Euthenics' planning work in replacement facilities has led
to the development of new services that are generally considered
post-planning. After the construction documents (CD's) have been
issued the sometimes daunting task of implementing the plan comes
to play. Having sufficient staff and expertise in bidding, procuring,
receiving, storing, installing and moving existing reuse equipment
is a very large order for the typical hospital.
We have been one of the leaders in providing project and procurement
management and have developed routines and processes that have
greatly enhanced the owner's position with the construction element,
pricing, and procurement. Logistics and move-planning have become
a very important product line that enables us to guide the owner
through all the responsibilities during construction and installation.
When considering the daunting task of relocating a hospital
or portions thereof, the more data that can be assembled and
managed the better the success rate is. Euthenics offers the
following article that appeared in the Journal of Healthcare
Management, November / December 2004, as information that can
help in developing the plans fior relocation:
and Operational Planning:
This article addresses the management challenges inherent
in bringing a replacement hospital online through a process that
maintains the continuity of the organization's business while
maximizing the benefits of the new facility. Planning for the
activation of a new facility incorporates the process of identifying,
defining, organizing, and facilitating all the tasks that are
required for the occupation of the new faility in a logical,
timely, safe, and cost effective manner. Successful project occupancies
do not just happen; rather, they are the result of focused and
systematic planning and implementation.
Early attempts at new-facility activation focused on the logistics
of installing new equipment and furniture, scheduling the building
turnover sequence with the contractor, and ensuring that the
patient move went well. In today's competitive healthcare market,
that limited focus is no longer adequate. To gain competitive
advantage and fully realize the benefits of a new facility, its
design for the future operating model (work and patient flows,
use of technology, deployment of human resources, management
practices, and performance targets) must be in integral focus
of the activation planning process.
OF AN ACTIVATION PLAN
Past research demonstrates the potential financial benefits
of replacing outdated healthcare facilities (Hosking and Jarvis
2003). Other benefits accruing to organizations that successfully
implement a replacement facility strategy including the public's
perception of market leadership and an improved customer service
environment. Additionally, in many replacement projects the leadership
expects that the new facility will not simply resolve long-standing
service delivery issues but will also enable the institution
to move toward a best in-class operational model characterized
by upper-quartile operating performance. Toward these ends, the
dynamics of a hospital's planned operational processes, organizational
culture, and ability to execute complex performance improvement
strategies must be addressed within the context of activation
planning to minimize risk and ensure a smooth facility transition.
Our experience in completing more than 30 healthcare activation
projects suggests that a clear vision for the future facility,
well-articulated guiding principles for planning, and specific
performance objectives are strong determinants of success. In
this context, the specific objectives of a structured operations
and activation planning process are as follows:
· Ensure that plans for the operation are developed in
accordance with the vision and operating priorities.
· Effectively manage the risks (economic and other) associated
with the activation.
· Minimize the time from construction completion to start-up
· Ensure that regulatory and compliance requirements are
· Manage the impact that activation will have on existing
· Ensure that patient care delivery and other service
delivery process are effectively planned and coordinated.
· Achieve service levels that meet or exceed the expectations
of medical staff, the public, and other constituencies.
· Facilitate accurate budgeting for start-up activities
and ongoing operations.
· Leverage the facility activation to promote the new
facility in the marketplace.
To effectively manage these objectives, leaders should specifically
and integrate them within the overall activation plan and (to
the extent possible)
metric measures of performance for each.
DIMENSIONS OF ACTIVATION AND
Activation planning involves anticipation of and control over
two types of issues: logistical and operational. In our view,
both must be addressed if the overall plan is to be successful.
Logistical issues include planning and implementation of the
facility-related aspects of the project. Such items include planning
for building turnover and readiness for occupancy; installing
new equipment, furniture, telecommunications, and signage; hiring
a moving contractor; and developing a departmental move-in sequence.
The outcome of successful logistical planning will be a series
of action schedules that describe tasks to be accomplished along
with task dependencies, budget allocations, and personnel assignments.
Operational issues include planning for new processes and
practices that define the way that the organization will conduct
business. The primary emphasis in this area of planning is the
review and design of clinical and business operations in an anticipation
of the new physical environment. Additionally, process design
will drive and education, training, and orientation work effort
that must be effectively coordinated. To the extent that future
operations have been well defined and articulated as part of
the functional space planning process, operational planning efforts
will take the form of detailed implementation planning (e.g.,
the establishment of new front-end patient processes to support
an integrated outpatient diagnostic center).
