Why Your Hospital Can't Wait to Reinvent Their Construction Practices

Karin Henderson, Executive Director, Strategic Facility Delivery, Cone Health

Systems theory supports the concept that “innovation occurs at the edge of chaos”. And what could be more chaotic than last two years of pandemic? As a result, Healthcare in particular is poised to break down and break through legacy practices in the design and construction of our healthcare facilities. One thing the last two years of pandemic has taught leaders in healthcare and clinical practice, is that we must be nimble and innovative in addressing the crisis at hand. The COVID pandemic has stretched both human and capital resources to the brink; and even before the pandemic, health systems were already poised for crisis. Multiple key factors have set the stage for the call to reinvention for the design and construction methods for built environment in healthcare. At Cone Health, we have realized significant value in reinventing our approach to Design and Construction for our capital and major renovation projects.

Traditional Design and Construction Methods are not sustainable: Value based care and stringent healthcare reimbursement models have stretched the capital capabilities of health systems across the nation to capacity. Many are struggling to produce even the most modest of bottom line performance and for some, a break even year in 2022 would be a win. The associated shrinking capital budgets along with significant escalation in the supply chain have caused health system across the country to rescale or hold on necessary healthcare construction projects. These organizations are vulnerable for loss of market share and potential regulatory issues with their next required survey.

At Cone Health we have joined a growing number organizations who have implemented a Lean Construction (Integrated Lean Project Delivery) approach for our capital projects. This value-based contracting method puts profit at risk for all build team members yet incentivizes quality, efficiency in project schedules, and delivers projects at significant savings. Lean Construction via an at risk poly-party contract parallels the same work context required of our clinicians and health systems: you will earn top profit for quality and value. As an owner-partner with our construction teams, our organization has realized cost savings, optimal project timelines, and excellent quality projects outcomes. We have implemented Lean Construction on multiple capital projects saved our organization tens of millions with teams who readily join us from project to project. Lean Construction is a win for owner, construction team, and our community.

Build and renovate for the staffing ratios you will have, not for the staffing ratios you are dreaming of. While the nursing and clinical staff shortages have been with us for more than a decade, today’s manpower shortages are apocalyptic. For as long as I have been in nursing (a couple of decades now), there has been a nursing shortage. However, our current labor shortage is different and sobering. There are just not enough people in nursing schools or interested in working the required hours in a hospital. This context will require hospital leaders to create new ways of delivering patient care with different roles working to the top of their license. The bottom line, the built environment in healthcare will need to be redesigned to meet these new approaches to labor realignment.

Because “form follows function” designing care spaces for new work flows and available staffing will produce new design for hospital architecture. Many organizations are beginning to see real impact by utilizing Lean design methodologies where optimal placement of equipment and supplies supports the different staffing mix and care requirements. Integrated Facility Delivery (IFD) utilizes the Toyota Lean methods that result in efficient work flows, and optimal staff and patient experiences. Our architect colleagues will need to be innovative and partner with us to re-design patient care areas in our hospitals and ambulatory care facilities to support the radically different staffing ratios or models of care we will have for the foreseeable future.

“At Cone Health we have joined a growing number organizations who have implemented a Lean Construction (Integrated Lean Project Delivery) approach for our capital projects”

The next pandemic is on its way (or you should be ready for it). Most health systems by now have added temporary renovation measures to meet the care needs of very sick and very contagious patients presenting during the pandemic. However, we must be pro-active in the design and construction of care spaces in preparation for the next crisis, whether it is this year or the next decade. As an example, the design of our waiting rooms, which were once designed to promote gathering in close spaces need to be re-designed for flexibility allowing optimal infection prevention. A paradign shift is required in the planning and design of care spaces. Rethinking the planning for Heating, Ventilation, and Air Conditioning (HVAC) systems as a core element of strategic operational planning. Design that supports patient care flows with maximum infection prevention and safety practices will need to be hardwired to meet the needs of the future.

Reinventing the approach to facility design and construction is more than an opportunity, it is necessary in the brave new world of pandemic readiness, shrinking capital, and innovative workforce redevelopment. We are at the edge of bold new innovative solutions to meet the needs of our communities and reinvent – join us!