Operational Considerations for Facility Planning and Capital Project

Transcription

Rural Health Capital Readiness Webinar Series
Operational Considerations and Project Management of
Health Care Capital Projects
Rebecca Polan, Project Consultant, Capital Link
Rick Breuer, CEO, Community Memorial Hospital
November 24, 2015
 2015 Capital Link
Sponsored by the National Rural Health Resource Center
and the Federal Office of Rural Health Policy
www.caplink.org
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About this Webinar Series
• Offered and developed by Capital Link through support from
the National Rural Health Resource Center (NRHRC) and in
cooperation with the Federal Office of Rural Health Policy
• Capital Link has 15+ years of experience with community
health capital project planning and financing
• April 2015, NRHRC released a capital needs assessment
prepared by Capital Link:
- 41% of Critical Access Hospitals and 100% of Rural Health Clinics have
plans to expand or replace existing sites
- Raising equity/cash reserves most common project barrier (56%)
- Other challenges: grant funding, fundraising, staff time, cash
fluctuations
www.caplink.org
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About this Webinar Series
• The response:
- Capital Project Readiness Manual and Toolkit
- Webinar Series:
• November 17 - Strategic Capital Planning and Capital
Budgeting
• November 24 - Operational Considerations for Facility
Planning, and Capital Project Management
• December 1 - Laying the Groundwork for a Capital
Campaign
• December 3 - Business Planning and Financial
Projections for Capital Projects
www.caplink.org
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Operational Considerations for
Capital Projects
Rebecca Polan, Project Consultant, Capital Link
www.caplink.org
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Capital Projects in Context:
Strategic Planning
www.caplink.org
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Capital Development Process
www.caplink.org
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Operational and Facility Planning:
Defining the Team
Size of the Team
• 5-11 persons reflecting the size of the project
• Identification of non-team resource staff
Characteristics of the Team
• Accessible and Available
• Comprehensive
• Invested and Committed
Every staff person should feel that someone sits on the
team that understands their role and their needs.
www.caplink.org
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Your Internal Project Team
• Did you Select the Right People?
-
Is every program represented?
Is every staff person represented?
Is there a balance of formal and informal leaders?
Is there a balance of community insiders/outsiders?
Is there a health center historian on the team?
Are the members available, accessible and willing?
Is the size of the team manageable?
Is there a team leader?
www.caplink.org
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Defining the Team
Lessons learned -
Consider the time commitment
Consider both credibility and ability
Consider interpersonal skills
Consider skill sets outside of the staff person’s current
scope and responsibilities
- Identify a process historian (clerk)
- Consider including a dedicated lead
This team is not the management team!
www.caplink.org
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Operational and Facility
Planning Process
Assessment
Program Plan
Operational Plan
Staffing Plan
Facility Plan
Protect the order of the process – Form responding to Function
www.caplink.org
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Gathering Data
Reflecting their Preferences
Send the Team Out
Given the opportunity, what kind of spaces do your
patients design for themselves? Visit community centers,
churches, restaurants, day care centers and fraternal
organizations. Is there a common color palette or
decorative theme? Are the spaces generally formal or
informal? How are they approached – are there defined
entry and interior transition zones or is the line between
interior and exterior blurred with glass walls and exterior
decking? What concepts are transferable as you design a
healing space for the community?
www.caplink.org
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Gathering Data
Asking for their Help
Engage Staff in
Data Collection:
Incorporate an
Exit Question
into the Visit
Process
“Thank you for coming today. Is there anything we could do to
make your next visit (smoother … more helpful … more
pleasant)?”
Evaluate patient complaints and comments to target the question
directly at what patients have been telling you in the past. Arrange
responses in categories identifying common themes. Define action
steps in the planning of the new facility which would address those
common themes and thus improve the patient experience.
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Gathering Data
Caring for their Friends and Family
Engage Staff in Data
Collection:
Query Existing Patients
“What could we do to make the people who come with
you to your appointments more comfortable?”
Addressing the needs of children, spouses, caretakers, and
community support persons will not only decrease the
stress of the patient and support continuity of care but
send a powerful message of mission and vision to the
community-at-large.
www.caplink.org
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Defining Capacity
How effectively are we utilizing…
the Facility?
the Schedule?
the Staff?
