Healthcare facilities are about as complex a building type as you can get, making a career in the healthcare planning and design field far from a cakewalk. And market conditions are only complicating matters. Hospitals and health systems are responding to the financial realities of reform (and remaining unknowns tied to the Affordable Care Act), implementing measures to support population health, and trying to figure out what to do with an aging building stock—each priority shaping expectations for new building projects and, more importantly, the project team members delivering them.

Healthcare A/E/C firms are responding to the new climate that’s been created, one where shorter schedules are the norm, collaboration is key, and expertise is a must. Healthcare Design asked healthcare design leaders to shed light on the business side of the industry today—specifically, what challenges are top of mind, from talent acquisition to streamlining project delivery to answering evolving client expectations.

In this special report, we profile not just those challenges identified, but the drivers behind them and the solutions being implemented. Here, Rudy Santacroce, vice president, operational excellence at CallisonRTKL, discusses his firm’s efforts to tackle efficient project delivery.

Name: Rudy Santacroce
Title: Vice President, Operational Excellence
Firm: CallisonRTKL (Dallas)
Number of employees: 1,000
Healthcare revenue in 2016: N/A

Business challenge: Efficient project delivery
The short durations of time allocated by the client to the design firm from project award to project completion is one of the main challenges we see in the healthcare industry. CallisonRTKL has found that this quick turnaround stirs the need for a highly efficient, Lean project delivery process to maximize time spent during design and delivery while still developing a functional, aesthetically pleasing facility. But sometimes that’s easier said than done.

What’s behind it
Healthcare systems are challenged in several different ways, due to rising costs, the shift to value-based models of care, advancement of technology, etc.—all resulting from the development of the Affordable Care Act. When building a new facility, organizations are often faced with financial constraints that lead to requests for shorter project schedules to decrease the cost, saving money by minimizing what’s spent on project team time and resources.

Our firm has determined that the best way to approach expectations for a fast turnaround and maintain an exceptional project is to implement a Lean project initiation process that starts well in advance of the traditional architectural design process. The Lean initiation process requires detailed planning before project programming, requiring more work and time at the beginning of a project. This process forces discussion to be more operational, which then informs project programming and budget. However, it also brings in a larger number of key decision-makers than the traditional architectural design process, increasing the necessity for early stakeholder buy-in.

The solution
While clients may see the upfront work as prolonging the project schedule, this approach results in much less rework later in a project’s lifecycle and saves a substantial amount of time—usually months— toward the end.

To deliver added value and quality results to a client via the Lean initiation process, our first step is to learn and understand the people and culture of the client’s organization. This is done during what we call the Discover Phase, before any design has taken place, and provides an opportunity for everyone involved on the project to get on the same page. We go to the “gemba,” a Lean term meaning the place where the work happens, to immerse ourselves in the operations of an organization and fully understand how our clients work.

After we’ve accomplished this, we move to the Create Phase, which begins with the development of performance metrics, key performance indicators (KPIs), and advanced data analytics. Performance metrics help quantify the significant elements of the process that are used to deliver care to a patient, focusing on efficiency in an organization’s operations. KPIs are then developed after examining the components of operation and might include increased ED capacity, improved throughput times, fewer patients who left without being seen, etc.

Once the current state of operations is fully understood, our team develops value stream maps (VSMs) that determine the future state of operations by incorporating principles of Lean and Six Sigma to reduce or eliminate waste in time, finances, and distance traveled by staff and improve quality and patient satisfaction. VSMs will also drive programming and schematic design, allowing form to follow the optimal function of the space.

Early on and throughout schematic design, the space is then simulated through predictive analytics to include the flow of providers, materials, and patients, and includes fine-tuning the design to maximize the experience of the patient and optimize the building’s plan.

Stakeholder buy-in is important, because the first step of the Lean initiation phase is to achieve a mutual understanding between all stakeholders that allows for sign-off on the project earlier in the design process. Then, details such as the number of rooms can be determined in advance of traditional architecture programming. This leads to less iteration of programming and schematic design. The result is a project schedule that has fewer people onboard in the final stages and stakeholders invested in the project thanks to that initial involvement.

Words of wisdom
Healthcare systems are evolving due to their own specific challenges. For healthcare design firms to be competitive, we must also evolve and deliver more value to our clients by answering their needs through innovative solutions. By incorporating a Lean initiation process, the efficiency of design delivery can be greatly improved.