Planning for the new SHNB … measure twice, cut once

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It will be more like “measure three times” before a final plan for a new Saskatchewan Hospital is decided, but it appears the end result will be a world-class facility designed from the inside out by the people most closely involved.

Friday saw the conclusion of the second of two week-long 3P (process, preparation, production) Lean capital planning sessions held in a warehouse space in North Battleford. That afternoon participants reported on the process they followed to arrive at their design conclusions and revealed scale models of the forensic services and therapies areas they envision taking Saskatchewan into the next 100 years of care for the mentally ill.

The designs move away from the traditional custodial model of care toward a rehabilitation model of care, reflect changes in therapies delivery and address quality of life issues for patients. Architect Paul Blaser had high praise for what he called

“some tremendous results,” saying, “in many ways, what you’ve done is to record your work with the building you are putting around your work.”

Blaser is the principal architect for RBM Architecture of Saskatoon and North Battleford and, for that week, the “sensei” architect supporting the Lean process being brought into Saskatchewan by the architectural firm of John Black and Associates of Seattle, Wash. through a contract with the Ministry of Health.

Providing input into the planning session were SHNB patients and staff, Prairie North Regional Health Authority senior leaders and board members, architects, mental health consultants, Ministry of Health and Ministry of Justice officials and other key partners. Blaser described the week’s work as an “incredible process” during which the traditional design process has been turned upside down.

“As architects, we’ve been standing on our heads, because, actually this is the right way up,”

said Blaser.

“The right way is for you guys to be figuring out how to be doing your job … and then building around it.”

He said the forensic unit participants designed was head and shoulders above any other he’s seen. “You have really thought it through and you’ve been willing to challenge yourselves in terms of ‘how are we going to do our job to provide the best value, to provide the best service to our patients,’”

said Blaser.

“You kept patients at the centre of this process and you’ve asked that again and again.”

Blaser said participants will be back at the process in about three weeks during which time another careful and detailed look will be taken, tracing flows, counting steps and considering wastes in order to report to Steve Manthy, “sensei” architect with John Black and Associates. He instructed participants to continue thinking about the process, and if they have any ideas about improvements that can be made or things that should be edited a bit, “write them down, and be ready.” The final results will then be carried forward for the indicative design and the next step, the public private partnership process, said Blaser.

Starting off the report out Friday was Linda Shynkaruk, director of SHNB.

“It was another exciting, grueling week with some really great positive outcomes,” she said.

Forensic services provides a 24-bed unit for remand assessments for the courts, disposition orders and treatment for the Saskatchewan Review Board, for persons found ‘unfit to stand trial’ or ‘not criminally responsible’ under the Criminal Code of Canada.
Addressing the design for a new forensic unit, Shynkaruk said the unit is currently a mixed population of remand and treatment patients. There is a lack of privacy, the rooms are undersized, the intensive care room is counter-therapeutic because it is located in the middle of unit with no natural light and there is an overall space of 85 square feet per patient, said Shynkaruk.

The design they came up with had a goal overall to provide better care and support, better assessment and treatment, and resulted in 120 square feet per patient. Dean Brick, nursing unit manager for forensic services, said the new plan would separate the treatment population from the remand patients. He also said of the 24 beds, the average occupancy is 76 per cent. There are approximately 140 annual remand admissions and 136 discharges, with approximately four staying under NCR and Review Board status.
In a brainstorming session, participants picked seven top wish list items: an interior courtyard; separate treatment and assessment units; high tech security and safety protocol; a separate admission unit with no-contact visit rooms, showers, interview rooms and exterior drive access; offices; a meds room; and more patient phones. Presenting a view of the final design for the forensic unit, registered psychiatric nurse Darcy McIntyre said the team took bits and pieces from several designs and amalgamated them into one working plan based on the wish list criteria. Features include sallyport doors between the assessment and treatment areas, clear lines of sight from the nursing stations, a med dispensing station separate from the nursing station and locating intensive psychiatric care rooms away from the main patient care area to avoid disrupting other patients. Dr. Linda Robertson, psychologist, pointed out other features on the treatment side of the unit such as a kitchenette where patients can learn cooking and other life skills, a television area, “zen” rooms on the end of each patient wing and private bathrooms.

“Some of our treatment patients have been in for 30 plus years,”

she said.

“It would be nice to have a place to leave toiletries and personal effects, and not have to cart them to the shower every time.”

She also noted a geriatric patient room and geriatric bathroom on treatment side. Patient feedback also prompted the inclusion of a music therapy room, said Robertson.

Mike Kramm, mental health therapist, explained some of the features of the new therapies area design, addressing the criteria of flexible space, a multi use gymnasium and auditorium, library resource, lots of natural light and unit adjacency. Through the main door, he said, is a therapeutic atrium, 28 feet by 50 feet, which will be an area for “everything and anything” focusing primarily, but not exclusively on, staff development and training. Next is a therapeutic common area of 2,500 square feet. It will be primarily a patient space, said Kramm, with a canteen, gift shop, apparel shop and beauty salon supervised by staff and run by patients. There will be a small stage adjacent to the music therapy room. He also pointed out a gaming office, education centre, internet cafe library resource centre, visiting specialist examination rooms, vocation programming area including a vocational woodworking group, greenhouse and document shredding room. There will also be a 6,000 foot gymnasium.

Kramm noted the psycho educational programming space was increased from 800 square feet to nearly 1,500 in anticipation of a larger need and additional staff, the woodworking program space was decreased from 14,000 to 4,000 and the vocational incentive shredding program area has been decreased from 7,000 to just under 3,500, allowing others to be expanded. Distance traveled for staff and patients was also an issue addressed.

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