Perkins+Will Scores with Interior Design at IMG

The elevator lobby has basketball texture on the floor, turf on the walls along with a scoreboard. Employees and clients congregate to meet and relax in the Half Time area. Larger meetings are held on bleachers that rise above a grass turf. The open office area with custom workstations is the gridiron with yard markers on the floor. The door handles are wrapped in pigskin with stitching used for footballs.

From the second you step off the elevator it’s obvious that at IMG College of Atlanta, it’s all about sports. Perkins + Will’s interior group focused on the sports theme when redesigning the office, down to the last detail.  “Everything in the space has the textures of college sports,” said Meena Krenek, a designer at Perkins + Will.

The interior design creates a profound connection to IMG, which represents the multi-media rights of more than 70 collegiate properties, with the use of iconic materials, textures, and graphics found in the collegiate sports world, allowing employees to feel comfortable in the office environment, while maintaining a professional and unique atmosphere for visitors.

“When you walk off the elevator, you immediately know what type of business we are in, and what caliber we are. We feel like we are a better company and I think it shows in the environment that’s been created for our employees, and also for our clients when they come to visit us. They are absolutely amazed,” said Cory Moss, Senior Vice President & Managing Director of The Collegiate Licensing Company, an affiliate unit of IMG College.  “It has dramatically improved our communication and our capabilities.”

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Sprout Space Becomes a Reality

A rendering of the interior of a Sprout Space

A rendering of the interior of a Sprout Space

Every aspect of the Sprout Space classroom was designed with the goal of enhancing student learning. The design incorporates green building strategies that eliminate energy costs, create a healthier learning environment, and reduce construction costs.

Sprout Space has a threefold mission: to provide healthy, sustainable, and flexible spaces for students to learn. Currently, more than 7.5 million children are being taught in temporary classrooms. Perkins+Will’s goal in creating Sprout Space is to use the firm’s institutional experience and design thinking to address issues associated with temporary classrooms. These issues include lack of local educational resources and declining test scores nationwide. Perkins+Will is addressing these issues by redesigning the classroom from the inside out to produce a new generation of affordable modular classrooms for the 21st century.

For a short video of the beginning of the installation process of Sprout Space at the National Building Museum, click here.

— By Allen Post

For more information on Sprout Space, please visit our website at

Please review our past columns on Sprout Space.

Continuing the History of Innovations in School Design

Being Healthy, Flexible, Sustainable Keys to Sprout Space

Next Steps for Sprout Space

What’s Your Favorite Part of Sprout Space?

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Pro Bono Work Can Bring Out Best Efforts in Consulting Partners

In this last of a four-part series on social responsibility and pro bono work, Chris Sciarrone, an associate in the Atlanta office of Perkins+Will, discusses the relationship the firm has with other consultants on its pro bono projects. 

Extraordinary projects of any kind rarely result from solitary authorship. Design in particular requires thoughtful collaboration among a team of professionals to succeed. It has been our privilege at Perkins+Will to have worked with some of the finest engineers, specialty consultants and builders in metro Atlanta and beyond. These industry professionals demonstrate the same commitments and values that prompted us to formalize the Social Responsibility Initiative.

While Perkins+Will can offer Architecture, Interior Design, and Urban Design services, we must rely on the generosity of trusted Engineering and Construction partners to offer their unique expertise on their own time for pro-bono projects. None of the projects shown in this series would have been possible without their direct involvement. For this we are grateful and by extension, so are our clients and the individuals they serve.

The Hamu Mukasa Library in Mukono Uganda. The design of the library is modern in form but draws on the historically successful courtyard designs of Oxford and Cambridge Universities. The design and the courtyard organization are well suited to support the program of a main library, seminar rooms, teaching spaces and faculty areas and take advantage of the climate in Uganda so that students experience an inspiring, light-filled building that has outdoor study space that students can take advantage of throughout the year. The 60,000-square-foot library will have the capacity for holdings of 100,000 volumes and seating for 900 students. It will have infrastructure for high speed wireless Internet, which is vital for research and teaching in East Africa. Perkins+Will and its team provided full programming, design, and construction oversight services. Photos: Mike Reid

One significant difference between pro bono work and paid work is the nature of the relationship with these sub-consultant team members. Because our Social Responsibility Initiative is ultimately organized by time instead of money, we ask sub-consultants such as engineers to provide their services via a direct agreement with the client, rather than contracting through the architect as is more common. The lead designers still maintain responsibility for coordination of services as a whole.

