Tackling The Transition To The New Parkland
In 2008, leadership at Parkland Hospital in Dallas realized that the facility built in 1954 had reached its useful life and it was time to embrace the future. So began a journey that lasted nine years. The new $1.3 billion, 2.1 million-square-foot New Parkland Hospital broke ground in 2010 and opened to the public on Aug. 20, 2015. What did it take to move staff, patients, and equipment literally across a highway from old location to new? An extreme amount of planning, persistence, and patience.
The relocation of any hospital or healthcare system typically involves similar components: the relocation of contents (medical equipment, IT equipment, furniture, supplies, etc.), staff offices and workspaces, and—most notably—patients. Though the elements of a transition may be typical across facilities, achieving a safe and efficient move requires a tailor-made plan based on the needs and goals for each individual location. For any hospital relocation involving the transfer of patients, patient safety is the primary objective, as was the case for Parkland.
The transition plan for the move had to account for the relocation of the existing 1.5 million-square-foot facility with more than 60 departments, 10,000 employees, and up to 650 patients. In addition to housing a Level 1 trauma center, Level 3 NICU, and regional burn center, Parkland sees more than 10,000 babies born there annually. So a plan had to be developed with respect to maintaining these vital services as well as the understanding that the facility couldn’t divert patients, as surrounding community hospitals weren’t able to handle the excess capacity—meaning Parkland had to remain fully functional during the transition.
Although new equipment is often purchased for replacement hospitals, Parkland had a significant number of medical equipment assets with plenty of remaining useful life. The relocation and reuse of this equipment had to be factored into the transition plan, as well, with as much as 50 percent of the medical equipment ultimately relocated and reused in the new facility.
Given the array of considerations required, the Parkland transition team began a planning process made up of five key components: a sequence plan, facility readiness plan, training and education plan, department move plan, and patient relocation plan. Given that patient safety was the primary goal, the sequence plan had to be developed first, the foundation of the overall relocation schedule that detailed the order in which all departments and patient units would be moved to the new facility.
The output of the sequence plan provided the following information:
- A comprehensive list of all departments that would relocate to the new facility and their new locations
- The optimal timing of when a department should relocate—prior to, during, or after patient relocations
- A determination as to whether departments would require a comprehensive or phased relocation prior to seeing patients in the new hospital to best maintain services and minimize downtime of operations
- An evaluation on the impact on day-to-day operations and patient safety throughout the sequence
- An assessment of operating dependencies between each department and the relocation strategy
- The order in which departments/units and patients would relocate.
The result of the sequence plan led the team to separate the relocation into four stages.
Stage 1 began approximately three weeks in advance of patient relocation. Primarily, this was for departments that could operate remotely at the new facility while maintaining operations for the existing facility.
These departments would relocate up to three weeks in advance of patient relocation, allowing staff to become familiar with the new facility. Some examples of Stage 1 moves include materials receiving and distribution, police, limited lab functions, desktop support, and offices. A potential risk for departments relocating in Stage 1 is the ability to efficiently support daily operations. Careful consideration was given to each department that would relocate during this time to ensure that there would be no impact felt during the three weeks of remote operations.
An example if this was in planning the relocation of a portion of the lab. It was understood early on that Parkland performs an extraordinary amount of lab processing each day and maintaining optimal efficiency could be a challenge during the transition. Some lab equipment could take weeks to validate prior to use. To solve and prevent a potential pitfall, Parkland’s clinical staff and transition team devised a plan that allowed for utilizing a mix of new and existing equipment to maintain full lab functionality.
Stage 2 primarily involved the equipping and prepping of patient care units at the new hospital. This stage began just days prior to activation and was based on the identification of units and services that would need to be online at the first moment the new facility would open.
This required that active patient care units at the existing facility free up as much equipment as possible to be moved and placed at the new facility upon opening while minimizing any impacts to operations or services. Since it had been determined early in the process that there could be little to no service disruptions during the transition, the team and clinical leadership had to develop a strategy to maximize both the medical equipment and human resources needed to bring the facility online.
