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Capital Planning: Developing Your Internal Project
Team
Cindy Barr RN, EDAC
Operations & Facilities Planner
IPHCA 2015 Annual Conference
The Thread that runs from Concept to Reality
is the Internal
Project Team
From Concept to Reality
Strategic Facility Planning
Internal AssessmentExternal Assessment
Core Values Site Selection & ControlOperational PilotsProgram/Service PlanOperational PlanStaffing PlanProject Principles
From Concept to Reality
Design Development Secure FinancingProgramming Finalization
Concept DevelopmentSchematic DevelopmentFinishes Plan FF&E Plan Construction Documents
Construction Remote Consultation Daily Management
From Concept to Reality
Operational Readiness Financial ReadinessStaff DevelopmentTools DevelopmentProcess DevelopmentPatient PreparednessCommunity Preparedness
Construction Complete
From Concept to Reality
Activation Deactivation of New Site of Old Site
Equipment/Furnishings/Support SystemsMoving Process
Opening DayCelebrations
Honeymoon PhaseCucumber Phase
Full Activation
From Concept to Reality
Strategic Facility Planning Site Selection and Control
Design Development Secure FinancingConstruction
Operational Readiness Financial ReadinessConstruction Complete
Activation of New Site Deactivation of Old SiteEquipment/Furnishings/Support Systems
Moving ProcessOpening Day
Full Activation
If you were to select your Internal Project Team right now,
who would you select?
Defining the TeamSize of the Team
• 5-11 persons reflecting the size of the project• Identification of non-team resource staff
Characteristics of the Team• Accessible and Available• Comprehensive• Invested and Committed
Every staff person should feel that someone sits on the team that understands their role and their needs.
Defining the TeamKey Members on the Team
• Staff member who is the health center historian• Staff member who is part of the target community• Staff member from outside the target community• Informal staff leaders• Administrative leadership• Clinical leadership• Operational leadership• Information Systems• Facility Director (if applicable)
Defining the Team
Lessons learned -
– Consider the time commitment– Consider both credibility and ability– Consider interpersonal skills– Consider skill sets outside of the staff person’s
current scope and responsibilities– Identify a process historian (clerk)– Consider including a dedicated lead
This team is not the management team!
Sustaining the Team
– If the thread breaks it must be mended• Continuity and unity are critical to function• Replace members that drop out or move on
– If the thread frays it must be reinforced• Monitor team dynamics• Monitor team credibility
– If the thread fades it must be renewed• Sustain the project vision• Maintain communication
Equipping the Team
Lessons learned -
•Define and communicate to your staff and board the function and authority of the team•Bring the team lead into the management circle •Allow sufficient time for an effective process•Provide staff to fill resulting gaps in daily operations •Provide tech and clerical support
Preparing the Team
What are other health centers doing?− Website Review: The broad brushstroke− Site Visits: Choose locations effectively− Learning Communities: Process Redesign
What are other health care providers doing?− Addressing Common Clinical Realities –
language, infection control, education− New materials and equipment
Preparing the Team
What are other industries doing?− Hospitality− Retail− Education
What is your community doing?− Given the opportunity, what do your patients
create?− What are your community norms?
Blending In vs. Standing Out
Gathering Data
Reflecting their Preferences
Send the Team Out
Given the opportunity, what kind of spaces do your patients design for themselves? Visit community centers, churches, restaurants, day care centers and fraternal organizations. Is there a common color palette or decorative theme? Are the spaces generally formal or informal? How are they approached – are there defined entry and interior transition zones or is the line between interior and exterior blurred with glass walls and exterior decking? What concepts are transferable as you design a healing space for the community?
Gathering Data
Asking for their Help
Engage Staff in Data Collection: Incorporate an Exit Question into the Visit Process
“Thank you for coming today. Is there anything we could do to make your next visit (smoother … more helpful … more pleasant)?”
Evaluate patient complaints and comments to target the question directly at what patients have been telling you in the past. Arrange responses in categories identifying common themes. Define action steps in the planning of the new facility which would address those common themes and thus improve the patient experience.
Gathering Data
Caring for their Friends and Family
Engage Staff in Data Collection: Query Existing Patients
“What could we do to make the people who come with you to your appointments more comfortable?”
Addressing the needs of children, spouses, caretakers, and community support persons will not only decrease the stress of the patient and support continuity of care but send a powerful message of mission and vision to the community-at-large.
Our Project – Their Project
The Role of the Project Team
Engage staff and community Process input
Apply inputProvide
feedback
Preparing the Team
Learning to translate three dimensions into two
•Tools of the Trade– Concept diagrams– Single line schematics– Detailed drawings– Construction drawings
Exercise: Spaghetti diagram processes in familiar spaces
RRRR
RRRR
RRRR
RRRR
RRRR
Spaghetti Diagram Current Processes
RRRR
RRRR
RRRR
RRRR
3 Providers3 ProvidersExamExamExamExamExamExam ExamExam
ExamExam ExamExam ExamExam
Medical Medical RecordsRecords
RecepRecep
Break Break / Mtg/ Mtg
LabLab
Proc.Proc.