Curiously, the absence of payment can reveal other motivations and encourage creative thinking. There is a heightened sense of working together for the common good that brings out everyone’s imagination and best efforts. Work becomes predicated on the satisfaction of meaningful contributions.

An interior shot of the Hamu Mukasa Library

Entering the holiday season, we may experience a renewed sense of gratitude for the skills we each have, and for the opportunities to use our skills and our time to benefit others. We may see the many ways that non-profit organizations strengthen our communities by serving people who find themselves in difficult situations. We may be reminded that what we give matters.

Below are three timely and inspirational links.

A special report by the American Institute of Architects on Design for the Common Good

Giving Tuesday: An initiative to encourage families, charities, businesses and individuals to give back on November 27, 2012

Georgia Gives Day, sponsored by the Georgia Center for NonProfits, is also an initiative to support a day of giving, on December 6, 2012

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Guidelines for a Positive Pro Bono Experience

In part three of the series on social responsibility and pro bono work, Chris Sciarrone, an associate in the Atlanta office of Perkins+Will, offers guidelines for a positive pro bono experience that could be used for any industry. 

Providing pro bono design services to community organizations has been part of the culture of Perkins +Will informally for several generations, yet Hurricane Katrina in 2005 spurred the firm’s leadership to do this in a more proactive and coordinated manner.

The Diabetes Health and Wellness Institute at the Juanita J. Craft Recreation Center is the result of collaboration between the City of Dallas Park and Recreation Department and the Baylor Healthcare Southern Sector Healthcare Initiative. It represents a first-of-its-kind facility designed to treat and prevent diabetes holistically through diagnosis, treatment, education and physical activity.
The Perkins+Will design team worked closely with the owner and user groups to design a facility that reflects the goals of DHWI. The level of design care and quality of materials chosen for the improved facility renews the community’s sense of pride in a historically underdeveloped neighborhood, and endeavors to honor the center’s namesake. Photo by Chuck Smith

We implemented a program we called the Social Responsibility Initiative (SRI), dedicated to “engaging social needs in the built environment where design can make a difference.”

We began by pledging one percent of our annual revenue to support public interest design work. Then we built an operational framework that would allow us to fulfill our intentions of treating pro bono projects exactly the same as paid projects. It was important that we avoid the mentality of “doing favors.”

Over the last seven years we have established guidelines that we hope are broadly applicable to other professions seeking to launch similar endeavors.

1. Focus locally

SRI projects are pursued by local offices, with special focus on the communities we live in. Often times it is a passionate designer who makes the first contact with a prospective client. An experienced group of staff reviews potential projects and selects those that we can best support.

2. Determine criteria for selecting projects

In addition to our local focus, we look for projects and organizations that are socially beneficial, serve the underserved and can incorporate sustainability.

3. Define scope of your work precisely

We have found that services during the early ‘project discovery’ phase are even more critical on pro bono projects, perhaps because of the greater disparity between needs and resources. Therefore, project architects are encouraged to define the scope of work being done and the scope of services being offered very precisely. Be explicit about what is included and what is not, since an open-ended arrangement tends to work to everyone’s detriment. Ask lots of questions to identify the client’s needs. Clarify options up front for how to proceed if the scope changes.

4. Execute an agreement

Make sure the agreement includes fair terms and ensure all parties understand them. Outline each party’s responsibilities, and be clear about schedule expectations.

5. Assign the appropriate staff

Consider how much and what kind of experience would be best suited for the tasks at hand.

6. Establish a realistic project budget

Whether your budget tracks effort in time or in cost equivalents, be sure to stick to it. Outline a work plan and track progress. Acknowledge the approximate value of in-kind services by issuing statements monthly.

7. Subject the work being done to the customary internal reviews for quality that all other projects undergo

This can take many forms; in the design world this means presenting the concepts to objective peers for constructive criticism.

8. Participate in and advise the client regarding selection processes for other project-related services such as construction or furniture procurement.

One of the valuable things we can bring to a client is the ability to make those connections through our knowledge of the market.

