Side of Design
A podcast from BWBR, for those with a craving to take their organizations and spaces to new heights, with a side of design. We explore topics and issues affecting how we heal, learn, work, research, play and pray with those whose passion and expertise centers on the spaces that enable us to do all of that.
Side of Design
Thinking Bigger: A System-Level Approach to Healthcare’s Future
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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This is Side of Design from BWBR, a podcast discussing all aspects of design with knowledge leaders from every part of the industry. Hello and welcome to Side of Design from BWBR. I'm your host, matt Gerstner. In today's conversation we're talking about the evolving healthcare landscape, how health system leaders must navigate increasing complexity when determining when to invest, where to build and what to build, across both inpatient and outpatient environments. We'll take a look at how a proven structured approach to system-level strategic facility planning aligns long-term capital investment with an organization's broader mission goals and strategic plan. Joining this conversation today from BWBR are Principal Jason Nordling, senior Pl Jessica Sweeney and principal Brian Zablujil. Thank you all for joining me today, thank you, thank you. Let's just kind of get things going, brian. What exactly do we mean by system-level strategic planning as opposed to, like, a master plan or other facility-level plan?
Brian Zabloudil:Right. So I think most people are fairly familiar with facility master plan or campus master plan or other facility level plan Right? So I think most people are fairly familiar with a facility master plan or campus master plan. It's usually that it's focused typically on a single campus, a series of buildings, one larger hospital building in and of itself. The process is data analytics informed. It's typically about a phased modernization and right sizing of key departments, service lines, getting out from under older infrastructure, optimizing flow and efficiency. It does take into account mechanical, electrical, plumbing services, utilities throughout the campus and they often lead directly into specific design projects. So that's, you know, the typical facility master planning process and what that looks like.
Brian Zabloudil:With system-level planning, you're often thinking about a network of campuses, so more of a system in and of itself, with an outpatient network, multiple hospital locations. Like facility master planning, it is data analytics informed. You think about services that are interconnected, so multi-location emergency departments, multi-location surgery departments and how they all work together. It can often lead to multiple master facility plans and are the precursor to that, rather than specific projects. And finally, the big focus is there's typically a 10-year allocation of capital of those multiple projects throughout that whole system. So it's thinking about things in that manner.
Matthew Gerstner:Okay, so really what else? A system level we're talking like it could be a very large geographic area of sorts right, Correct?
Brian Zabloudil:We're thinking about a larger primary and secondary service area and how each location will feed into and work towards that goal.
Matthew Gerstner:Oh wow, it sounds like a very complex process.
Jessica Sweeney: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 talking about the system, strategic level planning, we are going much further into the future than we otherwise would. So we get to really partner with our clients to think about that strategy piece how are things changing, how is healthcare changing, how is their population growing or ebbing and flowing, and what type of care are they going to need to provide in the future? As we're thinking about all of these pieces moving around, I really enjoy this deeper relationship that we get to have with our clients, where sometimes we get to be brought into those strategy conversations. What do you need to provide care to be successful in the future?
Jason Nordling:And you're having kind of crystal ball conversations about the future, right, Like things you can't predict necessarily, because we're always pivoting in healthcare right. Every time you've got new legislation or something, some new ruling from CMS or something changes how they're reimbursed. We can scenario, plan those out a little bit as well and talk about okay, X happens, we're going to do Y. Not that you can catch all those things, but it's good to have the conversation and at least be thinking about it.
Matthew Gerstner:Then what are the practical and tangible benefits of engaging in this sort of planning? I mean, it sounds like there's a lot of unknowns and some of those unknowns may stay unknowns, but what are the benefits of doing this?
Jason Nordling:I think, personally, it's just getting in front of these long-term decisions. I can't tell you how many times we've been involved in a project and you're trying to deal with a kind of messed up situation, either with a building or a series of buildings, because there was no forethought put into how things evolved or were developed previously, and so sometimes you're spending good money after bad, as they say, trying to fix things because there wasn't enough thought put into it. I would also say nowadays we're using data, we're leveraging data much, much more than we ever could in the past. There's just so much more available to us at our fingertips.
