cic regional seminar leedscic.org.uk/admin/resources/david-kershawcic-seminar-p21... · 2015. 5....

www.procure21plus.nhs.uk

CIC Regional SeminarLeeds21st May 2015


Improving Patient Outcomes whilst ReducingCost of Construction through StandardisationRepeatable Rooms andStandard Components

Agenda

• Introduction• Repeatable Rooms• Standard Components• Target Cost Savings• Summary• Q&A


Introduction

David KershawPSCP Programme Director

The Challenge

• GCS – EfficiencyAgenda

Our response• Cost Reduction

Programme• National Event 2013• Repeatable solutions

Ray StephensonJulian Colaco

David KershawAndrew Wightman

Geoff RitzemaRob Lane

Alan KondysJeff Stephenson

Mike Laide

Pat PembertonAndy Vernon

Richard VenablesOliver Hollick

Gary BarnesKane Greenough

PSCM representativesRosemary Jenssen

Guy BrookesAndrew Arnold

John Hatton

Kevin DundasStephanie Brada

Adam HealCharlotte Hamman

Omar Jomeen

Virtual teams

Today’s car is 50% cheaperand… Better quality, more reliable and safer

Standardisation - The Principles...

How this has been achieved…

Standardisation with continuous improvementReuse of designs and components with mechanisation


Choice to suit our requirements and budgetChoice to suit our requirements and budgetKit Car

£25,000+Seat Leon£18,490

Skoda Fabia£13,670

VW Golf£20,500


We are putting this Principle intoPractice for NHS facilities

We are putting this Principle intoPractice for NHS facilities

Unique but expensive –reliability?

Unique but expensive –reliability?

These all use the same main componentsOnly what we interface with differs – we choose

These all use the same main componentsOnly what we interface with differs – we choose

“for six (PSCPs) to agree to develop and share theirdesigns and procure standard specifications forcomponents across the framework is, frankly, I think it’s afirst – its certainly an exemplar“ – Peter Hansford

"this is a fantastic project, it is one that will bring hugebenefits to NHS, it is about public sector working withprivate sector, saving money and delivering much betterpatient care“ – Dr Dan Poulter MP

National Event 2014

• Roll-out in Londonand Leeds

• 240+ NHS Trusts andPSCMs Designers andSuppliers

• Dr Dan Poulter MP• Peter Hansford

What has been achieved?

• Adult Acute SingleBedrooms

• 4Bed Multi-bed bays• Consult/Exam rooms• Mental Health Functional

bedrooms• Mental Health Organic

BedroomINNOVATION

INTEGRATION ANDCOLLABORATIVEWORKING

EvidenceAnalysis

EvidenceAnalysis

Process

25th March,London26th March,Leeds Ironmongery Sanitary ware Doors Windows Others

Ironmongery Sanitary ware Doors Windows Others

11

Experience+ Visits

Experience+ Visits11

a

b

Matrix +Interviews

Matrix +Interviews22

PatientValidation

PatientValidation33

Assess toCriteria

Assess toCriteria44

EBD informdesign

EBD informdesign55 Expert

PanelsExpertPanels66

Standardcomponents

Standardcomponents77

Mock-ups +Testing

Mock-ups +Testing88

mh fight clubTechnical review

mh fight clubTechnical review99

BIM level 2Fully costedBIM level 2

Fully costed10

Roll OutRoll Out11

iPad App

Sharing information innovation – schemes rolling out


Repeatable Adult Single Bedrooms

Omar JomeenHealthcare Director – Galliford Try

EvidenceAnalysis

EvidenceAnalysis11a Matrix +

InterviewsMatrix +

Interviews22

Literature review + Evidence matrix

Bedroom design incl staff / clinical design features En-suite design featuresN

et ro

om a

rea

(sqm

)

Cor

ridor

leng

th (

excl

par

titio

n)

Fam

ily sp

ace

Bed

spac

e36

00x

3700

Resu

s spa

ce36

00 x

418

5

Loca

tion

of c

linic

al w

hb

Obs

erva

tion,

pat

ient

vie

w o

fco

rrid

or

Loca

l sto

rage

Hoist

pro

visio

n

Wor

k st

atio

n

Win

dow

size

/day

light

cal

c’

artw

ork

Doo

rty

pe +

size

Net

room

are

a (s

qm)

