe we have had our patients at heart, but we actually have patients here today and throughout the whole week who have said, ‘That doesn’t work for me.’ Or ‘This was my experience, we would recommend this.’”

Al Loustel and his wife were both asked to be involved in the emergency room utilization group that meets once a month. From there, Loustel was asked to get involved in the 3P process as a patient representative.

“My experience here this week has been that everybody had a lot of energy to put into the process,” Loustel said.

Throughout the week, he saw a lot of co-operation, teamwork, energy and movement.

“It was interesting to see some negotiating around if you aren’t using this space, can we use it, will this work, will that work,” he said.

The whole team was eager to get the four patient representatives opinions on the work they were doing.

“From a patient perspective, it was good for me -- one, just to get involved and have some opinions but (two) that folks here were not shy about coming to me, wherever I was and asking, ‘Could you come over and take a look and tell us what you think about this?’” he said. “There was a real interest in focusing on patients, focusing on people who come to the hospital and it is good for us to have input.

“There wasn’t any place we couldn’t volunteer input or were asked to provide input into the processes,” Loustel said. “It was a really good, positive experience for patients and certainly for me.”

He is excited for the process to continue and to see the hard work pay off.

“I am most excited about a cleaner, more accessible hospital, one that I will feel good about moving into, regardless of whether I am visiting someone or I am going to become a patient there or moving into the ER,” Loustel said. “From what I have seen of the designs here, it will be a very pleasant experience … I’m glad patients were asked to be involved.”

“We had the patients give us lots of feedback about what worked for them and our staff worked in these full scale models,” Hunt said. “I think that is the piece about real people, real staff and physicians, using space that it looks quite different from paper to full scale model.”

One of the hospital team members was Corinne Delparte, a medical imagining information technologist, who was working on the diagnostic imaging model.

Although the week was exhausting, she said it has also been an amazing experience.

“(The process) allows us to design things with each other in mind,” Delparte said.

That way they were able to do things such as hook the emergency department to the diagnostic imaging X-ray rooms in their models to allow better access.

“We did do a lot of negotiations at the beginning,” Delparte said. “We moved ourselves around the building so we have an outside wall. That will allow our patients to enter X-ray directly from the outside, not having to go through the whole hospital to have an X-ray and go back to their doctor’s offices.”

Since there are lots of new technologies the current Victoria Hospital does not have, they were able to plan for items they would like to see in the city.

“We have incorporated a lot of new imagining devices,” Delparte said. “There is a new MRI in our plan, nuclear med in our plan, a breast centre in our plan. Hopefully those all grow into something real. We do have the space for it and we do have a really good flow for out patients and technologists.”

The 3P process worked really well, Delparte said.

“At the beginning it was really hard,” she said. “We started with abstract ideas and to try to form that into a plan.

“I think by having everybody in the same room, doing the same thing at the same time, saves a lot of time,” Delparte added. “We don’t have to go back to a meeting and back and forth. We, at the end of this week, have a plan.”

Before coming to Prince Albert, Delparte was in Saskatoon when the Saskatoon City Hospital was developed and presented to them by architects. She said the 3P process makes more sense, because the front line workers get more of a say.

“You need the front line workers -- they are the people who do the jobs,” Delparte said. “They what they need, they know what they need next to them, they know what their patients need.

“If you just go to the Internet and get a basic X-ray room, it might work in the majority of places, but maybe it won’t work in this one,” she added.

There are unique challenges in Prince Albert because the hospital gets patients from the north as well as close communities such as Nipawin and Melfort, which had to be taken into consideration when making the plan.

So far, Delparte loves the plan they have come up with.

“I would love to work in this tomorrow but unfortunately I have to go back to the old building and its limitations,” she said. “I am probably going to be retiring before this ever comes on board but I might be coming back as a patient. This is a really good thing for Prince Albert.”

Those working on the project have been enjoying the 3P process, Hunt said.