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Defining Capacity
Facility Utilization Rate
Key Factor: Room Turnaround Time
Effective Flow Patterns
Schedule Utilization Rate
Key Factor: Matching Template and Culture
Staffing Utilization Rate
Key Factor: At-Any-Given-Time Staffing
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The Impact of Physical Spaces
- Develop a fresh schematic diagram
- Define home base for all staff
- Spaghetti Diagram daily processes to
define bottlenecks and inefficiencies
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Spaghetti Diagram Current Processes
Proc.
Exam Exam
Exam
Exam
3 Providers
Orange: Patient
RR
CM/R
Blue: Staff (Provider)
RR
Biller
Exam
Exam
Exam
Samples /
Immunization
Break
/ Mtg
Lab
RR
Green:
Staff (Nurse)
Site Mgr
Purple: Community
RR
Stor
Medical
Records Cashier
Recep
Eligibility
SA
RR
_____: Information
_____: Materials
Waiting Room
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The Impact of Physical Spaces
What do we do because it is the best for our
staff and patients?
vs.
What do we do because it works best in our
building?
or
It is simply how we have always done it.
www.caplink.org
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Broadening the Vision
It’s Not Just about How Many Patients…
What services do we want to provide?
How do we want to deliver those services?
Who do we need to deliver those services?
www.caplink.org
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Define the “What”
Start right where you are:
For each of your Current Services …
• Is capacity meeting demand?
• Are desired outcomes consistently attained?
• Is the service sustainable?
• What are the results of trending data?
• What changes are staff/patients anticipating?
www.caplink.org
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Then, explore Potential Services:
• Evaluate Referral Patterns
- What are the five most common referrals? Could those services be
offered on-site? By contract or staff?
- What type of referrals do patients not follow-up on? Is access a
problem? Language? Culture? Environment? Transportation?
www.caplink.org
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• Evaluate Gaps in the Plan of Care
- What do we ask of our patients that is
nearly impossible for them to accomplish?
- What do our patients ask for that we
neither facilitate nor provide?
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• Evaluate Changes / Developments in the Community’s Healthcare
Environment
- What providers are retiring, relocating?
- What services are new or being actively planned for?
- Are there opportunities to collaborate, fill service gaps or eliminate
services which are not sustainable?
www.caplink.org
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Define the “How”
The Model of Care Delivery
•
Patient-Centered Care –
Giving control back to the patient
•
Technology-Based Care –
Effective use of Information Technology
•
Team-Based Care –
Pooling skills to more effectively serve
•
Community-Based Care –
Back to our roots, the out-of-office experience
www.caplink.org
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The Model of Care Delivery
•
Patient-Centered Care –
Giving control back to the patient
•
Technology-Based Care –
Effective use of Information Technology
•
Team-Based Care –
Pooling skills to more effectively serve
•
Community-Based Care –
Back to our roots, the out-of-office experience
www.caplink.org
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The Process of Care Delivery
•
What is our optimal patient visit flow?
•
What are our optimal co-locations?
•
What are our optimal adjacencies?
www.caplink.org
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Define the “Who”
What Staffing Model will most effectively support our Operational Model?
• Generalists vs. Specialists
• Optimal Provider Mix
• Sustainable Support Staff Structures
• Core Requirements vs. Desirable Complements
• Specialty Silos vs. Interdisciplinary Teams
www.caplink.org
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Define the Vision
Based upon …
Who you will serve
What services you will provide
How you will provide those services
Who will provide those services
Experiences from pilot projects…
Define your optimal site and structure
www.caplink.org
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Screening Potential Sites
Screening Criteria A: Accountability
to Payors:
He who holds the purse strings makes the rules!
to Peers:
The heart of the health care community
to Patients:
Within Defined vs. Neutral Territory
www.caplink.org
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Screening Criteria B: Availability
Creative Realism Reuse
Reinvent
Restore
Raze
Raise
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Screening Criteria C: Accessibility
for Patients:
When does a visit begin?
for Staff:
Optimizing Recruitment and Retention
for Community:
Balancing Visibility and Privacy
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Screening Criteria D: Adaptability
How will this site meet our needs if we change as
much in the next twenty years as we have in the last?
Can we grow?
Can we respond?
Can we sustain?
www.caplink.org
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Screening Criteria E: Acceptability
Effective Operations:
Form follows Function
Accurate Communications:
Co-locations?
