TRADELINE_2007_Academic Medical Center Conference

1. TRADELINE: ACADEMIC MEDICAL CENTER CONFERENCETRADELINE: ACADEMIC MEDICAL CENTER CONFERENCE
SAN DIEGO, DECEMBER 3, 2007SAN DIEGO, DECEMBER 3, 2007
Mapping our UnderstandingMapping our UnderstandingMapping our UnderstandingMapping our Understanding
of Collaboration inof Collaboration in
KnowledgeKnowledge Worker EnvironmentsWorker EnvironmentsKnowledgeKnowledge--Worker EnvironmentsWorker Environments
to Academic Medical Centersto Academic Medical Centers
Dr. Debajyoti Pati, PhD AIIADr. Debajyoti Pati, PhD AIIA
HKS Inc.HKS Inc. -- Dallas, TexasDallas, Texas
Dr Arthur St Andre MD FCCMDr Arthur St Andre MD FCCMDr. Arthur St. Andre, MD FCCMDr. Arthur St. Andre, MD FCCM
Washington Hospital CenterWashington Hospital Center -- Washington, DCWashington, DC
Tom Harvey, AIA MPH FACHATom Harvey, AIA MPH FACHA
HKS Inc.HKS Inc. -- Dallas, TexasDallas, Texas
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2. ObjectivesObjectives
Review workplace strategies adopted to enhanceReview workplace strategies adopted to enhancep g pp g p
collaborationcollaboration
Understand the unique requirements of academicUnderstand the unique requirements of academic
medical centersmedical centers
Explore architectural design strategies to enhanceExplore architectural design strategies to enhance
collaboration in academic medical centerscollaboration in academic medical centers
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3. Three Pillars Of Academic Medical CentersThree Pillars Of Academic Medical Centers
KNOWLEDGE & IDEA: generationKNOWLEDGE & IDEA: generation
New procedures, new pedagogic techniques, new management stylesNew procedures, new pedagogic techniques, new management styles
Patents, copyrights, publicationsPatents, copyrights, publications
WORKFLOW DESIGN: innovationWORKFLOW DESIGN: innovation
Optimize procedures (clinical, pedagogic, managerial)Optimize procedures (clinical, pedagogic, managerial)
Innovations documented best practicesInnovations documented best practicesInnovations, documented best practicesInnovations, documented best practices
OPERATION: EffectivenessOPERATION: Effectiveness
P i d ffP i d ffPatient outcomes, student outcomes, staff outcomesPatient outcomes, student outcomes, staff outcomes
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4. The ConnectorsThe Connectors
KNOWLEDGEKNOWLEDGE
Generation
ContinuousContinuous
Collaboration &Collaboration &
InteractionInteraction
WORK FLOWWORK FLOW
Innovations
OPERATIONSOPERATIONS
Efficacy
InteractionInteraction
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5. Knowledge Workers Workplace DesignKnowledge Workers Workplace Design
Who are kno ledge orkersWho are kno ledge orkersWho are knowledge workers:Who are knowledge workers:
People who work with informationPeople who work with information
People who develop knowledgePeople who develop knowledge
People who use knowledgePeople who use knowledge
Examples:Examples:
Scientists, engineers, IT professionals, researchersScientists, engineers, IT professionals, researchers, g , p ,, g , p ,
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6. Tracing The Path Of Workplace DesignTracing The Path Of Workplace Design
Trends in knowledge worker work environment over theTrends in knowledge worker work environment over the
past decades:past decades:
Customer responsiveness, efficiency, agilityCustomer responsiveness, efficiency, agility
Less hierarchical unitsLess hierarchical units
More autonomy in decisionMore autonomy in decision--makingmaking
Team contributionsTeam contributions
Inter and IntraInter and Intra--workgroup communicationworkgroup communicationg pg p
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7. Driving ForceDriving Force
Tom Peters and Robert H WatermanTom Peters and Robert H Waterman JrJr (1982) , “In(1982) , “In
Search of Excellence”:Search of Excellence”:Search of Excellence :Search of Excellence :
…many of the best ideas produced by knowledge worker teams found…many of the best ideas produced by knowledge worker teams found
their germination in unscheduled ‘serendipitous’ encounters withtheir germination in unscheduled ‘serendipitous’ encounters with
workers outside the team.workers outside the team.
