July 30, 2025 • 39 mins
Healthcare executives juggle decisions worth millions of dollars across multiple campuses while trying to predict a future that keeps changing. Aging facilities need updates, new technologies demand space, and patient needs shift faster than anyone can track. For health systems managing everything from rural Critical Access Hospitals to major medical centers, the old method of planning one facility at a time leaves critical gaps.
BWBR Principal Jason Nordling, Senior Planner Jessica Sweeney, and Principal Brian Zabloudil help health systems tackle this complexity through system-level strategic planning. Their work extends well past traditional facility master plans, taking on the task of aligning an entire network of care.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Matthew Gerstner (00:00):
This is Side of Design from BWBR, a podcast
discussing all aspects of designwith knowledge leaders from
every part of the industry.
Hello and welcome to Side ofDesign from BWBR.
I'm your host, matt Gerstner.
In today's conversation we'retalking about the evolving
healthcare landscape, how healthsystem leaders must navigate
increasing complexity whendetermining when to invest,
(00:21):
where to build and what to build, across both inpatient and
outpatient environments.
We'll take a look at how aproven structured approach to
system-level strategic facilityplanning aligns long-term
capital investment with anorganization's broader mission
goals and strategic plan.
Joining this conversation todayfrom BWBR are Principal Jason
(00:43):
Nordling, senior Pl JessicaSweeney and principal Brian
Zablujil.
Thank you all for joining metoday, thank you, thank you.
Let's just kind of get thingsgoing, brian.
What exactly do we mean bysystem-level strategic planning
as opposed to, like, a masterplan or other facility-level
plan?
Brian Zabloudil (01:03):
Right.
So I think most people arefairly familiar with facility
master plan or campus masterplan or other facility level
plan Right?
So I think most people arefairly familiar with a facility
master plan or campus masterplan.
It's usually that it's focusedtypically on a single campus, a
series of buildings, one largerhospital building in and of
itself.
The process is data analyticsinformed.
It's typically about a phasedmodernization and right sizing
(01:25):
of key departments, servicelines, getting out from under
older infrastructure, optimizingflow and efficiency.
It does take into accountmechanical, electrical, plumbing
services, utilities throughoutthe campus and they often lead
directly into specific designprojects.
So that's, you know, thetypical facility master planning
(01:46):
process and what that lookslike.
With system-level planning,you're often thinking about a
network of campuses, so more ofa system in and of itself, with
an outpatient network, multiplehospital locations.
Like facility master planning,it is data analytics informed.
You think about services thatare interconnected, so
(02:08):
multi-location emergencydepartments, multi-location
surgery departments and how theyall work together.
It can often lead to multiplemaster facility plans and are
the precursor to that, ratherthan specific projects.
And finally, the big focus isthere's typically a 10-year
allocation of capital of thosemultiple projects throughout
(02:30):
that whole system.
So it's thinking about thingsin that manner.
Matthew Gerstner (02:34):
Okay, so really what else?
A system level we're talkinglike it could be a very large
geographic area of sorts right,Correct?
Brian Zabloudil (02:42):
We're thinking about a larger primary and
secondary service area and howeach location will feed into and
work towards that goal.
Matthew Gerstner (02:50):
Oh wow, it sounds like a very complex
process.
Jessica Sweeney (02:53):
And as we think about that future, we're always
working in the future.
When we're looking at designing, even if it's for a smaller
project, when we are talkingabout the system, strategic
level planning, we are goingmuch further into the future
than we otherwise would.
So we get to really partnerwith our clients to think about
that strategy piece how arethings changing, how is
healthcare changing, how istheir population growing or
(03:15):
ebbing and flowing, and whattype of care are they going to
need to provide in the future?
As we're thinking about all ofthese pieces moving around, I
really enjoy this deeperrelationship that we get to have
with our clients, wheresometimes we get to be brought
into those strategyconversations.
What do you need to providecare to be successful in the
future?
Jason Nordling (03:36):
And you're having kind of crystal ball
conversations about the future,right, Like things you can't
predict necessarily, becausewe're always pivoting in
healthcare right.
Every time you've got newlegislation or something, some
new ruling from CMS or somethingchanges how they're reimbursed.
(03:58):
We can scenario, plan those outa little bit as well and talk
about okay, X happens, we'regoing to do Y.
Not that you can catch allthose things, but it's good to
have the conversation and atleast be thinking about it.
Matthew Gerstner (04:12):
Then what are the practical and tangible
benefits of engaging in thissort of planning?
I mean, it sounds like there'sa lot of unknowns and some of
those unknowns may stay unknowns, but what are the benefits of
doing this?
Jason Nordling (04:27):
I think, personally, it's just getting in
front of these long-termdecisions.
I can't tell you how many timeswe've been involved in a
project and you're trying todeal with a kind of messed up
situation, either with abuilding or a series of
buildings, because there was noforethought put into how things
(04:49):
evolved or were developedpreviously, and so sometimes
you're spending good money afterbad, as they say, trying to fix
things because there wasn'tenough thought put into it.
I would also say nowadays we'reusing data, we're leveraging
data much, much more than weever could in the past.
There's just so much moreavailable to us at our
(05:11):
fingertips.
A lot of times theseconversations at a system level.
They are about what are wedeveloping new in the future?
How are we addressing something?
They also have 50 buildingsthat have asset preservation
needs as well.
That should be planned for inadvance.
Right, we know we're going tohave to replace this roof or
(05:36):
these windows or these rooftopunits, and you can put this
together in a comprehensive planacross a system.
One of the biggest challengesthat I've been told by VP
facilities of systems is justgetting their arms around all
the facility management stuffthat they have to deal with and
(05:57):
that can be incorporated intothese larger strategic plans as
well.
Jessica Sweeney (06:02):
Jason mentioned the change.
You know when you have externalfactors, whether it's
reimbursements or it's differentlaws or administrative rules or
whatever might be happening.
While we may not be able toanticipate exactly what is
coming down in the future, byhaving some of these strategic
conversations we've had some ofthat.
What if?
What if X Y Z happens?
(06:23):
Maybe we didn't define X Y Zperfectly when we had the
conversation, but we talkedabout something and we had a
plan for something, and so ourclients, whether they come back
and talk to us or whether theydo it on their own, they've had
some of those initialconversations and can be better
prepared to handle the thingsthat are coming at them.
Brian Zabloudil (06:39):
Yeah, I think, Jason, you touched on it but
understanding current state,assessing current state, both
from a facility standpoint, whatdoes it take to maintain asset
preservation?
What is our current strategy asa system?
There is some trust that has tobe built between us and our
client in this type of exercisewhere we're talking about pretty
in-depth strategy for bothpopulation health how are we
(07:02):
going to care for our communitybut also the business side.
Right, there's the reality ofkind of offensive and defensive
maneuvers that they're makingand so, I think, establishing,
like we talk about, goals forthe built environment, how does
our our strategy as a system?
How do we achieve that throughthe built environment?
How do we reinforce it or orelevate?
And the decision-makingframework we need to establish
(07:25):
upfront, because we often sit ina room, multiple executives,
everyone has their ownpriorities and decision-making
can be a real challenge.
So to some degree, we're amediator or we're facilitating
the conversation and mediatingand trying to bring different
perspectives and help themunderstand one another.
Again, trust is a foundationalelement to this process.
Jason Nordling (07:47):
We've seen multiple, multiple entities
doing this, whereas a lot oftimes our clients, you know they
only see what they see and sowe can bring that perspective as
well.
What are they doing here, thereand in other regions?
How can we bring that to bearor apply that to a situation,
whether it be a service linestrategy, growing a certain
(08:09):
service line, physicianrecruitment impacts on space,
all sorts of things.
It's not always volumes ofpatients determining KPUs in
space, right?
Brian Zabloudil (08:29):
KPUs in space, right?
Yeah, I think a good examplethat I've seen is level of
outpatient thinking versus maincampus.
From one client or system toanother, how much are we pushing
out into the community?
There's efficiency that youlose from kind of a provider and
operational standpoint, but itwidens that network.
It allows you to shift volumearound to different locations.
I mentioned EDs surgery greatexample too.
(08:50):
How much is on the main campus?
How much is out in thecommunity of ASCs?
Jason Nordling (08:55):
Yeah, that's a constant problem is how larger
systems decant from their maincampuses.
What makes sense?
Yeah, absolutely Good point.
Jessica Sweeney (09:05):
A lot of the trends in healthcare are kind of
leaning towards thoseconversations.
I think recently we've seen theinpatient volumes increase and
many of our rural clients aretaking care of patients that
they never thought they wouldtake care of in their inpatient
settings.
