Evaluating the Impact of a 3P Event Approach to Clinic Design
Analyzing two parallel real-world projects to determine if 3P events facilitate lower cost, faster delivery, and enhanced performance
The use of 3P events and other similar rapid prototyping approaches are a growing trend within healthcare design. While a 3P may vary in size and complexity, the basic premise remains the same: a team of designers, care givers and patients build full-scale mockups out of cardboard and use simulations to arrive at a design solution modeled after an ideal operational process. Over the course of the past several years, more healthcare systems and providers have been exposed to these events as a collaborative, hands-on way to gain design input from users, shorten design time, and improve operational performance. With the greater adoption of this approach, there are now opportunities to evaluate whether the promised benefits are delivered, and if there are other positive or negative impacts. This sets the path towards answering the question: “Is this really a better way?”
Boulder Associates’ association with Cook Children’s Health System had an ideal opportunity to conduct a post-occupancy study to answer that question. The design team had recently worked with Cook to design and deliver two projects that were strikingly similar in size and schedule. One involved the use of 3P, the other did not. The ability to study these two clinics side-by-side offered a rare opportunity to eliminate confounding variables typically present in a project comparison study. This created the opportunity to better evaluate quantitative information like cost and time, as well as objectively identify qualitative benefits.
The projects for the study were Cook Children’s Rosedale Urgent Care Center, and the Cook Children’s Renaissance Square Health Center. The former was designed using a traditional SD/DD/CD approach, the latter using 3P, which combines and condenses many SD/DD activities.
The study team dove into both projects to collect and review raw data. As the chart shows, the projects are broadly similar in size, schedule, and type. When differences in the projects were identified, the team adjusted for unique circumstances that could be objectively quantified. For example, in calculating construction cost, the team adjusted for variables such as exterior materials, site conditions and demolition requirements to arrive at a like-for-like per square-foot cost. It is important to note for this study that not only was it the same design firm for both projects, but it was also the same design team which further eliminates variables in the analysis.
Design and construction metrics. The design analysis showed several benefits associated to the 3P project. First, the total number of design hours was reduced by 202(1). This has the potential to reduce fees and allows an owner to move into their building sooner. There were also physical benefits that were identified in the 3P project. It had less circulation(2), larger work spaces(3), reduced exam room sizes(4), a larger staff lounge(5), and more offices(6).
After breaking down the construction cost by division and removing all anomalies, both projects had the same cost per square foot(7). While this might not be a surprise given the similarities between the projects, it does remove a stereotype. Some owners may be hesitant to allow such heavy user input for fear they might drive up the cost of a project. Based on the findings of this study, this concern appears to be unwarranted.
Post-occupancy metrics. The room utilization analysis shows a 19% higher patient room utilization rate for the 3P clinic. In addition, a study of patient satisfaction scores showed that the 3P clinic achieved higher patient satisfaction scores in seven out of ten categories for the first two years of operation. This may reinforce the importance of how patient participation produces empathy which reflects itself in the final design, and staff participation produces greater engagement and a sense of ownership in the project (IKEA Effect). It was also discovered that defined storage needs during 3P resulted in 35% fewer supply orders during occupancy compared to a similar clinic in the system.
Qualitative Findings. To date, Cook has benefited from operational savings gained beyond this project. Lessons learned from the 3P have been applied to existing operations at other facilities, increasing the return on investment from the event. Cook has also added another neighborhood clinic to their network. This clinic was modeled after the findings from the 3P which facilitated better site selection, enabled quicker design, streamlined owner decisions, and got them into their clinic sooner.
In addition, the urgent care center that did not undergo the 3P required extensive renovation to accommodate growth needs not long after completion. This involved a 30% physical expansion to building, extensive site rework, and increased parking.
This study has shown that there are distinct advantages to using the 3P approach to designing a healthcare facility. With collaborative, hands-on input from leadership and users, it is able to deliver efficiency and improvements to the design, operations, and user satisfaction. In addition, this process supports better site selection, reduces review time, and allows for quicker implementation to market on future projects.