Transforming vision into patient-focused facilities

Finding new space for the expansion of clinical practices that improve patient experience is often cost-prohibitive, but a structured approach to master facility planning can help practices turn a patient-focused vision into reality. Mayo Clinic in Rochester, Minn., developed a framework that enabled one department to increase volume in a national program without expanding its footprint. The team developed a successful approach to designing patient-focused facilities by answering these key questions:

• What should be included in a master plan?
• How do we know when practices are using their space efficiently?
• How do we encourage innovation and be 
realistic given financial constraints?

 The resulting framework has been used by master planning teams throughout Mayo Clinic with tremendous results and gains in efficiency. For example, one clinical department has revamped five floors to increase volumes in growing national programs by 50 percent without adding space, resulting in an improved net operating margin, increased efficiency and better use of space.

The plans that have had the most success were supported by a strong business and clinical case. To win endorsement for its plan, the aforementioned clinical department proved it could grow its high-priority national outpatient programs.

A structured approach can be used for a range of projects, from simple plans to large-scale, complex efforts. The three critical stages for any master plan are project definition and strategy formulation, data and information gathering, and facility planning.

Project definition and strategy formulation

When starting a master facility plan, first establish a project charter — a dynamic document that identifies the scope of planning, stakeholders, specific objectives to be measured, proposed timeline, project team and vision. The vision statement should include your practice’s future goals (seven to 10 years down the road) and incorporate direction from the organization’s leaders. Review the charter throughout planning to maintain focus on the scope, responsibility, timeline and stakeholders. Charters might need to be adjusted during the planning process for various reasons, including:

• Changes in physician leadership, which affect overall department strategy
• Room utilization data that does not support the plan objectives, which can prompt the leadership to realize that less space is needed than originally anticipated

Be sure any changes to the process receive 
project team endorsement.

If this is a large-scale project affecting multiple departments or divisions, the project facilitator should meet with service-line leaders for practices that will be affected to communicate overall vision, their responsibilities, how the process works and how they will be able to contribute. For instance, in one successful master planning effort, leadership set the expectation that service-line leaders develop ways to reduce their clinical footprint, which led to exciting and engaging discussions about the real space needs in clinical areas. Leaders came together to see how they could share space. These collaborative interactions took place because everyone understood how they could contribute.

At this stage, it’s critical to establish a common goal for the team, agree on a working approach and clearly define everyone’s role before moving forward. Many practices are tempted to minimize the importance of project definition and jump into data and information gathering. But it’s important to ensure that the project is clearly defined. If the team skips or rushes through the steps in the project definition phase, they are more likely to backtrack later, which extends the timeline, sends unclear messages to stakeholders, carries a risk of team members operating under different assumptions and can ultimately lead to failure. Space can be a sensitive issue, and it is important that the executive planning team take the time to get on the same page.

Data and information gathering

Collecting objective data will streamline the decision-making ability of practice professionals working to improve facility planning. Setting standards for how this data should be collected is important so that decision-makers can have a picture of what is occurring across the organization. There are four steps for successful data and information gathering:

Begin with the end result in mind. Understand what the team and its charter aim to accomplish. Careful planning will prevent unneeded data collection. All data collected should clearly contribute to the outcome. One example of unneeded data collection could be surveying utilization of patient rooms for four weeks when there aren’t practice variations in volume. If volumes are consistent, what would those extra three weeks tell the team? Another example is collecting survey data. If team members decide they would like to collect survey data from patients and/or staff, it’s important to clarify exactly how each question will inform the planning team’s decisions and empower the team to take action.
Before data collection begins, document the assumptions and methodology for collection. For example, if exam room utilization needs to be determined, you will need to answer and 
document the following questions:

• Will extra time be allowed for room turnover?
• Will lunch hours be included in the data?
• How will seasonal variation be accounted for?

Communicate your goals. It is essential for key stakeholders to understand the methodology and assumptions in data collection before it begins. Identify those stakeholders early. If key people don’t buy in to your methodology and assumptions, they might not trust the objective data you are working to collect. When considering stakeholders, don’t forget front-line staff. The data collection will often involve unusual activity in the clinical area. Make sure staff members know why unfamiliar people might be in their workspaces. You might also want to leverage staff to collect certain types of data.

Collect the data and analyze it based on the assumptions you made at the beginning of the process. Examples of important data to collect include:

• Patient and staff surveys
• Process flow analysis like spaghetti diagrams, utilization studies, scheduling analysis, 
volume trends and projections
• Financial analyses

Facility planning

In the final stage of the master planning process, inventory how staff and patients operate in the existing space to determine whether clinical space constraints affect the practice. We call this review Existing Space Validation. It is not uncommon to find that space is being used inefficiently. Once you complete this review, you will have documented the square footage of the existing space and will understand how the space functions.

Using a space program (as shown in Figure 1) allows you to show the existing square footage being used, the amount of space requested by service-line leaders and how much space the project team would like to allocate in the proposed plan.

Dedicate a column in this program to future space needs and requests. The needs of the service line should be considered and should be supported by data. This exercise helps you to “right-size” patient and staff space based on use; function; industry standards; the Guidelines for Design and Construction of Health Care Facilities (Facility Guidelines Institute), a reference manual endorsed by the American Institute of Architects; and institutional space standards. For example, Mayo Clinic has internal reference standards for office and workspace size and configuration based on work requirements.

After you’ve completed this exercise, ask the leadership team to review future space requests based on evaluation criteria developed at project initiation. Some space requests may be readjusted or removed from this document based on misalignment with evaluation criteria.

Following a final review, generate block diagrams based on the document, critical adjacency requirements and revised process/patient flow analysis. The diagrams represent a high-level analysis of the feasibility of facility
improvements. The block diagrams in Figures 2 and 3 illustrate the current state (prior to construction) and the future state (when construction is complete), respectively. Construction phasing plans, timelines and an initial cost estimate can be generated from the diagrams. Often complex plans will be multiphase and multiyear efforts to procure funding over time.

Using this standard framework for master facility planning allows practice professionals to find space for growth in their existing footprint — or it might prove that more space is needed.