The Ten Keys to Success

We have defined ten key elements for guiding the owner in managing a successful facility project. They boil down to the owner's taking the lead and arranging a fully partnered team, along with putting together a detailed plan of project-development tasks to be accomplished at the right time, by the right people, and with the right level of detail. Taken one at a time:

  1. Take full-scope leadership of the project. The owner needs to accept the leadership role for orchestrating and managing the facility design, completion, and transition of operations to new facilities. The work of the professionals and vendors needs to be managed, and all gaps existing within the overall set of project tasks filled. Abilities in project planning, scheduling, communications, and motivational psychology skills are important attributes.

    In assuming leadership of the project, the owner needs to recognize that the scope is broad and includes a wide variety of elements—specifically:

  2. Organize a partnered work team. Successful facility projects are exercises in trust-based teamwork involving all parties to the project. The interests, activities, and schedules of individual participants need to be intermeshed with the overall goals and sequence of the project, through development and commitment to a cooperative partnering culture in which cross-discipline planning is fostered and adversarial relationships are set aside.

    The process of team development must continue throughout the project as members are successively added to the team. The first teaming begins internally with the management and users, such as department management and the medical staff. This is followed with partnering efforts between the owner and the design team, the technical equipment and information management disciplines, the contractor, the vendors, and the furniture/equipment mover.

  3. Adopt high success criteria. Project success can be measured in many ways, depending on the quality standard used. Occupying the building after a short delay, minor cost overruns, a moderate drop in patient satisfaction, and a relatively short period of revenue disruption could be considered a “success” when compared with some of the alternatives. Beyond this, however, the newly organized management team needs to set a foundation for achieving project success by crafting a set of positive goals for the outcome of the project.

  4. Structure a “get it done” management culture. The typical hierarchical, perfection-oriented culture of today's healthcare organization is not designed to accommodate the demands of a fast-paced facility project. A different culture is required based on attention to detail, quick decision making, staff efficiency, individual specialization and accountability, “perfection relaxation,” decision documentation, and open communication.

    Implementing the necessary culture requires diligent work by owner leadership. Assumptions need to be clarified and documented, meetings need to be minimized and converted to progress-reporting sessions, minutes need to be action-oriented, and decision making needs to be proactive, with a clear schedule of decisions that will keep the project on track. Finally, project team members need to be shown appreciation regularly and allowed time for humor and fun. All of these culture components need to be routinely reemphasized because it is easy to slip back into old, familiar ways.

  5. Assemble project tools/resources. Several tools and resources are important to the support of project leadership and team action. Here are a few:

    Project information management system. A unified data-collection standard for the architect, interior designer, equipment planner, and others will provide a payback in convenience for planning and managing the procurement, the finish/fit-out, and the move-in. A relational database will also allow for selective reporting of data for various project purposes.

    Fiscal control system. A full-scope project budget is needed at the outset to prevent surprises and consequent surprise overruns. A facility change-modification request tracking system is also important for resolving facility operations conflicts.

    Issue resolution management system. Small difficulties can grow to large, expensive problems unless a ready mechanism is available to identify, record, track, and communicate the resolution of reported difficulties. The meeting-minutes approach is best replaced with a database organized by topic and assignee.

    Project overview document. This document serves as the project compendium of information about the facility and is designed to establish a common understanding about the project and the prevention of incorrect assumptions. It includes facts on the project, a description of the operational concepts underlying the design, a description of the design, and an overview of the services to be provided.

  6. Create a functional design. A successful project must ultimately result in a facility that meets the desired service and operational improvement goals that support and justify the capital expenditure. The basic project goals need to be converted by the owner to a set of design parameters, and to operational process concepts that are to be incorporated in the space program and final facility design. These goals would encompass such things as flexibility, energy efficiency, healing healthcare design principles, and operational concepts—e.g., circulation patterns/flows, information management techniques, environmental services support, materials management, and others.

    It has been estimated that up to 50% of owners/users can't conceptualize square footages and two-dimensional architectural plans in three dimensions. A proactive step for preventing the fallout from this type of problem is the use of mock-up rooms, isometric diagrams, wall-elevation drawings, and three-dimensional video simulations.

    The final design is a composite of a series of budget and site/facility constraint compromises on size, location, layout, equipment, and furniture. The compromises need to be documented by the architectural, engineering, and consulting disciplines and fed back into the original design goals. The resultant design documentation provides a great payback because operations staff understand the intent of the design for implementation of operational systems policies and procedures.

  7. Establish a full-scope communications program. The successful operation of the project team requires full and open communication. A well-defined program of written, visual, and oral communication will build the team's knowledge of the project and support cooperative efforts.

    Employees are expected to accommodate a project's numerous changes and need full support. It's essential to communicate what needs to be “designed around” and to prepare their minds for transition to the new operating mode. This can be accomplished through regular updates on the project, early exposure to the building, and a well-planned training program.

    The public communication program needs to be designed as an opportunity to represent the new facilities and operating format to the community, as well as the benefits to be realized.

  8. Create a unified project schedule. The detailed project task list is an assemblage of known activities and unique efforts that are required. It is generated over time by discussions with all participants. Each task is intended to be discrete enough for assignment to an individual but broad enough to embody a wide variety of details. Examples: Procure furniture, plan patient move, hire mover, acquire certificate of occupancy, etc.

    A fully integrated project calendar based on project milestones and sound rationale helps promote success for the project and all project participants. It also saves time and money and enhances the quality of the project, because resources can be properly allocated and mistakes and reworks prevented.

    All the individual team disciplines are expected to contribute their model activity schedule for incorporation within an overall project calendar, so that the full scope of the project is encompassed. As the melding of the schedules occurs, compromises are made so that the calendar accommodates the needs of the overall project and its working partners.

  9. Organize a unified work plan. A
    detailed work plan that lists and assigns all the project tasks according to the unified schedule serves as the overall project battle plan.

  10. Manage the unified work plan completion. Once the work plan is organized, the tasks can be assigned and distributed to individuals. Work can begin, and the owner-leader can begin monitoring assignees’ progress through regular reporting sessions and review of documented output materials. Gaps in planning can be identified and conflicts or difficulties resolved to maintain project progress. Positive support needs to be provided, as well as recognition for “above and beyond the call of duty” accomplishments of all participants.

    It has been our experience that once a team has operated under a well-planned project effort and gained confidence in knowing that big things can be successfully accomplished by coordinated attention to detail, it is difficult for them to return to the time-consuming traditional management approach. HD

James N. Verhey, MHA, CMC is President of Normandale Associates, Inc., a Reno-Tahoe–based consulting firm for health facility projects specializing for the past 25 years in guiding and advising owners in the successful development, completion, and transition/occupancy of complex facility projects.