PDC_2015_People Side of Change

1. The People Side of Change
Managing Expectations Early to
Eliminate Workarounds Post
Occupancy
Informing the transition process

2. Jennie Evans, RN, BS, EDAC, LEEP AP,
Lean Six Sigma CE
Associate Principal and Sr. Vice President
HKS Architects
Adeleh Nejati, PhD, MArch, EDAC
Architect and Design Researcher
HKS Architects
Meredith Slosberg, MBA, FACHE, CSC
Lean Six Sigma Green Belt
Deployment Leader
Organizational Effectiveness
Akron Children's Hospital
Acknowledgment: Center for Advanced Design Research and Evaluation
Principal Investigator: Upali Nanda

3. 1. Articulate the relationship between project
planning and transition planning for people.
2. Identify opportunities to deploy change
engagement directives during the project
planning and implementation process.
3. Identify why change engagement is necessary,
and effective, in all planning and design projects,
based on systematically collected data.
4. Learn about three key talking points to begin
conversations about implementation in your
organization.

4. 275,000 sf patient care tower
 75 bed NICU
 39 room emergency department
 6-OR outpatient surgery center
 High risk delivery area
Continuing to deliver on the
promises that were written in
1890, our campus expansion
will enhance the high quality,
compassionate and family-
centered care that we have
delivered to the communities
we serve for over 120 years.

6. Pre-Design Design Transition Occupancy
Visioning
Emerging Trends
Current to Future State
Site Visits
Site Visits
Dept. Mock Ups
Spaghetti Diagrams
Expectation
Check Survey
Ambassadors
Pulse points
Leadership Training
Ambassadors
Trials
Post Design Mock-up
Pulse Points
Expectation
Check Survey
Akron: Integrating Design and Change Management

7. Existing ED Future ED
39 Rooms
27,907 DGSF
26 Rooms
21,800 SF

8. Future NICUExisting NICU
59 Beds
27,843 SF
63 Private / 6 Twin = 75 Beds
68,179 DGSF

9. • Preparedness must consider model of care and work flow differences in
• Team Collaboration
• Visibility
• Walking distances
• Care delivery processes
• Post-occupancies identify spaces are not always used as intended
• Communication pathways are not established
• Team collaboration / Devices are under utilized
• Decentralized work stations are not used
• Visibility of peers
• Nurse servers are not used
• Walking Distances
Recent survey of healthcare administrators cites failure to create buy-in as one of
the top 2 barriers to sustainable change.
• American College of Healthcare Executives, Journal of Healthcare Management

10. progress
productivity
(effort)
project management timeline
human response to change
goal
change
management
area of impact
endings exploration
new beginnings
Source: Pritchett LLC

11. Pre-Design Design Transition Occupancy
Visioning
Emerging Trends
Current to Future State
Site Visits
Site Visits
Dept. Mock Ups
Spaghetti Diagrams
Expectation
Check Survey
Ambassadors
Pulse points
Leadership Training
Ambassadors
Trials
Post Design Mock-up
Pulse Points
Expectation Check
Survey
Akron: Integrating Design and Change Management

12. Survey 1
Survey 2
June 2013
Oct 2013
May 2014
ED Timeline
Survey 3
Survey 4
Jan 2015
June 2015
1. Leader Training Starts
2. Trials Start
3. Town Halls
4. Pulse Points Start
5. Trauma Room Mock up
6. Ambassadors
Design Phase
Complete

13. 1. Leader Training Starts
2. Focus Groups
Survey 1
Survey 2
Design Phase
Complete
June 2013
Oct 2013
June 2014
NICU Timeline
Trials Start
Survey 3
Survey 4
Nov 2015
June 2015

14. • Awareness
• Language and storytelling
• Messaging
• On-going dialogue
• Values and Key Behaviors
• Pulse Points

15.  Formalize it
 Overt communicate
 Venues
− Daily Huddles
− Staff meetings
− Department meetings
− Governance councils
− Town halls
− Focus groups
− Email and intranet
− Ambassadors
− Surveys

16. NICU Focus Groups, Focused Voice
Fears
• Loneliness
• Lack of help from fellow nurses
• Increased dependence on technology
• Looking incompetent for asking for help
Leadership Advocacy
• Communication technology
• Simulation time
• Parent/family expectations
Single room line of sight and patient safety

17.  When town halls don’t work
 Prn/evenings/week-ends/tight shifts
 1:10 ratio
 Flash drives or intranet
 Consistent regular messaging from leadership to staff and back
 Regular meetings for Ambassadors

