Healthcare Design - May 2017 - 26

RUDY SANTACROCE

Title: Vice President, Operational Excellence
Firm: CallisonRTKL (Dallas)
Number of employees: 1,000
Healthcare revenue in 2016: N/A

BUSINESS CHALLENGE: EFFICIENT PROJECT
DELIVERY

The short durations of time allocated by the client to the design firm from project award to project completion is one of
the main challenges we see in the healthcare industry. CallisonRTKL has found that this quick turnaround stirs the need
for a highly efficient, Lean project delivery process to maximize
time spent during design and delivery while still developing a
functional, aesthetically pleasing facility. But sometimes that's
easier said than done.
W H AT ' S B E H I N D I T

Healthcare systems are challenged in several different ways, due to rising
costs, the shift to value-based models of care, advancement of technology,
etc.-all resulting from the development of the Affordable Care Act. When
building a new facility, organizations are often faced with financial constraints that lead to requests for shorter project schedules to decrease the
cost, saving money by minimizing what's spent on project team time and
resources.
Our firm has determined that the best way to approach expectations for
a fast turnaround and maintain an exceptional project is to implement a
Lean project initiation process that starts well in advance of the traditional
architectural design process. The Lean initiation process requires detailed
planning before project programming, requiring more work and time at
the beginning of a project. This process forces discussion to be more operational, which then informs project programming and budget. However, it
also brings in a larger number of key decision-makers than the traditional
architectural design process, increasing the necessity for early stakeholder
buy-in.
THE SOLUTION

While clients may see the upfront work as prolonging the project
schedule, this approach results in much less rework later in a project's
lifecycle and saves a substantial amount of time-usually months- toward the end.
To deliver added value and quality results to a client via the Lean initiation process, our first step is to learn and understand the people and
culture of the client's organization. This is done during what we call the
Discover Phase, before any design has taken place, and provides an opportunity for everyone involved on the project to get on the same page. We go
to the "gemba," a Lean term meaning the place where the work happens,
to immerse ourselves in the operations of an organization and fully understand how our clients work.

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After we've accomplished this, we move to the
Create Phase, which begins with the development of performance metrics, key performance
indicators (KPIs), and advanced data analytics.
Performance metrics help quantify the significant elements of the process that are used to deliver care to a patient, focusing on efficiency in
an organization's operations. KPIs are then developed after examining the components of operation and might include increased ED capacity, improved throughput times, fewer patients
who left without being seen, etc.
Once the current state of operations is fully
understood, our team develops value stream
maps (VSMs) that determine the future state of
operations by incorporating principles of Lean
and Six Sigma to reduce or eliminate waste in
time, finances, and distance traveled by staff and
improve quality and patient satisfaction. VSMs
will also drive programming and schematic design, allowing form to follow the optimal function of the space.
Early on and throughout schematic design,
the space is then simulated through predictive
analytics to include the flow of providers, materials, and patients, and includes fine-tuning the
design to maximize the experience of the patient
and optimize the building's plan.
Stakeholder buy-in is important, because
the first step of the Lean initiation phase is to
achieve a mutual understanding between all
stakeholders that allows for sign-off on the project earlier in the design process. Then, details
such as the number of rooms can be determined
in advance of traditional architecture programming. This leads to less iteration of programming and schematic design. The result is a project schedule that has fewer people onboard in
the final stages and stakeholders invested in the
project thanks to that initial involvement.
WORDS OF WISDOM

Healthcare systems are evolving due to their
own specific challenges. For healthcare design
firms to be competitive, we must also evolve and
deliver more value to our clients by answering
their needs through innovative solutions. By
incorporating a Lean initiation process, the
efficiency of design delivery can be greatly
improved.

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Healthcare Design - May 2017

Table of Contents for the Digital Edition of Healthcare Design - May 2017