Capital Project Solutions – October 2012 Are You Ready to Move?
Rick Hood, Vice President Over the past ten years, healthcare facility transition planning has been referred to under many different names. This is not surprising, as every provider and healthcare organization seems to have a different opinion of what exactly “transition planning” means. Historically, when healthcare organizations planned for the transition to a new facility, they were focused primarily on relocating patients from the existing hospital to a new addition or replacement facility. Today however, transition planning has taken on a whole new meaning. While safely transporting patients remains a critical component of the comprehensive transition plan, most organizations now require the development of a thorough operational plan and training program to successfully integrate staff and activate a new facility. A successful “transition plan” has moved from a single event (patient move) to a three part approach (operational readiness, facility readiness and move logistics) that encompasses everything necessary to open a new facility. This issue of Capital Project Solutions will provide the roadmap for planning the activation of a new facility. Ideally, preparation should begin shortly after design documents are complete. The teams that participated in the planning and design of the facility should remain engaged since they were responsible for identifying the new model. Their input was critical in the beginning and remains so through opening.
Operational Readiness Often, the impetus for a new or expanded facility project is to alter and/or provide care in a new or innovative manner. To bring about this change, the inclusion of the operational staff in the planning and design is a necessity. This remains true for the activation process. Whether changes impact staffing, workflows, new systems and/or equipment, something about the way care is being delivered will change and staff must be prepared. 1
Capital Project Solutions – October 2012 In preparing an Activation Plan, the first step is to identify the changes from current to future state of care and document them. To evaluate and identify the ideal scenario for functioning in the new facility, an Operational Workflow & Education Committee should be established. The responsibilities of this group are as follows: Model Flow – How will patients, staff, visitors and materials move through the new facility? Model the Experience & Interaction Evaluate Current vs. Future State Eliminate Non Value Added Work Staffing - Will the new facility require additional staff? If so, what positions and volumes? Prepare the Operation Plan Train & Orientate Staff Once the changes are identified and documented a process must be developed to understand the impact of each change and create a strategy to train staff to implement each change. Through this process a comprehensive training plan and schedule should be developed to understand the cost and time associated with preparing staff to administer care in the new facility. Facility orientation often takes place throughout the construction process by touring department leaders or super users through the facility as the construction schedule reaches certain milestones. However, the majority of staff training takes place much closer to the opening of the new facility and typically within the last two months of the Activation Schedule. Training too early can be counterproductive as much of the information may be forgotten which then creates the need for retraining. Additionally, truly effective staff training occurs when the space is as close to patient ready as possible.
Facility Readiness KLMK defines the Facility Readiness Phase of the process as the period between the contractor’s substantial completion date and the opening date of the new hospital. To evaluate all aspects 2
Capital Project Solutions – October 2012 related to the physical plant, a Facility Readiness Team should be assembled that consists of the following: Procurement IT EVS Maintenance Materials Management Artwork Infection Prevention Preparing a facility to receive patients requires the development of a detailed Activation Schedule. The Facility Readiness Committee will assist in identifying the chain of events that must occur in order to successfully get to move day. Activities that must be considered in the Activation Schedule are as follows: Initial, periodic, and final cleaning Stocking supplies Placement and installation of Owner Furnished Owner Installed (OFOI) equipment Coordination of IT and Telecommunications Furniture & Artwork Security Final licensing and Certificate of Occupancy (CO) Staff training Grand opening events During the Activation Phase, a host of vendors must be coordinated to support the readiness of the new facility and staff training for specific systems and equipment. The planning process leading up to the Activation Phase should account for vendor access to hospital systems to properly install, test, and train on new equipment. Vendors may need access to servers, IP addresses, print capabilities, etc. and these needs should be well documented and accounted for ahead of initial vendor installation so as not to hinder the process. Additional vendors required to support the activation and move process include third party warehouse companies to receive, place, and install new equipment; select vendors to relocate equipment; and move vendors to manage the physical relocation.
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Capital Project Solutions – October 2012 Move Logistics As the building activation work draws to a close the relocation process begins. Often some support services and ancillary departments may relocate to the new facility weeks or months ahead of the actual opening to support the activation process. However, the movement of patients and all furniture, fixtures, equipment and technology (FFE&T) will take place after the Certificate of Occupancy has been received. While the move activities are the final piece of the activation puzzle, the planning process to develop a successful relocation plan will have taken many months to develop, test, and complete. To coordinate the patient move, a separate Patient Move/Patient Care Committee is required to develop a safe and comprehensive plan. The team typically consists of Support Services representatives for the various units relocating patients such as: Respiratory Pharmacy Nutrition Services Patient Transport Security Ambulance Services - if patients are moving externally Various vendor representatives to support critical equipment such as patient monitoring This team is responsible for identifying the following: The best day(s) to relocate patients, interim care and staffing model to support patient move day activities The best routes to move patients and equipment A patient and family communication plan A security plan to ensure the safety of patients and staff during the relocation process Planning assumptions will be tested during a series of patient mock move activities which will determine the final move plan and sequence. Simultaneous to creating the Patient Move Plan is the development of a detailed FFE&T Move Plan. Early in the process, an Operational Move Sequence will have been 4
Capital Project Solutions – October 2012 developed and approved by the organization's Senior Leadership Team. This Operational Move Sequence will serve as the foundation for the development of a day-by-day move schedule. The goal of the overall move plan is to relocate as many departments or partial departments ahead of patient move day as possible. This will allow for everyone to focus squarely on the safe relocation of patients on the actual move day. Typically, an organization will begin transitioning items and setting up departments in the new facility two weeks prior to the patient move. Any equipment, furniture and materials that have not been transferred in advance of patients will be relocated for a period of days following the patient.
Command Center In order to properly support the activation of a new hospital and subsequent relocation activities, a Command Center Process should be developed to manage issues that arise during the final weeks of the project as the building prepares for opening and move activities commence. Organizations may implement a Command Center Process supported by a work order system to track all facility and move related issues that arise. These issues may include computers that are not functioning properly, outlets without power, items lost or damaged in the move process or any number of other issues. Other organizations establish a Command Center to focus on the patient move process and model their center structure around the Hospital Incident Command System or H.I.C.S. A patient move is the closet activity that mirrors an actual facility evacuation and as such many organizations will structure their patient move process as an evacuation drill to test readiness plans. Finally, some healthcare organizations will develop a hybrid Command Center Process to track activation and move issues as well as the patient move process to measure the success of the activation and move plan.
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Capital Project Solutions – October 2012 Conclusion The goal in any transition plan is to effectively manage the opening of the new facility and ensure a safe and efficient patient relocation process. All of the years of hard work will be quickly forgotten if things don’t run smoothly. Early preparation and planning will allow time to evaluate and address all possible issues and scenarios. Though it typically is the last thing people think about, comprehensive facility activation planning should begin early in the planning and development life cycle. Save yourself the headache and don’t put activation activities off until the last minute.
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