A “Triage” Solution to Address Critical Issues
Project Details
The Problem
Our client, a regional hospital, served a community with relatively small population growth expected and an annual household income below the state’s median. The facility was the sole healthcare provider in the community but saw their chance for growth in expanding to a nearby area that had an expanding population but with greater competition.
In the current facility, the majority of patients were housed in a patient tower that was built in 1936 and needed considerable upgrades. The tower was built to a different standard of care, and rooms were not sized to accommodate modern-day equipment or families. In addition, expensive maintenance and repairs were needed to improve the infrastructure, including plumbing and electrical systems. The top priority was the intensive care unit, which was severely undersized and located within this older patient tower. The unit did not have enough floor space to provide care for patients, creating safety risks for both patient and staff working in the unit.
Wanting to capture growth in the neighboring community and needing to update their facility to current clinical standards, the hospital needed a roadmap to the future that would fit within their constrained budget. They engaged Haskell to develop a strategic facility master plan that would allow them to be purposeful in how they invested their funds while attracting patients and physicians to their facility.
The Approach
Haskell has a long relationship with the hospital’s health system. This relationship gave us the ability to evaluate their goals from both a system and local perspective and develop creative solutions to address their needs. Haskell presented to system and local leadership with several plans that could be implemented as funding became available. For example, one solution involved building a microhospital that included an emergency department, surgical services, and observation unit in the neighboring community before a competitor could move in. We also explored market dynamics with sister facilities to see how the hospital could leverage additional assets to manage capacity constraints.
Due to financial constraints, leadership chose Haskell’s “triage” solution that addressed the campus’ most critical issues. The triage solution provided architectural fixes for the ICU, the recently flooded endoscopy suite, and right-sized support services to enhance throughput. This solution was part of a larger master plan that positioned the hospital to capture market while supporting their existing community. The solutions allowed them to address issues in a purposeful way instead of making haphazard changes that could cause problems in the future. Phase 2 of this plan included renovations to several units to right-size patient rooms when funds became available.
Haskell’s master plan addressed the most urgent needs by creating spaces to improve how patients received care and how staff provided care in the ICU and proposed ways to address inefficiencies by enhancing throughput without requesting a capital investment. The hospital’s leadership valued that Haskell’s plan offered implementable solutions that worked within their financial realities. Haskell’s ongoing communication with leadership ensured consensus for the drivers of the master plan.
Addressing Behavioral Health from a Community Perspective
Project Details
The Problem
Like many communities, a Midwestern city was faced with constrained resources when dealing with behavioral health patients; emergency departments and the county jail were often left handling most of these individuals. These facilities often felt like the default landing spot for this patient population and acted as a “revolving door,” especially for high utilizers. Wanting a more proactive approach to behavioral health, a coalition group led by a regional healthcare system and various key stakeholders from the county engaged the Haskell team to determine the community’s behavioral health needs and the optimal strategy for implementing the plans over the short, intermediate, and long term.
The Approach
Haskell implemented a two-phase approach to evaluating behavioral health needs within the community. During Phase 1 we looked at current and future community needs and interviewed stakeholders to define gaps in care. Interviews were conducted with a variety of coalition members including a regional healthcare system, community health centers, a substance abuse center, the sheriff’s office, a school district, and organizations that serve the homeless population. Haskell also looked at case studies for how communities around the country tackled behavioral health treatment.
Following the data-collection stage, we presented our baseline findings and held an on-site “visioning session” with representatives from involved organizations to walk through various behavioral health profiles created by Haskell to better understand how each individual would seek help and receive treatment within the community. This group session helped shape the overall strategic direction for behavioral health in the area.
Based on our analysis of secondary data, case studies, and the work session with stakeholders it became clear that the community needs a more sustainable model of care for behavioral health. Over the long term, services – from job placement to primary care to treatment – should be integrated and co-located to ensure easy access.
However, because of capital constraints, Haskell developed an à la carte plan that the team could roll out over several years. In the near term, we suggested right-sizing existing facilities and incorporating behavioral health services within the existing primary and urgent care infrastructure. Operationally, we recommended largely focusing on evaluating current assets, reorganizing the team into task force groups, developing a business and marketing plan, and increasing training efforts for select community groups. The intermediate tier suggested new facility investments in wellness and primary care as well as providing housing for violent patients; on the operational side we recommended building out medical detox and eating disorder service offerings, incorporating prevention and early interventions as demonstrated in various national case studies, creating more robust transportation, and initiating an operational study to assess processes and hours. Longer-term, we ultimately suggested moving toward a community and comprehensive facility model of co-located resources.
Aligning Facility Plans with Future Projections
Project Details
The Problem
Located in a rapidly growing suburb, a regional medical center was rapidly outpacing original growth projections and starting to experience capacity constraints. Given strategic growth initiatives to add tertiary services to the campus, the hospital engaged Haskell to evaluate future inpatient, surgical, and emergency services needs on the campus and provide facility recommendations that align with future projections.
The Approach
As part of a systemwide initiative to increase access to care, the hospital had strategic plans in place to offer tertiary cardiac and neuroscience services. Since it is in a highly competitive region with no tertiary care within the primary service area, speed to market was key to successful execution of this strategy. Haskell quantified the additional capacity needs associated with this growth and evaluated the campus’s ability to absorb this volume. Increasing the level of care at the hospital required a deep-dive analysis of patient flow into the campus and between departments. Haskell’s analysis helped the planning team understand the physical space constraints and potential challenges of working within the hospital’s existing footprint.
From the facility’s standpoint, the strategic growth required additional emergency room, observation bed, ICU bed, and surgical capacity. In expanding emergency services, Haskell’s planning team recommended an addition that optimized the patient entry sequence so that trauma patients could be seen as quickly as possible. Understanding the increasing criticality of the hospital’s patient population, the recommended ICU solution provided right-sized patient rooms with a seamless connection to the emergency department and surgery. The recommended solutions allowed the facility to grow in alignment with operations and strategic goals.
Ambulatory Surgery Feasibility Study
Project Details
The Problem
A small rural hospital struggled to keep surgeons and anesthesiologists satisfied with the operations within their current Perioperative Department. Patient and staff satisfaction was low due to constant surgical delays in scheduling, low case turn around times, surgeon productivity, and late hours. Haskell was engaged to assess the viability of a ASC joint venture to preserve hospital market share and develop surgeon alignment.
The Approach
Haskell completed a market study to determine whether there was enough demand in the market to grow volume for either the hospital or a new ASC. Haskell determined that moving current outpatient cases to an ASC setting would cause a substantial decline in hospital revenues and the joint venture would not be sustainable.
While part of the exercise was to determine feasibility of a new ASC, Haskell was also able to identify the causes of the hospital surgery department’s poor utilization and create an action plan with surgery staff and providers to address these challenges. The solution addressed capacity, staffing and patient satisfaction issues and created a platform for measuring performance in the department over time.
Assessing Assets to Prioritize Investments
Project Details
The Problem
Haskell was tasked in the spring of 2016 to develop a master plan for a teaching hospital that is part of a larger health system to right-size their intensive care units and address major problems with their ED. Two years later, the Planning Team re-engaged Haskell to verify that the findings and recommendations were still valid and make adjustments where necessary.
A key focus of the Planning Team was developing options that would enable the hospital to not only defend its market position in a competitive environment but also regain market share that was lost to competitors over the years. Additionally, it was important to the leadership team that community goodwill was maintained.
The Approach
Haskell looked at regional assets and coordinated with the Planning Team to determine how these facilities work together and how they should be prioritized for investment. As part of the study of where to invest to improve the inpatient beds, the planning team studied several options. The options evaluated adding hospital functions and beds to an existing facility by adding on to the existing building. Other options studied expanding hospital functions across the street in either a freestanding building or connecting with a walkway to the existing facility. The site was somewhat limited by three easements that run north to south.
Recommendations from the core team included a new patient bed tower at the downtown campus and expanded ambulatory investments across the regional market. This option allowed the larger healthcare system to maintain a presence downtown and indicated to the community a significant investment in renewing the hospital. This new patient bed tower would allow the hospital to vacate and possibly demolish some of the facility’s older construction, creating a more compact and efficient acute care-focused facility.
In making our recommendations, Haskell considered the health system’s financial capacity to implement changes and tailored architectural plans to meet their needs.
