Opening a new building is a time of excitement and dread. Excitement, as a new building may yield increased efficiency, improved patient care, heightened service and new technology. Dread, as risks may be significant.

  • The risk of delay—not opening or ramping up volumes on time because the staff is not prepared for new technology in a new environment—can result in significant lost revenue while incurring the staffing expense.
  • The risk of error, as when incorporating unfamiliar new processes, the potential for the staff to make errors increases. These errors could impact efficiency only, and thus be relatively benign, or they could impact patient care directly, thereby jeopardizing the organization’s mission, reputation and finances.
  • And finally, the risk of inefficiency, as ineffective implementation of new operating models can result in not achieving the desired operational efficiencies. Workarounds or untested operating models can dramatically impact operational costs.

To help minimize these risks, Kurt Salmon has defined 10 questions that community hospitals should ask as they plan the activation of their new building. These questions enable hospitals to gauge their relative level of preparedness or readiness, as well as inform those using outside expertise of the types of questions they should be asking their consultants.

  1. Project Organization: Is there a senior-level project sponsor who has the full view of the operational model, the building development process and the information systems? A project management office must have a defined schedule and work flow continuously updated to manage the critical path. This schedule, to be effective, must be tied to all aspects of the building activation including construction, move planning, information systems, human resources, supply stocking, and education and training.
  2. Operating Model Documentation: Is there a single location in which all operating models and their changes are documented? The biggest challenge is ensuring all the operating processes have been thought through and are well documented. To ensure this, house all the documentation in a single living document, the Activation Plan. Then if there is a question raised about how a specific process will work, a single location can be checked. If it is not in the Activation Plan, it has not been addressed and a team can be deployed to address the question.
  3. Operational Goals: What is the organization’s operational viewpoint? How much operational change can the organization tolerate? Having a true operational perspective and understanding of what the organization is and isn’t comfortable changing will better inform the operational planning process and eliminate unnecessary work.
  4. Benchmarking: Is the organization a leader in operational performance, or does the middle of the pack seem to be a more appropriate and comfortable target? Identifying where the organization wants to be in relation to its peers will support examination and evaluation of existing practices and models, as well as drive the development and eventual adoption of new ones.
  5. Space and Location: Is there a clear understanding of how each new space will be used and where each department or function will be housed? Changes to the scope of construction or operations often occur during the four or more years from concept to completion. With these changes there is potential for various users to make plans to utilize the same space. A comprehensive review of the scope of services, operations and planned space usage is critical in identifying overlaps or gaps and preventing problems once the move is completed.
  6. Human Resources: Is the hiring and training plan tied to the operational and construction plans, specifically from a timing perspective? Often, opening a new building means adding staff. At a minimum, it means the staff needs to be trained on the new processes. Balancing when to hire and train staff is delicate—increased expenses can be balanced by opening with a staff that has not only helped plan, but has also been trained on new operations and processes. Being unbalanced on either side can result in large financial losses or increased risk to patient safety and operational efficiency.
  7. Information Systems: Are new information systems being implemented? New facilities almost always bring new information systems, software upgrades and increased functionality. These changes must be carefully coordinated to ensure the staff understands the capabilities of the new systems as well as the changes in order to achieve the full value of the investment.
  8. Change Management: Is there a clear change-management plan? Opening a new facility is an exciting time for most hospitals. Nevertheless, there will be significant change with the activation, and organizations, accordingly, need to process this change with individuals and groups differently.
  9. Communications: Is there a central communications plan and process? An ability to rapidly disseminate information across all stakeholders (internal and external) takes on increasing importance as the opening date nears. Initially ensuring the changes to operations are effectively understood by the staff shifts to ensuring that the staff understands and can adapt to any last-minute changes.
  10. Transition Budget: Has the necessary working capital been earmarked and infrastructure been put into place to ensure a successful activation and transition into your new facility? It is imperative that financial planning begins early. The list of tasks to accomplish can easily outstrip limited resources. As such, leadership must balance the requested resources with the available. Diligent financial modeling of the move process and the post-move operations is critical to making these balancing decisions.

Opening a new building can be risky, but with the right preparation, activating a new building can produce significant rewards. These 10 questions can help organizations rapidly assess their readiness and the status of their planning efforts to minimize some of the inherent risks associated with opening a new building.

30 September 2010