Centre for Excellence in Operations

Project 4: Medical Outpatient Unit Facility Layout

Detailed report
Final presentation

The Problem

The Medical Outpatient Unit (MOU) at the University of Alberta Hospital provides post operation medical procedures and treatments to patients not admitted into the hospital. The treatments, many involving intravenous equipment, include blood work, receiving medication, and blood transfusions. The MOU is faced with several challenges. The first challenge is the increased volume of regular procedures done in outpatient care. Operation hours have increased to 16 hours a day during the week, as well as accommodating numerous procedures on the weekend. This volume is expected to increase further as various other parts of the Capital Health system shift outpatient work to the MOU. It is necessary for the MOU to accommodate the increase in demand due to the sensitive nature of the outpatient procedures in the unit. These procedures necessitate that the clinic be located in the hospital, with close proximity to doctors and procedural centers. The unit is also faced with location challenges. The MOU is currently placed in the old Emergency Unit. The Emergency design was not planned for the Medical Outpatient Unit's procedures or treatments. Thus the MOU has had to make due with the space they were given. To make the problem even worse, the MOU was forced to move out of one of their large procedure rooms to accommodate an Emergency Transfer Unit, forcing the MOU to accommodate into a smaller room once again. There are also difficulties with the scheduling system. The system in place now is a paper and pencil schedule where the unit clerk makes all changes and adjustments. The current system does not allow for patients to make multiple appointments, nor is there flexibility to book more than a few days in the future. Information is not stored electronically, and only the most recent four to six weeks of scheduling data is kept at any given time. Any changes to the day's schedule is not incorporated onto the scheduling sheet, but is rather accommodated by attaching a 'sticky-note'. The unit clerk is the only one who understands the notations, and at the end of each day, it takes another administrative staff member several hours to type the schedule up. A better scheduling system could desperately be used in the MOU. The overall design of the unit is poor and inadequate for the patient's treatments and procedures. Nurses do not have the required space to properly administer intravenous, nor do doctors have the privacy to consult with patients one on one. Many treatments and procedures require patients to be in the MOU for more than four or five hours. Patient comfort is unfortunately not a high priority as the space is so limited. Several mismatched chairs have been placed in the hallway to accommodate patients waiting to be treated, instead of having a designated waiting area. Again, this problem as primarily attributed to the lack of physical space within the unit. Finally, the head nurse and the clinic clerk must sort all their paper work and bookings in the same cramped area. The Medical Outpatient Unit is very focused on patient care, but due to the location constraints, nurses have limited space to operate. The pressure of increased demand for the unit, an inadequate working environment and a scheduling challenge creates several problems for the MOU.

Recommended Solution

Our solutions are two fold, focusing on short-term and long-term suggestions. In the short-term we will be focusing on capacity design and facility layout within the existing MOU. This will involve suggestions for layout and additional organizational structures or units. The goal of the new layout will be to increase efficiency of nurses and increase patient care. Additional thought and care will be given to the potential of adding another bed or chair to increase capacity. This will be attempted through optimally using the given space. Another goal in the short term is to focus on patient care by decreasing perceived time of treatment or procedure. Through the use of perception management techniques, simple and inexpensive suggestions will be made to enhance the surroundings of the MOU. In the long-run, suggestions will be made to increase capacity by expanding the MOU into surrounding rooms. Adding one more adjacent room will allow the MOU layout to be more conducive to their procedures and treatments. Several suggestions will also be made for a computerized scheduling system that is compatible with the Capital Health database, as well as some additional medical equipment, which will make the nurse's jobs more efficient.

Expected Benefits

The underlying benefit is to create a working environment to facilitate the nurses in providing excellent patient care. This takes into consideration design layout and potential changes in the current location. Since moving the entire unit is not a feasible solution in the short term, it is necessary to work with the space that is given. Many patients will have to be in the MOU for upward to five hours. Through the implementation of some mental distractions, the MOU will hopefully be a more comfortable and entertaining patient unit. 'If you take care of the staff, they will take care of the patients.' This is our intended goal of the project. We will promote a better working environment for the staff and patients to increase efficiency as well as the overall MOU experience.