1. What is your facility’s user experience scores; are they identified by location?
  2. Do you know how your spaces are performing (productivity, safety and others)?
  3. Is the environment designed to reduce harm? What is its highest harm issue?
  4. What is the facility’s needs to support another surge experience?
  5. Does the environment support a culture of continual improvement?

In a recent Health Facilities Management Magazine feature article, Dr. MacAllister shares 9 DOMAINS that provide an evidence-based focus on a holistic plan of best practices. This article shares essential resources available to create a data-driven approach for operational planning.*

  1. Emergency Preparedness and Surge

The pandemic taught us that we must be prepared for everything and anything. The Health and Human Services Department has shared resources regarding assuring surge compliance. Be certain to have all the situations documented and thought through. The CDC  and the Joint Commission provide excellent guidance.

  1. Compliance

As hospitals are regulated by many organizations to assure, they are licensed to be operated, it is prudent to review the licensing agencies your organization uses as it could impact the ability to maintain operations. The Joint Commission (TJC)Det Norske Veritas or The Norwegian Truth (DNV), and Health Facilities Accreditation Program (HFAP) are some of the most common accreditation organizations (AO) used in the United States.

  1. Safety: No Harm

Safe operations focus on the reduction of harm for building occupants in four primary areas: operations, active intruder, air, and the environment. Facilities need to support zero-harm to match the safety standards of major health systems. While this is a significant goal, it is achievable through the evidence in the field that demonstrated its impact. Find out more through The International Crime Prevention Through Environmental Design AssociationThe Cybersecurity and Infrastructure Security Agency (CISA) and the CDC.

  1. Reliability-Centered Maintenance

Reliability Centered Maintenance (RCM) is a proven and structured framework for analyzing the functions and potential failures for a physical asset with a focus on preserving system functions, rather than equipment. It’s not just about keeping things running, it’s about assuring systems can perform reliably under all circumstances.

  1. Health and Resiliency

Stress is a primary barrier to health. The systems in healthcare can influence the health of all its occupants. The WELL Building Systems articulate how there are physiological barriers in the environment. As a primary consumer of our resources, we want to assure that the most advanced operations are practiced through the use of guidelines like the United States Green Building Council LEEDUS Climate Reliance, and the World Health Organization’s Climate Resilience Toolkit. Health and resilience plans are critical to assure that the systems are optimized for optimum operations.

  1. Universal Accessibility

The American Disabilities Act (ADA) requires that all public buildings be accessible to all, no matter their abilities. The ADA is placed in this section as the precursor to the accessibility needs necessary to achieve the highest outcomes. Diversity, Equity and Inclusion are addressed in the Universal Design in Health Care Institutions Manual, however, there may be local or state guidance that you may consider outlined in the full article to address in operational implementation.

  1. User Experience and Engagement

People are the center of our operations, and therefore it is vital to keep all users engaged and likely to recommend others in terms of receiving care or employment. The Consumer Assessment of Healthcare Providers and Systems, or CAHPS, Survey includes questions about cleanliness and quiet at night which can fully be directly influenced by the environment. There has been significant research in the field that the direct relation to the environment can be influenced for improved outcomes (MacAllister, 2016). Wayfinding and navigation are also operational staples for an improved experience.

  1. Space Performance

You should understand how all your physical spaces contribute to the bottom line. While space use is directly connected to the Strategic and Master Plans, spatial value is a way to track and allocate the spaces returning the financial outcome they were designed for. This should include a list of departments and the associated Department Gross Square Footage (DGSF), as noted by Kirk Hamilton. As operations and facilities are more tightly aligned, the ability to tie a department’s performance to its associated spaces will be crucial for further investment and management of the system.

  1. Build your plan for success 

Operational Master Plans must include all aspects of operations to assure that multiple systems are aligned and performing at their best; and be a dynamic resource of information on a day-to-day basis. Build each domain methodologically and align the team around these goals. Set up a “can do” culture of continuous improvement.

*Read the full article here. 


Emergency Preparedness and Surge

Assistant Secretary for Preparedness and Response (ASPR). (2012). What is Medical Surge? Public Health and Medical Emergency Support for a Nation Prepared.


