Measuring Up: Benchmarking Health Care Architecture

By Kaitlyn Badlato
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Today’s hospitals struggle to find a balance between providing the highest quality of care, achieving high levels of patient and staff satisfaction, and realizing operational efficiency. Evolving patient care models and advances in medicine directly impact building standards, often resulting in increased facility size.

Benchmarking, the systematic process of measuring one’s performance against recognized leaders for determining best practices, is a continuous exercise that can be applied to determine the appropriate size for health care facilities. (National Research Council, 2005) In its simplest form, benchmarking assists organizations to identify areas of achievement and improvement to define a better, more successful outcome. (McCabe, 2001)

It is important to understand that there is no “one size fits all” solution; it is necessary to go beyond the numbers and understand what conditions and variables were responsible for generating them. Seeking these conditions and analyzing multiple metrics will help deliver the necessary insights to discover both planning performance gaps and best practices.

In the architecture industry, benchmarking is an often-overlooked practice. It is difficult to determine the appropriate metrics to measure and to find accurate, “apples-to-apples” comparisons for projects. Benchmarking is typically approached as a singular, project-based initiative. In these casual benchmarking exercises, it is difficult to determine the appropriate metrics to measure and to find accurate comparisons for projects.

It is important to understand that there is no “one size fits all” solution; it is necessary to go beyond the numbers and understand what conditions and variables were responsible for generating them.

Benchmarking should be a source of continuous improvement — not a one-time effort. Implementation of a benchmarking practice eliminates the need for repetitive work, while providing opportunities for in-depth performance analysis.

Architecture is a decision-making process. While each decision that is made has an outcome, collectively it is difficult to measure the impact of each of these individual outcomes. The decisions made in the health care design process can translate directly to a health care facility’s functional performance and outcomes. Benchmarking isolates design decisions through the use of metrics, quantifying the value of the individual strategies implement and comparing the outcome to others in the industry. Benchmarking can transform the design process into a tool to measure performance, determine baselines, establish targeted outcomes, provide accurate comparisons to industry leaders and deliver uniform data firm (and industry) wide.

I conducted this study as part of the 2016 HKS Health Fellowship, a six-month program for recent graduates to conduct a research project in the field of health care. The following is an overview of my work.

What Was the Aim?

This project was initiated in response to the need for a stronger presence of benchmarking within HKS Health and to evaluate the use of an industry benchmarking program, the Construction Industry Institute (CII) Health Care Benchmarking Program. In conducting this research, I sought to:

  • Develop a clear framework for how benchmarking and data collection can better serve as an investment for the HKS Health Group.
  • Initiate HKS participation in the Construction Industry Institute (CII) Health Care Benchmarking Database.
  • Explore the efficacy of the CII Health Care Benchmarking Database to answer focused design questions.

What I Did

Literature Review
I conducted an initial literature review to assess the standard processes for benchmarking and evaluate applicable benchmarking programs within the design industry, including programs at the General Services Administration (GSA), the Department of Energy and tools developed by industry organizations such as the Advisory Board Company and the International Facility Management Association (IFMA). The benchmarking roadmap developed by Robert Camp, the creator of benchmarking, was used as a guide for establishing the processes required to launch a continuous benchmarking practice. This roadmap provides guidance for developing and maintaining a benchmarking practice to determine the needs of the users, ideal processes and current deficiencies and methods for integration into an organization.

Conversations with HKS Health Stakeholders
The current conditions of data collection and benchmarking within HKS Health were identified through conversations and webinars with key stakeholders. I interviewed 15 stakeholders selected for their expertise architecture, medical planning, strategy and business development, with representation from HKS Knox Advisors, HKS Practice Technology and HKS Knowledge Management. We discussed current data collection and analysis procedures, areas that could benefit from a benchmarking practice and the infrastructure required and available for a database.

Health Group Benchmarking Survey
Following these conversations, additional information was needed from the larger body of the health group. I conducted a Health Group Benchmarking Survey, tapping 250 architects, medical planners and members of HKS Knox Advisors to understand the current health care benchmarking and data collection habits, concerns and considerations. 53 survey responses from 11 US offices provided an honest evaluation and revealed both deficiencies and opportunities within existing practice.

