Construction and Design
Contributing Strategy to New Construction: the Board’s Role
By Lee Coplan, AIA
The CEO of a health care organization has just presented plans for a new pediatrics center to the board’s executive committee. The members applaud, offer praise and begin asking questions: Could the lobby be reduced to a single story to create more floor space above? Would it be more energy efficient to have fewer windows? Might a lighter color brick make the building stand out from the structures around it?
The ensuing two hours, and substantial amounts of time in later meetings, are spent reviewing the thought behind dozens of decisions—from the shape of waiting rooms to the selection of mechanical systems.
Hospital boards need to be confident that capital dollars are wisely invested. However, without well-defined roles, board involvement in facility planning, design and construction can add unnecessary layers of complexity. So where in this process can trustees’ participation provide the greatest benefit?
Generally speaking, a board’s job is to hold management accountable for the strategic imperatives that advance the hospital’s mission and vision. Facilities are the physical response to a hospital’s goals, and strategic imperatives should be trustees’ touchstones throughout the development of new structures, rehabs and expansions.
In each stage of facilities planning and construction, there are times when board members can help and times when they can hinder the process. Here are some examples:
1. Capital planning: The board’s main role is to evaluate a proposed capital plan in terms of the hospital’s strategy and mission, which should be clearly defined in a separate process before capital planning begins. In assessing a plan, board members should question the administration about items that seem inconsistent with the institution’s strategy and mission. For instance, trustees of a hospital that strives to be a leader in trauma care may challenge a proposed upgrade to outpatient facilities and instead recommend allocating the funds for an emergency department.
2. Community relations and fund raising: Trustees are essential in generating excitement within the community about new projects and can perform a unique role in motivating businesses and individuals to contribute funds. Cultivating support for the hospital’s vision is the bedrock for this. A community that understands and endorses an organization’s goals for preventing and treating heart disease, for example, will likely be enthusiastic about a new cardiac care center.
3. Selection of the architect: Trustees should have a chance to review the administration’s process and criteria for choosing an architect. Key considerations include a firm’s track record in achieving similar objectives for other hospitals, the qualifications of staff who would be assigned to the project, involvement of the firm’s principals, and the ability to perform the work within the required time frame.
4. Programming and conceptual planning: During this phase, the architect works closely with the hospital to design a building that solves the hard problems of delivering health care. It’s a highly complex endeavor, sometimes involving hundreds of doctors, nurses, clinical engineers, housekeeping staff and security professionals whose needs must be considered and addressed. Rarely does a trustee have expertise that benefits this process.
5. Design presentation: After many months of planning, comes the meeting trustees have been waiting for. It’s difficult to leave expectations and style preferences at the door, but the most effective board members bring an objective curiosity and strategic mind-set to meetings of this kind. Trustees should set aside matters of building shape and wall colors in favor of questions such as, “How is this going to make us the best obstetrics provider in the region?” Or, “How is our NICU going to compare to others in our area?” Such probing questions help keep management on track to accomplish the hospital’s long-term objectives.
6. Budget and schedule concerns: CEOs typically consult with trustees if management anticipates that a project may run over budget or behind schedule. Once again, the institution’s strategic imperatives are the lens through which boards should consider these issues. For example, if inflation rises more than expected, pushing up construction costs, the board will need to decide whether it can scale back its new obstetrics center and still become a regional leader. If doing so would prevent the hospital from reaching its goal, the board might opt to approve a budget increase.
Lee Coplan, AIA, is a senior principal at the firm of Hord Coplan Macht, a Baltimore-based architecture and landscape architecture company. To contact him or learn more about the firm, call (410) 837-7311.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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