Jason Nordling:A lot of times these conversations at a system level. They are about what are we developing new in the future? How are we addressing something? They also have 50 buildings that have asset preservation needs as well. That should be planned for in advance. Right, we know we're going to have to replace this roof or these windows or these rooftop units, and you can put this together in a comprehensive plan across a system. One of the biggest challenges that I've been told by VP facilities of systems is just getting their arms around all the facility management stuff that they have to deal with and that can be incorporated into these larger strategic plans as well.
Jessica Sweeney:Jason mentioned the change. You know when you have external factors, whether it's reimbursements or it's different laws or administrative rules or whatever might be happening. While we may not be able to anticipate exactly what is coming down in the future, by having some of these strategic conversations we've had some of that. What if? What if X Y Z happens? Maybe we didn't define X Y Z perfectly when we had the conversation, but we talked about something and we had a plan for something, and so our clients, whether they come back and talk to us or whether they do it on their own, they've had some of those initial conversations and can be better prepared to handle the things that are coming at them.
Brian Zabloudil:Yeah, I think, Jason, you touched on it but understanding current state, assessing current state, both from a facility standpoint, what does it take to maintain asset preservation? What is our current strategy as a system? There is some trust that has to be built between us and our client in this type of exercise where we're talking about pretty in-depth strategy for both population health how are we going to care for our community but also the business side. Right, there's the reality of kind of offensive and defensive maneuvers that they're making and so, I think, establishing, like we talk about, goals for the built environment, how does our our strategy as a system? How do we achieve that through the built environment? How do we reinforce it or or elevate? And the decision-making framework we need to establish upfront, because we often sit in a room, multiple executives, everyone has their own priorities and decision-making can be a real challenge. So to some degree, we're a mediator or we're facilitating the conversation and mediating and trying to bring different perspectives and help them understand one another. Again, trust is a foundational element to this process.
Jason Nordling:We've seen multiple, multiple entities doing this, whereas a lot of times our clients, you know they only see what they see and so we can bring that perspective as well. What are they doing here, there and in other regions? How can we bring that to bear or apply that to a situation, whether it be a service line strategy, growing a certain service line, physician recruitment impacts on space, all sorts of things. It's not always volumes of patients determining KPUs in space, right?
Brian Zabloudil:KPUs in space, right? Yeah, I think a good example that I've seen is level of outpatient thinking versus main campus. From one client or system to another, how much are we pushing out into the community? There's efficiency that you lose from kind of a provider and operational standpoint, but it widens that network. It allows you to shift volume around to different locations. I mentioned EDs surgery great example too. How much is on the main campus? How much is out in the community of ASCs?
Jason Nordling:Yeah, that's a constant problem is how larger systems decant from their main campuses. What makes sense? Yeah, absolutely Good point.
Jessica Sweeney:A lot of the trends in healthcare are kind of leaning towards those conversations. I think recently we've seen the inpatient volumes increase and many of our rural clients are taking care of patients that they never thought they would take care of in their inpatient settings. In the past they would have sent those to a higher level acuity facility and now, either through inability because there are too many beds that are taken up by others or other reasons, they're having to take care of those patients at home. So we're starting to see a shift to in where those patients would ebb and flow from one facility to another. So those large, I think system healthcare system level shifts and how we take care of patients is also a contributing factor in many of our conversations.
Jason Nordling:And that's tied directly back to value-based care right and and reimbursements.
Jessica Sweeney:And that's actually an interesting trend that I've seen in the literature. Right now I'm kind of interested to see if it's going to pan out in how we're caring for patients. Is there is a push and an expectation that we'll see more value-based care for Medicare patients, so as older populations kind of thinking about how can we keep them healthier, how can we get them care in the right place, and so that's always been a piece of that patient population. But we're seeing an increase right now, at least in the literature. We'll see if it increases in the volumes as well.
