By Glenn Sumner, Senior Manager, Major Health Programmes team, Pip Young, Senior Manager, and Krissie Ferris, Senior Consultant, Healthcare Technology team
Opening a hospital is an enormous task that ultimately will transform care for thousands of people. It starts with the approval of a business case for a new healthcare facility, planning the architectural design, and re-imagining care models. But how do you get from an empty building to a fully operational site? The answer is through ‘Hospital Activation’ - the process of preparing to open a new or renovated hospital facility. In 2020, the UK government announced plans to build or improve 48 hospital facilities by 2030 through the ‘New Hospital Programme’ (NHP) – the largest hospital building programme in a generation. The NHP presents a major opportunity to transform NHS services for patients, staff, and the wider community, so getting hospital activation ‘right’ has never been more important. In this blog, we introduce the concept of hospital activation, and provide some considerations for ‘successful activation’ informed by our work in the field.
What is hospital activation?
Hospital activation is sometimes referred to as hospital ‘commissioning’. It starts during the construction of the hospital facility and extends through to the new hospital’s opening day (also referred to as ‘day 1’). It involves loading the building with new equipment, IT, and furniture, making sure the building and its equipment are safe for use. It ensures the hospital’s digital infrastructure is up and running, operational readiness activities are complete, and staff are confident to work in the new environment.
Hospital activation can be split into three phases, ‘Ready Set Go’:
- Ready phase: Involves checking and preparing the building and infrastructure.
- Set phase: Involves preparing hospital staff to work in the new facility and testing workflows, equipment and processes.
- Go phase: Involves transitioning patients to the new site, the ramp up of clinical services and finally, the opening day.
Splitting hospital activation into three phases provides a clear framework for the sequencing of activities needed to ensure clarity of dependencies across programmes and smooth operationalisation of facilities. Importantly, hospital activation brings together the various functions of a new hospital build programme, including operational, clinical, IT and construction into one integrated roadmap. They key focus areas of hospital activation are outlined in Figure 1.
Figure 1: The key focus areas of hospital activation
What are the benefits of hospital activation for the NHP?
The main benefits of following a clear, tried and tested hospital activation programme, with well-defined focus areas include:
- having a clear sequence of activities to follow, which will help to avoid delays and bottlenecks
- improving clinical safety during the transition from the old site to the new one
- providing a smooth staff transition and better patient experience
- early detection of risks, and timely implementation of mitigations.
Getting hospital activation right can be the difference between opening a new facility on time, or opening months or years after the planned date. Delays to hospital opening can and do have significant financial impacts for the NHS and private healthcare providers, so it is essential to engage in early, integrated planning across multiple teams.1
Considerations for successful hospital activation
To be most effective, hospital activation planning should begin at least 18 months before the hospital’s planned opening date.2 Early and proactive planning will help to avoid common pitfalls such as inadequate time for loading the building and testing connectivity across equipment and IT. Figure 2 outlines some of the key elements that need to be considered for successful hospital activation, including having detailed scheduling, a suite of resources designed to deliver high quality transition (Ready, Set, Go frameworks and transition plans), plans for operational readiness, and plans to support the change management and training of staff.
Figure 2: Key elements of hospital activation
Underlying each of these elements are the key themes of ‘planning’ and ‘communication’. Planning involves creating a clear road map of what needs to happen and when, clear tracking and visibility of progress and an understanding of when different teams will need to work together to achieve mutual goals. Communication – working early on to gain clarity of the needs, responsibilities, and interdependencies of different teams, and having governance structures in in place to foresee and quickly deal with cross-discipline issues is essential.
Case study: Cleveland Clinic London
Cleveland Clinic is one of the leading providers of specialised healthcare in the world. It is an integrated healthcare delivery system with hospitals, clinics and wellness centres in the US, Canada, and the UAE. In 2015, the Cleveland Clinic Foundation embarked on a bold initiative to expand their world-class patient care model to the UK market and establish healthcare facilities in London, which include the Cleveland Clinic London Hospital, the Cleveland Clinic Portland Place Outpatient Centre and Contact Centre. The Cleveland Clinic team worked through the following activation phases:
Ready phase: Early on in the activation process, the team developed a comprehensive planning approach to integrate seven programme teams (from construction, to clinical, to supply chain teams) into a set of detailed plans and schedules, covering the timing and sequencing of key activities.
Set phase: Importantly, this plan was agile, enabling the team to better respond to the changing demands from construction, planning, and operational teams. The team carefully prepared for the Care Quality Commission inspection, engaged in multiple scenario testing activities, led the change management and training of incoming caregivers and hospital staff, and led the comprehensive roll-out of all end-user devices to support the organisation’s technical solution.
Go phase: To gain a helicopter view of all team’s activities, and to prevent and rapidly respond to issues, Cleveland Clinic London established a command centre to provide clear communication channels throughout all teams ahead of day 1 and the ramp up of clinical activities.
Cleveland Clinic achieved the following outcomes during the activation of their new healthcare facilities:
- opened the Cleveland Clinic Portland Place Outpatient Centre, a six-storey, 28,000-square-foot building with 17 consultation rooms3
- opened the Cleveland Clinic Grosvenor Place Hospital, a 184-bed, eight-storey, 325,000-square-foot building4
- trained over 800 caregivers through 150,000 hours of training
- installed and tested over 5,000 pieces of IT equipment
- sourced and staged 7,000 implants
- validated 1,200 surgeon preference cards in Epic (EPR system)
- procured 13,000 medical devices spanning 4,000 equipment packages
- procured 7,000 implants, 10,500 unique consumables and 10,000 instruments – delivered on time
- gained CQC registration, enabling the facilities to open on time and safely.
The NHP presents an exciting opportunity to improve patient care and healthcare staff experience across the UK, yet the challenge of successfully opening a fully equipped, safe and operational hospital on time cannot be understated. Activation requires many different skills, early engagement, and collaboration between many different teams. Our work in the field has taught us that early planning, clear sequencing of activities, and active involvement of clinical staff are critical to success. On 11 May 2022, we hosted a webinar with Cleveland Clinic London, where we discussed the challenges and successes of the hospital activation process and discussed first-hand what it is like to open a new facility in the UK! You can access a copy of the recording here.