No matter how much work you put into planning, designing, and constructing a space for healthcare, once you turn the keys over to the facility, all bets are off. You can design the world’s most patient-centered, aesthetically pleasing, community-serving, staff-supporting, and operationally efficient space ever known to mankind. But if the staff doesn’t understand why things were designed the way they were, or staffers take it upon themselves to jerry-rig new processes or signage or storage “solutions”—piece by piece, in a Frankenstein manner—all the design team’s hard work is going to be undermined, maybe permanently.

Hank Adams, vice president and director of healthcare for HDR Architecture, explains part of the problem: “In a typical design and construction project, our visioning, planning, and design work is front-end loaded very early in the life of a project,” he says. “In many cases, especially for large projects, we’re planning the clinical delivery models, operational support, and architectural space programming sometimes years before occupancy.  The construction phase of a project usually results in fewer meetings between design team members and clinical staff. And this construction time gap between early planning phases and transition planning for occupancy is where staff turnover, institutional memory loss, and changes in clinical delivery unfortunately happen.” 

But even if the current staff is trained properly and does have a decent understanding of the whys behind the design, what about the staff after that? Is there something in place to train the next 30 years’ worth of staff, and to allow for more strategic, across-the-board process changes that everyone understands? Whose job is it to make sure this happens?

To a greater degree these days, it seems, architects and designers are being asked (or at least have the opportunity) to contribute to this process. It was at the SEGD event I attended recently that this topic piqued my interest, when Gensler Design Director Greg Nelson spoke about the wayfinding project his team was doing for Cedars-Sinai in L.A. “We have to make sure our professional advice to our clients includes holistic recommendations for how their staff will use—and sustain—the new design we create for them,” he told me in a follow-up conversation. “More and more, organizations of all types are integrating change management activities with design efforts to get the most out of their investments.”

At HDR, Adams says, the use of newer 3-D modeling tools for operational simulation, full-scale clinical mock-ups, and operational readiness and transition planning meetings all help clinical teams get a solid understanding of the design decisions—while allowing them to contribute to those decisions, as well. At a recent HDR project, the facility owner then developed an online employee book called “How Do I…?” which explains all the new processes and procedures, outlining organizational expectations and behavior for current and future staff.

For the Cedars-Sinai project, Nelson says, Gensler started with organizational recommendations for how to train staff, how to budget for maintaining the wayfinding strategy, and how to create a maintenance team. Part of the staff training will include teaching everyone to accurately give directions using the new building nomenclature. And beyond these one-time recommendations, he adds, “We regularly use activities like ‘lunch and learn’ meetings, new user guides, videos, and intranet websites to communicate the information.”

Are these kinds of leave-behinds—videos, user guides, and other updatable, web-based materials—a growing opportunity for design firms to add value to their client relationships? How prevalent is this type of work already? I'd love to hear your thoughts and input via email, or you can log in to post comments below.