Designing for change before the shovel breaks ground
Successful healthcare projects are designed to anticipate change.
What does it mean when we speak of “change” on a healthcare project?
In healthcare capital work, “change” is a term with a narrower definition than one typically found in general management literature. We generally do not think of change as organizational transformation, but the need to evolve the design of a healthcare facility from a desired state to a future state of project completion.
Whether or not that transformation is achieved through a renovation or expansion, “desired” is the operative word. On any given project, the future state is rarely defined at the outset. In architecture, the key to effective predesign lies in arriving at a desired state as early in the process as possible, while the project is being defined and matured.
Why change is to be embraced, not feared.
Change is inevitable in healthcare projects. The question is never whether change occurs, but how it is managed.
When predesign manages change effectively, every proposed change reveals important information. For example, we begin to understand a clinical workflow with precision, a technology-based challenge becomes a people-based issue, and we can readily adapt to a shifting funding priority.
The question is never whether change occurs, but how it is managed.
The same is true of the people in the room with whom we consult. With group dynamics,
resistance to change is a natural, expected part of any process, but successful organizations address this dynamic head-on rather than suppress it. When a stakeholder pushes back, they are usually telling you something the process overlooked.
Contention is information: it helps us identify and locate risk. Instability comes when a project stops listening and fails to change.
Instability comes when a project stops listening
and fails to change.
What goes wrong when change is not managed?
Unmanaged change can creep up on any project team. Without structured change
management, small adjustments accumulate into major scope creep or cost, and schedule impacts become misunderstood. Over time, when decisions are made without alignment, the project drifts away from its original objectives. This occurs not through any single failure, but through 100 unexamined ones.
Change can come from external approval environments, not just from inside the project. Ontario hospitals that submitted master plans several years ago are now navigating a ministry preference for smaller, phased capital envelopes. This is simultaneously a legitimate response to multi-billion-dollar price tags, and a test of how well a project team manages a disruption in managing procurement. External and internal disruptions need to be managed, assessed, costed, aligned, and answered.
How Clover manages change with structure and an agile mindset.
We recognize the importance of moving the disciplines of people and technology forward together. Project management advances the technical side of change (i.e., design, develop, deliver), whereas change management advances the people side of things (i.e., engage, adapt, use). Consultancies that study large-scale change keep arriving at the same conclusion: project management drives the work, but change management is the enabler that secures stakeholder buy-in. Projects that pair the two are far more likely to meet their objectives on schedule and on budget. Either discipline alone can produce a building, but it is only when they work together that they produce a successful project. That is the whole argument of our Model of Success, where a “current state” and a “desired state” are supported by technical and people-related work.
In practice, this means change is processed through structure, not sentiment. Every change is assessed for its cost, schedule, and impacts that create valuable data. Programmatic and design decisions informed by data are required to achieve alignment. Every decision is documented in a log the whole room can see. This is where a shared definition of done informs us when alignment has been tested, not assumed.
The best projects integrate both the languages of evidence-based design and delivery discipline. This process means knowing when the most disciplined thing to do is to re-examine the project goals. The Project Management Institute has given this mindset a name: M.O.R.E. ( Manage perceptions, Own success, Relentlessly reassess, Expand perspective). Across a study of more than 5,800 project professionals, projects led with all four practices nearly quadrupled their success scores; only 7% of professionals consistently practice them.
Sometimes, the most disciplined act is to re-evaluate the business model of the endeavour itself.
Project success can no longer be defined by simply meeting scope, budget, and schedule. In the context of healthcare project change management, to “relentlessly reassess” is the most relevant. Sometimes, the most disciplined act is to re-evaluate the business model of the endeavour itself. For example, maybe the market has shifted, a technology has moved on, or a funder no longer endorses part of the scope. When this occurs, our structure allows us to be agile and transition seamlessly. This is when change management proves its value while saving the most money.