Workshop on Research Facilities of the Future, NewWorkshop on Research Facilities of the Future, New
York Academy of Sciences (1993):York Academy of Sciences (1993):York Academy of Sciences (1993):York Academy of Sciences (1993):
Emphasized need for “fostering interdisciplinary communication...andEmphasized need for “fostering interdisciplinary communication...and
alleviating the sense of isolation that has long been the lot of thealleviating the sense of isolation that has long been the lot of the
researcher” (researcher” (KreegerKreeger 1994)1994)researcher (researcher (KreegerKreeger, 1994)., 1994).
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8. Driving ForceDriving Force
In research and development laboratoriesIn research and development laboratories
i ti t h i l f i l h bi ti t h i l f i l h bcommunication among technical professionals has beencommunication among technical professionals has been
shown to be a significant determinant of technicalshown to be a significant determinant of technical
performance and the productivity of project teamsperformance and the productivity of project teams
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9. Interaction::CommunicationInteraction::Communication
Collaboration
COMMUNICATION
/INTERACTION
EFFECTIVENESS
/INTERACTION
Out of Box Thinking
INNOVATION
Out of Box Thinking
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10. Interaction DimensionsInteraction Dimensions
Three DimensionsThree Dimensions TypologiesTypologiesThree DimensionsThree Dimensions
PeoplePeople
IntraIntra--workgroupworkgroup vsvs InterInter--
TypologiesTypologies
IntraIntra--group :: Spontaneous :: Formalgroup :: Spontaneous :: Formal
IntraIntra--group :: Spontaneous :: Informalgroup :: Spontaneous :: Informal
IntraIntra group :: Scheduled :: Formalgroup :: Scheduled :: Formal
workgroupworkgroup
TimeTime
SpontaneousSpontaneous vsvs ScheduledScheduled
IntraIntra--group :: Scheduled :: Formalgroup :: Scheduled :: Formal
IntraIntra--group :: Scheduled :: Informalgroup :: Scheduled :: Informal
InterInter--group :: Spontaneous :: Formalgroup :: Spontaneous :: Formal
InterInter--group :: Spontaneous :: Informalgroup :: Spontaneous :: Informalpp
CommunicationCommunication
FormalFormal vsvs InformalInformal
g p pg p p
InterInter--group :: Scheduled :: Formalgroup :: Scheduled :: Formal
InterInter--group :: Scheduled :: Informalgroup :: Scheduled :: Informal
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11. ConservativeConservative vsvs GenerativeGenerative
Knowledge ConservativeKnowledge Conservative Knowledge GenerativeKnowledge Generative
IntraIntra--group::Spontaneous::Formalgroup::Spontaneous::Formal
IntraIntra--group::Spontaneous::Informalgroup::Spontaneous::Informal
IntraIntra group::Scheduled:: Formalgroup::Scheduled:: Formal
IntraIntra--group::Spontaneous::Formalgroup::Spontaneous::Formal
IntraIntra--group::Spontaneous::Informalgroup::Spontaneous::Informal
IntraIntra gro p Sched led Formalgro p Sched led FormalIntraIntra--group::Scheduled:: Formalgroup::Scheduled:: Formal
IntraIntra--group::Scheduled:: Informalgroup::Scheduled:: Informal
InterInter--group::Spontaneous:: Formalgroup::Spontaneous:: Formal
InterInter group::Spontaneous::group::Spontaneous::
IntraIntra--group::Scheduled:: Formalgroup::Scheduled:: Formal
IntraIntra--group::Scheduled:: Informalgroup::Scheduled:: Informal
InterInter--group::Spontaneous:: Formalgroup::Spontaneous:: Formal
I tI t S t I f lS t I f lInterInter--group::Spontaneous::group::Spontaneous::
InformalInformal
InterInter--group::Scheduled:: Formalgroup::Scheduled:: Formal
InterInter--group::Scheduled:: Informalgroup::Scheduled:: Informal
InterInter--group::Spontaneous:: Informalgroup::Spontaneous:: Informal
InterInter--group::Scheduled:: Formalgroup::Scheduled:: Formal
InterInter--group::Scheduled:: Informalgroup::Scheduled:: Informal
InterInter--group::Scheduled:: Informalgroup::Scheduled:: Informal
Effectiveness Innovation
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Effectiveness Innovation
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12. Impact of Physical StructureImpact of Physical Structure
Two dimensions of physical structure have beenTwo dimensions of physical structure have beenTwo dimensions of physical structure have beenTwo dimensions of physical structure have been
investigated with respect to interaction activityinvestigated with respect to interaction activity
(1) distance/proximity between potential communication partners and(1) distance/proximity between potential communication partners and(1) distance/proximity between potential communication partners and(1) distance/proximity between potential communication partners and
(2) degree of enclosure provided by physical barriers(2) degree of enclosure provided by physical barriers
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13. Knowledge Workplace StrategiesKnowledge Workplace Strategies
Conservative/CollaborativeConservative/Collaborative GenerativeGenerative
StrategiesStrategies
Visibility/ enclosureVisibility/ enclosure
StrategiesStrategies
Global configuration of spacesGlobal configuration of spaces
Accessibility/ proximityAccessibility/ proximity
Themes/FocusThemes/Focus
Work stationsWork stations
and circulationand circulation
Themes/FocusThemes/Focus
Neighborhoods and MainNeighborhoods and MainWork stationsWork stations
Meeting roomsMeeting rooms
Communal spacesCommunal spaces
gg
StreetsStreets
Corridors more thanCorridors more than
circulation spacescirculation spaces
Circulation ‘collection points’Circulation ‘collection points’
Support spacesSupport spaces
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14. Owens Corning World Headquarters,Owens Corning World Headquarters,
Toledo OhioToledo OhioToledo, OhioToledo, Ohio
Individual workspaces open and highly collaborative. Private enclavesIndividual workspaces open and highly collaborative. Private enclaves
available for use by any employee.available for use by any employee.
