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BJC Healthcare selected Lanner and its WITNESS Simulation Software to facilitate decision making, mitigate risk and enable multiple teams to work together as they set about transforming the Washington University Medical Center in St. Louis.

Improving Patient Experiences

BJC HealthCare’s Campus Renewal Project is a long-term project designed to transform Washington University Medical Center (WUMC) through new construction and renovations. The objectives of the project are focused on improving the patient and family experience from both a clinical and campus perspective. BJC HealthCare is one of the largest non-profit health care organizations in the United States.

A 12-story expansion of Barnes-Jewish Hospital includes the Women and Infants program, Siteman Cancer Center, surgical programs, and diagnostics and treatments. An expansion of St Louis Children’s Hospital will include an all-private neonatal intensive care unit adjacent to the Women and Infants program in the new Barnes-Jewish Hospital expansion, private inpatient beds, diagnostics and outpatient clinic space.

The second phase includes additional renovation and new construction at Barnes-Jewish Hospital, with a focus on increased critical care capabilities and additional private inpatient rooms, along with development of programs in medical and surgical services.

Both phases of the project will incorporate significant improvements to parking, traffic flow and navigation for patients.

Fostering Collaboration

The anticipation of providing patient care in brand new space provides opportunities for caregivers and support staff to examine best practices internally and externally, to hone and build on best practices and to be prepared on day one to provide exceptional care to patients. However, planning for this kind of transformation has to be thorough, sensitive and pragmatic, and with acceptance from those involved.

New work environments and processes inevitably results in culture change, which can introduce a degree of reticence, and this project was no exception. One of the primary challenges at the outset was to bring both obstetric, pediatric and neonate teams together to review current working practices and reach consensus on future practices.

“To do things better, we needed to fully understand how staff work today, processes that work well and those that don’t, and limitations and bottlenecks hindering best practices,” comments Margaret Tobin, Campus Renewal Activation Lead. “The health care environment is complex, and it can be emotional caring for patients and their families. Coupled with the size of our hospitals and acuity of patients, we faced challenges reaching consensus.” “We had a wealth of experience and expertise; however, we needed a means of applying greater rigor and objectivity to this experience to inform key decisions.”

Having had previous experience of simulation and modeling as a proven decision-making tool, project leadership determined that simulation was the optimum route to achieve this level of robust planning. The project team selected and worked with Lanner, to establish a suite of models to support planning and decision-making tools.

“The complexity of such a large, multi-faceted project is immense. Lanner’s WITNESS Simulation provided credible support tools that demonstrated the immediate and long-term impact of decisions we needed to make now. It supported collaboration across teams, gave us confi dence that we were headed in the right direction and enabled us to mitigate risk,” Margaret continues “Introducing the physicians, clinical staff and support staff to the simulation tools and methodology, and providing them the opportunity to understand and appreciate the benefits, facilitated early acceptance of the process, which enabled us to achieve consensus on our design.”

Building Confidence

One of the first, and most successful, projects the team tackled with Lanner was the Women and Infants program at Barnes-Jewish Hospital. The clinical team initially pointed to the unpredictable nature of labor and delivery resulting in the variability in current processes. However, when analyzing the processes further using the model, clear patterns and trends emerged, informing the basis for planning.

"Working with Lanner to create process maps for incoming and outgoing patient flow allowed us to make robust, informed decisions to optimize processes. The WITNESS model took all subjectivity away and enabled us to move forward with fact-based data-driven decisions rather than allowing emotions to lead us.”

The team first looked at how many beds were required for the Women and Infants program. Currently, 59 beds are available within 30 rooms, but as part of the overall plan, the team wanted to increase the number of private rooms. Having established an exhaustive number of questions to feed into the model, they concluded that 34 private rooms would accommodate the annual 4000 deliveries - for 99% of the time. For the remaining 1%, the team devised a strategy transferring labor and delivery overflow to the postpartum unit.

“This is a great example of how the WITNESS model enabled us to simultaneously reduce the number of beds in the department and increase quality of care and overall experience for patients,” Margaret explains. “Debate around such an emotional topic could have dragged on; instead we reached a conclusion within six months. When people understand the ‘why’ behind a decision they are more likely to accept it, thus enabling us to move forward.”

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WUMC is vast and includes Barnes-Jewish Hospital and St. Louis Children’s Hospital – the academic teaching hospitals for Washington University School of Medicine. Jacobs Engineering is managing the Campus Renewal Project, providing oversight to the prime contract team and more than 60 years’ experience managing large construction projects.

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