The New Akershus University Hospital

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The New Akershus University Hospital

• Erik Kreyberg Normann CEO Bjørn Magne Eggen
  CMO (www.ahus.no)

Congratulations !!
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Forming The New Hospital

• The building and the concept
• The technology steps
• Developing the organisation ? makes the
  difference

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How Do We Prepare ALL Staff Members?

• Our experiences, 112 days before October 01,
  2008 i.e. the final takeover of the new
  facilities
• Logistics
• Accessibility
• Patients participation
• Mental and physical preparation
• Organisational development, adjustments and
  readiness and the processes to achieve this

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• Some Key Figures
• Todays activities (2007 accounting)
• 280,000 inhabitants
• 48,800 over night stays
• 22,000 day treatments
• 165,000 outpatients (policlinic consultations)
• 4,800 total staffing

• 2015 Expectations(as defined in 2001)
• 340,000 inhabitants
• Now Will be 450,000
• 46,000 over night stays
• 40,000 day treatments
• 172,000 outpatients
• Can make 300,000 (?)
• 4,200 total staff

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Costs, Schedule

• Building budget NOK 8.5 billions (EUR 1.07
  billions)
• Start of construction March 1st, 2004
• Occupancy completed October 1st, 2008
• First units April 1st 2008 (ENT, day surgery,
  )
• May 19th 2008 Surgical outpatient clinics
• August 25th 2008 Medical outpatient clinics

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Economic Challenge

• To finance 20 of the total building costs (eq.
  NOK 150 mill / USD 30 mill / per year)
• Staffing reduction expected, and needed
• How to realise the gain i.e. connecting
  improved processes and cost reduction

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Where Do We Aspire?

• The most patient focused and patient friendly
  hospital in Norway
• Europes most modern university hospital
• An attractive working place with highly
  skilled health professionals

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Basic Structure
Paediatric and Adolesc. Clinic
Bed Cluster Wards
Treatment Wings
Treatment Wings
Bed Cluster Wards
Glass Promenade
Treatment Wings
Bed Cluster Wards
Bed Cluster Wards
Treatment Wings
Front Building
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Basic Structure
Psychiatrics departments
Drug Addiction Acute Unit
Bed Cluster Wards
Technical Centre
Paediatric and Adolescence Clinic
University Admin.
E. D.
Treatment Wings
AXIS Glass Promenade
Chapel
Main Entrance, Reception, and Cantina
Car Park
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ICT of Increased Importance

• Increasing dependency
• Critical / key success factor for all basic
  services 24 / 7
• New opportunities for
• patients
• all employees
• the primary care services, incl. G P s

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User / Patient Participation

• The patients have a unique experience and
  competence
• how to bring their knowledge into each project?
• can one patient represent them all?
• Evaluation feed-back Positive! from our
  staff, and the users
• building a knowledge database,and the personal
  competence

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Medication Project

• Electronic prescription
• Decision support
• Information to the pharmacy? robot (pill
  picker) ? packing and marking (bar code
  text)? deliveries by tube transportation?
  message to the nurse (phone text message)
• Administration and documentation(information
  from local bar code reader ? EPR)

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Optimalisation Accessibility

• Laboratories
• No analyse is to take place in more than one
  place
• Operating hours
• To utilise the floor space and equipment in the
  most efficient manner, and to make the
  facilities more available, opening hours are
  extended.An example, outpatient clinics will be
  used ten hours per day (currently seven hours)

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Organisational Development

• New facilities and Medical technology ?
  developing the working processes
• Implementation with tight follow-us
• Motivate the staff members (4,500) and promote
  staff safety
• Changes may motivate, but is threatening as
  well.Trust is mandatory
• Basic principle Make only one change per time
  i.e. conscious on sequence and timing of changes

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Organisational Development (O D)

• O D towards the new hospital started 10 years ago
• In total, gt 25 different internal projects on O D
• An internal project organiser / coordinator
• Each project with an internal project leader
• Project support mainly from internally
• Tight follow up of the projects progress and the
  implementation processes is mandatory

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Philosophy

• Controlling the patient flow
• Treatment lines
• Separate the emergencies from the elective
  courses
• Primary care services inclusion and cooperation
• Staffing flexibility
• Organisation
• 80 / 20 (nursing time usage)
• Turnus (shift) planning
• Area use flexibility
• No one is an area (or floor space) owner
• Prolonged opening hours (10 hours per day)
• Use of ICT to promote organisational
  development