Corridors intentionally widened to encourage interactionCorridors intentionally widened to encourage interactionCorridors intentionally widened to encourage interaction.Corridors intentionally widened to encourage interaction.
Eighty teaming rooms located throughout the facility; furnished withEighty teaming rooms located throughout the facility; furnished with
presentation equipment, computer logpresentation equipment, computer log--in, and teleconferencing capabilities.in, and teleconferencing capabilities.
Survey result from more than 400 Owens Corning employees 90 days afterSurvey result from more than 400 Owens Corning employees 90 days afterSurvey result from more than 400 Owens Corning employees 90 days afterSurvey result from more than 400 Owens Corning employees 90 days after
occupancy:occupancy:
88% report a high level of teaming with departmental co88% report a high level of teaming with departmental co--workersworkers
66% report a high level of teaming across departmental boundaries66% report a high level of teaming across departmental boundaries66% report a high level of teaming across departmental boundaries66% report a high level of teaming across departmental boundaries
Source: The Integrated Workplace, USGSA, 1999
Photo Courtesy of Owen Corning
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Photo Courtesy of Owen Corning
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15. Social Security Administration Headquarters,Social Security Administration Headquarters,
Woodlawn MarylandWoodlawn MarylandWoodlawn, MarylandWoodlawn, Maryland
One “break out” area for 8 people at every 15One “break out” area for 8 people at every 15--2020
k t ti di / ti d tt d th h t thk t ti di / ti d tt d th h t thworkstations; vending/eating areas dotted throughout theworkstations; vending/eating areas dotted throughout the
plan for informal gathering; large and small conferenceplan for informal gathering; large and small conference
roomsrooms
Atria to bring more light into existing large floor plates.Atria to bring more light into existing large floor plates.
Some of the atria woven into pedestrian malls andSome of the atria woven into pedestrian malls andpp
pathwayspathways
Closed offices limited only to directors and deputyClosed offices limited only to directors and deputyy p yy p y
commissionerscommissioners
Source: The Integrated
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Workplace, USGSA, 1999 15

16. UGA Biological Sciences ComplexUGA Biological Sciences Complex
“… having informal break“… having informal break--out spaces “woven into theout spaces “woven into the
l k fl th th t k d t th d fl k fl th th t k d t th d fnormal work flow rather than tacked onto the ends ofnormal work flow rather than tacked onto the ends of
corridors in outcorridors in out--ofof--thethe--way places.”way places.”
h b kh b k “ f ll l d“ f ll l d…the break…the break--out spaces were “carefully placedout spaces were “carefully placed
conference areas to facilitate both scheduled and casualconference areas to facilitate both scheduled and casual
discussions.”discussions.”
Source: Wineman and
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Serrato, 1997 16

17. Scottish Enterprise, UKScottish Enterprise, UK
bookable hot desks and hot offices, touchdown facilities,bookable hot desks and hot offices, touchdown facilities,
t d b tht d b thstudy boothsstudy booths
flexible project spacesflexible project spaces
‘oasis’ social/service centers‘oasis’ social/service centersoasis social/service centersoasis social/service centers
an innovation theatre (for team brainstorming)an innovation theatre (for team brainstorming)
range of informal meet spaces, including a large caférange of informal meet spaces, including a large caférange of informal meet spaces, including a large caférange of informal meet spaces, including a large café
facilityfacility
traditional meeting and conference roomstraditional meeting and conference rooms
no dedicated officesno dedicated offices
So rce Working itho t
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Source: Working without
walls. Allen et al (2004)

18. Office of Government Commerce, UKOffice of Government Commerce, UK
Bright and colorful breakout areas for:Bright and colorful breakout areas for:
Greeting visitorsGreeting visitors
Meeting informallyMeeting informally
Taking a breakTaking a breakgg
Located at entrance of each floorLocated at entrance of each floor
Small tables, soft seats, refreshmentsSmall tables, soft seats, refreshments
Source: Working without walls.
