A Military Health System Case Study

Page 1

DEVELOPING

A LIFE CYCLE FRAMEWORK WORLD-CLASS FOR CREATING FACILITIES MHS CASE STUDY

Deborah A. Franqui, MS Student

July 14, 2011

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Clemson University

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COMMITTEE MEMBERS

Dina Battisto, Chair, School of Architecture David Allison, School of Architecture Betty Baldwin, Department of Parks, Recreation and Tourism Management

Deborah A. Franqui, MS Student

July 14, 2011

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Clemson University


TABLE OF CONTENTS

I. Introduction II. Literature Review III. Research Design and Methods IV. Results / Findings V. Conclusion

Deborah A. Franqui, MS Student

July 14, 2011

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Clemson University


I.

INTRODUCTION

A. The Problem B. Thesis

Introduction

Table of Contents

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PROBLEM OVERVIEW

 As care shifts from inpatient to outpatient services, ambulatory care is poised for growth in the United States.  Primary care facilities are the fastest growing segment of healthcare spending and are poised for continued growth in the United States.

 While this growth is unmistakable, the availability of standardized spaceplanning tools that link the planning, designing and evaluation of primary care clinics is limited.

 The impact of the physical environment on patient, family and staff satisfaction and outcomes focused on primary care.  There is a need for an integrated process framework that spans from predesign to post-occupancy which includes standardized tools to guide, assess and evaluate the architectural process throughout the Building Life Cycle. This is vital to assist architects, facility managers and healthcare organizations in the planning of primary care facilities.

I. Introduction

A. The Problem

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Problem Overview


OVERALL GROWTH OF AMBULATORY CARE

 From 1997 to 2007, the number of ambulatory care visits increased overall by 25 % (figure 1), faster than the growth of the U.S. population, which rose by 11 % (Schappert, & Rechtsteiner, 2011).  The growth of ambulatory care visits is influenced by the healthcare reform,

clinical practice changes, technological advancements and higher reimbursement rates from the Centers of Medicare and Medicaid Services (CMS) for outpatient services.  The aging population and the rise of chronic conditions among this population will also direct more traffic to ambulatory care settings while chronic diseases will be managed with a more longitudinal approach on an outpatient basis.

Figure 1: Trends in Ambulatory Care Visits: U.S. 1997 – 2007 (Schappert & Rechtsteiner, 2011)

I. Introduction

A. The Problem

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Overall Growth of Ambulatory Care


GROWTH OF AMBULATORY CARE MHS PERSPECTIVE

 The Military Health System (MHS), one of the largest healthcare systems in the world, has also shown a significant growth in ambulatory care.  The MHS is a $49 B organization that provides care to 9.6 M beneficiaries across a range of care venues.  The MHS outpatient visits have grown from 967,500 visits per week in 2002 to 1.8 M in 2010, an approximate 86 % increase.

Figure 2: MHS Bedded, Medical and Dental Facilities 2004 – 2011 MHS 2011 Stakeholder’s Report

MHS Outpatient Visits per Week Eligible Beneficiaries Prime Enrollees Medical Centers Total Expenditure

2002

2003

2004

2005

2006

2007

2008

2010

967,500

1.2M

1.46M

1.7M

1.8M

642,400 Encounters

1.8 M

8.4 M

8.65 M

8.9 M

9.1 M

9.2 M

9.1 M

200,000 Daily Visits 9.2 M

4.006 M 4.04 M

5.1 M

5.2 M

5.0 M

5.0 M

5.02 M

9.6 M

460

461

461

411

411

412

413

364

24 B

21.8 B

27.36 B

37.4 B

37.1 B

39.32 B

42.178 B

49 B

Figure 3: Direct Care and Purchased Cara Weighted Visits 2005 – 2011 MHS 2010 Stakeholder’s Report

I. Introduction

A. The Problem

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Growth of Ambulatory Care MHS Perspective


OVERALL FORCES IMPACTING GROWTH OF PRIMARY CARE

 Consistently from 1995 to 2008 the largest percentage of ambulatory care (AC) visits has been made to primary care delivery sites (figures 4,5).  Healthcare reform in USA, will focus on primary and preventive care to improve management of chronic conditions in a coordinated outpatient oriented care delivery model (Johnson, 2010).  Increase in chronic illnesses in USA, in 2005 133 million Americans had at

least one chronic condition (45 % of US population); and this number is expected to grow to 157 million in 2020; in 2005 63 million had multiple Figure 4: Age Adjusted Ambulatory Care Visit Rates by Setting Type: U.S., 1997, 2002 and 2007

chronic conditions which is expected to reach 81 million in 2020 (Bodenheimer, Chen, & Bennett, 2009).  Currently most care for chronic illnesses takes place in primary care

Growth to Primary Care Visits

AC Visits

PC Visits

Total PC Visits

2005

1.2 B

49.0 %

588 M

2006

1.1 B

46.8 %

468 M

2007

1.2 B

48.1 %

577 M

2008

1.1 B

62.0 %

664 M

practices while primary care offers high quality care at lower costs for patients with chronic conditions (Bodenheimer, Chen, & Bennett, 2009).

 According to the U.S. Census Bureau the proportion of the population 65 and older will increase from 13 % to 20 %, an increase of about 30 million.

Figure 5: Percentage of Primary Care Visit Based on Total Ambulatory Care Visits: U.S. 2005, 2006, 2007 and 2008

I. Introduction

A. The Problem

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Overall Forces Impacting Growth of Primary Care


FORCES IMPACTING GROWTH OF PRIMARY CARE

MHS PERSPECTIVE

 The MHS has focused on the redesign of care delivery around primary care to yield an excellent return on investment  The MHS Patient-Centered Medical Home (PCMH) is emerging as a “best

practice” redesign model.  The MHS Value of Primary Care is focused on:  Improving efficiency; areas with higher primary care supply have lower

costs  Better outcomes; better health outcomes in areas with higher primary care supply  Improving quality of care, patient experiences, care coordination and

access  Reducing utilization of emergency department and inpatient services= savings in total costs

I. Introduction

A. The Problem

Forces Impacting Growth of Primary Care MHS Perspective

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CARE DELIVERY MODELS

 The growth of primary care facilities that integrate multidisciplinary teams will become essential in “improving care and at times lowering costs for

patients with chronic diseases” (Bodenheimer, Chen, & Bennett, 2009).  Primary care facilities will provide a hub for integrated services leading to excellent health outcomes.

 The Patient-Centered Medical Home as a central component of healthcare reform has markedly increased during the past few years, as recognition of the potential for improvements in healthcare quality and clinical outcomes.

