Collaborative considerations

Designed to support the work of two or more employees in multiple settings while improving the work of the individual, collaborative work environments often are seen at innovative companies like Google or Apple, where they are meant to break down communication silos and improve efficiency.

While health care providers have implemented collaborative environments in clinical care with staff stations complemented by team rooms and conference rooms, the business spaces of many health care organizations are designed to be traditional and hierarchical.

But a collaborative environment can take the functional units that support the health care
organization and transform them from segregated conventional environments to a consolidated shared environment.

Understanding the environment

Before a design team launches into the schematic design phase, it is important to understand the type of collaborative environment being designed. Good research and data collection help the team to understand the organization's culture, work patterns, work processes and business objectives.

One of many tools that can be deployed during the research phase is a series of leadership interviews. This informs the design team as to why hospital leaders feel a collaborative environment is important, what leaders expect to gain by changing the design of the facilities, what the business objectives of the organization are and how leaders see the space supporting these goals.

Leadership interviews often are followed by staff focus groups, where similar questions are posed to staff-level employees and responses then are compared against and shared with hospital leaders. To gather more detailed data, survey tools and observational studies are incorporated to understand details regarding work processes and space utilization. It is important that these are utilized in conjunction with each other to validate perception reporting compared with reality data gathering.

In the case of a compressed design schedule, the research phase can be facilitated utilizing a visioning charrette, performing the interviews, focus groups and a survey in a shorter amount of time. Observational studies should be a minimum of one week, with an ideal period of two weeks. At the conclusion of the research phase, the design team should be able to accurately articulate the vision for the collaborative environment.

Breaking down silos

At Lehigh Valley Health Network, Allentown, Pa., where 1,000 employees were located in 16 separate leased suites contained in nine different locations across a 16-mile area of eastern Pennsylvania, even departments located within the same facility had separate suites secured from other network employees.

This was reinforcing the silo mentality and employees were losing productivity traveling between sites. The situation also had financial implications, because the ability to consolidate would affect varying rental rates and different lease conditions. The vision not only was to unite these colleagues but also to create an environment that would promote collaboration and information sharing to enhance innovation and speed to market. Ultimately, a six-story, 250,000-square-foot facility was chosen to implement this new environment.

To begin to define the concept, the design team must fully understand the data collected in the research phase and begin to define the parameters of the space. The research phase should provide information in terms of the percentage of staff that fit into the following categories:

Fixed and focused workers. These employees spend the majority of their time at their individual work spaces. They have little need to be mobile and still may have technology that links them to a fixed location, such as a desktop computer or landline phone.

On-site mobile workers. These workers can work at an individual workspace or elsewhere in the facility. They often have mobile technology, including laptops, tablets and smart phones. In some cases, these staff members may have assigned workspaces.

Off-site workers. These employees may utilize the facilities, but have an assigned work space elsewhere.

Distance workers and visitors. These staff members are based remotely and occasionally will use the facility as will visitors.

The ratio of these types of work patterns and the quantity of staff within each sector will begin to drive the concept. All four of these work patterns can be woven seamlessly into a collaborative environment.

Zoning the floor

The concept begins with zoning the floor to support all the working patterns in a way that encourages collaboration while protecting the fixed and focused worker. One way of accomplishing this is to zone the floor from "quiet" to "active," locating the focused workers away from the open collaborative zones. Another way is to define buffer zones utilizing physical separations such as walls, furniture or glass that allow privacy but do not interfere with collaboration. Once the high-level zoning is set, the design team must decide how the collaborative spaces and the functional groupings come together within the following formats:

Open and informal zones. These can be outfitted with lounge furniture or casual chairs and tables. They often are open areas that encourage quick informal conversations or provide a touchdown space for a phone call that is not confidential. Areas such as these can be sprinkled throughout the space in alcoves and along wider corridors.

Open and formal zones. These can be outfitted with furniture similar to the open and informal areas, including set-ups with technology connections and opportunities for real-time collaboration. These formalized open zones should be located in the active area of the floor and situated with enough buffer that the activity will not disturb the fixed and focused workers.

Closed and formal zones. These are similar to traditional conference rooms. Often outfitted with tables and chairs, these rooms serve a conference space need within the suite or floor. Technology may be incorporated into these rooms as appropriate.

Closed and informal zones. Some of these zones serve as collaborative areas and others serve as individual work spaces. For collaborative areas, furniture to support small-scale meetings of two to four people with some technology and writable and tackable surfaces work well. Settings that support a single worker are key for individual work spaces.

