The new reality of master planning
Master Planning in healthcare today is increasingly complex as organizations use emerging practices to guide decision-making processes. While funding mechanisms differ around the world, the global credit crunch has made low-cost borrowing an unrealistic expectation and many more investors (whether public or private) expect assurances that funds will be used judiciously. Evidence-Based Design, Lean and Six Sigma are just some of the tools available to organizations to develop the highest and best use of facilities and funds. To be used effectively, there needs to be a more collaborative and integrated approach in the development of master plans and programs.
Southlake Regional Health Centre (SRHC) has recently embarked on a 20-year Master Plan to significantly expand the campus and services offered. They entered the Pebble Project in 2008 at this early stage in their process. Even at the earliest stages of planning, the intersection of selecting the planning team, selecting the “user teams”, setting the stage, developing a work plan, and communication and stakeholder engagement is crucial for success.
As Southlake entered into functional programming, however, they recognized the need for a period they called “Refocus, Refresh, and Renew.” This was not a project pause related to funding, but an opportunity to re-evaluate the course. Learning about other Pebble Projects allowed the team to step back and realize that even more could be achieved with the collaborative and integrated approach already in place. It was necessary to ensure that the right information was provided by the right person at the right time. With functional programming now drawing to a close, the organization achieved a process that became exciting, igniting great debate and discussion amongst the stakeholder teams
Southlake Regional Health Centre Existing Conditions (IPMT/PRISM Partners + Stantec Architecture Ltd.)
The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at firstname.lastname@example.org.
Selecting the right planning team
To ensure that the best emerging practices are considered, an important first step is the creation of a planning team who will not only act as advisors to the organization but challenge current practices. Understanding the need for flexibility in future care delivery models requires an integrated design team. This team should include a wide range of subject matter experts including but not limited to master planning/programming, functional programming, organizational visioning, architectural design, evidence-based design, process improvement, green and sustainable design, project management, financial planning, communications and stakeholder engagement, project scheduling and risk mitigation. Additional resources should also be identified early and contracted on an as required basis (i.e., cost consulting, municipal planning, retail IT, logistics). Historically, specialized consulting may not have been retained this early in the process.
But, perhaps more important than the specialty is the ability to share this knowledge in an enthusiastic manner that excites and inspires others. Without this engagement, the project risks a significant lack of active participation resulting in planning gaps.
Setting the stage: Part 1-the project vision
Another important early step in the planning process is the development of the Project Vision. This document is important to the overall success of the project as it sets the guiding principles for the project. Based on the organization's goals and priorities, the Vision Statement and Guiding Principles should provide a link between the strategic plan and the supporting capital plan. It should be a living document used to validate or inform decisions throughout all the planning phases. The SRHC Vision Charter established seven Guiding Principles to address areas such as teaching and research, delivery of care, and building the best with evidence-based design. One excerpt of the Guiding Principles shown here recognizes the importance of people.
Southlake Regional Health Centre: 2010-15 Plan (IPMT/PRISM Partners + Stantec Architecture Ltd.)
Southlake Regional Health Centre: 2023-28 Plan (IPMT/PRISM Partners + Stantec Architecture Ltd.)
Setting the stage: Part 2-operational visioning
Operational Visioning develops a process for the organization to consider work process and care models for the future - not just the ones already in place. It is impossible to translate what is needed from a capital standpoint without fully understanding how the space will be operationalized.
While attending a recent Capital Planning Conference hosted by the Ontario Hospital Association (OHA) one of the speakers noted that operational visioning “does not describe the design but describes the required outcome.” This is very much aligned with an evidence-based design process where developing hypothesized outcomes at all levels makes “form follows function” easier to understand and appreciate.
When an integrated planning approach has not occurred, gaps in service, process and flow appear become evident in the new space. How often have organizations been forced to make “user initiated” changes during or immediately after occupancy because the leadership of a program had changed or an operational plan for the space was never developed?
User groups versus stakeholder teams
In the past, user groups were often not expected to take ownership of what they had planned and quite often there was not a clear picture of the basis upon which decisions were made. When operationalizing a vision, it is important to bring new ideas and real life examples to the table. Using all available research that documents hypothesized outcomes, in addition to comparing other organizations through case studies, benchmarking, and site visits, creates a baseline for best or better practices. How can an organization advance care, not just rebuild the same model from decades before?
