Using a comprehensive approach is necessary to address all aspects of the strategy and master plan.

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While most hospitals are swimming in data, and it is easily accessible, it is not easily extracted, analyzed or evaluated for implementation. Because of the nonstop flow of information, facilities managers may have trouble keeping up with areas from which to collect data and how best to collect it. 

It can be overwhelming identifying how to take what is collected and make a meaningful impact on the organizations’ performance and prioritize the implementation. Utilizing a tool that serves as a template for decision-making and planning will allow the organization to move to the next level of performance.

Understanding operations in health care is as important as understanding the data, and it’s vital now more than ever. This has been experienced by facilities managers during the pandemic, when operations and surge expansion planning changed overnight because of the abrupt changes caused by COVID-19. While managers may have strategic plans or master plans, the tools of an active and easily managed operational plan were needed and, for many, nonexistent. 

Having a usable operational master plan that can be actively deployed as a planning guide for both ongoing needs as well as accommodating surges or unexpected changes is ideal for any organization to make informed and meaningful decisions.

Data-driven approach

A data-driven planning approach for management and operations needs to be developed in layers, starting with the highest evaluation of all assets in the system strategy facility plan, moving to a master plan and, finally, the operational plan. The overview description of the strategic facility plan and master plan is clearly discussed in a 2009 publication from the International Facility Management Association called “A White Paper on Strategic Facility Planning” and can be used as a reference to dive deeper into the foundation of strategic facility planning. 

Just as medicine is built on an evidence-based model, design is also evidence based. Planning and operations must be rooted in evidence to make informed decisions for change and ongoing operational management. Facilities management is no longer singularly focused on ensuring compliance, safety and maintenance; a comprehensive operational master plan to manage facilities must also include reliability, user experience, sustainability, health and operational performance.

Using a comprehensive approach to operational master planning is necessary to address all aspects of the strategy and master plan that was defined earlier in the process. Initially, a SWOT (strengths, weaknesses, opportunities and threats) analysis is completed to determine gaps in the strategic master plan phase, then the operational master plan follows to bridge the gap. 

A SWOT analysis is a planning process that helps an organization overcome challenges and determine which new leads to pursue. The primary objective of a SWOT analysis is to help organizations develop a full awareness of all the factors involved in making a business decision.

The operational master plan should be the roadmap to satisfying those operational gaps to achieve higher performance and overall strategic goals.  

Domain considerations

Significant shifts have occurred in recent years regarding operations and have shown that all planning must be viewed through a holistic lens. It is important that all domains are included to achieve the highest performance possible. The following template will serve as an overview of the available resources to consider when developing an organization’s plan. Facilities managers should be sure to build their template around the areas of their performance need and identify the data and systems that need to be in place to have an operational master plan.

Emergency preparedness and surges. The pandemic taught facilities managers that they can never have enough plans and that they must be prepared for anything. The Department of Health and Human Services has shared resources regarding what is required to ensure surge compliance and needs. 

Unfortunately, health care facilities have seen a rise in other emergencies and need to plan for natural disasters as well as lockdown emergencies. These lifesaving situations are essential in an operational master plan. Facilities managers should be certain to have all the situations documented and thoroughly considered. The Centers for Disease Control and Prevention (CDC) and The Joint Commission (TJC) provide excellent guidance, which can be accessed through the American Society for Health Care Engineering (ASHE) resource referenced on page 46 of this article.

Maintaining compliance. As hospitals are regulated by many organizations to ensure that they are licensed to be operated, it is prudent to review the licensing agencies that an organization uses, as it could impact the ability to maintain operations. TJC, DNV GL and the Healthcare Facilities Accreditation Program are some of the most common accreditation organizations (AOs) used in the United States. These AOs essentially look for compliance in the areas of environment of care, infection control and risk assessments. This would also include all licensed bed inventories for certificate of need states. 

Many organizations do not fully know all the beds that are licensed in their facilities, and a compliance document for these beds is vital, especially in the emergency preparedness area. Additionally, life safety drawings, asset inventories, and barrier management processes and plans are often not current nor accurate, creating a downstream negative impact on operational readiness and budgets.  

Safety. Safe operations focus on the reduction of harm of all the building occupants in four primary areas: operations, active intruder, air and the environment. Facilities need to support zero harm or aim toward zero harm to match the safety standards of major health systems. While this is a significant goal, it is achievable through the evidence in the field that demonstrated its impact. 

• Active intruder. Harm can occur on the grounds of the campus, so designing for crime prevention through environmental design will reduce potential harm. Resources on this topic can be found through the International Crime Prevention Through Environmental Design Association organization as well as the International Association for Healthcare Security and Safety. Active intruders are an unfortunate risk to state of operations. To obtain additional information, refer to the options of operation from the Cybersecurity and Infrastructure Security Agency.
• Air quality. The harm from airborne contamination became front and center with the COVID-19 outbreak. Air is a primary contributor of harm. There are guidelines for infection control through the air with the CDC.
• Environmental safety. There are additional evidence-led environmental practices from zero lift environment to light levels for safety to infection control through surfaces that can be implemented to reduce overall harm.

Reliability-centered maintenance. Reliability-centered maintenance (RCM) is a proven and structured framework for analyzing the functions and potential failures for a physical asset with a focus on preserving system functions rather than preserving equipment. 