Collaborations?
Adjacencies?
Colloquial Identifications?
www.caplink.org
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Screening Criteria F: Affordability
Evaluate Cost vs. Benefit
The cheapest is not always the best Some of the most expensive projects have started with
a donated site!
Some of the least successful projects have been in an
inexpensive but inappropriate location!
www.caplink.org
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Define the Structure
Develop a Functional Program Plan
Define the Guiding Principles and Priorities
Document the Objectives of the Project
• Program of Services with Target Volumes
• Operational Model with Staffing Plan
Document the Plan-to-Date
• Type & Number of Unique Spaces / Work Areas
• Special Equipment and/or User Needs
• Site Selection Criteria and Current Preferences
www.caplink.org
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Now You’re Ready…
• To hand it off to the architect!
www.caplink.org
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Capital Project Management
Rick Breuer, CEO, Community Memorial Hospital and
Sunnyside Health Care Center
www.caplink.org
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Rural Capital Projects
• Frequency
• Expertise
• Tight Financing
• Public Awareness
• Many Hats
• Which means…
www.caplink.org
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No Pressure, Right?
• Huge implications
- Facility
- Key individuals
• Importance of following a process, assembling the
right team
www.caplink.org
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Community Memorial’s
Experience
• Two major projects in last 10 years
- 2005
• $15 million
• Surgery, ED, Lab, Radiology, Pharmacy, LTC
improvements
- 2013
• $27 million
• Med/Surg, OB, ICU, Specialty Clinic, Education,
Kitchen/Cafeteria, Lobby
www.caplink.org
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General Rules
• Find Good Partners
- Architect
- Contractors / Project Managers
- Financing
- Internal
www.caplink.org
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Communication
• Key throughout
- Architect
- Contractors
- Staff
- Focus groups
- Management
- Financial
- Board
- Regulatory Agencies
www.caplink.org
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Significant Milestones
• Conceptual Plans to Architect
• Architect Feedback Loops
• Contractors in the Mix
• Bid / Proposal Process
• Financing Secured
• Fundraising process, if applicable
www.caplink.org
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Leading up to Construction
• Continuity of Operations
• Internal Team Identified
• Final Details
• Celebrate !!
www.caplink.org
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During Construction
• Vigilance
• Communication
- Written
- Walkthroughs
- Interviews
• Molehills out of Mountains
www.caplink.org
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Approaching Completion
• Ensure $$ in Order
• Punch List
• Publicity
- Consideration of Tours / Open House / Ribbon Cutting
- Continuity of Operations
www.caplink.org
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Our Results
• Both Projects
- On Time
- On Budget
- Huge Publicity
- Significant Increase in Volumes
- Very Little “If Only I Had Thought Of…”
www.caplink.org
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Capital Projects
• Significant Effort
• Signature / Legacy
• Access to Care / Programs / Services
• Make the Plan
• Follow the Plan
• Celebrate !!
www.caplink.org
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Questions?
www.caplink.org
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Website Resources
For the Leadership Team
For the Internal Project Team
www.caplink.org
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Contact Us
Main Office
Regional Offices
Massachusetts
Allison Coleman
Chief Executive Officer
acoleman@caplink.org
California
Tony Skapinsky
Project Consultant
Tel: 805-544-2355
tskapinsky@caplink.org
Rhode Island
Rebecca Polan
Project Consultant
Tel: 401-846-3109
rpolan@caplink.org
Louisiana
Jonathan Chapman
Director of CHC Advisory Services
jchapman@caplink.org
South Carolina
Terry Glasscock
Senior Project Consultant
Tel: 781-789-684
tglasscock@caplink.org
Susan Petrie
Chief Operating Officer
Tel: 617-988-2248
spetrie@caplink.org
Steve Rubman
Director of Data & Information
Systems
Tel: 617-988-2299
srubman@caplink.org
Dan Woodman
Project Consultant
Tel: 617-988-2202
dwoodman@caplink.org
Missouri
Mark Lurtz
Senior Director of Partnership
Development
Tel: 636-244-3082
mlurtz@caplink.org
www.caplink.org
West Virginia
Cindy Barr
Operations & Facilities Planner
Tel: 304-876-6996
cbarr@caplink.org
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Operational Considerations for Facility Planning and Capital Project

Transcription

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