Closed and formal long-term rooms. Also called project rooms, these areas should be incorporated as required by the functional program. These rooms often support collaboration in a specific way for a defined period.

Support and multipurpose areas. These areas often do double duty. For instance, such a space can serve as a pantry during dining hours and an open, informal collaborative space during the balance of the workday.

After the collaborative zones have been defined, the concept must fold in the individual work areas. Functional groupings of workers, also referred to as "neighborhoods," should be located around the space in a way that allows the units to work directly within the group as well as with adjacent neighborhoods. Collaborative zones within the individual neighborhoods should support the specific task being performed by the group. Even in the most collaborative environments, workers will gravitate to their assigned neighborhoods for the majority of their time.

The functional neighborhoods should balance with collaborative zones. For a basic collaborative environment, a ratio of one individual seat to one seat in a collaborative space (1:1) is appropriate. For a highly collaborative environment, a ratio of one individual seat to two seats in a collaborative zone (1:2) or an even higher ratio may be appropriate.

The design team at Lehigh Valley Health Network zoned the floor to be active in the center, anchored by the floor commons. Informal, open areas flanked the commons and encouraged the mixing of colleagues on the floor. Formal and informal enclosed areas were located off of the core circulation area as well as in locations where natural light was not available for the neighborhoods. The ratio utilized for the collaborative zones was 1:1, with 40 percent of the collaborative spaces designed to be open and 60 percent designed to be closed. The neighborhoods were located along the window wall and designed to allow colleagues to move seamlessly between adjacent neighborhoods. Lehigh Valley Health Network also enacted an open plan, designing a space that did not utilize built offices for fixed and focused workers.

Development and documentation

Once the concept is established, the design of the collaborative environment proceeds as any other design project with design development and documentation. The interior design and overall aesthetics should enhance the collaborative environment and provide visual cues for people to utilize the spaces.

A neutral base is recommended as a starting point. This allows the design team to layer on color and design details to define the different areas located within the floor or suite. Open, informal spaces can have bold yet soothing colors and inviting furniture that will draw people in and encourage use. Active areas, such as pantry spaces, can have more vibrant colors and unique furniture that will allow people to relax and enjoy a cup of coffee and friendly chat with colleagues. Such casual conversations and quick idea exchanges often turn into more effective collaboration than formal meetings.

General collaboration zones within the neighborhoods or around the floor or suite can take on a relaxing or active feel depending on the activities planned for the spaces. The interior design within the neighborhoods should be soothing, with color pops strategically placed to enhance the overall design.

While the design team works on the details, it is important for the organization's leaders to begin the change management process. The design team and the organization's leaders should look for ways to engage staff members who will reside in the new space. Some ways to do this are by creating mock-ups of the new space for the staff to see and asking for their input. Other suggestions include allowing the staff to attend site visits to see similar collaborative designs in action, involving staff in the selection of collaborative technology and in the creation of protocols for the utilization of the new collaborative spaces.

It's important to build buy-in and understanding into the goals and objectives of the new space. Leaders also should roll out educational sessions with all the staff who will be relocating to the new facility, so they have the opportunity to understand how the new space will function and how their work processes may need to shift. The notion of moving from a more traditional environment into a collaborative one will produce anxiety in some staff members and needs to be addressed. Adaptation to change is extremely individual — for some people, it is almost instantaneous; for others, it may take months or even years.

Once relocation occurs, the process of adaptation begins. This is the point when organizational leaders must engage in a hands-on manner and model the behaviors that will activate the collaborative environment. Leaders must utilize the varied collaborative zones so that staff understand that it is appropriate to use these spaces. Leaders also must model the notion of mobility that is inherent in any collaborative environment, changing locations throughout the day based upon his or her current tasks.

Based on the level of change that staff experience, they may immediately request modifications to the space. A recommendation that has worked in many installations is to institute a 90-day, no-change period. During this period, staff may note requested changes, but the three-month window allows a natural adaptation to occur and many initially requested changes become nonissues.

It's important to assess the success of any design project, following up with staff at defined time periods of 90 days and 365 days post-move. One easy way to analyze the success is to reissue the same survey that was utilized pre-move and cross-reference the results. This will provide an accurate measurement. Other ways of gathering information regarding the design include conducting focus groups or measuring key business results and comparing them pre- and post-move.

