Rightsizing’s sibling is the Lean Process. Lean is a strategy of analyzing a process to eliminate waste with the goals of improving the process, boosting productivity, and cutting costs, thereby providing increased value to the consumers of the process. Lean (and various similar forms such as Six Sigma and Continuous Performance Improvement) can be applied in forms such as Lean Management, Lean Design, and Lean Construction.

Another of rightsizing’s siblings is Value Engineering. Specifically applied to healthcare design, the Value Engineering process seeks out optimum value for both the initial and long-term investment of a project. The current economic conditions have magnified the great importance of applying smart economic principles of Value Engineering to the design and construction of healthcare facilities.

Underlying Rightsizing, Lean, and Value Engineering in healthcare is the core principle of Evidence-Based Medicine. Evidence-Based Medicine (EBM) aims to apply the best available evidence gained from the scientific method to medical decision making. It seeks to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment).

Evidence-Based Medicine in turn provides the foundation of Evidence-Based Design. Evidence-Based Design (EBD) stems from the recognition that the physical environment can have a measurable impact on one’s health and well-being. It seeks to objectively assess the impact of a specific design in terms of productivity, safety, employee and patient morale, and patient outcome.


Supersized Healthcare - How did we get here?    
 
The challenge of the events of the last two years has forced all healthcare providers to adapt their Strategic Plans to respond to changes in market and policy forces that many say are, in turn, a response to the Supersizing of healthcare.

In an article entitled “Right-Sizing Healthcare” in the October 2009 edition of Building Design and Construction magazine, the author states, “Over the last 30 years or so, the healthcare industry has quietly super-sized its healthcare facilities. Since 1980, OR’s have bulked up in size by 53%, acute-care patient rooms by 77%”.

Are our healthcare facilities being supersized? If so, what has caused Supersized Healthcare?

1. Laws and Regulations:
   
   • Mandates. Compare requiremens of original Hill-Burton requirements to the current 2001 AIA Guidelines and the forthcoming 2010 Guidelines.
   • ADA. When ADA became law in 1992, it was estimated that the requirements resulted in a 5% increase in the square footage of a typical project.
   • HIPPA. Additional space need for privacy, especially Patient Registration. Managers all need private offices for discussion of sensitive employee issues.
   • Sustainability: We are beginning to see suggested "green" practices become mandates as in the implementation of the new ASHRAE Standards that effectively increased the thickness of exterior walls.
2. Technology:
• Imaging Departments used to consist of a couple of basic Radiology and/or Radiology/Fluoroscopy Rooms. Today, there are additional rooms for CT and MRI. Conversely, technology has reduced spaces needed for film developing and storage and medical records.
• Operating Rooms have grown larger to handle the space needs of the equipment.
• Patient Rooms are larger not only to accommodate families, but also to accommodate equipment as more procedures are done in the room.
3. Evidence-Based Design:
• Families are encouraged to participate in the care of their loved ones, thereby increasing the space in the patient's room.
• Employee Break Rooms are now designed as spaces where the clinical staff can "decompress" from the stress of care-giving.
4. Societal:
• Bariatric patients: An increasing number of patients require additional space to accommodate larger beds, wheelchairs,etc.
• As preventative medicine becomes the preferred method of healthcare delivery, spaces for education and training drive greater space needs.
5. Stuff:
• Ask any Materials Management Director how much space he or she needs to store material, supplies, instruments, etc. The list probably does not shrink over time.
• As we all try to do more with fewer personnel, spaces like Clean Supply Rooms and Soiled Utility Rooms need to grow larger to handle larger carts that are less-frequently stocked or replaced.

Rightsizing - the Strategic Imperative.
The healthcare marketplace is in the midst of significant change. Providers have always faced the challenge of balancing the services they provide with the cost of providing the services. Successfully adapting to change involves rightsizing the services and the facilities in which to provide these services.

Rightsizing is not easy. Rightsizing must be developed in a manner that is systematic, thorough, and rigorous.

Return to the definitions of rightsizing at the beginning of this article. Notice that the term is used in a corrective sense, as in downsizing. Artekna believes in proactive rightsizing: incorporating from the very beginning a commitment to optimize quality, efficiency, and outcomes without waste of space, money, or environmental assets.


Rightsizing - One Size Does Not Fit All
 
Charles W. Moore, the late distinguished architect and educator, once quoted that a well-designed building was like a well-tailored suit: just the right material cut to the exact requirements of the wearer with no waste and yet with enough elasticity to accommodate those few extra pounds.
 
Clearly, the premise that “bigger is always better” is unsustainable both in terms of cost and resource utilization; nevertheless, the “less-is-more” approach can result in facilities that do not adapt to changes in healthcare delivery. Rightsizing is about finding value: the sweet spot where the design, administrative, and clinical team balance delivery of the highest quality product for the lowest cost. It is about “doing more with less”.

Many healthcare designers approach a project with the attitude that since they are the “healthcare experts”, the client should rely on and leave the decision-making in the designer’s hands. Many of these “experts” bring stock plans to the table that may or may not be appropriate for that organization. This approach often sacrifices value on the altar of cost.

At the opposite end of the spectrum are healthcare designers who let perceived space needs inflate the size of a project. Often, providers have operated out of inadequate spaces for a long time. They are desperate for as much additional space that they can gain for their own individual areas. They do not attempt the rigorous analysis to right-size their space needs. This approach sacrifices value on the altar of space.

Truly successful healthcare projects are those where healthcare designers lead the process of rightsizing. They become a strategic partner with the provider, analyzing each decision with respect to industry standards and codes and the facility’s needs. They ask the hard questions and make the case for the tough calls regarding what is really justified. They have the creative know-how of how to do more with less. This rightsizing approach seeks to achieve optimum value.

ARTEKNA has been a successful partner providing the optimum value in the design of over 1,800 healthcare projects in 22 years of serving our healthcare clients.