Capital Project Solutions – July 2011
The Components of Transition Planning- Operational Readiness Stevie McFadden – Associate Consultant Patrick E. Duke – Vice President
Last month we centered our discussion on the starting point for the transition planning process – Transition Readiness Assessment (TRA). The TRA sets the tone for the successful relocation of staff, assets, supplies and patients from an existing space to a new space. This month, and for the next two months, we will focus on the three components of the transition planning effort after completion of a TRA – Operational Readiness, Facility Readiness, and Move Management.
What is Operational Readiness? Operational Readiness involves planning for new processes and practices that define the way an organization will conduct business in a new facility. It requires an emphasis on review and design of clinical and business operations to allow their future state to be in harmony with the changed physical environment, thereby enabling the organization to achieve desired outcomes. The effort to achieve true Operational Readiness will involve education, training, and orientation that must be effectively coordinated and balanced with the Facility Readiness and Move Management components of the overall transition planning work. If the future state of operations was well defined and integrated into the design effort from the onset of the project, achieving Operational Readiness will be the result of more implementation planning and less process redesign work later on. There is often a perception that patient satisfaction and outcomes will improve by virtue of facility improvements and the eventual relocation into a new space. The reality is that without integrating desired process improvement into the design and then educating staff members on the benefits of adopting it, the new facility becomes no more than an empty suit. While you may conduct a successful move, you will not achieve true Operational Readiness
Capital Project Solutions – July 2011
and defeat the most likely primary driver for the new space – to deliver more efficient patient care and improve outcomes.
When Should Readiness?
We Start Preparing for Operational
It is important that leaders in healthcare organizations and project delivery teams understand the perspective of all staff members as they are challenged to “think outside of the box” when developing improved workflows in a new space. Staff members are prone to becoming overwhelmed on projects because of the amount of changes that must occur to their daily workflows in addition to the changes in how they do everything from park to clock in and out each day. The looming question is - How will I function in the new facility given the changes it will bring? To answer this question and reduce anxiety that can be associated with any change, we advocate launching your transition planning effort after the Architect completes their Design Development phase. Traditionally, user groups made up of staff members are heavily involved in the planning of the new facility from project inception and through the Design Development phase. It is during this time that interest and engagement is extremely high. Team members are actively involved in discussions and meetings to plan what the new facility will look like, identify how they can best move through the space, and develop strategies to improve patient care. However, typically a one to two year lull occurs after Design Development ends and when transition planning begins where there is no followup with the user groups. During this lull everyone returns to their day jobs, and valuable knowledge of the why and how is lost. Therefore, the previous alignment and buy-in around design and workflow decisions is at risk. The typical result is a reeducation process that results in decreased morale and changes on the project that were not anticipated in the budget or schedule. Changes later in the project are more costly and the schedule impacts much harder to mitigate, as depicted in the figure.
How Do I Organize and Facilitate the Effort to Achieve Operational Readiness?
Capital Project Solutions – July 2011
As you launch the transition planning process, it is important to first establish an organizational structure that will support the critical balance of the Facility Readiness, Operational Readiness and Move Management components. While the user groups that were integral to the design process can remain intact, they will need to do so within the framework of an organizational structure that promotes cross collaboration necessary to complete preparations for relocating and operating in the new space. Once an organizational structure is set-up the following steps are necessary to begin the journey towards achieving and sustaining Operational Readiness: Determine Resource Loading Required to Complete Planning Priorities – Healthcare organizations often struggle to manage the day to day requirements and must maintain a lean staffing model to be profitable. In order to prepare for relocation and operation in a new facility, there will be many resources that must go above and beyond their day to day duties. To avoid a strain on resources and impact on current operations, it is important to properly resource the transition planning effort. Team Alignment Session – Initial alignment meetings with the Team’s should be scheduled and facilitated. These sessions allow for shared goals to be developed for the planning effort as a whole. There also is consensus developed around expectations, roles, and methods of planning effort. The decision making process and how those decisions are communicated will also be agreed upon. Development of a Baseline Activity Schedule – It is important to develop a schedule of activities with each Team in coordination with the overall Master Program Schedule for the facility’s design, construction and installation of all furniture, fixtures, equipment and technology systems. We believe sessions that feature interactive and collaborative thought from key stakeholders and members of focused teams are the most productive. It is imperative that the “silo effect” is avoided during the entire planning process and all events encourage collaboration and group thought. Development of a baseline activity schedule will set a timeline for key activities and tasks that must occur prior to the targeted move sequence. The development of this work product will also highlight key synergies between different teams. Develop and Analyze Constraints – The development of a baseline activity schedule will provide a more detailed path for each focus team, but we find it necessary to go a step further and
Capital Project Solutions – July 2011
evaluate all constraints to meeting the milestone dates that were agreed upon. There is a distinct difference in being organized for presentation versus being organized for implementation. You must utilize communication and tracking tools that allow for ease of identifying and analyzing constraints and track where commitments are being met by each team member being held accountable. Complete Implementation Plans for Each Focus Team – Each focus team should use the information from the Alignment Session and Baseline Schedule Development Sessions to develop a detailed Implementation Plan for their effort. The Implementation Plan should feature a detailed team activity schedule, constraints analysis, resource allocation and budget. Considering there are typically a multitude of synergies between each transition team, it is essential to have a process in place to update key milestones. Present an Integrated Implementation Plan to Leadership for Approval – We suggest that each Team Leader present their Implementation Plan to Leadership for final approval. It is important to do this work as early as possible to identify one-time operational costs associated with the planning and implementation work in addition to the year one operating budgets for the new facility. Execute, Communicate, Adapt and Achieve – Each Team should execute its plan and the Team Leader’s should ensure that there is cross collaboration and communication as required. The Transition Steering Committee meetings will provide an excellent forum to identify any points of connectivity and clarification required. The teams should be prepared to adapt to changes in the field and stick to the structured process in place so they can eventually achieve Operational Readiness. Understand the Move is Not the End – Early in the planning process it is important to not only plan to achieve Operational Readiness for opening day, but have a process in place to help sustain the positive changes you have made and identify areas for improvement as well. Many organizations shut down their transition planning organization after opening day, when in fact there are still elements of transition going. We believe the transition planning structure should remain in effect six (6) months to a year after opening day. This provides a means to continuously assess and evaluate the effectiveness of implementation and provide support to all staff that are working to acclimate to their new physical environment.
Capital Project Solutions – July 2011
Critical Success Readiness
Factors
in
Achieving
Operational
Operational Readiness is a critical component to the overall success of the transition planning process. It must be achieved in balance with Facility Readiness and Move Management to ensure a smooth transition. The following are critical success factors in achieving Operational Readiness: Begin the Project with the End in Mind – From the onset of the project integrate operational planning into the design effort to avoid more work later. Avoid the Dangerous “Lull Period” – We recommend beginning your transition planning effort after Design Development. This will avoid a lull in action and participation by staff that oftentimes plagues projects through cost overruns, schedule delays and decreasing morale. Set a Structured Process and Stick to It – A structured process for transition planning and Operational Readiness needs to be set early and you need to have alignment achieved around that prior to developing implementation plans and continuing with your planning efforts. Plan for Beyond the Move – The move does not signify the end of transition. This is often an enterprise wide event that affects all systems, structures and staff members. Oftentimes, they need more support in the days and months following the move than prior to and during the move, keeping a structure in place to address issues and communicate decisions and changes throughout the organization. Conclusion We believe focusing on the factors above is an excellent start from a macro level as you launch your transition planning effort and work towards achieving true Operational Readiness. Next month, we will discuss Facility Readiness.