The team at Lehigh Valley Health Network utilized the survey methodology along with conducting focus groups. At the 90-day mark, there was a spike in the overall workplace satisfaction score, which then descended at the nine-month survey, ending slightly more positive than the pre-move baseline.

Information gathered from the focus groups informed the team that the sense of community was vastly improved from the pre-move situation. Although not measured in terms of numbers, colleagues have forged new connections with one another and broadened their connections within the workplace.

While much of the facility has been received positively, there have been some challenges. For instance, the survey results on the ability to concentrate did not fare as well as the overall workplace satisfaction. As a result, noise containment and control continues to be a factor in the collaborative environment that the design team is still working through.

Levers for change

Collaborative environments can be levers for change. They force employees to step out of the normal environment and embrace something innovative by allowing them to see other possibilities and forge new partnerships.

Jennifer Fink, AAHID, IIDA, NCIDQ, is director of planning and interiors, Lehigh Valley Health Network, Allentown, Pa. She can be reached at Jennifer_C.Fink@lvhn.org.

Lessons learned from health system project

As in any design project, Allentown, Pa.-based Lehigh Valley Health Network's efforts to turn its office space into a collaborative environment provided a number of lessons learned that can be used to improve the space and apply to future projects, including:

• Do the research. Every design project is unique. Every organization has its own culture and way of working. It is important for the design team to take the time to understand the organization and project. Having mutual goals and a respect for the work being performed in the new space will allow the design team to develop the best possible solutions. If the organization's culture is hierarchical, special attention should be paid to the work of senior leaders and design spaces appropriate to their work processes along with those of their team.

• If the design encourages mobility and choice, the design team must provide choice. Collaborative environments can strongly encourage mobility away from the individual workspace. The design team must provide a range of collaborative settings that encourage the movement of staff and attract colleagues to these collaborative zones. These zones should be located away from individual work areas so the areas do not disrupt focused workers. Even in collaborative environments, people need a place to recharge, so quiet rooms also should be provided.

• Technology infrastructure is key. This is a mobile world. In collaborative environments, workers expect to connect to technology easily. Technology infrastructure should be woven into the fabric of the design solutions. Colleagues should be able to connect to the wireless network quickly throughout the entire facility and immediately outside as well. If technology is provided in collaborative areas, it should be easy to use and quick to access information upon logging in.

• Noise control is essential. Noise is the No. 1 complaint in collaborative environments. It can be too loud or too quiet, and each one is a unique issue to be managed. The ideal is a low-level buzz, which can be difficult to achieve. Design teams should consider adding an acoustician to bring valuable insights on the design of white noise systems, soundproofing enclosures and zoning the floors to provide low-level buzz.

Change management advice from an expert

The design team at Lehigh Valley Health Network, Allentown, Pa., referenced the book Leading Change by John P. Kotter throughout its planning and design process. Of particular importance to the team were Kotter's eight steps of change:

1. Increase urgency. There must be a real need for change, and the first step in this process is to heighten recognition of current issues driving the need for change. This can be accomplished by highlighting performance gaps and stressing the importance of pending environmental changes.

2. Build the guiding team. Change or the vision for the change often becomes associated with one individual. But even the most powerful individual cannot pull off a change solo. A successful team requires a well-organized and high-performing guiding team with members who exhibit position power, credibility, leadership and trust.

3. Get the vision right. The initial vision usually comes from one person, but is developed by the guiding team. A vision that does not speak to the values of the organization will seem shallow and insincere, while a vision that is mired in values but without analytical facts will fail to achieve business goals.

4. Communicate for buy-in. Managers often undercommunicate or send inconsistent messages. Communicating should be done using multiple formats such as meetings, town halls, intranet, newsletters and memos. The message must be communicated repeatedly.

5. Empower action. Once people have heard and understand the vision, it's time for them to start working on the change. If the new vision runs contradictory to current policies and practices, these barriers need to be removed.

6. Create short-term wins. Short-term wins are the lifeblood of the change process. Creating and celebrating these wins has a huge impact on the overall change. Short-term wins allow the process to be seen.

7. Don't let up. During this step, the focus needs to be redirected back to the original vision. This is a time for pushing more change rather than basking in the glow of a short-term win.

8. Make change stick. True cultural change happens after the new changes have been proven to perform better than the old ways. Leadership involvement must continue and remain true to the original vision.

About this article

This feature is one of a series of quarterly articles published by Health Facilities Management (www.hfmmagazine.com) magazine in partnership with the American Academy of Healthcare Interior Designers (www.aahid.org).