CashierCashier
Samples / Samples / ImmunizationImmunization
StorStor
EligibilityEligibility
Site MgrSite Mgr
CM/RCM/R
SASA
BillerBiller
Waiting Room
Orange: Patient
Blue: Staff (Provider)
Green: Staff (Nurse)
Purple: Community
_____: Information
_____: Materials
Adding Furniture Helps
Profit by Design website
Read the Notes, Learn the Symbols
Preparing the Team
Evaluating new ideas in three dimensions
•Tools of the Trade– Role-playing in furnished open space– Define new processes in key room mock-ups
Exercise: Create optimal layouts without walls
Build a room with temporary materials
Tips and Tools for Each Phase of the Team’s Work
Programming
AssessmentProgram Plan
Operational Plan Staffing Plan
Facility Plan Protect the order of the process – Form
responding to Function
Site Selection
• Filters for selection discussions– Accountability– Accessibility– Alignment– Availability– Adaptability– Affordability
The first rule of real estate – location, location, location!
Design Development
Programming Finalization
Concept DevelopmentSchematic DevelopmentFinishes Plan /FF&E PlanConstruction Documents
The longer you wait to speak up, the more it will cost!
Operational Readiness
“When do you start preparing for Transition?”
As soon as you have:Secured a Site Signed your Construction Documents Secured your Financing
"If I had eight hours to chop down a tree, I'd spend six sharpening my axe."— Abraham Lincoln
Operational Readiness
“It’s not their job…”
The Team coordinates the transition planning process because they went through the design process.
• They have credibility with the staff• They represent all of the staff• They have developed team-based project work flows• They know the rationale for decisions
• They know the differences between “now” & “then”
Operational Readiness
“Can we just wait? Why commit resources now to Transition
Planning?”
Your facility is only a tool.
$ - Capital financing only pays for the tool. Ongoing operational cost must be covered
by full, effective utilization of that tool.
- The curiosity factor is short-lived. Sustained growth is built on good first
impressions.
The Faces of Operational Transition
Leading the Transition
Quickly Engage Staff -
– Celebrate - at the new site!– Confirm inclusion (“How do I fit in?”)
Describe how the new site will be organized.
– Role out pilot projects; mock-ups– Schedule demonstration equipment/furnishings– Initiate a photographic timeline
The Transition Work Begins
The Tasks of the Project Team
– Provide accurate and timely communication– Manage pilot projects; define new processes– Confirm fixtures, furnishings and equipment– Prepare Staff – Train-to-Retain Plan
Recruitment Plan– Monitor the Internal Timeline
Validate Staff Readiness …
Train-to-Retain Plan– Are job descriptions altered as needed?– Have all competencies been confirmed?– Have new team compositions been defined and
team building exercises completed?
Recruitment Plan– Have new hires been identified, trained and
integrated?
Scenario Building– Have you defined and practiced team-based and
facility-wide “what-if” scenarios?
Validate Staff Readiness …
Cheerleaders and Nay-Sayers– Have you identified informal leaders and inserted
them appropriately into the moving process?– Have you met with Team Leaders to explore their
fears and concerns? Have you familiarized them with the new building?
Consensus Building– Have you confirmed the operational objectives
and the timeline for meeting them?– Have you reviewed the patient-focused design
decisions and how to actively support their success?
Activation
“We are really moving!”
The task of the Team is to capture & mobilize –
– Prepare and affirm the staff– Physically complete the move– Successfully engage the community– Fully activate the site – and quickly
Sustainability is dependent on never missing a beat.
Moving Day!
Tips for Making It Go Smoother
Communicate Clearly and Consistently:
– Define team areas (zones) by color– Define spaces using construction document
#s– Label all equipment & furnishings to be moved to
the new space with space # on a zone colored label
– Label purchase orders with zone color & space #
Moving Day!
Tips for Making It Go Smoother
Define a Process Timeline and Stick To It:
– Define deliveries, set-ups in order of occurrence– Adjust schedule by the process not the clock– Place project team lead on-site in new spaces project team members on-site in old
spaces new site team leads on-site in new
spaces
Don’t forget the Food!
Celebrations!
Tips for Making them Effective
Build Momentum with Variety - Celebration Week
Schedule a variety of events
Align them with the community culture Post all events – with defined target audienceStay focused on two objectives:Staff affirmation and encouragement
Community exposure and attachment
When the Honeymoon is Over …
Moving to the Sidelines –
“Nobody asked us!”
You remember you did – but it is all a blur!
• Enlist the Project Team’s Process Historian
to gently but assertively take staff on a
“Remember when …” Journey
Effectively Moving Forward
Reassemble the Project Team
Acknowledge and discard disappointment
Incorporate new staff leaders
• Do a “clean slate” assessment of your space -Capture the power of the Pilot Project
• Refocus the Staff -Create a new Common Goal
• Reengage the Community -Launch an Exposure Campaign
Full Activation
“Can we just wait it out?”
NO – Remember, your facility is only a tool.
$ - Capital financing only pays for the tool. Ongoing operational cost must be
covered by full, effective utilization of that tool.
- The curiosity factor is short-lived. Sustained growth is built on good
first impressions.
If you were to select your Red Thread Team right now, who would you select?
Your Internal Project Team
• Did you Select the Right People?
– Is every program represented?– Is every staff person represented?– Is there a balance of formal and informal leaders?– Is there a balance of community
insiders/outsiders?– Is there a health center historian on the team?– Are the members available, accessible and willing?– Is the size of the team manageable? – Is there a team leader?
Website Resources
www.caplink.org
For the Leadership Team
For the Internal Project Team
