Pennsylvania Hospital Learns How to Do More with Less

by HCE Exchange on April 16, 2014

John-Krolicki-thumbWhen John Krolicki accepted the position of vice president of facilities and support services at the University of Pittsburgh Medical Center’s Presbyterian Shadyside Hospital six years ago, he was tasked with one overarching goal: standardizing the hospital’s systems from both a maintenance and medical perspective.

Originally from the Detroit area, Krolicki had previously worked with Beaumont Health System for 16 years as director of facilities development for design and construction. When he arrived at UPMC, he said the organization was “well along on some of their system standardization. We just took it to the next level.”

Creating space where there is none

One of the earliest projects he had hoped to complete was a new patient tower, but the necessities of healthcare reform delayed this goal until January 2015.

In the meantime, he and his team began pursuing other projects, such as constructing a new clinical labs building, relocating a helipad to the top of Presbyterian Shadyside, and preparing the radiology suite in the old children’s tower for relocation into Presbyterian.

Beyond these projects, Krolicki is in the process of privatizing as many patient rooms as possible while making them compatible with current technology.

“We struggle with that in our plan,” he said. “So our main goal is to really have the patient units be what they need to be, while also improving them with technology.”

He noted that each room will be considerably smaller from 10 years ago, when designers were creating elaborate, spacious atriums with multiple amenities. The focus is now on creating rooms with the appropriate amount of space that are more reliant on technology and less reliant on bricks and mortar.

Presbyterian Shadyside has enlisted industrial engineers from the University of Pittsburgh for its last four design projects. These engineers are especially skilled in improving processes and flow, Krolicki said. They’re also able to provide insight on making operations leaner.

For example, when his team was renovating the emergency department, they noticed that nurses were leaving patients 10 to 15 times during visits to retrieve supplies that weren’t in the room. To solve this, Krolicki and his team purchased carts fitted for the quantity of supplies each nurse would need, enabling them to be prepared when they saw each patient.

One of the greatest challenges Krolicki has confronted over the last six years is a lack of available space. Departments have had to move and adjacencies either created or found. And just because a temporary space is available doesn’t always mean it is right for patient flow.

“Our hospitals are all 100 percent occupied, so any project we’d move forward on was requiring dominoes,” he said.

Advancing the patient experience

Krolicki recently oversaw the construction of a new center for blood diseases at Shadyside’s Hillman Cancer Center. Because these patients and their families make repeat visits, Krolicki and his team figured they would be the best source for finding out “what works and what didn’t work.”

As a result of their input, the rooms were designed to be more flexible to the patients’ needs. Sometimes, for example, a cancer patient will feel fine and want to socialize with a roommate, but other times they want privacy. A movable partition in each room provides them with this option.

Each treatment chair was given Internet and TV access, and the location of parking was made more convenient. The waiting room was also eliminated. When patients arrive, they go to the treatment space where they are immediately seen by a clinician or physician.

Additionally, the chairs were redesigned to be more comfortable for waiting family members and were chosen with the involvement of the patients. His team also created an outside area for the summer months where patients and their families could go to relax. A tracking system was installed so physicians could find where the patients were on the floor with little confusion.

He said the patients were impressed and amazed that the design team not only took the time to listen to their concerns and suggestions, but implemented them as well.

Becoming less dependent on bricks and mortar

As an experienced design professional, Krolicki is fascinated by the many healthcare construction trends that are overtaking the industry. For one, he said the downsizing of space is becoming more of a priority.

“Before you do any bricks and mortars, you have to ask, what can you do just from a flow perspective?” he said. “Before you start spending dollars, the question is, can you fix a problem without capital?”

Technology is also shaping design in unprecedented ways with robotics becoming an even greater tool. He recently installed a robotic system for delivering food and emptying trash since the employees “hated pushing the carts. They were heavy, and they didn’t like doing the work.”

With the robotic system, the hospital now has fewer injuries. Furthermore, “it’s more efficient. They’re able to spend more time with the patients instead of that travel time up and down.”

The hospital is even testing robotic UV systems for disinfecting patient rooms and operating rooms.

“It doesn’t replace your normal cleaning process, but it’s an extra layer that tackles the 99.9 percent of all the other germs you don’t see,” he said. “There’s been research out there that says it reduces infection rates.”

Above all, he said, they have to work smarter with fewer resources while asking, how can they make it a better environment for the patients? How can they work smarter? “It’s how can we integrate technology with workflow to make people more productive.”

Involving the end users from the beginning can make all the difference in a project, he added, since the end users can look at its scope and tell you if it’s correct and if it’s realistic. Also, he advised including industrial engineers on the design team, since they’re experts on process flow and improvement.

Finally, staying on track with technology is vital. He said UPMC Presbyterian Shadyside is fortunate to have a progressive IT group that ensures technology is not being duplicated throughout the system.

“For how large we are, we’re very nimble,” he said.

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