Allen et al (2004)
Adjacent to mobile staff touchAdjacent to mobile staff touch--down pointsdown points
Helps OGC staff from different offices meet, exchange ideas,Helps OGC staff from different offices meet, exchange ideas,
identify opportunities for collaborationidentify opportunities for collaboration
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19. Furniture As CatalystsFurniture As Catalysts
Casual meeting areas.
Courtesy of Herman
Lobby seating
providing
impromptu
workspace.
Miller Inc.
p
Photo by
Hoachlander-
Davis
Photography
courtesy of High-tech conference Ease of reconfiguration incourtesy of
GSA Public
Buildings
Service
Marketing
High-tech conference
space with flexible
furniture arrangements
and state-of-the-art
technology.
Ease of reconfiguration in
team environments.
Courtesy of Steelcase
North America.
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Division. Courtesy of Steelcase
North America.
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20. Two Excellent SourcesTwo Excellent Sources
USGSA (1999).USGSA (1999). The Integrated Workplace: AThe Integrated Workplace: A
C h i A h t D l i W kC h i A h t D l i W kComprehensive Approach to Developing Workspace.Comprehensive Approach to Developing Workspace.
http://www.gsa.gov/gsa/cm_attachments/GSA_DOCUMhttp://www.gsa.gov/gsa/cm_attachments/GSA_DOCUM
ENT/integrated workplace rpt pdf R2OD26 0Z5RDZENT/integrated workplace rpt pdf R2OD26 0Z5RDZ--g _ p _ p _p _ _g _ p _ p _p _ _
i34Ki34K--pR.pdfpR.pdf
Allen, T., Bell, A., Graham, R., Hardy, B.,Allen, T., Bell, A., Graham, R., Hardy, B., SwafferSwaffer, F., F.
(2004).(2004). Working without walls: An insight into theWorking without walls: An insight into the
transforming government workplace.transforming government workplace. www.degw.comwww.degw.comg g pg g p gg
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21. Unique Dynamics in
Academic Medical Centers
Unique Dynamics in
Academic Medical CentersAcademic Medical CentersAcademic Medical Centers
KNOWLEDGEKNOWLEDGE
Generation
Resource AvailabilityResource Availability
ContinuousContinuous
Collaboration &Collaboration &
InteractionInteraction
WORK FLOWWORK FLOW
Innovations
OPERATIONSOPERATIONS
Efficacy
InteractionInteraction
y
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22. Operational ChangeOperational Change -- Motivating FactorsMotivating Factors
Scientific EvidenceScientific Evidence
T h l i I tiT h l i I ti CT MRI PETCT MRI PETTechnologic InnovationTechnologic Innovation –– CT, MRI, PETCT, MRI, PET
Knowledge ExpertiseKnowledge Expertise –– seasoned clinicianseasoned clinician
Process ExpertiseProcess Expertise –– e.g. IHIe.g. IHI
Regulatory RequirementsRegulatory Requirements –– The JointThe Joint
Risk ManagementRisk Management
Fiscal ImperativesFiscal Imperatives
Fear of CatastropheFear of Catastrophe –– e.g. avian flu, anthraxe.g. avian flu, anthrax
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23. Themes in Knowledge GenerationThemes in Knowledge Generation
and Utilization Workplacesand Utilization Workplacesand Utilization Workplacesand Utilization Workplaces
Knowledge generation subKnowledge generation sub--specialization can detractspecialization can detractKnowledge generation subKnowledge generation sub specialization can detractspecialization can detract
from cross discipline creativityfrom cross discipline creativity
Workflow DesignWorkflow Design OperationsOperationsWorkflow DesignWorkflow Design OperationsOperations
Translation hurdlesTranslation hurdles –– ‘Knowledge generation’ and‘Knowledge generation’ and
i t t t h t th kill di t t t h t th kill drequirements stretch our systems, the skills andrequirements stretch our systems, the skills and
experience of practitioners and resourcesexperience of practitioners and resources
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24. Operational StrugglesOperational Struggles
Passing care from one provider to anotherPassing care from one provider to another –– the batonthe baton
Comparative Standardized Clinical/
Resource Use Index
Team effectivenessTeam effectiveness –– Fulfilling expectations and sharingFulfilling expectations and sharing
information across servicesinformation across services
Delegation broader array of cliniciansDelegation broader array of clinicians3
4
1010
g yg y
Documentation overloadDocumentation overload
Input timeInput time
Display chaosDisplay chaos
2
ceUseIndex
3
4 5
6
7
8
9
A
B
CD
E F
GHI
J3
4 5
6
7
8
9
A
B
CD
E F
GHI
J
Display chaosDisplay chaos
Management of devices, process applications (e.g.Management of devices, process applications (e.g.
