On The Move

How to move to a new building and improve both operations and the patient experience.

Digestive Disease Associates (DDA), a physicians practice, and Berks Center for Digestive Health (BCDH), a surgery center owned by members of the practice decided to capitalize on the opportunity to relocate to a new building under one roof with the hopes of improving operations and the patient experience.

In this post, former Executive Director of the center, John T. Gleason, presents highlights of this move, decisions made, and lessons learned.

For some time, the owners had discussed how patients and the business could both benefit from consolidation. They came to the conclusion that they could run more efficiently from one location, especially because of staffing;it was difficult for the owners to optimize staff resources. There was a need for excess staff to ensure coverage in both locations. In addition, there were duplicate utility bills (telephone, cable,electric, internet, etc.) that if merged, would have resulted in efficiencies and cost savings. Lastly, the change would enhance the patient experience. Often-times, patients were confused about which location to re-port for an appointment. They would come to one office only to be redirected to the other. Thus, the decision to consolidate was in many ways an easy one—getting there was the challenge.

The move began with a quick review of available properties. A preferred site was selected at the end of March 2012. A lease was signed in early June after negotiations with the landlord; the build-out of the shell facility began immediately upon signing. It was a short time frame for accomplishing a great deal of work. The building was just that,a shell—walls and a roof. There were no floors, mechanicals, plumbing, etc. In some ways, this situation was good because demolition was virtually un-necessary. On the other hand, there was much to be done. Plus, the plan from the beginning was to be in the building and starting operations by the end of December of that same year.

Berks Center for Digestive Health

Since partnering with PE in 2001, the physicians of Berks Center for Digestive Health represent the largest physician group in the Wyomissing area. This 12,999 square foot facility employs 16 physicians.

1011 Reed Avenue, Suite 300
Wyomissing, PA 19610

(610) 288-3229

www.ddaberks.com

It was beneficial that a timeline was developed early on. So, all parties were held accountable for achieving the designated goals on the plan. The stakeholders met on a weekly conference call to ensure objectives were met. Unexpected glitches that could have easily prevented hitting targets did not occur because the parties handled them immediately in order to stay on track. The first patients were seen at the new facility on January 7, 2013, just one week after the original target date. Everything had been accomplished in a mere six months.

This new center is really something to be proud of in my opinion.

It will have a positive impact on the quality of care provided to patients in the community for various reasons. For one, BCDH now offers even better state-of-the-art equipment and computer systems. The center upgraded endoscope equipment, vital signs monitors, light sources and processors. While the initial plan was not to upgrade the electronic re-cord, the age of the system indicated the need for it. Therefore, it is in the process of upgrade. The timing was right to make these changes; the center had used its equipment and systems to full capacity. It helped that all of these costs could be rolled up into one financing vehicle for ease of payment and administration.

The new center benefits patients in a variety of ways too, besides being treated with enhanced equipment. Opening the center has improved standards,increased learning and strengthened teamwork. The new location meets all the current federal, state and local government regulations for patient care and facility design as well; the setup meets the highest standards of care in the industry. To prepare for the opening, management, vendors and Physicians Endoscopy trained the employees on the new equipment, systems, and protocols. The staff’s ability to grow by increasing their knowledge and engaging in planning will benefit the organization and patients in the long run. Our employees are some of the most educated in ambulatory endoscopy surgery centers because they have now been trained on the highest-quality equipment. Lastly, the coordination and planning involved in moving demanded tremendous teamwork. As a result, BCDH’s team is functioning at its strongest ever.All of these changes cumulatively will assure improved patient care at BCDH.

BCDH and DDA learned a lot in the process of this move. Below are just a few worth noting:

Focus

It pays dividends to have a good plan and facilitator driving all parties toward a goal. PhysiciansEndoscopy’s implementation team coordinated all aspects of the BCDH move under the direction of a single project manager (PM). The PM kept an internal timeline of important goals,benchmarks and deliverables to com-pare to those offered by the architect and general contractor (GC) in their agreements. The PM also made sure that the plans of the architect and GC met industry standards.

Select the right partners

Those chosen to complete a project are obviously an essential component of success. We spent a substantial amount of time interviewing and selecting the architect and the GC for the project.The architect possessed prior experience designing medical offices and endoscopy centers. He was creative, flexible and timely in providing options for design after receiving feed-back from our physician partners.He recommended an engineering company he had worked with for de-sign of the facility. Three GCs were interviewed; prior medical office and surgery center experience were considered. Since most candidates came in strong with their qualifications, cost was a significant determining factor in the final decision. Of equal importance was the plan that the GC offered for managing the short timeframe of construction. The GC ultimately selected presented a plan that instilled confidence that the project would be done on time.

Delegate

There were too many details for a single individual to deal with in a move like this one. So, the managers delegated aspects to staff members in both the office and center. The nurse manager in the center was assigned one or two staff members to specific areas (e.g. the procedure rooms or scope area); those persons were responsible for packing and unpacking in the same location of the new center. Two office staffers planned and coordinated the move of equipment and furniture to the new location. They labeled equipment and assigned locations to everything for the benefit of the movers. These individuals then met with the movers to field questions prior to the relocation date. This is one aspect of the move that went surprisingly well despite anxiety leading up to the big day.