In the past they would havesent those to a higher level
acuity facility and now, eitherthrough inability because there
(09:27):
are too many beds that are takenup by others or other reasons,
they're having to take care ofthose patients at home.
So we're starting to see ashift to in where those patients
would ebb and flow from onefacility to another.
So those large, I think systemhealthcare system level shifts
and how we take care of patientsis also a contributing factor
in many of our conversations.
Jason Nordling (09:46):
And that's tied directly back to value-based
care right and andreimbursements.
Jessica Sweeney (09:52):
And that's actually an interesting trend
that I've seen in the literature.
Right now I'm kind ofinterested to see if it's going
to pan out in how we're caringfor patients.
Is there is a push and anexpectation that we'll see more
value-based care for Medicarepatients, so as older
populations kind of thinkingabout how can we keep them
healthier, how can we get themcare in the right place, and so
(10:13):
that's always been a piece ofthat patient population.
But we're seeing an increaseright now, at least in the
literature.
We'll see if it increases inthe volumes as well.
Brian mentioned trust, andthat's a really important piece
for me.
That's why I like to be inthese conversations.
We have to have the folks thatwe're having the conversations
(10:35):
with whether they're theleadership team or the ones that
are providing the care.
They need to know that we'relistening to them.
They need to know that we areproviding them good feedback and
good information and that theytrust us in having those
conversations so that we can getto that end point.
That makes a lot of sense forthe care that they're providing,
and so that's key for mybackground.
(10:55):
I worked in healthcare for 10years and before coming to BWBI
I've been here now for three anda half, four years and so I've
been in that.
I actually worked in healthcarethrough COVID and we need to be
able to have thoseconversations.
We need to be able to thinkabout how we use the space.
Jason mentioned it's not justKPUs and volumes, it's how do we
(11:15):
move within the spaces when?
What are their hours ofoperation?
What are their hours ofoperation should be?
If we need growth, how are wegoing to handle that?
And so it gets down to thatreal care level volume, when
we're thinking about exam roomsand inpatient beds.
But also from that largersystem perspective, how are
patients going to flow betweenfacilities?
If we're growing ourorthopedics department, what
(11:38):
does that mean for all the otherdepartments and not just in one
area?
And if we're thinking about acommunity, where's community
growth?
How are they going to accesscare?
Where do they want to drive to?
And that changes based on thefacility that we're working with
.
So I think key is we need to bethinking about how do we use the
space, how do we use thefacilities, how do we want to
(11:58):
use the facilities, what are thestaffing that we're going to be
able to get?
What are the staffing that weneed to have and think about all
of those pieces as we'retalking about these decisions,
with patients flowing and wheredo we need to have, where do our
clients need to provide thatcare?
Jason Nordling (12:13):
I think that's an excellent point, whether it's
growth or contraction, becausewe do see a lot of times the
assumption is that if there isthat growth, we'd love to see
that, but if there is that, theassumption is that automatically
we're adding space.
We don't need to buildsomething, we just need to
rearrange a little bit or thinkabout processes a little bit
(12:35):
differently.
We can do a lot of thingsthrough optimizing flows within
a system, as well as a portionof the system, a building or a
facility, to allow them to takeup growth without having just a
ton of capital on some big thing.
Brian Zabloudil (12:57):
So sometimes the right answer how can we do
more with what we have?
Jessica Sweeney (13:06):
yeah, yeah that's capital that our clients
don't always have right now.
Health care has never been moreexpensive to build, and the
money flow coming in is not, youknow what I think many of our
clients would like to see it be,and so they need to trust us
too, that we're not just goingto recommend yep, you need a new
building here.
That conversation needs to bedeeper, because that's that
(13:29):
trust.
We need to provide the bestadvice that we can, whether that
is a new building or not, andoftentimes, like Jason said, it
can be managed without that newfacility.
Matthew Gerstner (13:38):
I'm hearing quite a few takeaways from this
portion of the conversation.
Part of it at the beginning wasyou're looking at aging
facilities in a lot ofsituations and sometimes there
was no forethought as to theplanning process of how things
went together.
So you're you know things mayneed to be optimized and came up
here later in the conversationThings may be outdated and may
(13:58):
need to be redone in some way.
I hear you're talking aboutleveraging data, which is
fantastic.
How do we leverage data tomaximize this?
I also heard it's not justabout building new facilities,
it's also about the assetpreservation and how can that
fall into it.
And then the big one here wastrust building trust, showing
(14:20):
that, listening, truly listeningto what's going on in the room,
truly evaluating needs, becausein the end, being system level,
we're not talking about justone area, we're talking about
large geographic area withmultiple facilities.
It's potentially a lot of moneyon the table and it's not
something that anybody takeslightly.
(14:40):
So, going back to the datainformation, jessica.
So, going back to the datainformation, jessica, you bring
this operational lens to thiseffort.
So how does that play intocreating an effective enterprise
strategy?
Jessica Sweeney (14:55):
Well, I think it's key and I know we talked
about a little bit earlier thathow do we move within this space
and how do we want to movewithin this space?
Big key conversations thatwe're having right now, and this
almost goes to the smallerfacility level planning how do
we optimize a space?
We can't build something andhave it used an hour a day or a
day a week, so we have to reallythink about different ways to
(15:18):
use it.
And that goes when we'retalking about patients that are
moving throughout a system.
That's key in there as well.
How do patients make decisions?
First of all?
So how well, what is the typeof relationship we built with
our clients?
So we can understand that piece?
I do know a facility or, I'msorry, I know a state where
patients will actually drivetwice the distance Southern than
(15:39):
they will to go directlyEastern or Western to go to a
different facility, becausethat's it's the concept that is
better in that specific state,and so.
But every state is differentand so how patients are making
some of those decisions, that'salso important when we're
thinking about that flow withina system.
But we have to be able to havethose conversations about how
(15:59):
are they going to use it?
What are they going to do?
How do patients walk into theirsystem?
How do they walk into theirbuilding?
Where are they being referredto?
So if you have a patient orthois a good example that we
already mentioned what's thatcadence?
Do they see PT before they doortho and after they do ortho?
So if we grow one department,what do other departments do?
Do they get smaller?
Do they get bigger?
What's their strategy?
(16:21):
Do they contract with an orthogroup?
Do they have it set?
Are they inpatient surgicalsuites or are they outpatient
surgery centers?
What are the decisions that weneed to make that just make
everything else pull in adifferent direction?
Brian Zabloudil (16:34):
The perspective that Jessica brings.
She can act as a bit of aliaison between architects like
Jason and I.
We are architects first andforemost.
We know healthcare very well,but we've never walked in their
shoes, we've never lived it.
Jessica has, and so you knowthere's there's kind of this
good in-between to help with thedialogue and building that
(16:55):
trust that we talked about is.
She has a different voice,she's seen things in a different
manner and is able to to be thein-between at times.
Jason Nordling (17:03):
Mostly she asks different questions because of
that and it elicits differentanswers than you or I would get
in that conversation.
So yeah, I found it highlyvaluable.
Matthew Gerstner (17:17):
I can totally see how that would happen.
You walk into a room and youeverybody can listen and hear
the same thing, but everybodycan have a different question in
the end too, and getting theright question asked will get
you a far better answer of whatyou're looking to do and hear
the same thing, but everybodycan have a different question in
the end too, and getting theright question asked will get
you a far better answer of whatyou're looking to do.
Jessica Sweeney (17:37):
That's a fantastic skill to bring into a
room.
One of the biggest limitingfactors in healthcare growth and
it's system-wide and almostevery system we interact with is
hiring and staffing.
And so one of the things thatwe always talk about in our
projects whether it's strategiclevel, that system level
thinking or the smaller projectsis you know what staff do you
need and can you get them?
Can you hire them, can youtrain them?
What is your process?
The majority of the times whenwe're looking at spaces or
(17:59):
facilities, if we say what'syour limiting factor, what's
stopping you from growing,what's stopping you from seeing
more patients, well, space issometimes indicated there.
Oftentimes it's staffing.
We can't get the people, and sothrough this process, it's
change.
Change is hard and we want tohelp our clients keep their
staff.
We want to help them be a placewhere people want to come work.
(18:20):
We want a system that makessense, facilities that make
sense for the patients and forthe staff, and so I see that as
a key piece of my role where Ican have some of those
conversations or even make themfeel listened to.
Our architects are fantasticlisteners.
They know the conversations,they know what they're doing and
sometimes me being in that roomalso just makes that different
level of yep, they get it, theyhear it, they hear what we're
(18:43):
saying.