 The Patient-Centered Medical Home is a central component of the Military Health System Primary Care Delivery

I. Introduction

A. The Problem

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Care Delivery Models


Clinical Settings

P

M

S

AS D & T UC

Ambulatory Care Delivery Models

Physician Office Group Practice Primary Care Clinic

Community Health Center P+M+D&T

Specialty Clinic Multi-Specialty Clinic

Multi-Specialty Clinic P + M + S + AS + D & T + UC

Physician Offices

Multi-Specialty

Specialty Clinic M + S + ASC + D & T

Clinic Community Health

Inpatient

Center AS Center AS Center

Group Practice

H

D & T Center E.D.

D & T Center

D&T Physician Offices

UC Center Hospital

Urgent Care

Outpatient

AS Center

Outpatient

P: Primary Care

Multi-Specialty Clinic P+M+S+D&T

Primary Care Clinic P+M+D&T

Figure 7: Most Common Ambulatory Clinical Settings

Services

Community Health Center P+M+D&T

Multi-Specialty Clinic P + M + S + AS + D & T + UC

Patient-Centered Medical Home

M: Medical Specialty Care S: Surgical Specialty Care AS: Ambulatory Surgery D & T: Diagnostic and Treatment Modalities

Figure 6: Community-Based Health Continuum

UC: Urgent Care

I. Introduction

A. The Problem

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Care Delivery Models


GAPS IN THE LITERATURE AND IN PRACTICE

Existing Space Planning Tools:  Architects, facility managers and healthcare organizations look for guidance in recognized sources such as FGI Healthcare Design and Construction Guidelines and the Whole Building Design Guide.  Sources available for room area sizing are Veterans Affairs (VA) and

Department of Defense (DOD) Space Planning Criteria and Templates, which provide prescriptive room area sizes; Space Med Guide is available to provide room area allocations and overall space calculation methods based on patient volumes and utilization targets.

I. Introduction

A. The Problem

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Gaps in the Literature and In Practice


GAPS IN THE LITERATURE AND IN PRACTICE

Limitations of Existing Tools:  What we have: Current planning tools are useful for determining minimum square footage of room-type areas and technical requirements; however they lack information that is critical for the effective design of primary care facilities.  What we need: Critical planning information should include space

allocations and room area standards, and facility recommendations that support:  Functionality and maximum space utilization;  Volume projections and utilization targets;

 Flexible and adaptable facility solutions that can accommodate volume fluctuations;  The on-going integration of new technology;  Shifts in staffing and workflow patterns that lead to operational

efficiency and effectiveness.

I. Introduction

A. The Problem

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Gaps in the Literature and In Practice


REFOCUSING CARE DELIVERY ON THE PATIENT

 Patient and family-centered care initiatives are refocusing care delivery on the patient.  Provide the best care to patients throughout their healthcare experience,

while including their family in the care process; clinics are beginning to align care delivery with patient needs and expectations.  According to the National Institute of Building Sciences, every effort should be made to make the outpatient visit as unthreatening and comfortable as possible, as well as to “embrace the patient, family and caregivers in a psychosocially supportive therapeutic environment” (Barker, Pocock, & Huber, 2010).

 Patient and Family Centered Care Organization in collaboration with the Institute for Healthcare Improvement has recognized four core dimensions, Dignity and Respect, Information Sharing, Participation, and Collaboration.  Planetree Organization Patient and Family Centered Care Organization, providers partner with patients and their family members to identify and satisfy the full range of patient needs and preferences. I. Introduction

A. The Problem

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Refocusing Care Delivery on the Patient


LINKING DESIGN TO OUTCOMES

 While there is evident growth in primary care services, few research studies specifically address the impact of the design of primary care clinics’

environments on outcomes (Center for Health Design, “Design Process”).  This trend has influenced planning and design decisions about the built environment based on credible research to achieve the best possible outcomes (Center for Health Design, “Design Process”), however evidencebased design has mostly focused on inpatient care.  Over the past fifteen years, evidence-based design (EBD) has emerged as a scientific response to the questions about how the built environment

impacts patient, staff and resource outcomes (Malone, Mann-Dooks, & Strauss, 2007).

I. Introduction

A. The Problem

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Linking Design to Outcomes


ARCHITECTURAL PROCESS MODELS AIA PHASES OF DESIGN  ORIGINATE  FOCUS  DESIGN  BUILD  OCCUPY Figure 9: AIA Five Phases of Design Retrieved from: http://howdesignworks.aia.org/fivephases.asp

 Five Architectural Process Models that recognize the facility life’s span from

pre-design to post-occupancy have been studied: 1. American Institute of Architects (AIA) Phases of Design (figure 9) 2. Building Performance Evaluation (BPE) Process Model (figure 10) 3. Center for Health Design (CHD) Evidence-Based Design Process (figure 11) 4. Spiral Model (Zeisel, 2006) (figure 12) 5. Military Health System (MHS) Life Cycle Model (figure 13)

 The AIA Phases of Design spans from pre-design to occupancy, however it is Figure 10: Building Performance Evaluation (BPE) Process Model (Preiser and Schramm, 2002) Retrieved from : http://www.emeraldinsight.com/journals.htm?articleid=844339&show=html

not represented as a cyclical model.  Preiser and Schramm’s BPE Process Model and the Center for Health Design Evidence-Based Design Process Model are cyclical models spanning from pre-design to post-occupancy feeding forward to the next building cycle.  These models present and overall framework yet lack developed standardized guidance, assessment and evaluation tools that inform each

Figure 11: Center for Health Design Evidence-Based Design Process (Retrieved from: http://www.healthdesign.org/clinic-design/design-process

I. Introduction

phase of the project. A. The Problem

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Architectural Process Models


ARCHITECTURAL PROCESS MODELS

 Spiral Model, John Zeisel sets out basic concepts regarding the relationship of research and design, researcher learns by making hypothetical predictions, testing ideas, evaluating outcomes and modifying hypotheses.  The MHS has adopted an evidence-based design framework that spans from pre-design to occupancy. Four phases within the Life Cycle Framework have been identified including:  Corporate Strategic Facilities Portfolio Planning (translating phase)

Figure 12: Spiral Model by Zeisel (1981) Retrieved from: http://www.sciencedirect.com/science/article/pii/S0956522110001405

 Requirements Planning (guiding phase)  Design and Construction (reviewing phase)  Facility Activation and Operations (measuring phase)

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

GUIDING

Phase IV Phase III Facility Activation Design & & Operations Construction

MEASURING REVIEWING

 Phases are supported by a library of tools that are informed by best practices, scientific research and national standards  The MHS Life Cycle Framework combined offers one of the most complete framework and set of tools to date, yet it is fragmented  There is no comprehensive documentation of this model, this model is

Figure 13: MHS Life Cycle Framework

I. Introduction

currently evolving A. The Problem

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Architectural Process Models


THESIS

 Gain an in-depth understanding of the Military Health System Facility Life Cycle Management current process and future vision, with a

particular focus on

Primary Care Facilities two parallel activities:  MHS Portfolio Planning and Management Division (PPMD) Facility Life Cycle Model, policy, criteria and process tools  MHS World-Class Initiative Facility Life Cycle Model, guidance, reviewing and measuring tools

I. Introduction

B. Thesis

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II.

