Preparation and Teamwork Key to Opening a New Hospital
Northwestern Medicine Lake Forest Hospital has been delivering care to the Lake Forest, Illinois, community since 1899. In 2011, leadership decided that to provide better patient care, it was time for a new building.
Opening a new hospital is no easy task. An Activation Leadership Team was formed, and from the early days of concepts, working with the City of Lake Forest and obtaining approval from leadership at Northwestern Memorial HealthCare, to the later stages of surveying staff and patients to help make design and process decisions, and then to the final countdown to Move Day on March 3, 2018, hundreds of thousands of hours, countless meetings, extensive training and even a Mock Move would be required to make the transition to the new hospital seamless.
Even though the new building is right next door to the current hospital, every detail had to be planned in order to move an estimated 65 to 110 patients, open an Emergency Department and perhaps even deliver a baby on Move Day.
Highly Coordinated Effort
Opening the new Lake Forest Hospital required an analysis of every piece of equipment in the old hospital, and making a decision about what would be moved, what would be added and what would be replaced. Spearheading that effort was Activation Leadership Team member Xuemei Cai, Procurement Manager, Supply Chain, Northwestern Memorial HealthCare. Once purchasing decisions were made and equipment to be moved was identified, Cai went about the task of planning to move each piece of equipment, from patient beds to an interventional room.
“It’s six months of planning for a six-hour move,” says Cai, although initial plans began in the summer of 2017, and some equipment would be moved outside of the six-hour Move Day window.
The process of moving patient beds may seem simple enough, but it would need to be highly coordinated, as new beds would have to be in place for the first wave of patients moving in the morning, and then the beds those patients leave behind in the old hospital would need to be stripped and moved, cleaned and prepared for the next wave of patients, and so on. Cai even timed each step of the process to determine how long it would take to strip a bed, move it down elevators, load it into a truck, navigate it to a staging area in the new hospital for a thorough cleaning and then deliver it to an assigned room. Every movement would be choreographed to avoid bottlenecks and stay on schedule.
Focus on Safety
Further complicating the process was the fact that the exact number of patients to be moved could not be known until Move Day (the new hospital has 114 beds). Plus, at any moment, a patient could arrive in the ED, or a new baby could be born. All scenarios would have to be planned for. Registration staff would be out in full force, as each patient would have to be officially discharged from the old hospital and then officially admitted to the new hospital upon arrival.
Care stations would be set up along the move routes to provide medical care as needed during transport. Two communication channels would be established — one for patient transport and one for patient care. An Incident Command Center staffed by hospital leadership would be able to relay critical information and make decisions as needed throughout Move Day. Hundreds of volunteers from across Northwestern Medicine would be on hand to play a role in the historic occasion.
A special moving company would help move larger pieces of equipment, with walk-throughs determining exact measurements of each space to ensure the equipment would fit through doorways and inside elevators. A Da Vinci surgical robot would need to be rolled through the tunnel connecting the old and new hospital. The tunnel is only 5 feet wide in certain sections, but using it would avoid the need to crate the precision equipment and risk damaging it during transit, even if the trip was just across the parking lot. Each piece of equipment delivered would need to be brought back online, with biomedical safety checks and IT connections made in order to ensure proper function in its new home.
Timing of key equipment movement would have to be planned carefully to ensure that critical patient care was available at all times. For example, non-critical surgeries would not be scheduled at the end of the week going into Move Day so that one set of OR equipment could be moved and brought online in the new hospital ahead of time.
Been There, Done That
Another key Activation Leadership Team member, Cindy Riehman, Program Director, Talent & Organizational Development, Northwestern Memorial HealthCare, spent more than two years planning for the training and support to ensure staff would be ready for a seamless transition to the new hospital. Riehman was on staff at Ann & Robert Lurie Children’s Hospital of Chicago when it relocated to a new facility, so she had a unique level of understanding about the impact the move would have on everyone associated with Lake Forest Hospital.
Because of her previous experience, Riehman was able to arrange for nursing directors who were part of the Lurie Children’s move to visit Lake Forest Hospital and conduct a panel for nurse leaders to ask questions and glean advice about the upcoming move. Also key to encouraging dialogue were informal monthly breakfasts with Thomas J. McAfee, president of Northwestern Medicine North Region and senior vice president of Northwestern Memorial HealthCare, and other senior leaders. These listening sessions were scheduled with each department over a six-month period, and afforded an opportunity for department directors and managers to share concerns and ask questions. Riehman took notes during these gatherings to help guide and address improvements going forward.
Riehman understood the importance of taking care of staff during the transition. She conducted pulse feedback surveys leading up to the move, which helped determine staff awareness, desire/motivation for change, and staff knowledge and ability. Results of the survey and other feedback helped guide training and support decisions.
In order to help ensure that staff and physicians would be ready to provide care in the new hospital on Move Day, Northwestern Medicine hired an outside consultant team, Cognitive Advisors, to design a staff and physician training program called MOVE READY! Everyone who would work in the new hospital was required to participate in the training, which included Building and Safety Orientation (including wayfinding), Department Orientation and five online foundational learning modules. Depending on department and role, additional training would be required for new equipment and workflows, and simulations conducted in order to practice and develop a comfort level in the new space.
