Join us for an enlightening conversation on healthcare facility design as we dive into the world of innovative architecture and its profound impact on healthcare spaces. In this first part of our series, we have the pleasure of hosting two esteemed architects from CMBA: Jim Brisnehan and Shane Labenz. Together, they bring decades of experience and a wealth of knowledge in designing cutting-edge healthcare environments.
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Episode Transcript
Skyler: Welcome to another episode of laying the foundation. Welcome back, everybody, to another episode of laying the foundation podcast. Now I'm really excited because in front of me today I've got Shane and I've got Jim. They're both architects from over in our Grand Island Nebraska branch and today they're going to sit down and talk to all of us about what it goes, or what goes into creating and designing a really truly exceptional healthcare facility. These guys I mean I couldn't get them to not talk about it before we started recording. So, guys, I'm really excited to have both of you on here, because I know you both have a lot to say. So I don't know.
If one of you wants yeah, if one of you wants to make a starting point and jump off, but I guess, at the end of the day, the real question, like I said, is what goes in? What does it take to make a really cool and functional healthcare facility or hospital?
Shane: whatever the case, that's funny because, as we were, right before we started recording, jim and I were just kind of talking and it was kind of a really interesting back and forth about you know well, what do we actually start talking about? Because hospitals are such a complex animal? Oh, absolutely, and so being able to pinpoint like certain things can be really very hard. Oh yeah, and so we're excited not only to be here today and talk about this, but potentially even as a springboard into future conversations as well.
Skyler: Oh, absolutely yeah.
Shane: So, as we've been working on hospitals, we've noticed a couple really very important things that help us to designing really critical, important, exciting healthcare spaces. Big pieces especially from where you start at is being able to have an administrative team that's all pulling in the same direction and having that leadership really set the standard and then having department leaders within each of the departments really following suit and coming together to form really a cohesive whole Because, like I said, hospitals are super complex animals with several different departments that are very well intertwined.
Jim: The other thing that I would add to that is the fact that we do rural hospitals, so they're community based. Community is very important to the hospitals. If you're out in a smaller town, the hospital may be the place that people gather for coffee or meals or anything else. It's not just a place where people are seeking medical treatment and such. So community involvement is extremely important as we go to design or to rehab a hospital facility.
Skyler: So what would be some of those ways that you would design the healthcare space in order to enhance that unity within the community? I saw that on a sign as I was driving in here. I think I passed through Central City and they have a big sign right by the highway that says community. But then unity is all like in bold and stuff. But yeah, how do you kind of help create that, since it is such an important space to the community?
Jim: Well, typically we really want to get the public involved. So we want to, after we've kind of got a vision for what the staff and the administration wants, a very conceptual staff. We want to talk to the public.
We want to have I think it's very important to have open houses and kind of show them what we're thinking and show them how much it's going to cost, because in some cases it may be a bond referendum. In other cases they can just do it, but it usually comes down to a board vote or something that's going to allow the project to move forward. So it's very important to inform the community. It's going to be put in papers. We want to make sure we get a digital presence on the situation so that everybody can get the correct information and give input for what it means. Hospitals do a lot of things, but no two are the same Right. They're very community driven in how they appear and how they want to be Absolutely, and they're individual to the people who are actually working there.
Shane: Yeah, another thing that I've seen is that when you're talking about what that message looks like to the community, it's really very critical to get the staff on board.
Because, who are you going to be more willing to listen to? That's bought into that idea, that really sells yourself, your community and is looking out for your best interests. And your friend down the street, right? The person who works at the facility, right? So getting those people engaged early on in the design process to help us to understand what really works and what for their community, their needs, is super critical and we've taken that all the way into that further design process where we start working with those staff closest to the work.
Yeah, it's important to have people at the top setting that overall vision, but to have people who buy into that process and method are the ones that get to design it themselves, right.
And so we go through processes where we're working one on one with the staff the nurses, the environmental services people, the people who are runners delivering things between different departments where they get to go through and tell us what steps do they want to take, right, how do they want to work. And then we go through with them to figure out how do we arrange all of the pieces of this complex puzzle to support the way that they want to work Right. And when they have that sort of level of input. Their buy-in is super high because they designed it themselves. And then by the time we go fast forward a year, two years, even five years down the road construction projects take time, but by the time that those departments open up, those people have already walked through and figured out how they wanted to work. They've gone back to their old facility and they've started to integrate some of those new processes and flows into their workflow. Now and then when they get into a space that actually supports that, it clicks because, they designed it.