Loca

tion

rela

tive

to b

edro

om

Posit

ion

rela

tive

to b

ed

Wc

dua

l or s

ingl

e sid

ed a

cces

s

Sigh

t-lin

e be

d to

wc,

wc

to b

ed

En-s

uite

doo

r size

, ope

ning

,re

stra

int

single bedroom assessment amendments

Assess toCriteria

Assess toCriteria44

Evidence told us:-•Sense of connection•Family space•Daylight, views and artwork

Evidence didn’t tell us:-•Position of en-suite to falls reduction•Same handed ‘v’ mirrored

Expert panel told us:-•Sufficient storage space•Positioning of furniture•Use of overhead hoists•Access to IT charging points•Informed Choice

7. Single Bedroom conclusionsEBD inform

designEBD inform

design55

compliant design features:-•bed space 3600 x 3700•en-suite HBN00-03 compliant•staff observation from corridor•daylight and views outrecommendations:-•observation + inclusion 'vs' daylight + view out•clear delineation of staff and patient zones•privacy +dignity•falls prevention•view to corridor for patient•staff base positioned for observation of group•local storage provision for clusterrepeating modules, rooms + en-suites, co-ordinate with mbb

7. Single Bedroom key criteriaEBD inform

designEBD inform

design55

1. Single solution wouldn’t work2. Standardised components + assemblies3. Variety of compliant arrangements4. Flexibility for refurbishment

Standardised assemblies:- En-suite pod/serviced walls Doors Glazed screen to corridor Bedhead trunking Clinical wash hand station Lighting

6. Expert Panel workshopsExpertPanelsExpertPanels66

8. Single bedroom mock-upMock-ups +

TestingMock-ups +

Testing88

10. En-suite podStandard

AssembliesStandard

Assemblies77

10. Pre-prepared drawings and BIM model


Fully costed10


Repeatable Adult 4Bed MBBs

EvidenceAnalysis


InterviewsMatrix +

Interviews22


Bedroom design incl staff / clinical design features En-suite design featuresN

et ro

om a

rea

(sqm

)

Layo

ut (b

ed p

ositi

ons)

Fam

ily sp

ace/

bed

cen

tres

Bed

spac

e 36

00 x

310

0

No.

and

Loc

atio

n of

clin

ical

whb

obse

rvat

ion

Loca

l sto

rage

Hoist

pro

visio

n

Wor

k st

atio

n

Win

dow

size

/day

light

cal

c’

artw

ork

Doo

r size

/pos

ition

Net

room

are

a (s

qm) s

h/w

c

Net

room

are

a (s

qm) w

c

Layo

ut s

h/w

c (c

lock

wise

from

lhs)

Posit

ion

rela

tive

to b

ed

Wc

dua

l or s

ingl

e sid

edac

cess

Hand

rail

prov

ision

Ensu

ite d

oor s

ize a

nd o

peni

ng

multi bed bay (4) assessments

Assess toCriteria

Assess toCriteria44

compliant design features:-•bed space 3600 x 3100 (3700)•staff observation from corridor and within mbb•dual access to wc•bed to bed and bed to trolley transfer

recommendations:-•observation + privacy 'v' cost + daylight•enhanced privacy and dignity•family zone enhanced buffer space•daylight and views out•view to corridor for patient

repeating modules, rooms + en-suites, co-ordinate with singles

7. Multi Bed Bay key criteria

EBD informdesign

EBD informdesign55

4

1

3

diamondmulti-bed bay

(part)

8. MBB mock-up re-testMock-ups +

TestingMock-ups +

Testing88

8. MBB mock-up conclusions

Issues:- Incursion into curtain zone

during resus and transfer Clinical whb user position Fixed cupboards impacting

on functional space

Response:- Increased overall

dimensions from 8200mmto 8450mm

Mock-ups +Testing

Mock-ups +Testing88

10. En-suite pod

StandardAssemblies

StandardAssemblies77



Fully costed10


Repeatable Consult/Exam Rooms

1a. Consult exam rooms lack of evidence

Matrix +Interviews

Matrix +Interviews22

Consult/exam room, staff / clinical design features Fixtures and furnishings featuresN

et ro

om a

rea

(sqm

)

