project report: whitehorse general hospital …...project report: whitehorse general hospital...
TRANSCRIPT
Project Report:
Whitehorse General Hospital ExpansionFebruary 2017
The current emergency department with 10 treatment spaces is undersized for the nearly 33,000 annual visits it currently handles. There is also a need for more suitable treatment spaces to help treat the types of patients and conditions that are seen. Based solely on today’s volumes, 21 spaces would be needed, which is more than double the current capacity. However, the data also revealed that a significant portion of those visits are for non-urgent or semi-urgent needs, which could be better supported within a community health setting. This means that planning for a new ED was done within the context of the whole health care system. A key assumption in project planning was that improved access to primary care services through family doctors, referred care clinics, collaborative care practices and/or drop-in clinics could effectively divert a large number of lower acuity cases from emergency departments to a more appropriate type of care. Expansion will help create an appropriately sized emergency department with 17 suitable treatment spaces to meet the community’s acute care needs.
The new two-storey hospital wing will be home to a modern emergency department (illustrated) and critical care observation area.
2.3 Goals & Objectives The following objectives were established to guide the development of the Project: Goal 1: Provide improved emergency care Objectives • improved patient flow • increased patient safety
WOOD LOOK SHEET
VINYL FLOORING
ACCENT COLOUR
SHEET VINYL FLOORING
MAIN WAITING AREA
WOOD LOOK SHEET
VINYL FLOORING
ACCENT COLOUR
SHEET VINYL FLOORING
A& D RECEPTION
Purpose of the Report
The purpose of this report is to provide key information to the public about the Whitehorse General Hospital (WGH) Expansion Project (the Project). This report describes the need for the Project, the key phases of the Project, and some of the work completed to move hospital expansion ahead and ready the staff and physicians for opening the new building in early 2018. The report explains the features and benefits of expansion, local involvement, community engagement as well as construction phases and key milestones that have been reached.
The report also details the ‘operational readiness’ (planning and preparations to move into the new space and care for patients) process such as procurement and planning activities as the hospital team prepares for the ‘first patient day’ and determines how to make the most appropriate use of the vacated and shelled space created by expansion. A summary of the key aspects of the operational readiness and space planning project charters (purpose and goals) are also provided.
The Yukon Hospital Corporation (YHC) is committed to a high standard of disclosure as part of its accountability for the delivery of this project. The organization is publicly accountable for projects through regular budgeting, auditing and reporting processes.
The YHC Project Steering Committee, which includes representatives from the hospital’s executive management team, is accountable for the contents of this project report. The steering committee receives advice/input from the project and operations teams and reports to the YHC Board of Trustees, which has ultimate accountability and oversight for meeting the project’s goals and outcomes.
An artist rendering illustrates the main entrance to Whitehorse General Hospital Emergency Department.All renderings by PCL Westcoast Constructors Inc. & CEI Architecture
3
Table of Contents
1. Executive Summary
2. Project Scope & Key Features
• Scope of Project
• Rationale
• Goals & Objectives
3. Budget Performance
4. Phase 1: Magnetic Resonance Imaging (MRI) facility and service
5. Phase 2: Construction of Emergency Department, Critical Care Observation Area & Shelled Space
• Phases & Key Milestones
• Local Involvement
• Local Service Providers
6. Phase 3: Planning & Preparations to Open New Emergency Department & Critical Care Observation Area
• What is Operational Readiness
• Purpose
• Roles & Responsibilities
• Principles
• Goals & Objectives
• Timeline
• Activities o Emergency Department o Medical Imaging o Information Systems o Admissions & Discharge
7. Phase 4: Needs Assessment & Functional Planning for Vacated & Shelled Space
• Purpose
• Goals & Objectives
• Activities o Needs Assessment o Functional Planning
• Timeline
5
6
10
10
12
15
23
4
New emergency departmentand shelled second-floor space
New ambulance station
Site plan of Whitehorse General Hospital campus shows location of expansion as well as new ambulance station.All renderings by PCL Westcoast Constructors Inc. & CEI Architecture
5
The Yukon Hospital Corporation (YHC) is a family of hospitals serving the entire territory – with a population of approximately 37,000 covering nearly 483,000 square kilometres – through facilities in Whitehorse, Dawson City and Watson Lake.
Whitehorse General Hospital is independently operated by YHC and funded in large part by the Yukon government. The facility was built on its current site on the eastern shore of the Yukon River in 1959 with major renovations completed in 1997. This work, while substantially improving the hospital at the time, was the last significant enhancement to the facility – and the emergency room was not optimally or flexibly designed to meet the changing and growing demand in hospital services.
The WGH Expansion project addresses the growing demand on acute care, increasing complexity of health care delivery and limitations caused by the current facility’s design, while enhancing and sustaining the ability of the hospital to deliver safe and excellent care – now and into the future.
The project includes a new two-storey wing to be built onto the existing hospital. This new building will be home to a state-of-the-art emergency department (ED), critical care observation unit adjacent to the ED, shelled second-floor space for future use, data centre for information technology systems and electrical and mechanical systems upgrades to support expansion. A new magnetic resonance imaging (MRI) program was opened in January 2015 as the first phase in the project.