Jessica Sweeney:Brian mentioned trust, and that's a really important piece for me. That's why I like to be in these conversations. We have to have the folks that we're having the conversations with whether they're the leadership team or the ones that are providing the care. They need to know that we're listening to them. They need to know that we are providing them good feedback and good information and that they trust us in having those conversations so that we can get to that end point. That makes a lot of sense for the care that they're providing, and so that's key for my background. I worked in healthcare for 10 years and before coming to BWBI I've been here now for three and a half, four years and so I've been in that. I actually worked in healthcare through COVID and we need to be able to have those conversations. We need to be able to think about how we use the space.
Jessica Sweeney:Jason mentioned it's not just KPUs and volumes, it's how do we move within the spaces when? What are their hours of operation? What are their hours of operation should be? If we need growth, how are we going to handle that? And so it gets down to that real care level volume, when we're thinking about exam rooms and inpatient beds. But also from that larger system perspective, how are patients going to flow between facilities? If we're growing our orthopedics department, what does that mean for all the other departments and not just in one area? And if we're thinking about a community, where's community growth? How are they going to access care? Where do they want to drive to? And that changes based on the facility that we're working with.
Jessica Sweeney:So I think key is we need to be thinking about how do we use the space, how do we use the facilities, how do we want to use the facilities, what are the staffing that we're going to be able to get? What are the staffing that we need to have and think about all of those pieces as we're talking about these decisions, with patients flowing and where do we need to have, where do our clients need to provide that care?
Jason Nordling:I think that's an excellent point, whether it's growth or contraction, because we do see a lot of times the assumption is that if there is that growth, we'd love to see that, but if there is that, the assumption is that automatically we're adding space. We don't need to build something, we just need to rearrange a little bit or think about processes a little bit differently. We can do a lot of things through optimizing flows within a system, as well as a portion of the system, a building or a facility, to allow them to take up growth without having just a ton of capital on some big thing.
Brian Zabloudil:So sometimes the right answer how can we do more with what we have?
Jessica Sweeney:yeah, yeah that's capital that our clients don't always have right now. Health care has never been more expensive to build, and the money flow coming in is not, you know 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 going to recommend yep, you need a new building here. That conversation needs to be deeper, because that's that trust. We need to provide the best advice that we can, whether that is a new building or not, and oftentimes, like Jason said, it can be managed without that new facility.
Matthew Gerstner:I'm hearing quite a few takeaways from this portion of the conversation. Part of it at the beginning was you're looking at aging facilities in a lot of situations and sometimes there was no forethought as to the planning process of how things went together. So you're you know things may need to be optimized and came up here later in the conversation Things may be outdated and may need to be redone in some way. I hear you're talking about leveraging data, which is fantastic. How do we leverage data to maximize this? I also heard it's not just about building new facilities, it's also about the asset preservation and how can that fall into it.
Matthew Gerstner:And then the big one here was trust building trust, showing that, listening, truly listening to what's going on in the room, truly evaluating needs, because in the end, being system level, we're not talking about just one area, we're talking about large geographic area with multiple facilities. It's potentially a lot of money on the table and it's not something that anybody takes lightly. So, going back to the data information, jessica. So, going back to the data information, jessica, you bring this operational lens to this effort. So how does that play into creating an effective enterprise strategy?
Jessica Sweeney:Well, I think it's key and I know we talked about a little bit earlier that how do we move within this space and how do we want to move within this space? Big key conversations that we're having right now, and this almost goes to the smaller facility level planning how do we optimize a space? We can't build something and have it used an hour a day or a day a week, so we have to really think about different ways to use it. And that goes when we're talking 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 type of relationship we built with our clients? So we can understand that piece?
Jessica Sweeney:I do know a facility or, I'm sorry, I know a state where patients will actually drive twice the distance Southern than they will to go directly Eastern or Western to go to a different facility, because that's it's the concept that is better in that specific state, and so. But every state is different and so how patients are making some of those decisions, that's also important when we're thinking about that flow within a system. But we have to be able to have those conversations about how are they going to use it? What are they going to do? How do patients walk into their system? How do they walk into their building? Where are they being referred to?