A Two System Partnership Through an Outpatient Strategy
Project Details
The Problem
Competing hospital systems partnered to create an outpatient campus that addressed the growing needs for clinics, urgent care, Imaging and Endoscopy services in the community. The facility was designed to straddle the county lines that delineated hospital service area; therefore bifurcating the services between the two hospitals.
The Approach
Distributing the services across the county line took ingenuity and clarity of codes and regulations to properly configure the departments and spaces. Working with authorities to confirm decisions prior to submission assisted in confidence the project could proceed.
The finished product is a facility shared by two healthcare systems in a symbiotic nature to achieve the needs of the community.
Accommodating Fixed Revenue with Variable Competitive Strategies
Project Details
The Problem
A health system was facing capacity constraints in key revenue generating departments – inpatient and surgery. The client commissioned the Haskell Team to conduct a strategic market and data review, resulting in a Strategic Master Plan that addressed the current capacity constraints and issues in key hospital departments, and prepared these key departments for anticipated future growth.
The Approach
Haskell experts conducted a strategic and operational assessment of the hospital campus through interviews with department, hospital and system leaders, and assessed the current functional use of the campus along various dimensions – utilization, space benchmarks, and site plan. The assessment identified deficiencies (inpatient beds, ORs, catheterization labs) in current space and highlighted the implications for the future of the campus. Future utilization projections and the associated required space were developed as well.
Once the gap between available and future key planning parameter and the associated space need for each focus area was identified, the Haskell team worked with the client to prioritize the recommended changes based on the strategic and clinical importance. A roadmap was developed showing at a high level (with block diagrams and floor plans), how to transform the facility to what it needed to be in the future to meet leadership’s goals. Phased construction cost estimates were provided, so that the leadership team could develop a financial plan for making the recommended capital improvements.
Addressing Multiple System Needs
Project Details
In the face of rapidly changing healthcare policy, increasing outpatient demand, and aging infrastructure our client was struggling to solidify a financially feasible strategic direction for their ambulatory services. They had a number of existing clinics in the market, but some were highly underutilized while others were operating at max capacity. From a branding perspective, the existing clinics lacked continuity with varying nomenclature, aesthetic features, and facility design. Consequently, operations and the patient experience were inconsistent between sites.
In the acute care environment, there were a number of services that could potentially shift to an ambulatory setting. Haskell helped determine service line shifts and identify the appropriate services to backfill the inpatient space. Given the evolution of the hospital infrastructure, the oldest buildings were located in the center of the hospital. Therefore, the hospital had over 5,500 square feet of space that was not suitable for patient care and there was no distinction between inpatient and outpatient zones. Because of this design, staff and patients often travel circuitous paths throughout the hospital.
To lay the foundation for capital investment initiatives, Haskell created ambulatory and acute care master plans. The plans resulted in recommendations to build new ambulatory outposts to meet community needs and an addition to the hospital to start to improve efficiencies, provide space to demolish old infrastructure, and reduce long-term operational costs. Before executing the recommendations, our client worked with Haskell to develop ambulatory prototypes, interior design standards, and exterior design standards to increase brand awareness, limit capital investment, and improve patient care. To increase speed to market, they selected Haskell to take the ambulatory prototypes through construction documents. While Haskell was working on the ambulatory design, our client received a grant to build a medical village on the hospital campus. Haskell tweaked the SFMP recommendations to accommodate the additional medical village components. Haskell continue to work on the medical village and ambulatory clinic build outs.
“Haskell has been a strategic partner for [us] for over two years, and continues to be our first choice for consultative expertise. The team we work with is extremely knowledgeable, responsive and flexible, and function as true partners – working with our senior leadership every step of the way to get our priorities accomplished. [We have] completed both an ambulatory network plan and a strategic master facility plan with Haskell and now continue to utilize Haskell for high priority site and program development projects.”
– Vice President, Planning
Aligning Prototyping with Efficient Operations
Project Details
The Problem
Building prototypes allows us to have a starting point when individualizing facility layouts for specific clients. Haskell strives to incorporate efficient operations with every facility design. More specifically, Haskell built a prototype to accommodate primary care, physical therapy, and imaging services while considering the flow of patients and anticipated bottlenecks.
The Approach
In order to say confidently our prototypes are not only ideal when it comes to architectural planning and square footage, but allow patient centered and high quality care delivery, Haskell tests prototypes using simulation software. Being able to watch patients and staff move through the proposed prototype gives planners and process improvement specialists a different viewpoint when considering operational aspects of the system (i.e., ideal placement of waiting room and storage).
Understanding the patient and staff process flows of the specific prototype accommodating primary care, physical therapy, and imaging services provided projected utilization of the registration and check out services. Knowing these utilization rates were low, a portion of space designated for registration and check out was reallocation for a larger waiting room. Shared resources between the three services for registration and checkout is an operational solution. Combining architectural and operational efficiency leads to a patient centered and ideal prototype for our clients.
Challenging the Need to Build With Operational Improvements
Project Details
The Problem
During the master plan work, the desire to expand the ED and the actual need were tested to determine if they could mitigate construction through operations.
The Approach
We ran four data-driven scenarios to evaluate the impact of operational decisions on overall facility size and cost. Improved operations assumptions were centered around reducing average length of stay (ALOS) and addressing psychiatric patient needs through a dedicated behavioral health pod. We could show a reduced need for treatment rooms by approximately nine spaces by improving operations and by an additional six spaces by siphoning urgent care volumes down the street.
We demonstrated the reduction in project size resulting from these initiatives lowered the project cost by almost $7 million.
Deploying Standards and Reducing Waste
Project Details
In a previous engagement, Haskell recommended to build new ambulatory clinics with a combination of primary care, urgent care, rotating specialists, lab, imaging, and physical rehabilitation. However, Haskell noted that all of the existing ambulatory sites in the system had different operational flow, aesthetics, and naming conventions. Before hitting the drawing board, Haskell worked with hospital leadership to create standards to avoid these issues with their new clinics and increase speed to market.
To save both time and money, each new clinic needed to create a consistent patient experience, maximize staff efficiency, and be flexible for changes in services offerings. Haskell developed ambulatory prototypes with column grids that make it easy to adjust operational flow and service offerings. From an operations perspective, the Planning Team evaluated design components like single-handed room to improve staff efficiency.
To create a consistent patient experience between clinics, interior and exterior finish guidelines were created. Installing consistent finishes throughout the clinics not only creates a familiar environment for the patient but it also saves the system money with bulk pricing and improved quality control. To further control costs, high-end exterior finishes were focused at the main entry where patients/visitors are interacting most with the facility. Creating this similar entry-way at each clinic improves association with the system brand and reduces confusion with site wayfinding.
Client Quote
“I have been in the business going into my 36th year and all interactions, experiences, and third party feedback has been nothing but positive on Haskell’s ability to deliver. I have been here for 10 months and basic facility programs and intelligence is not well documented and complete. This initial presentation open eyes to leadership for a consistent focus to align priorities, gather intelligence on a preventative basis, and reduce/eliminate surprises. Looking forward to a continued partnership.”
-Senior Director of Engineering and Facilities
Designing a Flexible Emergency Department
Project Details
The Problem
To maintain their position and grow their competitive market share, this client needed a new Emergency Department. The original department was disjointed, undersized and unsafe for modern care, future volumes and projected acuity levels. The design needed to address current and future capacity needs via throughput efficiencies gained from operational changes that were decided during the master planning process. Haskell, having previously completed the master plan, was able to maintain the integrity of previously made decisions and provide guidance during the design process.
The Approach
Haskell’s planning team developed consensus among the variety of ED staff. By overlaying process mapping for patient and staff flow with the proposed departmental layout, Haskell discussed and confirmed the future of ED operations in the new facility. By obtaining sign-off at milestones in the design process, Haskell developed champions with accountability for decisions made and future implementation of these efforts. Dashboards were developed to show capacity increases that occur when operational efficiencies are gained through design and workflow improvements.
At the completion of the engagement, Haskell delivered an operational-based design with key operatives for implementation of the new processes and subsequent facility implications. The design provided capacity through flexible use of universal treatment spaces. While zoned for acuity levels, the layout of the department is flexible to accordion up or down as volumes and acuity levels vary throughout the year and into the projected future.
Determining the Need for a Micro-Hospital
Project Details
The Problem
A hospital and a Native American Nation were evaluating ways to partner and better serve their local Oklahoma community. The entities wanted to understand the feasibility of and the facility implications associated with joint venturing to establish a micro-hospital in the community.