We trust this process.
Jason Nordling (18:45):
They hear it, they hear what we're saying, we
trust this process and to yourpoint, it's, it's all, almost
all the results, at least inthis time of staff deficit.
You know, asking people to domore with with less Right, and
that's.
Those are hard conversations aswell.
Matthew Gerstner (19:02):
You mentioned a phrase in there that I picked
up on was change is hard andchange is hard for everybody,
right, is that?
Is that a process that we helpto manage?
Do we?
Do we help manage change?
Jessica Sweeney (19:15):
management, managing those expectations.
It's identifying change.
So I know, when I'm in a roomwith folks, if I'm having a
conversation with our team orexternal, their little cues you
pick up on or different thingsthat you hear that you're saying
(19:35):
, oh, this department is notready for this.
So you can have, maybe, thatconversation, whether it's with
leadership or to say how can wehelp them?
What's going on here?
Why don't they feel like thisprocess is working for them?
And so that's part of changemanagement.
Another key piece of changemanagement is if there is a new
facility or if there is a changein that process, how do we talk
(19:56):
about it?
Do we identify that process?
Do we identify what we want itto be?
With the people that areproviding the care, with the
leaders that are having tochange their building setup, do
we make sure that they've hadthat conversation?
And if we're not, I think we'remissing a mark.
We have to be, we have to betalking about that.
It's going to be different.
Or else we're opening up afacility and everybody's unhappy
(20:18):
because we're changing rooms or, you know, we're shutting
something down and people don'tknow where they want to get
their care.
So we have to have thatconversation and I think that's
inherent in change management.
It's just identifying thechange, talking people through
it as much as possible.
Jason Nordling (20:33):
Yeah, I don't know how many times I've seen
that in working with differentgroups, but we've been doing it
this way for 30 years.
Right, like there's so muchdiscomfort pivoting to a
different way of doing things.
Not that I mean some people arejust naturally like, nope,
that'll, that will work.
Most of the time, though, withtime and incremental
(20:54):
conversations about people comearound to thinking about things
differently.
Right, that's how healthcare is.
It requires us to thinkdifferently about everything.
Brian Zabloudil (21:07):
Yeah, I think a big part of our value when it
comes to change management isdifferent perspectives.
Right, proof of concept.
I know it's scary.
This is going to be a bigchange.
You're going from an open bayNICU to a private NICU.
We've helped clients throughthis before.
Here's what it looks like andwe can get you in touch with
them.
We can talk about lessonslearned.
How did they operationalizethis new unit?
(21:30):
What bumps did they have?
What changes did they make?
So being able to provide proofof concept and yes, it's been
done and here's how it wassuccessful helps.
Matthew Gerstner (21:41):
Now I'm going to shift gears here and we're
going to go right back intosystem level strategic planning.
What would a clear, actionableroadmap for something like this
look like?
Brian Zabloudil (21:52):
Yeah.
So I would say there's not astrict formula.
However, we've done this andunderstand some steps that do
make sense throughout this.
I've outlined previously justin thinking about this recently
kind of six big picture steps Itouched on it earlier and all
these things are touched onreally to this point, but
(22:13):
establishing goals for the builtenvironment and setting up
decision making framework.
So what's our top goals?
What's our top priorities?
You know, putting those inorder and helping facilitate
that with our clients.
Priorities putting those inorder and helping facilitate
that with our clients.
And then later on, when we haveto make decisions, what is the
objective decision-makingframework?
Sometimes we use lean tools forthat, like choosing by
(22:39):
advantage or setting upfactor-based scoring.
So that's number one.
Number two assessing currentstate.
We touched on that.
So it's facility conditionassessment.
What do we need to maintainthese four different campuses
and ambulatory network locationsites there's an investment
there that has to be taken intoaccount before any other
expansions or renovations.
There's operational assessmentas well understanding current
(23:01):
state operations and what do wewant to do in the future.
Number three there's theanalysis portion.
So some of this we do in-house,some of this we work with
partners, but market analysisand forecasting.
Again, understanding currentstate what do we have for
surgery service line volumes,what do we have for ED
inpatients?
And then projecting out withpopulation growth, with
(23:24):
additional market capture, whatdoes that look like in the
future and what do we need tosupport it?
Number four I think about astarget location analysis.
So if we have additional sitesthat come online in the future
to meet that forecasted need,what's the right location?
We look at drive times, masstransit routes, competitor
(23:47):
locations.
Where's our locations today?
That starts to identify gaps.
Where's the population going?
Where do we want to be?
Fifth, prioritizing conceptualprojects.
I touched on this earlier.
I think about one client we'veworked with.
They had, over the next 10years, 50 to 60 projects they
could see and identify withoutanything else popping up in the
(24:10):
future.
When you talk to an executiveteam or leadership team, they
all have their own priorities.
They all think their projectsneed to fit in the first three
to four year window and thatjust can't happen, right,
there's only so much capital togo around.
And so how do we start toobjectively say here's our
strategy, here's our goals.
These have to fit in bucketnumber one.
(24:31):
These can go out a little bitfurther into bucket two, and
this next four to six yearwindow and so on.
So so helping them prioritize,and then the capital ties to
that finally.
So thinking about the money andhow that spread out over a 10
year window, 15year window,whatever it may be.
Jason Nordling (24:48):
T he other thing I want to add in there.
You mentioned that we partnerwith different data analytics
partners.
We also partner with differentfinancial analytics partners.
We've had several clients inthe recent past, as we're
looking at their system, whohave made changes like dramatic
(25:09):
changes.
Hey, this hospital in oursystem is no longer going to be
a regional hospital and we don'tneed 50 beds, we only need 20
beds there.
And oh, by the way, it would beadvantageous to change how we
get reimbursed.
So we're going to look atcritical access as a change, as
(25:29):
opposed to being a PPS facilitythat change the reimbursement
lands.
Having those financial folksalongside us can help make those
decisions as well.
Brian Zabloudil (25:43):
Along those same lines other partners,
construction partners,especially at the system level,
where if we're going to providegood, solid cost projection on
these different projects withina timeline, we'll partner with
construction managers to look atreally firmed up costs.
That has a lot of fidelity toit, a lot of rigor that goes
(26:05):
into coming up with thoseestimates and then applying
escalation on top of that too.
We all know that things getmore expensive over time, so it
doesn't do us any good to thinkabout a $10 million project
that's eight years out ifthere's no escalation assigned
to it.
Jason Nordling (26:20):
I think the big point, the big takeaway there is
it takes a pretty deep, robustteam to deliver system-level
things.
There's so many things to betaken into account.
Brian Zabloudil (26:33):
Yeah, I'm a sucker for sports analogies.
I think of the architect,whether it's on a project or
something like this.
That's a larger kind of systems, more macro level for the point
guard.
We're distributing, we'remaking the whole dance work.
Jason Nordling (26:50):
I'm not a basketball fan, but I like the
analogy.
Jessica Sweeney (26:52):
Yeah, I'm there with you.
We could find a different sport, but it works.
I'm not a basketball fan, but Ilike the analogy.
Brian Zabloudil (26:58):
Yeah, I'm there with you.
We could find a different sport, but it works.
Jessica Sweeney (27:01):
Hockey jest I don't know how to make a hockey
analogy.
That's okay.
Jason, you did mention talkingabout moving to critical access
status and I think that's reallythat partnership, that
strategic partnership that weget to have with our clients is
really important there becausewe are understanding the trends
from a larger perspective.
Science is really importantthere because we are
understanding the trends from alarger perspective.
So things like freestanding EDs, you know from we get to in
this conversation around systemstrategic planning, really think
(27:22):
about some of those pieces.
You know, do you have a worldwhere you need to put up a
freestanding ED?
Should we be closing beds inthis facility?
What are the true needs of thesystem?
What are the requirements ofthe system, what can they forge,
what can they pay for and howdo we maximize or optimize the
patients that they take care ofand bringing them in in
(27:42):
different ways?
And so that's right back tothat beginning of.
You know where do you needprimary care, where do you need
clinicians, where do you needoffices, where you know, where
do you have a great home-basedprogram that maybe we don't need
to have an outpatient facility,just thinking about the trends
in healthcare combined with thepatients and what the needs are.
Jason Nordling (28:01):
Yeah one of the big points of contention is
usually we get into more ruralareas, we do a lot of work with
rural facilities.
It's do we need inpatient beds?
And there's always this hugereluctance to get rid of
inpatient beds, even thoughaverage daily census, you know,
hovers two, three, four, and sowe've had a few facilities that
(28:24):
have actually looked at therural emergency hospital program
but there's a large reluctanceto getting rid of that inpatient
component and quite honestly Idon't know if the incentives are
strong enough yet to make thosechanges They've tried to
(28:46):
incentivize it a little bit.