Jessica Sweeney:So if you have a patient ortho is a good example that we already mentioned what's that cadence? Do they see PT before they do ortho 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? Do they contract with an ortho group? Do they have it set? Are they inpatient surgical suites or are they outpatient surgery centers? What are the decisions that we need to make that just make everything else pull in a different direction?
Brian Zabloudil:The perspective that Jessica brings. She can act as a bit of a liaison between architects like Jason and I. We are architects first and foremost. We know healthcare very well, but we've never walked in their shoes, we've never lived it. Jessica has, and so you know there's there's kind of this good in-between to help with the dialogue and building that 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 the in-between at times.
Jason Nordling:Mostly she asks different questions because of that and it elicits different answers than you or I would get in that conversation. So yeah, I found it highly valuable.
Matthew Gerstner:I can totally see how that would happen. You walk into a room and you everybody can listen and hear the same thing, but everybody can have a different question in the end too, and getting the right question asked will get you a far better answer of what you're looking to do and hear the same thing, but everybody can have a different question in the end too, and getting the right question asked will get you a far better answer of what you're looking to do.
Jessica Sweeney:That's a fantastic skill to bring into a room. One of the biggest limiting factors in healthcare growth and it's system-wide and almost every system we interact with is hiring and staffing. And so one of the things that we always talk about in our projects whether it's strategic level, that system level thinking or the smaller projects is you know what staff do you need and can you get them? Can you hire them, can you train them? What is your process? The majority of the times when we're looking at spaces or facilities, if we say what's your limiting factor, what's stopping you from growing, what's stopping you from seeing more patients, well, space is sometimes indicated there.
Jessica Sweeney:Oftentimes it's staffing. We can't get the people, and so through this process, it's change. Change is hard and we want to help our clients keep their staff. We want to help them be a place where people want to come work. We want a system that makes sense, facilities that make sense for the patients and for the staff, and so I see that as a key piece of my role where I can have some of those conversations or even make them feel listened to. Our architects are fantastic listeners. They know the conversations, they know what they're doing and sometimes me being in that room also just makes that different level of yep, they get it, they hear it, they hear what we're saying. We trust this process.
Jason Nordling:They hear it, they hear what we're saying, we trust this process and to your point, it's, it's all, almost all the results, at least in this time of staff deficit. You know, asking people to do more with with less Right, and that's. Those are hard conversations as well.
Matthew Gerstner:You mentioned a phrase in there that I picked up on was change is hard and change is hard for everybody, right, is that? Is that a process that we help to manage? Do we? Do we help manage change?
Jessica Sweeney:management, managing those expectations. It's identifying change. So I know, when I'm in a room with folks, if I'm having a conversation with our team or external, their little cues you pick up on or different things that you hear that you're saying, oh, this department is not ready for this. So you can have, maybe, that conversation, whether it's with leadership or to say how can we help them? What's going on here? Why don't they feel like this process is working for them? And so that's part of change management.
Jessica Sweeney:Another key piece of change management is if there is a new facility or if there is a change in that process, how do we talk about it? Do we identify that process? Do we identify what we want it to be? With the people that are providing the care, with the leaders that are having to change their building setup, do we make sure that they've had that conversation? And if we're not, I think we're missing a mark. We have to be, we have to be talking about that. It's going to be different. Or else we're opening up a facility and everybody's unhappy because we're changing rooms or, you know, we're shutting something down and people don't know where they want to get their care. So we have to have that conversation and I think that's inherent in change management. It's just identifying the change, talking people through it as much as possible.
Jason Nordling:Yeah, I don't know how many times I've seen that in working with different groups, but we've been doing it this way for 30 years. Right, like there's so much discomfort pivoting to a different way of doing things. Not that I mean some people are just naturally like, nope, that'll, that will work. Most of the time, though, with time and incremental conversations about people come around to thinking about things differently. Right, that's how healthcare is. It requires us to think differently about everything.
Brian Zabloudil:Yeah, I think a big part of our value when it comes to change management is different perspectives. Right, proof of concept. I know it's scary. This is going to be a big change. You're going from an open bay NICU to a private NICU. We've helped clients through this before. Here's what it looks like and we can get you in touch with them. We can talk about lessons learned. How did they operationalize this new unit? What bumps did they have? What changes did they make? So being able to provide proof of concept and yes, it's been done and here's how it was successful helps.
