Organizational Readiness

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What is Organizational Readiness?

The proposed capital project should be driven by community and program needs and be consistent with the overall strategic plan. Organizational Readiness includes review of the Strategic Plan (long-term goals and the short-term implementation steps for getting there), assessing organizational capacity (board and volunteer expertise, fundraising capacities, expertise in business planning and financing options, and design and/or construction experience), forming ad hoc committees (i.e. capital campaign committee to cultivate donors/financing, building committee to determine scope and hire design/construction teams), and preparing a budget for planning activities (i.e. space needs study, evaluating fundraising readiness, preliminary schematics, feasibility study).

Organizational Readiness Activities

The tasks are also not always sequential and overlap in most cases. Click on the activities tab on the right to see the common activities within the organizational readiness phase and a brief definition or description. Use the resources tab for tools and other publications for this phase.

Evidence-Based Design

During organizational readiness, two EBD processes are started: Step One) define EBD goals and objectives; and Step Two) find sources for relevant evidence. Click the Evidence-Based Design Tab for more detail about EBD activities during this phase.

Sustainability

Sustainability, as formally achieved through LEED for Healthcare (Leadership in Energy & Environmental Design), an internationally recognized green building certification system through the United States Green Building Council is another aspect to consider for your project.

Not all organizations are ready to become carbon neutral or to achieve zero waste. One of the first steps in the sustainability process is to understand the readiness of executive leadership to assume the mantle of sustainability, and how quickly and aggressively that should occur. If your organization is willing and able, start to define goals for building performance (site, water, energy, materials, indoor environment) and determine the impact sustainability and energy efficiency will have on the life-cycle cost of operating the building.

At this stage, you should define how the organization’s mission supports sustainability initiatives. Review the LEED and Green Guide for Healthcare checklists in the resources tab.

Lean Process

Other aspects to consider for your project during organizational readiness include Lean processes (elimination of “waste,” such as waiting, hunting and gathering, etc.) Is your organization using Lean concepts already or is Lean a cultural change issue? (This ranges from a top management philosophy down to front-line behavior.) Consider a Readiness Assessment for Lean such as:

Standards and norms of the organization
Performance management and measurement
Employees interaction with patients and each other
How employees think about their work
Methods used to identify and solve problems
Other aspects of behavior that must be aligned for continuous improvement.

Design Activities

Print Design Activities

See Evidence Based Design tab for EBD activities during this phase

Conduct Operational Planning (C)

Define the services to be offered and how care will be delivered. Both may be different from the existing conditions.

Determine Staffing Needs (C)

Evaluation of the number and type of staff based on services you expect to provide and expected number of patients.

Conduct Allocation Planning/Preliminary Space Assessment (C, D)

A systematic accounting of each program and/or department that results in a reasonably good estimate of how much space (usable, net square feet) will be required for the envisioned operations.

Finalize Strategic Planning (C)

The strategic plan is a definition of your organization’s long-term vision and the short-term objectives. It helps align facility design with the organizational mission to best achieve care delivery and business goals.

Develop Community Awareness/Engagement (C)

The proposed project should be supported by the community. Foster goodwill for the project by creating an understanding of the project scope, services, and potential impact on traffic. Consider how the community and patient perspective will be used to develop the project.

Develop the Business Plan (C)

A roadmap that outlines supply, demand, costs, and revenue stream. It also provides insights into how different decisions will affect your return on investment, cash flow, debt load and work processes.

Plan for the Project Mission/Vision (C)

The project mission and vision establishes project goals and objectives - guiding principles that should be used throughout the design and construction to guide decision making.

Create Project Organizational Leadership (C)

The team is established to implement the project – with a unified management structure, authority to manage the project and accountability for results.

Development of Project Budget (C)

Sets the stage to obtain financing and includes both sources of funds and how funds will be used, along with hard costs (construction), soft costs (professional fees, permitting) and contingencies (unknowns).

Explore various financing options (C)

There are multiple financing options, such as conventional loans, community development institutions, federal funding, foundations, or bonds, supplemented by clinic funds reserved for the project, and/or a capital fundraising campaign.

