MHS Facility Innovation and Research Model
Tom Harvey, Aletta Van der Walt, Debajyoti Pati, Francisco Gonzalez, Brent Willson, Frank Kittredge, Sandra Ray, Sipra Pati, Adeleh Nejati, Bridgett Sharp, Mason Couvillion, David Ziegler, and Betty Teller
Phyllis Kaplan, Senior Health Facilities Architect, Department of Defense, Defense Health Agency
Michael Lanier, Medical Facilities Center of Expertise and Standardization, U.S. Army Corps of Engineers (USACE)
Jelani Ingram, Huntsville District, U.S. Army Corps of Engineers (USACE)
Rick Bond, Associate Executive Director, Office of Operations for CFM, Department of Veterans Affairs
Military Health System, US Department of Defense
“We shape our buildings, thereafter they shape us”
– Winston Churchill
Collaboration of ideas and people leads to innovations. Implementation of a significantly enhanced or new idea transforms processes, as well as the market itself. To accomplish innovation, we must inform, explore, validate, test, recommend, and apply solutions that redefine healthcare delivery. Dr. Jonathan Woodson, Assistant Secretary of Defense for Health Affairs is quoted from the health.mil website in his remarks regarding the MHS Innovation strategy:
“Underlying all of our efforts is our need to continue to focus on innovations that can allow us to better deliver health and customer services in more imaginative and efficient ways... We will be engaging our military medical leaders in a concerted effort to identify and promulgate those innovations that present the most promise”
In addition to supporting military medical leaders, MHS Innovation also applies to world-class medical treatment facilities and their infrastructure world-wide. First cost investments in capital facilities are minimal in light of life-cycle expenditures. Also understood is a direct relationship between healthcare building design and the cost of operations and maintenance associated with performing the mission. These correlations between building design, operations, maintenance, and expenditures are the impetus for formally establishing a mission-critical entity that is already under development through existing resources within the DHA. The MHS FIRM drives innovation within the basic Infrastructure domain of the World Class Healthcare Facility objective.
No formal, organized structure coordinates, conducts, and collects facility research data and studies associated with the MHS built environment. Nor is there a system-wide approach to facility research and innovation leading to better cost management or outcomes. An entity is needed within the MHS to launch an aggressive initiative to pursue innovation in how its capital assets support the overall healthcare mission. Within the collective efforts of the Services, there is a need to minimize redundancy and consolidate resources in conducting research for healthcare facility design. Research executed by the MHS must be shared and expanded to better inform leadership in capital resource management. For example, “best practice” design discoveries and full scale mock-up results associated with one project should be reviewed and considered for other projects within the MHS inventory. Thus, MHS research outcomes can be improved by establishing a rigorous, consistently applied research approach across the Services. This approach channels knowledge about the current MHS infrastructure, with original facility design research, into innovation aimed at strengthening MHS’s foundation for World-Class healthcare facilities and reducing their life-cycle costs.
This report discusses and presents a unique model supporting an opportunity to innovate within the MHS and re-define its infrastructure for healthcare delivery. This allows MHS to act from a position of profound knowledge, backed by quality research, and a capacity to implement exploratory studies leading to innovation. The working title for this paradigm is the “MHS Facility Innovation and Research Model” or MHS FIRM. It fosters innovation by systematically exploring, identifying, and studying a multitude of concerns and issues affecting the MHS Life Cycle Cost Model for healthcare facilities, including improved communication of discoveries and application of innovation solutions back through the system. These solutions may result in safer, more efficient, and more satisfying MHS healing environments. With knowledge gained from research findings, validation of the precepts of cost effective operations, faster and cheaper methodologies for construction, and life-cycle cost and return on investment improvements can be realized for the MHS. The MHS FIRM incorporates and addresses the “Basic Infrastructure” domain of the six MHS World-Class Facility Domains by developing a broader, more reliable knowledge base across the MHS facility infrastructure, conducting research to help identify root causes of problems or best practice designs, and executing tests of proposed solutions through collaborative efforts with SMEs. The goals are to: 1) realize efficient, effective world class healing environments within medical facilities; 2) provide electronic means to support knowledge gathering, storage and dissemination of facility related information; 3) enable credible and reportable research; and, 4) directly apply research findings and results to the MHS portfolio.
The vision is built around three distinct Programs within the MHS FIRM. Its Knowledge Program focuses on assimilating, sharing, and analyzing existing MHS data assets and published design research. An orderly creation of a data repository will improve MHS stakeholders’ understanding of their current capital assets and the methods by which evidence-based design research contributes toward World-Class Healthcare Facilities. Its Research Program equips the MHS FIRM to prioritize, manage, commission, and conduct facility-focused research. To facilitate the standardization of research supported by the MHS, a Research Framework is conceptually developed to ensure a rigorous approach to designing and executing research efforts. A Fast Track Framework is also provided for less rigorous, rapid cycle studies. These frameworks guide research and investigative studies toward a consistency of approach and a quality of results that reflect MHS’s commitment to World-Class healthcare facility goals. Its Implementation Program consists of a leadership core of internal and external subject matter experts in strategic innovation sessions intended to convert research discoveries into rapid prototype solutions that can be infused throughout MHS through future capital projects as they are budgeted. Through this formalized approach, knowledge and discovery can be effectively fed back into the innovation loop, leading to continuous improvements in standards, guidelines, and protocols for facility planning, design, and delivery.
The MHS FIRM assimilates information and generates evidence that can continuously improve facility performance as it affects operational objectives and patient outcomes. The resulting products lead to innovative ideas for incorporation into MHS medical treatment facilities (MTF) and infrastructure. The business case for the MHS FIRM may be examined in terms of qualitative return on value, quantitative return on investment, and the impact on the MHS’s mission and operations of not implementing the MHS FIRM. The relationship between investment and benefit from a facility perspective is still poorly understood. The MHS FIRM creates such capability through identification of metrics that critically evaluate current conditions and prospective new innovations with greater effectiveness. Many of the components are already in place in the MHS, and there is simply a need for priority and leadership to focus on coalescing efforts toward the mission of the MHS FIRM. As additional resources permit, the full objectives, impacts, and benefits of this model will come to fruition.