Involve all parties in the plan

Develop a plan for your move early;meet with all parties to make sure everyone is onboard and understand their roles. Just a few months before the move, a timeline was presented in a meeting detailing the movement of furniture, medical and office equipment/supplies and information/tele-phony systems. This meeting was useful because all attendees were able to comment on their particular assignments; they could also weigh in on how the proposed timeframe would enable them to achieve their duties.Also, if there were problems with the plan, they could be addressed in advance to head off potential issues.This was especially helpful for the two vendors involved in information/telephony systems. The vendors work relatively well together but the face-to-face introductions at the meeting facilitated even better planning be-tween them.

Minimize downtime

The doctors were very concerned about the impact of downtime in the center on the overall financial condition of the facility. So, a plan was developed to minimize downtime, but with some leeway for issues that could arise. One ex-ample: new equipment and supplies were shipped directly to the location and put away/set up prior to the move weekend. The staff began packing and moving what they could in advance of the date—mainly office and medical supplies. The week of the move, patients were still seen up until Thursday at noon. Immediately after the last patient left, the movers and staff began packing for transport. Some staff went to the new site to put away supplies from storage while others packed up remaining items from the old site. The next morning, the movers filled trucks for delivery to the new site. On Friday,the movers delivered the equipment and furniture in the morning while the employees were busy with in-services.Once everything was dropped off and training was complete, employees re-turned to their work areas to put away supplies and set up equipment. Saturday was a day to continue to handle supplies as well as to troubleshoot is-sues with the computers, phones, etc.Sunday was a buffer day in case serious problems arose and to clean up for Monday. Fortunately, the move did not result in too many difficulties.

Keep employees busy

As mentioned in the previous point, there were flux periods when some staff were not situated and could not fulfill their usual roles. Specifically, this occurred Friday morning when the movers were bringing furniture, desk supplies, phones and computers from the old to new location. While the materials were in transit, the employees were without work areas. During this time, the group completed the annual training requirements for HIPAA,OSHA, emergency drills, compliance,etc. So, the “downtime” became productive tackling matters that are difficult to fit into the daily schedule. Also, some employees were sent home during this period to prevent excess over-time. They were allowed to reclaim the hours on the weekend while set-ting up the new facility.

Ensure vendor support

Vendors responsible for new equipment delivered excellent support for the most part. They were on site to set up, train and troubleshoot at the new facility,easing the stress of the move.

Develop a master list

Keep an inventory of all the problems that arise during and following the move. This list should include the issue, the date it was discovered, the responsible party, actions taken to resolve the situation and a status update. This ensures accountability and that everything is addressed in a timely manner.

Celebrate Success

After the move, take some time to recognize successes with the people who made it happen.

Unexpected challenges that in hindsight would have been addressed differently:

Electronic record

Many computers had been used for years in the procedure rooms. One PC failed in transit. A variety of mis-communications, new system requirements, de-lays and misunderstandings created a lapse of a few weeks before thisPC could be replaced and electronic documentation could resume in that room. It would have been wise to have a backup computer that met with the updated requirements of the electronic record. Also, a representative of that PC’s company should have been on site to troubleshoot during the move. Bottom line: Backup provisions should be in place for problems that may arise with the electronic record.

Fax systems

One of the biggest miscues was an inaccurate under-standing of how many analog lines the office used in its processes for faxing,etc. Proper assessment of the use of analog lines and fax systems is essential to prepping for the best setup in a new location.

Subcontractor management

The weekend move went so well that all of the equipment, furniture and supplies had been transferred and set up by the middle of the day on Saturday. After everyone else left, subcontractors continued working; they created messes where order had been established.This did not make the first day of operations easy for the staff on Monday.

Labeling ports on the network rack

A significant number of ports were mislabeled, creating challenges with setting up computers and phones. Extra effort to ensure that the ports tie back to the network rack will make things go smoother during the first days of a move.

A number of tactics were implemented to notify patients and the community of what was happening:

  • Placing an announcement in EndoEconomics and in the local news paper’s quarterly health magazine
  • Announcing the move on the official web site and Facebook page
  • Creating fliers to be distributed to the referral community
  • Leaving fliers at the front desks of both offices beforehand
  • Hanging signs in the waiting rooms of both offices prior to the move
  • Providing maps with directions to the new location, including to patients right after they scheduled appointments
  • Using the appointment reminder phone call system to notify patients
  • Having the front desk and scheduling staff verbally remind patients

Despite the stress of moving, the experience was a positive one.

The team came together to develop a beautiful new site for patient care that is convenient for visitors; it is good for those being treated and benefits the community too. In the process, a great deal was learned. Hopefully, you can benefit from our experience if you are contemplating a similar change in the near future.

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