Matthew Gerstner:Now I'm going to shift gears here and we're going to go right back into system level strategic planning. What would a clear, actionable roadmap for something like this look like?
Brian Zabloudil:Yeah. So I would say there's not a strict formula. However, we've done this and understand some steps that do make sense throughout this. I've outlined previously just in thinking about this recently kind of six big picture steps I touched on it earlier and all these things are touched on really to this point, but establishing goals for the built environment and setting up decision making framework. So what's our top goals? What's our top priorities? You know, putting those in order and helping facilitate that with our clients. Priorities putting those in order and helping facilitate that with our clients. And then later on, when we have to make decisions, what is the objective decision-making framework? Sometimes we use lean tools for that, like choosing by advantage or setting up factor-based scoring. So that's number one.
Brian Zabloudil:Number two assessing current state. We touched on that. So it's facility condition assessment. What do we need to maintain these four different campuses and ambulatory network location sites there's an investment there that has to be taken into account before any other expansions or renovations. There's operational assessment as well understanding current state operations and what do we want to do in the future. Number three there's the analysis portion. So some of this we do in-house, some of this we work with partners, but market analysis and forecasting. Again, understanding current state what do we have for surgery service line volumes, what do we have for ED inpatients? And then projecting out with population growth, with additional market capture, what does that look like in the future and what do we need to support it? Number four I think about as target location analysis. So if we have additional sites that come online in the future to meet that forecasted need, what's the right location? We look at drive times, mass transit routes, competitor locations. Where's our locations today? That starts to identify gaps. Where's the population going? Where do we want to be?
Brian Zabloudil:Fifth, prioritizing conceptual projects. I touched on this earlier. I think about one client we've worked with. They had, over the next 10 years, 50 to 60 projects they could see and identify without anything else popping up in the future. When you talk to an executive team or leadership team, they all have their own priorities. They all think their projects need to fit in the first three to four year window and that just can't happen, right, there's only so much capital to go around. And so how do we start to objectively say here's our strategy, here's our goals. These have to fit in bucket number one. These can go out a little bit further into bucket two, and this next four to six year window and so on. So so helping them prioritize, and then the capital ties to that finally. So thinking about the money and how that spread out over a 10 year window, 15year window, whatever it may be.
Jason Nordling:T he other thing I want to add in there. You mentioned that we partner with different data analytics partners. We also partner with different financial analytics partners. We've had several clients in the recent past, as we're looking at their system, who have made changes like dramatic changes. Hey, this hospital in our system is no longer going to be a regional hospital and we don't need 50 beds, we only need 20 beds there. And oh, by the way, it would be advantageous to change how we get reimbursed. So we're going to look at critical access as a change, as opposed to being a PPS facility that change the reimbursement lands. Having those financial folks alongside us can help make those decisions as well.
Brian Zabloudil:Along those same lines other partners, construction partners, especially at the system level, where if we're going to provide good, solid cost projection on these different projects within a timeline, we'll partner with construction managers to look at really firmed up costs. That has a lot of fidelity to it, a lot of rigor that goes into coming up with those estimates and then applying escalation on top of that too. We all know that things get more expensive over time, so it doesn't do us any good to think about a $10 million project that's eight years out if there's no escalation assigned to it.
Jason Nordling:I think the big point, the big takeaway there is it takes a pretty deep, robust team to deliver system-level things. There's so many things to be taken into account.
Brian Zabloudil: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're making the whole dance work.
Jason Nordling:I'm not a basketball fan, but I like the analogy.
Jessica Sweeney:Yeah, I'm there with you. We could find a different sport, but it works. I'm not a basketball fan, but I like the analogy.
Brian Zabloudil:Yeah, I'm there with you. We could find a different sport, but it works.