While much of this appears to be common business sense, it is surprising how readily good-hearted people sometimes waive these practices simply because no money is changing hands.

A non-profit client of ours once remarked about how many donations of used furniture they received that were in poor condition and unusable. She appreciated the donors’ generosity but at the same time had to establish some criteria about what kinds of donations were acceptable.

It remains part of our role as design professionals to approach our clients as partners — not charities.

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Why Do Pro Bono Work in a Down Economy?

This is the second in a four-part series by Chris Sciarrone, an associate in the Atlanta office of Perkins+Will, on pro bono work and  social responsibility in the architecture industry. 

Design, of course, is also a business, and one that often suffers disproportionately when the economy lags because of its ties to real estate and construction. An obvious question then, is, Why give away free work even when paid work has become difficult to find?’

The last 10 years have witnessed a recognizable movement in the architecture profession towards socially relevant, public-interest design, yet the motivations for an individual or a firm to pursue this kind of work are usually internal. Some frequently acknowledged reasons include:

Filling A Need

Not-for-profit organizations can articulate their needs very well, and are adept at raising funds to support a capital project. But typically, they do not have in-house design and construction expertise. It makes perfect sense that architects and other design professionals would be the ones to help bridge the gap between wish list and groundbreaking.

For their 10th annual visual arts festival, Atlanta Celebrates Photography (ACP) commissioned artist team McCallum and Tarry to construct one of ACP’s largest public art installations. Perkins+Will provided architectural and construction services to create a dramatic viewing experience for the artists’ temporary sound and video display housed in and around the 100-foot-tall abandoned concrete water tower within blocks of the Martin Luther King, Jr. Center.

Personal Satisfaction

Pro bono projects create opportunities for designers to make a difference in people’s lives as well as experience the impact that difference makes. Pro bono projects can end up being some of the most rewarding work that we are involved in, connecting us with the noblest values of our profession.

Civic Engagement

Local pro bono projects can strengthen ties and build relationships in our community. They can be done with a public participation process that considers the interests of numerous stakeholders. Many pro bono projects provide a venue for collaboration with artists, engineers, government agencies, material suppliers, and other design firms.

Creativity and Innovation

Pro bono projects provide opportunities to exercise the firm’s best creative abilities and to tackle challenges introduced by atypical project types. They offer the chance to seek and define design problems proactively.

The South Fork Conservancy was formed to restore and protect the riparian systems of the South Fork Watershed of Atlanta’s Peachtree Creek. The Conservancy aims to preserve and enhance the natural beauty of the creeks and streams and promote harmonious, low-impact recreational use through the development trails. Perkins+Will was enlisted to produce a vision document for the conservancy.

Recruitment + Retention

Pro bono projects give the firm a chance to engage and inspire every employee, design and non-design alike. Pro bono projects may also lend themselves to mentoring relationships between junior and senior staff as well as afford more direct client interaction for junior staff. People want to work for firms that demonstrate a commitment to socially relevant work.


Pro bono projects can demonstrate the value of good design to a wider audience. Not-for-profit organizations and their clients deserve and need thoughtful, sustainable, high-quality environments.

Perkins+Will has had the privilege to partner with a broad range of clients who are addressing important issues like healthcare, education, counseling, job training, affordable housing, and arts and culture on severely restricted budgets. As the economy has staggered through the last few years, the need has intensified and the available resources have dwindled. We have been able to support their missions by advising them on decisions related to design, land-use, facilities and construction. In short, we do this because we believe that a practice of architecture that is socially responsible and civically engaged creates benefits for both the designer and the client.

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The Case for Pro Bono Design

This first column in a new four-part series by Chris Sciarrone, an associate in the Atlanta office of Perkins+Will, is on pro bono work and  social responsibility in the architecture industry. 



A core belief shared among architects, urban designers, interior designers and related professionals is that good design can create positive transformation in the world. This is not the kind of belief that emerged from our profession, but truly is one that led us into it in the first place. And this transformation is of the kind that can benefit whole communities, not only our clients.

The Fugees Family is a non-profit organization devoted to working with child survivors of war and their families in the Clarkston, Georgia, area. Perkins+Will provided site master planning and schematic design of a new school building.