LITERATURE REVIEW

A. Ambulatory Care B. Primary Care C. Patient Centered Approach D. Post-Occupancy Evaluation

II. Literature Review

Table of Contents

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AMBULATORY CARE

 Ambulatory care services are important because of their central role as the initial and continuing point of contact with the health care system; they are the major source of intake for patients who need healthcare (Ross, Williams, & Pavlock, 1998).  According to National Ambulatory Medical Care Survey (NAMCS) from May 1973 to April 1974, office-based physician visits amounted to 590.8 million visits, and in 1990 these visits had increased to 704.6 million (Schappert, 1992).  Conversely from 1970 to 1990, the number of hospitals, the number of beds, and the hospital occupancy rates began to decrease, while the number of outpatient visits rose (Marberry, 1995).

 From 1997 to 2007, the annual number of ambulatory care visits increased by 25%, reaching 1.2 billion visits in 2007 (Schappert & Rechtsteiner, 2011).

II. Literature Review

A. Ambulatory Care

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PRIMARY CARE

 Primary care dates back to the 1920s when the Dawson Report was released in the United Kingdom and “primary health centers” were mentioned, intended to become the center of regionalized care.  In response to the growth of specialties, the new concept of primary care as

a field became a major focus of health care in the United States, and family medicine was established as a specialty in 1969 (Mann, Schuetz, & RubinJohnson, 2010).  Nearly half a century after its inception, primary care stands at the top of the United States health care system priorities and the central focus of the health care reform (Mann, Schuetz, & Rubin-Johnson, 2010).  Conversely, the proportion of all physicians practicing primary care has

decreased.  As shared by many experts, “while the crisis in primary care presents a tremendous set of challenges, is also offers a remarkable opportunity for change through the increased use of effective innovations” (Mann, Schuetz, & Rubin-Johnston, 2010). II. Literature Review

B. Primary Care

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PATIENT CENTERED APPROACH

 Patient-centered care became a central focus in health care delivery since the Institute of Medicine’s report, Crossing the Quality Chasm: A New Health System for the 21st Century, which advances that healthcare must be safe, effective, patient-centered, timely, efficient, and equitable, in order to

improve quality and safety (IOM, 2001).  The IOM developed ten rules to transform care delivery centering on the following areas: care should be based on continuous healing relationships; care should be customized on patient needs and values; the patient should be placed as the source of control; shared knowledge and free flow of information is necessary; and a need for transparency in the care delivery process (IOM, 2001).

 Research by the Picker Institute has delineated eight dimensions of patientcentered care to “improving Healthcare through the Patient’s Eyes”.  The MHS is transforming its primary care system into a Patient-Centered Medical Home (PCMH) model of care in order to improve health care quality, access, care coordination, satisfaction and safety. II. Literature Review

C. Patient Centered Approach

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POST-OCCUPANCY EVALUATION

 “Post-occupancy evaluation is the process of systematically comparing actual building performance, i.e., performance measures, with explicitly stated performance criteria” (Preiser, 1995)  POE dates back to the 1960s when severe problems, some of which were attributable to the built environment, were observed in institutions, such as mental hospitals and prisons (Preiser, Rabinowitz, & White, 1988).  Types of POE:  Indicative POE - This level simply indicates the major successes and failures of a building’s performance.  Investigative POE - When indicative POE have identified major issues that warrant more detailed study, an investigative POE is performed.  Diagnostic POE - This advanced POE is a comprehensive and in-depth investigation conducted at a high level of effort.  The MHS desires to be a national leader in patient care, health education, training, research and technology.

(MHS Vision Statement, Department of Defense – Military

Health System; http://www.health.mil/StrategicPlan/Vision.aspx). process to assist the MHS in achieving this vision.

II. Literature Review

D. Post-Occupancy Evaluation

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The POE is a viable


III. Research Design and Methods

A. Areas of Focus and Objectives B. Research Questions C. Theoretical Framework D. Research Design E. Data Analysis

III. Research Design and methods

Table of Contents

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RESEARCH AREAS OF FOCUS

 Gain an in-depth understanding of the Military Health System Facility Life Cycle Management Process current process and future vision, with a particular focus on Primary Care Facilities, two parallel activities:  MHS Portfolio Planning and Management Division (PPMD)  Life Cycle Model  PPMD Policy  PPMD Criteria - under revision by Health Facilities Steering Committee (HFSC)  Unified Facilities Criteria (UFC) Appendix A and B  Space Planning Criteria  MIL-STD 1691  Templates PPMD Tools - under revision by HFSC Space and Equipment Planning System (SEPS) Capital Improvement Decision Modeling (CIDM) & DD 1391

 MHS World Class Initiative  Life Cycle Model  World-Class Checklist / Design Strategies – currently used as guidance, will eventually become a Policy  World-Class Reviewing Tools – have not been developed  MHS Evaluation Tools / Post-Occupancy Evaluation – in process

III. Research Design and methods

A. Areas of Focus and Objectives

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Areas of Focus


OBJECTIVES

1. Develop an understanding of the MHS Life Cycle Framework so it can be compared to other leading healthcare organizations for the future development of a Universal Architectural Process Model. 2. Apply this Model specifically to Primary Care Facilities. 3. Identify if any of these standardized planning, pre-design and postoccupancy evaluation tools could be used across other organizations to inform architects, facility managers and healthcare organizations planning future Primary Care Clinics.

III. Research Design and methods

A. Areas of Focus and Objectives

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Objectives


RESEARCH QUESTIONS

 How does the PPMD Facility Life Cycle Activities relate to MHS

World-Class activities? Similarities and Differences  What key guidance, reviewing and measuring tools does the MHS currently use?  What key guidance, reviewing and measuring tools are planned for the future?  What are the potential areas of overlap between the PPMD and World-Class

Initiative

in

terms

measuring tools?