The Project also includes considerable planning so YHC can seamlessly transition services into these new areas as well as best utilize space within the hospital.
In June 2014, following a competitive selection process, YHC entered into a performance-based, fixed-price project agreement with Siemens Healthcare Canada Ltd. to provide the MRI scanner.
As part of the $6 million agreement, Siemens secured a third-party contractor, West Med, to build a modern facility to house the MRI service.
In June 2015, following a competitive selection process, the YHC entered into a performance- based, fixed-price project agreement with PCL Constructors Westcoast Inc. (PCL) to deliver the $54.6 million construction project. PCL will design and build the project over an approximately two-year construction period.
In February 2016, following a competitive selection process, the YHC entered into an agreement with Stantec Consulting Inc. to provide planning expertise and advice so the hospital is ready to provide safe and excellent patient care in the new facility on day one. In August 2016, Stantec was also selected to support business planning support on how to best utilize the new shelled space in expansion as well as vacated space within the existing hospital building.
The total cost of the project is estimated at $72 million and funded by Yukon government. This includes elements within and outside the contract with PCL, such as design and construction costs, equipment, project management, procure-ment, implementation, and contingency costs.
YHC will remain responsible for all hospital
program and service delivery as well as the
building’s ownership, operation and maintenance.
The hospital will continue to be publicly funded
in accordance with the Canada Health Act and
operated/governed in accordance
to Yukon’s Hospital Act.
1. Executive Summary
6
As the first large-scale enhancements to WGH in nearly 20 years, the project will enhance and sustain the hospital’s capacity to provide safe and excellent care – now and into the future – to meet growing and changing needs, improve the quality of care for patients, improve access to services, and maximize staff and physician recruitment and retention.
2.1 Scope of the Project
The hospital expansion is carefully designed to meet the needs of Yukoners, ensuring the greatest benefit for the best value. The project includes a new two-storey, 40,000 square-foot wing, building on the existing hospital and will include:
• New emergency department with 17 treatment spaces
• Four-bed Critical care observation unit next to emergency department
• Design and construction of new radiology and CT rooms and associated support services
• Shelled second floor for future inpatient use (the outfit of this space is out of scope)
• New data centre to support improved information systems
• Mechanical and electrical upgrades
• Relocation of ambulance station
• Renovations to the vacated space (limited work is in scope)
• New MRI facility with reception/waiting area, patient preparation area and exam suite with scanner (completed January 2015)
Ensuring available inpatient beds is an on-going challenge for the hospital. Once construction began on the new emergency department, it was determined that building second-floor space at the same time was a cost effective solution and could be fitted at a later date for inpatient use. A comprehensive needs assessment is now underway to determine how to use this space, including what service and number of beds will meet the need. This means the fitting out of this space is out of scope in this phase of expansion.
The needs assessment, functional planning and limited renovations to vacated space are in scope. A process is now underway to determine how to make the best use of these areas as several hospital functions require more space to manage current and future growth in patient volumes and changing population demographics.
2. Project Scope & Rationale
The current emergency department with 10 treatment spaces is undersized for the nearly 33,000 annual visits it currently handles. There is also a need for more suitable treatment spaces to help treat the types of patients and conditions that are seen. Based solely on today’s volumes, 21 spaces would be needed, which is more than double the current capacity. However, the data also revealed that a significant portion of those visits are for non-urgent or semi-urgent needs, which could be better supported within a community health setting. This means that planning for a new ED was done within the context of the whole health care system. A key assumption in project planning was that improved access to primary care services through family doctors, referred care clinics, collaborative care practices and/or drop-in clinics could effectively divert a large number of lower acuity cases from emergency departments to a more appropriate type of care. Expansion will help create an appropriately sized emergency department with 17 suitable treatment spaces to meet the community’s acute care needs.
The new two-storey hospital wing will be home to a modern emergency department (illustrated) and critical care observation area.
2.3 Goals & Objectives The following objectives were established to guide the development of the Project: Goal 1: Provide improved emergency care Objectives • improved patient flow • increased patient safety
The new two-storey hospital wing will be home to a modern emergency department (illustrated) and critical care observation unit.
7
The expansion project’s scope will be carried out in four phases or stages. Progress on each of these areas are detailed in the pages of this report.
