The challenge for today’s healthcare leadership is to leverage every aspect of your enterprise to drive maximum efficiencies without losing your culture and quality of care. As margins continue to shrink, this means continually doing more with less. The most innovative systems are partnering with a variety of consultants to create effective strategies and find new ways to enhance their brand, increase their revenue, and drive operational costs down. Enter the enterprise architect.
Gone are the days where architecture firms only provide planning and design services. The best design firms have created a strong multidisciplinary array of services to tackle any challenge a health system may have. These services include capital asset planning; financial and market analysis; design anthropology and research; work process analysis; and building performance analysis, including LEAN expertise, systems and campus optimization, and technology analysis and integration—all in addition to medical planning, design, and project management. The most successful partnerships start with a clearly defined vision and strategy.
Creating a system-wide strategy takes systems thinking. First, key criteria for success should be identified along with clear benchmarking to measure what success will look like throughout the process. This takes alignment of key stakeholders across the system so that once work begins, everyone agrees on the desired outcome at a high level.
It starts with a clear reimagination of the challenges you face without initial constraints. It is informed by the most relevant market assessment data identifying your competition and market base and a comprehensive financial analysis. Service lines may grow or shrink as they align with demographic and market projections. Layered into this analysis are facility assessments and geographic/location data. Potential options can then be vetted to provide a roadmap for the future to enhance operational performance. Finally, a system-wide strategy involves engaging the community to understand how patients perceives the brand and access service.
System-wide Standard Planning – Midwestern Provider – Prior to a recent merger expanding its footprint, a large healthcare organization in the Midwest had seen extensive demographic and economic growth in its region. HGA worked with the organization’s strategic market group to understand current ambulatory asset utilization, rental agreements, neighborhood viability, and primary/specialty care coverage. We implemented a strategic assessment identifying key areas of opportunity. For instance, in one service region, we recommended they could better position a future replacement hospital through a new Medical Office Building (MOB) attached to an existing facility. In another service region, we identified new ambulatory practice locations, along with a strategy to support primary and specialty recruitment.
Standards and Guidelines
To maintain and evolve a complex healthcare system requires continuous improvement. Maximizing and enhancing productivity, whether physical or operational, first requires the definition of standards. The core role of an enterprise architect is to partner with in-house teams to develop or refine system-wide facilities standards and operational guidelines.
Master Specifications typically drive facility standard optimization. There are a variety of benefits to creating clear and concise standards: protecting brand and design standards, promoting consistent and well-defined quality expectations, and providing flexibility as materials and methodologies change. Comprehensive master specifications include interior and exterior materials; furniture, fixtures, and equipment (FFE); infection prevention concerns; code preparedness, MEP systems and components; and information technology. They can also provide clear direction to plan procedural areas, exam rooms, and office space and capture nuances of specialty areas, such as pharmacies and labs. Partnering with an enterprise architect can strengthen facility standards saving time and money.
Optimizing Building Systems – Campbell County Health – At the 90-bed acute care community hospital in Gillette, Wyoming, HGA worked with the engineering team to optimize their existing facility. The Central Plant was in good condition with consistent preventive maintenance practices; however, building systems were operated as a steady state system, and energy efficiency was poor when compared to peer hospitals. To better meet industry standards, a master list of projects was developed to maintain the building systems and reduce life-cycle costs. Upon implementation, the hospital avoided 39 percent of 2016 energy costs while improving the reliability of energy infrastructure systems. They have consistently optimized (passive) existing facilities mechanical systems for an annual savings of more than 20 percent.
Operational guidelines identify efficiencies in care delivery and prescribe metrics to measure success within a system by both facility and department. Through LEAN planning and evidence-based design, enterprise architects create efficient workflows and movement of people, processes, and products, while delivering the highest quality and safest care possible. The LEAN process assesses workplace operations to understand the current state of care delivery to determine if people, spaces, and technology are enabling or inhibiting efficiency. By using LEAN benchmarks and research-based assumptions, organizations can identify areas for improvement throughout the enterprise as well as on a service line basis.
Universal Care Platform – Ascension – This national health system operates more than 2,600 sites of care, including 151 hospitals and more than 50 senior living facilities in 21 states and the District of Columbia. For a system this size, it is imperative that standards are clearly defined and communicated across the many partners that work with them.
In collaboration with Ascension’s in-house Kaizen LEAN team, together we developed a Universal Care Platform within the Emergency Department at St. Elizabeth Hospital in Wisconsin. The goal was to utilize the existing square footage more efficiently to deliver care according to patient volume throughout the day and to drive patient throughput effectively. The concept combined co-located comparable services, such as observation, infusion, and pre/recovery with centrally located “flex rooms” that function as ED or Surgery pre/recovery depending on scheduling and needs through the day. Through space sharing, the Universal Care Platform reduced the number of medical rooms from 23 to 17, reduced pre/recovery rooms from 28 to 16, and identified 10 rooms as “flex” for either department resulting in a highly effective and efficient Emergency Department.
Testing New Operational Ideas Through Research – Ascension – At the core of every research project is a hypothesis. For Ascension, the hypothesis was that a decentralized nursing unit would provide an advantage over one that was centralized and operating with workstation on wheels (WOW). Through a post-occupancy evaluation, it was determined that although the charting time was comparable between both, the decentralized unit resulted in less corridor clutter as charting occurred at dispersed collaboration hubs, eliminating the potential of cross-contamination created by WOWs pushed from one patient room to the next. The findings were shared with key leadership and the nurses, providing better buy-in to the new design and workflow.
Building a Healthy Brand
Healthcare organizations communicate their brand in multiple ways, often establishing a premise for an experience before a patient or family member steps across the threshold of a facility. That brand is reinforced over many touchpoints through the patient journey, including the arrival, check-ins/check-outs, signage and wayfinding, architecture and design, clinical space, quality of service, and most importantly, patient-caregiver interaction. The brand reflects the organization’s vision for quality of care and their commitment to a community. Through the enterprise architect relationship, it possible to curate a consistent experience, and through research, document the changes in patient and employee satisfaction over time.
A New Healthcare Experience – SSM Health – St. Clare, a 154-bed hospital in Fenton, Missouri, was designed to reinvent the way healthcare was delivered to patients. Using work process improvement, technology roadmaps, and future-state development, the goal was to achieve a balanced system of patient demand with available resources balancing budget, quality of care, access and delivery, patient and staff safety, and patient experience. Once completed, patient satisfaction moved from the 66th to the 92nd percentile in HCAP scores, physician experience moved from the 48th to 74th percentile, and overall staff experience moved most dramatically from the 5th to the 94th percentile.
Partners for Success
Directing and operating a healthcare system leaves little time during the day-to-day to act on a strategic level. With multifaceted partners who understand your business, it is possible to drive change faster, stay ahead of the competition, grow your business, and increase operations and satisfaction. Think of an enterprise architect as an extension of your internal team, whose sole purpose is to make your system more effective and your team more efficient. It is a partnership based on trust. Our job is to help you solve the most complex and biggest challenges you face, so that you can not only survive but thrive.