The Approach
Haskell developed a demographic profile of the community, conducted a market and competitor analysis, and studied healthcare service utilization trends for emergency, inpatient and surgical services in the community. Overlaying square footage requirements, construction cost implications, and various market capture scenarios, it became apparent that there were significant challenges associated with developing a typical micro-hospital in the community.
The low population density and presence of substitutes and competitors in the market limited the likelihood of achieving the market share required to achieve a sufficient return on investment. Recognizing that the two entities were interested in other synergistic approaches, Haskell explored different micro-hospital models that could improve the viability of developing a micro-hospital in the market, as well as alternative service models that would meet the entities’ strategic and financial goals. Throughout the process, Haskell weighed the relative advantages and disadvantages of establishing a micro-hospital in the community for each entity; presenting options that had a synergistic effect for both.
Determining the Right Services in the Right Location
Project Details
The Problem
Over a two year period, a historically dominant player in the healthcare market lost over 4,500 inpatient discharges. In other words, the health system was losing over 50 patients per day because their relationship with referring providers soured and market volume was stagnant. Haskell was brought in to identify strategies to stop the decline and improve profitability.
The Approach and Solution
Capitalizing on service gaps and physician shortages was one way to increase market presence and better serve the community. Haskell determined there was a significant gap between availability of primary care physicians and demand for their services. In addition, the market required more medical-based specialists like gastroenterology and endocrinology. The Planning Team quantified future volume need in the market and identified a location for an ambulatory clinic. The ambulatory outpost would help secure the referral stream to the system’s inpatient network.
Furthermore, even with market share growth, market dynamics suggested that the health system would never fill the number of inpatient beds the system currently had built infrastructure to support. Haskell recommended that the smaller, community hospitals in the system’s rural submarkets transition into ambulatory hubs with fewer inpatient beds and the hospitals in the more urban markets serve as the system’s hubs, providing higher acuity and more complex care. This consolidation of inpatient beds would achieve greater economies of scale and lower the system’s overall cost structure.
Determining What and Where to Place Services
Project Details
The Problem
In the face of significant policy and reimbursement change, a healthcare system sought to improve patient access, reduce costs, and fend off competitors. The system contacted Haskell to assist in determining where to locate a new ambulatory center and the types and quantity of space needed.
The Approach and Solution
Utilization trends, demographics, and payor mix data highlighted significant service shortages in the low income area located less than five miles from the system’s flagship hospital. The system’s Emergency Department data indicated patients originating from this area were utilizing the ED more frequently than other patients in the service area were and this population was more likely to use the ED for non-emergent problems. After reviewing traffic patterns, identifying bus stops, and hot-spotting volume growth, Haskell identified an ideal location for the new ambulatory outpost.
The proposed ambulatory center has outpatient surgery, primary care, urgent care, and imaging to increase access and to provide low-cost alternatives to the Emergency Department. The surgical component appealed to the neighboring community that was experiencing significant growth, and the recommended location served as deterrent for future market entrants.
Suburban Freestanding Emergency Department Feasibility Study
Project Details
The Problem
An urban, coastal hospital struggled during summer months to reach more remote parts of its market areas due to traffic congestion. In additional, fast growth created emerging areas that did not have high levels of access to hospital or emergency care. This hospital desired to locate a Freestanding Emergency Department in an area with desirable demographic and growth profile, while also understanding the impact, if any, of a new facility on its existing hospital income.
The Approach
Haskell’s charge was to complete a comprehensive proforma that considered potential market size and makeup, location, appropriate facility sizing, and costs of construction and operating. With the input of ED, finance and other hospital staff, Haskell created an interactive set of tools that allowed the hospital stakeholders to manipulate growth, revenue and cost variables and allowed the testing of multiple conservative and aggressive scenarios. Haskell developed a set of proxies for revenue and cost targets based on known operations and contractual arrangements at the main hospital.
Haskell determined that one area was more attractive than another for creating a facility due to a number of factors, including available land, an attractive demographic, available services and fast growth. The proforma identified not only whether the endeavor would be profitable, but also provided a break even point during a ten-year period. Haskell also provided a space program for the planned facility that would specifically meet the needs of the new local market.
Improving the Patient’s Experience = More Revenue
Project Details
The Problem
A hospital with more than two million square feet and over 500 beds was regularly turning patients away because their inpatient capacity was regularly running over 80% occupancy. Capacity constraints forced the hospital to utilize ICU rooms that lacked windows. Landlocked in an urban environment with an inability to expand vertically due to its proximity to an historic district, health system leaders required creative solutions to accommodate patient demand.
The Approach and Solution
There was no available vacant space on the campus for additional inpatient beds. Without an open chair space, it was difficult to renovate individual units. After investigating whether it was achievable to retrofit outpatient space for inpatient use, the Haskell team recommended demolishing original campus buildings that housed the chapel and business support space to backfill the space with a new nine-floor pavilion housing 84 new ICU beds and 32 Med-Surg beds. These changes provided an open chair for right-sizing, decompressing and renovating existing inpatient units over time. The net effect of the new pavilion allowed the hospital to cease investing new money in old, suboptimal space that resulted in a less than ideal solution. Instead, the system can invest in new space and reuse the old for non-clinical functions.
Landlocked: Operational Changes or Build New?
Project Details
The Problem
Growth in patient volume at a large tertiary hospital Emergency Department was growing faster than expected, to well over 100,000 annually, requiring the ED to “take over” adjacent space to meet capacity demands. The resulting department was a disjointed, poorly configured set of pods that created challenges for efficient operations and staffing and ability to meet the demands of the types of patients being seen. Recognizing the need for expansion, hospital leadership wanted to make sure they did not perpetuate a poor patient experience or place another Band-Aid on the already taxed department.
The Approach
Haskell completed computer simulation modeling of the current department, testing what opportunities for process improvement could be salvaged from the choppy layout. While improvement existed, a planned surge in volume could not be accommodated. Haskell first looked at locations on campus for a new Emergency Department. There were two options: expand in place or build new in a different spot on campus. Earlier studies of the hospital campus recommended that the Emergency Department remain in place, and a new layout was designed for the current location. However, the new layout would take as many as nine construction phases, adding cost, and up to three years of disruption before completion. Hospital leaders chose the more desirable option to build new, which was facilitated by a plan to collocate acute services in procedural and inpatient platforms.
Using computer simulation, lean methods and computational analytics, Haskell identified the most appropriate location to support current and future state operations, maximize patient flow, reduce the number of construction phases and cost, and lower overall organizational disruption.
Haskell then identified the best model to optimize patient satisfaction, length of stay, outcomes, and operations in current and future states and created an action plan that could be implemented while the new department was being designed and constructed. To measure improvements, Haskell also created a data-driven performance tracking platform so that improvements could be tracked and maintained while the new department was being constructed.
Making the Case to Construct a Replacement Facility
Project Details
The Problem
After consolidating all of the inpatient beds from this smaller hospital to their hub, leadership was challenged with planning the future of their now ambulatory center located in an 1920’s inpatient chassis with several subsequent facility additions. The most recent addition expanded surgical services and added other functions on both levels of the building, a significant investment.
The Approach
The main question was whether to rejuvenate and reuse the vacant space in the hospital for ambulatory services or to construct a right-sized outpatient replacement facility. Despite the objective to create a modern patient care environment through rejuvenation and re-organization, renovating the existing campus would leave significant waste in operational processes, require notable infrastructure capital investment, and not occupy an efficient footprint. Haskell’s planning team studied various solutions of renovation, demolition, and additions, as well as a replacement facility.
Due to the combined cost of infrastructure improvements and capital required to convert the existing facility into a modern ambulatory facility, a replacement facility was justified. While the initial first cost was slightly higher, Haskell found significant long term operational savings with an on campus replacement strategy. Haskell’s planning team created a conceptual space program based on national benchmarks and information specific to the campus in order to generate block diagrams, massing model, pricing and renderings.
Maximizing Episode of Care
Project Details
The Problem
The COO and CMO needed to determine their Orthopedic Service Line cost of delivery and identify opportunities for operational improvement, growth and payor negotiations. Haskell was engaged to determine current and future state service line structures, cost, outcomes, and develop performance metrics across the entire episode of care for joint replacements.
The Approach
Utilizing computational and predictive analytics, lean methodologies and visualization capabilities, Haskell identified multiple opportunities that would allow our client to gain efficiency, reduce cost, and proactively align physician requirements with organizational needs. Analysis was performed across the entire patient process and indirect and direct cost established from physician office to patient returned to work or discharged from care.