2.2 WGH Expansion Project Phases
SCOPE
• Build new MRI facility with reception/ waiting area, patient preparation area and exam suite with scanner
• Build new two-storey hospital wing with:
o New emergency department with
17 treatment spaces
o Four-bed critical care observation unit
next to emergency department
o Design and construction of new
radiology and CT rooms and associated
support services
o Shelled second floor for future inpatient
use (the outfit of this space is out of scope)
o New data centre to support improved
information systems
o Mechanical and electrical upgrades
o Relocation of ambulance station
o Renovations to the vacated space
(limited work is in scope)
• Identify, define, organize and implement activities that are necessary to occupy and provide care in the new emergency department & critical care observation area
• Determine how to best use, adapt and outfit all of the vacated and shelled space created by expansion
Phase 1: Magnetic Resonance Imaging (MRI) facility and service
Phase 2: Construction of Emergency Department, Critical Care Observation Area & Shelled Space
Phase 3: Planning & Preparations to Open New Emergency Department & Critical Care Observation Area
Phase 4: Assessment & Planning for Vacated & Shelled Space
STATUS
3 Complete and open in January 2015
• In Progress (several milestones within this phase have been met)
• In Progress (several activities within this phase have been completed)
• In Progress (several activities within this phase have been completed)
8
2.3 Rationale
In general terms, the planning process and assessment of available quantitative and qualitative data identified the primary reasons for expansion.
2.3.1 Quality and Safety
Yukon hospitals’ mission is to provide safe and excellent hospital care. Ensuring that our facilities can support and sustain our ability to meet this commitment over the immediate and long term is essential to the health and well-being of people in the territory. Along with using feedback from Accreditation Canada, WGH measured itself against the current Canadian design standards for health care facilities (CSA Z8000-11) and noted the existing emergency department was not optimally designed for:
• Infection control
• Line of sight between staff and patients
• More direct access to ED from the main entrance or ambulance bay
• Patient’s first point of contact with triage personnel
• Mass casualty incident management
• Decontamination
Quality and safety is the primary driver for expansion, which will create modern clinical space designed on the basis of best practices and standards. This will not only provide an enhanced working environment for direct care providers, but also enable us to provide the best care possible for Yukoners.
2.3.2 Yukon demographic health needs
While the Yukon population is projected to grow by up to 23% by 2024, the proportion of the population over 65 years is expected to grow by 17%. Over the same period, the 15-29 year age group is expected to decline by about 4%. What’s more, chronic disease, smoking, alcohol use, injury, acute myocardial infarction, and self-injury rates are higher in the Yukon than the Canadian average.
This demographic shift along with the territory’s unique health needs means the provision of hospital care will become increasingly complex. A larger and older population will create increased demand on WGH’s ED, Critical care, and inpatient capacity that will be extremely difficult to manage within the current space – both from a volume and quality of care perspective. Based on projections, this project will effectively meet the future acute care needs of a changing community.
YUKON POPULATION PROJECTIONS % CHANGE FROM 2014
2014 2019 2024 2019 2024
37,078 40,128 43,043 8.20% 16.10%
Age Cohorts as a Proportion of Overall Yukon Population
30-6454%
30-6453%
30-6452%
65+11%
65+14%
65+17%
0-1416%
0-1416%
0-1416%
15-2920%
15-2917%
15-2915%
2014 2019 2024
9
2.3.3 Health care delivery
The current emergency department with 10 treatment spaces is undersized for the between 33,000-34,000 annual visits it currently handles. There is also a need for more suitable treatment spaces to help treat the types of patients and conditions that are seen. Expansion will help create an appropriately sized emergency
department increasing treatment spaces from 10 to 17 in order to meet the community’s acute care needs. The spaces will be optimally designed for care, increase privacy and enhance patient safety, comfort and security.
2.4 Goals & Objectives
The following objectives were established to guide the development of the Project:
Goal 1:Provide improved emergency care
Objectives
• improved patient flow
• increased patient safety
Outcomes
• improved patient experience
• improved quality of emergency care
Goal 2:Provide improved healing environment
Objectives
• improved delivery of care
• increased staff safety and productivity
Outcomes
• Decreased average length of stay
• Improved staff retention
Goal 3:Ensure sustainable building and services
Objectives
• Established energy efficient and sustainable design
• Improved space for staff and physicians to support recruitment and retention efforts
• Implemented Lean principles for design to ensure facility supports improved staffing and operational efficiencies
Outcomes
• Sustainable staffing and operational systems
• Engaged, supported people
Goal 4:Provide improved diagnostic imaging services
Objectives
• Decreased associated medical travel expenses
• Enhanced local diagnostic services
Outcomes
• Better access to diagnostic services
• Improved patient experience
• Better health outcomes
10
3. Budget Performance
4. Phase 1: Magnetic Resonance Imaging (MRI)facility and service
Whitehorse General Hospital offers a range of medical imaging services, including radiography, fluoroscopy, ultrasound, CT and digital mammography. The addition of Magnetic Resonance Imaging (MRI) meets a significant health need in the territory and improves access to care.
MRI is an advanced and safe test that uses a magnet and pulses of radio waves to make images of organs and structures inside the body. The technique is widely used in hospitals for medical diagnosis, staging of disease and for follow-up.
The MRI facility at Whitehorse General Hospital is the first of its kind North of 60 in Canada and is a key part of the hospital’s expansion. The MRI service opened in January 2015 on time and under budget.
