This is the first in a series of articles by Jon Huddy, author of ACEP’s ED design book, offering insights to ED physician leaders on how to position your emergency department for architectural design success.  The great 20th century philosopher, Mick Jagger, once said “You can’t always get what you want, but if you try sometimes, you just might find, you get what you need.”  So why is it that no matter how hard some physician-led in-house design teams “try,” their final ED projects don’t deliver what they “need?”    I recommend three initial steps to “get what you need” and set yourself and your ED up for project success.

I am assuming that your ED is in the position of needing to be upgraded, renovated, expanded or completely redesigned.  This may be due to safety concerns; rising volumes and lack of capacity; aging facilities; or an overall environment that is inadequate on many levels and doesn’t deliver your vision of an appropriate patient experience or support provider/staff satisfaction.

In almost all ED design projects it’s the early analysis and planning meetings that set the project on a path to success or failure, and many times you as an ED Medical Director may not even know that these initial meetings are taking place.  In some cases it is informal meetings amongst senior administrators or facilities directors that set department or service line priorities for future architectural projects.   And in many of these cases, a scope of project is discussed as well, meaning the potential size and budget of any upgrades or expansions.   These initial “prioritization” meetings will have long term impact on the success or failure of many architectural project since department size and construction budgets may be set even before a project is officially authorized to proceed.  But, before we cover how you may impact the scope of a proposed project, we have to make sure that you have positioned yourself to actually have an impact on any potential ED architectural project, including the ability to position the ED for architectural project consideration.

The following steps will allow you to position yourself in a way that will allow you to lay the foundation for a successful emergency department design project.

1. Consider Yourself the “Mars Lander”

In the fall of 2012, NASA’s spacecraft Curiosity landed on Mars.  This Mars lander immediately started to seek out clues of life.  Your job is similar, but you will be searching out clues for potential life in a future ED project.   Don’t wait to “hear” about an ED project, make the pro-active effort to find out if any consideration is being made to an ED project.  Search out and contact those people in your hospital or healthcare organization that may be involved in early strategic planning or the very earliest stages of facility planning.   Start with the Senior Administrator or Vice President over emergency services and start asking questions about “the last time any master planning or facility planning” was completed for the organization.   My advice is start with general questions about overall planning for the campus instead of specific questions regarding the ED.   Discussing “general” planning with administrators allows you to start to understand how the planning process works in your unique organization.   If you start with immediate questions regarding ED planning you will most likely get a quick response of “yes, we really do need to do something with the ED” in more of a brush-off response than an actual answer to your question of “if and when any general master planning has been recently completed?”  You may also seek out your Director of Engineering or Facilities and start to inquire about any future planning that is being considered for the overall hospital campus.   Your objective is to understand the current thinking of key organizational leaders regarding any facility planning, renovations, or expansions that the hospital may be considering.  In many cases, the actual clinical personnel are the last to know, so do your best to search out any clues that facility alterations are being considered.   You may find that no facility updates or expansions are being considered.  Or, you may find that facility planning for the future is being considered or is already underway.  In either case, your next step is to clearly understand the “pathway” to your organization’s method for project consideration, planning, and early approval to proceed.

2. Map out the Landscape

In 2012, Curiosity immediately began to map out the terrain of Mars and document many environment conditions.  Your next step is to research and document what may be a very complicated “terrain” for getting an ED project considered, authorized to proceed, designed, and finally constructed.  This is where I refer back to Mick Jagger’s “if you try sometimes” statement.   It will take some effort to understand and document the pathway that any project takes from a “seed” of an idea to a completed construction project.   Every healthcare organization has a different methodology or different planning/approval groups for architectural projects.   Do your research and find out how projects are brought forward for consideration.   You may be a smaller facility that has all requests go through a Director of Facilities, COO or even CEO.  Or, there may be a specific “Building and Grounds” group that gathers and refines any specific facility requests.  Some larger organizations have completely separate Planning Departments that oversee all architectural projects for multiple campuses.   Don’t be confused with researching the method to getting a project positioned for consideration versus the authority that may be needed to deliver final approval for construction.   Your early focus should be on how projects are listed or prioritized for consideration.   Approval for construction could be years away and may include an even more complicated path to approval regarding capital funding.  At this point, you just need to define the person, group or authority that can assist you in positioning the ED for consideration of an architectural project.   Clearly document who makes the very earliest of decisions, how they prioritize project(s), and how a project is authorized to proceed into early planning or vetting.   Once you understand who, how, or why a project may be considered, you need to position yourself to be a part of the process moving forward.

3. Start Building Relationships

Once you understand the group(s) that can position a department for architectural upgrade considerations, then start to position yourself to get in front of, or be a part of, this group.  This may start as informal meetings over lunch or your organization may have a method for you to formally document and submit your needs for consideration.   Either way, start making friends and start positioning the ED for redesign consideration.   You may very well find out that within your organization clinicians aren’t usually involved in very early project planning.   However, you would be amazed at the number of decisions that are made at the very, very beginning of any project, even just the first consideration of focusing on a department like the ED.   Many times ED physician leaders will voice their opinion about the ED needing to be assessed for future architectural changes and they are told “don’t worry, you’re on the list, but we won’t need your input until the actual design project starts.”   Yes, it’s great the ED is on a list “to be considered” but you not being able to deliver your insights as to “why” the ED should be at or near the top of that list is the problem.  Do your best to find the means and methods to voice your opinion, as early as possible, in a way that will support the need to assess the ED and clarify the reasons that the ED needs to be redesigned.   You can do this without alienating the decision-makers by displaying your passion for developing an environment that supports a greater patient experience, that supports safe, efficient, and sound modern clinical care.  In one case, I had a Chief of Emergency Medicine do his best to (carefully) remind his organization’s administrators that the ED is the source of 70% of the hospital admissions and (based on his research) that almost 40% of all hospital revenue starts in the ED.  But, I will caution you that if you start throwing out statistics that you make sure your information is justified with real data or people will start shooting holes in your case for positioning the ED for redesign consideration.   Think about the influence you really have within your organization, not what is allocated to you just by title; make friends in the C suite and on the Board of Directors, or call on any longtime friends in such positions.   In any situation, you have to position yourself as early as possible in hopes of influencing the decision to consider the ED for architectural redesign.  Remember…. “if you try sometimes, you just might find, you get what you need.”  Next, we will discuss the importance of your role regarding early participation.

My next “ED Design” article will cover why you need to be involved in initial discussions and how early decisions (that you may not even be involved in) will impact the end success of a project.

Please contact Jon Huddy directly should you have any questions, comments, or would like any additional information on the topic of positioning yourself for a successful role and final outcome with regards to an ED design project.

Jon Huddy can be reached at (803) 517-7522 or