Consider Sites (C)

Aside from cost, site selection considerations can include: accessibility to nearby services, topography, size, configuration, water, sewage, and drainage issues. Sites can be purchased or leased.

Conduct Peer Site Visits (C)

Visiting others allows you to see what is being done elsewhere in order to benchmark and begin a “wish list” of design features to consider.

Develop a Preliminary Project Schedule (C)

High level goals for major milestones and project completion.

Hire a Project Manager and Architect (C)

Select a project manager with relevant development experience and an architect with relevant healthcare experience. Orient yourself to the process and conduct a series of informal discussions with the staff to solicit their ideas, desires, and expectations about a potential project.

Create Project Organizational Leadership (C)

The team is established to implement the project – with a unified management structure, authority to manage the project and accountability for results.

Assess Project Needs and Viability: Includes Operations and Finances (C)

This includes assessing the facility’s current and anticipated space needs based on programs/services and anticipated volumes and determination of whether to renovate or build new. Sometimes the cost of renovation can exceed the cost of a new building, and an analysis needs to be completed to determine the best option.

Initial Assessment Phase: Operations and Finance

Assessing the facility’s current and anticipated space needs based on programs/services and anticipated volumes. Determine whether to renovate or build new - sometimes the cost of renovation can exceed the cost of a new building. An analysis needs to be completed to determine the best option.

Lead by: Provider

Evidence-Based Design Activities

Print Evidence-Based Design Activities

EBD Step 1: Define EBD Goals & Objectives

At the core of an evidence-based design process is the link between design and desired outcomes. This can be established early in the process through visioning - defining broad goals and objectives for the project that support the organization’s mission and vision. Continually referencing these goals throughout the process helps the team evaluate various design strategies and keep the project on track. Consider the following steps and related questions.

Use the arrow to expand or collapse this section

Assemble interdisciplinary design team (P)

In addition to the architect, the executive director, the staff, and the board of directors, each have a unique role and perspective to share during the development process. Your team may include an executive steering committee, as well as subgroups. In an evidence-based design process, there is a diverse group of stakeholders who bring varying perspectives to help define the goals, objectives, and solutions. Are there specialty consultants you might need, such as an expert in project development, clinical processes or technology? Determine how patient and staff input will be gathered throughput the process and how they will be represented at an executive level. Have roles and related scope of responsibility been defined for each team member?

In a clinic setting, it is a good idea to poll your Board, staff, and other volunteers to find out what expertise they may be able to contribute to the project, whether developing a business plan or understanding construction. You may also find experts in your community that are willing to help, but it is important to define expectations, especially when work is being offered pro bono.

Identify issues and/or problems (P)

Consider if there are key areas or outcomes that would be of interest to your community and organization. What problems or issues are you trying to solve? What is it that you hope to achieve to support your strategic plan, business case, and/or care model? In a clinic setting, community issues might include access to care or compliance rates for care regimens. Organizational problems might include staff efficiency.

Define Outcomes (P)

Defining the intended outcomes will provide clarity for everyone involved throughout the duration of project. Outcomes may be closely tied to staff, patient and/or family and will most likely involve operational, administrative and cultural changes. What are the anticipate improvements or changes to be achieved through a new or renovated building?

In a clinic setting, outcomes might include patient & clinical outcomes, such as improving access to care by providing easy access to public transportation, improving compliance with care regimens through family engagement in care. Staff outcomes might include improved efficiency offered by a medical home model and its related layout (that may improve patient compliance, as well). It may also include operational outcomes, such as reduced long-term operating costs. Long term costs need to be carefully considered relative to “first” (capital) costs in development of the business case.

EBD Step 2: Find Sources for Relevant Evidence

As the team begins to develop design guidelines, the search for relevant evidence begins. Knowing what strategies are supported by evidence will depend upon a review of the literature. A resulting set of project priorities is defined in conjunction with the literature review findings.

Inform design challenge and formulate research questions (P, R)

In addition to defining the issues and problems, consider what additional questions need to be raised and the evidence that might be used to inform decisions. Learn about what others have done through benchmarking visits or interviews to establish some early ideas to guide the project.