Jessica Sweeney:Hockey jest I don't know how to make a hockey analogy. That's okay. Jason, you did mention talking about moving to critical access status and I think that's really that partnership, that strategic partnership that we get to have with our clients is really important there because we are understanding the trends from a larger perspective. Science is really important there because we are understanding the trends from a larger perspective. So things like freestanding EDs, you know from we get to in this conversation around system strategic planning, really think about some of those pieces.
Jessica Sweeney:You know, do you have a world where you need to put up a freestanding ED? Should we be closing beds in this facility? What are the true needs of the system? What are the requirements of the system, what can they forge, what can they pay for and how do we maximize or optimize the patients that they take care of and bringing them in in different ways? And so that's right back to that beginning of. You know where do you need primary care, where do you need clinicians, where do you need offices, where you know, where do you have a great home-based program that maybe we don't need to have an outpatient facility, just thinking about the trends in healthcare combined with the patients and what the needs are.
Jason Nordling:Yeah one of the big points of contention is usually we get into more rural areas, we do a lot of work with rural facilities. It's do we need inpatient beds? And there's always this huge reluctance to get rid of inpatient beds, even though average daily census, you know, hovers two, three, four, and so we've had a few facilities that have actually looked at the rural emergency hospital program but there's a large reluctance to getting rid of that inpatient component and quite honestly I don't know if the incentives are strong enough yet to make those changes They've tried to incentivize it a little bit.
Brian Zabloudil:I think that's an important note, jason, and, top of mind, incentive reimbursements. Just the way the system is set up is evolving and changing daily, weekly. Right now we're really trying to stay on top of that and educate our own, you know again, outside of architecture, just understanding how things are changing at the federal level, state level. That's going to be important to our clients.
Jessica Sweeney:And I think it's important to us. So many of our staff are really passionate about keeping healthcare in rural areas in a way that makes sense for them. I think we do all understand the economic impact that having a facility in a rural location can have, and we understand that piece of how it helps our systems through bringing patients in. You know, coverage covered lives. How are we caring for the population? But there's an economic impact, and so I think a lot of our staff are passionate about working with our clients to make sure that it continues to work for them. Whether it's new payment models, whether it's changing strategically. How do we do what's best for our clients to keep care as local as what makes sense for them?
Matthew Gerstner:All right. So with this next question I've got for you all I know we've probably touched on elements of this question, but I don't think we've come to this conclusion is like what can we expect for outputs from this process, like at the end of the process? All these, all these tough conversations have happened. We've had all the people in the room. We've we've done it. What? What are the outputs that go to the clients in these situations? Now?
Brian Zabloudil:system as well. It's almost like an onion where, over time, layers have been added to the campus, to the buildings or to the system and, and yes, there may have been some plan for that moment in time, but not at a large, big, strategic macro level. So it's putting together that 10 to 15 year horizon, that timeline of of aligning the built environment and the capital with strategy. You know that every hospital has a strategic plan. We want to think about that strategy and how it ties to the built environment, how we provide that care right place, right time.
Jason Nordling:Yeah, typically the output we provide it's a digital format, though you know. I mean planning is usually done in PDF form. All the financial stuff, costs, etc. That's in a living Excel document. At this point, I think those are still the tried and true tools that we use. I haven't seen anybody come up with anything much better than that yet.
Brian Zabloudil: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 on a shelf. The strategy evolves almost immediately. We find that happen with clients where within three months, something that was in year six all of a sudden is pushed up to year one. There's a domino effect and that plan has to evolve. You know, we we can absolutely be there to help, but to some degree whether it's a VP of facilities or someone within the executive team has to be able to adjust those things to overtime.
Jason Nordling:And I feel like we've if we've done our job really well and had those conversations, they're able to do that. Not that we're not consulted on something, but the heavy lifting is hopefully done at that point and they can make those tweaks on their own.
Jessica Sweeney:There's a true benefit in just undergoing the process, having the conversations, bringing up the pieces that matter.
Matthew Gerstner:All right, so we're going to switch this again just a little bit. Can you all talk about some of the challenges or successes that you've seen implementing these system level plans?
Jason Nordling: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 got everybody 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 it gives you a sense of ease about the future. Not that you're to Brian's point previously not going to have to pivot for some thing, but at least you've got that foundational work set, and so that'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 works together with other departments.