“I think we have heard from the people we serve directly participated in looking at the rooms and talking about the flow and giving the things that are important to them,” Hunt said. “I think, for us and our region … this is very much a first-time strategy with the people we serve.”

Having others involved in the process opened their eyes to a lot of issues they may not have considered before, she said.

The patient representatives explained it is difficult for some patients to walk from one side of the building to another if they are not mobile or have small children and asked if it was possible to bring the services closer to the patients. They reminded the staff to think about the patient too.

“I think that is what we have learned today and in our models have tested that out,” Hunt said. “We have also thought about signage -- sometimes we can have buildings that can be quite confusing and have multiple entry points.”

They also thought about parking, where STARS will land in the future and other aspects.

“This is only a beginning but we have tried to think about some of those things and I think getting feedback from staff, physicians and most of all our patients, I think has been a critical first step,” Hunt said.  “I think of the 40 people in this room I think you would hear a resounding support for this strategy.”

Since this was only the first step of the process, Hunt said they will continue work, doing more 3P workshops and working with other agencies.

“The next steps are we will continue to plan with the Ministry of Health -- we are very happy to have received $2 million for planning,” Hunt said. “We will need to have some further consultation on how we will roll out further 3Ps, how we will use some of our planning documents that are already developed and how will we bring it together to make sure it is an affordable, sustainable building that will take it into the future.”

Both MLAs for the Prince Albert region were happy to see everyone excited about the 3P process.

“It sounds very exciting,” said Victoria Jurgens, Prince Albert Northcote MLA. “I think there has been a lot of hard work and when people see how it is built and they can see what they have put into action, it helps a lot. They might make some changes in the future but his is a good first step.”

Prince Albert Carlton MLA Darryl Hickie said he sees vision and a new way of doing business.

“We have heard from the architects that they are going to take what has been done here today and incorporate that for the most part,” Hickie said. “That is what the whole issue is for 3P and the LEAN process -- see what we have, see what we can do to make it better and like my colleague said, it gives us a starting point.

“This is what we are looking at as part of the government’s investment in this renewal project for the hospital.”

Although the process is a new one, it seems to be resonating with those working on the hospital renewal.

“When you can get the people that work in the system, when you get the people that use the system, everybody all pulling in the same direction, that is always exciting,” Jurgens said. “As the MLAs, it is exciting for us to see how the dollars we are investing is actually coming to fruition.”

“People’s input is important because we don’t always understand what a patient’s perspective is,” Hickie added. “As a government, we know we need to renew, we need to put money into new projects or even renovate old projects but this is a way to look at it from the ground floor up.”

Through 3P, they are getting to hear input from the men and women who actually work in the hospital and the patients who are admitted.

“This could be a whole new way of doing business in the health-care field in Prince Albert for many, many years to come,” Hickie said. “I think what we see today is just a starting point of things to come.”

The $2 million invested will continue to fund the planning process and determining what the next steps will be.

“I’ve been talking to a few people that I worked with (in the health region) and knew in the system and they are excited for looking to the future,” Jurgens said.

“I’ve talked to some people who were just in the hospital system as well and they are very excited for this renewal and new project,” Hickie said.

He said this process will be very similar to the process used to create the new Moose Jaw hospital.

“Every project that has been started the same has received funding -- look to Moose Jaw for a clear example,” Hickie said. “We put money in to start the project, the study of the new hospital facility and now it is almost finished with this year’s budget releasing funds to finish it.

“The people of Prince Albert can feel very confident that this government will be looking at this model moving forward with the $2 million investment for renewal as the first steps to the funding of additional hospital builds.”

In the future, they will also have to consult with the architects, Hunt said. They will be taking the initial drawing and looking at some practical aspects such as heating, ventilation and air conditioning that will need to fit in the plans as well.

“We need to let those experts think about that as well.”

Organizations: Prince Albert, Victoria Hospital, Saskatoon City Hospital Ministry of Health Moose Jaw hospital

Geographic location: Saskatoon, Nipawin, Melfort Moose Jaw

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