III. Research Design and methods

B. Research Questions

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of

guidance,

reviewing

and


THEORETICAL FRAMEWORK

 The theoretical framework used for this research study is complexity theory.  A complex system constantly changes due to different types of transitions.  First the internal structure of a system can change to better interact with the external changes.  Second the outside forces drive a system to an unorganized state before changing into one of more organization (Schieve and Allen, 1982).  Complex systems as constantly changing its internal structure and external environment through self-organization (Manson, 2001).

III. Research Design and Methods

C. Theoretical Framework

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RESEARCH DESIGN

 Qualitative approach to research, following case study design for descriptive understanding of the MHS FLCM process, using:

“Case study research excels at bringing an indepth understanding of a complex issue to extend the researcher experience and add

 Phase I

Archival Data Collection and Validation

 Phase II

Focus Group Discussion Session

 Phase III

Semi-Structured Expert Interviews

strength to what is already known”.

 Qualitative case study:  Emphasis on the exploration of a phenomenon within its context using a variety of data sources  Sequential approach ensured that the issue was explored through a

variety of lenses, allowing multiple facets of the phenomenon to be revealed and understood (Baxter, & Jack, 2008).  This research study follows researcher Robert K. Yin definition of case study, “an empirical inquiry that investigates a contemporary phenomenon, in which multiple sources of evidence are used” (Yin, 1984, p. 23).  The type of case study is exploratory, as we explored those situations in which the intervention being evaluated had no clear, single set of outcomes

(Yin, 2003). III. Research Design and Methods

D. Research Design

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SINGLE CASE STUDY

 A single case study has been considered, the MHS FLCM process, which includes the MHS PPMD Facility Life Cycle Model, policy, criteria and tools, and

the MHS World–Class Initiative Life Cycle Model, guidance, reviewing and measuring tools.  Our rationale for selecting a single case:  MHS is one of the largest healthcare systems in the world joining efforts with healthcare leaders to develop leading edge innovations to plan, design and execute World-Class Facilities with a recent focus on Primary Care.  MHS FLCM process is a comprehensive system that deals with the full Life

Cycle of a building that integrates regulatory, guidance, assessment and evaluation tools informed by scientific research, best practices and regulations focused on World-Class Primary Care Clinics.  In addition a single case was selected due to the scale and complexity

of the MHS FLCM process  This study is bounded by the MHS current (FY 2011) and future (FY 2012) vision of the FLCM process. III. Research Design and Methods

D. Research Design

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MHS ORGANIZATION

 Portfolio Planning and Management Division (PPMD): Serves as the focal point for all issues pertaining to the acquisition, sustainment, renewal, and

modernization of the full range of facilities within the Tricare Military Health System (MHS).

(Retrieved from: http://www.tricare.mil/ocfo/ppmd/index.cfm).

 World-Class Initiative: Serves as the focal point for the development of the World-Class policy, guidance, reviewing and measuring tools to plan, design and execute World-Class medical facilities.  Health Facilities Steering Committee (HFSC): Serves as the working body for MHS facility-related policy development, program analysis and advocacy, issue resolution, and TMA/Service coordination and collaboration.

(Retrieved from:

.

http://www.tricare.mil/ocfo/_docs/hfsc_charter.pdf)

 Noblis: A science, technology, and strategy organization that provides expert technical and advisory services to the Department of Defense (DoD) (Retrieved from: http://www.noblis.org/AboutNoblis/Contracting/Pages/default.aspx).  Tricare Management Agency (TMA): Has authority, direction, and control

over all DoD medical and dental personnel, facilities, programs, funding, and other

resources

within

the

http://www.tricare.mil/charters/tmacharter.html).

III. Research Design and Methods

D. Research Design

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Department

of

Defense

(Retrieved

from:


RESEARCH METHODS DATA COLLECTION

PHASE I Archival Data Introduction  The PPMD and the World-Class Facility Life Cycle models are two separate models and not currently considered as an integrated model of the FLCM process.  The PPMD criteria, policy and tools selected are the documents that have been identified as regulatory and currently implemented by the MHS FLCM

process; they are currently under revision by the Health Facilities Steering Committee.  The World-Class Checklist is currently used as a guidance tool influencing the criteria revision and the design and construction process; the World-Class tools will eventually become a Policy.

III. Research Design and Methods

D. Research Design

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RESEARCH METHODS DATA COLLECTION

PHASE I Archival Data Reviewed MHS PPMD:  Facility Life Cycle Model  Policy  MHS FLCM process Department of Defense Instructions (DoDI)  Criteria  Unified Facilities Criteria (UFC) currently under revision by HFSC  Space Planning Criteria currently under revision by HFSC  MIL-STD-1691 Medical (Equipment Data Base) revised quarterly  MHS Templates currently under revision by HFSC  Tools  Space and Equipment Planning System (SEPS) Plan for Design Output currently under revision  Capital Improvement Decision Modeling (CIDM) currently under revision by HFSC  DD 1391 Project Costing Guidance

MHS World-Class:

 Facility Life Cycle Model  MHS World-Class Tools  World-Class Checklist - completed  Post-Occupancy Evaluation (POE) Tools Summary - in process III. Research Design and Methods

D. Research Design

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RESEARCH METHODS DATA COLLECTION

PHASE II Focus Group Discussion Session  Purpose of the focus group discussion session:  Identify future vision of the MHS FLCM process

 Establish joint collaboration among the Department of Defense and the Veterans Affair to eliminate duplicity of efforts, bring financial strength, stronger capacity for resources and a larger data base informed by research to attain a common goal, World-Class Healthcare  The participants of the focus group discussion session included key experts from the MHS Tricare Management Agency (TMA), PMD and the Health Facilities Steering Committee (HFSC), key stakeholders of the Veteran Affairs and key experts from Noblis and NXT/Clemson.  The focus group discussion was approximately one hour in length.

III. Research Design and Methods

D. Research Design

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RESEARCH METHODS DATA COLLECTION

PHASE III Semi-Structured Expert Interviews  Experts were selected based on key characteristics including their responsibility for the MHS FLCM current process and future development, their role in the implementation and control of the policy, criteria and tools, their privileged access to information, as well as their involvement in the resulting knowledge.

 Six experts were interviewed from TMA (PPMD and HFSC), and two experts from NXT/Clemson.  Interviews ranged from 25 minutes to 1 hour

 Interviews were recorded and transcribed  Interview Protocol:  Introduction: Purpose of the Interview and 5 Research Objectives  Questions: Total of 6 topical areas with questions  Conclusion: Two open ended questions  Critique of a proposed diagram of an integrated Facility Life Cycle Model III. Research Design and Methods

D. Research Design

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DATA ANALYSIS

 Data Analysis included analysis of case context, case description, and within case theme analysis.  Interview Coding Strategy:  Regulatory  World-Class  Tools  Purpose  Content  Relation to Other Tools  Users  Implementation Phase

 Future development

III. Research Design and Methods

E. Data Analysis

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IV.