RCM is used to develop scheduled maintenance plans that will provide an acceptable level of operability with an acceptable level of risk in an efficient and cost-effective manner. 

It’s not just about keeping things running; it’s about ensuring assets and systems can perform reliably under all circumstances. This model of high reliability takes infrastructure assessments as well as ongoing maintenance and operations to the next level of strategic operations. 

Health and resiliency. Stress is a primary barrier to health, and the systems in health care can be a barrier to the health of all its occupants. The International WELL Building Institute articulates how there are physiological barriers in the environment. 

As a primary consumer of resources, health care facilities should ensure that operations are the most advanced and sustainably practiced by using guidelines such as the U.S. Green Building Council’s LEED ratings, the U.S. Climate Reliance Toolkit and the World Health Organization’s Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities. Health and resilience plans are critical to ensuring that the systems are enhanced for optimal operations. 

Universal accessibility. Public buildings need to be accessible to all, no matter their abilities; this notion was cemented by the creation of the Americans with Disabilities Act (ADA), which became law in 1990. While the ADA is specifically aligned with compliance, it is placed in this section as it is the precursor to the accessibility needs to achieve the highest outcomes. 

After the ADA became law, the need to accommodate all people has advanced to the “universal design” standards, which looks to guide fully inclusive environments. Diversity, equity and inclusion are addressed in universal design. However, there also may be local or state guidance that needs to be addressed in operational implementation. 

User experience and engagement. People are the center of health care operations and, therefore, it is vital to keep all users engaged and likely to recommend a facility to others for receiving care or obtaining employment. This can encompass anyone experiencing the space, ranging from patients to loved ones to staff experience affecting retention. 

The HCAHPS Survey includes questions about cleanliness and quiet at night, which can be directly influenced by the environment. There has been significant research showing the direct relation to the environment can be influenced for improved outcomes. Wayfinding and navigation are also operational staples for an improved experience, as noted in the references that can be accessed through the ASHE resource on this page.

Space performance. Health care organizations need to understand how all physical space is contributing to the bottom line, which is a relatively new area of implementation for an operational plan. While space use is most directly connected to the strategic and master plans, this is a way to track and allocate the spaces that are returning the financial outcome for which they were designed, also known as defining the spatial value. At minimum, this should be a list of departments and the associated department gross square footage, as noted by D. Kirk Hamilton and Sarel Lavy in the ASHE monograph, “Area Calculation Method for Health Care,” as a standard way of measuring spaces. As operations and facilities are more tightly aligned, the ability to tie department performance to its associated space will be crucial for further investment and management of the system. 

A plan for success

The health care field is seeing significant and rapid changes, and organizations need to integrate the proven tools of evaluation and data needed to make and maintain operations over time. The operational master plan is a dynamic resource of information to use in making decisions on a day-to-day basis.

The plan must include all aspects of operations to ensure that multiple systems are aligned and performing at their best. A simple way to begin developing an operational master planning process might be to ask the following questions:

• What are the HCAHPS scores for the health care facility? Are they identified by location in the facility?
• Has the facilities team assembled a comprehensive space assessment that aligns a department’s performance to its associated space?
• Is the facility’s environment designed to reduce harm? Does the facilities team know what is the highest harm issue at the facility?
• What would the facilities team need if there was another surge experience at the facility?
• Does the culture support continual improvement?

From there, each domain should be built methodologically with incremental information (if not all areas are available at this time) and with clear goals and measures that will help the team see the destination.

Finally, and most importantly, health care facilities managers must align the team around these goals and set up a “can-do” culture of continuous improvement that can move the facility to high performance and optimal operations. 

An operational master plan to help care for caregivers 

Focusing on creating an operational model that supports teamwork in an effective way to achieve resilience and engage staff was highlighted by the American Medical Association when discussing the importance of “caring for the caregiver” during COVID-19 and beyond. 

Health facilities managers should review the following areas to see the impact that can occur when people are placed at the center of an organization: 

• Team-based care. According to the American Hospital Association’s 2020 “Value Initiative Issue Brief,” the shift to a team-based model of care for clinics and key patient services will improve value for the patient while also improving staff coverage and support. This will require a shift to more teamwork spaces and moving away from one-to-one isolated office spaces. Facilities managers should consider converting individual workspaces or offices into more collaborative work areas. This supports a fully integrated staff work approach as well as provides the team members with a system of support for each other.
• Childcare. According to the Center for American Progress, more than 30% of the U.S. health care workforce have children that are too young to be left alone. In a recent piece by the Harvard Business Review, some organizations have proactive solutions to provide support for working parents, as demonstrated by the company Genentech, which helps locate childcare programs for staff when school is not in session. Consider how a health care organization can best resolve the childcare issue, either by building an on-site childcare program or partnering with an established program to support important employee needs.  
• Mental health and well-being. According to the Harvard Business Review, 93% of the health care work force experienced stress during the pandemic, as stated in a recent survey conducted by Mental Health America. Facilities managers should consider integrating respite or wellness rooms into a hospital campus to ensure staff have a place to restore during their shift work. 

Lorissa MacAllister, Ph.D., AIA, LEED AP, is founder and president of Enviah, Grand Rapids, Mich. She can be reached at lorissa@enviah.com.

About this article 

This is one of a series of monthly articles submitted by members of the American Society for Health Care Engineering's member tools task force.