In a clinic setting, this may include better understanding models of care, their delivery, and how this affects the building layout and space requirements. Your questions may focus on how effectively you are able to deliver care in the new model by measuring throughput times, compliance, and satisfaction. You may want to engage a researcher to help identify research questions, but you may be able to identify certain questions and related metrics on your own through information you already gather.

Identify types of evidence (P, R)

Initially, it is important to identify all types of evidence, such as published papers, case studies, peer interviews, site visits, and structured benchmarking. The type of evidence may be tied to the type of information your team is trying to learn – newer information may only be found while conducting a site visit, rather than in a published format.

There are very few peer-reviewed published papers that will identify conditions specific to clinic settings, however, information can often be extrapolated from other environments, whether acute care or ambulatory care. It is important to get help understanding how less rigorous sources can still be applied to a clinic setting. This may be through a researcher or someone well-versed in the EBD process who can establish some guidelines for how you might best use the information collected.

FAQs

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What are the deliverables I should expect during organizational readiness?

Key deliverables during this phase include: project concept and direction, a needs assessment, a business plan, and a preliminary space assessment

How do I determine how much space I might need?

The space assessment is usually completed by an architect with input from the Provider on how spaces are used for both tasks and overall workflow. The result is a comprehensive listing of every room and/or space in the facility, its estimated square footage, and additional space required for circulation, mechanical, and utilities that is balanced with codes, guidelines and other requirements. You should consider your future operating vision, as well as several scenarios of what might change in 10 years to understand how your vision differs from the present and what to consider for flexibility.

What should be defined for each person’s role and responsibility?

It is important to define expectations for the participants, including the duration of the project, decision-making authority and processes, and project deliverable responsibilities. Understanding expectations of those participating is also important to encourage an open two-way dialogue.

What is included in the business plan?

It typically includes an executive summary, clinic history and operations, management and governance, market analysis and strategy, the facilities project, the financial operations, including historical data, capital needs, and projected performance.

Resources

Print Resources

My Safety-Net Clinic: Cost-Benefit Tool

Created by Western Michigan University. My Safety-Net Clinic (MySNC) is a tool to help clinics and designers understand the costs associated with various aspects of renovating, or designing a clinic. Use the tool to calcuate costs for the following areas:

Waiting Areas
Patient Care Areas
Greeen Design
Exterior Lighting

Phases and activities related to this tool include:

Organizational Readiness

Develop the business plan
Develop the project budget
Explore various financing options

Pre-Design

Determine financial feasability
Plan and program
Refine project budget/schedule

Breaking Ground: A comprehensive planning guide for health center projects

Created by NCB Capital Impact. Phases and activities related to this resource include:

Organizational Readiness

Conduct operational planning
Conduct allocation planning/preliminary space assessment
Finalize strategic planning
Develop community awareness/engagement
Develop the business plan (Sect VII)
Development of project budget
Explore various financing options
Develop a preliminary project schedule
Hire a project manager and architect (Sect IV)

Pre-Design

Determine financial feasability
Conduct a market needs analysis and assessment
Select/survey sites and evaluate space availability (Sect IV.b)
Select an attorney, architect/interior designer, contractor and construction manager
Establish the remaining project team
Property aquisition/site control
Refine project budget/schedule (Sect VIII)

Design

Continue conceptual diagramming
Design development
Permit process
Zoning/use processing
Furniture, fixtures, equipment (FFE) and technology planning
Purchasing plan
Construction documents
Value engineering (p. 33)
Early permit - third party approvals (p. 40-41)
Bid and award - this may be phased, based on contract type

Construction

Conduct construction inspection and surveillance (p. 43-49)
Create the punch list (p. 55)

California's Safety-net Clinics: A Primer

Created by the California HealthCare Foundation. Phases and activities related to this resource inlcude:

Organizational Readiness

Development of project budget
Explore various financing options

Occupancy

Liscensing

EDAC Study Guide 3

Study Guide 3: Integrating Evidence-Based Design: Practicing the Healthcare Design Process.