To effectively integrate the multifaceted planning process
required to prepare a comprehensive activation and implementation
plan, hospitals should consider the establishment of a multidisciplinary
task force structure, as described in Table 1.
An important assignment for each task force is to create an
integrated plan that defines major tasks and implementation activities,
time frames for execution, task dependencies, responsibilities,
and resource requirements. The real level of integration of these
plans will be tested by a steering group and a master Gantt chart
depicting the project tasks and critical path to minimizing implementation
FACTORS TO SUCCESS
Activation planning and implementation may be organized and
managed through a variety of approaches that will be shaped by
organizational time constraints, resource availability, strategic
priorities, and corporate culture. It has been the authors' experience
that no two activation plans are exactly alike. However, some
common elements have characterized successful activation planning
programs, and these can be considered as emerging best practices
relative to the activation and operational planning process.
In particular, the following guidelines should be considered
as preparations for activation planning are undertaken:
· Use multidisciplinary teams to drive the planning
process and ensure that cross-functional process, as well as
enabling elements (e.g., information technology, human resources),
are clearly integrated within process and activation plans.
· Equip planning teams with the necessary knowledge
and tools to effectively complete their work. This may include
training in meeting facilitation as well as specific orientation
to project objectives, macroschedules, and guiding principles.
· Provide consistent, real-time communication of project
schedules and plans to all revenant constituencies, including
planning teams, medical staff, employees, and the community.
· Develop a database of activation issues, questions,
and answers that is accessible to interested parties. Many organizations
have adopted intranet capabilities to serve this need.
· Assign a project champion to coordinate, facilitate,
and drive all aspects of activation planning and implementation,
and ensure that this individual has adequate time allocated to
fulfill this role.
· Make decisions in a timely manner, and communicate
the decisions across the planning organization.
· Do not underestimate the time and dollar investments
that activation planning and implementation will require.
Multidisciplinary Task Force Structure
| Task Force
Areas of Focus
| Building Readiness
||· Contractor building turnover schedule
· Coordination with building-commissioning activities
· Building cleaning and security
· Inspection and licensure preparedness and schedule
· Equipment and furniture installation and acceptance
· Preoccupancy stocking of supplies, medications, and
| Information Technology (IT) and Telecommunications
||· Implementing the IT/telecomm program
· Ordering and installing IT/telecomm equipment
· Validating new phone numbers, new computer addresses
· Subnetworking to support departmental operations
· Relocating equipment as planned, with minimal operating
| Patient-Move Planning
|| · Establishing patient-move sequence
· Organizing patient-move support equipment and personnel
· Maintaining patient safety and dignity during the move
· Defining support department responsibilities during
· Maintaining lines of communication with families and
| Department-Move Planning
|| · Department operating dependencies
and move sequences
· Specialty equipment disconnect/ reconnect requirements
· Moving-contractor support
· Interim operating plans and continuity of service
| Marketing and Public Relations
|| · Grand opening activities
· Public and specialty tours and events
· Public communications, including service scheduling
· Facility staff communications and updates
· Change of address issues
| Education and Training
|| · Orientation of staff to new facilities,
including new operational plans and practices
· Staff training on new building systems
· Staff training on new equipment, including IT/telecomm
| Operations Design and Implementation
||· New business operational procedures
· New clinical and support operational procedure
· Training and simulation activities
· New Policy and procedure documentation
· Initiate activation planning activities at least one
year in advance of the expected facility occupancy date.
· Provide for adequate staff training and orientation
time in the new facility.
· Simulate operational procedure changes before introducing
them to the public.
Our experience demonstrates that effective planning for facility
activation involves focus and control over the logistics of occupancy,
as well as the design of future clinical and business processes,
to be established within the new physical environment. In some
cases, new operating methods are driven by a desire for improved
performance. In either instance, it is critical to design new
operating methods with input for functional stakeholders to ensure
consensus and ownership in solutions.
Successful facility activation also depends on close coordination
of the logistics of a building start-up. Integration of contractor
activities and schedules, the timely installation of new equipment
and furniture, and a well-communicated sequence of departmental
events via and easily accessible scheduling program are predictors
of success. Hospital leaders preparing to undertake facility
activation planning are advised to benchmark successful projects
to benefit from the significant industry experience in this complex,
time-intensive, and high-risk arena.