It's there so they understand it. Then they get to go talk to their friends about like this is what we needed.
Skyler: This is why it's good for us they get to kind of practice because obviously if you have a preexisting healthcare facility that already exists like a hospital, you don't shut down because, hey, we got some renovations or some construction that we got to do, like these people are working in it. But, like you said, they get to see the new space that they'll be working within and they get to sort of pseudo integrate that along the way until it's ready for them to kind of move into.
Shane: Yeah, One of the hard parts about the healthcare spaces that these people work in is that they've especially the ones closest to the work, like I said, the nursing staff or whomever they figured out what's wrong with their system, so they figured out their own workflows to circumvent the problem. Yeah, yeah, okay Well what if that was no longer a problem? How much time, money, effort, how much that would save them and how much more time than they would be spending with patients, with their family, with their friends, absolutely Actually caring for people.
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Jim: Yeah, as we deal with staff, there's really two types of staff that we typically run into, and one of them is the staff that embraces change and wants to figure out better ways to do things Right. And then, of course, you've always got the staff who's. This is the way we've always done it.
Skyler: Yep.
Jim: I'm not sure I want to go outside of my box. Is this really right? I'm comfortable doing it this way and for those folks, we've got a process that we'd like to do, which is called Lane PE.
Okay, welcome to Science we love, but it's really running the folks through a simulation of what their space is going to look like.
Skyler: Oh, ok, and.
Jim: Shane can probably go through that a little bit more so and kind of run you through the steps, but it really helps them visualize, not just in renderings and stuff that we may do, but in a full-fledged scale mock-up of what it means.
Skyler: OK, you want to talk about that one a little bit, shane?
Shane: Yeah, so this is a process that I got incorporated in probably about seven, six years ago. Ok, had a really great opportunity here in Central Nebraska to work with a great staff that really embraced that change and, like I said, that vision came from the top. Ok, and while there was some reluctance, especially as you go into something you don't know, I learned a whole lot about health care myself.
Sure yeah.
Shane: That these people that I'm working with cannot read plans. So they can't. They don't know what I'm drawing Right and I don't know what they're doing. So we were kind of on like this level playing field where both of us wanted the same outcome, but we are coming at it from two different directions, which gave us a lot of opportunity to kind of think creatively and bringing in other areas, other departments, representatives from the hospital, so that they had some insight as well. You know, somebody might have figured this out already. We just don't know about it because we work in our own little Right Silos.
So we bring all of these people together and, like I said, we work through their processes and flows. They get to tell me how they want to work and then we go through and and say, ok, well, we know that we have this many patient rooms, we have this many nursing stations, we have toilets and other support spaces, we need offices, stuff like that. Well, then we get to start thinking about how those layout, how they lay out in relationship to each other, and then we like fast forward, right, we start building this out of cardboard, three dimensional and tested out, because it's not good enough to look at it on a floor plan that they don't understand spatially what that feels like, and I don't understand experientially, like how they actually work in.
So we get a building in full scale cardboard and allow the staff to come in and actually start experiencing that space. It's no longer just a couple lines on a plan, it's a room that you're in, that you're pretending to practice running through simulations about how, how do we do work and as we have some people participating in those simulations, we have others who have had insight or input into the process and flow that look on.
Jim: OK.
Shane: And they get to observe what's going on and then offer their insight about like well, that was weird, right. Like that didn't look right, this is in the wrong spot, it's too, big, it's too small.
There's. It was too cramped inside the room. It was actually way too much space. So we really get to start honing in on things that, on paper, doesn't make sense, right, like I would never be able to figure out like, oh well, this room is two inches two and a narrow. Right, if I didn't actually get to stand inside that room.
Jim: Yeah, absolutely.
So, yeah, and when we do that, I mean we bring in full size beds and and, and they practice simulations, and if they need to bring in a cart or something, and how many people they can get around the bed, all of those things are experienced, and and it's even down to the point of where we're putting light switches and gas outlets and all of those things to see you know, where should it be, where does it feel comfortable? Because to them, as they're going through these things and you're trying to save somebody's life, it's got to be second nature.