Highlights include:
• a state-of-the-art 1.5-Tesla SiemensMagnetom Aera MRI scanner
• a beautiful back-lit photo of northern lightsover Two Moose Lake, Yukon, on the ceilingabove the scanner, designed to offer patientcomfort by providing a focal point duringan exam
• patient preparation areas
• a reception and waiting room
The Yukon Hospital Foundation spearheaded a two-year campaign that raised $2 million to purchase the MRI scanner – an effort that was overwhelmingly supported by residents, businesses and community organizations across Yukon. The Yukon government matched this $2 million in funds and then contributed an additional $2.8 million to build the facility.
MRI Budget Final Expenses
Construction 3,199,825 2,848,806
Equipment 3,373,433 3,357,615
Project Planning & Management 219,853 181,652
Total 6,793,111 6,388,073
EMERGENCY DEPARTMENT & SHELLED SPACE Budget Expenses to Date (Dec. 31, 2016)
Construction 54,660,700 39,723,583
Equipment 4,447,000 609,685
Project Planning & Management 4,244,519 2,136,504
Renovations to Vacated Space 1,851,000 19,837
Total 65,203,219 42,489,610
Total Budget 71,996,330
11
4.1. Procurement
After a competitive Request for Proposal (RFP) process, Siemens Healthcare Canada Ltd. was selected to supply Whitehorse General Hospital with the MRI scanner. As a part of the agreement with Siemens, the company secured a third-party contractor, West Med, to build the new, modern facility that is now home to the MRI program.
4.2 Local Involvement
Local sub-trades made significant and quality contribution to the building of the MRI facility, including:
• Carpentry
• Construction equipment and materials
• Millwork
• Electrical, plumbing and heating
• Civil design
• Signage
4.3 Needs Assessment & Planning
WGH undertook a comprehensive needs assessment and business planning process before construction started on the MRI facility. The assessment looked at, among other things, space requirements, the number of Yukoners traveling outside the territory for an MRI scan as well as MRI utilization rates in other jurisdictions across Canada.
Before the introduction of the service in Yukon, about 600 people travelled outside the territory for a scan. In addition, looking at how other provinces use MRI, Yukon was expected to conduct 49 scans for every 1,000 residents. Based on this information the hospital estimated about the MRI would conduct about 1,800 patient exams each year.
As of the date of publication (January 2017), the actual numbers show that more than 2,000 scans were conducted at WGH in each of the first two full years of service..
4.4. Scope of Service
WGH offers MRIs for a wide range of health conditions, but does not provide some very specialized, higher risk procedures such as those with neo-natal patients who require sedation or interventional (used during surgery) MRI exams. This means about 5-10% of individuals who require MRI may still have to travel outside of Yukon for a scan.
4.5 Benefits of MRI Service
4.5.1 Improved and timelier access to care
While wait times for an MRI scan may vary based on the urgency, Yukoners continue to receive a scan here sooner than outside the territory. For example, numbers show that the average wait for an urgent MRI in BC and Alberta is five weeks, while in Yukon these scans are provided within seven business days.
4.5.2 Reduced patient stress and cost
Thousands of Yukoners have been able to stay at home rather than travel south for this important test. This means less time away from family and work, which has a positive impact on patients and the overall health care experience. By making this MRI available here, more Yukoners have been able to have this test. In fact, three times the number of MRI scans are being conducted now as compared to before the introduction of this service.
4.5.3 MRI raises the standard of care
MRI is considered a required standard for any major health care facility. The addition of this sophisticated diagnostic and assessment equipment has enhanced health care for the entire territory. This means that Yukoners now have a vital health service available to support patient needs, as well as an advanced tool to support our physicians and clinical teams. This will help attract top talent to the territory.
12
YHC selected PCL Constructors Westcoast Inc. to design and build the new two-storey hospital wing. A summary of the final design-build agreement is provided in the Project Report published in November 2015.
This publication and the DBA agreement (along with other project documents and resources such as the Needs Assessment) are available for download from our website at www.yukonhospitals.ca/ wghexpansion under ‘Publications & Resources’.
5. Phase 2: Construction of Emergency Department, Critical Care Observation Area & Shelled Space
An artist rendering illustrates an aerial view of the exterior of Whitehorse General Hospital with the new two-storey wing pictured on the right.
Quick facts about the final project agreement
Design-Builder
Project Owner
Contract value
Construction complete
Term of Agreement
PCL Constructors Westcoast Inc. & CEI Architecture
Yukon Hospital Corporation
$54.2 million (without GST)
Fall 2017
June 4, 2015 to est. September 2017 (once YHC and PCL have completed all requirements of the DBA).
13
SCHEDULE
September 2015
September 2015 to March 2016
April 2016
April 2016
July to September 2016
April to September 2016
September 2016
November 2016
May 2017
September 2017
January 2018
STATUS
3 Complete
3 Complete and Open
3 Complete
3 Complete
3 Open
3 Complete
3 Complete
3 Complete
• Upcoming
• Upcoming
• Upcoming
MILESTONE
Initial site preparation
New ambulance station
Old ambulance station demolished
Demolition on exterior of existing hospital building
New public parking area – additional 48 spaces
Expansion foundation and steel structure
Final concrete pour
Expansion ‘clad to weather’
100 Days to Substantial Completion
Substantial Completion
‘First Patient Day’ in new emergency department and critical care observation area
A timeline of key construction milestones and status
The new two-storey hospital wing will be home to a modern emergency department (illustrated) and critical care observation area.
