Texas A&M Health Science Center’s plan of consolidation

During this watershed moment of economic crisis and healthcare reform, responsible healthcare institutions are pausing to take a hard look at where they are and what they want their future to look like. Priorities get reassigned during times like these; even core businesses adjust to meet new operational and financial goals. For healthcare providers particularly, their core focus on patient care and patient wellness does not change. However, leaner operating models, business functions, and facility operations introduce new ways of doing business so that institutions can survive and even thrive. These are the times of transformation. Clarity of vision, emboldened operations, and quality of care strengthen a health system’s competitive advantage—repositioning them for the next generation of business. So how do you get to this state of renewed vision?

You arrive where you plan to arrive, so create a solid strategic plan. Sound strategic planning maps the route health care leadership will use to direct his/her institution toward a stronger reality. A sound plan includes equally sound operations and facilities plans that support the direction of the institution. It is often at the point of developing the facilities strategy that you bring in health care planners and designers. Some clients will run this part of the planning concurrently with the strategic planning. In larger systems, this adds value to the process. Whatever timing clients choose, we recommend consistent consideration of the health planner’s credentials:

  1. Hire the team that can interpret your strategic vision.
  2. Hire the leader that will investigate solutions and alternatives to support your vision.
  3. Hire the team that can do it quickly and efficiently.
  4. Hire the team that gives you a 360 degree view of your decisions.
  5. Hire the team that whose style supports your culture and style.
  6. Hire the team whose leaders know your business.

What to expect from a Facility Master Plan

Here is where the rubber meets the road. The Facility Master Plan is where all those great ideas for service-mix and operational models get tested. Here is where good decisions are seen operationally. Administrators can really see what works and what does not work. I like to work with a modeling team as we are building the facility plan. Using modeling, we can explore what happens when new services are introduced. The model is informed by demographic input, market trends, and the physician practice mix. Using 3-D modeling, we can virtually test how spaces function by watching how our clients function. How long it takes a nurse to travel from point A to point B; how many patients can move through a clinic hourly; what staging procedures add time or congestion to the system; how will the new services tax the system. All of this informs the architect as new solutions for space use are explored

Exploration: The power of “Why?”

It is this exploration that the architect cannot shy away from: he or she must explore all options. Back in 1985, long before BIM and Internet were our tools, we were commissioned to renovate the ambulatory program at what is now Memorial Hermann Northeast Hospital. They wanted better throughput for their program. As we investigated the expensive reorientation of the front door and subsequent relocation of multiple clinics and functions we started to explore some basic “Why’s?” Why are patients not entering here? Why are they choosing other locations? Why do they park and walk from the back? What if they parked in front? This gave us the “ah-ha” moment. In the end, by expanding parking at the existing front door, Northeast did not relocate operations, saved unwarranted construction costs, saved significant disruption in service, and significantly improved patient throughput. This was quite an achievement for a short term planning exercise, and design of a few parking stripes!

If there is no purpose in the facility plan, there is no power and there is no value. Therefore, be clear about its purpose. A strong plan responds directly to the institution’s vision of who they are and where they need to go. Staffing strategies and service-mix are two key components that build the plan. The planner must know these strategies as well as his/her client in order to prepare a viable facilities plan. He/ She must consider that both components have significant physical impact on space and operations; and know that the financial impact will guide some of the development and staging recommendations that come out of a plan.

As the plan builds, it gives concrete guidance to the priorities set in the strategic plan. If successful, this should offer administration a strong tool for development. I use to describe it as a tool that offers checks and balances to the strategic planning process, but it does so much more. I see it more today as the chassis on which to build your future. It gives direction to follow toward specific goals. Administration may change its mind, but the chassis contains the data needed to make sound decisions as well as test new approaches should the system need to go in a different direction.

I am thinking of one of my beloved clients on the west coast for whom we were hired to do a new children’s hospital. As we moved into the planning for this hospital on an urban site, we started asking “What’s next?” They of course thought I was just trying to expand the scope of work, but really what I was trying to understand is where are you going? Today’s buildings are big investments. You always want to look beyond what’s there now, to where it needs to go in 5 or 10 years. You do not want facilities in the way of your progress.

As we explored the ideas of what is next, they saw clearly that their hospital would grow toward the west and across the street. We needed to plan the building as part of a bigger complex, at least in concept, so that we could make smart operations decisions for the tower they would occupy in 4 years. Good planning and strong facilities response has now given them a series of options under which to grow.

Today, many of our clients feel like the wheels are coming off those chassis I referenced. The question of “What’s next?” instills fear in some, rather than the challenge it once evoked. We suggest to them that facilities planning is one tool that allows administration to take back control of the institution’s destiny. At times, full scale planning is too daunting, so we might recommend looking at those components that have strong impact on your campus and on your operations. For example, take time to look at:

  1. The organization of your complex. How do different buildings relate? How do the service functions relate? Is it giving you the return you need?
  2. The circulation pattern in your buildings and on your campus. Is it safe for pedestrians and vehicular traffic? Can it move people efficiently?
  3. Evaluate the highest and best use of varying pads on the site. Determine your tolerance for short term and long term investments. Work with the monies available.
  4. Invest in your infrastructure. The only certainty right now is that things will change. Your plant and facilities have to be adaptable and ever ready to accommodate the business you will find yourself in within the next 5 years.

This economic slowdown will end at some point, and businesses – particularly health businesses --need to be at the ready. Smart planning will assist administration in keeping your vision of quality care at the core while preparing to capture the competitive advantage that will keep your business viable and thriving