Designing Spaces and Organizational Structures to Enhance the Patient Experience

On the Road with Sibley Memorial Hospital – April 2017

by Deanna Frings and Stacy Palmer

Our latest On the Road took us to Sibley Memorial Hospital in the Palisades area of Washington, D.C. A member of John Hopkins Medicine, Sibley is a not-for-profit and full-service community hospital. They believe an enhanced patient experience includes the voice of the patient and strongly correlates to improved safety, clinical outcomes, health outcomes and employee engagement.

A New Space to Deliver Excellent Care

We had the pleasure to tour Sibley soon after they opened a new building which includes 200 fully private patient rooms with accommodations for visitors, an expanded medical oncology and inpatient oncology units, a new Women’s and Infant’s Services department, including 18 private special care nursery bassinets, an orthopaedic unit with a dedicated rehabilitation gym and integrated technology focused on improving the patient and visitor experience.

The hospital’s warm, inviting environment showcases artwork, sculptures, family-friendly lounges and concierge service. Tracking for Leadership in Energy and Environmental Design (LEED) gold certification, the new facility also offers five new state-of-the-art operating rooms and a patient safety and infection control focused design including bacteria resistant doors and seamless floors and walls.

Representing the diversity of the local population they serve, the entry incudes a ‘Welcome Wall’ greeting visitors in 17 different languages. Upon entering visitors have access to Centre Sibley, a concierge area where patient’s loved ones can receive assistance with things like travel needs, toiletries, phone chargers, outside food options and even help in celebrating milestones. Inside the lobby you’ll also find an organic juice bar reinforcing Sibley’s commitment to support the community and staff in healthy living.

Explaining the significance of the new building, Ronald Peterson, president of Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine said, “It marks a new era for Sibley Memorial Hospital and, most importantly, enhances our ability to deliver patient- and family-centered care to those seeking health care at this new state-of-the-art facility.”

That focus on patient-and-family-centered care, as well as staff engagement, was evident throughout our tour of the oncology floor. The Sibley team was proud to showcase the many features of the new space, all enhanced by a modern, spa-like feel. Patient rooms all include sleeper sofas, closets and safes to accommodate visitors.

Special design consideration was given to ease of work and efficient use of space, with aisle coves built-in so carts do not impede workflows and medication and linen closets are located between hallways with multiple entrances for quick and easy access. The team pointed out several efficiencies identified by staff as they participated in “a day in the life” interactive scenarios in the space during construction. Staff members would read and walk-thru specific patient scenarios and then offer recommendations on potential improvements. According to staff, this time was invaluable as it allowed the team to experience the space and prepare for the change while also sharing their complex knowledge of common situations and challenges.

Interestingly, an initial worry from staff was that they would be too spread out, having grown accustomed to work much closer together in the tight quarters of their former work space. The “a day in the life” scenarios helped alleviate some of those concerns by highlighting the efficiencies built-in to the design of the space.

Encouraging Caring Moments

The new space allows staff to experience more “caring moments” with patients – a Sibley commitment. In addition to white boards with standard information such as care team names, medications and pain levels, a second board in each room gives patients an opportunity to share what they would like the staff to know about them and what they value or love most. This information helps fuel more meaningful and personal conversations. Staff are also encouraged to seek cues that may start additional conversations, such as family photos, flowers, cards or personal mementos. Nurses are asked to sit at eye-level and spend at least 3-5 minutes with every patient during every shift in this type of personal dialogue.

Patient Engagement through Rounding, Shift Reports and Discharge Teach-back

The role of the patient experience liaison is relatively new at Sibley and one of their primary functions is to conduct proactive patient experience rounds to ensure patient needs are consistently identified and met. With a goal to see every single admission, the liaisons are quick to point out their job is not to add to staff tasks, but to help make things easier for both patients and staff. In addition to ensuring patients and families are aware of resources available to them, they focus on asking questions around what they know units are working on in order to gather insights that may be helpful in their efforts. The patient experience liaisons also collect feedback to reward and acknowledge staff, referred to as shining stars, who go above and beyond to provide exemplary service.

