While the term “team-based planning” is used in an array of contexts, in healthcare design it means the opportunity to move beyond the traditional architect-owner collaboration and bring in the key users, engineers, and contractors from the start.
The healthcare industry is already pushing to engage the full project team at the onset of a project, but the project team can begin even earlier by having experts involved in the planning phase, resulting in more accuracy and better outcomes. For example, working with a construction manager early on can provide better cost and timing accuracy, and involving clinical leaders will ensure the project includes what they truly need to do their jobs.
Also, planning exercises such as visioning, goal creation, and programming can help foster conversations that address, solve, and anticipate future problems. Team-based planning allows owners to work through process and scope issues early, establish a real-world budget, and set up the framework for expectations ahead of committing to a full design and construction project. In other words, the client can test-drive a design.
The facility had dated wall construction and equipment that led to performance issues within the department, including meeting proper pressurization and maintaining temperature control within the facility. Staff, gowned in full PPE, were tagging in and out of the department in order to stay cool.
To begin addressing these issues, the project team, including the owners, users, architect, engineer, and contractor, performed a visioning exercise to help establish project needs, guided by insight from staff, including Julie Thornsberry, sterile processing manager at SOMC.
Key priorities included fixing pressurization issues, increasing comfort for staff, and improving the process/flows of the department. By having all team members in the room, the group was able to establish additional priorities beyond the traditional design concepts and begin to explore questions such as, “How can this be phased for construction?” and “What other impacts would be required to make this project work?”
Danis Construction, the construction partner on the project, engaged with MEP trade partners and accounted for unknowns and other cost drivers, as well as engaged with design engineering firm Heapy Engineering, which had knowledge of the facility’s systems and helped to identify additional unknowns, such as if tapping into a water line for new sinks would disrupt another area or department.
The planning study was intended to lay the groundwork so the hospital could plan for budget allocations in the next year. However, a few months after the study was completed (and at the start of the pandemic), a key instrument failure required rapid implementation of the project.
With a clear plan already outlined, the study group quickly mobilized to onboard new team members, which was especially challenging given the social distancing requirements at the time.
The biggest hurdle to implementation was how to keep the department operational during construction. The central sterile department services nine operating rooms, three cardiovascular operating rooms, eight endoscopy rooms, three Cath Labs, a maternity department, and countless other services. This meant that stopping services during construction wasn’t an option.
Likewise, the small footprint of the project—the decontamination room was only 1,000 square feet, with the total project renovation being 1,500 square feet—created its own challenges in keeping the hospital functional during construction.
One solution would have been to bring in a mobile decontamination unit and undertake the entire project in one phase, but it came at a premium cost and created unwanted inefficiencies with the sterile processing department workflows.
Another idea was to deliver the project in two phases: renovating half of the rooms in the first phase and the remaining ones in the second. While this process would lengthen construction time, it allowed the hospital to remain functional.
After three months of construction, the new decontamination room was operational with improved workflows, the minimal interruption to hospital functionality, and a cooler-temperature work environment for staff.
Because the framework and roadmap were already established, the core team delivered the project on budget and on time while meeting expectations and keeping the department operational.
“I think the overall highlight for me is that we delivered a complex construction project on schedule and under budget while meeting every stated goal from the stakeholder group without reducing any operational throughput,” says Justin Clark, director of plant operations at Southern Ohio Medical Center.
Team-based planning allows owners to “test drive” designs and rapidly implement them when the time is right—whether that’s immediately after a study, years down the road, or even when equipment fails in the midst of a worldwide pandemic.
Angela Kolosky, ACHA, AIA, NCARB, LEED AP BD+C, is an associate principal, healthcare planner at DesignGroup (Columbus, Ohio). She can be reached at [email protected] Michael Forejt, AIA, NCARB, is an associate principal, project manager at DesignGroup (Columbus). He can be reached at [email protected]