BJC HealthCare builds confidence in expansion project with predictive simulation

BJC was initiating a long-term Campus Renewal Project to improve the patient and family experience from both clinical and campus perspectives. The first phase involved a multi-storey expansion of Barnes-Jewish Hospital, including the women and infant programme, cancer centre, surgical programmes, diagnostics and treatments. An expansion of St Louis Children’s Hospital included an all-private neonatal intensive care unit adjacent to the new women and infant programme, as well as private in-patient beds, diagnostics and outpatient clinic space.

Challenge: Reaching a consensus on new collaborative working processes for the expanded hospital facilities

New work environments inevitably result in culture changes, which can introduce a degree of reluctance. This project was no exception. One of the primary challenges during the Campus Renewal Project’s first phase was to bring obstetric, paediatric and neonatal teams together to review current working practices and reach consensus on future practices in the new space. This process had to be thorough, sensitive and pragmatic – gaining acceptance from those involved. 

“To do things better, we needed to fully understand how staff work today – processes that work well, those that don’t and limitations and bottlenecks hindering best practices,” said Margaret Tobin, Campus Renewal Activation Lead at BJC HealthCare. 

“The healthcare environment is complex, and it can be emotional caring for patients and their families. Coupled with the size of our hospitals and the acuity of patients, we faced challenges reaching a consensus. We had a wealth of experience and expertise; however, we needed a means of applying greater rigour and objectivity to this experience to inform key decisions,” she explained. 

The project’s leadership team had used predictive simulation before and concluded it was the optimum decision-making tool for robust planning. 

Solution: Using predictive simulation to understand processes and get buy-in on new ways of working

The Campus Renewal Project team selected Lanner, now under the Twinn brand, for our predictive simulation software and expertise. The aim was to create a suite of models that would help plan collaborative working practices for the expanded hospitals. 

“The complexity of such a large, multi-faceted project is immense. Twinn Witness predictive simulation software provided credible support tools that demonstrated the immediate and long-term impact of decisions we needed to make now. It supported collaboration across teams, gave us confidence that we were headed in the right direction and enabled us to mitigate risk,” Margaret explained. 

“Introducing the physicians, clinical staff and support staff to the simulation tools and methodology – and providing them with the opportunity to understand and appreciate the benefits – facilitated early acceptance of the process. This then enabled us to achieve consensus on our design,” she added. 

Impact: Data-driven decision-making that improves patient care

One of the first and most successful elements the team tackled was the new women and infant programme at Barnes-Jewish Hospital. The clinical team initially pointed out that the unpredictable nature of labour and delivery would require variability in existing processes. However, by using the Witness simulation to analyse those processes, the team identified clear patterns and trends, which provided the basis for effective planning. 

“Creating process maps for incoming and outgoing patient flows allowed us to make robust, informed decisions to optimise processes,” said Margaret. “The Witness model took all subjectivity away and enabled us to move forward with fact-based, data-driven decisions rather than allowing emotions to lead us.” 

The team first looked at how many beds the women and infant programme required. Currently, there were 59 beds available within 30 rooms, but as part of the overall plan, the team wanted to increase the number of private rooms. Having established an exhaustive number of questions to feed into the model, they concluded that 34 private rooms would accommodate the 4,000 annual deliveries – for 99% of the time. For the remaining 1%, the team devised a strategy for transferring labour and delivery overflow to the postpartum unit. 

“This is a great example of how the Witness model enabled us to simultaneously reduce the number of beds in the department and increase the quality of care and overall experience for patients,” said Margaret. “Debate around such an emotional topic could have dragged on. Instead, we reached a conclusion within 6 months. When people understand the ‘why’ behind a decision, they’re more likely to accept it, enabling us to move forward.”