A multifaceted solution was developed to align physician practice with hospital operations and streamline care processes, perioperative intervention, discharge planning, resources planning, and many others from the point of scheduling, through surgery and discharge. Key to our success was bridging clinical and operational process and metrics to create actionable analytics so that each stakeholder involved in the patient’s care, had a clear understanding of their impact on the overall outcome of the patient.
Maximizing Inpatient Beds with Strategic Growth
Project Details
The Problem
The small specialty hospital was originally designed and built to support an initial patient volume and had the capability to expand horizontally, adding bed capacity. The diagnostic and treatment services as well as the ancillary services were already designed for the larger bed capacity. The physicians, with ownership in the facility, had ambitious goals to take market share and expand their service area, capturing new volume, but didn’t understand how that volume would translate into bed need or have realistic expectations for what could realistically be captured. With the physician team believing a replacement hospital was necessary, to the tune of tens of millions, leadership needed Haskell to determine if it was even feasible.
The Approach
Haskell’s planning team studied the zoning ordinances of the site to understand how it would limit the expansion abilities of the facility and created test fits of the expansion and necessary renovations to meet the strategy goals and to support patient capacity. Finally with a total bed capacity of the site and facility, Haskell calculated the market share and volume that the physicians would have to reach in order to fill the beds.
Ultimately Haskell’s discoveries set realistic expectations for strategic growth and allowed hospital leadership to plan strategic moves annually to reach established targets. Financially, Haskell proved that the current physical asset met the needs of the physicians and eliminated the desire and cost (in tens of millions) to construct a replacement facility.
Operational Analysis Drives Massive Renovation
Project Details
The Problem
Challenges presented by this project included 100% renovation within existing envelope and maintaining existing operations during the multi-phased construction.
The Approach
The renovation and addition tripled the size of the existing facility to house a major trauma department, two CTs, three X-rays, one ultrasound and lab services. The plan subdivided the large, long building footprint into functional zones and care team areas. Creating these operational units produced an ideal environment for providing optimum healthcare services while minimizing staff travel distances and providing flexibility in the operating size of the department.
Haskell provided operational analysis of the existing workflow, staffing, and capacity to ensure the design would reflect the emergency department’s specific patient and staff needs. Although the ED renovation and addition tripled the size of the existing department, functional planning minimized staff travel distances and operational inefficiencies.
Operational and Strategic Transformation Study
Project Details
The Problem
A community medical center with a high acuity patient mix, high percentage of admitted patients and unprecedented growth was experiencing multiple bottlenecks and delays in their Emergency Department, ICUs, ORs, and Interventional Cardiac Services. Growth was outpacing expansion and bottlenecks impeding throughput at such a rate, the hospital was continuously on diversion. Leadership needed to understand what short term solutions were needed strategically and operationally to meet current demand and what expansion plans were appropriate long term.
The Approach
Working with hospital leadership, department leaders, physicians, nursing, performance improvement, and support staff, Haskell conducted clinical, operational and financial analysis, process mapping events and integrated simulations to understand current state, identify various pressure points, bottlenecks, discharge delays, and test possible solutions, including staffing levels, hours of operation, physician discharge and travel times, centralized scheduling, and perioperative operations for their impact on overall hospital performance.
Haskell identified gaps and opportunities in hospital and internal/external physician protocols, admissions and discharge times, scheduling, travel distances, resource inefficiencies, and physician practice opportunities that would alleviate many of the delays they were experiencing short term. Simulation testing highlighted ways to free up bed capacity while a more aggressive system strategy and expansion was being pursued.
Optimizing Perioperative Performance
Project Details
The Problem
To determine the appropriate growth strategy the COO needed to determine if the perioperative staff were fully capitalizing the current operating room space.
The Approach
Leveraging our deep knowledge of Perioperative Services, comprehensive analytical platform and visualization capabilities, we identified multiple interdependent opportunities to gain efficiency and reduce hidden cost and resource consumption. With our diverse team of clinicians, MBA’s and engineers we developed a multidimensional strategy that allowed department leaders, surgeons, physicians and leadership to implement, measure, and sustain improvements.
Parallel solutions were developed to drive operational and functional efficiencies across the entire Perioperative Suite which included Pre-Admission Testing (PAT), Post-Anesthesia Care, Operating Room, Sterile Processing, scheduling, and resource utilization. These solutions were instrumental in reducing direct and indirect cost, inefficient patient throughput, resource cost and improving staff and surgeon productivity.
OR Standardizing in an Active Surgical Platform
Project Details
The Problem
The client was hemorrhaging surgical cases in the existing 13 OR platform. The existing conditions of each OR were not equal, creating a differential in utilization capacity of each OR. Haskell’s planning team was challenged to create capacity without adding operating rooms to the facility.
The Approach
Haskell analyzed the current utilization of the ORs to determine where opportunities could be gained through improved room orientation, size and configuration. Working with both physicians and surgical staff, and utilizing real time modelling, iterative hand sketching and operational mapping, Haskell developed the ideal configuration for the client’s operating Room. Each OR was compared to this ideal state to determine needs and ability to convert to a standard configuration.
Through minimal renovation to expand and/or reorient the operating rooms, the client’s surgical platform increased flexibility by outfitting each operating room the same. Standardization enabled an increase in surgical capacity through the increase in utilization of each OR; therefore, preventing the need to construct any additional operating rooms.
“I trust Haskell to come up with creative and realistic solutions.”
-System Director of Planning and Design, Sisters of Charity of Leavenworth
Provider Placement Strategies to Leverage Economies of Scale
Project Details
The Problem
A small, critical access hospital with a strong physician practice network had specialty physician offices spread across a two-mile radius from the hospital. Aside from the lack of connectivity between practices, some clinics had outgrown their space while others had antiquated design that restricted operational flow and growth. Separately, the hospital had a number of leased spaces that represented a potentially unnecessary expense. Hospital leaders reached out to the Haskell Team to help evaluate and recommend adjustments to the specialty practice network through determining the appropriate location and size of each clinic based on future needs and reducing the reliance on leased space.
The Approach
Interviews with the physician practice staff revealed challenges with existing space and how it inhibited physician recruitment and therefore limited volume growth. The Haskell Team evaluated the existing physician practice space against industry benchmarks and specific operational parameters to determine how much space in each practice was needed to accommodate current and future patient volumes. Vacant space located in a newly built cancer center was also evaluated as a possible outlet for practice space.
The Haskell Team recommended an integrated approached that relocated certain surgical specialties from leased space locations into the vacant cancer center space. This consolidation reduced the total number of leases in the system. The integrated design allowed the specialty providers to flex exam rooms as needed and share support space. Economies of scale were also achieved with the continuous back-of-house corridor and centralized shared waiting. Space was further maximized with the reduction of public toilets. Ultimately, the client experienced cost savings and practice with the new design.
Realigning Service Line Distribution to Maximize Assets
Project Details
The Problem
A 13-hospital system in an urban market was in the middle of building a replacement hospital, but the replacement hospital was designed too small to meet growing market demand. Knowing the replacement hospital would struggle to accommodate projected volumes upon opening, health system leaders looked to the Haskell Strategy team to identify ways to shift volumes between other hospitals in the system and optimize existing system capacity.
The Approach
Haskell evaluated the distribution of service lines across the system to identify any duplication of services or service gaps and sought stakeholder feedback on which service lines could be relocated and test possible consolidation scenarios. Patient origin maps identifying patient access preferences across the system helped Haskell understand which patterns could be modified. Next, interactive dashboards were created for scenario testing of inpatient beds and operating room (OR) need relative to service line shifts.
Based on the analysis, key service lines were identified to shift service location. The Women’s and Infants service line was consolidated into one hospital to eliminate volume cannibalization, and the transplant program was consolidated at one hospital to concentrate clinical focus and conserve costs. Certain patient types and procedures, like complex orthopedic cases, were relocated to the new replacement hospital.
Even with service consolidation recommendations, the Haskell Team’s analysis highlighted the need for more surgical rooms across the system. An ambulatory surgery center was recommended to release current capacity constraints and absorb more inpatient surgical volume.
Resource Optimization
Project Details
The Problem
A small rural community hospital needing to accommodate a bolus of unexpected patients when a neighboring Emergency Department closed. The additional volume exposed a bottlenecked system and a potential need for more beds. The operating room also faced undersized and poorly configured space needed to meet the demands of changing technology. When a proposed facility solution was deemed too expensive, the Haskell’s operations team was engaged to help find ways to reduce capital exposure through an operational improvement.