Brian Zabloudil (28:46):
I think that's an important note, jason, and,
top of mind, incentivereimbursements.
Just the way the system is setup is evolving and changing
daily, weekly.
Right now we're really tryingto stay on top of that and
educate our own, you know again,outside of architecture, just
understanding how things arechanging at the federal level,
(29:08):
state level.
That's going to be important toour clients.
Jessica Sweeney (29:11):
And I think it's important to us.
So many of our staff are reallypassionate about keeping
healthcare in rural areas in away that makes sense for them.
I think we do all understandthe economic impact that having
a facility in a rural locationcan have, and we understand that
piece of how it helps oursystems through bringing
patients in.
You know, coverage coveredlives.
(29:33):
How are we caring for thepopulation?
But there's an economic impact,and so I think a lot of our
staff are passionate aboutworking with our clients to make
sure that it continues to workfor them.
Whether it's new payment models, whether it's changing
strategically.
How do we do what's best forour clients to keep care as
local as what makes sense forthem?
Matthew Gerstner (29:54):
All right.
So with this next question I'vegot for you all I know we've
probably touched on elements ofthis question, but I don't think
we've come to this conclusionis like what can we expect for
outputs from this process, likeat the end of the process?
All these, all these toughconversations have happened.
We've had all the people in theroom.
(30:14):
We've we've done it.
What?
What are the outputs that go tothe clients in these situations
?
Now?
Brian Zabloudil (30:35):
system as well.
It's almost like an onion where, over time, layers have been
added to the campus, to thebuildings or to the system and,
and yes, there may have beensome plan for that moment in
time, but not at a large, big,strategic macro level.
So it's putting together that10 to 15 year horizon, that
timeline of of aligning thebuilt environment and the
capital with strategy.
(30:56):
You know that every hospitalhas a strategic plan.
We want to think about thatstrategy and how it ties to the
built environment, how weprovide that care right place,
right time.
Jason Nordling (31:08):
Yeah, typically the output we provide it's a
digital format, though you know.
I mean planning is usually donein PDF form.
All the financial stuff, costs,etc.
That's in a living Exceldocument.
At this point, I think thoseare still the tried and true
tools that we use.
I haven't seen anybody come upwith anything much better than
(31:31):
that yet.
Brian Zabloudil (31:33):
Yeah, you make a good point, jason, about it
has to be dynamic.
These plans can't be static.
It can't be a book that sits ona shelf.
The strategy evolves almostimmediately.
We find that happen withclients where within three
months, something that was inyear six all of a sudden is
pushed up to year one.
There's a domino effect andthat plan has to evolve.
(31:54):
You know, we we can absolutelybe there to help, but to some
degree whether it's a VP offacilities or someone within the
executive team has to be ableto adjust those things to
overtime.
Jason Nordling (32:05):
And I feel like we've if we've done our job
really well and had thoseconversations, they're able to
do that.
Not that we're not consulted onsomething, but the heavy
lifting is hopefully done atthat point and they can make
those tweaks on their own.
Jessica Sweeney (32:24):
There's a true benefit in just undergoing the
process, having theconversations, bringing up the
pieces that matter.
Matthew Gerstner (32:32):
All right, so we're going to switch this again
just a little bit.
Can you all talk about some ofthe challenges or successes that
you've seen implementing thesesystem level plans?
Jason Nordling (32:40):
I think one of the successes that I see is just
it gives them space to breathe,right Like when you lay the
plan out and you've goteverybody in the room going yeah
, this is solid.
We did some hard work here.
It's taken us months to achieve, but now we feel we've got this
roadmap in front of us and itgives you a sense of ease about
(33:05):
the future.
Not that you're to Brian'spoint previously not going to
have to pivot for some thing,but at least you've got that
foundational work set, and sothat's the biggest success I
think I've seen is just this,this ease of knowing you've got
a plan and a plan that workstogether with other departments.
Jessica Sweeney (33:29):
You know that idea that maybe you're had a
facility in one area hasn'treally spoken to somebody else,
but now they're sitting at thesame table and they're talking
and having those conversations.
And I think Brian mentioned the60 projects.
Maybe they didn't get theirproject in year one but you know
, they know that they're,they've been listened to and
they know that they were able tohave that set out plan and talk
(33:49):
to other people's needs andwants and requirements.
Jason Nordling (33:53):
That's a great point, jess.
The process is about buildingconsensus as well, right, like
that's a big part of it.
Getting everybody to go.
Yep, this makes the most sensebecause, again, as I think Brian
mentioned, there's all sorts ofcompeting interests.
You know when we're working atthis level.
Brian Zabloudil (34:14):
I would say that's the biggest challenge
arriving at that consensus with.
You know, I think about eight,10 individuals in the room
that's that are not part of ourteam, that are on the client
side and, uh, some may benodding their head, yeah,
egregiously, I'll come alongwith this.
I understand, and so I thinkreally having that
decision-making framework,something objective, something
(34:35):
to point to, removes the emotionfrom it helps people have that
peace of mind.
Jason Nordling (34:41):
As facilitators of the process, as you referred
to earlier.
Getting people in the room, ina place where you're checking
your ego and your preconceivednotions at the door, I mean
that's really the way to getsuccess.
Jessica Sweeney (35:01):
And we all have to do it right.
We all have to succeed.
With regards to some of thechallenges, I think that one of
the biggest challenges that theminute you have created your
strategic plans, it's startingto get old.
There are so many changes,especially right now, happening
rapidly, where our job is to dothe best we can to make sure
that it's considered some ofthese other pieces or that we've
thought about it, but you don'tknow what.
(35:23):
We don't know what's happening.
I mean, there have beensignificant health care
disruptors over the last 10years that people had no thought
that they were coming, and soat that point, you know, does
the plan encompass it enough?
Can it give us a?
Maybe it's not a roadmap, maybeit's a couple of directions, or
do you need to take anotherlook at it?
Jason Nordling (35:41):
And it's a significant improvement over the
sometimes the magic eight balldecision-making that has
happened.
Jessica Sweeney (35:49):
having that plan in place, I think one of
the other challenges is you areseeing large-scale healthcare
organizational changes, so largefacilities or systems are
joining up with other systems.
We work with many ruralfacilities and oftentimes, while
their goal is to maintainindependence, their next best
goal is to decide what theirfuture is, and so we're seeing
(36:12):
large changes where, suddenly,you're not in charge of your
future.
There's collaboration withanother facility or another
system that you need to considerin these decisions, and so
things can change rapidly inthat essence as well.
Brian Zabloudil (36:27):
A lot of what we've talked about.
It's not traditionalarchitecture, it's not bricks
and mortar.
It is very complex andchallenging and it requires
iteration.
Having done it, you refine itover time.
We talked about the teams.
They're big and complex.
It's architects, it's stateanalytics firms, people doing
pro formas and financialmodeling, construction managers
(36:48):
looking at costing, facilitatingand mediating.
So that's what I love, and Ithink this team loves to, is the
challenge of it.
It's different.
It's not the challenge ofputting together a building,
it's putting together a systemand thinking about it at a much
more macro level.
I think it's something thisteam does exceptionally well.
Jason Nordling (37:07):
I love that comment because I think the
preconceived notion is thatarchitects do buildings right
and absolutely.
We are right Like that.
We think about buildings andhow things get put together so
that they endure.
But if you really break it downto its most basic level, we are
(37:29):
trained to be problem solversand that's what we do.
Jessica Sweeney (37:34):
This piece is really rewarding.
I think it's rewarding for meand I think it's rewarding for
all of us, where we get to thinkabout healthcare strategy on a
larger scale.
We get to really be partnerswith our clients, be involved
and see some of theirdecision-making help, providing
the information and facilitatingthe conversations that lead to
those decisions and, as such, itmakes us better at our jobs too
(37:58):
.
And that next project, thatnext client, that next strategic
planning, whatever it means, wehave a greater base and depth
of knowledge and experience aswe continue to have additional
conversations.
So when it is those traditionalarchitectural conversations,
they're deeper, they're moremeaningful and I think it goes
back to that trust I like whenwe're brought in, when we're
(38:21):
trusted to have thoseconversations with our clients.
Matthew Gerstner (38:24):
And I think that's a great spot to wrap this
conversation up today.
Y'all You've provided so muchinformation in this short little
window for all of our listenersto think about.
Thank you all for your timetoday and to our listeners.
We'll see you again soon.