Assisting Riehman was Chris Renno, program manager, Northwestern Memorial HealthCare, who Riehman says played an extremely valuable role on the Activation Team supporting physician and nurse training. Renno oversaw the online staff and physician training modules, and shared weekly completion reports with senior leaders so they could track training completion and ensure that all required training was finished prior to Move Day.
Before hospitalwide training could be conducted, select directors, managers and staff first had to be trained themselves. They, in turn, were able to lead Building and Safety Orientation tours and train their own departments on future workflows, new equipment and all other relevant aspects of their new space.
Practice Makes Perfect
Clinical simulation trainings completed for the new hospital move included emergency code response simulations to ensure code team members were receiving pages in the new facility, were able to find their way to all areas, and were able to learn to use the new equipment. Physicians, nurses and team members from Respiratory Therapy, Pharmacy, Security and Social Work were all required to attend the training sessions.
In addition, department simulations were required for all nurses and patient care technicians, utilizing real patient actors, to practice taking care of patients in the new facility prior to the opening. These simulations covered all new workflows, aspects of the new medical record and wayfinding. The simulations were designed to build staff confidence in working in the new facility prior to Move Day.
Support and Reinforcement
Reinforcement and encouragement are key to a successful training strategy, and Riehman used her creativity to support staff and physicians throughout the long months of preparation for Move Day. For example, staff who participated in tours of the new facility received “I toured” buttons to help encourage colleagues to follow suit.
One favorite reinforcement activity involved the Northwestern Medicine weekly employee newsletter and intranet page devoted to Activation, which began running a game called “Where’s Dr. Kopin?” A new photo was published each week that featured a location in the new hospital with a cartoon likeness of Jeffrey Kopin, MD, senior vice president of Northwestern Memorial HealthCare and chief medical officer at Lake Forest Hospital. Employees would email their guess at the location of Dr. Kopin based on the photo, and those who answered correctly would be entered into a weekly raffle for a prize. Participation level was outstanding, and the game became a fun way to build excitement and enthusiasm around the new hospital while reinforcing training.
Riehman herself led sessions to help clinical and non-clinical staff and leaders at Lake Forest Hospital work through various phases of change to support their teams during the transition. And to ease the stress and tension that can always accompany change, Riehman coordinated with Northwestern Medicine Lake Forest Health & Fitness Center to offer weekly self-care and wellness sessions for all staff.
New Electronic Health Record System
While the Activation Leadership Team was adding finishing touches to the Move Day plan, many others at Northwestern Medicine were hard at work planning for another project: Project One, Northwestern Medicine’s plan to launch a new, integrated electronic health record (EHR) across the health system. The new EHR would go live on March 3 — Move Day. The EHR helps patients receive seamless care at any Northwestern Medicine facility across the system. For example, a patient whose primary care physician is in DeKalb, Illinois, could see a specialist in Chicago, and that specialist could access the same EHR used by the primary care physician.
So while staff and physicians were busy training to understand new processes, workflows and even the layout of the new hospital, they were also tasked with learning how to use the new EHR system. A high level of coordination was required among staff in order to schedule, track and communicate all of the training requirements for both MOVE READY! and Project One.
After many months of planning Move Day strategy, leadership at Lake Forest Hospital scheduled a Mock Move in January 2018, six weeks prior to Move Day. The simulation allowed staff the opportunity to practice moving patients and helped identify areas for improvement. Volunteers from the Activation Leadership Team posed as patients for three patient-move scenarios: laboring mothers and their spouses; patients from the Intensive Care Unit; and two mother/baby couplets, along with the mothers’ spouses.
To test the timing of how quickly the March 3 relocation process would likely take and to identify areas to improve performance and efficiency, laboring mothers and ICU patients were moved by ambulance, and mother/baby couplets were moved through the campus tunnel system. The simulated patients were also asked to share their experiences in order to help identify ways to make Move Day a positive experience for patients.
After years of planning, the Activation Leadership Team was excited to move into the new hospital, and confident that staff and physicians were ready for Move Day. Senior leaders praised the team members who dedicated themselves to making sure every detail was planned for.
"I would use the word ‘spectacular’ to describe the work they've done over the last couple of years,” says Dr. Kopin. “To analyze what our needs are, and to translate that into being able to train the number of people that needed to be trained is amazing.”
"The activation and planning work is the culmination of thousands of hours of time and focus over the last couple of years,” says McAfee. “We had to reengineer virtually every process that we perform on a daily basis, and look for opportunities to introduce technology and change so that we could improve the way we deliver care. That required an engagement of virtually everyone in our workforce. Moreover, that had to be done simultaneously while we were doing our day jobs — running a hospital and taking care of our patients and community. It required a lot of dedication."
Dr. Kopin notes that the planning efforts would translate not just into a successful Move Day, but into better patient care at the new hospital. “I think that's a really important aspect of this,” he says. “It's not just that they did all this work so that we could move patients on March 3. What it's really about is what happens after March 3.”
Learn more about the new Northwestern Medicine Lake Forest Hospital at nlfh.nm.org.