An organization faces many challenges when building a new healthcare facility and preparing to move or expand into this facility. Strategies to plan and implement such a move have been described in the literature. Guzman, Nering, and Salamandra (2008) outline the use of specific project management tools and the application of the nursing process (assess, plan, implement, and evaluate) in organizational transition planning. The scope of a successful transition plan must address the roles and responsibilities of organizational members, licensing and regulatory requirements, a transition budget, move planning, and management of change related to transition (Guzman et al., 2008). Since the physical transition to the new facility is at the heart of a move or expansion project, other authors focus on specific guidelines for occupancy or activation planning. According to Wilson, Hejna, and Hosking (2004), “Activation planning involves anticipation of and control over two types of issues: logistical and operational” (p. 359). Logistical issues address facility-related aspects such as new equipment, readiness for occupancy, and a move-in sequence. Operational issues include implementing novel processes and practices within the new environment, which in turn drive education, training, and orientation efforts for staff. Recommendations for success include using multidisciplinary teams, developing a database for activation issues, timely decision making, real-time communication, adequate staff training and orientation time, and simulation of operational procedures (Wilson et al., 2004). Focusing on staff education, Stichler and Ecoff (2009) outline five key areas to address: new clinical competencies, life safety training, training on new equipment, workflow exercises, and general orientation.
Despite these guidelines, there are few reports describing successful transitions to new hospital facilities. Those that exist outline moving into a replacement hospital, with full occupation of the new facility as the end result (Duffy, Pearson, & Waters, 2002; Ecoff & Thomason, 2009). There is little published on expanding into a new healthcare facility and re-purposing the previous facility for continued use. Using the Iowa Model of Evidence Based Practice to Promote Quality Care (Titler et al., 2001), our purpose was to adapt the new facility transition strategies found in the literature and apply them to our adult hospital expansion project. In particular, we focused on activation planning surrounding workforce education, patient move-in day, and the re-opening of units in the previous hospital facility.
The expansion of our medical center, with the opening of a new adult hospital facility in February 2013, provided an opportunity to utilize activation planning as a transition strategy. First, we employed this strategy to develop and implement a training program for staff who would interact with and within the new facility. Beginning six months prior to the move-in date, lists of new equipment and technology were compiled to address the logistical aspects of the transition. Examples included wireless phones for nursing staff, the use of patient status boards, and expanded telemetry monitoring capacity. New safety measures and expected changes in practice were catalogued to address the operational aspects of the transition. These included more containment isolation rooms, easily accessible medication and supply rooms, and centrally located interdisciplinary workrooms.
Following identification of new clinical competencies, learning paths were created for the 173 individual roles within the organization. Training was built by vendors, educators, and internal clinical experts, and five methods of delivering the education were identified: station, class, on-line, mock room, and tour. Based on recommendations in the literature, employees were oriented and trained using a step-wise approach followed by simulation. Phase one included training on basic new equipment and safety measures, while department-specific training occurred in phase two; each phase took place over six weeks. Subsequent “Day in the Life” simulation scenarios allowed staff to test the new systems and workflows in real time. Issues that arose from these simulations were systematically logged, prioritized, and addressed prior to the move.
Second, activation planning was applied to move-in day. Both the new and previous hospital facilities are on the same medical campus within a two block radius, connected by underground tunnels. The patient transport sequence, pathways between buildings, and timeline of the move were carefully designed. Two weeks prior to the move, staff members began daily rehearsals of patient transfers. Revisions to move-in day plans were made based on feedback generated by testing the system in advance.
As part of organizational expansion, multiple units in the previous facility were designated for re-purposing. On move-in day, these inpatient units were decommissioned. Activation planning was again applied to identify and address logistical and operational issues. These included refurbished single occupancy patient rooms, relocation of the inpatient dialysis unit, and creation of a short-stay unit. Following structural and equipment updates, the units were sequentially re-opened beginning three days post-move and continuing throughout the following year.
Over 200 educators, vendors, and internal clinical experts assisted in designing the training program, which resulted in the education of 2500 clinical and procedural staff. The training program was completed under budget; reduction of training hours without loss of content occurred as the curriculum continued and was refined. For example, training was originally budgeted at 20 hours per registered nurse but was delivered in less than 16 hours total. Weekly lists of questions from each training station were compiled and answered by clinical experts. These answers refined the curriculum and became the source of a Frequently Asked Questions document for staff. The over 1500 issues that arose from “Day in the Life” simulations were addressed based on priority, with critical problems resolved first and less urgent matters deferred until after the move.
On move-in day, 157 patients were safely transferred to the new hospital facility in 6 hours and 58 minutes, and ten inpatient units were successfully opened. Over 2000 staff, faculty, and volunteers participated. Feedback from patients and families regarding the move was uniformly positive. The operating rooms, pre- and post-operative care units, pharmacy, and blood bank were also subsequently moved and opened in the new facility.
In the previous adult hospital, fourteen inpatient units designated for re-purposing were decommissioned. Based on assessment of patient care and space requirements, five units have been updated and reopened since March 2013, with two additional unit openings planned. The demand for additional geographic space due to increased clinical program volume continues to drive our hospital expansion project.
Since move-in day in February 2013, the need for additional training was identified through staff requests and assessments by clinical educators. Nursing staff completed in-services to improve knowledge and skills in telemetry use for cardiac monitoring. Unit secretaries underwent refresher training on new modalities for tracking patients and contacting staff members. As planned prior to the move, vendors returned for in-situ training on new patient care tools and equipment to help staff troubleshoot. Training to ensure accurate and current familiarity with technology, workflows, and clinical practices in both facilities is ongoing.
Conclusions/Implications for Practice:
As academic medical centers build new hospital facilities and prepare to move their workforces into these facilities, a systematic approach to staff training and patient-care transition is critical for success. Based on the Iowa Model, we utilized strategies from the literature and adapted them to our organizational expansion project. Activation planning identified and addressed logistical and operational hurdles for training staff members, ensuring a safe and efficient move-in day, and re-opening units in the previous facility. Despite constraints of cost, construction, regulatory issues, and trainee scheduling, the training program was delivered on-time and under-budget. This was accomplished with support from organizational leadership and by continuous performance improvement while delivering the educational curriculum. Simulations of new workflows and of move-in day were instrumental to ensure safe practices and transitions in patient care. Activation planning continues to inform the expansion of our medical center within the previous facility as our adult inpatient population grows. As noted by others, transition planning is resource-intensive, lengthy, and complex. However, the reward of a successful transition is a well-trained workforce confident to safely care for patients in an environment that facilitates the quality of that care. Sharing and disseminating information about our experience in activation planning and implementation for a new facility hospital expansion project may be valuable to other organizations facing similar challenges.
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