19. • Respiratory
• Fast Track
• Distance to Transport
• Suture Cart
• Communication devices
• Pulse Ox
• Staffing Model
• Supply carts

20. Stake holder Issue Action
RN -Develop/implement new FT/triage
process
-Development of staffing model for new
ED
-Develop education and communication
plan
-Continue use of ambassadors, tours
and behaviors/values role out
Physicians -Staffing
-New roles/interactions with fellows
-Room assignments
-Even flow of patients through entire ED
-Develop education and communication
plan
-Recruitment
-Consider flow/teamwork when
developing new FT/triage process
NPs
Registration/Secretaries
Respiratory Integrating Transport in ED operation -continue presence at huddles in ED
-Global plan around integrating into
services in new building
Mental Health Technicians -maintaining consistent processes with
new and revolving staff
-developing guidebook for RN/MHT staff
-scripting to communicate what to
expect to families
MAs
Suture Staff -integrating suture staff in FT
-geographic separation creates some
challenges in
communication/touchdown space
-uncertainty around change at satellites
-continue to monitor, remind ED staff of
where suture staff may reside

21.  To do a regular check in with the staff
to assess their perceptions,
expectations and level of
preparedness for the move
 To use the survey results to inform
specific change engagement
initiatives
 To analyze the survey to understand
how involvement in the design of the
new facility, and new processes,
contributes to staff preparedness and
adaptation for the new move

22. ED 1: N= 47
ED 2: N= 88
14.9
51.1
31.9
4.34.5
9.1
68.2
18.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Leadership Medical staff Clinical staff Non-clinical staff
%ofParticipants
Job Role
ED 1 ED 2
12.8
6.4
48.9
10.6
8.5
2.1
10.69.1
11.4
42.0
9.1 8.0
10.2 9.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
< 6 mths < 1 yr 1-5 yrs 6-10 yrs 10-15 yrs 15-20 yrs > 20 yrs
%ofParticipants
Years of Experience
ED 1 ED 2
ED Survey Demographic

23. 16.3
8.2
71.4
4.1
9.3
2.3
86.0
2.3
0.0
20.0
40.0
60.0
80.0
100.0
Leadership Medical staff Clinical staff Non-clinical staff
%ofParticipants
Job Role
NICU1 NICU2
8.2
6.1
30.6
6.1 6.1
8.2
34.7
2.3 2.3
46.5
9.3
2.3
4.7
32.6
0.0
10.0
20.0
30.0
40.0
50.0
< 6 mths < 1 yr 1-5 yrs 6-10 yrs 10-15 yrs 15-20 yrs > 20 yrs
%ofParticipants
Years of Experience
NICU1 NICU2
NICU 1: N= 49
NICU 2: N= 43
NICU Survey Demographic

24. Level of
Involvement and
Knowledge
Type of
Involvement in the
Facility Design
Type of
Involvement in the
Process Design
Perception of Preparedness
How prepared do you feel to work in the new environment?
Perception of Adaptation
To what extent do you feel your involvement in/ knowledge of design
will help you adapt to your new environment?
Preparedness
Make ready ahead
of time
Adaptation
Adjust to a new
state

25. 3.4
1.4
1.8
1.6
2.2
2.5
3.7
0.9
1.7 1.6
2.6 2.6
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Years of
Experience
Level of
Involvement
Level of Facility
Knowledge
Level of Process
Knowledge
Preparedness Adaptation
ED1
ED2
Summary Results for ED and NICU Surveys – Mean Comparison
T-test: Significantly different from Survey 1 to 2
NICU 1: N= 49
NICU 2: N= 43
ED 1: N= 47
ED 2: N= 88
4.6
1.4
2.0
1.4
1.9
2.6
4.5
1.4
2.2
1.5
2.1
2.7
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Years of
Experience
Level of
Involvement
Level of Facility
Knowledge
Level of
Process
Knowledge
Preparedness Adaptation
NICU1
NICU2

26. Importance of involvement in design
phase will be a recurring theme today
For ED, a range of activities informed
preparedness including:
 10 trials
 Ambassadors
 Leadership training
 Interactive mock-up of trauma room
Some leadership/staff trust issues were more
pressing. Only a small core group involved.
Leadership matters!

