Leaner Decision-making

“When you come to a fork in the road, take it.” This quote actually came from Yogi Berra giving directions to Joe Garagiola, who was coming to his New Jersey home. As it turns out, his home was accessible by two routes—either way would get to the same place.

Decisions should be easy, right? If you take Yogi’s advice, you just need to pick one and get on with it. Unfortunately, most healthcare design and construction-related decisions do not take you to the same place, and various routes have vastly different impact.

At our oldest child’s graduation last weekend, I learned “Dare to Plan” is the motto for the University of Illinois’ 100 year anniversary of their College of Urban Planning (the oldest in the country). The “dare” part of setting a plan is you have to live with decisions made ahead of time.  Further, the more money involved and the more people affected, makes critical decisions even more difficult.

Most healthcare projects require plans involving high-dollar decisions that affect large numbers of people and go through sometimes laborious administrative approvals. Many times a delayed decision results in unwanted cost impact. Although it is easy to cast blame on the decision-maker, more often there is insufficient backup preparation to allow a timely decision to be made, and sometimes “analysis-paralysis” results.

One of the challenges we face in working toward leaner, more efficient design and construction of healthcare facilities is that decisions need to be made early enough to allow follow-on activities such as design, coordination, prefabrication, site logistics, installation, and start-up to happen in proper sequence.

Today, we have more accurate tools (such as one page “A3’s”), better technologies (such as computer-modeling or BIM), more collaborative processes (such as “IPD”) and loads of ‘great practice’ examples at our disposal. It takes a team approach to not only design and build the building, but increasingly, to provide the proper metrics to allow informed, timely decisions to be made along the way. In best application of these, a few example questions may be asked about the information used in making the decision:

  • How current is reference information? Has it been updated in the past 2 quarters? [Market Data]
  • How similar is the reference project to the subject project? How many applicable similarities (or differences) are you able to draw conclusions from? [Relevant]
  • Which choices make a difference and which don’t? [Sensitive Variables]
  • What was the outcome of prior projects or decisions? What would they do again (or not)? [Reference/Outcomes]
  • What were/are the long term impacts? [Life Cycle]
  • How widely have the proposed solutions been reviewed by the right people? [Buy-In]
  • What are the Pro’s and Con’s? [Choosing By Advantages]

If the majority of these items are covered, there is a very good chance that solid, timely, and informed decisions can be made. If not—it might be good to get the team to take another look at the back-up.

Many design and construction teams today have approaches to aiding decision-makers, with early project planning. At Turner, we have a database tool (T-Cost Model) which is able to analyze hundreds of sensitive variables, based on preliminary quantitative information, utilizing data on hundreds of healthcare projects from our experience, to give solid support for long-term planning decisions.  The goal is to help confidently drive facility costs down, increasing savings below reimbursement, while maximizing patient satisfaction and outcomes.

“Waiting is waste of time” may seem a Yogi-ish banality, but we find ourselves waiting more often than we realize.  Bringing together a proactive team, experienced in using the latest tools, processes and technologies, while addressing questions like those above, gives the best opportunity to make critical decisions, execute the plan timely and produce successful results.

I would be happy to hear your thoughts (or favorite quote)—

— Steve Whitcraft, CHC, CPC, EDAC, is director of healthcare for Turner Construction Company, and he can be reached at swhitcraft@tcco.com


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