St. Joseph’s Healthcare Hamilton’s West 5th Campus, a 214-bed mental health facility in Hamilton, Ontario, Canada, needed a change. The majority of its patient bedrooms—including minimum and medium security forensic beds—were housed in either four-bed wards or two-bed semiprivate spaces. Programs were run out of facilities that ranged from 50 to 100 years old, which created many challenges, such as suboptimal security, a lack of privacy and independence for patients, and the inability to modify the environment for patients with diverse needs. Services included inpatient care, outpatient clinics, and specialized ambulatory care, including rehabilitation.

The solution was a new 855,000-square-foot building offering 305 single-patient bedrooms that was completed in December 2013. In addition to existing programming, the replacement also houses community-based outpatient programs, enhanced diagnostic services, and medical clinics. Its design addresses the issues of the former environment with a layout that balances the need for safety and security with the therapeutic benefits of patient autonomy and freedom, while a number of new technologies also support care delivery.

However, the dramatic changes to the physical environment, program expansion, development of new services, and the organization’s desire to improve upon existing processes all contributed to the need for a comprehensive readiness strategy well before the transition from old to new.

The team
To ease the process, an operational readiness team was created, beginning with the hiring of a team director 18 months prior to occupancy. Later, two managers joined the team, one responsible for clinical interactions and the other specifically dedicated to improvement activities and training. Starting in 2011, each manager at the unit or department level gathered frontline staff to attend “day-in-the-life” workshops conducted by the operational readiness team, to identify processes that needed to change or be challenged prior to the move. This activity formed the basis for the development of unit/department work plans.

Beginning in early 2013, the director and clinical readiness manager met with unit/department managers monthly to further develop these plans and monitor progress. This concentrated time provided staff with the opportunity to focus on readiness activities, add new issues for consideration, prioritize tasks, and assign activities as needed. Through this process, operational readiness staff also provided a link between the managers and a redevelopment team, which was led by the director of project construction and a number of project managers/coordinators, to facilitate the flow of information and coordination of building activities with operational planning.

For example, detailed operational discussions about staff roles informed locations for details like communication boards.  And if the redevelopment team discovered a problem requiring a facility design modification—for example, a filing cabinet location would interfere with access to a light switch—the readiness team worked to find alternatives. As much as possible, the group’s goal was to prevent the need to alter the built environment.

Becoming re-acquainted with the future space, the furniture and equipment, and the intended workflow was also an important outcome of these meetings. Although many of the managers had been involved in the design, significant time had passed since that phase and some managers had been hired after it took place. To further support this understanding, some work plan meetings were held on-site.

Stepping it up
Eventually, in lieu of monthly meetings, the operational readiness staff hosted full-day events where highlights of individual work plans were shared, focusing on those processes that impacted and/or had a dependency on another service. For example, materials management reviewed supply delivery to inpatient units and pharmacy discussed the changes associated with new medication dispensing units.

During the work plan process, issues that were common to all or many units were identified. These matters were addressed via two alternate readiness streams. First, a clinical operational readiness meeting occurred monthly to resolve issues. And then corporate-wide matters made it to a “big dot” list, or items that required the creation of ad hoc committees and/or were assigned to a senior leader for resolution.

The process next moved to training of both new and existing staff members, with a “train-the-trainer” model used for both unit-specific training and equipment training. Frontline workers were trained by various equipment or systems vendors and were responsible for familiarizing themselves with their new space and processes, and then took turns training their colleagues. The process also included a building orientation/wayfinding exercise for staff.

Time to transition
At a certain point in any project planning schedule, focus must turn to planning for the transition to the new building.  For the St. Joseph’s project, this occurred about three months prior to occupancy. However, some final operational issues that remained had to be resolved as they related to the move. To that end, weekly 30-minute meetings were held with inpatient managers and the operational readiness team to identify burning issues, assign responsibility, and commit to future follow-up.

A room was dedicated to this task, where various communication tools could be posted, especially those that could help with quick decision-making. Examples include a move schedule, marked-up floor plans, and previously tabled questions with answers. This became the forum for resolving minor but important operational details to complete the readiness process.

The move then took place in February 2014 without incident. In the first days post-occupancy, units and departments were able to provide care or service with few problems, thanks to preparations that allowed for an immediate move to new operations and staff anticipating the plan of action. However, in some instances, what was planned didn’t work when implemented in the new space with actual patients. Greater time spent prior to occupancy on process simulations may have uncovered these glitches ahead of time and allowed for a Plan B.

The weekly 30-minute meetings continue and remain valuable in sorting out issues and identifying new ones as the facility gradually moves toward a steady state of operations. As a result, the list of issues gets smaller and smaller, with only a handful remaining after 50 concerns were addressed since occupancy.

A timeline of the operational readiness process for St. Joseph’s Healthcare Hamilton’s West 5th Campus.

Looking back
Operational planning shouldn’t be a standalone initiative, given its strong connection with a hospital’s overall organizational goals. Assistance with policy development, the removal of roadblocks to planning or schedule, and the assurance that operations align with financial goals are some of the benefits of a regular dialogue between a readiness team and senior staff, with reporting of progress necessary to ensure focus is maintained.

For St. Joseph’s, it’s anticipated that this work will continue up to even six months after occupancy, or until senior managers decide that operational goals have been achieved. By reviewing critical system functionality, the number and type of requests to facilities management, and feedback from frontline staff will be used to determine when that state has been reached.

Lee-Anne M. Kidd is director of operational readiness at St. Joseph’s Healthcare Hami
lton. She can be reached at Rob Howe is process improvement manager for St. Joseph’s Healthcare Hamilton. He can be reached at