This has been Side of Designfrom BWBR, brought to you
without any paid advertisementsor commercials.
(38:45):
If you found value in whatyou've heard today, give us a
like, leave us a comment or,better yet, share us with your
network.
You can also reach out to us ifyou'd like to share an idea for
a show or start a discussion.
Email us at sideofdesign atbwbrcom.
This is Side of Design from BWBR, a podcast
discussing all aspects of designwith knowledge leaders from
every part of the industry.
Hello and welcome to Side ofDesign from BWBR.
I'm your host, matt Gerstner.
In today's conversation we'retalking about the evolving
healthcare landscape, how healthsystem leaders must navigate
increasing complexity whendetermining when to invest,
(00:21):
where to build and what to build, across both inpatient and
outpatient environments.
We'll take a look at how aproven structured approach to
system-level strategic facilityplanning aligns long-term
capital investment with anorganization's broader mission
goals and strategic plan.
Joining this conversation todayfrom BWBR are Principal Jason
(00:43):
Nordling, senior Pl JessicaSweeney and principal Brian
Zablujil.
Thank you all for joining metoday, thank you, thank you.
Let's just kind of get thingsgoing, brian.
What exactly do we mean bysystem-level strategic planning
as opposed to, like, a masterplan or other facility-level
plan?
Brian Zabloudil (01:03):
Right.
So I think most people arefairly familiar with facility
master plan or campus masterplan or other facility level
plan Right?
So I think most people arefairly familiar with a facility
master plan or campus masterplan.
It's usually that it's focusedtypically on a single campus, a
series of buildings, one largerhospital building in and of
itself.
The process is data analyticsinformed.
It's typically about a phasedmodernization and right sizing
(01:25):
of key departments, servicelines, getting out from under
older infrastructure, optimizingflow and efficiency.
It does take into accountmechanical, electrical, plumbing
services, utilities throughoutthe campus and they often lead
directly into specific designprojects.
So that's, you know, thetypical facility master planning
(01:46):
process and what that lookslike.
With system-level planning,you're often thinking about a
network of campuses, so more ofa system in and of itself, with
an outpatient network, multiplehospital locations.
Like facility master planning,it is data analytics informed.
You think about services thatare interconnected, so
(02:08):
multi-location emergencydepartments, multi-location
surgery departments and how theyall work together.
It can often lead to multiplemaster facility plans and are
the precursor to that, ratherthan specific projects.
And finally, the big focus isthere's typically a 10-year
allocation of capital of thosemultiple projects throughout
(02:30):
that whole system.
So it's thinking about thingsin that manner.
Matthew Gerstner (02:34):
Okay, so really what else?
A system level we're talkinglike it could be a very large
geographic area of sorts right,Correct?
Brian Zabloudil (02:42):
We're thinking about a larger primary and
secondary service area and howeach location will feed into and
work towards that goal.
Matthew Gerstner (02:50):
Oh wow, it sounds like a very complex
process.
Jessica Sweeney (02:53):
And as we think about that future, we're always
working in the future.
When we're looking at designing, even if it's for a smaller
project, when we are talkingabout the system, strategic
level planning, we are goingmuch further into the future
than we otherwise would.
So we get to really partnerwith our clients to think about
that strategy piece how arethings changing, how is
healthcare changing, how istheir population growing or
(03:15):
ebbing and flowing, and whattype of care are they going to
need to provide in the future?
As we're thinking about all ofthese pieces moving around, I
really enjoy this deeperrelationship that we get to have
with our clients, wheresometimes we get to be brought
into those strategyconversations.
What do you need to providecare to be successful in the
future?
Jason Nordling (03:36):
And you're having kind of crystal ball
conversations about the future,right, Like things you can't
predict necessarily, becausewe're always pivoting in
healthcare right.
Every time you've got newlegislation or something, some
new ruling from CMS or somethingchanges how they're reimbursed.
(03:58):
We can scenario, plan those outa little bit as well and talk
about okay, X happens, we'regoing to do Y.
Not that you can catch allthose things, but it's good to
have the conversation and atleast be thinking about it.
Matthew Gerstner (04:12):
Then what are the practical and tangible
benefits of engaging in thissort of planning?
I mean, it sounds like there'sa lot of unknowns and some of
those unknowns may stay unknowns, but what are the benefits of
doing this?
Jason Nordling (04:27):
I think, personally, it's just getting in
front of these long-termdecisions.
I can't tell you how many timeswe've been involved in a
project and you're trying todeal with a kind of messed up
situation, either with abuilding or a series of
buildings, because there was noforethought put into how things
(04:49):
evolved or were developedpreviously, and so sometimes
you're spending good money afterbad, as they say, trying to fix
things because there wasn'tenough thought put into it.
I would also say nowadays we'reusing data, we're leveraging
data much, much more than weever could in the past.
There's just so much moreavailable to us at our
(05:11):
fingertips.
A lot of times theseconversations at a system level.
They are about what are wedeveloping new in the future?
How are we addressing something?
They also have 50 buildingsthat have asset preservation
needs as well.
That should be planned for inadvance.
Right, we know we're going tohave to replace this roof or
(05:36):
these windows or these rooftopunits, and you can put this
together in a comprehensive planacross a system.
One of the biggest challengesthat I've been told by VP
facilities of systems is justgetting their arms around all
the facility management stuffthat they have to deal with and
(05:57):
that can be incorporated intothese larger strategic plans as
well.
Jessica Sweeney (06:02):
Jason mentioned the change.
You know when you have externalfactors, whether it's
reimbursements or it's differentlaws or administrative rules or
whatever might be happening.
While we may not be able toanticipate exactly what is
coming down in the future, byhaving some of these strategic
conversations we've had some ofthat.
What if?
What if X Y Z happens?
(06:23):
Maybe we didn't define X Y Zperfectly when we had the
conversation, but we talkedabout something and we had a
plan for something, and so ourclients, whether they come back
and talk to us or whether theydo it on their own, they've had
some of those initialconversations and can be better
prepared to handle the thingsthat are coming at them.
Brian Zabloudil (06:39):
Yeah, I think, Jason, you touched on it but
understanding current state,assessing current state, both
from a facility standpoint, whatdoes it take to maintain asset
preservation?
What is our current strategy asa system?
There is some trust that has tobe built between us and our
client in this type of exercisewhere we're talking about pretty
in-depth strategy for bothpopulation health how are we
(07:02):
going to care for our communitybut also the business side.
Right, there's the reality ofkind of offensive and defensive
maneuvers that they're makingand so, I think, establishing,
like we talk about, goals forthe built environment, how does
our our strategy as a system?
How do we achieve that throughthe built environment?
How do we reinforce it or orelevate?
And the decision-makingframework we need to establish
(07:25):
upfront, because we often sit ina room, multiple executives,
everyone has their ownpriorities and decision-making
can be a real challenge.
So to some degree, we're amediator or we're facilitating
the conversation and mediatingand trying to bring different
perspectives and help themunderstand one another.
Again, trust is a foundationalelement to this process.
Jason Nordling (07:47):
We've seen multiple, multiple entities
doing this, whereas a lot oftimes our clients, you know they
only see what they see and sowe can bring that perspective as
well.
What are they doing here, thereand in other regions?
How can we bring that to bearor apply that to a situation,
whether it be a service linestrategy, growing a certain
(08:09):
service line, physicianrecruitment impacts on space,
all sorts of things.
It's not always volumes ofpatients determining KPUs in
space, right?
Brian Zabloudil (08:29):
KPUs in space, right?
Yeah, I think a good examplethat I've seen is level of
outpatient thinking versus maincampus.
From one client or system toanother, how much are we pushing
out into the community?
There's efficiency that youlose from kind of a provider and
operational standpoint, but itwidens that network.
It allows you to shift volumearound to different locations.
I mentioned EDs surgery greatexample too.
(08:50):
How much is on the main campus?
How much is out in thecommunity of ASCs?
Jason Nordling (08:55):
Yeah, that's a constant problem is how larger
systems decant from their maincampuses.
What makes sense?
Yeah, absolutely Good point.
Jessica Sweeney (09:05):
A lot of the trends in healthcare are kind of
leaning towards thoseconversations.
I think recently we've seen theinpatient volumes increase and
many of our rural clients aretaking care of patients that
they never thought they wouldtake care of in their inpatient
settings.
In the past they would havesent those to a higher level
acuity facility and now, eitherthrough inability because there
(09:27):
are too many beds that are takenup by others or other reasons,
they're having to take care ofthose patients at home.
So we're starting to see ashift to in where those patients
would ebb and flow from onefacility to another.
