Healthcare Design is a Process; Visualize, Plan, Adapt

One of the only certainties Health Care Organizations are faced with today is change. Change is pervasive through-out healthcare. It seems every facet is being affected; technology, delivery of care, staffing models, financial resources, codes and standards, best practices. The way in which these organizations prepare to adapt will determine how they can effectively manage change. A knowledgeable Project Team can be a valuable resource to identify and address challenges that exist today and prepare for challenges that will arise in the future. The best preparation is to be able to react as challenges arise. Be prepared to adapt to a changing world.

Health care building projects have the ability to facilitate change or impede it.  The right Process and the right Team are essential parts in making a project a success; now and in the long term.  Building projects need to respond to today's needs and be flexible enough to adapt to tomorrow's challenges.  Small investments in time to clearly think through strategies will prove beneficial in the future.  Rushing to move may prove wasteful. Developing a Team then developing a Process is the key to preparing for a successful project.

The first step in any building project, regardless of size, is determining the right Team.  The Team has the most profound impact on a project.  They will leave their mark on a very complex environment for decades. The Team will address complexities of the physical environment (rooms, equipment, and safety) and the complexities of the performing environment (operations, culture, perceptions).  With such diverse implications, the Team should be carefully selected based on diverse talents and knowledge.  The Project Team is comprised of representatives from the Hospital, Community, as well as Design Professionals.  It is a must for the Hospital Leadership to be part of the Team. The more complex changes the project entails, the more commitment is required from the Hospital Leadership.  Involving the right people early in the process helps to flush out complex issues and address them at the strategic level rather than the construction site.

The Team should match the Organization's vision.  Every organization has a strategic direction established by its leadership. The Project Team's responsibility is to identify how to properly align a new project with the overall system vision.  Organizations should carefully look within to select those who best exemplify the direction of the facility or the system. For the Owner, identify a leader who can be a champion for the project. If the goal of the project requires profound changes in operations, the leader needs to have enough authority to enact change. For the consultants, identify Team members that bring value to the project. Delivering a project on time and on budget is required for every project.  However, there is always more that is expected from Health Care projects.

Visualize:
With the Project Team in place, it's time to begin the Process.  Establishing the organization's goals early during the initial steps will give the entire Team a direction and underlying mission to adhere to throughout the design process.  This will be the Project Vision. Keep it simple.  The purpose of the Vision is to drive all decisions. Therefore, it needs to be a simple idea that everyone can recall easily. The Vision will play a vital role in the solidarity of purpose for all the Team members and stakeholders. Every decision that made throughout the design, budgeting, and construction phases will be checked against the vision. For example, if construction costs need to be reduced during the budgeting phase, what will be cut and what will remain? These decisions will be made based on the effect they have on the overall project vision.  All stakeholders must agree and consensus gathered if a decisions impact the principles established by the Vision Statement. 

The Vision statement needs to be simple. A guiding principle is all that is needed to get things moving. A Vision statement can be as simple as a goal to provide a family centered critical care unit. It can also be as complex as developing a world-class replacement hospital. The Vision is the starting point to which all other efforts are tied. 

Plan:
If the Vision is a destination, then the Master Plan is the road map. It is the path to which a hospital or a system reaches its short term and long term goals.  The Master Plan can be a system wide endeavor or can be site specific. Regardless, the Master Planning process is a crucial step in the process. It will define how an immediate project will react to current needs. It will predict how a project will adapt to future needs.  The goal of the planning process is to avoid constructing healthcare spaces that are not functional in the long term. 

Master Planning will require a variety of experts and talents.  A typical team consists of Staff, Physicians, Strategists, Planners, and Designers.  More complex institutions may also require LEAN consultants, Workflow Strategists, and Market Forecasters.  The most comprehensive teams will achieve the most comprehensive results. 

First, the Planning Team will observe. Team members will spend time within a facility learning the methods and means by which a facility delivers care.  They will learn the organizations unique culture.  They will document how a typical patient flows through the facility and what environments the patient and families experience.  The Team will interview Staff and Physicians to learn about what opportunities exist and what challenges may lay ahead.

Second, the Team will evaluate.  By closely observing and interviewing critical components of a system, the Team can begin evaluating their observations.  A knowledgeable Team will compare existing conditions against leading industry best practices.  The Team will also compare the workplace methods against other like-facilities that have proven performance based successes. 

In the final step, the Team will react.  The Team will work closely with Administration, Staff, and Physicians to develop a long term strategy that is achievable and adheres to the overall Vision of the organization. The finished product is a Master Plan that reflects the long term business model for the facility. It describes the desired outcomes for strategic changes, operational changes, and facility changes. It is at this point where the Team will strive to achieve buy-in from all the key stakeholders in the organization.  It is very important that all parties embrace the plan.  A cohesive Team will net the best results.

Adapt:
With a Vision defined and the Master Plan developed, the Team can begin to concentrate on developing the project. This is the step in the process where the Team will begin to adapt the project to the overall Vision and Master Plan of the organization.  The definition of adapt is "to make fit often by modification".  That is the purpose of healthcare project design.  The completed project must fit within the Vision of the organization.

The project begins as a set of goals that need to be accomplished. The goals can be as specific as an order of magnitude budget or increasing bed count.  They can also be as undefined as improving patient satisfaction and safety.  However specific or generic the goals, they will give the Team a starting point from which to proceed. One way to document these goals is through a Project Charter.  The Project Charter is a project management tool that communicates vital project information.  The Charter will include information such as:

• Project Name
• Date of Origin (and Revisions)
• Vision Statement
• Project Purpose (referring to the Master Plan)
• Project Scope
• Project Stakeholders
• Project Constraints
• Assumptions
• Concerns/Risks
• Schedule Expectations
• Budget Expectations
• Stakeholder Signatures

The management of information is vital to a project's success. The Charter is one of the first steps taken to ensure that all stakeholders are informed of decisions made and issues yet to be resolved.

Once the Team understands the Vision of the organization, has developed the Master Plan road map, and has established the project Goals, it is time to move forward with the design.  Great design solutions are a product of integrated teams.  Teams comprised of Nurses, Physicians, Administrators, Support Staff, Patients, Families, Contractors, Architects, and Engineers collaborating to determine the best solutions for design challenges.  Everyone on the Team is a designer and everyone's input is vital to testing solutions from multiple perspectives. 

As the design progresses, input from the Team will be gathered and recorded in various forms. Meeting notes are important for sharing decisions and questions, especially for those who may have missed a meeting.  Marked up plans from plan review sessions can be distributed as documentation about how a space transforms throughout the design process.  Information management is crucial to ensuring accurate translation of ideas from the Team into the working drawings the Contractor will use during construction.  The information is also useful in recalling why decisions were made should there be a change in personnel within the Hospital's Team.

In closing, planning and designing health care facilities is more about the process than the material building.  What makes facilities successful in the near term and the long term is their performance.  The aesthetics and the physical environment are very critical to Patients, Families, and Staff. However, the physical environment is only one piece of a very complex solution. The process must be both methodical and integrated.  The time spent on the front end of a building project will help to ensure sustainability, viability, and flexibility.

Contact details:
CDH Partners, Inc.
675 Tower Road, Marietta, GA 30060
E: kevin.donalson@cdhpartners.com