Yeah, absolutely you can't be looking for where things are at. So it's got to be comfortable, it's got to be within reach and it's got to be right where they want it. So some of the conversations are you know, you can same hand patient beds, you can mirror patient beds. There's a whole way of laying out patient rooms, right. So we want to go through and simulate those so they can decide which one works best for us. Some may cost a little bit more than others and upper echelon wants to understand is it worth the cost? Right, and make an argument and see what the data says as they run through that. So we want to run through those different ideas with them to make sure that they totally understand what they're thinking about.
Shane: It's almost like a crash course, compression of the entire design and construction process all at once, happening within like this span of a week that we even get to bring more people into. So we go through the design, we build it, we test it and then we get all these people's insight. And so essentially, yeah, it's start of design process to end of construction process in that one week where we really sit down and figure out how does this space work. And then we get to bring in other voices, like contractors, who get to be there as well, who get to start helping us inform our decisions as well. You know, I might not know if you know back to back toilets cost more or less, but if they're saying like, hey, yeah, we really want to be looking at mirrored rooms, like Jim had said, well, that would save X amount of money.
Well then that becomes a really big consideration for the staff and for the overall design process that it's not just a owner gets to tell me what to do. I get to go design it in a vacuum. I get to hand it off to a contractor and set all of all. Three of those people are sitting in the same room right working side by side to figure that problem out.
Skyler: Right. It gets a lot more input in at the beginning stages so that as you guys process and go through you know a number of designs and things like that. Things are better at the end of it all because you've gotten that input from the very beginning.
Shane: And that's the overall goal is that by by going through this process, we actually are better able to anticipate where changes might happen. Eliminate change orders or you know what would add time to the construction schedule, add money to the construction schedule. Basically, we eliminate change from happening in a construction project which is, which is a thing that really can start to drive owners.
Skyler: Yeah, absolutely. Oh. Hey, this is you know, we have to spend less because we know things from the get go and we've seen how it all works and we feel super confident in the fact that it all works.
Jim: So yeah, I mean, it doesn't totally eliminate change orders, but it minimizes them significantly.
Skyler: Yeah, absolutely, and that would if I was the owner, obviously I would feel a lot more confident knowing that from the from the early stages.
Jim: Well, and even the owners that we have seen part, those who have participated in this process. I think they really enjoy it when, when it's done because they've seen their staff to understand what the concerns are of their staff and they've gone through the hard work with them so that when, when they get to that point, they feel like they've got buy in, they understand what their staff is looking for. They feel like they've they've taken the steps that are going to ensure that the staff is happy.
Skyler: Right.
Jim: So it's not helping with staff retention. Usually we're talking about patient lifts and some of those things that are going to help them do their jobs better, and all those little things come together so that, in the end, really, they can just do their job better. Yeah, absolutely, and people are healthier and happier and and he'll quicker, and all of those things make a difference.
Skyler: Absolutely Kind of. Comes back to what you said about the community.
This all ends up reflecting on the amount that the hospital is able to offer to the surrounding community, which is why it's such an integral part of said community, of course. So awesome, awesome. Well, you guys have just been an absolute wealth of information. I'm sure that this might be one part of a much longer series of discussions or series of episodes discussing the inner workings of the health care, but I think this was a really great discussion, so thank you both for for being on today.
Jim: You bet. Thank you, my pleasure.
Skyler: Awesome. Well, again, this has been Shane and Jim, and then, of course, myself, Skyler:, on another episode of Laying the Foundations. Thank you all for listening to this episode. Be sure to stop by on our social medias and follow us there. You can find us on Facebook, twitter, instagram and LinkedIn, as well as checking out our website, where you can find all kinds of resources as far as projects we've worked on in the past, including some of the amazing health care facilities that Jim and Shane have both worked on. You can see a lot of the pictures and other things that they've they've created right on our website and, of course, make sure to follow Laying the Foundation podcast. You can find it just about anywhere that podcasts can be found, such as iTunes, spotify, google Podcasts and everywhere else. Once again, this has been another episode of Laying the Foundations.
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August 10, 2023