Implementing Healthcare Excellence: The Vital Role of the CEO in Evidence-Based Design

By Craig M. Zimring, Ph.D.; Godfried L. Augenbroe, MSCE; Eileen B. Manone, RN, MSN; Blair L. Sadler, JD

Published by The Center for Health Design and Georgia Institute of Technology College of Architecture, 2008

EXECUTIVE SUMMARY

There is growing evidence that chief executive officers (CEOs) can use research-validated evidence-based design (EBD) fea- tures as a tool to transform healthcare safety and quality. This paper explores how successful CEOs were able to navigate the multiyear process of project development. The utilization of EBD to create a building that supports cultural transforma- tion and care redesign can reduce patient and staff harm and stress and still improve the bottom line.

The CEOs of successful projects were the pivotal leaders who inspired their orga- nizations to measure and confront unacceptable patient and staff outcomes, established strategies to meet improvement goals, and required disciplined reengineering of clinical and business processes—resulting in the achievement of the organizations’ desired end state.

This paper also identifies 10 strategies that reflect the systems thinking and leadership approaches shared by CEOs who bridged the gap between aspiration and reality. They used daily decision-making and team-shaping opportunities over the lifecycle of the building to create a genuinely healing environment.

This paper is adapted from a full-length article, “Implementing Healthcare Excellence: The Vital Role of the CEO in Evidence-Based Design” by Craig M. Zimring, Godfried L. Augenbroe, Eileen B. Malone, and Blair L. Sadler, originally published in the spring 2008 issue of HERD (Health Environments Research and Design Journal), Vol. 1, No. 3. For more information about HERD, visit the website at www.herdjournal.com.

As the United States enters one of the largest waves of healthcare facility building in our nation’s history—with construction projected to exceed $67 billion a year by 2012 (FMI, 2008)—some leading healthcare organizations are using their construction programs as a catalyst to bring about significant, measurable improvements in key patient, staff, and organizational outcomes, such as increasing patient safety, improving patient and family satisfaction, increasing market share, increasing the effectiveness of its work force, improving retention and reducing turnover, and increasing revenue and reducing cost.

For example, OhioHealth’s new facility, Dublin Methodist Hospital, has been open for 8 months and has yet to experience a single hospital-acquired infection; Press-Ganey patient satisfaction scores remain above the 98th percentile, and staff turnover is below 6% (C. Herbert, personal com- munication, 2008). It appears that its innovative built environment has played a significant role in these results along with significant investments in clinical and process improvements and culture development.

While every organization would like to achieve the kinds of transformational outcomes that are emerging at Dublin Methodist Hospital, many projects fall short of their potential. We have spent the past year exploring how some organizations have been able to navigate the multiyear process of project development and remain true to their vision of facilities that work with cultural transformation and care-process redesign to help transform healthcare quality and safety. We found that successful organizations often represent a fundamental shift in the way healthcare organizations think about, deliver, and manage buildings. Rather than simply being regarded as cost centers, facilities are seen as an integral part of a healing environment where the facilities are fundamental components of a system that includes capital investment, culture and care, clinical, and business process. Successful organizations put in place structured evidence-based processes that established broad agreement on principles underlying the design; articulated goals that must be satisfied to achieve those principles; and set measurable, expected outcomes. They infused these principles, goals, and expected outcomes throughout all steps of planning, designing, and operating buildings, establishing specific measurement, re- porting, and accountability at each step. The successful projects reflected an organization’s ability to recognize its problems, an openness to change, a willingness to measure, and the ability to take action based on the results of measurement.

Further, we found that, while project planning and development are often outsourced to construction management firms or architects or are handled by facility staff, even a highly competent team cannot replace the key role of the chief executive officer (CEO) and other senior executives. The CEO is in a unique position to cut across departments and specialties—break down silos—and create an agile and open organization that can deliver much safer, higher quality, and more efficient healthcare. Many complex decisions will be made during an evidence-based design (EBD) journey; the effective CEO shapes a culture and process that ensures that the best decisions are made for the organization.

These conclusions are based on significant original research. We interviewed CEOs who have led current and completed construction projects, examined published and unpublished case materials about transforma- tional projects, and drew on our experience as researchers, consultants, and CEOs. We conducted 28 interviews with CEOs or senior staff from Ascension Health, DeKalb Medical, Emory HealthCare, Kaiser Permanente, Massachusetts General Hospital, MCGHealth, MD Anderson Cancer Center, Memorial Sloan-Kettering Cancer Center, LSU Health Sciences Center, OhioHealth, Palomar Pomerado Health, and others. We examined case material from The Center for Health Design’s Pebble Project, Healthcare Design magazine, and other sources.

However this paper is a guide to CEOs rather than a research paper; our detailed results are available elsewhere (Zimring, Augenbroe, Malone, & Sadler, 2008). Rather, this paper addresses several questions:

• How have these organizations actually been able to implement trans- formational change, moving beyond rhetoric to action?
• What is the role of the CEO and other senior executives in creating transformational change that significantly improves outcomes for patients, staff, and organization?
• What are the key considerations for the busy CEO?