The full life cycle of a new healthcare facility project from concept through design, construction, and opening can range anywhere from 3-10 years. During this time, project activities change hands a number of times: from the design team to the construction team to the transition planning team. Engagement with users during this process is cyclical with heavier work at the front end during design, little engagement during construction, and then re-engagement a few years later during the transition planning phase.
A lot can also change after the design phase is complete, as organizations evolve over these years, leadership and staff change, mergers and acquisitions take place, or technology and operational models advance. Additionally, value engineering or user change requests made during a project can have an operational impact on users in the new environment. Taken together, these shifts make it challenging to ensure the design intent from the early phases of planning is maintained all the way through day one of operations.
That’s where the latter end of this cycle comes into play, with transition planning teams tasked with guiding organizations as they convert front-end planning and design from concept to implementation, applying new operating models in a new healthcare facility.
Start planning
After construction is underway, an organization develops an internal structure to tackle the activities required to ensure a safe and successful facility opening.
While the transition planning process is often thought of as the preparation of the physical space, there’s a significant operational, staffing, and technology planning component requiring time and staff resources to support the optimization of the new environment. The time frame for this process can span 12-24 months before opening day, depending on the size and specialty of the project.
Transition planners are found in a variety of places. They can be internal to a hospital or healthcare system, within an architecture or consulting firm, or independent contractors. Many transition planners are clinicians who are able to translate floor plans into language users understand.
The first thing a transition planner does is collect and review project documents that outline the design intent, guiding principles, operating models, and technology assumptions to be implemented in the new facility. Next, a series of operational planning events is conducted to validate how the facility will operate on day one. These interdisciplinary, collaborative sessions include a review of the operational intent of the design and the mapping out of patient, staff, and visitor flows; supply distribution; medical code response process; pharmacy distribution; and registration. Layered into these sessions are the staffing models and technology utilization that are ideally built into the design intent during the front-end planning phase. If unknown, these operating plans are developed at this time, which can be challenging for organizations opening a new facility while maintaining ongoing operations of an existing facility.
Once the building construction is substantially complete, transition planners conduct a number of simulations in the building with users from all departments. These events allow staff to test and validate the building and operations and can include hundreds of users. Many organizations will run these simulations two or three times to ensure staff members are comfortable with the new building, workflows, and technology before caring for patients when the project opens.
Achieving buy-in
Still, even with these steps and simulation events, many users still struggle to understand the full impact of new design trends, particularly if they’ve been working in their current environments for many years. User buy-in requires time to fully digest the change in work routines as well as the chance to be part of the planning and testing before adopting new processes. Here are some concepts that, if incorporated during the design phase, would benefit an organization as they transition into a new facility.
1. Consider early involvement of a transition planner. This individual or team is able to interpret the early design drawings into outcomes, including workflow models, performance indicators, acuity standards, staffing requirements, costs, supportive technology, and change management impacts. As post-design changes are made, this role can re-analyze the operational impact of changes made and explain the clinical rationale to users, enhancing buy-in and decreasing user change requests.
2. Do an operational planning deep dive. Early operations planning uncovers new processes, paths of communication, and manual tasks that will become technology in the future. A seemingly simple update like an inpatient whiteboard becoming an electronic patient tracking board can create a big change to the charge nurse flow and communication with other nurses.
When operational planning work is done during design to address such changes, the organization has the opportunity to pilot or implement changes in the existing facility, allowing users time to test, refine, and adapt as much as possible prior to moving into their new space. Change management during a move into a new building is often under-emphasized, and the impact can have a negative impression on staff, potentially affecting retention, satisfaction, and attrition. Some of the opportunities for early rollout include: patient population relocation or co-location, provider rounding patterns, early adoption of future state technology, cross-training staff, patient education platforms, and more. The extent to which an organization can adopt these changes is project-specific, but it’s worth the effort to implement new systems and processes early on to decrease the amount of training and change a user will have to undergo in a new environment.
3. Leave enough time for technology integration. The IT element of a new healthcare facility is often more involved than an owner expects and requires coordination among various vendors. Early discussions on programming and planning of IT systems can help ensure the integration supports the operations for department and ancillary staff.
Still, it’s common for organizations to wait until the transition planning phase to complete the detailed technology programming due to the rapidly changing technology environment and the desire to implement the latest and greatest models. However, while the specific vendor or device may not be selected until later, the logic and assumptions of technology utilization can be determined, documented, and integrated into the operational plan early on. The infrastructure for these systems is built into the design, but if operational utilization is left until the transition planning phase, there’s risk for underutilization, redundancies, and work-arounds when staff are unable to spend time training and testing to become comfortable with the new systems.
Time to open
The transition planning process builds on all the work done from project visioning and takes the project to opening day. A key component to this is the integration of the clinical operations and technology components early on to better understand how best to incorporate these pieces into the transition planning phase. Optimal environments are achieved when the design, process, and technology all work in tandem to provide the best care for patients and staff. Staying on top of planning and coordinating these elements will greatly improve the transition planning phase and, ultimately, day one of operations.
Erin Clark, RN, MS, EDAC, is a healthcare operations specialist and owner of ClarkRN Consulting (San Diego). She can be reached at erin.clark@clarkrn.com.
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