Jessica Sweeney:You know that idea that maybe you're had a facility in one area hasn't really spoken to somebody else, but now they're sitting at the same table and they're talking and having those conversations. And I think Brian mentioned the 60 projects. Maybe they didn't get their project in year one but you know, they know that they're, they've been listened to and they know that they were able to have that set out plan and talk to other people's needs and wants and requirements.
Jason Nordling:That's a great point, jess. The process is about building consensus as well, right, like that's a big part of it. Getting everybody to go. Yep, this makes the most sense because, again, as I think Brian mentioned, there's all sorts of competing interests. You know when we're working at this level.
Brian Zabloudil: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 our team, that are on the client side and, uh, some may be nodding their head, yeah, egregiously, I'll come along with this. I understand, and so I think really having that decision-making framework, something objective, something to point to, removes the emotion from it helps people have that peace of mind.
Jason Nordling:As facilitators of the process, as you referred to earlier. Getting people in the room, in a place where you're checking your ego and your preconceived notions at the door, I mean that's really the way to get success.
Jessica Sweeney:And we all have to do it right. We all have to succeed. With regards to some of the challenges, I think that one of the biggest challenges that the minute you have created your strategic plans, it's starting to get old. There are so many changes, especially right now, happening rapidly, where our job is to do the best we can to make sure that it's considered some of these other pieces or that we've thought about it, but you don't know what. We don't know what's happening. I mean, there have been significant health care disruptors over the last 10 years that people had no thought that they were coming, and so at that point, you know, does the plan encompass it enough? Can it give us a? Maybe it's not a roadmap, maybe it's a couple of directions, or do you need to take another look at it?
Jason Nordling:And it's a significant improvement over the sometimes the magic eight ball decision-making that has happened.
Jessica Sweeney:having that plan in place, I think one of the other challenges is you are seeing large-scale healthcare organizational changes, so large facilities or systems are joining up with other systems. We work with many rural facilities and oftentimes, while their goal is to maintain independence, their next best goal is to decide what their future is, and so we're seeing large changes where, suddenly, you're not in charge of your future. There's collaboration with another facility or another system that you need to consider in these decisions, and so things can change rapidly in that essence as well.
Brian Zabloudil:A lot of what we've talked about. It's not traditional architecture, it's not bricks and mortar. It is very complex and challenging and it requires iteration. Having done it, you refine it over time. We talked about the teams. They're big and complex. It's architects, it's state analytics firms, people doing pro formas and financial modeling, construction managers looking at costing, facilitating and mediating. So that's what I love, and I think this team loves to, is the challenge of it. It's different. It's not the challenge of putting together a building, it's putting together a system and thinking about it at a much more macro level. I think it's something this team does exceptionally well.
Jason Nordling:I love that comment because I think the preconceived notion is that architects do buildings right and absolutely. We are right Like that. We think about buildings and how things get put together so that they endure. But if you really break it down to its most basic level, we are trained to be problem solvers and that's what we do.
Jessica Sweeney:This piece is really rewarding. I think it's rewarding for me and I think it's rewarding for all of us, where we get to think about healthcare strategy on a larger scale. We get to really be partners with our clients, be involved and see some of their decision-making help, providing the information and facilitating the conversations that lead to those decisions and, as such, it makes us better at our jobs too. And that next project, that next client, that next strategic planning, whatever it means, we have a greater base and depth of knowledge and experience as we continue to have additional conversations. So when it is those traditional architectural conversations, they're deeper, they're more meaningful and I think it goes back to that trust I like when we're brought in, when we're trusted to have those conversations with our clients.
Matthew Gerstner:And I think that's a great spot to wrap this conversation up today. Y'all You've provided so much information in this short little window for all of our listeners to think about. Thank you all for your time today and to our listeners. We'll see you again soon. This has been Side of Design from BWBR, brought to you without any paid advertisements or commercials. If you found value in what you'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 if you'd like to share an idea for a show or start a discussion. Email us at sideofdesign at bwbrcom.