The Approach
The Haskell’s operations team used its comprehensive analytical and visualization solutions to identify challenges to capacity, space and staff utilization within the current system. The team worked with executive leadership, physicians and departmental ED and OR staff to create solutions and implementation plans to address operational challenges. To garner system-wide support, Haskell demonstrated and visualized how improvements and changes could, not only improve their working environment, but improve the patient’s experience, lower length of stay, decrease the amount of patients who leave the ED without being seen, and increase OR productivity.
The resulting operational recommendations reduced overall future bed and space needs and identified a much smaller footprint needed to accommodate future patients.
Standardizing and Modernizing Critical Care
Project Details
The Problem
The large urban hospital has four separate Intensive Care Units (ICU) across their campus that each have no more than eight to thirteen patient beds. Each unit benchmarked more than 3o% under the industry standard for department area per patient bed. To complicate matters, several of the ICU units are in a open bay configuration and lack many of the items that would be required in new constructed and expected from a patient, family, and nursing perspective. Having separate units has continued to challenge operations and nursing staff with placement of patients in the appropriate specialized unit as well as staffing those units.
The Approach
Given that the existing ICU units are located in the oldest infrastructure, the team evaluated the feasibility of renovating those units, which was not possible. With the lowest cost option eliminated, the team pursued how those units could serve other strategic needs on the campus. Finally, the team collaborated on the best way to consolidate the various ICU units, improve staffing efficiency, provide specialized ICU care, and how to provide the optimal patient and family experience.
As part of a greater solution, the team standardized the ICU platform into one 30-bed unit in a three-story inpatient pavilion with vertical expansion capabilities. Furthermore, having each room be an identical design and the unit having a consistent layout, the staff will be able to work efficiently and spend more time caring for patients instead of hunting for supplies or creating work-arounds to issues in patient rooms.
Supply Chain Optimization
Project Details
The Problem
Without the support of a well-planned, detailed, change management strategy and comprehensive analytics, business and revenue transformation initiatives can bring many unwanted challenges. Our client engaged Haskell to develop an approach, methodology and implementation plan that would align and engage their organization in achieving a margin improvement and cost reduction plan of 15%.
The Approach
Working with hospital leadership, Haskell identified opportunities to not only enhance business and revenue capabilities, but reduce significant direct and indirect cost. Haskell developed a comprehensive implementation plan to reduce resource cost, streamline internal distribution and address purchased services opportunities. Throughout the process, our visualization and analytical capability was used to support implementation and measure long term sustainability.
A multi-dimensional strategy was developed to rectify charge master, item master and IT discrepancies. Vendor and payer contract analysis identified multiple opportunities to support vendor re-negotiations and normalize price parity.
Emergency Department Activation and Transition Planning
Project Details
The Problem
With little more than eight months before opening, a small suburban hospital needed to consider all aspects of the move from an old ED to a new ED. However, the hospital had inadequate resources available to manage operational change and logistics planning.
The Approach
Working with facility planning leaders, the local construction management company and hospital departmental leaders, Haskell lead the effort to create and document the move plan. Over the next eight months our project manager participated in “big room” planning meetings during ED construction, and held individual action planning and problem solving meetings with hospital department leaders. Additionally, when ED operations had not been thoroughly considered, Haskell worked with ED staff to develop transition plans and training and orientation materials. Each aspect of the activation plan was tracked to its completion.
While many hospitals may have the expertise to execute an activation plan, most need executive oversight and project management to ensure all logistics are handled. Our dedicated move manager was able to focus on the logistics plan, allowing hospital leaders and staff to concentrate on daily hospital operations. Areas of focus included communications planning, equipment installation and move timing, existing furniture and computer cataloging, biomedical testing, patient safety checklists, engineering checkoffs, security readiness, education and training, disaster planning, among many other others.
When the Facility is Too Old to Meet Community Needs
Project Details
The Problem
An aging community hospital serving a rural, but thriving community has a 82-acre greenfield property available to build a replacement facility. The site currently houses an operational an ambulatory surgery center. Given the lack of consensus from various stakeholders about the appropriate allocation and magnitude of services to be offered in the replacement hospital given capital limitations, the Haskell Team was engaged to complete a strategic market and data review to identify how the community uses the hospital services today and how the complement of services might change in the future.
The Approach
The Haskell Team focused on identifying which inpatient and outpatient services should shift to the replacement facility. In addition, the Planning Team assessed potential market share gains that may result from attracting providers and patients to new facility. An operational assessment of the current campus was completed to inform the planning and layout of the new facility. The team examined whether the new facility could be attached to the ambulatory surgery center as a way to reduce capital and duplication of services. To fully vet out this scenario, extensive research regarding reimbursement regulations was conducted before proceeding with planning efforts. The outputs of the market and data review and operational assessment were used as the basis for the programming analysis.
The Planning Team developed an option that incorporated the ASC into a full 52-bed replacement facility. In an effort to reduce capital, outpatient construction was designed to business occupancy standards and only inpatient areas were designed to I2 construction. After initial costing and phasing, a complete replacement hospital was deemed too expensive. Haskell worked with the client to develop a phased approach to build an acute campus on the greenfield 82-acre site attached to the ASC while leaving the behavioral health beds at the current location. In the future, the behavioral health beds will move to the replacement facility.
Consolidating Existing Provider Locations to Maximize Patient Experience
Project Details
The Problem
Nestled in the shadows of the Appalachian Mountains, natural features provide geographical barriers to patient access, movement, and drive times for a regional health system. The health system had been focusing on reaching the more rural communities to bring them into the network while simultaneously employing providers in patients’ own backyard. To set themselves up for the future, the health system engaged Haskell to redevelop and realign their ambulatory and provider location strategies to take advantage of their size and scale for the benefit of patients, their staff, and their overall long-term financial viability.
The Approach
To understand each market, Haskell analyzed each patient/consumer profile, mapped existing providers/referral patterns, and graded each facility asset based on convenience, operational functionality, facility condition, and level of flexibility to grow or shrink.
Through our analysis, we determined that the health system’s existing ambulatory network in zones outside the core 30-minute drive time was adequate for existing and future patient needs. By establishing drive time zones, Haskell was able to break down the system’s geographical footprint into manageable pieces to analyze each market’s referral patterns, density, roadways, competition, patient profiling, and existing assets.
Haskell’s solution was to develop an optimized network and create a hub-and-spoke approach. Because patients could get to any location within 30 minutes, it didn’t seem reasonable to keep inadequate, small, geographically dispersed facilities around the community. Instead, the system needed to leverage economies of scale, develop a care model that was patient focused, and create brand awareness by establishing three “hubs” – primary and light specialty care; procedural based; and heavy subspecialty.
This solution was further refined through detailing provider operations, recruiting strategies, succession planning, optimizing shared spaces, and developing a facility/site program that supported the overall vision for each location. Haskell also analyzed existing lease terms and conditions to determine overall timing, financial implications, and the logistical allocation of each relocation or move. Our solutions allowed the health system to provide additional market services through enhanced referral patterns, co-location of specialties (diabetes, bariatrics, etc.), and volume efficiencies, resulting in a better financial picture.
Enhancing Service Offerings and Furthering Ambulatory Care Strategies
Project Details
The Problem
Located in a region with relatively stagnant growth and increasing competition, a community hospital needed a winning facility strategy to combat market share threats, improve the patient and staff experience, and address aging infrastructure and deferred maintenance. The hospital engaged Haskell to develop solutions to enhance their existing service offerings as well as to further their ambulatory care strategies and revitalize their women’s health platform.
The Approach
Because of ambulatory migration, the hospital’s inpatient surgical platform had capacity for growth. Haskell worked with leadership to strategize on how to leverage this capacity and right-size the department to improve operations and increase ORs sizes to be capable of handling higher-acuity, more complex cases. Part of the surgical strategy was to leverage MOB space attached to the hospital for surgical specialists. Digging further into the system’s ambulatory strategy, Haskell recommended renovating the on-campus MOB and expanding off-campus ambulatory clinics for clinic and rehab volume growth.
Representative of its age, the hospital faced challenges around “haves and have-nots,” in particular in inpatient units. The newest building additions flowed well and were aesthetically pleasing, while the departments and inpatient rooms in the original tower were small and dated. Haskell focused on refurbishing the labor and delivery unit to add higher acuity neonatal services, right-sizing the C-section OR, and improving the overall experience in the department so that it would be seen as the “go-to” birthing center in the community.