5.1 Key Milestones
14
5.2 Local Involvement
Local businesses and specialized trades have made a significant and quality contribution to the Project. As part of the commitment to ensure as many Yukon companies as possible benefit from the hospital expansion, both YHC and PCL have worked together to promote local involvement whenever possible.
Two business-to-business networking sessions were held – one during the procurement process for a design-build partner and one after the successful proponent (PCL) was selected. It provided local businesses and sub-trades
opportunities to promote their services and build market awareness for the Project builder. PCL also signed an agreement with Local 2499 of the Carpenters’ Union to use Yukon skilled labour.
As the design-builder, PCL contracts directly with sub-trades and other vendors to fulfill its obligations on project budget and timelines established in its agreement with YHC. During and prior to the construction process, local businesses contact PCL about active or upcoming opportunities and are invited to participate in a competitive selection process.
MILESTONE
PCL monitors local involvement on the construction site and reports to YHC on a monthly basis:
100%
80%
60%
40%
20%
0%
May 2016 June 2016 July 2016 Aug. 2016 Sept. 2016 Oct. 2016 Nov.2016 Dec. 2016
69%
53%62%
54% 50%42%
7% 7% 8% 6% 5% 9% 12%
PCL SUB-TRADES LOCAL
92%
41%
15%
85%
93%93% 92% 94% 95% 91% 88%
Local sub-trades have represented 60% of the total on-site time since June 2015
15
5.3 Local Service Providers
As of December 2016, about 75 Yukon-based companies have been part of the project. In fact, nearly 60% of work on the construction site is performed by local businesses and sub-trades. In addition, many other local companies that provide goods and services have realized significant benefit from hospital expansion. These include:
• Demolition and excavation
• Electrical, plumbing and heating
• Carpentry
• Concrete and paving
• Construction equipment and materials
• Windows and overhead doors
• Painting
• Flooring
• Signage and window film
• Millwork
• Printing and graphic design
• Landscaping
• Transportation, accommodation and other services
• Waste management and remediation
• Engineering services
• Civil design
WGH Expansion was ‘clad to the weather’ in November 2016.
6. Phase 3: Planning & Preparations to Open New Emergency Department & Critical Care Observation Area
Construction is just one component of the expansion project. Just as important is the planning and preparation to seamlessly transition into the new space and provide exceptional care on day one. This process of getting people, treatment areas, work spaces, policies and equipment in place and ready is known by the formal term ‘operational readiness’.
YHC has undertaken a comprehensive ‘operational readiness’ planning and implementation process
to ensure the organization is fully ‘ready for the first patient day’ and can achieve normalized hospital operations within two months or less.
Readiness includes a wide range of activities that will identify, define, organize and implement the components that are necessary to occupy and provide care in the new space in a safe and timely manner.
16
WOOD LOOK SHEET
VINYL FLOORING
ACCENT COLOUR
SHEET VINYL FLOORING
MAIN WAITING AREA
Once the new building is complete and open to the public, Yukoners will use access. Pictured is an artist rendering of the new emergency waiting area.
6.1 Purpose
The purpose of operational readiness is to have the:
• right people;
• right place;
• right time;
• right equipment and technology; and
• right policies and protocols in place for the first patient day
Operational readiness is not an isolated process or project – it is integrated into other phases of the Project as well as other on-going plans and initiatives within the organization.
In fact, operational readiness is a critical part of the overall strategy for the hospital to achieve its goals. YHC wants to ensure the consistent application of organizational priorities and principles.
Most significantly, readiness supports YHC’s people. This means hospital (clinical and
support services) and medical staff are looking at what they do today and what they will need to do in the new space. This work includes assessing, analyzing and designing patient flows, work processes, communications plans and training plans. Equipment needs and other considerations will also be identified that have an impact on the hospital’s efficiency and effectiveness.
When the emergency department and critical care observation area reaches substantial completion (construction is complete), there will be a short window of time before the new space opens that gives the organization an opportunity to test, learn and refine protocols and practices in the new space. Some activities will include mock run-throughs, process and procedure tests, tours to help staff and the public to become more comfortable and familiar with the new space.
17
YHC secured a third-party vendor to support the planning process with an ‘Operational Readiness and Transition Plan’. The timeline of the competitive selection process for operational readiness is outlined in the table below.
TIMING
January 2016
February 2016
March 11, 2016
March 31, 2016
OUTCOME
YHC issued RFP to select a proponent to provide readiness planning support. Submissions were received from four proponents.