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Internal Project Consultants Exclusively (
Almost )
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Some Recent O D Projects
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Standardisation the Systematic Approach

• Standardising the
• areas
• organising
• equipment
• day-to-day ward leadership
• documentation / E P R
• procedures
• treatment lines
• teaching and training
• ISO 9001 certification

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C E O

• Medicine and Strategy
• Health Services
• Human Resources
• Finance Economy
• Communication
• Project New Hospital

Centre of Diagnostic Imaging
Centre of Laboratory Medicine
Centre of Internal Services
Division of Psychiatrics
Division of Medicine
Division of Surgery
Division of Paediatric Adolescence Medicine
Division of Nursing
Research Centre
Centre of eHealth, ICT, and Med Tech Devices
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The Emergency Core

• To ensure / promote cooperation, key emergency
  medical functions such as
• the emergency department (treatment centre)
• observation ward
• diagnostic imaging
• surgery
• cardiac monitoring / cardiac ICU
• I C U
• are grouped together (in close proximity).

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• Re- Establishing the Emergency Core at Oct 1st
  2008
• The organisation is expected to be
• Adjusted
• Trimmed
• Skilled
• Prepared
• The move is a huge logistics project
• Total plan for area usage (2008-2010)
• Three phases of moving before Oct 1st 2008

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Acutely Admitted Patients

• Integrating the Emergency Department and the
  Observation ward
• Establish an acute care ward
• Considering Emergency medicine as a new M. D.
  speciality (in Norway)
• Increased focus on the initial phase in the
  patients hospital contact
• Improve the acute triage function in the E D
• Capacity of the Out-patient clinics

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When Doing the Major Move, We Will Substantially
Reduce the Activity
No of E D admissions
Internalactivity
Total protection
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Elective admissions
2
100
Oct. 01
50
0
Time
Sept 26
Oct 06
Moving window
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Teaching, Training, and Education

• Training in the new building, with the new
  equipments, using the ICT solutions is a
  prerequisite to move
• A training project, with mandate
• ensure competence in all groups? proper use of
  the buildings, equipments, and technology
• Which implies (e.g.)
• define the minimum ICT competence for all
  professional groups before starting the training
• ensure training plans at each adequate level in
  this meeting the actual need of each group, and
  for the organisation as such

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Implementation Tasks

• Establish the new organisation
• Operate new units
• Personal shift in working tasks
• Implement new working processes and main
  principles
• work flow. procedures, routines
• Follow up of the RAV analyses performed during
  the project phases

Implementing the new organisation, working
processes, and main principles are crucial to
ensure that we reach the required results and
benefits
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Flexible Solutions

• Treatment areas, treatment wings, and the Bed
  ward wings
• distance, degree og integration
• Logistics, options and solutions
• a new building vs. changing an existing hospital
• Technology (different aspects / areas)
• ICT / EPR / automation
• Vulnerability and security / safety
• incl. towards internal situations

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Teaching and Training

• Training in the new facilities, with the new
  equipment and the new ICT solution IS A NEED
  FOR A SAFE TAKEOVER
• A training and teaching project
• Define minimum ICT competence (in each health
  professional) before entering the training
  programme
• Ensure adequate level og the trapining and
  teaching programmes i.e. according to the
  individual needs, the needs of each
  organisational unit, and the hospital
  organisation at whole

My learning plan my key to the new hospital
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Lessons Learned

• Organisational adjustments before moving
• Internal full-time project management
• Involvement of patients
• Internal project leaders (and participants)
• Project evaluation
• Defined dates of no-more-changes
• Detailed planning, incl. implementation
• Strict reporting ? corrective action

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Developing the Organisation

• New buildings, new technology ? redesigning the
  working process
• Implementation with tight follow up (and
  reporting)
• Motivating all of the staff (4,600) i.e. make
  them feel secure
• Changes motivate but might be regarded a treat
  as well TRUST is essential
• Basic principle Just one change each
  timeConsciousness on timing and sequence

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The CEO, Eagerly Watching The First Day in the
New Hospital
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Human touch and empathy with professional
skill !