DESIGN
The children’s play area.
detect and analyse problems with flow as they became evident and suggest solutions. An example was to correct the insufficient and unclear signage, which resulted in problems for patients finding where they needed to go. More complex problems have also emerged. One was in relation to staff needed on each floor. A functional analysis of the shape of the building revealed the need for more personnel to manage the two wings in relation to the number of patients. Another problem related to the needs of paediatric patients for whom an elevator was originally provided for use in an emergency. Currently it can be used by all patients, which necessitated the installation of a security device. An operational costs analysis has been
produced to identify possible inefficiencies in the building, comparing the pre-integration and post-integration periods. After an analysis of the available literature,8
the study examined internal
documents and data supplied by the management office during meetings with medical staff and following observations and encounters with patients and discussions. The limits of the study are that it relates only to the new building and there are a lack of comparable cases.9 One of the most relevant results relates
to intensity of care. The major issues come from low intensity care; most patients who are admitted for the first time are hospitalised on the low intensity ward and then transferred before returning to low intensity when preparing for discharge. Because of the consistently heavy flow of patients on to the low intensity ward, the passage from high or medium to low intensity can be problematic.
An operational costs analysis has been produced to identify possible inefficiencies in the building, comparing the pre- integration and post-integration periods
As a result of discussions with medical
staff, a focus on improving the pre- admission phase when patients should be evaluated with outpatient procedures has been suggested. This should avoid long periods of hospitalisation while waiting for surgery, allowing more efficient use of beds.
Conclusion Many things have been achieved with the introduction of the new building. The intention is naturally to continue to address other challenges. A formal patient satisfaction survey has not yet been carried out, but it has been suggested that this should be postponed until a stable operating routine has been achieved. However, the welcome presence of patient associations, the chance for patients and relatives to communicate with the highest level of management and proactive exchanges with the community has always been a goal at the polyclinic.
References 1 University Policlinic Sant’Orsola of Bologna. [
www.aosp.bo.it/content/who-we-are].
2 Nollert G, Wich S. Planning a Cardiovascular Hybrid Operating Room: the technical point of view. The Heart Surgery Forum, 2009. [
cardenjennings.metapress.com].
3 Kpodonu J, Raney A. The cardiovascular hybrid room a key component for hybrid interventions and image guided surgery. Interact Cardiovasc Thorac Surg 2009; 9 (4): 688–92.
4 Gabutti I, Mascia D, Cicchetti A. Exploring ‘patient-centred’ hospitals: a systematic review to understand the change. BMC Health Serv Res 2017; 17 (1): 364.
5 Groene O. Patient centredness and quality improvement efforts in hospitals: rationale, measurement, implementation. Int J Qual Health Care 2011; 23 (5): 531–7.
6 Nardi R, Arienti V, Nozzoli C, Mazzone A. Hospital organization based on intensity of care: potential errors to avoid. Italian J Med 2012; 6 (1); 1-13.
7 Liberati EG. Reorganising hospitals to implement a patient-centred model of care. Emerald Insights 2018. [
www.emeraldinsight.com/doi/abs/10.1108/ JHOM-07-2014-0129].
IFHE
8 Burns LR, McCullough JS, Wholey DR, Kruse G, Kralovec P, Muller R. Is the system really the solution? Operating costs in hospital systems. Med Care Res Rev 2015; 72 (3): 247-72.
9 Villa S, Prenestini A, Giusepi I. A framework to analyse hospital wide patient flow logistics: evidence from an Italian comparative study. Health Policy 2014; 115 (2-3): 196-205.
Cross section of the building. IFHE DIGEST 2019
Plan of the ground floor of the building. 45
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