I must confess that I enjoy a guilty pleasure; I love watching home makeover shows. My favorite show is “Love it or List It.” Even though I know the shows are scripted and staged, I still can’t wait to see the result when homeowners see their transformed space for the first time. As a Project Architect, I enjoy helping clients transform their healthcare environments like we’re on a home makeover show (but with much less drama). It takes quite a bit longer than a 1-hour episode to show the results of the transformation, but the reveal is just as impactful.
Currently, I am working with Reedsburg Area Medical Center (RAMC) on a multi-year hospital renovation project. RAMC is a critical access hospital in southwestern Wisconsin. As a hospital serving a small and rural community, they faced unique challenges during the renovation project. We are nearing the end of construction and I would like to share some tips that our team has learned from this complex phased renovation project.
#1: Start with a Vision
We began working with RAMC in 2015 on a master facility plan. The RAMC Master Plan looked at the entire campus to address aging infrastructure and create private inpatient rooms. The analysis kicked off with a visioning session to develop goals and drivers. We then used process mapping to document current and future workflows for the inpatient units. Using that information, we identified a master plan solution that met RAMC’s vision of creating a robust infrastructure and private inpatient rooms. By including an approach to project phasing early in the process and assigning proper responsibilities to the project team and hospital staff, facilities are better positioned for a renovation project.
#2 Engage the Stakeholders
An advantage of working with a smaller facility like RAMC is that the staff is more accessible. We met with clinical, facilities, housekeeping and administrative staff during the design phase to receive their input. The phasing of the renovation project was an important discussion point throughout design. Input from hospital staff was critical in developing a project that could be built without negatively impacting RAMC’s ability to care for their patients. Replacement of major infrastructure equipment like the new IT system was intentionally planned to take place overnight to minimize any downtime.
Another tool that was critical to gather input was a physical mock up for the new inpatient room design. Nursing staff was then able to test the patient room size and layout. Support services staff such as housekeeping and material management were then able to comment on revised workflows needed to support features like nurse server cabinets. The mock up process paid off with no major design changes to the patient rooms during construction.
Another important element of stakeholder engagement is communication to the employees, patients and visitors. RAMC has done a great job of keeping these groups informed of the desired end-result during the construction project. Banners and signs throughout the building create excitement about the project and help allay frustration for any associated disruptions. RAMC works closely with the contractor to ensure that the construction work doesn’t negatively impact patient care. Carla Mercer, Vice President of Marketing and Customer Experience, said ear plugs and white noise machines are provided for patients on the rare occasion that construction noise could interrupt their rest.
#3 Be Flexible
As we discussed phasing throughout the design meetings, we had to be flexible in our thinking and refine design solutions as the drawings progressed. A smaller facility like RAMC doesn’t have the luxury of extra space. For the laboratory renovation, we considered a temporary trailer as a possible solution to allow construction to occur in the lab’s current location. The team determined it was not feasible due to cost, so we revised the design to create a solution that would let the lab stay in their current location while their new space was constructed. Non-patient care departments like Administration and Finance temporarily moved to the adjacent clinic to free up space within the hospital for construction. The hospital made the hard decision to remove the gift shop for six months because there was no code compliant space available for a temporary location.
#4 Expect the Unexpected
In a renovation project that is complex and long, you should expect the unexpected. Planning for unexpected encounters for existing conditions in the schedule and budget makes the process easier to navigate. I have learned through many renovation projects that even though we model the building in 3 dimensions and do thorough coordination, there will always be a surprise that wasn’t shown in the existing drawings. Another reality of a phased renovation project is that the scope will change. New technology or equipment will likely become available during the life of the project and need to be incorporated. Carrying a robust contingency will help the team respond to surprises and keep the project moving forward.
#5 Partner with Experts
EUA provides expertise for our healthcare clients because we have completed hundreds of renovation projects and are committed to guiding our clients and being their advocates through the construction process. This expertise is valuable for smaller facilities that don't frequently undertake construction projects. It is important that designs are constructible, and phasing is a key component to implement a successful final project; this goes beyond just handing a plan to the contractor. With RAMC’s input, we provided detailed information to the contractor on project components and timing, and discussed as a team how to overlap and shorten phases to help control construction costs.
When I was recently talking to Robert Van Meeteren, President of RAMC, he stated that the key to success in this project is “partnering with a contractor who understands healthcare and 24/7 operations – our challenge is keeping essential services operational on a day to day basis. RAMC doesn’t have anywhere else to send patients for services since we are stand-alone facility.”
It’s Design Reveal Time; Move That Bus!
Keeping these 5 tips in mind when embarking on a complex or phased renovation project will help you be successful. By creating a thorough phasing plan, you will have a roadmap for the project duration. Your healthcare renovation project probably won’t include a wall of shiplap but implementing these tips will help to keep the project on track until the final reveal. I’d love to keep the conversation on healthcare design going and get involved in your project reveal – whether it’s talking about phasing, or Lean Design, you know where to find me – watching my favorite show.
Robin Anderson, AIA, LEED AP