Haskell recommended solutions that integrated infrastructure needs and addressed deferred maintenance. A range of options would be suitable through different capital environments.
Ensuring Patient Safety and Minimizing Disruptions
Project Details
The Problem
With two campuses that offered overlapping services located across the street from each other, a regional hospital built a new patient tower to consolidate its services on one campus. Once the new tower was finished, the hospital needed an activation readiness plan that would ensure it opened with minimal disruptions. This included preparing the staff for the new building and familiarizing them with new policies and procedures, Haskell implemented a phased strategy to complete the activation of the new tower with minimal disruptions and without compromising patient safety.
The Approach
Haskell formed work groups for each department scheduled to move into the new tower, as well as those affected by the move. The 18 work groups included departments such as the ED, ICU, surgery, the blood bank, and patient and family services. In addition, five global work groups looped in all work groups plus departments such as education, communications, regulatory, and change management.
Each departmental work group developed an operating manual to drive functional and operational programs and serve as the detail for implementation planning and staff training. Developing an operating manual provided clear road guidelines on the processes that needed to be changed as well as a platform to explore alternative solutions and document the change.
A critical part of activation is ensuring patient safety, so Haskell simulated a “day in the life,” which had two distinct parts. The first was performing a mock move in which a patient was moved from the old campus to the new tower to make sure everyone knew the necessary processes and to uncover any snags. The second part of day-in-the-life simulations was to run practice scenarios in the new tower.
The new patient tower – and the new processes that came with it – had the potential to cause confusion with staff and patients alike. Staff members were working in brand-new spaces, with new places to store equipment and supplies and new travel paths to learn. Patients needed to know where to park at the new facility, where their provider or treatment was located, and any new check-in procedures that had changed in the new building. The activation plan ensured that staff was familiarized with their new space so they could work efficiently, while patients received communications on changes and what they could expect in the new tower.
In addition to education around the new tower, during the activation period continuous communication needed to be spread to all areas of the hospital. Leading up to Move Day there was constant change on who needed to be where and what areas were open to the public. Haskell worked with the in-house marketing team throughout the activation process to eliminate duplicate work and confusion. Website, commercials, weekly emails, and blogs involving information about the new tower were regularly updated to reflect the most accurate and timely information about Move Day, construction, parking, etc.
When Move Day finally arrived, the activation occurred with no major issues and no threats to patient safety. A hospital employee involved in the move said, “This project was a huge undertaking, and Haskell expertly and efficiently guided us through the planning and implementation phases with no significant problems. A job very well done.”
Evolving to Meet Growing Demand
Project Details
The Problem
With the introduction of the Affordable Care Act, our client, who historically provided a high level of indigent care in the ED, continued to see their volumes escalate. To meet the demand, they, not only needed to create capacity and transform their emergency department, but a design that would provide a face lift to the ED entrance since it also acted as the “front door” to the institution.
The Approach
To meet ongoing patient demand, the ED redesign incorporated both phased renovation in place and new construction. The new redesign provided a total of 89 new private treatment spaces to serve an expected 135,000 acute, behavioral, and detention patients annually. To maximize the space and appropriately inform the design, Haskell performed an in-depth operational and clinical analysis of their ED to identify process inefficiencies and throughput, bottlenecks, and operational models that would optimize and enhance the patients’ experience.
Working with our client, Haskell developed a phased renovation in place approach that allowed for large sections of the ED to be renovated at once. The main intake process was streamlined to mitigate patients returning to the main waiting room and, to insure the safety of the general population, an additional intake location was located at the back of the ED for detention and behavioral health patients.
Identifying Causes for Perioperative Bottlenecks
Project Details
The Problem
Located in a growing metropolitan area, a local hospital’s space was at a premium. While performing a facility master plan, Haskell found the hospital needed several new ORs. With an increasing number of cases and the long timeline for adding more ORs, it needed to increase capacity within the current footprint by reducing room turnover time between cases and increasing on-time starts.
The Approach
Haskell determined the baseline operations in surgery to identify the root causes driving perioperative operational congestion, bottlenecks, and patient care delivery. Key to Haskell’s analysis was determining what could be done short-term to improve operational flow and what would require operational changes, modifications to the existing structure, or expansion and redesign.
Using actionable data, Haskell provided a roadmap to identify reasons for delays in perioperative areas. Analysis of the data didn’t easily identify where to focus to address delays. For example, codes that were entered for root/cause analysis for late cases were entered into the system as free text, resulting in more than 2,000 unique delay codes. To standardize those delay codes, we narrowed them down to a distinct list of 44. When the delay codes were first rolled out, there were no system parameters to force recording of the delay, causing an approximately 60% response rate. That rate was increased to over 95% by the time we finished the project. Standardizing these procedures provided a roadmap to fixing the hospital’s high TOT and increasing first case on-time start.
Haskell’s successful perioperative strategy was based on two separate unique attributes. First, Haskell’s on-site team combined engineers and analysts with a registered nurse with extensive operating room expertise, allowing us to provide recommendations that are achievable based on how a hospital actually performs. Second, Haskell took a substantial amount of time to identify a baseline to accurately determine how the system could be improved. Taking this step gave the hospital actionable data to find the best operational solutions for issues in their perioperative services.
Improving Care for a Rural Community
Project Details
The Problem
Located in a rural area with a declining population, a local hospital provided valuable care to its community. The facility needed to develop clinical spaces that enhanced the patient experience and facilitated provider recruitment efforts, both of which were necessary for growth. The planning team, made up of hospital/system leaders, wanted to ensure that the facility was well-equipped to support the needs of the community and grow services that the hospital could provide. Haskell was engaged to evaluate the state of the campus and develop concepts for long-range development based on community needs, competitive market factors, historical trends, projected future utilization, and broader system strategic initiatives.
The Approach
Haskell developed future use projections and incorporated the hospital’s strategic/operational priorities, tested these priorities using data-driven models, produced a number of planning options, and developed a focused scope of facility responses. Haskell created planning concepts that addressed the hospital’s priorities and allowed leadership to manage capital and timeline constraints.
Haskell found several departments were undersized, which caused other issues. Inpatient departments lacked support and staff space, and the finishes in patient rooms needed upgrades. The ED did not have enough rooms, but the most significant issue was circulation around the triage rooms and waiting areas. The endoscopy area and imaging department both lacked support space for equipment, supplies, and staff. Cardiac rehab and physical therapy both were undersized for the modalities they housed, which created some safety issues for patients and staff circulating around equipment.
The preferred plan demolished the outdated physician office space, and consolidating the medical office space on campus resulted in a new building, which the planning team wanted to be physically connected to the existing hospital. The building was sized to accommodate future growth and recruitment of physicians.
The master plan also provided an option to correct the flow around the ED and triage area, which was a key priority. This resulted in a domino effect on other diagnostic and treatment departments. Their deficiencies were addressed, with attention paid to patient flow and experience. Finally, the master plan presented an option to expand skilled nursing should the need or desire arise to increase the number of patient rooms.
Haskell’s solution prioritized keeping appropriate services local, eliminating the need for patients to travel further for care.
Improving Patient Experience in a Growing Market
Project Details
The Problem
The birthing center at a large teaching hospital was facing challenges on numerous fronts: overcrowding, losing share to a competitor, and an aging infrastructure. To improve the patient experience, the hospital wanted to provide private labor and delivery rooms to all families while at the same time addressing overcrowding.
The Approach
Haskell compiled staff members’ key concerns, informing which analyses needed to be conducted to support future discussions and decision processes. After setting the priorities, we used utilization heat maps, Tableau, and Excel to help the hospital visualize its current utilization and opportunities for improvement. Haskell then interviewed personnel from various departments that work with obstetrics (such as environmental services, security, and facilities) to get their perspectives on operational challenges.
Review of the data found several operational inefficiencies. For example, operational practices and physician practice patterns needed to be reviewed and revised to optimize operational efficiencies. Variations in shift lengths by job (eight- versus 12-hour shifts) resulted in inefficiencies in work flow, reporting, and patient care. Space constraints also contributed to inefficiencies and inconsistencies throughout the department.
Hospital leadership wanted a new operating room in the department. Review of heat maps found that both the PACU and OR had very low utilization across all rooms, with an unusually high spike in procedures occurring consistently on Fridays. Haskell suggested investigating why OR use was so high on Fridays as well as adopting scheduling standards and criteria to improve efficiencies rather than build a new OR.
