Managing a seamless transition from old to new
If your health system is planning a major facilities renovation or new construction project, you've probably already thought about the architect and the contractor. But how will you bridge the gaps between design, construction, and the end user? How will you ensure that your new space and your staff will be fully operational when you need them to be?
Chances are, what you'll remember most about a major construction or renovation project is not whether it was completed on time and on budget, but whether you were able to resume effective clinical operations from the moment the doors of the new facility opened. The problem is, most healthcare administrators don't consider the transition until much too late in the design and construction process, if at all.
Healthcare facility transitions present unique challenges–not the least of which is imposing a minimal impact on patient care. Healthcare administrators need to ask themselves:
Who is responsible for managing the specification, procurement, instal-lation, and validation of “owner-furnished” equipment, furniture, and fixtures?
Who is responsible for planning the training sessions for new patient care and technology systems?
Who will motivate the staff and coordinate the transition of patients and daily operations to the new facility?
Who will ensure that all critical departmental/support services have been involved in the planning process and are ready to mobilize?
Who will coordinate approvals from regulatory agencies?
Basically, who is identifying the gaps and closing them?
The critical coordination involved in both working with the design and construction team to activate the building and working with end users to develop and implement a transition plan for existing operations is paramount to achieving success. At Gilbane, we've handled transition planning and management (TPM) for more than 15 healthcare projects across the country and are currently managing the transition of three healthcare facilities, including Johns Hopkins Hospital in Baltimore and Shady Grove Adventist Hospital in Rockville, Maryland.
From the initial stages of any project (ideally during the design phase), we approach TPM as a detailed process that includes the following steps:
Planning–identifying goals and developing a schedule, budget, and detailed checklist to make sure nothing gets missed
Operations Planning–forming work groups to handle specific tasks; conducting training
Procurement and Vendor Coordination–tracking orders and shipments associated with the transition
Equipment Coordination–managing the process for equipment relocation
Move Coordination–assessing site readiness; staff inventory check-out
Close-out–compiling lessons learned and transferring all files
Communication: Talking to the Right People
On any transition project, we help develop a working group structure that defines a point of contact for each stakeholder department. These points of contact become the transition work group and the heart of the transition project. Sub-work groups are also formed, each with its own targeted charter, such as facility activation, clinical methods/patient care, training and orientation, communications, medical equipment, and move logistics for patient transport.
In many projects, the management-level points of contact involved in the design programming process are not those tasked with facilitating the transition or even operating in the new space once it's activated. The programming process typically focuses on what the building should structurally look like, but may not take into account how the space will be used and how procedures or systems will need to change.
So how do you decipher this information? Ask the right people. Hold initial meetings to establish two-way communication for project concerns, and focus attention on how daily operations will be affected by the new facility design. A good communications plan ensures that participants, both internal and external, will be comfortable with the transition, and it establishes procedures for how employees, patients, families, and the community will be kept informed throughout the process.
At University of Massachusetts Memorial Medical Center in Worcester, Massachusetts, Gilbane recently completed the relocation of a 200,000-square-foot Emergency Department, an existing ICU, and the Pre-/Post-Op and PACU areas, as well as the integration of 10 new operating rooms with existing support services. The process began with in-depth staff interviews to explore the details of how each unit operated and to establish critical dependencies. Armed with an operational understanding, our team was able to develop a transition sequence that met the organizational goals and formed the foundation of the necessary schedules to address the move's complexities.
The communication over the course of the project created a sense of teamwork that broke down traditional departmental barriers and engaged the entire hospital to foster a sense of direction and purpose. This teamwork was the most often-cited reason for the transition's success. After 10 months of planning and literally hundreds of meetings, the transition of the ED to its new home was completed two hours ahead of schedule.As a transition partner, our participation in design meetings, even as an observer, can be essential. We can often add suggestions that may help identify operational concerns before they become costly change orders after construction documents have been issued.
Case in point: We are currently handling the complete transition and activation of Johns Hopkins Hospital's new clinical towers, which are part of an aggressive renovation project to replace crowded and outdated facilities with a children's hospital tower and a cardiovascular and critical care tower for adults. Our team has been sitting in on the final design signoff meetings. Through observing the discussions, we were able to identify areas where the client needed to consider simulation exercises that would drive electrical, data, workspace, and equipment requirements.
On a recent large-scale project (involving more than 1,000 people and 850,000 square feet) at a federal hospital in Bethesda, Maryland, we assisted the clinical staff in conducting what we call a “Day in the Life” session, which helps prepare staff for operation in their new work environment. First, we worked with the hospital's team to identify which clinical staff members needed to participate. We then enlisted several volunteers to act as patients and family members, while key management personnel served as observers and facilitators. The exercises included “code blue” drills; emergency response; food, pharmacy, and supply deliveries; and testing of new communications systems and applications.
In this and other transition management projects, we also employ “mock moves” to help us develop specific patient move procedures for each unit. We work with the nurse managers to define how the patient will be prepared for transport, where charts and personal items will be stored, how to handle family members, which clinical staff is needed to attend to the patient during transport, what infection control procedures must be used, and more. We find it helpful to have a real person in the bed so that movers can assess accurately how long it will take for each patient to be transported and how many movers must be involved in each individual patient's move.
Through this mock move process at the federal hospital in Bethesda, we uncovered critical issues that had to be addressed. Lessons learned included a change in move routes because the elevators were too small to accommodate the full-size patient beds and the implementation of a ramp in areas where the floor was too rough to push patient beds over.
Once the actual transition phasing plans are developed, it's not unusual to determine a need for groups to conduct parallel operations for a brief period of time during the transition, which means operations are occurring in both the new space and the existing units. This often drives the need to purchase additional equipment.
For example, at Shady Grove Adventist Hospital, we were brought into the process approximately 18 months in advance of occupancy. Early operational interviews revealed the need to order new equipment for the first units to move, which would allow parallel operations for a limited time and for enough “swing” equipment to support the phases that followed. Early identification of such items allows them to be added to the project budget and purchasing plan up front, minimizing surprises later in the process.
Finally, don't underestimate the importance of planning the new medical equipment delivery, installation, and testing process. The development of a procurement tracking database, proactive contact with vendors, provisions for warehouse receipt and redelivery to the site, and close coordination with the clinical engineering department can help you maintain control of your new assets and ensure that they are delivered and activated as necessary.
Good news! If you've put forth the effort on planning the transition and involved all the correct parties in the process from the start, the actual move day is in fact the easiest part. We like to say that only 10% of what we do during a transition is implementing the physical move. The other 90% is expended during the planning process. HD