Participation in the Construction Industry Institute (CII) Health Care Benchmarking Program
To explore the benefits of benchmarking in an external industry program, participation in the Construction Industry Institute (CII) Health Care Benchmarking Program was initiated. HKS’ participation included entering one of our recently completed projects, an inpatient hospital tower addition, into the CII database. This allowed HKS to utilize the CII Performance Assessment System to benchmark the performance of the project against design firms across the industry, in the categories of cost, schedule, dimension and planning.

What We Found

A benchmarking practice will grant users the power to:

  • Determine Baselines. Benchmarking will analyze past performance to determine baselines and set targets for outcomes. This provides opportunities to share applicable and meaningful metrics with clients, affirming their facility will be built using the firm’s best practices.
  • Make Accurate Comparisons. A national industry benchmarking program is just as important as an internal one. A best practice has more weight when defined by industry consensus. Industry programs, such as the Construction Industry Institute’s Health Care Benchmarking Program, provide an avenue to accurately compare projects to competitors’ facilities across the country.
  • Deliver Data Firm-Wide. A standardized set of metrics sourced from a central repository will promote consistent and exceptional design.

To transform current data collection practices into an investment for future projects and benchmarking into a firm-wide benefit at HKS, we must consider the following:

  • A Practical Framework. A definition of the key metrics to be measured, a method for data collection and sharing and a system for data storage must be established to frame the purpose and measure progress.
  • Cultural Change. An investment of manpower and time must be dedicated to collect data from current and past projects to determine best practices for future projects. Design teams must learn to see benchmarking as a continuous endeavor integrated into the project process and timeline.

An accurate view of HKS’ performance requires the firm to assess external benchmarks in order to compare our performance to others in the industry. Participation in a national benchmarking program will provide concrete metrics to indicate areas in which HKS is an industry leader, as well as insights into markets where we could improve. An industry-wide benchmarking program, external to HKS will prove effective, it meets the following criteria:

  • Relevant Metrics. The metrics that are used in the benchmarking program must align to the metrics that matter to HKS Health. If the program doesn’t provide information applicable to the needs of architects, medical planners and strategists, participation in the program will not present pertinent results.
  • Adaptable Interface. The effort required to participate in the program must be able to integrate into the current project timeline. As with an internal benchmarking practice, additional effort will be required; however, the effort to learn how to use the program and input the data should not exceed the value of the program to HKS.

What the Findings Mean

Implementing a benchmarking practice will require two initial efforts: an initiative to collect data and the development of an infrastructure to store and manage it.

Establishing a benchmarking practice within HKS will require a cultural change. Educating members about the practice of benchmarking and the system that has been developed for HKS will require a supplementary effort to ensure that the practice is understood and utilized to its greatest potential. The practice of benchmarking must be integrated into all aspects of a project’s life cycle, including the use of metrics as a decision making tool in the planning and design phases and the collection of data throughout the duration of the project.

Our benchmarking practice will be a continuous effort and a means of continuous improvement for HKS. We will need to evaluate our benchmarking practice on an ongoing basis to determine our return on the investment, and also to evolve it as necessary to align with the needs of the health group, our clients and the industry.

What’s Next

Moving forward, additional steps are required to implement a successful benchmarking practice within HKS. The next phase of this research will provide a more in-depth approach for implementing a new benchmarking program. Additional actions required to reach successful implementation include:

  • Engage HKS clients and discover their interests and needs for health care benchmarking.
  • Standardize tools and processes for unobtrusive data collection and storage.
  • Further explore the CII Health Care Benchmarking Program and other industry practices.

Kaitlyn Badlato

Kaitlyn Badlato is an architectural designer in HKS’ Washington D.C. office. She was selected as the 2016 HKS Healthcare Fellow, conducting research focused on benchmarking the design and construction of healthcare facilities. She is a co-chair of the Mid-Atlantic Design Fellowship.