Submissions were evaluated in two parts: • Meet the mandatory requirements as detailed in RFP
• Submissions that met the mandatory requirements
were evaluated using the following criteria:
o Comprehensive work plan that demonstrates
understanding of project requirements
o Approach
o Experience with projects of equal or greater complexity,
in healthcare and hospital sector, in northern remote
locations, and with private and public sector entities
o Cost
Stantec Consulting Inc. was selected as the preferred proponent
Operational Readiness and Transition planning underway
PROJECT STAGE
Request for Proposal
Evaluation
Award
Work Commenced
6.2 Procurement Schedule
6.3 Planning Principles
• YHC’s mission and goals are the basis for new initiatives, decision-making and deliverables
• Planning is being undertaken through engagement of our health system, industry and government partners to ensure appropriate integration and coordination of services
• Yukon’s First Nations communities will be engaged in operational readiness and transition planning through WGH’s First Nations Health Program
• YHC’s department operational plans will include the development and implementation of operational readiness and transition plans
• An operational readiness and transition planning roadmap will be used from the beginning to the close of the Project.
• Collaborative teams of hospital and medical staff will be formed and engaged to ensure a successful transition and change.
• Transparency and communication channels will be developed and maintained to ensure the commitment, involvement and empowerment of all internal and external stakeholders.
• YHC will follow its established project management process for capital and operational requests.
• New capital equipment needs will be assessed and aligned with YHC’s current procurement and asset life-cycle.
• Availability of our people will be aligned with activities required for a successful ‘first patient day’.
18
6.4 Goals on First Patient Day
SUPPORT PASSIONATE & ENGAGED PEOPLE
• Ready to provide effective patient and family centred care
• Have the knowledge, skills and tools to provide safe patient care in the new environment
• Oriented to new work flows to maximize utilization of new space
• Have safety of our people as a key consideration in all patient and work flows
• Benefit from change management plan and show resiliency
• Establish approved staffing complement
• Create a sense of pride and ownership of the new space
• Create/update policies and procedures to reflect changes in processes and space
ENHANCE EFFECTIVE HEALTH CARE PARTNERSHIPS
• Provide a welcoming, culturally accepting and safe environment
• Be a recognized part of the health system serving all Yukoners
• Use technology to engage partners for educational support
• Provide service integration efficiencies amongst our partners accessing the new space
CREATE EXCELLENCE IN PATIENT CARE
• Clinical and support services are sustainable and functioning at optimal capability
• Coordinate admission/registration and triage processes to improve safety and experience
• Ensure emergency wait times are not comprised
• Plan emergency code procedures and response times according to new expansion
• Provide families and support person an opportunity to participate in improving patient experience
• Determine patient flow to optimize beds in the Emergency Department
CREATE STRONG ORGANIZATIONAL CAPABILITY
• Follow YHC’s established project management throughout expansion project
• Allocate funds necessary to support patient experience, access to care and operational efficiency
• Leverage technology and equipment to optimize clinical and support services
• Open data centre before start of general training and orientation
• Have all systems and equipment clinically ready before start of training and orientation
• Ensure hospital space is flexible and adaptable over time
• Have environmentally friendly waste management, utilities and biomedical activities
• Maximize efficient work flows
• Improve measurable outcomes
• Appropriate use of emergency department
Below is a table outlining YHC’s strategic goals and how our view first patient day (future state) aligns within these four areas.
19
RESPONSIBILITY
• Support YHC with Operational Readiness & Transition project advisory, planning and controls and reporting as it relates to the affected Programs/Services (ED, MI, Data Centre)
• Engage leads of affected Clinical Services/Support Services to identify work plan deliverables, accountabilities and timelines
• Utilize healthcare experience and knowledge to assist Programs/Services in the development of their work plans and risk mitigation
• Identify Operational Readiness & Transition risks and monitor as required
• Develop and monitor monthly reporting dashboard
• Assess monthly performance of project and risks and provide go-forward advice on Operational Readiness & Transition Planning
• Communicate the Operational Readiness & Transition strategy and vision
• Provide direction for planning and implementation of the Operational Readiness & Transition strategy
• Review risk items identified
• Assess and provide oversight for risk mitigation
• Identify process re-design opportunities and develop implementation plans
• Coordinate the development and implementation of the Operational Readiness & Transition Plan
• Guide and support staff through the plan and transition
• Liaison with the Capital Planning/Construction Team
• Identify barriers and work towards solutions
ROLE
Stantec Consulting Inc.
YHC
Individuals from all levels and departments in the organization participate on teams that play a role in the governance, oversight and success of the Project. Each group has specific responsibilities that adhere to the planning principles.
6.6 Goals & Objectives
The goals of operational readiness are aligned with YHC’s goals of creating excellence in patient care, supporting our people, building capability and enhancing partnerships. The objectives for operational readiness are:
1. Achieve operational readiness by ‘first patient day’ o Fully moved into the new space o Normalized operations within two months
2. Deliver an enhanced patient experience o the right people at the right place at the right time o the right equipment and technology in accordance with the right policies and protocols o the right attitude
3. Develop a planning, implementation and evaluation process o Identify the deliverables and tasks required for the activation and occupation of the new space in a logical, timely, safe, and cost-effective manner that is consistent with YHC goals.
