CALGARY INTERACTIVE SESSION, OCTOBER, 27, 2017 FOOTHILLS MEDICAL CENTRE, CALGARY QUESTION #1 – HEALTH CARE DELIVERY A. We are currently in the realm of large regional health care delivery systems yet we want to bring service closer to home. How will we evaluate the success of these models? Services closer to home. How do we measure success? Metrics: speak to government they want data. ALC rates – percentage points in acute care vs home Re-admit rates Survival rates $ cost point, $ cost RX, # of points treated/ dollar. Prevention as an innovator. Contracted homecare services: Lower cost than acute care. Different costs and cost drivers across the country Preventive Care: Nutrition / wearable tech AI Guidance / Glucose monitor B/P Leverage Pharmacies Have infrastructure Role of nurse practitioners in increasing (prevention trained) Sick care: Implantable sensors Identify trends Robot caretakers Air B&B homecare (England) Medical school (disease based) B. Does the future hold a place for a scale shift within health care delivery models? How do you envision this change, given new thresholds in information technology, interactive technology and virtual reality, etc... Questions #2 RESEARCH & TEACHING A. Teaching models and research streams can be seen as silo’d from patient care through long established methodologies embedded in culture. Are these current models providing the strongest context for innovation? Research embedded Smaller platform Teaching and research funding within healthcare is difficult Healthcare Authority needs to implement innovations Partnerships to create innovations and implement are needed It’s a risk to implement research challenge internally to improve broader audience Define and develop small groups for improvement with collective goals at a high level Global sharing B. How can discipline convergences and cross-multi-trans-and inter-disciplinary teamwork be accelerated to push health care, research, teaching and innovation forward? Facilitate collaborative teams Quality improvement process tools shared with departments Listen and learn from others Breakdown silos between departments Develop partnerships Understand synergies Values / Ethics / Statement of requirements Patient Family Centred Care – don’t lose sight od who care is for Innovation teams priorities Operating standards: is it just because we always have clinic times, empty spaces (how to maximize) Questions # 3 – PATIENT EXPERIENCE A. Major health care developments are focused on the 'patient experience’. How successful has this focus been given the current situation? Greater attention to families, bring in patient support Acknowledging IPC and protecting the patient Family/ patient input in the design process More intuitive buildings that ae less confusing an intimidating Patient experience starts Before the hospital visit. Technology is filling care gaps Human interaction and customer focus. You can have a beautiful building and bad people experience. Success? Getting better but still have a way to go. B. What are the key challenges in the transformative shift in patient interface with our health care systems, given new thresholds in evidence-based design, information and interactive technology and virtual reality? Are we measuring the right metric or anything? Adoption / uptake. Welcomes or imposed? Industry – built-in obsolescence Staff training Tech is cool or truly helpful Generation differences and cultural differences QUESTION #4: ARCHITECTURE & URBANISM A. Major new hospitals are radically changing the structure of cities through the insertion of populations, economies, ‘health districts' and infrastructure. Are we cognizant enough of these responsibilities? Not typically not, but… Saskatchewan Children’s Hospital - City can’t handle its information needs (driven staff resource) E,g. University of Alberta – Distribution Energy Centre Toronto – University Health Network, Lake Ontario Royal Columbian – attracted developers Architects South Health Campus – Planned Community, YMCA, Food Court, Assisted Living Academic Health Campus: - CHUM - U 0f A - Quebec City CHUQ – changes site - McGill – Little community input and disruption of neighbours - Canada CAN and SHOULD be a catalyst B. How can we overlay our mandates more effectively, using large scale healthcare infrastructure to help frame the health and future of our cities? (consider attracting capital, housing demand / types, amenities) Ideas to integrate - District / renewable energy - Cross-over of services and program - EG YMCA retail assisted living - Healthy food, fitness education - Community Centre - Hostel, hotel, daycare, amenity, entertainment - Public transport Integration - Public outdoor space including greenroof - Relax, Codes, By-Laws and standards (National, provincial, territorial / municipal) - Pet therapy music, art - Holistic medicine (NYGH example) - Cultural diversity, events, activities, - Hospital as a node - Balance of centralized / decentralized Question # 5 – PUBLIC PRIVATE PARTNERSHIP (NA) Question # 6 – DESIGN THINKING A. The basis for our understanding of needs is through user engagement, is usually tightly confined to a particular institution. Is this current model effective in understanding the broader needs of the community, region? Architect - use PR Public relations, social media, etc…multiple modes Design Build GC – Global Perspective: Confidential survey through multiple networks like survey monkey Local groups may not have the experience that a global group could have Only a certain portion of the population can attend user group meetings. Need to integrate global ideas with local needs. Who will be using the facilities and programs at the time it becomes available? Questions are key: What information do you want to collect? Mix of people creating the questions. Need to broaden methods of data collection, and the scope of people surveyed. B. How can we utilize more fully ‘design thinking’, putting forward tools allowing us to create more meaningful engagements of stakeholders, citizens and societies, implicitly broadening our understanding? Creativity of methods used to collect information Give a situation them ask questions as to how it can made more comfortable i.e. changing into a gown, how can the space be made more comfortable? Asking questions that allow for answers that may not have been previously thought of? (open ended provide suggestions that push thought – processes outside the box) Touring existing facilities with users of those facilities Provide the ‘ideal’ situation then get groups to provide information on how they got there Game Boarding – facilitating user group sessions Virtual reality plus actual module – multiple modalities - mock-ups in various materials – cardboard with more detail each time Surveys, input for naming f areas and departments Cultural input colours symbols Provide users with education out the process and how they can affect that Other types of education for user groups prior to the beginning of their involvement in the project Question # 7 – BUILDING SYSTEMS A. Building systems (mechanical, IT, sustainability, etc.) can be tailored for specific building types. Are we allowing emerging innovations to help create our current health care environments? YES, Bleeding versus leading edge Hardwire versus wireless Space for expansion IP based systems To allow for future integration (middleware) Interstitial space and cable tray and conduit and fibre Reserve capacity to allow future flex M&E Wearable tach data Command Centre – Patient Care – Manage and Prioritize data DAS / Wireless / Mobile device – real time tracking Feedback, how do you know it works Make technology appropriate Questions # 8 TECHNOLOGY A. Technology (materials, digital tools, new media) are transforming society and our understanding of it. Are health care delivery systems and models behind this curve? Facilities Maintenance Engineering – yes some work orders can be completed on a palm pilot whereas other contractors must complete a work order on a computer (increasing time spent on tasks) IPC / Frontline – Example of patient records, not all on one system (e.g. EMS uses a different system from acute care. Different zones in Calgary are on different PCR systems also. Vendor – US Integrates more tech (eg RFID). Canada doesn’t integrate newest technologies due to multiple issues such a regulations and funding. FME – RFP process in Alberta tends to favour lower quality, older and low technologies, products due to accepting lower bids above other factors. New technologies may be integrated but can run into ongoing issues that doesn’t allow integration of new technology. (eg. AGV system in use but elevators are broken) B. Should health care delivery models, systems and building develop methods to more quickly embrace these technological shifts, and how? FME - Yes, difficulties with changing process to implement new technologies (eg. Procurement, P.O’s) Vendor – Yes it takes a long time. Recruiting the right people and talent. IPC / Frontline – Differences in generations and cultures etc… some groups maybe more accepting of technological shifts. Possibly easier to implement technology shifts as work generation shifts. .