CPOE), data applications (e.g. EMRs), policy/proceduralCPOE), data applications (e.g. EMRs), policy/procedural
and process documentsand process documents
0
1
Resourc
55
and process documentsand process documents
Communication among clinical and technical personnelCommunication among clinical and technical personnel
(within institute and with industry)(within institute and with industry)
-1
-2 -1 0 1
Clinical Performance Index
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ICU Unit XXXXXXX
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25. More Silos than Meet the EyeMore Silos than Meet the Eye
Clinical servicesClinical services
Direct providersDirect providers -- physicians, nurses, therapists, physician assistants,physicians, nurses, therapists, physician assistants,
nurse practitioners, social workers, pharmacists, nutritionists, physicalnurse practitioners, social workers, pharmacists, nutritionists, physical
therapytherapy
Clinical servicesClinical services –– radiology, laboratoryradiology, laboratory
Administrative servicesAdministrative services –– leadership, administrativeleadership, administrative
management, quality services, clerical, biomedicalmanagement, quality services, clerical, biomedical
engineering IT DES transport facilitiesengineering IT DES transport facilitiesengineering, IT, DES, transport, facilitiesengineering, IT, DES, transport, facilities
Corporate managementCorporate management
PatientsPatients -- CommunityCommunityPatientsPatients -- CommunityCommunity
IndustryIndustry
Regulatory AuthoritiesRegulatory Authorities
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Regulatory AuthoritiesRegulatory Authorities 25

26. Process Hurdles Idea and Workflow DesignProcess Hurdles Idea and Workflow Design
Geographic dispersionGeographic dispersion –– multi institution systemsmulti institution systemsg p pg p p yy
CentralizationCentralization –– Decentralization tensionDecentralization tension
Meeting overloadMeeting overload –– effectivenesseffectiveness
Email overloadEmail overload
Minimal cross silo face to face timeMinimal cross silo face to face time
Time dispersionTime dispersion -- cross shiftcross shift
Industry interactionsIndustry interactions
‘Adolescent’ systems‘Adolescent’ systemsAdolescent systemsAdolescent systems
Highly configurable devices and systemsHighly configurable devices and systems
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27. VisualVisual (Inter/Intranet)(Inter/Intranet) andand
AudioAudio (Telecom)(Telecom) SolutionsSolutionsAudioAudio (Telecom)(Telecom) SolutionsSolutions
SimulationSimulation –– physical and virtualphysical and virtualp yp y
Improve procedural performance and using devicesImprove procedural performance and using devices
Evaluation and management of patientsEvaluation and management of patients
ReplayReplay TiVoTiVoReplayReplay –– TiVoTiVo
Chat roomsChat rooms
Search toolsSearch tools RemoDocRemoDoc™™Search toolsSearch tools
TelecomTelecom –– voice activation, teleconferencingvoice activation, teleconferencing
Surveillance toolsSurveillance tools -- eICUeICU
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28. Informal InterchangeInformal Interchange –– Design ImplicationsDesign Implications
Clinical arenasClinical arenas –– formal and informal ‘meeting’ spacesformal and informal ‘meeting’ spacesg pg p
Cross discipline clusteringCross discipline clustering –– Offices, Conference roomsOffices, Conference rooms
‘Water cooler’ exchange‘Water cooler’ exchange –– ‘Libraries’, Lounge areas,‘Libraries’, Lounge areas,
ElevatorsElevators
‘Enhanced’ informal meeting areas‘Enhanced’ informal meeting areas –– Cafeterias,Cafeterias,
HallwaysHallwaysHallwaysHallways
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29. How Can Physical Design Contribute?How Can Physical Design Contribute?