Results / Findings

A. Introduction B. Review of Components C. Overall Facility Life Cycle Management Process

IV. Results / Findings

Table of Contents

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MHS FACILITY LIFE CYCLE FRAMEWORK

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

GUIDING

Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

LIBRARY OF TOOLS POLICY

 DODI  Sustainability and Energy  World-Class Healthcare

CRITERIA TOOLS  UFC  Space Planning Criteria  MIL-STD-1691  Templates

PROCESS TOOLS

 SEPS  DD 1391  CIDM

GUIDING TOOLS

 World-Class Checklist  Design Guidelines  Case Studies

PPMD

REVIEWING TOOLS

 UFC  Sustainability & Energy  World-Class

MEASURING TOOLS  POE Toolkit

World-Class Figure 12: MHS Life Cycle Framework

IV. Results / Findings

A. Introduction

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RESULTS / FINDINGS

EVOLVING VIEW POINT DIAGRAM Process Tools SEPS DD 1391 CIDM

POLICY

PPMD WC

IV. Results / Findings

DODI Sustainability & Energy

World-Class Healthcare future policy

Criteria

UFC Space Planning MIL-STD-1691 Templates

S1 – S6 GUIDING TOOLS

World-Class Checklist Design Guidelines

A. Introduction

Facility Life Cycle Timeline

REVIEWING TOOLS UFC Sustainability & Energy World-Class Checklists

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MEASURING TOOLS POE Toolkit


RESULTS / FINDINGS

MHS Facilities Life Cycle Management Process DoDI

PPMD POLICY

PROCESS TOOLS

Purpose: Department of Defense Instructions (DoDI) defines roles and responsibilities across the services Army, Navy and Air Force, defines the scope

POLICY

PPMD

CRITERIA

DODI

of the Facility Life Cycle

S1 – S6

WC FUTURE POLICY

GUIDING TOOLS

Facility Life Cycle Timeline

REVIEW TOOLS MEASURE TOOLS

EVOLVING VIEW POINT DIAGRAM

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

GUIDING

Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

Content:  Phase I

Corporate Strategic Facilities Portfolio Management

 Phase II

Requirements Planning

 Phase III

Design and Construction Execution

 Phase IV

Facility Activation and Operations

Users: Services, Army, Navy, and Air Force; Health Affairs; the Agents, Army Corps of Engineers and Navy facilities (NAVFAC)

PROJECT PHASES IV. Results / Findings

B. Review of Components

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PPMD Policy


RESULTS / FINDINGS

WORLD-CLASS POLICY

World Class Healthcare

(currently a guidance tool and will eventually

become policy)

PROCESS TOOLS

Purpose: Guide the planning, and design process to deliver World-Class CRITERIA

POLICY

PPMD WC

facilities.

S1 – S6 World-Class Healthcare future policy

GUIDING TOOLS

Facility Life Cycle Timeline

Content:

REVIEW TOOLS MEASURE TOOLS

 Guiding Principles: The guiding values, abiding Rules and beliefs that need to be followed in order to plan, design and execute World-Class Facilities.

EVOLVING VIEW POINT DIAGRAM

 Core Dimensions: Key dimensions that encompass the design strategies and address the guiding principles  Objectives: Clearly defined and measurable outcomes aimed towards

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

GUIDING

Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

achieving a particular goal.  Design Strategies: Design intervention and suggested plan of action that works towards achieving a particular goal and objective. Design strategies are categorized into World-Class Mandatory, Best Practice Mandatory,

World-Class Consider and Best Practice Consider.  Supporting Literature: Best Practice Case Studies, Scientific Research and

PROJECT PHASES IV. Results / Findings

Regulations. B. Review of Components

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World-Class Policy


RESULTS / FINDINGS

WORLD-CLASS POLICY

WC

 HFSC is currently integrating the World-Class Checklist to:  Space Planning Criteria

CRITERIA

PPMD

S1 – S6 World-Class Healthcare future policy

(continued)

Relation to Other Tools:

PROCESS TOOLS

POLICY

World Class Healthcare

GUIDING TOOLS

Facility Life Cycle Timeline

REVIEW TOOLS

 Unified Facilities Criteria MEASURE TOOLS

EVOLVING VIEW POINT DIAGRAM

 Templates  Measuring Tools (POE) Future Developments: On-going review of the World-Class Checklist based on POE results

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

GUIDING

Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

PROJECT PHASES IV. Results / Findings

B. Review of Components

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World-Class Policy


GUIDING PRINCIPLES:

HBD DOMAINS:

01: Provide a Patient and Family-Centered Care 02: Achieve World-Class Quality and Safety 03: Create a Positive Work Environment 04: Improve Operational Effectiveness 05: Be Sustainable with a High Level of Community Responsibility 06: Provide High Value and Be Good Stewards of Taxpayer Money 07: Be Evidence and Performance Based 08: Design for Maximum Flexibility, Standardization and Growth 09: Decision making Based on Best Practices and Innovation

1

Basic Infrastructure

Phase II Requirements Planning

2

Leadership and Culture

3

Process of Care

4

Performance

GUIDING

5

Knowledge Management

6

Community Responsibility

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

WORLD-CLASS LIBRARY OF TOOLS

and

Social

MHS FACILITY DASHBOARD

TRANSLATING TOOLS

GUIDING TOOLS

REVIEWING TOOLS

MEASURING TOOLS

Synthesis and Vetting

WC Checklist Design Guidelines Case Studies

Guidelines Design review

POE (Post-Occupancy Evaluation)

WEB-BASED INTERFACE TOOL Inventory Projects Requirements

KNOWLEDGE AND COLLABORATION BEST PRACTICES

Case Study Data Base MHS Facilities and Other

SCIENTIFIC RESEARCH MHS POE Database Evidence-based Design Research National Data Sets

REGULATIONS Codes Policies Guidelines Figure 12: MHS Life Cycle Model

IV. Results / Findings

B. Review of Components

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World-Class Facility Life Cycle


RESULTS / FINDINGS

PPMD REGULATORY CRITERIA

PROCESS TOOLS

Unified Facilities Criteria (UFC)

(last revised November 2009)

 Purpose: Provides mandatory design and construction criteria for facilities in

the DoD Medical Military Construction Program. While these criteria were not CRITERIA UFC

POLICY

PPMD WC

developed primarily for use to review military construction program and

S1 – S6 World-Class Healthcare future policy

GUIDING TOOLS

Facility Life Cycle Timeline

REVIEW TOOLS MEASURE TOOLS

budget submissions, it is recognized the UFC may be used for this purpose.  Content:  Appendix A: Architectural and Engineering Design Requirements