6.5 Roles & Responsibilities
6.7.1 Major Milestones
Operational Readiness planning and implementation will take place over two-year period and is integrated with the final Project construction milestones:
DESCRIPTION
YHC will outline the steps and time frame for services to reduce and then return to normal. The duration of the ‘Ramp Down/Up’ timeframe will be confirmed and communicated prior to ‘first patient day’
The date at which the construction is sufficiently completed to allow the expanded area to be used. YHC assumes ownership and maintenance of building.
The date at which deficiencies have been addressed and completed.
YHC will focus on the physical move, training & orientation, implementation of new processes and work flows in new space and adjusting to the new working environment.
Pre-occupancy tasks such as verification of readiness of the space, clinically readying the space, system and equipment as well as some minor equipment and accessory installations by YHC.
YHC Board of Trustees’ decision to proceed to ‘First Patient Day‘ for the expanded hospital.
Period where public tours and grand opening will occur usually about two weeks before first patient day.
Physical movement of patients, equipment and supplies into the new space – usually one day in length
Begin providing care in the new space.
MILESTONE
Ramp Down/Up Plan
Substantial Completion
Total Completion
Freeze Period
Owner Occupancy
Approval to Transition to New Space
Celebration Period
Move Period
First Patient Day
6.7 Readiness Timeline
TIMELINE
April 2016
March 2017
September 2017
November 2017
December 2017
January 2018
MILESTONE
Operational Readiness planning is initiated
Ramp down/ramp up plan is confirmed and communicated
Substantial completion of Operational Readiness
Total completion
Approval to transition into the new space
First patient day
20
21
WHAT PATIENTS WILL SEE AND EXPERIENCE
• New 24/7 main entrance to hospital
• New access point to emergency care and way finding within hospital
• Registration located next to triage personnel
• Security located at entrance
• New treatment areas
• New staff work spaces
• New equipment
• CT and X-ray located within new emergency department
• New equipment
• Reduced service disruptions/ more efficient care
• More use of technology at the bedside (including bar codes and scanners, etc.)
• Main registration desk will be in new location and register patients for specific hospital services, including emergency, surgery and inpatient care (admission)
• More direct access to emergency health care provider
• Patients register at the point-of-service for outpatient services such as lab, medical imaging, visiting specialist clinic, etc.
• Volunteers will help provide information and way finding
WHAT WE’RE DOING TO BE READY
• Emergency measures planning
• Staff orientation and training
• Patient care/service delivery model(s)
• Policy and procedures review/ revision, development
• Triage process redevelopment
• Leveraging technology to create efficiencies
• Work flow and process redesign
• Patient care/service delivery model(s)
• Policy and procedures review/revisions, development
• Communication plan
• Staff schedules
• Bed/clinic/service maps
• Re-allocation of functions better managed by other departments
• Integration with the patient triage process
• Support volunteer activities
HOSPITAL DEPARTMENT
Emergency Department
Medical Imaging
Information Systems
Admissions & Discharge
In order to achieve Operational Readiness by the ‘first patient day’, many departments and teams within the hospital will be required to undergo various activities during the planning stage. These planned methods of training are outlined in the table below:
6.8 Activities
22
6.9 Project Completion
YHC’s objective is to be ready to provide the same level of care, or higher, in the new space on day one. To this end, the organization will be looking at the following criteria to determine the success of the Project:
• No patient is harmed due to the transition to the new space
• Stakeholder satisfaction is maintained at current levels
• Operations not adversely impacted due to the transition to the new space
• Staff, physicians, health system partners, government and the public well informed on the progress of the Project and oriented to the new space
• Hospital and medical staff prepared and received training before their first patient encounter
• First Patient Day Views (future state) achieved within two months of first patient day
• Quality improvement targets achieved
• Clinical and financial performance targets met
• Terms and conditions of design-build agreement not compromised
• Project goals and outcomes achieved
• Project on time and on budget
WOOD LOOK SHEET
VINYL FLOORING
ACCENT COLOUR
SHEET VINYL FLOORING
A& D RECEPTION One of the most significant benefits of the new emergency department is that patient registration (admitting) is co-located with triage, providing patients with more direct access to nurses who can conduct an assessment to ensure health needs are met. Security personnel will also be located in the ED’s main lobby, offering an additional level of safety and comfort.
23
7.1 Purpose
Whitehorse General Hospital has experienced patient flow pressure and service provision challenges due to space constraints across the facility as hospital service volumes grow and inpatient occupancy remains high. The Project will create much-needed new space within the expansion as well as vacated space (to be utilized) in existing areas of the hospital once services relocate to the new building. This includes:
• Shelled space on the second floor of expansion
• Vacated emergency department in existing hospital
• Vacated CT and radiology (X-ray) suites within existing medical imaging area
• Vacated Intensive Care Unit (ICU) in existing medical unit
• Vacated Admissions & Discharge desk in existing hospital
A comprehensive needs assessment and functional planning process started in fall 2016 to determine how to best use, adapt and outfit all of these spaces. This process will take into account opti-mal patient and work flows as well as clinical and support service delivery requirements. As a result, other departments or services may shift or be reconfigured – opening up additional vacated space to be utilized.
