Blog contribution by Kaycee Shiskowsky RN, MBA, NE-BC, EDAC, Manager of Clinical Planning and Design @ UCHealth.
As a bedside nurse and nurse leader, I was an alien on a strange land in a healthcare design role about 7 years ago. Even after being a nurse manager on a previous new floor project, I didn’t know what was my role was, how hard I should advocate for operational flow and what change orders did late in the project. I work as a manager of clinical planning and design within a hospital system in Colorado, on a small team of clinicians within the facilities, design and construction department. Over the course of the time in my new role I have learned and integrated into the focus on schedule, budget and clinical operational flow. Once I acclimated to this new role, I felt compelled to ensure that other nurse managers and department leaders didn’t feel as lost as I was on my first project. So I created a presentation that I share with the leaders on every project at the beginning of the design phase. I found that every group of department leaders had varied experience levels on new projects whether they are renovations, additions or new building sites. Three key points I share are:
Phases of healthcare design
Leaders role and responsibility
Changes management and impact
In order to have a successful design process it is vitally important to align the leaders with the financial limitations and strategic schedule of the full project. Taking the time to educate the leaders of the design phases correlated with their responsibility during each phase helps to ensure the end operational flow and function of the departments is optimized. It is important to highlight that there is a lot of variety in design phases, but this is what I commonly see on our systems projects so please adapt to your design process or organization as needed. Let’s dive into the three key points I highlight in more detail:
Phases of design:
Leaders may be brought into a project in various phases of a project, so educating them on what each phase entails is important to meet architects and designers where they are at. The phases I identified was the programming phase (or concept design), schematic design, design development and construction documents.
Program/concept design: Within the programming phase or concept design phase this is where the big strategic decisions are made. Determining which specialties, how many rooms, which rooms are needed to support the service and the general spaces included are key decisions to lead into the next phases of design.
Schematic design (SD): This phase is where the fun starts. The focus on this phase is the floor plan. This is where we identify what the operational flow is so that the rooms that need to be co-located are where they need to be, and rooms that need to be off stage are placed at the right location within the floor plan.
Design Documents (DD): This phase, sometimes called detailed design, is the where we get into the specific rooms to detail exactly the floor plan and what needs to fit. This focus really clarifies all the pieces and parts that need to be accommodated such as medical equipment, furniture, information technology, electrical placements, flooring, cabinetry etc… At the end of this phase I make sure to emphasize that this ends user involvement, so leaders really need to ensure their vision is complete for their departments.
Construction Documents (CD): This phase is focused on the architects, engineers, and the contractor collaboration to ensure what has been designed can be constructed and creating a final budget. This is not an opportunity to redesign spaces or add a change.
Above image shows the construction phase of future Operating Rooms
Photo provided by: Kaycee Shiskowsky RN, MBA, NE-BC, EDAC, Manager of Clinical Planning and Design @ UCHealth.
Leaders role and responsibility.
Clinical leaders are at the frontline of patient care and have a deep understanding of the daily workflow and patient experience within their respective departments. It is essential to involve them in discussions that focus on these aspects of care delivery. By understanding the clinical workflow and patient experience, designers can create space layouts and workflows that enhance efficiency and promote better patient outcomes.
During meetings: Sitting in your first design meeting for a construction project is intimidating, but some general tips we have given our leaders is to speak up and participate. Providing honest operational feedback about their space is important to relay as well as give us the why behind the feedback so we can help troubleshoot a resolution. We have many big brains on the team and this is a great time to educate the group on the priorities for workflow and functionality. The last thing we want to do is create negative changes to the current workflow that is successful. We also want leaders to envision the daily work that needs to occur both for their staff as well as support staff that come and go into the department. This is the time to identify current pain points or “work arounds” that we could potentially improve with design.
Between meetings: Leaders want to create the best future space for their staff, but sometimes don’t know exactly how to prepare. This is the time to involve staff and see who has great ideas for improvement, within reason. One easy way to get feedback is to ask the question, what should we start, stop and continue, so that we don’t try to fix something that isn’t officially broke. After each meeting, it is important to review meeting minutes and drawings to ensure that the leaders direction is accurately documented. Once you have drawings in hand, one option is to share them with staff to get their feedback so you can incorporate that feedback in the next meeting. I always mention that ONLY the items on the drawings are what is being constructed, so make sure nothing is missing.
Above image shows the final hybrid operating room.
Photo provided by: Kaycee Shiskowsky RN, MBA, NE-BC, EDAC, Manager of Clinical Planning and Design @ UCHealth.