Ensure that users take ownership of their plans by making this a clear expectation at the start of the process. At a minimum the Team Leader must be expected to sign off on the final functional program. Create this ownership of the process and outcome by making “Stakeholder Teams.”
In the past teams were created in silos. Specific departmental teams would meet about “their space” with minimal regard on how the decisions that they were making affected other departments.
No more silos
In order to get teams to think about service delivery in the future, take ownership in their plans, and ensure an integrated approach to planning it is important to create teams that are “flat” as opposed to “silo” in nature. For example stakeholder teams are created for divergent areas such as, critical care, acute medical/surgical inpatient, interventional platform, ambulatory, clinical support areas, and public and retail spaces. Each team includes membership from a cross-section of programs which were directly or indirectly involved in the delivery of service within a team. Who serves you? And whom do you serve?
While it is often unavoidable that staff will move to other organizations or to other departments within an organization, it is important to maintain consistent representation on stakeholder teams throughout the planning process whenever possible. Documenting all of the decision making into an information repository also ensures a common organizational understanding of the history of decision making, the where, whys, and how.
Developing the work plan-Plan the work and work the plan
Each project will be driven by competing priorities. While there may be many valid reasons to move a project forward quickly, it is very important to create a balance between the time constraints created by internal and external priorities and the time that is required to develop a strong program.
The development of a detailed work plan is required to keep the teams focused and on track. A regularly updated work plan identifying all necessary activities will allow changes in priorities or the development of risk mitigation strategies. This is often required to address issues or changes during the planning process. Depending on the reporting structure of the teams and approval which may be required it is often useful to include standing meeting dates on the work plan to make sure that submissions and reviews are complete in time for approval presentations.
The schedule must not simply consist of a series of lines representing various work streams and dates. It must clearly delineate and identify the entire work plan and schedule for each activity and must show the interdependencies of each activity with key delivery dates and milestones.
“Get and Keep Great People”
Southlake and Stevenson will attract, train, and retain the brightest and best people to enhance the quality of healthcare services provided by both organizations, educate a new breed of healthcare providers and conduct research.
Southlake and Stevenson will provide its People with the best and safest environment in which to work and learn and the systems and technology required to deliver exceptional care, and conduct research with the goal of being recognized as an employment destination of choice. Supportive spaces and amenities for staff and students will be made available to address work/life balance issues that are of high priority in today's workforce.”
*Southlake Regional Health Centre/Stevenson Memorial Hospital - Project Vision Charter “Put Patients First Always: 7 Guiding Principles.”
Contingency time is needed in any schedule as it is probably unrealistic to expect that every milestone date will be met. In addition, time is needed in the schedule for the teams to actually do their project work. Meetings or presentations should not be scheduled during that time, but check-in points should be considered to ensure the work is happening.
Communications and engagement-Do you really want engagement?
Finally, a significant amount of effort must be allocated to developing a communications and engagement strategy. Actions taken to execute this strategy will help get the word out about the project and can effectively build excitement and support amongst staff, physicians, patients, and visitors. Done well, it can also help build support in the community and promote the need for the project with approving agencies and authorities.
SRHC Project Readiness Schedule (IPMT/Prism Partners + Project Control Group Inc.)
When developing a plan it is important to remember the target audience and whether the goal is “communicating” or “engaging” the audience. It is possible to communicate information pertaining to a capital planning process without seeking feedback. However, depending on the audience it may be beneficial to engage the group and actively ask for their input on the ideas and concepts being considered. With the expanded role of collaboration in the capital planning process seeking feedback from stakeholders provides an additional source of ideas and thoughts from a unique perspective that may not be available within the planning team.
Clear, articulate presentations which outline the need, (population growth, old/outdated facilities, expanded services, aging population, etc.), the vision, and some of the concepts being explored for the project will generate discussion and ideas. The healthcare experience is seen through many pairs of eyes and each has a story to share or an idea of how their experience could have been made better. A well developed and executed communications plan provides a platform for these experiences to be captured so they can inform the planning process.
Planning for any capital project signals the beginning of integration and collaboration but is most certainly not the end. Integration and collaboration is now occurring in all aspects of capital development and will be increasingly used as projects become more complex, expensive, and time critical. Having the right people at the table at the right time working collaboratively does not guarantee project success but most certainly provides a solid foundation for success to be attained. HD
Rob Mayhew is the Director of Capital Planning + Implementation at Southlake Regional Health Centre. Healthcare Design 2010 January;10(1):22-27