Five Critical Operational Considerations for the Successful Launch of a New Healthcare Facility
By Liz Durrence, FACHE, Katherine Kay Brown, MSN, RN, and Terri Palazzo, MSN, RN, FACHE
For many healthcare leaders, opening a new hospital or outpatient facility is a once-in-a-lifetime experience. There is a great sense of pride and accomplishment once the new facility opens—and a great deal of anxiety leading up to it! Having collectively managed the transition to more than 40 new or renovated healthcare facilities, Hammes Healthcare’s Operational Readiness team has experienced common pitfalls that healthcare organizations can avoid through early operational engagement and judicious planning. We have distilled our collective experience into five critical operational considerations for the successful launch of a new healthcare facility.
1. Bring operational considerations into the design and planning phase
You are building for the future—not just replicating today’s operations in a bigger and newer space. Leverage this opportunity to evaluate your organization’s current operational and clinical practices. The design phase is precisely the time to eliminate broken processes and incorporate industry best practices, optimizing your environment to support safe and high-quality care. Additionally, as your organization goes through the design process, it is important to consider how the new design will be supported by current operations. For example, are there any materials management or supply chain operational changes required to support newly designed nurse servers?
Form should always follow function. However, operational and clinical utilization of new spaces are not always thoroughly vetted during the design phase. Ensure your design accommodates operational workflows that emphasize improvements in clinical outcomes while maximizing staff efficiency, rather than creating workflows that accommodate the new design. We recommend creating detailed, simultaneous workflows that map out the flow of equipment and information, patients and staff, supplies, waste, medications, and family for every unit in your new facility.
2. Design with as much flexibility as possible
The time between facility design and opening is often years. Inevitably, there will be changes during this time that impact the building’s design. External forces such as changes in technology, care delivery models, reimbursement, community demographics, physician partnerships, or your competition may require your organization to rethink your initial plans. Or you may be managing internal changes such as changes within your leadership team, staff turnover, changes in volume and clinical specialties, or changes to the overall project budget.
In order to be successful in the future, it is prudent to design with as much flexibility as possible today. This could be a well-designed interventional platform where the procedural–surgical room design can accommodate multiple specialties. Another design that fosters flexibility is the acuity adaptable patient room model that meet the needs of varying levels of patient severity. Evaluate all design decisions with an eye for flexibility and operational impact on staffing, supplies, daily processes, and workflows. Be sure to track the rationale for and the impact of design decisions on future operations.
3. Technology solutions must be identified, thoroughly understood, and approved during the design phase
Technology is a huge part of any new healthcare facility, encompassing security and access systems, staff communication systems, nurse call systems, medical record software, equipment, patient registration, and much more. It is important that all IT assumptions are socialized, thoroughly understood by leadership, and approved early in the project. The technology planning for your capital project should be congruent with your organization’s strategic investment roadmap. Likewise, it is essential to have early alignment between your IT assumptions and budget, given the significant impact IT has on the overall project cost.
While transitioning to a new facility may provide the perfect opportunity to upgrade various technology solutions, do not fall victim to “shiny and new.” Choose technology that will enhance patient outcomes and pilot it prior to opening, preferably within your current environment. If you cannot test new technology in your current state, assess your organization’s comfort level going live with new technology for the first time in your new facility. If this is not possible, or if you are designing for future technology that does not yet exist, build additional time into the project schedule for testing and training.
4. Medical equipment planning is an iterative process throughout the project lifecycle: expect changes
In most projects, baseline medical equipment needs are identified during the initial planning phase and then revisited 16 – 18 months before the new facility opens. However, medical equipment planning should be an iterative process throughout the project lifecycle. Programming changes may impact medical equipment needs. Or, you may have to right-size certain items based on changes in volumes or even technological advances with the equipment itself. For example, one hospital initially planned for three CT scanners but later discovered that only two were necessary based on patient volume forecast and advancements in CT technology that reduced study times.
Another related consideration is the operational impact of reusing medical equipment. For example, if you have a comprehensive stroke center with one biplane interventional radiology lab, you cannot simply shut it down. Another example would be a pediatric facility with a large NICU. You cannot move all of your NICU monitors and patients at the same time, as there are typically very few loaners to be had. We recommend that clinical team members, as well as people familiar with transition timelines and facility moves, are involved in medical equipment planning and procurement to ensure a safe plan with minimal disruptions to your existing operations. Organizations should also be mindful of current supply chain constraints, which require medical equipment orders to be placed much farther in advance.
5. Certain project-associated costs should be considered operational and budgeted for much earlier
Budget management for any project is challenging, especially with today’s market pressures and construction cost escalation. Therefore, it is important to determine early on where certain costs can and should be allocated and ensure alignment among the project team and organizational leaders. Consider routine capital allocation as an example. A common practice is to shift the cost of new equipment to the project budget, even equipment that should have been funded by routine capital as an end-of-life replacement. Organizations can maximize their project budget by ensuring typical end-of-life replacements are covered by routine capital rather than inflating the project budget, particularly in the fiscal years leading up to the opening of your new facility.
Another common practice among organizations is to defer certain expenses until the new facility opens—be it additional staffing, new hire training, technology, etc.—because they do not want to carry the cost burden any earlier. This, however, can be short sighted. Consider staffing and new hire training. In order to have a smooth opening of your new facility and be fully operational on Day One, you may need to hire and train staff several months before the new facility is scheduled to open. This requires allowances for increased labor costs and non-productive time prior to any revenue generated by your new facility.
In closing, as you look ahead to operationalizing your new or renovated facility, remember that early engagement with your operational leaders is key. Bringing operational considerations into the entire project lifecycle, starting with the design and planning phase, will help your organization stay on-schedule and on-budget and, most importantly, optimize patient outcomes and staff satisfaction in an operationally superior new facility.
Liz Durrence, Katherine Kay Brown, and Terri Palazzo are Operational Readiness Executives with Hammes Healthcare. They have a wealth of operational and clinical expertise and have collectively managed the transition to more than 40 new or renovated healthcare facilities over their careers.