Room

inte

rnal

dim

ensio

ns

des

k po

sitio

n

Cou

ch p

ositi

on

Patie

nt to

con

sulta

ntpo

sitio

n

Loca

tion

of c

linic

al w

hb

Mon

itor p

ositi

on a

ndvi

ewin

g

Loca

l sto

rage

Cub

icle

cur

tain

trac

kar

rang

emen

tW

ind

ow s

ize/d

aylig

htca

lc’

artw

ork

Doo

r size

/pos

ition

light

ing

floor

ing

Med

ical

gas

pro

visio

n

Fitte

d fu

rnitu

re

Spec

ialis

t fea

ture

Des

k ty

pe, r

ound

ed e

dge

set

c

Patie

nt C

hair

type

consult/exam room, 3 sided couch access, assessments

Assess toCriteria

Assess toCriteria44

compliant design features:-•clinical space 900mm width on rhs of patient,•space for changing 100mm width (rhs)•650 lhs, assuming 650 x 1950 couch•daylight and views out

recommendations:-•create distinct zones for consult separate from exam•pc screen positioned to be viewed easily by all•avoid hierarchy of seating•choice for consultant/patient seating arrangement•flexibility for MDT attendees

repeating modules, co-ordinate with other consult/exam rooms

7. Consult exam rooms key criteria

EBD informdesign

EBD informdesign55

8. Consult/exam option 01 mock-up

consult/examroom – 3 sided

corridorAlternativeconsult/exam

2 sided

3 sided

2 sided room extent 3 sided room extent

Mock-ups +Testing

Mock-ups +Testing88



Fully costed10


Repeatable Mental Health Bedrooms

EvidenceAnalysis


InterviewsMatrix +

Interviews22


Per

sona

lisat

ion

Uni

t Siz

e

Day

Lig

htin

g

Per

sona

l Sto

rage

Arti

fical

Lig

htin

g

Artw

ork

Reduce Violence & Aggression Reduce Stress & Agitation Increase Patient Safety Increase Patient Satisfaction Increase Patient Control

Increase Social Support

Increase Staff Observation

Increase Staff Satisfaction

Ther

apeu

tic E

nviro

nmen

t

Ope

nnes

s &

Sig

ht L

ines

Per

sona

l Spa

ce &

Priv

acy

Ant

i-lig

atur

e M

easu

res

Patie

ntEx

perie

nce

Staf

fEx

perie

nce

Fixtures & Fittings

Loca

tion

of th

e be

droo

m

Res

iden

tial C

hara

cter

Win

dow

Spe

cific

atio

n

Doo

r & H

andl

e S

peci

ficat

ion

Tem

pera

ture

Ven

tilat

ion

Aco

ustic

s

EnvironmentalComfort

Out

look

Design Principles

“What does this space expect of me?”• Bed position• Furniture• Storage• Personalisation

Service User co-productionmh fight club

Technical reviewmh fight club

Technical review99 “What does this space say to me?”

Bedroom design incl staff / therapeutic features En-suite design featuresN

et ro

om a

rea

(sqm

)

Cle

ar w

idth

Cle

ar d

epth

Bed

pos

ition

Sigh

t-lin

e fro

m d

oor

Wor

k sp

ace

Stor

age

prov

ision

Pers

onal

isatio

n /

artw

ork

Tech

nolo

gy

Cei

ling

heig

ht

Win

dow

size

+ op

erat

ion

Doo

r typ

e

Doo

rsiz

e +

oper

atio

n

Net

room

are

a (s

qm)

Duc

t are

a (s

qm)

Loca

tion

rela

tive

tobe

dro

om

Con

stru

ctio

n in

-situ

/pod

Doo

r typ

e

doo

rsize

,ope

ratio

n +

lock

-ba

ck

MH Functional bedroom assessments

Assess toCriteria

Assess toCriteria44

features:-100% sight-line, 2 bed positions, efficient footprint, reduced corridor length

MH functional bedroom en-suite – in-board

En-suite

sh/wc

En-suite

sh/wc

Sleep/rest

Sleep/rest

Work/play

Work/play

storagestorage

support recovery

entryentry

bedroom, 11.8sqmen-suite, 3.1 sqmduct, 0.4sqm

Mock-ups +Testing

Mock-ups +Testing88

MH functional bedroom mock up

Bedroom design incl therapeutic/nursing features En-suite design featuresN

et ro

om a

rea

(sqm

)