Key to improving the patient experience was increasing the number of private rooms. Data found that 57% of patients were moved from a semiprivate bed to a private location because of dissatisfaction, and some patients were moved multiple times. This practice caused bottlenecks in admissions and additional work from housekeeping to support room turnover. Haskell recommended reducing the number of semiprivate beds by unofficially designating these rooms as “private” to decrease both patient movement and staff workload.
However, with LDR utilization at 70-80%, operational improvements would not address all capacity issues. Because we recommended against building a new OR, we also suggested the capital could be spend on adding private rooms.
Haskell provided utilization reports and root cause analyses to explain why the hospital was experiencing bottlenecks and helped them develop best practices for managing utilization challenges. Increasing the capacity of the hospital’s birthing center allowed the labor and delivery staff to provide high-quality care with patient safety at the forefront. Ultimately, Haskell’s solutions bought the hospital some time until it could build more LDRs, allowing it to improve patients’ stays.
Integrating a Multidisciplinary Space
Project Details
The Problem
A collaboration between two leaders in oncology treatment was envisioned as a patient-centric, research-based facility that would offer some of the most advanced cancer care in the country. Through its multidisciplinary clinics, the facility set up “one-stop shops” that allow patients to make one appointment with their medical, surgical, and radiation oncologists rather than making separate appointments, enabling better communications and making the treatment process easier for the patient.
The first-floor of the Scripps MD Anderson Center included approximately 12,000 sf of shelled space. Haskell was engaged to program and design a patient-centered, multidisciplinary clinic space that would accommodate learning and clinician collaboration.
The Approach
Haskell facilitated a multidisciplinary team of stakeholders from both organizations to identify the key clinical workflows, number of exam rooms, physician office needs, enclosed and open team collaboration spaces, and staff respite areas.
Small group collaboration spaces were located near the exam rooms to enable clinicians to conference about patients without leaving the patient care areas. Larger conference space for more formal meetings and educational programs were located outside the clinical area. Shared staff workrooms co-located clinicians to facilitate interaction and discussion of patient care.
The project represented a true integration of clinical collaboration, research, and learning to building integrity.
Leveraging Existing and New Assets to Compete Effectively
Project Details
The Problem
As the sole acute care provider in the community, this community health care system has been building their network of care for over 100 years. Despite the strong community reputation and ambulatory network the system has established over time, the system is now facing internal and external pressure associated with incoming competitors in growing markets and aging infrastructure. Haskell was hired to provide strategic direction on how and where to make large capital investments.
Ambulatory Approach and Solution
The existing ambulatory clinics have varying degrees of occupancy and profitability. Although a majority of the ambulatory clinics are primary care, the system controlled less than 15% of the primary care market share and needed a strategy to increase market share and strengthen their referral stream to the hospital. Before simply adding another ambulatory clinic to the network to try to increase market share, Haskell conducted a baseline analysis of the existing network and determined the underutilized clinics were oversized for their population base and located in areas with minimal new growth. Instead of continuing to sink capital into these locations, Haskell recommended right-sizing the clinics and consolidating services into new locations that geographically better position the system to face competitors.
SFMP Approach and Solution
The needs and opportunities in the acute care environment were also considered throughout the ambulatory strategy development process. The hospital campus evolved around the original 1909 building. Consequently, the main goal of the master plan was to identify how to phase out of the oldest buildings to reduce costs, improve operations and departmental adjacencies, and improve patient flow. The surgical department was located in the 1909 building. Haskell tested various surgical department shift scenarios to evaluate the best options to improve access, decompress inpatient space, and generate revenue. After evaluating these scenarios and factoring in recent policy changes related to CMS’s site-neutrality rule, the Planning Team determined it was best to relocate surgery on the existing hospital chasee.
Medical Village Approach and Solution
To phase out of the remaining old structures on the hospital campus and create distinct inpatient and outpatient zones, the Emergency Department (ED) needed to move. The existing ED is operationally inefficient and is not properly designed to serve its high behavioral health population. Since the system received a grant to create a medical village to better serve this population, Haskell recommended combining the ED, outpatient behavioral health, and surgery into a new pavilion and demolish the old space to create a consolidated campus with improved adjacencies and patient flow. The pavilion could be structured to expand vertically for inpatient beds when the system is ready to decompress semi-private beds and/or needs to abandon old infrastructure. Planning for the campus to self-perpetuate over time reduces hospital expenditure on infrastructure and poor operations.
“I have been in the business going into my 36th year and all interactions, experiences, and third party feedback has been nothing but positive on Haskell’s ability to deliver.”
-Senior Director of Engineering and Facilities
Managing a Possible Increase in Capacity
Project Details
The Problem
Serving a four-state region in a market with flat growth, a regional hospital’s emergency department was outdated and could not handle current patient volume, let alone any future growth. In addition, rumors were circulating that its only local competitor might be closing. If that hospital did close, our client would be the only hospital in the area, receiving an influx of patients it might not be prepared to handle. The hospital needed a master plan that would update its ED and provide guidance on what steps should be taken to manage the possible increase in capacity.
The Approach
The ED was out of date and unable to accommodate current patient volumes. In addition, it acted as the front door to the hospital. This set-up resulted in most pedestrian traffic moving through the department to access other areas of the facility, constricting access for emergent patients.
Haskell suggested moving the ED to a different part of the hospital in a newly built addition. Moving the department would improve access by separating ED traffic from patients and visitors for other departments. The new location also allows for the opportunity to build a new tower if the hospital’s patient population were to increase. Using the data provided by Haskell , management presented the plan for the new ED to its board to secure funding.
The hospital’s competitor was rumored to be shutting down. With only two hospitals in the city, having one close would cause an influx of patients in the remaining hospital. If our hospital was unable to accommodate the increased volume, patients would need to travel farther to receive care. Not knowing with certainty whether the competitor would actually close, management was unsure how to approach planning for possibly increased volume.
Initially management thought they might need to spend $100 million on a new, multistory tower. Haskell evaluated different solutions to account for either incremental growth or an inundation of patients. Haskell developed options that allowed the hospital to adjust based on future scenarios. We outlined methods to relocate and streamline services to create inpatient capacity. Finding an operations solution gave the hospital the flexibility to quickly create capacity if needed rather than prematurely committing to a large capital investment.
The relocated ED also allowed for the addition of a patient tower if it was ultimately needed and be appropriately co-located with primary entry points for patients and adjacencies with clinical and support departments. Coordinating the location of the new ED with options for different growth scenarios gave the hospital a stepwise roadmap of solutions to follow based on what happened in the market.
Our client was grateful for the operations solutions Haskell provided that would eliminate the need for an immediate $100 million investment in addition to the capital needed for the new ED. They also appreciated having a clear path forward to address the multiple scenarios that could happen in the market.
Maximizing Space on a Landlocked Site
Project Details
The Problem
Landlocked on an island, the hospital had very minimal land for expansion but needed a solution to their capacity challenges. With over 50 operating rooms across 8 different OR platforms and 1,000+ inpatient beds, there were significant operational challenges that exacerbated capacity constraints. A majority of the operating rooms were small for the types of cases being performed in them and several of the intensive care units were undersized. Given the hospital’s continued strategic growth in tertiary services, the hospital needed more capacity and treatment spaces capable of serving their high-acuity patient population.
The Approach
The hospital’s service area adult population was projected to grow 1.7% annually over the next five years. Overlaid with their aging demographics, the market was projected to see notable growth in Cardiac Surgery, Neurology, and Spine. We analyzed the hospital’s historical volume and operational data to identify current capacity trends and challenges. Marrying this data up with physical design restrictions, our team identified a need for additional ICU, OR, and support services capacity.
Our team recommended a pavilion expansion to house new intensive care beds and support services. Some existing ICU rooms could be renovated in place, but an expansion was still necessary to get the campus to the compliment of beds it needed to support market demand and strategic growth initiatives. A phased OR solution was recommended to right-size and modernize the main OR platform and a clean-core was recommended to improve operational flow. While the recommendations came with a high price tag, our team quantified a positive return on investment in less than 5 years.
Phased Implementation Breaks Improvements into Affordable Chunks
Project Details
The Problem
Located in the foothills of the Blue Ridge Mountains, a regional health system was faced with aging facilities, an imperative to control costs, and a competitor gaining a foothold in the market. Until a few years ago, the system had been anchored by two acute care facilities. Changes in utilization and reimbursement and an increasing need to manage costs prompted health system leaders to discontinue acute care services at one campus.