So those large, I think systemhealthcare system level shifts
and how we take care of patientsis also a contributing factor
in many of our conversations.
Jason Nordling (09:46):
And that's tied directly back to value-based
care right and andreimbursements.
Jessica Sweeney (09:52):
And that's actually an interesting trend
that I've seen in the literature.
Right now I'm kind ofinterested to see if it's going
to pan out in how we're caringfor patients.
Is there is a push and anexpectation that we'll see more
value-based care for Medicarepatients, so as older
populations kind of thinkingabout how can we keep them
healthier, how can we get themcare in the right place, and so
(10:13):
that's always been a piece ofthat patient population.
But we're seeing an increaseright now, at least in the
literature.
We'll see if it increases inthe volumes as well.
Brian mentioned trust, andthat's a really important piece
for me.
That's why I like to be inthese conversations.
We have to have the folks thatwe're having the conversations
(10:35):
with whether they're theleadership team or the ones that
are providing the care.
They need to know that we'relistening to them.
They need to know that we areproviding them good feedback and
good information and that theytrust us in having those
conversations so that we can getto that end point.
That makes a lot of sense forthe care that they're providing,
and so that's key for mybackground.
(10:55):
I worked in healthcare for 10years and before coming to BWBI
I've been here now for three anda half, four years and so I've
been in that.
I actually worked in healthcarethrough COVID and we need to be
able to have thoseconversations.
We need to be able to thinkabout how we use the space.
Jason mentioned it's not justKPUs and volumes, it's how do we
(11:15):
move within the spaces when?
What are their hours ofoperation?
What are their hours ofoperation should be?
If we need growth, how are wegoing to handle that?
And so it gets down to thatreal care level volume, when
we're thinking about exam roomsand inpatient beds.
But also from that largersystem perspective, how are
patients going to flow betweenfacilities?
If we're growing ourorthopedics department, what
(11:38):
does that mean for all the otherdepartments and not just in one
area?
And if we're thinking about acommunity, where's community
growth?
How are they going to accesscare?
Where do they want to drive to?
And that changes based on thefacility that we're working with
.
So I think key is we need to bethinking about how do we use the
space, how do we use thefacilities, how do we want to
(11:58):
use the facilities, what are thestaffing that we're going to be
able to get?
What are the staffing that weneed to have and think about all
of those pieces as we'retalking about these decisions,
with patients flowing and wheredo we need to have, where do our
clients need to provide thatcare?
Jason Nordling (12:13):
I think that's an excellent point, whether it's
growth or contraction, becausewe do see a lot of times the
assumption is that if there isthat growth, we'd love to see
that, but if there is that, theassumption is that automatically
we're adding space.
We don't need to buildsomething, we just need to
rearrange a little bit or thinkabout processes a little bit
(12:35):
differently.
We can do a lot of thingsthrough optimizing flows within
a system, as well as a portionof the system, a building or a
facility, to allow them to takeup growth without having just a
ton of capital on some big thing.
Brian Zabloudil (12:57):
So sometimes the right answer how can we do
more with what we have?
Jessica Sweeney (13:06):
yeah, yeah that's capital that our clients
don't always have right now.
Health care has never been moreexpensive to build, and the
money flow coming in is not, youknow what I think many of our
clients would like to see it be,and so they need to trust us
too, that we're not just goingto recommend yep, you need a new
building here.
That conversation needs to bedeeper, because that's that
(13:29):
trust.
We need to provide the bestadvice that we can, whether that
is a new building or not, andoftentimes, like Jason said, it
can be managed without that newfacility.
Matthew Gerstner (13:38):
I'm hearing quite a few takeaways from this
portion of the conversation.
Part of it at the beginning wasyou're looking at aging
facilities in a lot ofsituations and sometimes there
was no forethought as to theplanning process of how things
went together.
So you're you know things mayneed to be optimized and came up
here later in the conversationThings may be outdated and may
(13:58):
need to be redone in some way.
I hear you're talking aboutleveraging data, which is
fantastic.
How do we leverage data tomaximize this?
I also heard it's not justabout building new facilities,
it's also about the assetpreservation and how can that
fall into it.
And then the big one here wastrust building trust, showing
(14:20):
that, listening, truly listeningto what's going on in the room,
truly evaluating needs, becausein the end, being system level,
we're not talking about justone area, we're talking about
large geographic area withmultiple facilities.
It's potentially a lot of moneyon the table and it's not
something that anybody takeslightly.
(14:40):
So, going back to the datainformation, jessica.
So, going back to the datainformation, jessica, you bring
this operational lens to thiseffort.
So how does that play intocreating an effective enterprise
strategy?
Jessica Sweeney (14:55):
Well, I think it's key and I know we talked
about a little bit earlier thathow do we move within this space
and how do we want to movewithin this space?
Big key conversations thatwe're having right now, and this
almost goes to the smallerfacility level planning how do
we optimize a space?
We can't build something andhave it used an hour a day or a
day a week, so we have to reallythink about different ways to
(15:18):
use it.
And that goes when we'retalking about patients that are
moving throughout a system.
That's key in there as well.
How do patients make decisions?
First of all?
So how well, what is the typeof relationship we built with
our clients?
So we can understand that piece?
I do know a facility or, I'msorry, I know a state where
patients will actually drivetwice the distance Southern than
(15:39):
they will to go directlyEastern or Western to go to a
different facility, becausethat's it's the concept that is
better in that specific state,and so.
But every state is differentand so how patients are making
some of those decisions, that'salso important when we're
thinking about that flow withina system.
But we have to be able to havethose conversations about how
(15:59):
are they going to use it?
What are they going to do?
How do patients walk into theirsystem?
How do they walk into theirbuilding?
Where are they being referredto?
So if you have a patient orthois a good example that we
already mentioned what's thatcadence?
Do they see PT before they doortho and after they do ortho?
So if we grow one department,what do other departments do?
Do they get smaller?
Do they get bigger?
What's their strategy?
(16:21):
Do they contract with an orthogroup?
Do they have it set?
Are they inpatient surgicalsuites or are they outpatient
surgery centers?
What are the decisions that weneed to make that just make
everything else pull in adifferent direction?
Brian Zabloudil (16:34):
The perspective that Jessica brings.
She can act as a bit of aliaison between architects like
Jason and I.
We are architects first andforemost.
We know healthcare very well,but we've never walked in their
shoes, we've never lived it.
Jessica has, and so you knowthere's there's kind of this
good in-between to help with thedialogue and building that
(16:55):
trust that we talked about is.
She has a different voice,she's seen things in a different
manner and is able to to be thein-between at times.
Jason Nordling (17:03):
Mostly she asks different questions because of
that and it elicits differentanswers than you or I would get
in that conversation.
So yeah, I found it highlyvaluable.
Matthew Gerstner (17:17):
I can totally see how that would happen.
You walk into a room and youeverybody can listen and hear
the same thing, but everybodycan have a different question in
the end too, and getting theright question asked will get
you a far better answer of whatyou're looking to do and hear
the same thing, but everybodycan have a different question in
the end too, and getting theright question asked will get
you a far better answer of whatyou're looking to do.
Jessica Sweeney (17:37):
That's a fantastic skill to bring into a
room.
One of the biggest limitingfactors in healthcare growth and
it's system-wide and almostevery system we interact with is
hiring and staffing.
And so one of the things thatwe always talk about in our
projects whether it's strategiclevel, that system level
thinking or the smaller projectsis you know what staff do you
need and can you get them?
Can you hire them, can youtrain them?
What is your process?
The majority of the times whenwe're looking at spaces or
(17:59):
facilities, if we say what'syour limiting factor, what's
stopping you from growing,what's stopping you from seeing
more patients, well, space issometimes indicated there.
Oftentimes it's staffing.
We can't get the people, and sothrough this process, it's
change.
Change is hard and we want tohelp our clients keep their
staff.
We want to help them be a placewhere people want to come work.
(18:20):
We want a system that makessense, facilities that make
sense for the patients and forthe staff, and so I see that as
a key piece of my role where Ican have some of those
conversations or even make themfeel listened to.
Our architects are fantasticlisteners.
They know the conversations,they know what they're doing and
sometimes me being in that roomalso just makes that different
level of yep, they get it, theyhear it, they hear what we're
(18:43):
saying.
We trust this process.
Jason Nordling (18:45):
They hear it, they hear what we're saying, we
trust this process and to yourpoint, it's, it's all, almost
all the results, at least inthis time of staff deficit.
You know, asking people to domore with with less Right, and
that's.
Those are hard conversations aswell.
