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Health Facilities Planning & Development. Rural Hospital Summer Workshop June 24, 2008. Construction Projects: Strategy to Implementation. Jody Carona Health Facilities Planning and Development Joe Kunkel The Healthcare Collaborative Group. Setting the Stage… Creating the Vision.

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Rural hospital summer workshop june 24 2008

Health Facilities Planning & Development

Rural Hospital Summer WorkshopJune 24, 2008

Construction Projects: Strategy to Implementation


  • Jody Carona

  • Health Facilities Planning and Development

  • Joe Kunkel

  • The Healthcare Collaborative Group



"I saw an angel in the stone,

and I carved to set it free"

-Michelangelo


First things first strategic master planning creates the vision
First Things First: Strategic/Master Planning Creates the Vision

  • SP Process: Quantification of –

    • Community need and demand-inpatient and outpatient

    • Market position

    • Medical staff

    • Community perceptions

    • Physical plant needs versus current physical plant—major space drivers (beds, ED, ORs, etc.)


Visioning is also important
Visioning Is Also Important Vision

  • May also require revisiting of vision and mission statements.


Understanding your community s need and demand
Understanding Your Community’s Need and Demand Vision

  • What is the size of the market?

    • How do you define your primary service area?

    • Who else serves this market?

    • How many admissions annually?

    • How many ED visits, surgeries etc?

    • How are demographics changing? What impact will this have on future need and demand?



Demographics are a major driver of future volume
Demographics are a Major Driver of Future Volume Vision

  • Understanding demographics is key…

    • Elderly use services at 2.5 times the rate of under 65.

  • What assumptions do we want to make about the future role of the hospital— service delivery, etc.?


Drill down as far as possible
Drill Down as Far as Possible…. Vision

  • The ‘Typical’ Rural Area

Slow, steady growth overall

Flat growth for peds and OB women

Lower % of peds and OB women

Higher % of seniors

Rapid growth forseniors


Inpatient market position is easy to quantify
Inpatient Market Position is Easy to Quantify Vision

  • Inpatient:

    • CHARS allows us to easily quantify size of inpatient market—by zip code of residence, patient age, DRG, and hospital/MD.

      • Can track changes in utilization and market share over time.

      • This data is key to projecting future inpatient bed needs.



But we continue to struggle with the ever increasing outpatient market
But, We Continue to Struggle with the Ever Increasing Outpatient Market

  • Outpatient

    • Historically, much more difficult to quantify—but “proxies” are possible via community surveying and/or Solucient outpatient data.

    • Changes in outpatient as much a function of technology and reimbursement as demographics.


Understanding medical staff need and current situation is also key
Understanding Medical Staff Need and Current Situation is Also Key

  • Should first compare community need for MD against supply. Are there unmet needs and realistic opportunities?

  • Must also include existing MDs in process:

    • Are they committed to staying in the community? For how long?

  • Is there a need for a formal medical staff development process. How much $$ will this require?


Surveys are often a good way to collect the needed information
Surveys are Often a Good Way to Collect the Needed Information

  • Key Survey Questions

    • Practice Data (visits, % at the Hospital, payer mix, etc.)

    • Practicing In/ Recruiting to the Community

    • Perceived Manpower/Recruiting Needs

    • The Hospital’s Role in Recruiting

    • Specific Perceptions of the Hospital



How does the community perceive the hospital will they support growth and development
How Does the Community Perceive the Hospital? Will they Support Growth and Development?

  • Strongly consider a community survey and a series of key informant interviews.


How does the community perceive the hospital
How Does the Community Perceive the Hospital? Support Growth and Development?

  • Community survey-will address issues of:

    • Utilization and patient satisfaction:

      • Primary care practitioners

      • Specific outpatient services

      • Inpatient services

      • Urgent care

      • Specialists

  • Reasons for leaving the community

  • Awareness/perceptions of Hospital

  • Priorities for local health care

  • Demographic info (insurance, etc.)

  • Willingness to tax

  • Other issues as appropriate


How does the community perceive the hospital1
How Does the Community Perceive the Hospital? Support Growth and Development?

  • Key Informant Interviews:

    • Perceptions of hospital, hospital leadership

    • Role of hospital in the community

    • Other divergent/convergent issues facing the community

    • Future vision for the hospital


The end result

Clear goals and direction. Support Growth and Development?

Clear delineation of space needs at varying market share assumptions.

Must take the next step of comparing existing plant to projected needs.

The End Result….


Financial Model Logic Flow Support Growth and Development?

Demographics

  • Drivers:

  • Population Projections

  • Age/Gender

  • Utilization History

Gross Volumes

  • FILTERS:

  • Clinical

  • Volume

  • Market Share

  • MD Availability/Supply

  • Support

  • Financial

Specific

Volumes

Space & Capital

Requirements

Operating P&L


From strategy to implementation

From Strategy to Implementation Support Growth and Development?


Major facilities directions
Major Facilities Directions Support Growth and Development?

Replacement

Major Expansion

Minor Expansion

2

3

1

New

New

Existing Facility

Existing Faculty

Existing Facility

New Replacement

New

New

Major Expansion

High Cost

Long Duration

Larger System wide Strategic Decision

Lower Cost

Shorter Duration

High Cost

Medium Duration


Market Analysis and Plan Support Growth and Development?

Financial

Plan

Patient

Experience

Hospital Expansion/ Renovation Plan

Technology

Physician

Develop

Operational Design

Vision & Strategy

Environment


Getting organized
Getting Organized Support Growth and Development?


