By Gary P. Wilkinson and Ellyn Roberts / Special to Healthcare Facilities Today

According to a "Project Solution" article on the KMLK Group's website, there is a standard in clinical training that there are “5 Rights” for delegation and medication management.

The same can be said for staff operational readiness, say authors Gary P. Wilkinson, KMLK principal and director of facility activation solutions, and Ellyn Roberts, principal consultant. Excellent patient care and continuity of care is the goal and objective of staff operational readiness. In order to achieve this standard, an organization must commit to the following:

• Staff orientation, education and training 

• Proper operating sequences

• Appropriate staff alignment

• Technology education and implementation

• Equipment education and implementation

A replacement facility is operationally ready when the "5 Rights of Operational Readiness" have been achieved. Too often operational planning occurs to an organization as an afterthought, but what defines a successful capital project is the combination of both facility readiness and staff operational readiness. Operational readiness is a living, fluid and flexible process with multiple moving parts and interdepartmental implications. The result of following a structured operational planning schedule will be confident staff that is well prepared to perform and exceed patient care expectations.

The vision for a replacement hospital varies from one system to the next. Communication of the vision and mission from leadership sets the tone for the goals of operational planning. Prior to beginning staff Operational Planning, it is important to perform a baseline assessment on the unique qualities of the hospital system and the community it serves. The current organizational structure, its politics and its patient population are all additional components for assessment and operational planning consideration. Understanding all of these components will set the tone, approach and ultimate success of facility activation services as a whole. 

Key components of staff operational planning

Generally, a replacement hospital affords an opportunity to improve upon current operational practices, enhance technology systems, standardize processes, and update organizational policies and procedures. First, it is essential to develop a communication plan to all stakeholders early in the operational planning strategy and maintain regular, open and accurate channels of communication throughout the process. Both an internal and external communication plan will serve as a guide and reminder of the vision, mission and goals for accomplishing the challenges throughout the process. 

Another important component of staff operational planning is the early and frequent inclusion of stakeholders. Stakeholders and end users are eager to participate, desire to have input and want to feel empowered to have an impact on outcomes of the processes that impact patient care. 

This should begin at an administrative level with the objective of gaining ‘buy in’ from administration, physicians, and board members, other key leaders and clinicians. High-level communications and early exposure to project plans, goals and mission, will set the stage and momentum. Next, the establishment of a steering committee will include and involve major stakeholders and afford them an opportunity in decision making and conflict resolution. Once established, stakeholder user groups can be formed. These teams are the front line employees engaged in developing current and future state patient and process flows. 

Key components of staff operational readiness

Staff orientation, training and education are significant components of the operational readiness process. The responsibility of staff training will involve many hospital departments. Human Resources may have an educational team associated with it; consultants may participate in staff training; and often each unit/department assigns and develops project champions to spearhead the orientation, education and training process. Often, an orientation and education ‘passport’ or ‘checklist’ is designed to reflect all training stations, vendor training, facility wide and unit specific requirements. This checklist is used to document staff participation in training for management, human resources, Joint Commission and any other regulatory purposes. The staff training package is designed around construction and facility activation schedules and is a component of the overall transition budget. Staff overtime (includes OT coverage for all departments as defined necessary); per diem staff and RN traveler cost should be captured in this budget item. 

Tools for staff operational readiness:

1) Conducting stakeholder assessment interviews is the starting point for gauging the status of stakeholder’s perceptions at a particular time in the operational planning process. Implementing a structured process to gather baseline data will provide valuable information prior to the development of current state processes.

2) The 'current state' flow diagram graphically represents current processes and allows for the identification and investigation of operational barriers and failure modes. Also, creating the Current state process map often leads to the identification of opportunities for process optimization and improvement. An outcome of this process is a list of priorities, risks and action items. To begin, the hospital may consider the use of unit specific floor plans and guided tours on each unit. Be sure to identify gaps and/or barriers and document them on an issues log.

3) 'Future state' mapping balances staff need, opportunity, and available resources. Teams will often have far more ideas for improvement than can reasonably be achieved in the future state map’s time frame. The future state is not a wish list but is a vision of how the value stream will really look. As projects are completed, current and future state maps should be updated.

4) 5-S is a tool that each unit/department will use to identify the proper place for all equipment and supplies. In addition, it will aid in the maintenance and availability of materials. Transitioning to a replacement facility affords the opportunity to de-clutter and remove outdated overstock. Actively engaging clinicians to work with Materials Management will ensure that each unit is stocked with only necessary and relevant materials. This effort will foster teamwork, collaboration and trust among departments which will be critical for success in the new facility.

5) Practice, evaluate and reassess throughout the process. Staff operational readiness does not focus solely on clinical processes. Every department or unit is impacted by the operational changes and each is significantly important to the success of the overall project. Other considerations to address throughout staff operational readiness preparation are:

      • Human resources strategy should include recruiting and on-boarding of additional support and clinical/physician staff; updating existing organizational policies and procedures to reflect newly developed processes; and managing and documenting staff orientation, education and training.

      • IT Strategy should involve both the changes and additions to new hardware as well as IT integration with medical equipment. IT’s involvement is essential to operational readiness and project success as they must ensure all systems are available, properly integrated and ready for staff training usage.

      • Construction; furniture, fixtures, equipment and technology (FFE&T); schedules; budgets and tracking programs are similarly essential for achieving facility activation and operational readiness. The timing of the implementation of these elements of a project is key to validating the operational workflows that were established during design. It behooves the hospital, staff, and physicians to allow the proper amount of time between construction completion and “Go Live”. 

Conclusion

Staff operational readiness does not end with the patient move. A post occupancy evaluation should be conducted to assess newly implemented processes and flows. Best practices and lingering issues should be identified and addressed. Opportunities to refine or improve systems should be evaluated at one, three and six months post occupancy.

It is important to acknowledge that no one tool or exercise can stand alone in staff operational readiness planning. As mentioned earlier, the unique challenges of each organization will set the baseline for beginning the staff operational readiness process and help determine the specific tools most effective for that system. Collaboration, flexibility, and a willingness to constantly adapt to ensure patient safety and care are keys to achieving optimal Operational Readiness. 

 Read the article with enhanced graphics.