Recall that the Latin ‘pro-bono’ is a shortened form of ‘pro-bono publico’ meaning for the public good, not ‘for free.’ Endorsing pro bono design in practice suggests something significantly more than merely providing services free of charge.

The medical and legal professions have an established tradition of pro bono service; one presumably built on a premise that health care and legal representation are basic rights that should be available regardless of one’s ability to pay for them. Increasingly it seems that the design and construction industries are embracing a similar ethic. Is this an admission that some of what we do has value beyond what is recognized in the marketplace?

The Lifecycle Building Center is a community-based warehouse facility dedicated to the intelligent use and re-use of building materials and the implementation of sustainability strategies. Perkins+Will performed site assessments and schematic design for their warehouse operations.

Well-known organizations such as Public Architecture and Architecture for Humanity have been doing excellent work for many years promoting community-based socially engaged architectural practice. Closer to home, many are familiar with Bryan Bell’s Design Corps in North Carolina and Sam Mockbee’s Rural Studio in Alabama; Architect magazine recently devoted its full August issue to coverage of Spontaneous Interventions: Design Actions for the Common Good.

The HEALing Community Center is a non-profit clinic providing healthcare services to several medically underserved intown Atlanta neighborhoods. Perkins+Will provided design consultation and space planning for the clinic.

An interesting way to regard pro bono practice is to consider that the most basic responsibility of architects to the public is to ensure health, safety and welfare. This is our professional obligation and the basis of our licensure, but it sets a rather low standard for design.

If we start with those three criteria, we may tend to believe that design is all of the stuff above and beyond heath, safety and welfare requirements. Which brings to mind Le Corbusier’s quote: “You employ stone, wood, and concrete, and with these materials you build houses and palaces. That is construction.  Ingenuity is at work. But suddenly you touch my heart, you do me good, I am happy and I say: `This is beautiful.’ That is architecture.  Art enters in.”

Another way to consider it is that design can also operate from within a framework of health, safety and welfare. Architects and designers can apply our innovation and creativity and our unique skills and knowledge to issues regarding the health of building occupants, the safety of communities and the welfare of society. We can expand the understanding of these sometimes mundane issues to create holistic solutions that benefit broad segments of the public.

From this new perspective, we begin to understand a community instead of just a building. We see a wider range of needs, we ask more questions, we take more initiative, and we meet some really remarkable people who we might not traditionally call our clients.

Chris Sciarrone, AIA, LEED AP, Perkins+Will

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A Run Along the Eastside Trail of the Atlanta BeltLine

Allen Post, author of the columns on Sprout Space in March 2012, writes this week about his experience with the new section of the Atlanta BeltLine. The photo is from Ryan Gravel, a senior urban designer for Perkins+Will, who conceived of the BeltLine while earning his master’s degree in architecture at Georgia Tech. Read more and watch the video about Ryan’s concept in Chris Schroder’s  Moments series in Saporta Report.

A photo along the Eastside Trail of the Atlanta BeltLine, which was dedicated October 15, 2012, and runs along the railroad corridor from 10th Street & Monroe Drive near Piedmont Park down to Irwin Street near DeKalb Avenue.

After much anticipation, I was excited to test out the newly opened Eastside Trail of the BeltLine. My wife and I recently ran the length of it and back from Piedmont Park, through Virginia Highland, Poncey-Highland, Inman Park and Old Fourth Ward. I was amazed at how crowded and vibrant it has already become and excited to see everyone taking advantage of this new urban amenity.

One of the many great surprises of the new BeltLine path is its accessibility between neighborhoods. I felt like a kid again, finding a new secret cut-through between my house and my best friend’s house.

As an architect, I was fascinated by the new vantage points created as one snakes through the once undeveloped and inaccessible land. This photo shows a good example of that.  My colleague, who now uses the path as a stress-free commute into Midtown from Kirkwood, tells me that she notices more bikers joining her every day.

As a native of Atlanta, it is refreshing to see such a complicated civic project like this one take shape and have such an impact on our community. I look forward to the other sections of the Beltline as it begins to take shape in the not-too-distant future.

