Healthcare Facility Design: Hitting the Right Target

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

Design teams have many techniques to ensure budgets, schedules, and programs developed at the concept stage of the project are achieved. Lean Construction, Last Planner, and other methods have led to improved team performance and predictability. But what if the team is aiming at the wrong target?

Healthcare is a dynamic enterprise influenced by many forces. For example, a large replacement hospital project based on strategic data from 2017 would have drastically changed by the time the project was completed in 2024. Changes in reimbursement, regulations on Hospital Outpatient Departments, and competition (moving in or out) can dramatically affect previously accurate data and strategic direction. Like a FedEx package that is already en route, projects oftentimes have so much momentum behind them that it can be difficult to pause or redirect if there needs to be a change to the final destination. There are many reasons a project’s strategic linkage becomes frayed. Securing funding for a large project is complicated and, in many cases, data-driven proformas become the underpinning for the project approval. Making one change to a project’s assumptions can set off a complex chain of reactions.

Consider a new hospital that had designed an ED for 60,000 visits but then the nearby competitor closes its doors. The impact would double the ED’s projected volume. If the project team ignores this information and does not recalibrate the project accordingly, the result will be a new hospital that lacks sufficient capacity from Day One—i.e. the wrong target.

The alternative approach would be to continually assess and evaluate data throughout the design and construction phases. As changes emerge, such as a significant change to projected ED volume, the project team can forecast potential consequences and make recommendations on any course correction that might be advisable. For example, could we consider dual headwalls in the rooms or expansion into another soft space adjacent to the ED? Reduction or expansion of other programmatic elements might make sense in light of the new situation.

At Hammes, we take this alternative approach—what I call “Design 360”—to ensure we’re hitting the right target. Our strategy, design management, and project management disciplines are under one umbrella, which makes it easier to ensure alignment between the design and strategy. Our project managers cross over between strategy and design to provide a continuous connection back to the underlying strategic foundation. And the fact that we also own some of the healthcare facility projects we manage gives us a unique perspective on the judicious use of capital—especially in a constrained environment.

One of our tenets is to consider what if we are wrong? How will the work that we are creating respond to an event after the project is completed? Scenario planning can facilitate a flexible plan that minimizes risks. While you certainly want to make sure your target is the right one, designing with as much flexibility as possible is always prudent in the ever-changing world of healthcare.

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.