A needs assessment and functional plan are the first steps in the full planning process and get the hospital to a point where it can determine cost and make recommendations.
7.2 Goals
The outfitting of the shelled space within the new expansion is out of scope for the Project, while the renovations of vacated space for another use is considered in scope. However, for a more efficient and effective process, both the vacated and shelled space are being assessed and planned jointly to ensure we have a sustainable and highly functional facility that can meet current and future hospital needs of Yukoners.
Both the needs assessment and functional plan will form the basis of a full business case to address how to use the shelled second floor that will be presented to Yukon Government for consideration.
This allows YHC to ensure the proposed use of the shelled space is based on current and projected needs and includes co-dependent needs in other service areas, including ambulatory services, speciality services, and inpatient services.
The goals of this process are:
• Effectively assess which areas of the hospital require more space within the new structure
• Determine which areas are in the most urgent need right now
• Determine what future service needs may arise
• Examine the possibility of changes in medical technology and what requirements new technology may need
• Relieve pressure of space confinements within the existing hospital building
• Maximize the layout of available shelled-space to ensure it is being used to its full potential
Needs assessment and functional planning provides YHC with an opportunity to effectively plan for future use of spaces in an objective evidence-based manner.
7. Phase 4: Needs Assessment & Functional Planning for Vacated & Shelled Space
24
7.3 Needs Assessment
YHC is undertaking a needs assessment for the shelled and vacated space to determine needs or gaps between current conditions and desired future conditions – with any gaps measured to accurately identify the needs.
As part of the assessment, the following areas are being examined:
• current space challenges across the facility
• current workload pressures across the facility
• population projections for future service needs
• projections on technology changes
• appropriateness of space for proposed services
• needed adjacencies (what services/functions should be located nearby or close to one another)
• future capacity
• potential efficiencies
The Project is also gathering information from statistics, trends, demand on Yukon’s hospital services and focused work groups with hospital and medical staff. Moving forward, the Project will continue to involve staff and physicians to ensure opportunities are not missed.
7.4 Functional Planning
The next step in the planning process is a ‘functional plan’ which details all of the service requirements as well as the activities that will take place in these spaces. Functional planning will ensures smooth and sustainable future hospital operations. This process began in December 2016 with focused and broad staff and physician involvement.
The final functional plan will be presented to YHC’s Board of Trustees for approval in March 2017.
VACATED AREAS - MAIN FLOOR WHITEHORSE GENERAL HOSPITAL
1 2 3
4
5VACATED AREAS
VACATED AREAS
No. CURRENT USE AREA1 CT CAT SCAN 34.6m2
2 RADIOLOGY 24.9m2
3 EMERGENCY/TRAUMA 357.1m2 4 MAIN RECEPTION A&D 67.7m2
5 SECURITY DESK 5.2m2
6 INTENSIVE CARE UNIT 64.6m2
No. CURRENT USE AREA1 CT CAT SCAN 34.6m2
2 RADIOLOGY 24.9m2
3 EMERGENCY/TRAUMA 357.1m2 4 MAIN RECEPTION A&D 67.7m2
5 SECURITY DESK 5.2m2
6 INTENSIVE CARE UNIT 64.6m2
TOTAL 554.1m2
6
VACATED AREAS - SECOND FLOOR WHITEHORSE GENERAL HOSPITAL
VACATED AREAS
VACATED AREAS
Floor plans of Whitehorse General Hospital highlight spaces within
the existing hospital where vacated space will be created by moving some services into
the expansion.
25
The timeline of the competitive selection process for the needs assessment and functional planning is outlined in the table below.
7.5 Procurement Schedule
TIMING
July - August 2016
August 2016
August 2016
August 2016
OUTCOME
YHC issued RFP to select a proponent to provide a needs assessment and functional plan for vacated space and new shelled space. Submissions were received from two proponents.
Submissions were evaluated in two parts: • Meet the mandatory requirements as detailed in RFP
• Submissions that met the mandatory requirements
were evaluated using the following criteria:
o Comprehensive work plan that demonstrates
understanding of project requirements
o Approach
o Experience with projects of equal or greater complexity,
in healthcare and hospital sector, in northern remote
locations, and with private and public sector entities
o Cost
Stantec Consulting Inc. was selected as the preferred proponent
PROJECT STAGE
Request for Proposal
Evaluation
Award
Work Commenced
The following timeline has been established to guide the needs assessment and future plans for the vacated & shelled-space.
7.6 Timeline
TIMELINE
September 2016
October - December 2016
December 2016
January - February 2017
March 2017
MILESTONE
Charter development
Needs assessment engagement
• Executive review and endorsement of the needs assessment
• Board review and approval of the needs assessment
Functional planning engagement • Executive review and endorsement of the functional plan
• Board review and approval of the functional plan
5 Hospital Road, Whitehorse, Yukon Y1A 3H7 yukonhospitals.ca