St. Francis Hospital and Medical Center
Given the opportunity to begin a major facility expansion, how can you be certain your plan will help your hospital stay competitive for the long run? How do you improve efficiency? How do you stay true to guiding principles of patient safety and better outcomes? If you ask Robert J. Falaguerra, Vice President of Facilities, Support Services, and Construction at St. Francis Hospital and Medical Center, he would recommend early planning, strong communication and coordination, and constant vigilance to make sure everyone is doing what is expected of them.
Dr. Robert McAllister, co-director of the Connecticut Joint Replacement Institute (CJRI), a point-of-care service center within St. Francis, would add that the strong communication and coordination should include getting facility users - including surgeons - involved in the planning and design process.
Both, Falaguerra and McAllister would also emphasize the importance of keeping everyone focused on the patient - first and foremost.
The combination of these approaches recently resulted in the successful opening of St. Francis' $184-million John T. O'Connell Tower in Hartford, Connecticut. Named for the son of its primary benefactor who lost his battle with cancer, the new 10-story, 318,000 square-foot tower features a new seventy bay Emergency Department, seventeen state-of-the-art operating rooms, including hybrid and cardiac suites - as well as six additional dedicated ORs for CJRI. The tower also includes three floors of private inpatient rooms, rehabilitation gyms, and a new rooftop heliport.
Getting users involved from the beginning
According to Falaguerra, who has spent almost half of his 40 years in the industry at St. Francis, initial planning began in 2005 with specific goals being defined early. "We wanted to modernize our facilities, expand our emergency and perioperative services and be able to coordinate everything to increase our volume and patient satisfaction," he says. To meet those objectives, all stakeholders had to be part of the process from the start.
McAllister recognized and appreciated the unique degree to which the surgeons were involved in planning the physical space. "From equipment and systems selection, to room orientation, IT decisions and the need for high tech educational facilities, we were there - meeting after meeting after meeting - hammering out the details with the engineers and architects," he says.
It was early on in the equipment specification process that one request lead to a partnership which brought considerably more to the project than originally imagined.
"Several of our surgeons had seen innovative products from TRUMPF Medical Systems at tradeshows and said ‘those are the lights we want'," according to Falaguerra, describing the surgeon's reaction to TRUMPF's LED surgical lights.
"When you are building a new facility, you want the most sophisticated solutions and TRUMPF had the best surgical lighting system on the market," explains McAllister.
"We soon realized, however, that TRUMPF also had Boom systems, and surgical tables," he adds. "Although we already had a relatively mature relationship with another vendor, that relationship was reversed after the surgeons, the administration and the facilities team realized the quality of the TRUMPF products."
Beyond its innovative products, however, TRUMPF's real contribution may well have been in the perspectives on efficiency it shared with the St. Francis team.
"A meeting of like minds"
Although TRUMPF Medical Systems is located in Charleston, SC, the team from St. Francis met at TRUMPF's, Farmington, CT facility which is the US headquarters for the company's Machine Tool division.
"It really didn't matter that the medical equipment is showcased at our Design and Innovation Center in Charleston," says Burke Doar, Vice President Sales and Marketing at TRUMPF, Inc. "Rather than being product-specific, that first meeting was focused on processes that could improve efficiency. We discussed throughput and process improvement approaches that TRUMPF had developed and refined over years of experience in various manufacturing fields."
In fact, the international TRUMPF Group, which counts TRUMPF Inc. and TRUMPF Medical Systems, Inc. among its divisions, is so committed to continuous improvement that it operates under an organization-wide efficiency initiative known as SYNCHRO. Under SYNCHRO the systematic search for and elimination of waste in all company areas is the basis for continuous improvement.
"I would describe it as a meeting of like minds," says McAllister. "We were focused on efficiency and had a lot of Six Sigma types and TRUMPF was the same. Although everyone understands that treating a patient is very personal and not like turning out products, those same principles that bring efficiency to manufacturing can be applied to a healthcare environment with the ultimate benefits of improving safety and yielding better care."
Room layouts improve efficiency
TRUMPF Sales Consultant John Moore, who coordinated the medical device company's involvement from initial meetings through installation and training, explains that efficiency was designed into every aspect of the project. "The ORs, for example, are identical: the mounting positions of the booms and the equipment they hold, the location of the doors, the documentation station - it's all the same," says Moore. "This allows the staff to work in a focused and efficient manner within the same physical layout regardless of what room they are actually operating in."
Increased volume guides decisions
According to McAllister, another efficiency may improve patient safety and outcomes while potentially reducing hospital costs.
"CJRI opted for TRUMPF's JUPITER System Table," says McAllister. The JUPITER tabletops that interchangeably connect to the system's in-room control pedestal for each case are also used to shuttle the patient in and out of the OR. Consistent with the efficiency ideas initially discussed with TRUMPF, this approach saves time, eliminates several patient moves and cuts out waste.
Through efficiencies that St. Francis and CJRI evolved over the years, and have now enhanced with technologies like the JUPITER System, they have gone from scheduling two to three procedures each day to handling up to nine cases daily, per room, per surgeon. "What's important about this is, since clinical protocols are based on data we derive from our own patients, a higher volume of patients allows us to look at a wider range of data. This helps us make changes that can positively impact patient outcomes."
Significant savings possible
Shifting to staff safety and reduced costs, McAllister also notes that the team at St. Francis have identified another key benefit. The JUPITER System and modified workflows, according to McAllister will save the hospital "in the order of a couple of hundred thousand of dollars a year by reducing work-related injuries for the people that handle patient transfers."
No time to rest
Designed to accommodate the very latest innovations in "green" construction, medical technology advancements and cutting-edge telecommunications, the new tower has gone a long way toward making St. Francis one of the premier medical facilities in the Northeast. The reaction from the community and patients is nothing short of fantastic according to Falaguerra. The staff is also thrilled with the layout, the look and the leading-edge equipment. So, with a successful multi-year expansion under their belt, one might think the St. Francis team deserves to sit back and admire their work. They, however, have other ideas.
Plans are moving forward, according to Falaguerra, to renovate the space left from the old operating rooms, emergency department and patient rooms. A new PACU, pathology department and additional outpatient women's services are planned.
Going forward, McAllister wants to more thoroughly explore and apply the potential efficiencies of the JUPITER System Table. Having formerly served as a trauma surgeon in Afghanistan, McAllister associates the JUPITER to the procedures born out of necessity in the field. "A soldier would come in, be blocked, operated and recover all on the same stretcher," he explains. That approach plays out in a more high tech way with the JUPITER. McAllister says he wants to fully integrate the system into CJRI's clinical protocols and see where that takes them in further improving efficiency.