Capital Project Solutions – December 2012 The Power of Integrated Process Planning
Curtis Skolnick, Vice President Form follows function – the 3F theory, it rolls off the tongues of many healthcare administrators, planners, and architects. Unfortunately, under the traditional design phase of a project the simple 3F theory is not always followed. This happens because disciplines of process design / redesign, programming and schematic design are poorly aligned at the outset of the design phase. Often the traditional approach to space programming and design is based on siloed user groups determining the space needs for the facility. This segregated decision making can lead to “Form Follows Familiarity” instead of “Form Follows Function.” User groups generally meet over the course of weeks and months to discuss operations and necessary room elements for their specific departments. While this activity ensures user input and ultimately yields a room-by-room space listing based on operations, the isolated nature of this approach does not typically stimulate process improvement discussions on a multi-disciplinary level. Instead these groups tend to design space around the current departmental processes with which they are familiar, rather than at a more appropriate cross-functional level. Integrated Process Planning The traditional model of engaging separate, non-related parties has changed. A new paradigm has evolved in which an integrated design and project delivery team is developed early in the process to tackle process flow, value stream mapping, space programming, and design all at the same time. These processes are inextricably linked and a 1
Capital Project Solutions – December 2012 team approach ensures that all parties are working toward achieving a common goal. This method known as Integrated Process Planning (IPP) is transforming the approach to healthcare design by dissecting the patient experience and the direct and indirect care delivery elements in order to define value and eliminate waste. Following this model in the initial stages of the planning and
conceptual
design
process
will
lead
to
the
development of a more operationally efficient and cost effective design. It is imperative that the right resources are dedicated to this process during the Launch Phase. With the increased emphasis on improved operations to control the cost side of the revenue equation and increase throughputs; whether it is through Lean Processing, Six Sigma, or other similar
approaches;
the
best
method
to
space
programming and design is to first value stream map the processes, get rid of the waste and then program and design the facility based on the developed strategic scope and operational redesign. This requires participation from a multi-disciplinary group of end users including clinical, administrative, support and ancillary services departments. The project delivery team must collaborate with and creatively challenge the internal users to define a program that is designed around needs and improved functions, not wants and outdated delivery models. Consider Processes for Effectiveness When designing a facility there are many clinical and operational processes that should be considered by the user groups.
Taking these process considerations into
account at an early stage during the Launch Phase will help ensure that the facility is designed in the most effective way to enable growth, flexibility and productivity.
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Capital Project Solutions – December 2012 Many key considerations are noted below with details about their affect on operational and clinical process.
Patient Access Wayfinding and Entry Points Utilization Efficiencies Bed Allocation and Aggregation Care Delivery Models Adjacencies Supply Chain Management Utilization of Tools and Technology
If the key operational and clinical process considerations are part of the Launch Phase this will lead to a better user group team design and will ultimately lead to a stronger space program.
Furthermore, now is the time to make
changes early where it is much easier and less costly to modify plans on paper, than it is deep in the design phase or once construction has begun. Additionally,
The
Facility
Guidelines
Institute
2010
Guidelines for Design and Construction of Healthcare Facilities clearly take into account that functionality and environment of care are often overlooked. Sections 1.2-1 & 1.2-2 specifically cite the need to include and address the
planning,
“Environment
design, of
and
Care
implementation and
Facility
process; Functions
Considerations”; and to develop functional programs. Within the Guidelines there is recognition of a multidisciplinary process including both internal users and external experts - architects and design professionals, and those with knowledge of the organization’s functional goals. Space Programming Once the key operational and clinical processes are mapped and agreed upon then each user group will create the ideal space and process relationships to achieve the 3
Capital Project Solutions – December 2012 ultimate patient, staff, and physician experience. These “future state” flows will be used by the planners to develop an accurate space program that lists all the required physical spaces and spatial relationships for facility design. Each group will identify space program needs and desired adjacencies based on the outcomes of the previous steps. This initial integrated process planning sessions will form the bases for additional departmental space programming meetings. It should take no more than three meetings to gain concurrence on the space programs. This information is then “tested” against project budget guidelines to ensure a balance of program and funding. Once the space program is developed, the design team then develops a conceptual design plan to match process flows and programs.
The team is tasked with finalizing
what amounts to schematic design. The process teams are involved to ensure value-stream and programmatic goals are met and adhered to. Many times, physical “mock-ups” and / or computer simulation models of certain functional areas are created to further test operational assumptions. Concurrently,
other
team
members
will
discuss
infrastructure design in order to create the “behind the walls” and site elements of the design team’s schematic product. This is compared to the programs and process maps in an effort to avoid “scope creep”. Since the design team is involved in the previous steps, the risk of awkward handoffs and translation issues is significantly minimized. At the conclusion of this phase, the design is again “tested” against project budget guidelines to ensure a balance with funding. A major by product of the traditional approach to programming and design is “scope creep”. Scope creep occurs when the scope is not managed by the same integrated team from start to finish.
Controlling scope
during the integrated process planning and design phases 4
Capital Project Solutions – December 2012 is critical to the financial success of the project delivery. Controlling scope begins in the early stages of Project Launch. A scope control model should be developed by the integrated team and that model should feed directly into the cost control model. The typical time line for an Integrated Process Planning Phase is four to six months. An equal amount of time will be shaved off of the traditional programming and design approach resulting in a better product, in a shorter time, that minimizes re-work in later phases. Conclusion The primary benefits of the IPP process are:
SME input: Gains input from a multi-disciplinary team of internal and external subject matter experts (SME) to drive an accurate project
Positive Team Dynamic: Fosters a collaborative team atmosphere
“Scope creep” avoidance:
By developing a more
accurate scope and program early, later project phase rework and “scope creep” is minimized thereby saving overall project time and money
Forward thinking program: Creates a program that is based on “future state” function
Early
design
and
budget
test:
Allows
for
early
conceptual designed and budget testing to confirm a realistic program
Eliminates “hand offs”: All members of the project team have first-hand knowledge of process and program intent avoiding translation issues
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Capital Project Solutions – December 2012 Simply stated, IPP establishes an agreed upon scope and the foundation for further detailed operational and physical design ensuring that informed form follows function.
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