Guide Three pulls together the evidence-based design (EBD) process to walk you through the key steps of the design process in detail from pre-design, design, construction and occupancy. Practical examples demonstrate key areas and show how EBD is practically applied.

Purchase >

Phases and activities related to this resource include:

Organizational Readiness

Pre-Design

Evaluate work flow
Start conceptual diagramming

Design

Continue conceptual diagramming
Design development
Bid and award-this may be phased based on contract type

Construction

Substantial completion
Final completion

Occupancy

Community development financial institutions (CDFI), Nonprofit Finance Fund® (NFF)

Created by the Nonprofit Finance Fund who makes loans to nonprofits and pushes for fundamental improvement in how money is given and used in the sector. Phases and activities associated with this resource include:

Organizational Readiness

Develop the business plan
Development of project budget
Explore various financing options

LEED 2009 for Healthcare

Created by USGBC, last updated in May 2011. The phases and activities related to this resource include:

Organizational Readiness

Develop community awareness/engagment

Pre-Design

Select/survey sites and evaluate space availability
Plan and program

Design

Design development
Furniture, fixtures, equipment (FFE) and technology planning

LEED 2009 for Healthcare

Created by USGBC, last updated in May 2011. The phases and activities related to this resource include:

Organizational Readiness

Develop community awareness/engagment

Pre-Design

Select/survey sites and evaluate space availability
Plan and program

Design

Design development
Furniture, fixtures, equipment (FFE) and technology planning

LEAN: Overview of a Customizable Lean Health Care Transformation Program

Created by NC State University. Phases and activities related to this resource include:

Organizational Readiness

Assess project needs and viability: includes operations and finances
Conduct operational planning
Plan for the project mission/vision
Create project organizational leadership

Pre-Design

Evaluate work flow

Launching a Capital Facility Project: A guide for healthcare leaders

Authored by John E. Kemper. Phase related to this resource is Organziational Readiness.

Business Plan Template

Created by Anita Addison of La Clinica de la Raza for the Promising Practices Seminar in 2011. The phases and activities that are applicable to this resource include:

Organizational Readiness

Develop a business plan

USDA Captial Assistance Funding: A Rural Health Resource Guide

Created by the USDA. Phases and activities related to this resource include:

Organizational Readiness

Develop project budget
Exlpore various financing options

Pre-Design

Start a capital campaign feasability study
Develop a capital process/fiscal plan

VA Building and Interior Design Guidelines (multiple resources)

Created by the Veterans Administration. The attached files are guidlines for working with the VA in primary care settings. Phases and activities that relate to these resources include:

Organizational Readiness

Conduct allocation planning/preliminary space assessment
Site considerations (note narrative)

Pre-Design

Conduct a market needs analysis and assessment
Create space function/flow analysis
Plan and program

Design

Continue conceptual diagramming
Design development
Furniture fixtures, equipment (FFE) and technology planning

Who Moved the Finish Line? Redefining Readiness in a World Obsessed with Go-Live

Created by Deloitte. Phases and activities included in this phase include:

Organizational Readiness

Conduct operational planning
Determine staffing needs
Develop a business plan
Plan for the project mission/vision

Construction

Internal readiness

Facility Expansion & Renovation Planning for Capital Projects & Campaigns

Created by Gates Family Foundation. Phases and Activities applicable to this resource include:

Organizational Readiness

Conduct operational planning
Develop community awareness/engagement
Develop a business plan
Development of project budget
Explore various funding options

Pre-Design

Determine financial feasability
Start a capital campaign feasibility study
Develop a capital process/fiscal planning
Continue community engagement and collaboration
Refine project budget and schedule

Design

Design development

Report from the Field: Insights by Community Clinics on Information Technology Adoption

Created by the the Comunnity Clinics Initiative. Phases and Activities applicable to this resource include:

Organizational Readiness

Create a business plan

Pre-Design

Evaluate work flow
Refine project budget and scope

Design

Design development

Creating a Business Plan for a Commnity Health Center Capital Project: A "How-to" Manual