KNOWLEDGEKNOWLEDGE
Generation
ContinuousContinuous
Collaboration &Collaboration &
I t tiI t ti
WORK FLOWWORK FLOW
Innovations
OPERATIONSOPERATIONS
Efficacy
InteractionInteraction
y
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30. Key Characteristics to TargetKey Characteristics to Target
Foster collaborative opportunitiesFoster collaborative opportunities
Students / trainees and facultyStudents / trainees and faculty
Physicians and other and care giversPhysicians and other and care givers
Care givers and researchersCare givers and researchers
Care givers and familyCare givers and family
Complex,Complex, segragatedsegragated contextcontext
Patient Care (patient care and supportPatient Care (patient care and support
EDUCATION PATIENT CARE
Patient Care (patient care and supportPatient Care (patient care and support
areas)areas)
TeachingTeaching
ResearchResearch
RESEARCH
Connections / Linkages betweenConnections / Linkages between
NeighborhoodsNeighborhoods
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31. NeighborhoodsNeighborhoods
EDUCATION PATIENT CARE
RESEARCH
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32. Spontaneous / Informal CollaborationSpontaneous / Informal Collaboration
Corridors / HallwaysCorridors / Hallways Intersections / “Nodes”Intersections / “Nodes”
Spontaneous
collaboration
points
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33. Spontaneous / Informal CollaborationSpontaneous / Informal Collaboration
LobbiesLobbies
(entries / elevators)
“Great Spaces”“Great Spaces”
(atria / gardens)(e t es / e e ato s)
Spontaneous
collaboration
pointsp
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34. Formal / Scheduled CollaborationFormal / Scheduled Collaboration
Classroom/Lecture HallClassroom/Lecture Hall Conference RoomConference Room
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35. Formal / Scheduled CollaborationFormal / Scheduled Collaboration
Simulation LabsSimulation LabsProcedure SpacesProcedure Spaces
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36. Workflow EnhancersWorkflow Enhancers
“Physical”“Physical”
Clinical PathwaysClinical Pathways
Optimal ProximitiesOptimal Proximities
by Designby Design
Dept A
1 1
Dept A
2 2Dept B
3 3
4 4
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37. Workflow EnhancersWorkflow Enhancers
Clinical Care /Clinical Care /
P d SP d S
Multidisciplinary OfficeMultidisciplinary Office
Cl tCl tProcedure SpacesProcedure Spaces ClustersClusters
O.R.
Medicine
`
Surgery
I.R.G.I. Collaborative Cluster
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38. Operations EnhancersOperations Enhancers
Lean Design PrinciplesLean Design Principles
Sink Fridge
Minimal travel distancesMinimal travel distances
Aggregated work spacesAggregated work spaces
Spontaneous collaborationSpontaneous collaborationSpontaneous collaborationSpontaneous collaboration
opportunitiesopportunities
Stove
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39. Simulation as a ToolSimulation as a Tool
Trains, then builds individual accuracy and precisionTrains, then builds individual accuracy and precision
F ilit t t i t tiF ilit t t i t tiFacilitates team interactionFacilitates team interaction
Fosters innovation in group settingsFosters innovation in group settings
Reaction from multiple perspectives toReaction from multiple perspectives toeact o o u t p e pe spect es toeact o o u t p e pe spect es to
diverse situationsdiverse situations
Team collaboration through interdisciplinaryTeam collaboration through interdisciplinary
responsesresponses
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40. Workflow EnhancersWorkflow Enhancers
Digital Results ReportingDigital Results Reporting Ubiquitous Data AccessUbiquitous Data Access
Data Sources Patient
Room
Exam
Room
Proc
Room
IT Sim
L b
Respite
Zone
IT
LabZone
Collaborative
Correlated Analysis
Kiosk
Portal
Collaborative
Resource
Center
Instant
Consult
Center
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41. Workflow EnhancersWorkflow Enhancers
Kiosk PortalKiosk Portal
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42. Workflow EnhancersWorkflow Enhancers
InstantInstant
C lt C tC lt C tConsult CentersConsult Centers
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43. Workflow EnhancersWorkflow Enhancers
CollaborativeCollaborative
R C tR C tResource CentersResource Centers
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44. A Vision for the FutureA Vision for the Future
Nodes of Learning and CollaborationNodes of Learning and Collaboration