Hospital Support Growth and Development?

STEERING COMMITTEE

Vision

Baseline Assumptions

Policy

Strategy

Image

Budget

CEO

VP

CMO

COO

CFO

VP Support Services

VP Marketing

VP HR

VP IT

Equipment Planner

Property Manager

Mission Services

STAFF

Internal Project Lead

Physician

Development

OPS

Planning Design

Equipment

Planning

Human

Resources

Information

Technology

Project

Development

Community

Relations &

Communication

MOB

PROPERTY

MANAGER

WORKING GROUPS

Report to Steering

Committee

User Group Leadership

& Communication

Operational Concepts

& Philosophies

CMO

COO

Equipment Planner

VP HR

VP IT

THCG

VP MARKETING

Hospital

Leadership

Physician

Leaders

Architect

THCG

Hospital

Leadership

Physician

Leaders

Architect

THCG

Hospital

Leadership

Physician

Leaders

Architect

THCG

Hospital

Leadership

Physician

Leaders

Architect

THCG

Hospital

Leadership

Physician

Leaders

Architect

THCG

Hospital

Leadership

Physician

Leaders

Architect

Contractor

Hospital

Leadership

Physician

Leaders

Architect

THCG

Hospital

Leadership

Physician

Leaders

Architect

THCG

Physician Need Analysis

Recruitment Strategy

Medical Staff

Dev’t/Priviledging/

Credentialing

Establish Adjacencies

& Flow

Department Design

Room by room

equipment planning

Procurement Strategy

Overall staffing

strategy

Training

Leadership

Development

Overall IT Strategy

Telecom, Voice/Data

Low Voltage

Access Control

Clinical Applications

Day to day management

of construction process

Public Approvals

Design Control

Budget/Schedule

Q/C

Internal Communication

External PR/Image

Community Health/

Mission Integration

Fundraising

Developer Selection

MOB Development

Leasing

USER GROUPS

LOCAL JURISDICTION

Design Review

Building Department

Fire Marshall

STATE

DOH

MOB

Developer

Physicians

HOSPITAL

Dx & Tx

Emergency

Inpatient Imaging

Outpatient Imaging

Cardiac Cath

Lab

Surgery

PT/OT

Rehab Therapy

Resp Therapy

SUPPORT

Central Sterile

Pharmacy

Mat. Mgmt/Recycle/Doc

Housekeeping

Admitting

Pre-Admission Testing

Medical Records

Gift Shop

Chapel

Public Spaces

Hospitality/Valet

Administration

Dietary

Conf/Med Ed/Library

PATIENT BEDS

Med/Surg

ICU

Step Down

Short Stay

PACU

Prep/Hold

OTHER

Plant/Engineering

Security

IT/Telecom

Parking

Infection Control

Space & Equipment Needs

Room Details

Room Function & Configuration

Operations

Current/Future Needs

Project Structure Chart


Visioning
Visioning Support Growth and Development?

  • Different than Strategic Vision

  • Set Guiding Principles for Project

    • Overarching common attributes

      • Safety

      • Flexibility v. expandability

      • Efficient

      • Healing

      • Recruitment/retention


Visioning1
Visioning Support Growth and Development?

  • Set Metrics

    • Measurable goals

    • Project-specific

    • S-t-r-e-t-c-h

    • Project-influenced goals as well


Keys to a successful project
Keys to a Successful Project Support Growth and Development?

  • Communication, Communication, Communication

  • Set of written “Working Assumptions”

  • Clear Decision-Making

  • Regular Updates

    • Written

    • Phone

    • In-person

  • Project Management – Owner/Architect/Contractor


Design getting it right
Design – Getting it Right Support Growth and Development?


Prioritization of flow in design
Prioritization of FLOW in Design Support Growth and Development?

Objective

Subjective

Strategic Importance

Patient Volume

Brand

Profitability

Competition

Growth

Physician Relations

Disruptive Tech

Community

Staffing Intensity


Design issues
Design Issues Support Growth and Development?

  • Clear Space Program

  • Master Planning – Long-Term

  • Project Design – Short-Term

  • Mock-ups and Other Tools


Establishing a project budget
Establishing a Project Budget Support Growth and Development?

  • Land

  • Entitlements

  • Construction

  • Escalation

  • “I” v. “B”

  • Soft Costs

  • Contingencies


Land costs
Land Costs Support Growth and Development?

  • Purchase Price

  • Criteria for Development

  • Time Horizons

  • Location, Location, Location

  • Infrastructure & Entitlements

  • Timeframes


Construction
Construction Support Growth and Development?

  • Market Comps

  • Escalation

  • “I” v. “B”

    • Cost

    • Flexibility

    • Reimbursement


Soft costs
Soft Costs Support Growth and Development?

  • Cost the Same as Hard Costs!

  • Design Fees

  • Engineering

  • Project Management

  • Jurisdictional Fees


Owner s costs
Owner’s Costs Support Growth and Development?

  • Medical Equipment (and Planning)

  • Furniture/Fixtures/Equipment

  • Information Technology

    • Cabling

    • Applications

  • Contingencies


Md development recruitment
MD Development & Recruitment Support Growth and Development?

  • Do the Math

    • How many by specialty

    • Lead times/degree of difficulty

    • Population-based v. facility-based

    • “Need” v. “redistribution”

    • Don’t be “beggars”

    • Pool of potential staff

    • Open process/project structure/communication

    • Exclusives/RFP’s


Think creatively
Think Creatively Support Growth and Development?


In the end
In the End…….. Support Growth and Development?


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