Created by Capital Link. Phases and Activities applicable to this resource include:

Organizational Readiness

Develop a business plan

Developing a Health Center

A free resource from Capital Link and Primary Care Development Corporation on developing a health center. Phases and Activities applicable to this resource include:

Organizational Readines

Conduct operational planning
Conduct allocation planning/preliminary space assessment
Finalize strategic planning
Create project organizational leadership
Development of project budget
Explore various financing options
Consider sites (see chapter 5)
Develop a preliminary project schedule (see chapter 2, and Appendix B)
Hire a project manager and architect

Pre-Design

Determine financial feasability
Select/survey sites and evaluate space availability (see chapter 5)
Select an attorney, architect/interior designer, contractor and construction manager (see chapter 3-4, 6 and Appendix D)
Establish the remaining project team (see chapter 4, Appedix D and E)
Property aquisition/site control
Plan and program
Refine project budget/schedule
Start conceptual diagraming

Design

Continue conceptual diagraming
Schematic design
Design development
Construction documents
Bid and award - this may be phased based on project type (see chapter 7)

Construction

Notice of completion
Final completion
Transition planning

Resources for Capital Development: Community Clinics Initiative

The Community Clinics Initiative and Capital Incubator developed a list of tools and resources for capital development projects. Phases and Activities applicable to this resource include:

Organizational Readiness

Assess project needs and viability: Includes operations and finances
Plan for the project mission/vision
Development of a project budget
Explore various funding options

Pre-Design

Determine financial feasability
Start a capital campaign feasability study
Develop a campital process/fiscal planning

Capital Campaign Readiness Quiz

Many ingredients combine to make a successful capital campaign. To help you determine if your organization is well positioned to move into a formal campaign planning process, we’ve developed the following Campaign Readiness Quiz. Answer yes or no to these questions then check your score to see how well you are positioned and what your next step may be. Created by Pathway Associates

Phases and Activities applicable to this resource include:

Organizational Readiness

Assess project needs and viability: Includes operations and finances
Development of project budget
Explore various financing options

Pre-Design

Determine financial feasability
Develop a capital process/fiscal planning
Continue community engagement and collaboration

Self-Assessment of Organizational Readiness to Develop

New York State Division of Housing and Community Renewal (DHCR)/Franke Consulting Group developed a checklist for Organizational Readiness. While the checklist is for housing, most of the questions can be adjusted for clinics.

Phases and Activities applicable to this resource include:

Organizational Readiness

Conduct operational planning
Determine staffing needs
Create project organizational leadership

A Toolkit for Redesign in Healthcare: Case Study

Prepared For the Agency for Healthcare Research and Quality (AHRQ), 2005. The broader and deeper the scope of the redesign effort of a hospital, the more likely redesign produces system-wide transformation. For the purposes of this project, “redesign” and “system transformation” will both be used to describe the desired process outcomes.This project was supported by the Agency for Healthcare Research and Quality.

Phases and Activities applicable to this resource include:

Organizational Readiness

Assess project needs and viability: Includes operations and finances
Develop community awareness and engagement
Create project organizational leadership

Pre-Design

Evaluate work flow
Start conceptual diagramming

Clinic Examples

Print Clinic Examples

Thundermist Health Center

Unique feature: New medical model of admission/reception office

Through involvement with the Institute for Healthcare Improvement's Re-designing the...

Grace Hill Neighborhood Health Center-Water Tower

Grace Hill Neighborhood Health Centers is a FQHC, Federally Qualified Health Center, whose mission is to provide a medical home to the uninsured and under insured in St. Louis City. The design...

La Clinica de la Raza at Fruitvale Transit Village

Unique feature: The Clinica de la Raza Community Health Center is a component of a transit-based development village that provides physical renewal and economic...

Organizational Readiness

Organizational Readiness

What is Organizational Readiness?

Organizational Readiness Activities

Evidence-Based Design

Sustainability

Lean Process

Design Activities

Evidence-Based Design Activities

FAQs

Resources

Clinic Examples

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