Cle

ar w

idth

Cle

ar d

epth

Bed

pos

ition

Sigh

t-lin

e fro

m d

oor

Wor

k sp

ace

Stor

age

prov

ision

Pers

onal

isatio

n /

mem

ory

box

artw

ork

Cei

ling

heig

ht

Win

dow

size

+ op

erat

ion

Doo

r typ

e

Doo

rsiz

e +

oper

atio

n

Net

room

are

a (s

qm)

Duc

t are

a (s

qm)

Loca

tion

rela

tive

tobe

dro

om

Sigh

t-lin

e be

d to

wc

Con

stru

ctio

n in

-situ

/pod

,gr

abra

ils

Doo

r typ

e

doo

rsize

,ope

ratio

n +

lock

-ba

ck

MH Older Adult/Organic bedroom assessments

Assess toCriteria

Assess toCriteria44

features:-100% sight-line, efficient footprint, four bed positions, sight-line to wc

MH organic bedroom in-board en-suite

En-suite

sh/wc

En-suite

sh/wc

Sleep/rest

Sleep/rest

Work/play

Work/play

storagestorage

support recovery

entryentry

bedroom, 14.3sqmen-suite, 3.8 sqmduct, 0.4sqm

bay, 0.6 sqm

Mock-ups +Testing

Mock-ups +Testing88

• En-suite comfortable, not over or under sized

• Bed type and size• Option peninsula or against the wall

MH organic bedroom in-board en-suite – room testing

Mock-ups +Testing

Mock-ups +Testing88

features:-Shallower plan depth, two bed positions, seating area within corridor

MH organic bedroom nested en-suite

En-suite

sh/wc

En-suite

sh/wc

Sleep/rest

Sleep/rest

Work/play

Work/play

storagestorage

support recovery

entryentry

bedroom, 13.8sqmen-suite, 3.8 sqmduct, 1.3 sqm

bay, 0.6 sqm

Mock-ups +Testing

Mock-ups +Testing88

Organic in-board en-suite

Increased lengthby 275mm

Increased depthby 200mm

whb

showerchair

1010mm s.o.doorset

assistance on and off wc, with two staff1. 2. 3.

adjustments made to organic en-suite post technical workshop

layout pre and post workshop

Mock-ups +Testing

Mock-ups +Testing88


Standard Components


MH components

Standardcomponents


9 Month Savings

• Total: £1,114k

• Lighting: £511K• Sanitary Ware: £319k• Ceilings: £180k• Flooring: £92k• Doors: £9k• Fire Dampers: £2k

AiredaleBuckland and Dover

CroydonDarlington Memorial

HillingdonLeighton

New CrossNottingham University

RotherhamRoyal Stoke University

ScarboroughSouthampton General

St BernardsStepping Hill

The Walton CentreWorcester Royal

Queen Elizabeth, Gateshead

Standardcomponents



Target Cost Savings


Savings Optimisation

Time

Ben

efit

100%

<0%

Ben

efit

Standardisation

Up to 11%target costsaving:Area/DesignBetter buying

Road to Savings

GCS 14.1%target

20%+Potential with:StakeholderengagementStafffamiliaritySupplierresponseLifecycle


Summary


C-Sheets


Fully costed10

Federated BIM Model


Fully costed10

iPad App

Roll OutRoll Out11

www.procure21plus.nhs.uk/club/

Roll OutRoll Out11

Accessing Standard Share

Where to implement

• New Build• Refurbishment

• Whole Rooms• Assemblies• Components

“It represents best practice in design. Wewere looking for cost-efficiency, and forefficiency in operation with improvementsin patient safety. One of the benefits of therepeatable room layout is that staff becomefamiliar with the layouts and equipmentwithin a room, and that helps them toprovide good quality care for patients.”

Capital and Infrastructure Programme Director,James Hayward

Current Development

• ED Rooms• Majors• Minor• Chair Centric


Any Questions?

Thank you

cic regional seminar leedscic.org.uk/admin/resources/david-kershawcic-seminar-p21... · 2015. 5....

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