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Improving the Architectural Process

Amanda Mewborn of Perkins+Will shares a Lean exercise that will be used to improve the architectural process and integrate client operations into the process

In my last post, I talked about hurrying creativity. Last week, I had the opportunity to collaborate with two architects to further understand the architectural process, redesign it to improve efficiency and quality, and integrate client operations and efficiency into the process. In this post, I’ll be sharing a few details about this Lean exercise, often called a Kaizen. Note that I am not an architect, and my descriptions of the architectural process are simplified based on my limited understanding.

The Traditional Architectural Process

The traditional architectural process can be summarized in six phases:

  1. Master Planning – converting the organization’s strategic plan into a plan for how the facilities will grow and change to support the strategy
  2. Space Programming – figuring out how much space is needed based on current capacity and work volumes and projections of future work volumes
  3. Schematic Design – developing the first pass of the building design pieces, such as department locations, standard rooms, the shape and positioning of the building on the land site
  4. Design Development – builds further on schematic design by defining the building features in more detail, such as department shapes, interior finishes, and landscaping
  5. Construction Documents – converting all of the details from design development into detailed instructions for the contractor to build the facility; this step involves putting all of the details “into the computer.”
  6. Construction Administration – monitoring construction progress to ensure that the building is being built according to the plan

First, the team identified the high-level tasks that take place in each of the six phases, assuming that we would be building a new 100-bed hospital. The team wrote each task on a sticky note, and put it on a board, with each combination of sticky note color and marker color indicating a phase.  Traditionally, each phase must be completed in sequence, meaning that schematic design does not begin until space programming is completed, for example.

The board with each phase of construction represented in a column, and each task in that phase listed below it

Next, we used fishbone diagrams to identify the failure points and root causes of the failures in each phase of the traditional architectural process.

This fishbone diagram outlined several problems related to space programming in the traditional architectural process.

Next, the team looked at trends across the fishbone diagrams, and identified some common problems that plague the traditional architectural process.

Some of the common issues identified with the traditional architectural process

The New Lean Architectural Process

Next, the team laid out three foam core boards on the table, and detailed each week in the architectural process across the top (using sticky notes with numbers). Then, the team began pulling the sticky notes of tasks from the traditional architectural process and placing them on the weeks when they could happen in the new process.

The team kept in mind the common issues with the traditional architectural process, and worked to mitigate those issues by integrating the tasks where possible. The traditional six phases of the architectural process were ignored, and instead, the team thought about what tasks could be done at the same time. What emerged was a board that looked less like a rainbow, and more like a smattering of color boxes amongst the board.

Additionally, the team identified Lean tools that could be utilized throughout the process. These tools were built into the new architectural process. Tools such as Kaizen, process mapping and simulation were incorporated. The concept of operationally driven design was obvious as design tasks were moved on the board based on when operational information would be available.

The new process would not only shorten the amount of time needed to complete the architectural tasks, it would also incorporate the client’s operations, or planning into the process. Additionally, fewer meetings would be needed with the client, as the team would be integrated into meetings together.

In the traditional architectural process, there is lots of rework, as each phase has a kick-off and meetings that end up invalidating some of the work completed in the previous phase. Since the phases were designed to no longer take place in sequence, and instead were completed together and simultaneously, there was less rework and duplication of efforts. The new process should have fewer changes to the design late in the process, providing for more accurate budgeting as well.

The team plans to test the newly designed process on an upcoming project with a hospital client.

Amanda Mewborn, RN, CPN, CPHIMS, PMC, DSHS is a senior healthcare consultant with Perkins+Will where she assists clients with improving operational efficiency, patient experience, and quality. 

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You Can Hurry Creativity, Cut Design Time By Overlapping Phases

In this third part of a series on the planning and strategy of healthcare design, Amanda Mewborn discusses how she works with the architects at Perkins+Will and their healthcare clients on efficient design that enhances the quality of the patients’ experience.

When I first joined Perkins+Will, I understood that I would have two main roles:

  1. Working with healthcare clients to improve their operational efficiency, patient experience and quality
  2. Working with architects to improve the speed and quality of the design process

While my career had focused mainly on the first role, I was intrigued at the opportunity to do the second role. How would I apply industrial engineering tools, such as Lean, to the architectural process? After all, architecture involves a lot of creativity and drawing, and how would I make creativity and art happen faster?

Amanda Mewborn is a Senior Healthcare Operational Planner in the Atlanta office of Perkins+Will.