EVOLVING VIEW POINT DIAGRAM

(informs the Design and Construction Phase)  Appendix B: Design Submittals and Documentation for Design/Bid/Build

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

GUIDING

Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

Acquisition Process (currently used as review instrument)  S-1 Block Plan  S-2 Schematic Design  S-3 Concepts Design (30 % design submittal)

 S-4 Technical (35 % design submittal)  S-5 Final (65 % design submittal)

PROJECT PHASES IV. Results / Findings

 S-6 Final (100 % design submittal) B. Review of Components

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PPMD Regulatory Criteria


RESULTS / FINDINGS

PPMD REGULATORY CRITERIA

PROCESS TOOLS

POLICY

PPMD WC

 Relation to Other Tools:  World-Class Checklist (the World-Class checklist informs the UFC)  Space Planning Criteria

CRITERIA UFC

S1 – S6 World-Class Healthcare future policy

Unified Facilities Criteria (UFC) (continued)

GUIDING TOOLS

Facility Life Cycle Timeline

 Templates  Informs SEPS

REVIEW TOOLS MEASURE TOOLS

 Users: Used by the agents (Corps of Engineers and NAVFAC), the architects and contractors

EVOLVING VIEW POINT DIAGRAM

 Future Development: Last updated November 2009, update in process by HFSC.

IV. Results / Findings

B. Review of Components

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PPMD Regulatory Criteria


RESULTS / FINDINGS

PPMD REGULATORY CRITERIA

PROCESS TOOLS

PPMD WC

 Purpose: Provides guidance for Space Planning for Primary Care / Family may include: family practice, general outpatient, immunization, internal

S1 – S6 World-Class Healthcare future policy

(last revised 2006)

Practice / Patient Centered Medical Home (PCMH). Primary care Clinics

CRITERIA Space Planning Criteria

POLICY

Space Planning Criteria

GUIDING TOOLS

Facility Life Cycle Timeline

medicine, pediatric and physical examination clinics.

REVIEW TOOLS MEASURE TOOLS

 Content:  Definitions (staffing, room areas, net to gross, workload)

EVOLVING VIEW POINT DIAGRAM

 Policies (required space program areas)  Program Data Required (questions to generate space requirements)  Space Criteria (room name, room code, NSF, description- calculation

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

GUIDING

Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

methodologies and specific requirements per room type area)  Relation to Other Tools:  World-Class Checklist (the World-Class checklist informs the Space

Planning Criteria)  UFC  Templates

PROJECT PHASES IV. Results / Findings

 Informs SEPS B. Review of Components

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PPMD Regulatory Criteria


RESULTS / FINDINGS

PPMD REGULATORY CRITERIA

PROCESS TOOLS

POLICY

PPMD WC

 Users: Services, Army, Navy and Air Force and the Architects

CRITERIA Space Planning Criteria

 Future Development: A process for continuous update has been developed

S1 – S6 World-Class Healthcare future policy

Space Planning Criteria (continued)

GUIDING TOOLS

Facility Life Cycle Timeline

REVIEW TOOLS MEASURE TOOLS

EVOLVING VIEW POINT DIAGRAM

IV. Results / Findings

B. Review of Components

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PPMD Regulatory Criteria


RESULTS / FINDINGS

PPMD REGULATORY CRITERIA

PROCESS TOOLS

PPMD WC

MIL-STD-1691 Medical (Equipment Data Base)

CRITERIA 1691

POLICY

S1 – S6 World-Class Healthcare future policy

GUIDING TOOLS

Facility Life Cycle Timeline

REVIEW TOOLS MEASURE TOOLS

 Purpose: Provides a detailed list of equipment (medical equipment and furniture)  Content:

EVOLVING VIEW POINT DIAGRAM

(revised quarterly)

Coded

equipment

list,

equipment

specifications

recommended manufacturers  Relation to other tools:

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

 Templates  Informs SEPS

GUIDING

Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

 Users: Services, Army, Navy and Air Force, A + E designers

PROJECT PHASES IV. Results / Findings

B. Review of Components

Copyrighted material. Please do not distribute without permission

PPMD Regulatory Criteria

and


RESULTS / FINDINGS

PPMD GUIDANCE CRITERIA

PROCESS TOOLS

PPMD WC

 Purpose: Their main purpose is to provide a recommended layout,

 Content: They include a space layout, the equipment (furniture and medical

S1 – S6 World-Class Healthcare future policy

(last revised 2006)

equipment and infrastructure to support the function of key room areas.

CRITERIA Templates

POLICY

Templates (Formerly known as Guide Plates)

GUIDING TOOLS

Facility Life Cycle Timeline

REVIEW TOOLS MEASURE TOOLS

equipment) required to support the specific room function, and the

infrastructure (electrical and medical gases) that supports the specified equipment. Each key Room area has a room code that is referred in the Space Planning Criteria and in the Unified Facilities Criteria.

EVOLVING VIEW POINT DIAGRAM

 Relation to Other Tools:  Unified Facilities Criteria (UFC) Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

GUIDING

Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

 Space Planning Criteria  MIL-STD-1691 Medical equipment  SEPS, the templates can be accessed through SEPS  Users: Services, Army, Navy and Air Force; the A + E designers

PROJECT PHASES IV. Results / Findings

B. Review of Components

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PPMD Guidance Criteria


RESULTS / FINDINGS

PPMD GUIDANCE CRITERIA

PROCESS TOOLS

POLICY

PPMD WC

 Future Developments:  Clinic Templates (Planning Concepts)  Department Templates (Planning Concepts)

CRITERIA Templates

S1 – S6 World-Class Healthcare future policy

Templates (Former Guide Plates) (continued)

GUIDING TOOLS

Facility Life Cycle Timeline

REVIEW TOOLS

 Process for continuous update  The templates will integrate the World-Class Checklist

MEASURE TOOLS

EVOLVING VIEW POINT DIAGRAM

IV. Results / Findings

B. Review of Components

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PPMD Guidance Criteria


RESULTS / FINDINGS PPMD TEMPLATES

PROPOSED EXAMPLE FOR TEMPLATE REFINEMENT

AREA:

OUTPATIENT

FAMILY ZONE

ROOM: EXAM ROOM CODE:

EXRG1

SIZE:

120 SQUARE FEET 12’- 0” X 10’- 0”

CEILING HEIGHT:

153

2021

2021

20 SQ.FT / 17 %

STAFF ZONE

33

40 SQ.FT / 33%

PATIENT ZONE

8’ – 0”