Matthew Gerstner (19:02):
You mentioned a phrase in there that I picked
up on was change is hard andchange is hard for everybody,
right, is that?
Is that a process that we helpto manage?
Do we?
Do we help manage change?
Jessica Sweeney (19:15):
management, managing those expectations.
It's identifying change.
So I know, when I'm in a roomwith folks, if I'm having a
conversation with our team orexternal, their little cues you
pick up on or different thingsthat you hear that you're saying
(19:35):
, oh, this department is notready for this.
So you can have, maybe, thatconversation, whether it's with
leadership or to say how can wehelp them?
What's going on here?
Why don't they feel like thisprocess is working for them?
And so that's part of changemanagement.
Another key piece of changemanagement is if there is a new
facility or if there is a changein that process, how do we talk
(19:56):
about it?
Do we identify that process?
Do we identify what we want itto be?
With the people that areproviding the care, with the
leaders that are having tochange their building setup, do
we make sure that they've hadthat conversation?
And if we're not, I think we'remissing a mark.
We have to be, we have to betalking about that.
It's going to be different.
Or else we're opening up afacility and everybody's unhappy
(20:18):
because we're changing rooms or, you know, we're shutting
something down and people don'tknow where they want to get
their care.
So we have to have thatconversation and I think that's
inherent in change management.
It's just identifying thechange, talking people through
it as much as possible.
Jason Nordling (20:33):
Yeah, I don't know how many times I've seen
that in working with differentgroups, but we've been doing it
this way for 30 years.
Right, like there's so muchdiscomfort pivoting to a
different way of doing things.
Not that I mean some people arejust naturally like, nope,
that'll, that will work.
Most of the time, though, withtime and incremental
(20:54):
conversations about people comearound to thinking about things
differently.
Right, that's how healthcare is.
It requires us to thinkdifferently about everything.
Brian Zabloudil (21:07):
Yeah, I think a big part of our value when it
comes to change management isdifferent perspectives.
Right, proof of concept.
I know it's scary.
This is going to be a bigchange.
You're going from an open bayNICU to a private NICU.
We've helped clients throughthis before.
Here's what it looks like andwe can get you in touch with
them.
We can talk about lessonslearned.
How did they operationalizethis new unit?
(21:30):
What bumps did they have?
What changes did they make?
So being able to provide proofof concept and yes, it's been
done and here's how it wassuccessful helps.
Matthew Gerstner (21:41):
Now I'm going to shift gears here and we're
going to go right back intosystem level strategic planning.
What would a clear, actionableroadmap for something like this
look like?
Brian Zabloudil (21:52):
Yeah.
So I would say there's not astrict formula.
However, we've done this andunderstand some steps that do
make sense throughout this.
I've outlined previously justin thinking about this recently
kind of six big picture steps Itouched on it earlier and all
these things are touched onreally to this point, but
(22:13):
establishing goals for the builtenvironment and setting up
decision making framework.
So what's our top goals?
What's our top priorities?
You know, putting those inorder and helping facilitate
that with our clients.
Priorities putting those inorder and helping facilitate
that with our clients.
And then later on, when we haveto make decisions, what is the
objective decision-makingframework?
Sometimes we use lean tools forthat, like choosing by
(22:39):
advantage or setting upfactor-based scoring.
So that's number one.
Number two assessing currentstate.
We touched on that.
So it's facility conditionassessment.
What do we need to maintainthese four different campuses
and ambulatory network locationsites there's an investment
there that has to be taken intoaccount before any other
expansions or renovations.
There's operational assessmentas well understanding current
(23:01):
state operations and what do wewant to do in the future.
Number three there's theanalysis portion.
So some of this we do in-house,some of this we work with
partners, but market analysisand forecasting.
Again, understanding currentstate what do we have for
surgery service line volumes,what do we have for ED
inpatients?
And then projecting out withpopulation growth, with
(23:24):
additional market capture, whatdoes that look like in the
future and what do we need tosupport it?
Number four I think about astarget location analysis.
So if we have additional sitesthat come online in the future
to meet that forecasted need,what's the right location?
We look at drive times, masstransit routes, competitor
(23:47):
locations.
Where's our locations today?
That starts to identify gaps.
Where's the population going?
Where do we want to be?
Fifth, prioritizing conceptualprojects.
I touched on this earlier.
I think about one client we'veworked with.
They had, over the next 10years, 50 to 60 projects they
could see and identify withoutanything else popping up in the
(24:10):
future.
When you talk to an executiveteam or leadership team, they
all have their own priorities.
They all think their projectsneed to fit in the first three
to four year window and thatjust can't happen, right,
there's only so much capital togo around.
And so how do we start toobjectively say here's our
strategy, here's our goals.
These have to fit in bucketnumber one.
(24:31):
These can go out a little bitfurther into bucket two, and
this next four to six yearwindow and so on.
So so helping them prioritize,and then the capital ties to
that finally.
So thinking about the money andhow that spread out over a 10
year window, 15year window,whatever it may be.
Jason Nordling (24:48):
T he other thing I want to add in there.
You mentioned that we partnerwith different data analytics
partners.
We also partner with differentfinancial analytics partners.
We've had several clients inthe recent past, as we're
looking at their system, whohave made changes like dramatic
(25:09):
changes.
Hey, this hospital in oursystem is no longer going to be
a regional hospital and we don'tneed 50 beds, we only need 20
beds there.
And oh, by the way, it would beadvantageous to change how we
get reimbursed.
So we're going to look atcritical access as a change, as
(25:29):
opposed to being a PPS facilitythat change the reimbursement
lands.
Having those financial folksalongside us can help make those
decisions as well.
Brian Zabloudil (25:43):
Along those same lines other partners,
construction partners,especially at the system level,
where if we're going to providegood, solid cost projection on
these different projects withina timeline, we'll partner with
construction managers to look atreally firmed up costs.
That has a lot of fidelity toit, a lot of rigor that goes
(26:05):
into coming up with thoseestimates and then applying
escalation on top of that too.
We all know that things getmore expensive over time, so it
doesn't do us any good to thinkabout a $10 million project
that's eight years out ifthere's no escalation assigned
to it.
Jason Nordling (26:20):
I think the big point, the big takeaway there is
it takes a pretty deep, robustteam to deliver system-level
things.
There's so many things to betaken into account.
Brian Zabloudil (26:33):
Yeah, I'm a sucker for sports analogies.
I think of the architect,whether it's on a project or
something like this.
That's a larger kind of systems, more macro level for the point
guard.
We're distributing, we'remaking the whole dance work.
Jason Nordling (26:50):
I'm not a basketball fan, but I like the
analogy.
Jessica Sweeney (26:52):
Yeah, I'm there with you.
We could find a different sport, but it works.
I'm not a basketball fan, but Ilike the analogy.
Brian Zabloudil (26:58):
Yeah, I'm there with you.
We could find a different sport, but it works.
Jessica Sweeney (27:01):
Hockey jest I don't know how to make a hockey
analogy.
That's okay.
Jason, you did mention talkingabout moving to critical access
status and I think that's reallythat partnership, that
strategic partnership that weget to have with our clients is
really important there becausewe are understanding the trends
from a larger perspective.
Science is really importantthere because we are
understanding the trends from alarger perspective.
So things like freestanding EDs, you know from we get to in
this conversation around systemstrategic planning, really think
(27:22):
about some of those pieces.
You know, do you have a worldwhere you need to put up a
freestanding ED?
Should we be closing beds inthis facility?
What are the true needs of thesystem?
What are the requirements ofthe system, what can they forge,
what can they pay for and howdo we maximize or optimize the
patients that they take care ofand bringing them in in
(27:42):
different ways?
And so that's right back tothat beginning of.
You know where do you needprimary care, where do you need
clinicians, where do you needoffices, where you know, where
do you have a great home-basedprogram that maybe we don't need
to have an outpatient facility,just thinking about the trends
in healthcare combined with thepatients and what the needs are.
Jason Nordling (28:01):
Yeah one of the big points of contention is
usually we get into more ruralareas, we do a lot of work with
rural facilities.
It's do we need inpatient beds?
And there's always this hugereluctance to get rid of
inpatient beds, even thoughaverage daily census, you know,
hovers two, three, four, and sowe've had a few facilities that
(28:24):
have actually looked at therural emergency hospital program
but there's a large reluctanceto getting rid of that inpatient
component and quite honestly Idon't know if the incentives are
strong enough yet to make thosechanges They've tried to
(28:46):
incentivize it a little bit.
Brian Zabloudil (28:46):
I think that's an important note, jason, and,
top of mind, incentivereimbursements.
