Some months ago, several nursing colleagues of mine invited me for a walk-through of their brand new hospital. It was a beautiful space: light and bright, with the latest technology.

As we travelled the floors, the problem emerged. Supply rooms were too small and too few; they were also placed at the end of long corridors, far from point of care. Staff improvised the best they could. Without storage space, oxygen tanks stood in the hallways despite their ballistic potential. Housekeeping doubled up on linens, adding to waste. Supply carts cluttered the corridors outside of patients' rooms, posing a hazard to passers-by. Stocking those carts instead of drawing from a centralized storeroom caused expenses to jump.

In one fell swoop, a single miscalculation had compromised patient care, public safety, and cost savings. I asked my colleagues if they had been involved in the planning process. It was a rhetorical question.

Tap your experts

Building or renovating a healthcare facility is a big job fraught with complexities and hidden pitfalls. However, every organization has an in-house team of experts who can help ensure success. From patient admissions to infection control, an institution's personnel have amassed indispensible knowledge about what they require in a physical space to provide efficient, high-quality care.

Involving stakeholders does not mean asking for opinions on the color of countertops. It means really involving them. How do they perform their jobs, step by step? What floor layout would aid their work? Where should equipment be placed? How can efficiency and ergonomics be considered in design plans?

It's all in the process

To solicit the right information from the right people requires a highly structured process. A project management approach can guide the way. Project management is a professional discipline that defines how to identify and meet requirements-your requirements-to the letter.

Conducting that process requires a specific skill set. An effective project manager is:

  • an excellent facilitator and communicator;

  • highly organized with an attention to detail;

  • disciplined about process, schedules, and deadlines; and

  • able to lead without explicit authority.

Many healthcare facilities and architects now work hand-in-glove with trained project managers, who help secure the information necessary to create a robust architectural design. The following are six tips and techniques from the project management playbook for effectively harnessing stakeholder input.

Identify your stakeholders. Depending on your project's scope, your stakeholders may span from the ICU to the laundry staff-generally one or two representatives per unit. To make sure you don't miss anyone, obtain a list of every single department in your facility (the accounting office is often a good source). Go through the list one by one. Which will be impacted? Who needs a voice?

Get them thinking-and talking

The patient is coming …

What does the front door look like?

How do patients feel when they enter?

Who is there to greet them?

You need to do your job …

What set of needs must this room fulfill?

What problems are you trying to solve?

How do you perform your job, step by step?

What equipment and supplies do you need?

Could technology help you?

How many staff need to work here at one time?

Can the working conditions be improved?

What could enhance:

ergonomics?

patient privacy?

patient satisfaction?

efficiency?

safety?

Who are your stakeholders?

Depending on the type of unit or facility and complexity of its services, your stakeholders may include:

Direct clinical providers, such as:

Indirect support providers, such as:

  • nurses

  • nursing or other clinical assistants

  • respiratory therapists

  • laboratory staff

  • radiology staff

  • physical therapists

  • infection control staff

  • physicians

  • dietitians

  • transporters

Patients and their families

  • unit secretaries

  • volunteers

  • central sterile supply

  • pharmacy

  • security

  • receiving

  • maintenance

  • finance

  • accounting

  • admitting

  • mail delivery

  • quality

  • risk management

  • legal services

  • medical supply distribution

  • housekeeping

Be proactive. Call their directors and identify yourself as the project leader. Who on your staff would you like me to work with? At your next organization-wide management team meeting, alert the group to the project and your role. It's yet another opportunity to raise awareness and enlist participation. You cannot be too thorough.

Hold a kick-off meeting. Launch your project with a group stakeholder meeting. First ask them to look around the room. Are we missing someone who should be involved? It's OK to be redundant! Securing all the right stakeholders is essential to your success.

Then set the stage. Describe what they will do over the course of the planning phase, along with a detailed schedule and project milestones. Ask participants to start thinking about their workflows: What job will they have in their new environment? How will they perform it? Ask them to map out each and every step to bring to their one-on-one interviews with you and the architect.

Conduct stakeholder interviews. For the architect to be effective, he or she must know your needs, down to the shape of door handles, heights of countertops, and placement of outlets. That's where project management really kicks in. Spark a conversation among your stakeholders and the architect using generalized but thought-provoking questions, which will quickly lead to discussion of the nitty-gritty. The architect will listen intently, take notes, and probe for details. Facilitate the dialogue to ensure everyone is heard and understood, draw out crucial information, and make sure that nothing falls between the cracks.

Mitigate risk. Project management is as much about managing risk as achieving your desired outcome. Your stakeholders can help you identify the watch-outs. Think through the pros and cons of every design choice. Should you identify a risk, is it significant enough to address? If so, how will you address it?

After constructing a facility based in part on thoughtful patient interviews, a Midwest cancer center saw its patient-satisfaction scores leap from the 30th percentile to the 90th.

Keep communicating. After your interviews, schedule brief but regular meetings among yourself, your architect, and your individual stakeholders, to ensure throughout the design process that each detail is accounted for. Update participants and senior executives on the project's progress with clear, transparent communications to maintain confidence and prevent misunderstandings.

Don't forget patients. Willing patients and their families can provide invaluable input on matters of privacy, comfort, and positive distractions during procedures or while waiting for loved ones. What would have made the day easier for them? For the sickest patient, are the handicapped parking spots still too far to walk to? Do patient-room doors offer too public a view? Together, you and your patients can work with the architect to create solutions-and raise their satisfaction. Little changes can make a big difference. After constructing a facility based in part on thoughtful patient interviews, a Midwest cancer center saw its patient-satisfaction scores leap from the 30th percentile to the 90th.

The bottom line

Doing it right requires intense focus. To plan an imaging suite can take a few months; an entire outpatient campus, over a year. The effort will be well worth your while. Without early stakeholder involvement, unwelcome surprises may greet you after your hospital unveils that gleaming new wing. Without a dedicated receiving area, you're tripping over cartons in the hallways. With nursing stations at the end of blind halls, staff can't hear their patients call out.

By harnessing stakeholder input, you'll get the facility you need, with fewer headaches and far more staff satisfaction. You'll save money. You'll run more efficiently. But most important, you'll provide your patients better care. HD

Marilyn Daley, RN, BSN, MBA, has more than 30 years of experience as a clinician and hospital administrator. You can reach her at 630.789.8600 or at

mdaley@ipmcinc.com. Healthcare Design 2009 November;9(11):30-34