Define the services to be offered and how care will be delivered. Both may be different from the existing conditions.
Organizational Readiness
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
Evaluation of the number and type of staff based on services you expect to provide and expected number of patients.
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.
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.
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.
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.
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.
The team is established to implement the project – with a unified management structure, authority to manage the project and accountability for results.
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).
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.
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.
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.
High level goals for major milestones and project completion.
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.
The team is established to implement the project – with a unified management structure, authority to manage the project and accountability for results.
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.
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
FAQs
Key deliverables during this phase include: project concept and direction, a needs assessment, a business plan, and a preliminary space assessment
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.
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.
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
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
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)
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
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.
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
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
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
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
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
Authored by John E. Kemper. Phase related to this resource is Organziational Readiness.
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
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
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
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
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
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
Created by Capital Link. Phases and Activities applicable to this resource include:
Organizational Readiness
- Develop a business plan
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
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
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
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
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
Unique feature: New medical model of admission/reception office
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