60 SQ.FT / 50%

55

169

IV. Results / Findings

ID

Design Strategy

Metric

2001

Family Zone

Total Square Feet Percent of Total Space

55

Patient Comfort and Control

Total Square Feet Percent of Total Space

55

Patient Comfort and Control

# and Type of Controls

33

Staff Zone Sized to Support Procedures

Total Square Feet Percent of Total

153

Visual Access to Nature

Window Size Height from Finished Floor

169

Assistive Devices

# of Assistive Devices

2021

Opportunities for Patient and Family Education

Size of Educational Wall Display

B. Review of Components

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Benchmark

PPMD Templates


RESULTS / FINDINGS

PPMD CRITERIA AND PROCESS TOOLS RELATIONSHIPS REQUIREMENTS PLANNING

CRITERIA

CRITERIA

PROCESS TOOLS

PFD

UFC

Space Planning

SEPS

Program For Design

DESIGN

DESIGN

World-Class CRITERIA Templates 1691

IV. Results / Findings

B. Review of Components

Copyrighted material. Please do not distribute without permission

PPMD Criteria and Process Tools


FINDINGS / RESULTS

PPMD PROCESS TOOLS DEFINED Space and Equipment Planning System (SEPS) is an automated tool that takes the space planning criteria, UFC Appendix A and the MIL-STD-1691 to calculate programmatic requirements. Questions relate to the Mission, Staffing and Workload. The output is a Program for Design (PFD) which integrates the Space

Planning Criteria, UFC, and Equipment list. The Templates can be accessed through SEPS. DD 1391 Form is the cost estimating guidance for Medical projects. The purpose of this guidance is to have reliable cost estimates for the Budget Estimate Submission (BES). It uses an area cost factor, a sizing factor and an escalation factor. PACES is a Parametric Cost Estimating System is an alternative cost methodology that can be used for estimating Medical projects. The VA has invested and in in the process of integrating SEPS with PACES. Future costing models include Life Cycle Costing solutions. Capital Investment Decision Modeling (CIDM) was developed to prioritize facility capital investment proposals to support strategic planning decision making. Is used to assist the MHS to validate facility requirements and alignment with strategic goals. Includes a Program for Design and an Economic Analysis. The result is a list of recommended facility projects ranked in order of merit based upon a consistently applied set of strategic evaluation criteria. IV. Results / Findings

B. Review of Components

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PPMD Process Tools


DESIGN AUTHORIZATION PROCESS REQUIREMENTS PLANNING

PROCESS TOOLS SEPS space & equipment planning system

PFD

PROCESS TOOLS

Program For Design

PROCESS TOOLS

DD 1391 PACES

CIDM

IV. Results / Findings

project costing

capital investment decision modeling

B. Review of Components

DA

TMA

Design Authorization

Approves PFD DD 1391

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DESIGN

DESIGN

Design Authorization Process


RESULTS / FINDINGS

WORLD-CLASS REVIEWING TOOLS

World-Class Design Review Checklist Purpose: Design Review Instrument that will assess the implementation of the

PROCESS TOOLS

Design Strategies through the Design Process POLICY

CRITERIA

PPMD WC

S1 – S6 World-Class Healthcare future policy

GUIDING TOOLS

REVIEW TOOLS WorldClass Checklist

Facility Life Cycle Timeline

Content:  UFC (existing as a separate document)

MEASURE TOOLS

 Sustainability and Energy Management (existing as a separate document)

 New Design Review Checklist (proposed) EVOLVING VIEW POINT DIAGRAM

Relation to Other Tools:  World-Class Checklist (Design Strategies)

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

 Measuring Tools (based on a general consensus by the experts the reviewing tools should align with the POE tools /metrics)

GUIDING

Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

Users: Services, Army, Navy and Air Force, Corps of Engineers and NAVFAC Review Board, and the A + E designers Future Development: Review tools are under development.

PROJECT PHASES IV. Results / Findings

B. Review of Components

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World-Class Reviewing Tools


WORLD-CLASS

REVIEWING TOOLS PROPOSED EXAMPLE Phase of Design

Area

Submittal

Design Strategy

Metric

S-1 Block Plan

Facility

Access Diagram

139, 2020, 145

Distance from parking to building entrance

1. Access and Way-finding

S-2 Schematic

Department

Arrival Sequence Diagram

139, 2020, 145

Travel distance from building entry to Department

1. Access and Way-finding

Department

Staff Flow Diagram

85, 96, 24, 145, 33, 179, 168, 2001

Travel distance from nurse station to patient care area

14. Optimize processes and workflow

Department

Patient Flow Diagram

85, 96, 24, 145, 33, 179, 168, 2001

Travel distance from waiting to patient care area

14. Optimize processes and workflow

Department

Zoning Plan

85, 96, 24, 145, 33, 179, 168, 2001

Square footage of Public, Patient and Clinical area, percentage of total area

14. Optimize processes and workflow

Facility, CSA, Room

Daylight and Views

22, 24, 153

Percentage of total Patient Care Rooms with daylight and views

10. Access to Daylight and Nature

Department

Visibility Diagrams

165, 248, 341

Sight lines from nurse station to patient care areas

8. High visibility, collaboration and effective communication

Room

Annotated Key Room Floor Plan

2022, 246, 169, 168, 179, 2001, 55, 172, 125, 33, 171, 131

Number and type of personal controls in patient care areas Size of Patient and Family Zone in patient care areas, percent of total room area Number of Safety Features (assistive devices, HWS)

2. Patient and family privacy, comfort and control 3. Patient and family involvement in care decisions 5. Safe Environment for patients

S-3 Concept Design

IV. Results / Findings

B. Review of Components

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Benchmarks Core Dimension

World-Class Reviewing Tools


ARCHITECTURAL REVIEW PROCESS DESIGN AND CONSTRUCTION BLOCK PLAN 10 %

UFC

S1

UFC

Access Diagram

S1

Potential Metrics:

Travel distances from parking to entry (1)

UFC

Site Plans Floor Plans Elevations Equipment Plan Finish Schedules Narrative Net Area Net to gross area Cost Estimate

Arrival Sequence Staff Flow Diagrams Patient Flow Diagrams Zoning Plans Compliance w/ Space Planning S2 Criteria

Travel distances from building entry to department (1) Travel Distance from nurse station to pt. care area (14) Travel distance from waiting to pt. care area (14) SF & percent of total area for Public, Patient, Clinical & Provider Zones (14)

Current reviewIing tools

WorldClass

Researcher recommended reviewing tools

PROCESS

IV. Results / Findings

FINAL 65 %

FINAL 100 %

S3

UFC

UFC

S4

S5

Comprehensive Fire Protection Equipment Specifications

Corrected S3 Renderings

World-Class

Potential Metrics:

UFC

TECHNICAL 35 %

S2

Executive Summary Floor Plans w/ programmed spaces & circulation paths Narrative Net Area Net to gross area Cost Estimate

Block Plan Site Plans Floor Plans w/ circulation patterns & critical dimensions

World-Class

CONCEPT 30 %

SCHEMATIC 20 %

UFC

World-Class

Daylight and Views S3 Diagrams Visibility Diagrams Annotated key Room plans Compliance w/ templates

Potential Metrics:

Percentage of pt. care areas with daylight and views (10) Sight lines from nurse stations to pt. care areas (8) Personal Controls, # and type (2) SF and percent of total room area for Patient and Family zone (3) Safety features, # and type (5)

B. Review of Components

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World-Class

Final Revision of Compliance w/ Design Strategies, Space Planning Criteria and Templates

S4

S6

Final Drawings and Specifications Cost Estimate Instruction to Bidders

Architectural Review Process


RESULTS / FINDINGS

MEASURING TOOLS

MEASURING TOOLS

Purpose: Evaluate the performance of the facility, inform future planning and

PROCESS TOOLS

PPMD WC

design decisions.

CRITERIA

POLICY

Content:

S1 – S6 World-Class Healthcare future policy

Post-Occupancy Evaluation

GUIDING TOOLS

REVIEW TOOLS WorldClass Checklist

Facility Life Cycle Timeline

MEASURE TOOLS POE

EVOLVING VIEW POINT DIAGRAM

 Eight Step POE process and methodology and 20 core dimensions  Patients, Staff and Leadership Surveys  Leadership Interviews  Case Study of the Facility through plan take-off, walk-through, photos and

diagrams Relation to Other Tools:

Phase I Corporate Strategic Facilities Portfolio Planning

TRANSLATING

Phase II Requirements Planning

GUIDING

Phase IV Facility Activation & Operations

Phase III Design & Construction

MEASURING

REVIEWING

 World-Class Design Strategies (Checklist)  UFC, Space Planning Criteria and Templates  Reviewing Tools Life Cycle Model: Facility Activation and Operations Phase IV

Future Development: The tools are currently been developed, there will be onPROJECT PHASES IV. Results / Findings

going development of the tools as future POEs get completed. B. Review of Components

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Measuring Tools


FACILITY LIFE CYCLE MODEL FRAMEWORK

1. STRATEGIC AND PORTFOLIO PLANNING

PRELIMINARY PFD

3. DESIGN AND CONSTRUCTION

2. REQUIREMENTS PLANNING

SEPS

PREDESIGN

BLOCK PLAN 10 %

SCHEMATIC 20 %

CONCEPT 30 %

TECHNICAL 35 %

FINAL 65 %

FINAL 100 %

CONSTRUCTION

4. ACTIVATION & OPERATIONS

NEXT CYCLE

PFD DD 1391 CIDM

PRIORITIES

S1 DA

TMA PFD/1391

S2

S4

UFC SUSTAINABILITY AND ENERGY WORLD-CLASS

A/E SELECTION

MISSION

S3

S5 UFC SUSTAINABILITY AND ENERGY WORLD-CLASS

DESIGN

S6

BID/BUILD

OCCUPY

POE CRITERIA

QUADRUPLE AIM Readiness Population Health Positive Patient Experience Cost

TEMPLATES / 1691

GUIDING TOOLS

SPACE PLANNING CRITERIA

PROCESS

UFC WORLD-CLASS SUSTAINABILITY AND ENERGY MANAGEMENT

POLICY & TOOLS

POLICY

 DODI  Sustainability and Energy  World-Class Healthcare

IV. Results / Findings

CRITERIA TOOLS  UFC  Space Planning Criteria  MIL-STD-1691  Templates

PROCESS TOOLS

 SEPS  DD 1391  CIDM

GUIDING TOOLS

 World-Class Checklist  Design Guidelines  Case Studies

C. Overall Facility Life Cycle Management Process

REVIEWING TOOLS

 UFC  Sustainability & Energy  World-Class

MEASURING TOOLS  POE Toolkit

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V.

CONCLUSIONS

A. Strengths and Limitations B. Conclusions and Next Steps

V. Conclusions

Table of Contents

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STRENGTHS

 This research study has been performed at an essential time where the MHS is rethinking the way they plan, design and execute facilities to deliver WorldClass Primary Care.

 The process aimed at developing a full integration of the Facility Life Cycle framework that includes the Portfolio Planning and Management Division policies, criteria and tools, the efforts of the Health Facilities Steering Committee and the World-Class Initiative efforts.  The interviews and focus groups have collected critical information that currently resides within each independent work grouP.  It ultimately provided a link between the critical pieces that are necessary for

an integrated Facility Life Cycle Management Process to plan, design and execute World-Class Primary Care Clinics.

V. Conclusions

A. Strengths and Limitations

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LIMITATIONS

 Most of the criteria tools are currently under development; therefore it was

difficult to evaluate how World-Class would be finally implemented within these tools.  MHS is a very complex system requiring more expert interviews with key experts responsible for each key process steps within the Facility Life Cycle Management process.

V. Conclusions

A. Strengths and Limitations

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CONCLUSIONS

 This study has provided insight into developing an integrated project delivery process by providing a Facility Like Cycle Framework that captures the MHS current process and tools, on-going developments and their future vision to plan, design and execute World-Class Primary Care Facilities.  Revealed many of the complexities that exist within the MHS Facility Life

Cycle Management process and how the PPMD and World-Class policies, criteria and tools need to relate in order to have an integrated framework.  Revealed post-occupancy evaluation as a critical step for continuous improvement of the World-Class design strategies, criteria and reviewing tools to deliver World-Class Healthcare.

V. Conclusions

B. Conclusions and Next Steps

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NEXT STEPS

 Continued work with the MHS to further develop the Facility Life Cycle Framework and key process steps, as well as the future developments of the guidance, reviewing and measuring tools.  Future studies will focus on the development of a Universal Architectural Process Framework, informed by standardized guidance, reviewing and measuring tools to plan, design and execute World-Class Primary Care

Facilities.  A flow chart of common pathways could then be developed

to inform

architects, facilities managers and healthcare organization planning future World-Class Primary Care Facilities.

IV. Conclusions

B. Conclusions and Next Steps

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ACKNOWLEDGEMENTS

Special Thanks Dina Battisto, Primary Thesis Advisor David Allison, Member of my Thesis Committee Betty Baldwin, Member of my Thesis Committee NOBLIS MILITARY HEALTH SYSTEM

Deborah A. Franqui, MS Student

July 14, 2011

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Clemson University


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