Casual, but highly sophisticated resource centersCasual, but highly sophisticated resource centers
Instant access to data for reference and discussionInstant access to data for reference and discussion
Progress reports on subProgress reports on sub--specialization research and discoveryspecialization research and discovery
Electronic notepads for interdisciplinary brainstormingElectronic notepads for interdisciplinary brainstorming
Emerging clinical pathways to better outcomesEmerging clinical pathways to better outcomes
Clinical “Kitchen of the Mind”
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45. Review of Design GoalsReview of Design Goals
1.1. Integrate the physical environmentIntegrate the physical environment
of academic medical centers,of academic medical centers,
d fi d b i h di i i itid fi d b i h di i i itidefined by rich, diverse inquisitivedefined by rich, diverse inquisitive
thinkingthinking
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46. Review of Design GoalsReview of Design Goals
2.2. Accommodate spontaneousAccommodate spontaneous
collaboration with convenient,collaboration with convenient,
i iti t iti f li iti t iti f linviting opportunities for casualinviting opportunities for casual
interactioninteraction
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47. Review of Design GoalsReview of Design Goals
3.3. Support collaborative learning inSupport collaborative learning in
the moment with convergence ofthe moment with convergence of
ltidi i li k dltidi i li k dmultidisciplinary work areas andmultidisciplinary work areas and
generous alternative conveninggenerous alternative convening
spacesspaces
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48. Review of Design GoalsReview of Design Goals
4.4. Inform and excite collaborativeInform and excite collaborative
thinking with convenientlythinking with conveniently
ibl i f ti t f llibl i f ti t f llaccessible information centers fullyaccessible information centers fully
linked to all data resourceslinked to all data resources
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49. Selected BibliographySelected Bibliography
USGSA (1999).USGSA (1999). The Integrated Workplace: A Comprehensive Approach to DevelopingThe Integrated Workplace: A Comprehensive Approach to Developing
WorkspaceWorkspace..
http://www.gsa.gov/gsa/cm_attachments/GSA_DOCUMENT/integrated_workplace_rpt_pdf_R2Ohttp://www.gsa.gov/gsa/cm_attachments/GSA_DOCUMENT/integrated_workplace_rpt_pdf_R2O
D26_0Z5RDZD26_0Z5RDZ--i34Ki34K--pR.pdfpR.pdf
Allen, T., Bell, A., Graham, R., Hardy, B.,Allen, T., Bell, A., Graham, R., Hardy, B., SwafferSwaffer, F. (2004)., F. (2004). Working without walls: An insightWorking without walls: An insight
i t th t f i t k li t th t f i t k l ddinto the transforming government workplaceinto the transforming government workplace. www.degw.com. www.degw.com
SerratoSerrato, M.,, M., WinemanWineman, J. D. (1997)., J. D. (1997). Enhancing communication in labEnhancing communication in lab--based organizationsbased organizations..
Proceedings of the Space Syntax Symposium University College London, London, volume 1, ppProceedings of the Space Syntax Symposium University College London, London, volume 1, pp
15 115 1 15 815 815.115.1 -- 15.815.8
Serrato,MSerrato,M.,., WinemanWineman, J. D. (1999)., J. D. (1999). Spatial and communication patterns in research andSpatial and communication patterns in research and
developmentdevelopment. Proceedings of the Space Syntax Symposium University of Brasilia, Brasilia,. Proceedings of the Space Syntax Symposium University of Brasilia, Brasilia,
volume 1 pp 11 1volume 1 pp 11 1 -- 11 811 8volume 1, pp 11.1volume 1, pp 11.1 11.811.8
Rashid, M.,Rashid, M., KampschroerKampschroer, K.,, K., WinemanWineman, J.,, J., ZimringZimring, C. (2006)., C. (2006). Spatial Layout and FaceSpatial Layout and Face--toto--faceface
Interaction in OfficesInteraction in Offices–– A Study of the Mechanisms of Spatial Effects on FaceA Study of the Mechanisms of Spatial Effects on Face--toto--faceface
InteractionInteraction. Environment and Planning B: Planning and Design, Vol. 33, pp. 825. Environment and Planning B: Planning and Design, Vol. 33, pp. 825––844844
WASHINGTON HOSPITAL CENTER
g g g , , ppg g g , , pp
49

50. Selected BibliographySelected Bibliography
Rashid, M., Zimring, C., Wineman, J., Flaningam, T., Nubani, L., Hammash, R. (2005).Rashid, M., Zimring, C., Wineman, J., Flaningam, T., Nubani, L., Hammash, R. (2005). TheThe
Effects of Spatial Behaviors and Layout Attributes on Individuals' Perception ofEffects of Spatial Behaviors and Layout Attributes on Individuals' Perception of