Just the way the system is setup is evolving and changing
daily, weekly.
Right now we're really tryingto stay on top of that and
educate our own, you know again,outside of architecture, just
understanding how things arechanging at the federal level,
(29:08):
state level.
That's going to be important toour clients.
Jessica Sweeney (29:11):
And I think it's important to us.
So many of our staff are reallypassionate about keeping
healthcare in rural areas in away that makes sense for them.
I think we do all understandthe economic impact that having
a facility in a rural locationcan have, and we understand that
piece of how it helps oursystems through bringing
patients in.
You know, coverage coveredlives.
(29:33):
How are we caring for thepopulation?
But there's an economic impact,and so I think a lot of our
staff are passionate aboutworking with our clients to make
sure that it continues to workfor them.
Whether it's new payment models, whether it's changing
strategically.
How do we do what's best forour clients to keep care as
local as what makes sense forthem?
Matthew Gerstner (29:54):
All right.
So with this next question I'vegot for you all I know we've
probably touched on elements ofthis question, but I don't think
we've come to this conclusionis like what can we expect for
outputs from this process, likeat the end of the process?
All these, all these toughconversations have happened.
We've had all the people in theroom.
(30:14):
We've we've done it.
What?
What are the outputs that go tothe clients in these situations
?
Now?
Brian Zabloudil (30:35):
system as well.
It's almost like an onion where, over time, layers have been
added to the campus, to thebuildings or to the system and,
and yes, there may have beensome plan for that moment in
time, but not at a large, big,strategic macro level.
So it's putting together that10 to 15 year horizon, that
timeline of of aligning thebuilt environment and the
capital with strategy.
(30:56):
You know that every hospitalhas a strategic plan.
We want to think about thatstrategy and how it ties to the
built environment, how weprovide that care right place,
right time.
Jason Nordling (31:08):
Yeah, typically the output we provide it's a
digital format, though you know.
I mean planning is usually donein PDF form.
All the financial stuff, costs,etc.
That's in a living Exceldocument.
At this point, I think thoseare still the tried and true
tools that we use.
I haven't seen anybody come upwith anything much better than
(31:31):
that yet.
Brian Zabloudil (31:33):
Yeah, you make a good point, jason, about it
has to be dynamic.
These plans can't be static.
It can't be a book that sits ona shelf.
The strategy evolves almostimmediately.
We find that happen withclients where within three
months, something that was inyear six all of a sudden is
pushed up to year one.
There's a domino effect andthat plan has to evolve.
(31:54):
You know, we we can absolutelybe there to help, but to some
degree whether it's a VP offacilities or someone within the
executive team has to be ableto adjust those things to
overtime.
Jason Nordling (32:05):
And I feel like we've if we've done our job
really well and had thoseconversations, they're able to
do that.
Not that we're not consulted onsomething, but the heavy
lifting is hopefully done atthat point and they can make
those tweaks on their own.
Jessica Sweeney (32:24):
There's a true benefit in just undergoing the
process, having theconversations, bringing up the
pieces that matter.
Matthew Gerstner (32:32):
All right, so we're going to switch this again
just a little bit.
Can you all talk about some ofthe challenges or successes that
you've seen implementing thesesystem level plans?
Jason Nordling (32:40):
I think one of the successes that I see is just
it gives them space to breathe,right Like when you lay the
plan out and you've goteverybody in the room going yeah
, this is solid.
We did some hard work here.
It's taken us months to achieve, but now we feel we've got this
roadmap in front of us and itgives you a sense of ease about
(33:05):
the future.
Not that you're to Brian'spoint previously not going to
have to pivot for some thing,but at least you've got that
foundational work set, and sothat's the biggest success I
think I've seen is just this,this ease of knowing you've got
a plan and a plan that workstogether with other departments.
Jessica Sweeney (33:29):
You know that idea that maybe you're had a
facility in one area hasn'treally spoken to somebody else,
but now they're sitting at thesame table and they're talking
and having those conversations.
And I think Brian mentioned the60 projects.
Maybe they didn't get theirproject in year one but you know
, they know that they're,they've been listened to and
they know that they were able tohave that set out plan and talk
(33:49):
to other people's needs andwants and requirements.
Jason Nordling (33:53):
That's a great point, jess.
The process is about buildingconsensus as well, right, like
that's a big part of it.
Getting everybody to go.
Yep, this makes the most sensebecause, again, as I think Brian
mentioned, there's all sorts ofcompeting interests.
You know when we're working atthis level.
Brian Zabloudil (34:14):
I would say that's the biggest challenge
arriving at that consensus with.
You know, I think about eight,10 individuals in the room
that's that are not part of ourteam, that are on the client
side and, uh, some may benodding their head, yeah,
egregiously, I'll come alongwith this.
I understand, and so I thinkreally having that
decision-making framework,something objective, something
(34:35):
to point to, removes the emotionfrom it helps people have that
peace of mind.
Jason Nordling (34:41):
As facilitators of the process, as you referred
to earlier.
Getting people in the room, ina place where you're checking
your ego and your preconceivednotions at the door, I mean
that's really the way to getsuccess.
Jessica Sweeney (35:01):
And we all have to do it right.
We all have to succeed.
With regards to some of thechallenges, I think that one of
the biggest challenges that theminute you have created your
strategic plans, it's startingto get old.
There are so many changes,especially right now, happening
rapidly, where our job is to dothe best we can to make sure
that it's considered some ofthese other pieces or that we've
thought about it, but you don'tknow what.
(35:23):
We don't know what's happening.
I mean, there have beensignificant health care
disruptors over the last 10years that people had no thought
that they were coming, and soat that point, you know, does
the plan encompass it enough?
Can it give us a?
Maybe it's not a roadmap, maybeit's a couple of directions, or
do you need to take anotherlook at it?
Jason Nordling (35:41):
And it's a significant improvement over the
sometimes the magic eight balldecision-making that has
happened.
Jessica Sweeney (35:49):
having that plan in place, I think one of
the other challenges is you areseeing large-scale healthcare
organizational changes, so largefacilities or systems are
joining up with other systems.
We work with many ruralfacilities and oftentimes, while
their goal is to maintainindependence, their next best
goal is to decide what theirfuture is, and so we're seeing
(36:12):
large changes where, suddenly,you're not in charge of your
future.
There's collaboration withanother facility or another
system that you need to considerin these decisions, and so
things can change rapidly inthat essence as well.
Brian Zabloudil (36:27):
A lot of what we've talked about.
It's not traditionalarchitecture, it's not bricks
and mortar.
It is very complex andchallenging and it requires
iteration.
Having done it, you refine itover time.
We talked about the teams.
They're big and complex.
It's architects, it's stateanalytics firms, people doing
pro formas and financialmodeling, construction managers
(36:48):
looking at costing, facilitatingand mediating.
So that's what I love, and Ithink this team loves to, is the
challenge of it.
It's different.
It's not the challenge ofputting together a building,
it's putting together a systemand thinking about it at a much
more macro level.
I think it's something thisteam does exceptionally well.
Jason Nordling (37:07):
I love that comment because I think the
preconceived notion is thatarchitects do buildings right
and absolutely.
We are right Like that.
We think about buildings andhow things get put together so
that they endure.
But if you really break it downto its most basic level, we are
(37:29):
trained to be problem solversand that's what we do.
Jessica Sweeney (37:34):
This piece is really rewarding.
I think it's rewarding for meand I think it's rewarding for
all of us, where we get to thinkabout healthcare strategy on a
larger scale.
We get to really be partnerswith our clients, be involved
and see some of theirdecision-making help, providing
the information and facilitatingthe conversations that lead to
those decisions and, as such, itmakes us better at our jobs too
(37:58):
.
And that next project, thatnext client, that next strategic
planning, whatever it means, wehave a greater base and depth
of knowledge and experience aswe continue to have additional
conversations.
So when it is those traditionalarchitectural conversations,
they're deeper, they're moremeaningful and I think it goes
back to that trust I like whenwe're brought in, when we're
(38:21):
trusted to have thoseconversations with our clients.
Matthew Gerstner (38:24):
And I think that's a great spot to wrap this
conversation up today.
Y'all You've provided so muchinformation in this short little
window for all of our listenersto think about.
Thank you all for your timetoday and to our listeners.
We'll see you again soon.
This has been Side of Designfrom BWBR, brought to you
without any paid advertisementsor commercials.
(38:45):
If you found value in whatyou've heard today, give us a
like, leave us a comment or,better yet, share us with your
network.
You can also reach out to us ifyou'd like to share an idea for
a show or start a discussion.
Email us at sideofdesign atbwbrcom.
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