Sibley’s patient relations department also conducts regular patient rounds, enlisting volunteers to check-in on patients, play the hospital’s welcome video, provide blankets, check remote controls and introduce patients and families to The Care Channel, a music and nature-focused relaxation program available across the hospital.

“Through our rounding efforts we let patients know we are here for them,” said Carole Groux, patient experience liaison manager.

The introduction of bedside shift reports has also provided opportunity for meaningful dialogue and improved communications. The patients and family members are invited to get involved in the conversation. Shift reports are always conducted at the head to toe position and care technicians join if available.

Similarly, Sibley recently implemented a discharge teach-back process to ensure patients have a clear understanding of discharge instructions prior to leaving the hospital. Family members are encouraged to be active participants in the teach-back process.

Sibley is known for its commitment to innovation, which is apparent after speaking with front line staff and touring the Innovation Hub. The staff is empowered to deliver patient and family-centered care. Joanne Miller, chief nursing officer, shares “After a 14 month participative process to developing Sibley’s new mission: ‘To deliver excellence & compassionate care – every person, every time’, the staff are utilizing their skills and provided access to tools such as Design Thinking, Comprehensive Unit-based Safety Program (CUSP) Teams and LEAN methodology”. More recently they also re-introduced the updated version of the Language of Caring communication framework and training along with standardized improvements such as purposeful and nurse leader rounds, visibility boards and discharge phone calls (attempting to contact 100% of patients).

Patient Experience Council – Building a Structure to Drive Improvements

Reinforcing the importance of addressing experience within their organization, Sibley created a multi-disciplinary Patient Experience Council to guide the efforts. The council, co-chaired by Joanne Miller and Lawrence Ramunno, chief medical officer, includes eight groups aligned with HCAHPS domains and grounded in the hospital’s mission to deliver excellence and compassionate care to every person, every time.

The council’s primary responsibilities are to be accountable for effective interventions and to establish priorities to improve the patient experience. They also serve to identify or design systemic methods to close gaps in addressing patient experience, also significant as Sibley is currently on a journey to achieve both Baldridge and Magnet recognition.

The co-chairs, each guiding four domain work groups, identify and mentor domain champions from appropriate areas, typically including one experienced Sibley staff member and one newer team member to bring in additional outside perspective. These champions analyze the organizations strengths, weaknesses, opportunities and threats related to their specific domain and establish and oversee interdisciplinary groups, including patient and family advisors, to develop domain-specific strategies for improvement. The composition of each work group varies based on domain; for example, the Clean/Quiet domain work group includes a nursing coordinator, transporter, EVS, hospitality, linen, plant ops, front line med-surgical staff and nurse.

Miller and Ramunno hope next steps for the council will be to identify four and five star hospitals to visit and learn from, share networking and learning opportunities with staff through resources such as The Beryl Institute and to identify departments for enhanced coaching.

A Commitment to Innovation

One highlight of our visit was a tour of Sibley’s 3,500 sq. feet innovation hub, a space where they live out their vision to be a role model for innovation in healthcare and wellness for all. The Johns Hopkins Sibley Innovation Hub is a team of designers, lean engineers, technologists and project managers who work on problems in healthcare which have been historically difficult to solve or opportunities to create the future.

The hub coaches internal staff-led projects and works on larger projects of strategic importance to the community and hospital. Sibley’s proximity to the national policymakers, legislators and agencies in Washington, D.C. allow their teams to collaborate and have an impact at the federal level.

Ideas and collaboration are welcome from Sibley staff, physicians, patients and families, community members, entrepreneurs, government, and other interested parties. By encouraging ideas from diverse perspectives, the Innovation Hub fosters creativity, imagination and partnerships between innovators who might not otherwise have a chance to work together.

It was a pleasure to spend time with the Sibley staff to learn more about their efforts to deliver patient and family centered care as an organizational commitment seen well beyond their beautiful, newly designed space. There was clear acknowledgement that while the new building has provided opportunities for enhanced patient experiences, the overall focus on experience is core to Sibley’s broader commitment to deliver the best in care.