Psychosocial Constructs in OfficesPsychosocial Constructs in Offices. Proceedings of the Fifth International Space Syntax. Proceedings of the Fifth International Space Syntax
Conference, Delft, NetherlandsConference, Delft, Netherlands
Rashid,M., Zimring, C., Wineman, J. (2006).Rashid,M., Zimring, C., Wineman, J. (2006). Modular versus Landscaped Office: AModular versus Landscaped Office: A
C i f S B h i d E i t l P tiC i f S B h i d E i t l P ti P t d t thP t d t thComparison of Space, Behavior and Environmental PerceptionComparison of Space, Behavior and Environmental Perception. Paper presented at the. Paper presented at the
Environmental Design Research Association (EDRA) 37 Conference, Atlanta, GA, May 03Environmental Design Research Association (EDRA) 37 Conference, Atlanta, GA, May 03--0707
Penn, A., Desyllas, J., Vaughan, L. (1999).Penn, A., Desyllas, J., Vaughan, L. (1999). The space of innovation: interaction andThe space of innovation: interaction and
communication in the work environmentcommunication in the work environment Environment and Planning B: Planning & DesignEnvironment and Planning B: Planning & Designcommunication in the work environmentcommunication in the work environment. Environment and Planning B: Planning & Design,. Environment and Planning B: Planning & Design,
vol.26, no. 2, pp 193vol.26, no. 2, pp 193--218218
Oldham, G. R., Rotchford, N. L. (1983).Oldham, G. R., Rotchford, N. L. (1983). Relationship between office characteristics andRelationship between office characteristics and
employee reactions: a study of the physical environmentemployee reactions: a study of the physical environment Administrative Science QuarterlyAdministrative Science Quarterlyemployee reactions: a study of the physical environmentemployee reactions: a study of the physical environment. Administrative Science Quarterly,. Administrative Science Quarterly,
vol. 28, pp 542vol. 28, pp 542 -- 556556
Rashid, M., Zimring, C. (2003).Rashid, M., Zimring, C. (2003). Organizational Constructs and the Structure of Space: AOrganizational Constructs and the Structure of Space: A
Comparative Study of Office LayoutsComparative Study of Office Layouts. Proceedings of the Fourth International Space Syntax. Proceedings of the Fourth International Space Syntax
WASHINGTON HOSPITAL CENTER
p y yp y y g p yg p y
Conference, University College London.Conference, University College London. 50

51. Selected BibliographySelected Bibliography
Rashid, M.,Rashid, M., ZimringZimring, C. (2005)., C. (2005). Psychosocial Constructs and Office Settings: A Review of thePsychosocial Constructs and Office Settings: A Review of the
Empirical LiteratureEmpirical Literature. Proceedings of the Environmental Design Research Association (EDRA) 36. Proceedings of the Environmental Design Research Association (EDRA) 36p ca te atu ep ca te atu e oceed gs o e o e a es g esea c ssoc a o ( ) 36oceed gs o e o e a es g esea c ssoc a o ( ) 36
Conference, Vancouver, CanadaConference, Vancouver, Canada
SundstromSundstrom, E., Altman, L. (1989)., E., Altman, L. (1989). Physical environments and workPhysical environments and work--group effectivenessgroup effectiveness..
Research in Organizational Behavior , vol.11, pp 175Research in Organizational Behavior , vol.11, pp 175 -- 209209
Campbell, D. E., Campbell, T. A., (1988).Campbell, D. E., Campbell, T. A., (1988). A new look at informal communication: the role ofA new look at informal communication: the role of
the physical environmentthe physical environment. Environment and Behavior, vol. 2, pp 211. Environment and Behavior, vol. 2, pp 211 -- 226226
Hatch, M. J. (1987).Hatch, M. J. (1987). Physical barriers, task characteristics, and interaction activity inPhysical barriers, task characteristics, and interaction activity in
research and development firmsresearch and development firms. Administrative Science Quarterly, vol. 32, 387. Administrative Science Quarterly, vol. 32, 387 -- 399399
Rashid, M., Craig, D.,Rashid, M., Craig, D., ZimringZimring, C.,, C., ThitisawatThitisawat, M. (2006)., M. (2006). Sedentary and Fleeting Activities andSedentary and Fleeting Activities andgg gg ( )( ) y gy g
Their Spatial Correlates in OfficesTheir Spatial Correlates in Offices. Proceedings of the 37th Annual Conference of the. Proceedings of the 37th Annual Conference of the
Environmental Design Research Association (EDRA), Atlanta, GAEnvironmental Design Research Association (EDRA), Atlanta, GA
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