I have quickly learned that the discipline of architecture is far more than art and drawing (although, I have a hearty respect for that aspect of the work). In shadowing some of my peers who are architects, they listen for the root cause or issue that the client is trying to address. Often, because architects don’t live in the same world as the client, they have a fresh perspective and innovative ideas to address challenges. Not only do they create beautiful spaces to provide patient care and work, they design spaces that help improve efficiency, experience and quality.

Before the Design is Drawn

The adage “form follows function” is old and tired. However, I didn’t truly understand the meaning and implications until I saw this in action. While there are many phases in the process of designing a new building or space, it is important to note all of the activity that takes place before any design is ever drawn.

Generally, there is a master plan that follows an organization’s strategy. The master plan demonstrates how the facilities and space will need to change over a period of years to support a strategy. For example, the plan may include building a new bed tower, renovating an existing unit or changing the use of existing space without renovations.

Space programming is usually the next step. This step determines the amount of space needed, including the number and size of each type of space.

The next step (and one that is sometimes skipped) is planning. Once we know how much space is needed, we have to figure out how the space will be used. How will patients flow through the space? How will staff work in the space? What spaces need to be nearby other spaces? This phase is the one that is most exciting for me, as this is the time when current operations can be analyzed to improve the way that staff works in the space.

Observational studies are analogous to the Lean concept, Gemba. Gemba is a Japanese term that means going to the place where the work is done. It is amazing what we can be learn by seeing the environment where the work is done. Often, the people working the front line have the best ideas for how to improve things. Empowering these people by including them in design meetings, listening to their ideas and executing on their ideas can have the biggest impact on improving efficiency and experience for patients and staff.

At other times in Gemba walks, some front-line workers are so involved with their daily routines or have been doing their role one way for so long, they can’t imagine another way of doing the work. Involving a multi-disciplinary team in the Gemba walk allows for a third-party to see the opportunities and suggest more efficient ways for accomplishing the work.

Master planning, space programming and planning all happen before design, ensuring that form follows function. This means that the space (form) will be designed to support the work (function) that takes place.

In most of my career, when working to improve efficiency, quality and experience, I have worked around the existing walls and placement of sinks, utility rooms and the entire built environment. In working with an architectural firm, we can actually design those spaces to be located in the areas that will help facilitate the most efficient, highest quality patient care.

Integrating the Design Process

It was important for me to understand the traditional architectural process of strategic plan, master plan, space program, planning, and then all the other pieces of the process that follow. However, when the architects took an interest in “this Lean thing,” they were quick to jump on the bandwagon and started with looking at their own processes for improvement.

It turns out that you can hurry creativity. What if we could have the phases of the design process overlap? We could start drawing the building design earlier, using some of the latest technologies to visualize the potential space, such as Building Information Modeling (BIM). So far, we’ve found that we could cut the design time almost in half by integrating the various phases of the design process! Not only do we reduce the length of the process, we also reduce the number of meetings, and therefore the time spent by clients, by combining some of the phases. Further, workflow and operations take a more prominent role in the process, which was often missing in the traditional process. Additionally, in the traditional process, each phase tends to invalidate parts of the previous phase. For example, during planning, one may change the space program based on workflow patterns identified. When doing the phases in an overlapping manner, the invalidation (also known as “rework” in Lean terms) doesn’t exist.

Many clients are also changing their current workflows before they move into their new building. This allows them to test the new processes and tweak them, starting their continuous improvement journey before moving.

While I hadn’t worked with architects before, and I was concerned there wouldn’t be a way to Lean the process of creativity and art, I have been pleasantly surprised. The architects are enjoying the more efficient processes, clients understand the impact of the physical environment on workflow, and both parties are enjoying the more expeditious process that is resulting in a better outcome.

Amanda Mewborn, RN, CPN, CPHIMS, PMC, DSHS is a senior healthcare consultant with Perkins+Will where she assists clients with improving operational efficiency, patient experience, and quality.

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Hospital Can Treat Emergency Room Patients Faster with Analysis of Treatment Process

Amanda Mewborn of Perkins+Will worked with a client on to understand process changes in the emergency department of a hospital, and used analytics to determine the impact of those process changes on the physical space.

