DIL exercises facilitate successful opening of a new cancer hospital

Merging multiple physician office practices with six inpatient units from 20 different locations and coordinating operational processes of more than 14 departments to open a new 128-bed inpatient cancer hospital with 104 ambulatory treatment spaces requires military precision.

And that's exactly what the Smilow Cancer Hospital at Yale-New Haven did to plan for this merger: employ “Day in the Life” (DIL) exercises used by the military to simulate and test operational systems before opening military medical environments, said Lisa Truini-Pittman, RN, BSN, MPH, OCN®, CPON®, of the hospital in New Haven, Connecticut, at the Oncology Nursing Society 36th Annual Congress.The purpose of the project was to ensure operational safety and readiness prior to the hospital's opening to assure the new environment was ready to receive patients in the first day of operations. Exercises consisted of patient scenarios that involved staff from every discipline performing their role within scenarios developed by staff volunteers. Each scenario was timed to the minute and sequenced to run simultaneously. A kick-off rally for all participants was held before each event and conferences were held before and after each scenario was conducted, noted Truini-Pittman Each scenario was led by a “director” and an “evaluator” to assure it was fully played-out. Participants used an evaluation tool to record observations throughout the scenario and guide feedback discussions during the conference afterwards. The DIL event concluded with a high-level debriefing, during which the director/evaluator partners reported the issues of most concern to department heads and key stakeholders. Following the event, a summary of findings was created within 24 hours, and an executive report and action plan were finalized and presented to senior administration within 72 hours.

Five exercises held on different dates comprised 23 complex interdepartmental scenarios and involved 356 staff, 96 RN participants, and 30 patient volunteers. A total of 404 operational issues were identified, prioritized, and addressed prior to the hospital's opening, as was multiple staff training needs. Participants expressed a sense of empowerment related to their contribution toward safeguarding the new environment, she noted, as well as provide an opportunity to see into the future and affect a safer environment for patients, families, and staff on the first day of occupancy. This strategy is one that can easily be adopted by other organizations planning on opening new cancer services, Truini-Pittman concluded.
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