While it was vital to equip the new facility, some things had to remain at the old site to keep it functional. The challenge was determining exactly what to move and when, so the team used the following process to tackle the challenge:
- Determine which services were mandatory to be online in the new hospital to provide care to all patient types that could present on day one
- Determine where patient care could be consolidated among inpatient units and clinical support areas
- Determine the number of inpatient units necessary to serve “new” incoming patients as well as transfer patients from the existing facility.
These areas were prioritized to be outfitted and/or equipped to serve the immediate needs of the new facility, with the process repeated to prioritize the activation of the second- and third-day units to accommodate new and transfer patients. With the essential Day 1 units determined, the facility could then plan for the patient unit relocation sequence, which was based on needs, availability of equipped units, and logistical considerations. For example, the first unit to relocate was the post-partum unit, as this unit was in the direct path of travel for patients to reach the new facility. The remaining units then were relocated in pairs of dissimilar units, to allow for a more efficient relocation.
One of the greatest risks in a multiday/phased move of this magnitude is staffing coverage and maintaining optimal care for all patients throughout the transition. With the development of the patient relocation plan above, the Parkland clinical and transition team was able to ensure that the staffing and care needs for each patient population were maintained.
Stage 3 consisted of the actual opening of the new hospital, beginning with the ED and the start of patient relocations. All patient care units identified in Stage 2 would be staffed and operational, which required some dual operations between sites until patient relocations were completed. In order to reduce the duration of dual operations, no new patients were admitted to the existing facility once the new facility had opened.
A three-day patient relocation was planned to restrict the transfer of patients to a specific window of time each day and to accommodate the equipment relocation/reuse plan. Relocation of 626 patients was completed in just two days, nearly 30 hours ahead of initial projections.
Relocating patients is always the greatest risk in any move. While it’s common for patient relocation to be completed ahead of schedule, it’s usually by a matter of minutes or a few hours, depending on the number being transferred. Having the ability to significantly reduce the patient move, as was the case at Parkland, can lessen a number of risks associated with staff fatigue and dual operations.
Completing the transition ahead of schedule was a direct result of detailed planning and communication among clinical leadership and the transition planning team. For example, over the course of the project, a detailed calendar was developed that outlined the specific activities and start times for each activity to be completed each day. This calendar, in conjunction with documents detailing activation tasks by day and sequencing, assured that all team members, clinicians, and staff members were aware of the comprehensive plan. As the move progressed and efficiencies were realized, the team was able decrease the overall move duration by adhering to sequential priorities.
Stage 4 was reserved for departments/units that would relocate after “go-live” at the new facility. This stage was primarily for phased departments that required a presence at the existing facility until all patients were relocated and for equipment/contents that weren’t available to relocate in their entirety during Stage 1 or Stage 2. Examples include a portion of the surgery ORs, pharmacy, and imaging. All Stage 4 departments completed their moves within four days of patient relocations.
Always be prepared
With the relocation sequence plan defined, the Parkland transition team began the three-year process of developing, planning, and finalizing the facility readiness, department move, training and education, and patient move plans. The process included the development of schedules, budgets, checklists/logs, RFPs, and gap analyses. The end result was a customized transition plan that achieved success. When all was said and done, staff, patients, and equipment/furniture were moved without incident and a full day ahead of schedule.
Any hospital move, no matter the size, requires a logical, well-thought-out plan. Though it is the culmination of an arduous process, transition planning shouldn’t be left to chance. Start early, involve hospital clinical and medical professionals, map out all processes, communicate the plan and, most importantly, be prepared and carefully plan to avoid the pitfalls.
Roman Buckner is healthcare director of project management for CBRE Healthcare. He can be reached at firstname.lastname@example.org. Jeffrey Powell is senior project manager at CBRE Healthcare. He can be reached at Jeffrey.email@example.com.