Q&A: How to lead a hospital transitioning to a new facility

When Thomas McAfee, MHA, took over as president of Lake Forest Hospital in Lake Forest, Illinois, in 2006, he already knew the existing facility, opened in 1940, needed to be replaced. Nearly 12 years later, after an extensive planning process and a change in ownership as the hospital became affiliated with Northwestern Medicine, the new $400 million facility is ready to welcome patients.

Other options were considered, like retrofitting or renovating the older hospital, but McAfee told HealthExec the price tag didn’t make sense considering how much more could be achieved by starting from scratch. What helped was the abundant land the hospital had to build upon, which allowed for expansion while also respecting the wishes of a “conservative community” like Lake Forest, for which this was the biggest capital project in town history.

“I’ve been an administrator for a long time and this is the first time in my professional career that I’ve had enough flexibility in mapping out a campus plan to really do it right,” McAfee said.

The nearly 500,000-square-foot facility is surrounded by 116 acres of open space and 7,000 feet of walking and bike paths, while inside it includes 114 private rooms, 72 outpatient care spaces, 106 exam rooms, 16 emergency room treatment bays and eight operating rooms.

Ahead of the final move on March 3, McAfee spoke to HealthExec about how the hospital went through the planning, design and construction process and what other C-suite leaders can do to make their own transitions to new facilities successful.

HealthExec: What are some of the challenges leading an organization making this kind of transition, especially considering you merged with another hospital during this period?

Thomas McAfee, MHA: It’s been an interesting time because our market has evolved. Internally, we needed to realign our organization and make heavy investments to be competitive in our market. Large health systems had acquired or grown up and around Lake Forest, so from my perspective as the new CEO at the time, we needed to make a variety of investments. The new hospital was just one of many. We also had to make some internal adjustments in our clinical offerings to make sure we had a clinical base that not only met the needs of the community but was also economically viable. We started to make a variety of changes years ago in building a clinical platform that would complemented by this new hospital.

I would say flexibility, first and foremost, is what you need to be successful in taking on that level of change, and, also, being able to articulate to your management team where you’re headed and what’s the goal. For us, we were laser-focused on bringing Lake Forest Hospital to being one of the best-performing community hospitals in the country on every metric.

That worked beautifully with Northwestern’s vision of being a top academic health system in the country, so when we came together, we really didn’t lose a stride. The preliminary work was completely aligned with where they believed healthcare needed to progress in our region and we just continued to invest in clinical talent, IT and building the program and systems we could leverage as a health system—like our ambulatory facilities, our multi-specialty platform in Glenview and immediate care centers deployed in the region—and the new hospital is really just the cherry on the dessert.

What kind of input did physicians, nurses and other staff members at the hospital have on its design—and did patients in the community have some say as well?

Absolutely, it was vital we have all our key stakeholders actively engaged in helping us design this new hospital. It’s a once-in-the-lifetime opportunity and we wanted to make it the best we possibly could, so we started with our patients. We have a patient family advisory group that participates in helping us with our routine operations, but they were actively engaged on the design.

We created what we called “Styrofoam City.” In a building where we had a large, open space, we reconstructed a patient room, a surgical suite, a clinical documentation area—all to scale—and had our staff assess everything from how high the bathrobe hooks should be and where light switches should be placed, door swings, equipment and counter heights. Everything associated with each of the designs, we had staff active staff participation in that process. We felt it was critical.

It also helps with buy-in. They literally had the design laid out for them and could see the benefits and drawbacks with some of the scenarios we played out.

Even though the staff had their say, at the end of the day it’s still a new and unfamiliar facility. How do you address the operational challenges of making it feel familiar before it creates problems in delivering care?

It’s a process we called activation, a very formal and comprehensive way of reducing the change management associated with people moving into new spaces. We’re introducing people to a lot of new technology, too, not just the physical configuration of the space change. We had a principle to try and limit the new technology, believe it or not, that was introduced for the first time in the new hospital.

For example, we flipped our phone system that’s identical to the one in the new hospital a few years ago so that staff could get used to it. We acquired new anesthesia equipment earlier. Even the patient beds we acquired earlier in the process, so we weren’t introducing change in that regard.

We also made a series of management changes that were designed to reflect what we expected to be the right clinical management structure in the new hospital, given its integrated clinic/hospital design. We even tried to incorporate teams which were used to working together so that they were used to working together so that when they were introduced to the new building, you weren’t introducing new relationships, new leadership changes and new technology.

We also went through a very thoughtful and coordinated training simulation program. We not only did tabletop exercises to simulate workflow, but we had a whole team of process improvement engineers that worked with our staff to map out their old processes in the old hospital, map them out in the new hospital, used lean engineering and process improvement methodology to see if there’s opportunities to reduce waste or improve efficiency.

This whole process comes to an end March 3 when patients will be transferred over. What will that day be like?

As part of our simulation exercises, we’ve gone through a series of mock moves. We’ll have a command center established, with a team that is responsible for prepping the patients and getting them ready to leave the old hospital and another team equipped to accept those patients and getting them registered in the new system and repopulate them the new hospital.

We hope to have this as a non-event. We expect it to take roughly three hours, depending on our patient census and the acuity of our patients on (March 3). Starting at 6 a.m., we’ll start a coordinated move, running two hospitals simultaneously until we repopulate the new hospital. We’ll take the most acute patients first—the emergency room and the operating room will be flipped first—and then rapidly close off the access to old hospital and redirect everyone to the new. We expect about half our patients to come by wheelchair and then the other half will come by ambulance. Probably around 11 a.m., we should be fully active in the new hospital.

For other hospital leaders considering or planning on replacing their current facility, what would your advice be?

When you take on a project which has this kind of time horizon, you have to be enormously flexible. What we thought was a great idea several years back might not be so logical anymore given what’s happened in the marketplace or from a technological standpoint. Flexibility is paramount, and we really designed this building to be flexible. We really looked to reduce variance. There’s also this desire that some department have special attributes that you have to accommodate, but that’s really a disservice to your ability to be flexible.

All our operating rooms are identical; all the pre- and post-procedural rooms are identical. It doesn’t matter whether you’re there for an MRI or an outpatient surgery, the front and back end of that process, the variance was really very limited. Obviously, there are some clinical attributes you have to accommodate, but we designed the space to be almost generic to support all of those. Make sure what you’re designing is flexible, because so much is changing in this world.

I’d say you to have to heavily engage all the key stakeholders in your process, identify principles at the onset and back them up with true metrics. We have efficiency metrics, operational metrics that we will continue to track so we’ll know what’s the full-time-equivalent delta, did we achieve our efficiency metrics, our through-put metrics, our patient satisfaction metrics that we agreed on at the onset.