A large community hospital with more than 100,000 emergency visits annually struggled with patient waiting times, and decided to make some drastic changes to the process used to care for patients. The initial perception was that the hospital lacked space to care for all of the patients, as all exam rooms and the waiting areas were occupied during peak times. The department operated as four entities: Children’s Emergency Center (CEC), Fast Track (FT) Main, and Observation. The CEC cares for all pediatric patients, while the other three areas care for adults. FT is for simple medical issues, Main is for complex medical issues, and Observation is for patients that need to be observed further, but do not need to be admitted to the hospital.

FT, with the shortest turn-around-time for patients, at less than two hours, was targeted for improvement. If more patients could be seen in the FT area, space would be freed up in the other areas, patient turn-around-times would decrease and patient and staff satisfaction would improve. The team decided to dedicate five triage rooms and three recliners in a hallway. Quickly, even this small area became overwhelmed, and the team identified that many more patients could be seen in FT, if only there was more space.

Analysis of the Process in the Existing Space

The team toured the existing space, learning about the current processes, and visualizing the spaces, how they are currently utilized and the barriers created by the existing space. The team then met with several members of the department to understand and map the current workflow. Additionally, challenges currently encountered in the process were highlighted with yellow bursts. The swim lane format was used for the process map. A sample of the process maps developed is featured below:

Analysis of Possibilities for the Future State

Next, the team imagined a future state where many more patients could be cared for in FT. When envisioning the future state, the team utilized Lean principles, such as the elimination of waste, delivering more value to the customer in less time, and 5S for organization of spaces. The future state reflects an ideal, or utopia of sorts and was documented as process maps, assuming space and staffing wouldn’t be an issue. Again, swim lane maps were utilized, with the swim lanes representing physical spaces. A sample of the future state process is shown below:

Analyses and Simulation

Next, the team analyzed patient volumes and the impact of shifting care of patients to various areas of the department. The first step in the analysis was to identify how many patients are in the ED at any given time of day. This analysis demonstrated that the facility might need 71 spaces (including Waiting Areas) to care for Adults and 16 spaces (including Waiting Areas) to care for Children with current volumes. Next, the same analysis was completed for FT patients. This analysis suggested that seven spaces are needed to care for current FT patients, and that the existing FT space (five rooms + three recliners) is unable to accommodate any additional patient visits.

Data provided on patient visits that could qualify to be seen in FT (if there was capacity) was reviewed. The daily FT volume in its current state is 52 visits. There were 122 additional visits per day identified that would qualify for FT if there was space capacity. This represented a 235% increase in daily patient visits to FT, to 174 visits per day. The analysis suggested that 24 spaces are needed to care for the proposed FT patient visits.

Certainly, shifting 122 visits per day from care in Main and CEC to FT would have an impact on the space needed by CEC and Main. Creating additional care spaces for FT would result in reduction in existing rooms in Main and CEC. The analysis demonstrated 241 hours of additional patient care per day that would take place in FT. This resulted in 10 additional FT spaces needed to accommodate the additional patient visits.

The next step was to identify the reduction in spaces needed in Main and CEC for patients that would now be cared for in FT. The analysis showed that 527 hours of patient care each day would no longer take place in Main and CEC. This resulted in almost 22 Main and CEC spaces that would no longer be needed.

Based on this cursory analysis, it is suggested that if the ED would like to shift patient visits from care in the Main and CEC to FT, the ED will need to add 24 more patient care spaces in FT to provide an additional 241 hours of care each day. Further, it is estimated that the ED may need 11 to 22 fewer patient care spaces in Main and CEC to provide 527 fewer hours of care each day.

Potential Architectural Design

While the current state, future state, analyses and simulation were taking place, architects designed a new Fast Track that alleviated the pressure on the Waiting Area and addressed many of the challenges identified in the current state process map. The initial design was completed before the analyses and simulation; therefore, some changes will be needed. For example, more FT care spaces or rooms will be needed. However, the drawing is a great visual for the clinical team to imagine the possibilities.

We are still actively engaged with this client, helping them to determine next steps on both the analysis and design. The client is trialing the future state process in their existing space for two weeks to test the change before proceeding with bigger changes to the physical space.

Amanda Mewborn, RN, CPN, CPHIMS, PMC, DSHS is a senior healthcare consultant with Perkins+Will where she assists clients with improving operational efficiency, patient experience and quality. 

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