Capital Project Solutions – September 2011
Move Management - The "Big Move Day" Is Here Patrick E. Duke, Senior Vice President Gary Wilkinson, Senior Consultant
It All Comes Down to "The Big Move" The day-to-day activities that are associated with delivering a major healthcare capital project can be overwhelming. During construction, it is easy to lose site of the goals that were established at the onset of the project. Often times, these goals are replaced with the single minded notion of “just finishing” and “getting it complete”. The pressure to stay on schedule and within budget, combined with change orders and patient and staff disruptions often overshadow the need to properly plan the physical move into the new facility. The cliché that “people only remember the last three months of the project” is only too true. All of the praise for proper programming, design, and construction can be lost in an instance if the team fails to properly plan the move. Over the past three months, we have discussed the importance of conducting a Transition Readiness Assessment as well as Operational Readiness and Facility Readiness. These three critical planning elements can ensure a smooth transition into the new building. The time for planning will inevitably come to an end and you must make "The Big Move" into your new facility. In this edition of Capital Project Solutions, we will focus on: Setting the date for the "The Big Move" Setting up a command and communication structure Recommended support after "The Big Move"
Setting a Date for "The Big Move" Setting the date for “The Big Move” can often times become one of the most discussed, debated and misunderstood issues during Transition Planning efforts. The primary reasons are as follows: 1
Capital Project Solutions – September 2011
Lack of Clarity Around the Definition of Contractor Completion - The Owner's project management team should clearly define “Contractor Completion” in the Construction Management Agreement. We often see confusion because contracts can use the terms Substantial Completion and Certificate of Occupancy separately. It is preferred to link the two and define Contractor Completion as the date that the Owner can legally take control of the building after receiving a Certificate of Occupancy (CO). A Contractor that achieves Substantial Completion typically has punchlist work and commissioning activities remaining before CO can be achieved. Therefore, Owner activation activities such as stocking and training cannot begin until after CO and this should be the date defined as Contractor Completion. Lack of Clarity Around Inspection Process to Determine Clinical Readiness - You are probably well versed in routine or surprise inspections that occur from your local, state and sometimes national health officials and accrediting bodies. While some elements of these inspections are similar to the inspection process to determine clinical readiness, there are also some differences. Because of the variability from state to state and inspector to inspector, we recommend that communication between the project delivery team and inspection agency occur prior to project launch. This communication should continue throughout the life of the project in order to thoroughly understand all of the requirements for clinical readiness inspections. The date of "The Big Move" cannot be set with any accuracy until you fully understand all of the requirements of clinical readiness inspections. Lack of Understanding of Time Required for Activation Activities – By their very nature, healthcare organizations are flexible and quite skilled at quickly adapting to their environment so as to remain focused on delivering quality patient care. As expected, they are well versed in emergency preparedness. This trait, while extremely positive when related to patient care, can actually work against the need to provide adequate time 2
Capital Project Solutions – September 2011
to complete all activation activities. There is no doubt, that given a deadline, the staff in a healthcare organization will meet it and ensure that proper patient care is delivered. Unfortunately, the amount of time that is required for appropriate staff training and process retooling is typically way underestimated. The result is often an increase in cost and a decrease in efficient early in the new facility's life cycle. In our experience, there cannot be too much time allotted for activation activities. While construction is never an exact science it behooves the Owner to set a date for "The Big Move" as early as possible. Once this date has been established, a cascade of decisions can be made. For example, if new services that require additional FTE's will be added, recruiting must be factored into the schedule. In addition, procuring a Relocation Specialist (the physical mover) should happen sooner rather than later. There are only a handful of companies that specialize in large hospital moves and their calendars are booked well in advance. Considering all these factors and based on our experience over the years, we recommend that a date be set for the "The Big Move" that is no less than 60-90 days from Certificate of Occupancy for smaller projects or those that are in ambulatory settings. For larger and more complex projects, we recommend that the date be a minimum of 90-120 days from Certificate of Occupancy. Setting Up a Command and Communication Structure Given the complexities and risks surrounding the move to a new facility, it is recommended that this task be approached in a manner similar to an Emergency Preparedness situation. Many hospitals utilize principles of the Hospital Emergency Incident Command System (HEICS) and set up the requisite Incident Command Center (ICC). Since healthcare staff is familiar with these terms and procedures, it will be beneficial to closely mimic this set-up for the command and communication structure to
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Capital Project Solutions – September 2011
