The hospital as design partner in the capital planning process

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“I got what I asked for, but it’s not what I wanted!” was the phrase used by the Project Director at a teaching hospital to relate a planning experience from his recent past. Poor communication between consultants and users and inadequate organization of the hospital’s resources through the programming and planning stages of a capital project can result in a state-of-the-art yet inefficient facility. A few thoughts follow on the structure and role of each party.

The hospital’s planning and/or senior management teams must address certain

  • elements which include:
  • the composition of the user group
  • the duties and availability of a dedicated project manager or client representative, and
  • the evaluation of existing systems and facilities.

For a user group meeting to be effective, it should involve no more than eight to ten individuals including consultants and the hospital’s Project Manager. The hospital should recruit employees from different shifts or work teams otherwise the dialogue may translate into “groupthink”. When selecting potential members of the user group, consider:

  • familiarity with the current space
  • work experience
  • previous project planning involvement
  • communication skills
  • availability
  • creativity
  • commitment to a process which can easily extend from twelve to eighteen months.

An operations director or physician director brings to the table the requisite level of authority; they must contribute on a regular basis if not on a continuous basis. The architect may schedule one or more open-house events over a half-day or a day. It then becomes incumbent upon the physicians and program directors to stop by and review the material at a convenient moment.

Solicit the input of former patients within each user group dedicated to the design of patient care areas (ambulatory care suites, imaging, in-patient units, recovery rooms for example).

The hospital’s role and user group activity change as the project progresses. Through schematic design their input revolves around systems and operations. Time spent on documenting an appraisal of existing conditions is invaluable at this stage. At the design development stage, the focus shifts to procedures and to the physical characteristics of each space: millwork, fixtures, controls, security, power and heating/cooling/ventilation requirements to name a few. The user group can downsize at this point. Also at the design development stage, the architect involves the various support services to review the features of the design which may impact their operations.

A dedicated full-time Project Manager present during the planning meetings can shorten the timeline by responding to operational issues which are outside of the architect’s scope of intervention. If the PM does not have the answers to these questions, he or she becomes the conduit to senior management where the issues are raised, discussed and answered. Along with the architect, the Project Manager shoulders the responsibility for participation of stakeholders and relevance of their contributions:

“…poor management of group activities will yield a morass of unnecessary information, may aggravate conflict rather than achieve consensus, and, in general, contradict the main objective (…) which is to organize useful information…”1

Documenting the existing conditions is perhaps the step which contributes most to the efficiency of a new design. Since not all staff members have the opportunity to participate in the planning meetings, the architect should chair at least one “town hall” session aimed at getting the stakeholders of a given department to defend or decry its physical characteristics. In order to make this an efficient exercise, the architect may circulate a workbook or display a worksheet in the weeks prior. The workbook may include a schematic plan of the existing department. There may be features within an existing which are taken for granted yet risk disappearing through the planning process if not properly identified.

A design group at UCLA developed a system called Bridge: project information and parameters concerning the design of a new university building were graphically displayed at an information kiosk located at a busy intersection on the campus. A volunteer staffed the display at peak times to answer questions and space was provided for the notes and sketches of passers-by. The architects updated the data daily (presumably by hand as this event goes back to the mid 1970s). Today’s advanced Computer Aided Drafting and Design (CAD) resources allow the inputting of such candid impressions and the frequent updating of the project file with minimal effort. The design process becomes truly consultative.

In order to encourage participation and stimulate discussion among members of the user group, the architect relies on brainstorming, synectics, gaming and even role playing in encouraging participant interaction. Brainstorming is the quickest to organize. Alex Osborn identified four rules of brainstorming more than sixty years ago: criticism is prohibited, the wilder the ideas – the better, the more ideas – the better and “free-wheeling” is encouraged, where you build on other ideas. Synectics is a similar problem-solving technique which relies more on exaggeration or irrationality to unlock solutions. Despite its value, role playing is seldom used in the pursuit of design solutions because it can require a significant amount of preparation on the part of those involved as well as the temporary suspension of beliefs. Participants must also be willing to shed inhibitions about “performing” for an audience of peers.2

Pressure on the architect to meet a production schedule and on the Project Manager to deliver often translates into subtle pressure on the department head to sign-off the drawings. Healthcare providers are as comfortable interpreting drawings as architects are reading an electro-cardiogram (!). Three-dimensional computer images, including animated fly-overs, spring to mind as examples of the potential visualization techniques which architects now bring to the table. A dedicated “war room” within the hospital and at the consultants’ disposal, allows for:

  • projection of these images
  • interactive CAD design sessions
  • display of sketches, models
  • creation of rudimentary mock-ups with the help of modular panels and tiles
  • evaluation of material samples

Acting as a facilitator as well as a designer, the healthcare architect brings to the table planning expertise and observations from work with diverse user groups. Hospital stakeholders and senior management themselves clearly have a role to play in identifying critical and in a sense proprietary aspects of their operations which may not be immediately apparent to the consultants. Formulaic design is now inappropriate in hospital planning: specialization and constant change in the delivery of healthcare warrant a truly consultative approach.