Recall the last time you were on the eve of a significant building project or physical space redesign: You were likely a bit anxious about the weight of the capital investment being made but, at the same time, were full of hope that this new space would yield better outcomes — in efficiency and quality, improved team performance, in exceptional patient experience and cultural transformation.

You probably hired a Lean consultant to help improve operational systems and efficiencies. You may have done some investigation to improve patient experience. You most likely have a preferred architect. But you may not have thought to ask some important questions. For example:

·      Who orchestrates this multidynamic group of people to ensure that a clearly articulated care delivery model becomes a reality in your new facility?

·      How do you manage expenses and calm the churn of a design or redesign when there is a lack of clarity regarding operational models and intended outcomes?

·      How do you know if you will achieve intended outcomes, including return on your investment? Do you have measures that reflect the culture you are striving for — in the current space and in the new one?

·      Are you aware of the facility design and scientific evidence that has proven specific outcomes in experience, safety and efficiency?

·      Is the entire leadership team clear on what culture is essential to make the most of the facilities investment?

·      Do you have engaged team members already demonstrating the culture intended in the new space?

·      What patients and/or family members are involved in designing your desired culture and the spaces that support it?

If you lack clear answers to these questions, it is highly likely you are not maximizing your investment. You are missing the chance to ensure that a facilities project creates excitement, energy and focus toward all key metrics.

Culture Comes First

A new environment on its own will not fully transform a system.

When organization leaders decide to build a new space or redesign their environment, they are also creating the opportunity for large-scale transformation. Environmental design can be an exceptional springboard for a cultural shift that will excite and stimulate the active engagement of every player.

Building projects do not happen often, sometimes only once in an entire career. When these projects are funded and supported, leaders are in an enviable position to not only transform a physical environment, but to lead systemwide transformation. These wide-scale, transformative endeavors provide the opportunity to demonstrate phenomenal leadership — or to fail miserably. Leaders who strive to cultivate a holistic view of culture and systems to achieve positive outcomes have intentionally designed their organizations for transformation; hence, they have created the architecture of the organization.

It is no surprise that current complexity causes health care leaders to struggle with accelerating demands for results in quality, safety, experience and financial vitality. When they’re determining necessary future programs and facility investments, leaders often do not know where to focus their energy or how to achieve the greatest value for their community.

As a result, investments of time, money and energy do not achieve the desired returns.

Fallout from these struggles takes many forms: the escalating burnout of physician and team engagement, frustrated patients, changing measures of success, lack of strategic thinking, and investments in facilities that are more suited for the past than for the future.

The success of new environmental design is dependent on strong leadership and a comprehensive plan that includes cultural and operational development.

A Framework for Leaders

An ideal framework for transformational design is a human-centered, co-design process. While using this process, individuals combine their unique experiences and skills to design the interactions, systems and spaces that will enable effective patient-team partnerships and a thriving culture. Within this framework, everyone contributes to the final design, knows his or her role in achieving the intended outcomes, and moves forward with a unified sense of contributing to something larger — the architecture of the organization.

The five P's of the architecture of organizations are purpose, passion, partnerships, potential and prosperity.

1. Purpose, and 2. passion. Purpose and passion are the foundation of the architecture. To have a solid foundation for change, an organization must have the purpose and the passion to promote and support the transformation. Purpose must be found in each of the actions undertaken by leaders: purpose in alignment with metrics, purpose in transforming culture, purpose in intent and engagement, and purposeful input from all stakeholders. Purpose is what will link people and create alignment and consensus.

Purpose is critical to any organizational change — but passion must be the driving force. Passion must recognize the valuable role of all stakeholders. Passion is the story — the why and how — making connections to the purpose and painting a vision for the future.

Passion is sustained through coordinated and disciplined actions that link to, and drive forward, the purpose. Meaningful engagement and a sense of contribution are excellent barriers to burnout.

2. Partnerships, and 3. potential. Health care is a team sport. The organization must engage everyone in the process.

Leaders often engage key partners such as physicians, nurses, safety and Lean experts, patient experience professionals, and so forth. But strategic partnerships must also include patients and families — perhaps the most underused partners within health care systems. With the growing awareness of the expertise patients and families bring and increasing demands for excellence in patient experience, an urgency exists to bring their voices to the design.

Strategic partnerships must also include the care team. These are the people who will be the leading voices of cultural and operational change. Their passion and investment in the project is incredibly valuable.

Finally, strategic partnerships must also include the greater community. Change does not occur in a silo. Organizational building and redesign projects must have an impact on the health of the community. Such projects should be co-designed and optimized.

Health care leaders who have cultivated passion, purpose and partnerships for organizational change will find themselves at the center of enormous potential. Systems designed by a team with significant investment in the process will be systems that work at every level of engagement.

3. Prosperity. Prosperity stems from attaining the full return on the organization’s investment. Prosperity can be quantified as organizations that are thriving and flourishing both culturally and financially. Change initiatives that seek to achieve prosperity in both human and capital outcomes will be most successful when they are following the framework focused on passion, purpose, partnerships and reaching potential.

The powerful impact of this holistic approach creates a prosperous and thriving organization and cannot be underestimated. The approach results in improved patient and family experience, better engagement of staff and improved staff retention. Leaders will notice an increase in the number of staff who take joy in their work, who show pride in their environment, who have found ways to reduce stress and who report fewer instances of burnout. For the sake of all such improvements, we must commit to building effective spaces!

Where to Next?

Design your facility, but purposefully design your culture as well.

Failing to invest in, or recognize, the multidimensional components that go into building physical spaces will result in suboptimal outcomes; decreased impact; and wasted time, money and energy. Use the energy and excitement of the building project as a springboard for true transformation and sustainable outcomes.

The financial commitment has been made; it’s a visible symbol of the dedication of the board and executive team to the continued growth and strength of the team. People are excited about the new space; they’re full of interest and anticipation. As a leader, you need to leverage that energy and focus — and you need to do it with purpose.

Employing the five P's of transformational design, in conjunction with scientific evidence, can ensure that you — as the leader of a dynamic and passionate team — will have everything you need for optimal outcomes, organizational thriving and prosperity.

Barbara Balik, R.N., Ed.D., is a co-founder of Aefina Partners, a member of the senior faculty at the Institute for Healthcare Improvement, and a member of the National Patient Safety Foundation Board of Governors. She is based in Albuquerque, N.M. Lorissa MacAllister, Ph.D., A.I.A., N.C.A.R.B., L.E.E.D. A.P., E.D.A.C., is the founder and president of Enviah in Grand Rapids, Mich., as well as a senior fellow at the Samueli Institute. Kristine White, R.N., B.S.N., M.B.A., is a co-founder of Aefina Partners and a faculty member at the Institute for Healthcare Improvement. She is also based in Grand Rapids.