St. Thomas Elgin Expansion Project Supports Vision of Excellent Patient Care

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Paul-Collins-thumbPaul Collins, President and Chief Executive Officer, St. Thomas Elgin General Hospital

Transforming emergency-department care delivery and lowering wait times are major initiatives in many hospitals not just in the United States, but also in Canada.

One hospital in Ontario has been taking major steps in improving emergency-department care by embarking on a three-year transforming care and expansion program.

Creating a culture shift

In 2011, St. Thomas Elgin General Hospital (STEGH), a 166-bed community hospital that serves the city of St. Thomas and eight municipalities within Elgin County, began a journey to develop a lean culture based on the Toyota Production System. Central to this culture is seeing the patient journey and experience of care through their eyes. This involves respecting the frontline staff and their knowledge and accountability, while providing them with the tools, leadership support, and decision-making authority to solve problems and make improvements.

Through these changes and its focus on the patient experience, STEGH has drastically reduced wait times and sustained them at levels that are now the lowest in the province of Ontario. One outcome from this initiative is increased volumes in the emergency department.

STEGH is also planning to build a three-story addition to the hospital. It is the largest investment project the hospital has undertaken in its 60-year history.

Expanding to continue the transformation of care

The expansion project will add more than 100,000 square feet and will provide a new home for the emergency department, surgical suite, sterile processing department, and a 15-bed inpatient acute mental health unit, as well as ambulatory mental health services.

The new building design, which goes out to tender in early 2015, will enhance privacy, comfort, and wayfinding for patients and workflow for staff and physicians.

“Our STEGH vision is to deliver an excellent patient care experience every time, which is what has driven the design,” said Paul Collins, president and chief executive officer. “We have been working to transform our care and our thinking about design through their eyes. This new facility will match the level of quality and compassion our staff are passionate to provide.”

The design work is now complete, and the emergency-room design makes extensive changes to support the experience and improvement culture created at STEGH.

“Our employee and physician teams have worked through the planning and design stages thinking about what patients value in their care experience and how their work processes will deliver that care,” Collins said. “The intent of the emergency-department design is to be person-centered, creating a connection with patients. We want to reduce patient and family anxiety, while providing personalized and rapid assessment and care.”

To help reduce anxiety, the ambulance and walk-in patient entrances will be separated, with private triage and patient registration areas. The department will have15 modern exam rooms and two trauma rooms. A unique use of natural light throughout the addition is expected to aid in recovery and reducing patient anxiety.

“We launched a Patient Experience Advisory Council this past year and patient advisors from this Council have been partnering with us to help in this design process, and their contributions have been invaluable,” Collins said.

The Sterile Processing Department (SPD) is designed to enhance efficiency and streamline workflow for the 9,000 cases it manages annually. Two dedicated elevators will connect the SPD with the new surgical suite, allowing surgical equipment to flow directly between departments.

The new facility features lean process redesign to streamline workflow and be more responsive to the patient experience, but one of the most challenging aspects of any design is planning for the future.

“Designing any new facility is a complex process, particularly for high-tech areas like the emergency department and the operating rooms,” Collins said. “You have to think about how long this will serve the needs of the community and the health system. In healthcare, that time can be pretty short. We need to anticipate evolving technology and space requirements, which adds to the complexity of the design process.”

The expansion project is expected to be operational in the autumn of 2017.

Moving to paperless

Another major investment STEGH has made is its move to an electronic system for ordering tests, prescribing medication, and treatment. Its CPOE system was launched in January as part of a collaboration with eight other hospitals in the region.

“Implementing an electronic system is a challenge in the way it changes workflow,” Collins said. “Clinicians rightly want the fewest number of ‘clicks’ to get through, a minimal amount of typing, and easily recognizable screens for finding patient information and executing orders.”

The hospital is addressing the growing pains of an organization making the shift to paperless, but Collins said he sees the benefit in the system once it is optimized and customized for effective and efficient use by the frontline provider.

Between electronic health records and the expansion project, STEGH is not only furthering its patient-centered goals, but also remaining forward-looking, trying to support the organization’s strategic vision.

“One of the biggest challenges facing hospitals today is identifying those changes that are critical for our organizations to embrace,” Collins said. “We must continue to attempt to plan for five and 10 years ahead. Clearly, patients and families are leading the way. If we listen, the evidence shows that our care will improve and our costs will go down. We do best to focus on a few things at a time, learn how to do them really well, as opposed to trying to do too many things poorly.”

-by Patricia Chaney

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