support "The Big Move". should be as follows:
Some considerations in your plan
Timing of Command Center Activation - The physical move of contents may take place the weekend prior to first clinical visit or for larger facilities it could begin two to four weeks ahead. Typically, patient moves occur in one day over a weekend. However, depending on your volume, it may be best for your organization to phase your patient moves. Regardless, we recommend activating the Command Center to support the beginning of the physical move. Obviously, there is a ramp up period from the early days of your Command Center operations to when you complete the move. Keeping The Clutter Out - Especially on patient move days, it is vital to include only essential Command Center personnel who have a defined role in the process. Setting a "Contractor & Vendor Support Room" that is linked by communications with the Command Center is critical to coordinate all activities. Should staff require systems support during the patient move, contractors and vendors can easily be dispatched from this area to the trouble spot. Also, separate rooms for media, volunteers and patient's families should be set up in a similar fashion. Leverage Technology - The best Command Centers we have encountered have been those that utilize the facility technology to allow for enhanced monitoring and communication. With proper planning, temporary measures can allow for effective use of the facility communication and monitoring systems even if the Command Structure location is not part of a permanent Central Command in the hospital. The Command Center should be able to access all camera locations to view activity, view bed management and have its own unique phone number with an extension that is easy to remember such as x6683 or "MOVE".
The Command Center is the epicenter of "The Big Move" and should be activated when the physical move begins. Roles and 4
Capital Project Solutions – September 2011
responsibilities for all staff supporting "The Big Move" should be well defined and only those essential to the Command Center operations should occupy it. Other separate areas for groups like contractors, vendors, media, volunteers and patient's families should be designated and linked through the communications systems to the Command Center to maintain a stable environment during the patient move. A Command Center that leverages technology systems in the new facility most effectively allows for closer monitoring and better response time to any issues that may arise. Recommended Support After "The Big Move" A common mistake in approach to transition planning is to close the planning window at the conclusion of "The Big Move". The reality is that transition does not stop at that point. It continues past "The Big Move" and depending on the scope of the project, can last months, even years longer. Failure to plan and support staff post "The Big Move" can lead to low morale, low patient satisfaction scores, increased operating costs and lower margins. In looking beyond "The Big Move" you should consider the following: Command Center Operations Post Move – A proven best practice is to keep the Command Center open at least one week post "The Big Move". The hours and staffing model should be discussed and adjusted based on agreed need. Using the Command Center in this time period to address issues provides a safety net to staff and allows the organization to respond quickly to any issues that may arise. Maintain Transition Planning Structure Post Move - The Transition Planning structure should be maintained up to a year post "The Big Move". For the first 3 months following the move, the Transition Steering Committee should meet on a bi-monthly basis and address ongoing issues related to the transition. Allowing these issues to filter through existing management processes and systems can lead to delays in response times and may strain relationships with staff, patients and visitors. 5
Capital Project Solutions – September 2011
Gear Up Your Lean Team - Lean or Performance Improvement teams, inside healthcare organizations, should be integrally involved in the transition planning effort and should be maintained post "The Big Move". Modeling and development of processes and workflows that aligned with your facility design prior to transition need close evaluation and optimization in the near term after the move. This level of support and monitoring will address any bottlenecks that occur and provide yet another critical support element to the staff. It is easy to quickly return to operations as usual once "The Big Move" is completed. Avoiding this scenario is highly recommended. Staff, patients and visitors need time to adjust to the new environment and new processes. Despite their unique ability to adapt and adjust to new environments while maintaining focus on patient care, staff involved in the transition are experiencing change in a way that most have never experienced before. This change needs to be recognized and a bridging process should be developed post "The Big Move" to provide critical support before returning to normal operating procedures. Conclusion The last thing anyone remembers about the project is "The Big Move". In order to finish strong, it is imperative that adequate time for all of the Owner's activation tasks be built into the schedule initially. While you may begin with more time than you think is necessary between Certificate of Occupancy and "The Big Move", construction is never an exact science and contingency time should be allocated. Given the dramatic change that many staff will experience for the first time in their careers, providing a support network dedicated to the move, and more importantly post move, will be welcomed. Proper planning, flexibility and team work will ensure that your new facility achieves your goals and fulfills your vision.
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