System leadership, armed with a market assessment and strategic plan developed with help from staff, acknowledged a need for even more changes to support a broader approach to not only adequately serve the community but also compete with providers located in adjacent counties.
The Approach
The Haskell project team evaluated the built network of service outlets, including both acute care facilities, long-term-care facilities, and select ambulatory facilities. conducted a robust analysis of patient utilization and trends. We then aligned these findings with insights gained from numerous stakeholder interviews to determine how to support the community in the near and long term.
Haskell provided our client with a multifaceted solution that addressed spending, infrastructure improvement needs, and a whole-system perspective. The solution validated some beliefs of the system staff and delivered a workable plan that accommodated market changes. Recommendations for the campus leadership wanted to shutter focused on improving the patient experience and updating the space and its equipment. Haskell’s plan included a phased implementation that broke improvements into affordable chunks. Despite the high initial investment to realize the plan, the system saved money over the long term.
Providing Flexibility to Plan Long-Term While Addressing Short-Term Challenges
Project Details
The Problem
Facing inpatient capacity constraints, the leadership team of an independent community hospital wanted to position the campus for the future with a focus on the interventional platform. The hospital engaged Haskell to develop concepts for long-range campus development focused on its priorities of rightsizing the interventional platform and increasing inpatient bed capacity.
During the planning process, however, a more urgent situation presented itself: a group of orthopedic surgeons affiliated with the hospital was developing its own ambulatory surgery center. The physicians group used the hospital’s surgical facilities and was the main driver of OR volume. While the group was moving their ambulatory cases off-campus, they requested a capital investment for an inpatient orthopedic “center of excellence.” The upgraded orthopedic center would not necessarily result in more inpatient cases, but it would mean less capital would be available for other initiatives. Therefore, the hospital reordered Haskell’s priorities to provide advice on how to best handle the physician group’s proposal.
The Approach
The hospital’s leadership wanted to invest in the new orthopedic center. Haskell provided a financial analysis around the proposal; the net present value analysis showed that investing was not a good move in the long run. However, we suggested rebranding current orthopedic surgical services as the and investing in refreshing the existing OR platform.
As part of our analysis, we found that the surgical department was severely undersized, with a need for an additional OR and incremental support space across the interventional platform. However, our team identified opportunities to improve operational standards to reduce turnaround times and increase capacity. In the short term, hospital leadership wanted an OR added to the current department. This solution was fast-tracked, and Haskell was brought in to design the new ER while we continued the master planning effort.
Haskell’s solutions allowed SCH to adapt and improve their campus between the ORs and inpatient units instead of focusing their investments on an area that would not provide growth. Our client appreciated our ability to present a flexible approach that allowed them to navigate short-term issues while keeping the larger macro plans front-of-mind. We provided data from financial, strategic, and operational perspectives that gave our client leverage to negotiate with the physicians group while seeing tangible results from addressing short-term issues.
Our clients said: “Haskell has turned a comprehensive road map into exceptional results through strategic analytics, master planning, facilities condition assessment, and patient flow enhancements. Through a collaborative and integrated process, these results are driving value to our patients and their families, are aligned to the strategic direction of the organization, and are helping as we continue to continuously improve the organization.”
Supporting Growth of Specialty Services
Project Details
The Problem
A 259-bed, acute-care hospital with multiple complex specialties was facing a growing patient population that was straining existing capacity. Two specialties, cancer and cardiovascular, had outgrown their facilities. Cardiovascular services were significantly undersized and located on the opposite side of campus from the ED and surgery, causing significant travel for highly time-contingent patients. Existing cancer services were not contiguous and lacked ease of access for the quantity of patients seeking care. Medical oncology was in a separate building down the street, while radiation oncology was tucked in a back corner of the acute campus with no room for expansion due to unusable terrain. An internal expansion to accommodate growth or equipment replacement would displace existing imaging modalities and push cancer services into the oldest structure of the facility.
The Approach
The Haskell team developed a strategic facility master plan to recommend operations and design strategies to increase patient capacity.
Haskell proposed that cancer services be offered off-site from the acute campus due to patient needs, growth projections, and physical campus restrictions. This would allow for additional capacity on-site for services that would need coupling with procedural and inpatient areas and be most appropriate for the area’s demographic and market while also offering an opportunity to build all cancer services together in one new building.
Haskell recommended organizing the campus with complex, high-acuity, and inpatient services co-located in one zone, including diagnostic and treatment areas with clear expansion zones for long-term campus viability.
Inpatient services could be expanded in two shelled units of the newest building so that older beds could be decommissioned. Haskell proposed creating additional inpatient capacity through a dedicated observation unit that would be located adjacent to the ED rather than on an existing inpatient unit. This would enable synergies in operations between the ED oversight of these patients while locating them in a cost-appropriate design.
The proposed architectural solutions were scheduled to be implemented at a cost of $240 million over a five-year period.
The Impact of Systemization of Facility Planning
Project Details
The Problem
When we first met the system leaders of a conglomerate of multiple Catholic health systems throughout a large metro area, they had recently been acquired. One of their first strategic initiative as a member of the largest Catholic health system in the United States was for Haskell to lead the development of their systemwide facilities master plan.
Encompassing 17 campuses spread over 90+ miles in a highly competitive market, the health system wanted to identify pain points within their existing facilities, capitalize on opportunities for consolidation, and set the campuses and system up for long-term viability.
The Approach
Given the geographic spread of the hospitals, we started by breaking the network up into three regions: Metro, Northwest, and South. Understanding the priorities at a regional level allowed the system’s leadership team to understand each region’s top priorities so they could determine how they fit into the overall capital plan. Haskell deployed individual teams to work closely with regional and hospital-specific decision-makers as well as leaders from each region to work in tandem with system leaders. Communication was key in successfully executing our multipronged approach:
To determine priorities, it was crucial to have data that could support decision-making and capital investment. To provide this evidence, Haskell reviewed hospital- and market-specific data and benchmarked each facility to determine how critical each campus’ needs were. With limited capital available to be invested throughout this large system, Haskell was able to provide quantifiable data to help the health system rank facility investments based on criticality and their ROI potential.
Key to the success of this endeavor was Haskell’s ability to ensure the right staff members were included in the conversations about priorities. The integration of these groups increased transparency throughout the process and ensured that all voices were represented.
By creating a master plan for each campus, Haskell provided a road map and a level of consistency for how facility investments would be phased in the 10-year horizon and beyond. Haskell’s recommendations were scalable to what is appropriate to each facility, whether that involved expanding and modernizing a campus, consolidating services, or monetizing the property.
Haskell provided real-world, actionable recommendations, backed by data, that the client was able to adopt systemwide. Our ability to facilitate discussions and work with leadership teams helped guide the planning process to achieve solutions that benefit not only the health system but also the community as a whole.
Understanding Where to Invest in a Growing Market
Project Details
The Problem
Haskell completed a strategic facility master plan for a children’s hospital in 2016. After successfully implementing recruitment strategies and with population growth exceeding expectations, the hospital experienced notable volume growth in acute care and surgery, and the infectious disease inpatient service line — which accounts for nearly 20% of discharges — saw 16% annual growth over a five-year period.
Once the only children’s hospital in the region, our client saw signs of a competitor moving in and engaged Haskell to revisit their strategic facility master plan to address growing need in the area and position itself against the competition.
The Approach
With growth project in almost every service line and continued efforts to capture the tertiary/quaternary pediatric population, the hospital faced significant inpatient bed capacity constraints in the five-year horizon. Given current capacity limitations, shrinking market share associated with a competitor hospital, and the threat of new market entrant, Haskell evaluated three scenarios:
While doable, adding capacity to the existing campus posed some significant challenges. This solution exacerbated congestion and wayfinding challenges. It also required an expensive parking deck solution that allocated capital to non-patient-treatment functions. Finally, this option did not achieve the leadership team’s goals to bring care closer to patients. The alternative two options provided care outside of the urban core, allowed low-acuity patients to be treated closer to home, and shifted low-acuity volume out of the hospital to make space for the influx of tertiary, maternal fetal medicine, and behavioral health volume associated with strategic initiatives.
To evaluate the other two options, Haskell analyzed various demographic variables, residential and commercial development, traffic patterns, and existing pediatric provider locations. Overlaying these variables allowed our team to identify an ideal location from a patient need, facility access, and strategic growth perspective. Our team quantified the program needs for each option and developed high-level costs to understand the impact of all the options on the table. Haskell’s analysis and findings helped the health system better understand where to best invest in this growing market.
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