Ask the people who know
On October 27 and 28, the Canadian Centre for Healthcare Facilities will be holding its conference in Toronto. I will be moderating a panel called “Closing the Loop: How strategic predesign makes activation and accreditation predictable,” where I hope to shed light on a hypothesis of mine.
I think that most activation pain is not caused by bad design. It is caused by decisions made too late, by people whose names were never on them, based on assumptions nobody wrote down.
Three people are well placed to tell me whether that is true or naive. Robert Hofmann has spent 30 years opening hospitals as an owner, and the owner is the one who pays for the late question. Helen Margiotta is a nurse with 25 years’ experience in hospital operations. She is the one who helps prepare the team for transformation. Brandon Bayley-Hay runs procurement and delivery. He must anticipate how the equipment will be used before anyone can tell him where it’s going.
They agree on less than you might think. On the question of who is authorized to decide when two departments are both being reasonable, they do not agree at all. That is the point of a panel.
what predesign owes a project
Preparing with them has already sharpened what I believe predesign should accomplish. A project should not leave predesign without four things.
- Planning Assumptions Register: What do we believe to be true?
This records everything we assumed, and who confirmed or refined those assumptions. - A Decision Log: What has been decided, and by whom?
This is needed to understand who owns the program-related decisions and when those decisions have to reach consensus. - Rules of Engagement: Who participates and how are decisions made?
This is about who sits in the decision-making group, and how it decides. The most common failure is the right people not being asked the right question. Maybe it’s one senior voice speaking for a department without going back to the people who do the work each day. - A Roadmap: What needs to be decided, and when?
A sequence of decisions between the first question and the first drawing.
With this Predesign Record: Basis of design as a live document, we can build a case for good design. Once design begins, the hospital’s internal project office owns it and keeps it current. Ideally, the healthcare design process does not change when leadership changes, but when a business case validates a reason to change it.
THE QUESTION UNDERNEATH THE QUESTION
Traditional programming asks a department for the spaces it requires. Usually, the person providing the longest list usually wins. Strategic predesign asks the following: What needs to happen? How should it happen? What would make it better?
Healthcare architecture should not accommodate the processes a hospital already has, but it should help the organization understand and redesign those processes before translating them into programmatic requirements. Clover’s Readiness Index measures the progress along several key milestones to ensure the necessary work has been done.
I hope that my panel will describe, through the real-life experiences of my guests, how a successful predesign healthcare process is achieved, and by whom.
Join us at the CCHF conference!
Closing the Loop is part of the conference’s track on operations, readiness and risk, at the Li Ka Shing Knowledge Institute in Toronto.