27. 27.7
31.9
29.8
10.6
8.0
36.4
39.8
15.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Not at all A little bit Moderately so Very much so
%ofParticipants
ED1
ED2
32.7
44.9
18.4
4.1
14.0
65.1
16.3
2.3
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Not at all A little bit Moderately so Very much so
%ofParticipants
NICU1
NICU2
NICU 1: N= 49
NICU 2: N= 43
ED 1: N= 47
ED 2: N= 88

28. 23.4
21.3
36.2
19.1
10.2
39.8
33.0
17.0
0.0
10.0
20.0
30.0
40.0
50.0
Not at all A little bit Moderately so Very much so
%ofParticipants
ED1
ED2
10.2
42.9
28.6
18.4
7.0
39.5
30.2
23.3
0.0
10.0
20.0
30.0
40.0
50.0
Not at all A little bit Moderately so Very much so
%ofParticipants
NICU1
NICU2
NICU 1: N= 49
NICU 2: N= 43
ED 1: N= 47
ED 2: N= 88

29. Level of
involvement in the
facility design
Level of
Knowledge of
New Facility
Level of
Knowledge of
New Process
Preparedness
Make ready ahead
of time
Adaptation
Adjust to a new
state[S1, S2]
[S1]
ED Survey Result
Level of Involvement & Knowledge
[S1]
[S2]
Correlation
Prediction
Survey 1
Survey 2

30. Preparedness
Make ready ahead
of time
Adaptation
Adjust to a new
state[S1, S2]
Level of
Knowledge of
New Facility
Level of
Knowledge of
New Process
Level of
involvement in the
facility design
NICU Survey Result
Level of Involvement & Knowledge
[S1]
[S2]
Correlation
Prediction
Survey 1
Survey 2

31. Level of
involvement in the
facility design
Preparedness
Make ready ahead
of time
Adaptation
Adjust to a new
state
Level of
Knowledge
Process
Facility
ED only
Summary Result
Level of Involvement & Knowledge

32. Being involved in facility design was key:
• To increase knowledge of process and knowledge of environment
• To increase ED’s perceptions of both preparedness and adaptation
• To increase NICU’s perception of adaptation but not preparedness
This points to how the future design configuration affects
the current model of care. The new NICU design has a huge
impact on current model of care. The new ED is a larger space
but has less impact on the model of care. Preparedness and
adaptation seem to be more closely aligned when the new model
of care is similar to the old model of care.

33. Knowledge of facility and knowledge of process did not have the same
impact on each group.
• Knowledge of process and facility increased NICU’s perception of
their ability to be ready ahead of time.
• Knowledge of facility increased ED’s perception of their ability to
adjust to the new space.
• Knowledge of process increased ED’s perception of their ability to
be ready ahead of time.
Since our goal is to have our employees ready to utilize the
space in a way that is congruent with intended use we need to
pay attention to providing them with both types of information.
However, one group may need a certain type of information
more than the other and at different times in the transition process.

34. Pre-Design Design Transition Occupancy
Part of design team
Tour mock up
Patient care processes
Choosing design options
Workshop report outs
Regular communication
Part of design team
Tour mock up
Patient care processes
Choosing design options
Workshop report outs
Regular communication
Trialing new equip/ tech
Trial new equip/tech
Leadership training
Focus groups
Regular communication
Trial new equip/tech
Leadership training
Focus groups
Regular communication

35. 13
23
9
6 7
27
7
20
4
9 11
69
0
10
20
30
40
50
60
70
80
Part of the
Design Team
Tour Mock-up Create Patient
Care Processes
Choose Design
Options
Attend
Workshops
report outs
Regular
Communication
NumberofParticipants
ED1
ED2
10
13
10
16
8
38
5
13
7 6
3
39
0
10
20
30
40
50
60
70
80
Part of the
Design Team
Tour Mock-up Create Patient
Care Processes
Choose Design
Options
Attend
Workshops
report outs
Regular
Communication
NumberofParticipants
NICU1
NICU2
NICU 1: N= 49
NICU 2: N= 43
ED 1: N= 47
ED 2: N= 88

36. NICU 1: N= 49
NICU 2: N= 43
ED 1: N= 47
ED 2: N= 88
46.9
14.3
28.6
44.2
9.3
34.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Trial of New
Equipment &
Technology
Leadership Training Focus Groups
%ofParticipants
NICU1
NICU2
23.4
21.3
31.9
35.2
6.8
12.5
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Trial of New Equipment
& Technology
Leadership Training Focus Groups
%ofParticipants
ED1
ED2

37. Involved in
trialing new
equipment and
technology
Preparedness
Make ready ahead
of time
Adaptation
Adjust to a new
state
Involved in
leadership
training
Involved in
focus groups
Part of the
design team
Toured the
mock up
Involved in
creating the
patient care
processes in
the new
department
Involved in
choosing unit
design options
for the new
department
Attended the
workshop
report outs
either in
person or via
webex
Receive and
read regular
communication
on your unit
design
TypeofInvolvementin
FacilityDesign
TypeofInvolvementin
ProcessDesign
[S1]
[S1]
[S2]
Prediction
Survey 1
Survey 2
ED Results