Centers for Disease Control and Prevention. (2020, April 4). Preparedness & Planning: Resources for Emergency Health Professionals. Emergency Preparedness and Response. https://emergency.cdc.gov/planning/index.asp


The Cybersecurity and Infrastructure Security Agency (CISA). (2021). Hospitals & Healthcare Facilities Security Awareness for Soft Targets and Crowded Places. Department of Homeland Security.


Centers for Disease Control and Prevention. (2019, July 22). Background C. Air. Infection Control. https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/air.html

Gandhi TK, Feeley D, Schummers D. Zero harm in health care. NEJM Catalyst Innovations in

Care Delivery. 2020 Mar/Apr;1(2). [Published online February 19, 2020]

The International Crime Prevention Through Environmental Design Association. (2021). ICA White Papers. https://www.cpted.net/


Det Norske Veritas Group. (2020). Healthcare accreditation by DNV GL. DNV. https://www.dnv.com/services/international-healthcare-accreditation-7516

The Joint Commission. (2021). Emergency Management. https://www.jointcommission.org/resources/patient-safety-topics/emergency-management

Reliability-Centered Maintenance

American Society of Healthcare Engineering. (2020). Reliability Centered Maintenance – what is it and why do I need to use it? ASHE. https://www.ashe.org/reliability-centered-maintenance

Health and Resiliency

  • US GREEN Building and LEED
  • WELL Building Institute
  • WHO Guidance for Climate resilience
  • US Climate Reliance Toolkit

LEED. LEED Rating System | U.S. Green Building Council. (2021). LEED Education. https://www.usgbc.org/leed

International WELL Building Institute. WELL Certification. (2021). https://www.wellcertified.com

Sustainable and Climate-Resilient Health Care Facilities Toolkit | U.S. Climate Resilience Toolkit. (2021). U.S. Climate Resilience Toolkit.


World Health Organization. WHO publishes guidance on climate resilient and environmentally sustainable health care facilities. (2020, October 13).



ADA National Network. Health Care and the Americans With Disabilities Act. (2021).

Issuu. (2019). Universal Design in Health Care Institutions Manual.


It’s all about the experience.  Just as operations are designed the experience of the visitor needs to be curated and designed.  Disney and Hotels have figured this out first.  What is the impact of experience on business performance?  With staffing shortage across the nation we can create a space and building that support the workforce and that inspires them to be more engaged and productive.  Google and others harnessed this concept.


Other 3rd party satisfaction

New Hybrid work force “example”

MacAllister, L.; Zimring, C.; Ryherd, E. Environmental Variables That Influence Patient Satisfaction: A Review of the Literature. HERD 2016, 10, 155-169, doi:10.1177/1937586716660825.


How do we really know the space is preforming?

Hamilton, K. (2018). A new method for calculating health care spaces. (2018). Health Facilities Management. American Society for Health Care Engineering. https://www.hfmmagazine.com/articles/3244-calculating-health-care-spaces


American Hospital Association. Improving the Patient Experience of Care. (2016, September 12).  https://www.aha.org/chairpersons-file/2016-09-12-improving-patient-experience-care

American Hospital Association. Issue Brief: Team-based Care Creates Value (2020, September). The Value Initiative.


Childcare Is a Business Issue. (2021, April 29). Harvard Business Review. https://hbr.org/2021/04/childcare-is-a-business-issue

Huelat, B. J. (2007). WAYFINDING: DESIGN FOR UNDERSTANDING: A Position Paper for the Environmental Standards Council of The Center for Health Design. The Center for Health Design.


International Facility Management Association. (2009). A White Paper on Strategic Facility Planning. IFMA. https://www.energy.gov/sites/default/files/2013/04/f0/IFMA_-_Strategic_Facility_Planning_-_WhitePaper.pdf

The U.S. Coronavirus Response Must Meet Health Workers’ Child Care Needs. (2020, March 30). Center for American Progress. https://www.americanprogress.org/issues/early-childhood/news/2020/03/24/482086/u-s-coronavirus-response-must-meet-health-workers-child-care-needs/