Design 360: A Proven Approach to Design Management

By Robert A. Pratt, AIA, Principal, Planning and Design

A healthcare facility project can take years to come to fruition. It is a long journey and a tremendous undertaking. Owners must align countless stakeholders and team members as they navigate hundreds—even thousands—of line items on a project work plan. An entire team of architects, construction and engineering professionals, and many other consultants are engaged to help carry the vision to reality.

Project Management’s Role in Design Management

During that process, the role of the project manager is to advocate for the owner, to be the “Chief of Staff” collaborating with the design and construction teams while advancing the healthcare providers’ vision and mission, including the inclusion of key stakeholder input.

Project managers do not just provide construction administration. They know how to ask the right questions about the plan and process that led to the design, review, and validation of the program, operational flow, and budget. It is the critical role of the project manager to challenge assumptions and pressure test processes and conclusions—to measure twice and cut once.

What Poor Design Management Looks Like

Once a project reaches that auspicious moment when shovels hit the ground and workers stand ready to mobilize, owners should have confidence that all this kinetic energy will be unleashed in the right direction. Imagine, however, a health system ready to proceed with an outpatient center in a new market. The plans, budget, and schedule have been approved by the board. Now, imagine launching the project and realizing that the new facility should have been double the planned size to accommodate the market demand. The site, as designed, is not capable of expansion and the facility is unable to accommodate the true volume and service demand in the new market. It sounds extreme, but we have encountered this type of situation too many times.

To avoid this scenario and to ensure the overall success of the project, a rigorous design management approach is required.

Design 360

Hammes is unique in our ability to engage early in the project, leveraging our internal expertise in master planning and design management to appropriately guide the early phases of design on major capital programs. Part of the goal of early engagement is to reduce or eliminate the need to go back to the board to request more funding.

Hammes’ design management approach, which we sometimes refer to as "Design 360," is an approach that thoughtfully challenges assumptions that are not in line with the master plan or guiding principles. In many cases, we establish the parameters of the project upfront (e.g. gas versus electric air handling units, certain types of flooring for the operating rooms, etc.) so there is no miscommunication or misalignment going forward.

The key benefits of a Design 360 approach include:

  • Maximize Leverage during Initial Phases
  • Control Scope
  • Integrate “The Project” with “The System”
  • Share the Load

Benefit #1: Maximize Leverage during Initial Phases

The window to effect maximum change with limited financial impact is at its peak early in the project. Continuity of strategic alignment and clarity around the project’s guiding principles, including scope and budget, are key during master planning and the early design phases.

A project manager practicing design management will be present during conceptual and schematic design to advocate for the owner’s guiding principles, not just for the project, but for the organization. Asking key questions about how the design or the project will impact current operations, IT strategy, and the ability to meet key financial and/or market goals.

Benefit #2: Control Scope

It is common during the design phase to experience scope creep. The process of design is exciting for user group participants—many of whom have never been asked “what they want” in a new patient care unit or as part of clinical operations. Design management allows for close and careful cooperation with the design team and the user groups, thoughtfully addressing the business scope of the specific unit, managing scope creep, and testing the operational philosophy of what design is recommending and the operational capability of the clinical teams. In a word, balance is the ultimate goal in this phase. This includes the balance of needs, goals, and budget to maintain pace on the schedule, a positive project culture, and meaningful engagement of key stakeholders. After all, at this point, there is still a long way to go before the shovel hits the ground.

Benefit #3: Integrate “The Project” with “The System”

Issue mitigation is at the heart of design management and a key responsibility of any project manager. The design and construction team must focus on the new project as well as how it will integrate into current operations. Some key issues to address:

  • How will the phasing of the new project impact existing operations? Will floors need to be shut down or operations halted? Will the hospital staff have to implement this phase? Who will be responsible?
  • What are the enabling moves required internally to “make room” for the new project? This could include demolishing buildings or a simple department move—all action items that are typically managed and completed by hospital or health system staff.
  • How will the new technology integrate with current technology? Who needs to be engaged in technology planning during design?
  • Will the proposed new operational flow work with the existing flow and teams?

In short, design management is not just about design. It is about managing the integration of the new into the existing smoothly, efficiently, and with enough time for teams to adequately prepare.

Benefit #4: Share the Load

Over the last twenty years, owners have developed very experienced internal design, construction, and facilities teams. In fact, many owners manage projects without a project management partner. That said, it is a significant undertaking to balance workload, demand for time, and attendance at design meetings while facilitating executive leadership and clinical participation and decision-making. Project management professionals should be experienced leaders who are capable of efficiently leveraging the time of executive leadership, leading teams through difficult decisions, and sharing the load of managing major capital programs.

Hammes Design 360: Continuity and Insight

Unique to Hammes is our multi-disciplinary team that fills the gaps between strategy, planning, design, construction, and operational readiness. Because we are also developers and owners of healthcare facilities, we give our clients the same advice that we would give to ourselves. Healthcare providers should expect no less from their project management team: to serve as their advocate and partner during these exciting and challenging programs. This is Design 360.

Bob Pratt is a Principal, Planning and Design with Hammes Healthcare's Advisory Services practice. With more than 30 years of healthcare planning and design experience, he has held leadership roles in a wide variety of healthcare projects totaling more than $1.7B. Prior to joining Hammes, Bob was CEO and founder of Pratt Design Studio, which designed more than $900M worth of healthcare facilities over 15 years. He has earned a reputation as a leader in innovative construction techniques and has been recognized with numerous design awards.