38. Preparedness
Make ready ahead
of time
Adaptation
Adjust to a new
state
[S2]
Involved in
trialing new
equipment and
technology
Involved in
leadership
training
Involved in
focus groups
Part of the
design team
Toured the
mock up
Involved in
creating the
patient care
processes in
the new
department
Involved in
choosing unit
design options
for the new
department
Attended the
workshop
report outs
either in
person or via
webex
Receive and
read regular
communication
on your unit
design
[S1]
[S2]
Prediction
Survey 1
Survey 2
TypeofInvolvementin
FacilityDesign
TypeofInvolvementin
ProcessDesign
NICU Results

39. Part of the
design team
Preparedness
Make ready ahead
of time
Adaptation
Adjust to a new
state
 Touring the mock up
 Creating the patient
care processes
 Attending the
workshop report outs
ED
 Trialing new equip/
tech
 Leadership training
 Focus groups
NICU
ED & NICU
Summary Result
Type of Involvement
Process design
involvement is more
critical when the model
of care changes

40. Key Learnings: Type of Involvement
• Being part of design team led to both more adaptation and
preparedness for ED and NICU
• ED’s involvement in design activities led to more adaptation
• NICU’s involvement in process activities led to more
preparedness
We’ve said this multiple times. Being actively involved in the design
phase of the project matters when it comes to being prepared and
adapting to a new space.
Type of involvement produces different results. Understanding the type of
involvement that leads to either adaptation or preparedness help leaders select
the best activities for change engagement.

41. Summary of ED Qualitative Results
ED1 and ED2 ED1 ED2
Excited about
Newness, clean
environment, more space,
better patient flow and
processes.
Concerned about
Proximity to main hospital,
adjusting to changes,
staffing issues
Lack of involvement in
design, not enough
computers.
Communications
Facility designers
Should have
Involved more staff,
considered PICU and or
locations, design issues.
Management/ senior
leadership should have
Involved more staff,
considered PICU and or
locations
Design issues
Comments
Looking forward to prepare
for move, see new building,
staffing.

42. Summary of NICU Qualitative Results
NICU1 and NICU2 NICU1 NICU2
Excited about Private rooms, clean and
new environment
Windows New equipment
Concerned about Staffing, patient safety Size of unit vis-à-vis
response time, not able to
see babies constantly,
how to get help in
emergent situations, not
having enough time with
babies (parent
satisfaction), distance
between patients and
supplies
Nurse safety, staff
morale, proximity of staff
Facility designers
Should have
Involved more staff
members
Designed private rooms
and pods
Made rooms smaller
Management/ senior
leadership should have
Considered staffing Involved more staff Be concerned about staff
concerns
Comments Familiarize with space and
processes before moving,
tour facility, staffing
Have concerns addressed Discuss workflow and
processes, practice on
new communication
system

43. Pre-Design Design Transition Occupancy
Akron: Integrating Design and Change Management
Visioning
Emerging Trends
Current to Future State
Site Visits
Site Visits
Dept. Mock Ups
Spaghetti Diagrams
Expectation
Check Survey
Ambassadors
Pulse points
Leadership Training
Ambassadors
Trials
Post Design Mock-up
Pulse Points
Expectation Check
Survey

44. progress
productivity
(effort)
project management timeline
human response to change
GO
LIVE
endings exploration
new beginnings
human response to change
post go-live!
Source: Pritchett 2013 and Meredith Slosberg 2014

45. Design Team
 Recommend the need for pre-
design operational planning
with cross-functional teams
 Choose design team members
who will serve as ambassadors
- Provide job descriptions
 Implement initiatives to engage
staff who are not at design table
- Collect responses to specific
questions
- Post images / drawings
- Communicate
- Solicit constant feedback
Healthcare Leadership
 Integrate Change Engagement
concepts into the design/project
plans
 Create early dialogue with all
staff and continue through post
go-live
− go to the people
− use many modalities
 Establish ambassador program
− how to get many voices
while maintain a small
decision-making group
 Establish pulse point checks and
continue three to six months
post occupancy

46. • What interventions help staff prepare and
adapt and when should they be implemented?
• What kind of ripple effect do these results
(with the staff) have on the patient and family?
• What role does leadership play in the staff’s
willingness to adapt and be prepared?
• What design process is the most effective for
preparing staff for their new environment?