Effective design.

"Idealized design" focuses on the relationships within an organization

WHEN DISCUSSING BUILDING PROJECTS, we've all heard the maxim "form follows function," or that design should follow program, not the opposite way around. Yet how does one accomplish this daunting task of ensuring that the design of a building meets the purpose of an organization?

"Idealized design" starts at the beginning. More importantly, it focuses on the most important aspect of any organization, and that is relationships. Whether pertaining to strategic planning, organization design, or any type of organizational development, understanding relationships-both inside and outside of the organization-is where the real work of leadership can be found. Systemic thinking approaches leadership with this exact philosophy: "The whole is greater than the sum of its parts."

Many organizations, when faced with planning a building project, have heard of the Design-Build project delivery method. This concept involves an architect or architectural firm extracting information from both the organization and a pre-selected builder/developer to incorporate a wide range of functional and cost issues into the design. A systemic approach within the design process then requires a paradigm shift to incorporate both interactive planning and idealized design in the process.

Interactive planning

In this type of planning, systemic thinking is used to view an organization in a different light. This challenges traditional architectural planning that often considers simply work flow, number of occupants, and space and equipment requirements. Interactive planning helps define an organization as follows:

* Function or the purpose of the organization

* Structure or the manner in which things relate

* Key processes, which include:

* communication

* access to information

* decision-making

* problem-solving

* work design

* training and growth

* evaluations and rewards

It recognizes that there are many processes and forms of structure within an organization, and that effectiveness is found in how these things relate. On the micro-level, this includes the relationships of each individual within the organization and, on the macrolevel, it understands the organization's roles within a health care system as well as within a larger circle of the surrounding community and state, industry, economy, and the entire long term care industry.

An organization becomes effective when it understands its purpose regarding these relationships and aligns these various levels of systems and goals. In other words, effectiveness combines relationships with efficiencies. If management is the process of evaluating and managing relationships in terms of efficiencies, then leadership is the process of understanding the relevance of relationships. This concept of leadership can be applied to planning for design and construction of building projects. In fact, to ensure that it is done effectively, it should be done within the context of relationships.

For a planning and design process to incorporate systemic thinking, four characteristics must be in place:

It must be fully participative. All members must be involved in the process.

It must be fully integrated. All decisions and design should be made in keeping with how the elements relate to one another. Further, values must be placed on such decisions to weigh their priority and inclusion in a building project.

It must be ongoing. A planning project is a process instead of an event. In the case of a building project, certain milestones must be identified, at which time project costs can be projected.

It must allow constant feedback and learning. This concept sees change as a positive that promotes fluid growth and development. In building projects, "change" is viewed as costly, so architects must be challenged to design for flexibility and probable changes within larger areas of space.

Square one

Idealized design begins with starting from scratch, or designing something from the very beginning in a process of re-creation. One of the biggest pitfalls to any planning process is premature admission of barriers or constraints-- simply said, reasons why something cannot be done. We may hear this in many forms, such as it is too expensive, or it has never been done this way before. Adding constraints too early in a planning process accomplishes one thing: it limits options by stifling creativity.

When beginning an idealized design, there are three constraints that should be added: (1) the project must be technologically feasible, (2) the project must be economically viable, and (3) the process must allow constant feedback--there must be a commitment to constant adaptation.

Idealized design involves repeated iterations of planning. Each iteration is a process that is circular, looking at purpose, structure, and key processes. The first iteration is the process of creating a vision--both mentally and on paper--of what the project should look like when it is completed. It is planning with the end in mind. In a building project, this means that the entire organization, the architect, and, optimally, the builder work together to develop a master plan of what the project should look like when complete.

For a long term care facility, it means combining many components and service-delivery systems such as direct care, resident record storage, social services, pastoral services, recreational therapy, physician services, environmental services, food services, human resources, and business support staff. In the end, it should be integrated in a manner that is consistent with those systemic definitions of an organization: purpose, structure and key processes.

Conveying to an architect how these delivery systems interact is critical in understanding relationships and designing an effective building. We were recently reminded of this during a planning session for an idealized design within our organization. We are planning a project that will redefine our organization. It combines a complete renovation of our original building, built in 1918, with a significant amount of new construction composed mostly of community space and work space.

Identifying relationships

Creating unity in this project involves understanding the relationships within our organization, merging our heritage with our visions of the future, and designing a building that will enable us to meet the potential of our mission. During a planning session, a relationship we would not have necessarily been aware of was identified by one of our recreational-therapy members. She pointed out that she could increase participation in her recreational-therapy program if she were located closer to the main dining room.

She went on to explain that our residents spend at least three hours a day in the dining room itself, and a majority spend additional time congregating outside the dining room before and after meals--some up to an hour before and after the meal. What an opportunity that provides to organize a recreational therapy event and make that "waiting time" purposeful.

She also identified that the location was central to the various residential living spaces, minimizing the distances that residents would need to travel to get to the recreation-therapy room. We saw that this location would facilitate an important aspect of our mission--to promote independence--because it would allow residents to ambulate independently to this area while providing exercise. The design team (composed of various organizational members, the architect, and the builder) heard this suggestion and incorporated it into the idealized design.

Sanctuary

We, like many in our industry, have worked hard to change the perception that we are "a nursing home where people go to die." Yet the fact remains that end-of-life issues are something we deal with on a daily basis.

Issues relating to the death of a resident affect residents, families, and staff members. To this end, we began thinking about the purpose of our chapel. We hold many viewings and funeral services here and realize that this is a strong element of our purpose. With he help of our board of directors, architect, staff, and local funeral directors, we designed a viewing room in the chapel area. There was no denying that his design element felt right and sent a strong message to those we serve.

Once internally integrated, the design must also be reviewed in light of its connectedness to larger systems. How does the building look to the surrounding community? Is it inviting? How does it affect local traffic patterns? Does it fit within community goals?

The idealized design should also take into consideration how the delivery of services (and which services) fits into the continuum of care.

Once the first iteration is complete, then begins the process of successive iterations, which admit additional constraints and realities. This may be the financial implication of the design or issues relating to the engineering of the building. These issues, plus many more, add continuing constraints and potentially affect the design of the project. Including architects and builders when evaluating several iterations is valuable in that they have expertise in identifying which concepts are "buildable" and the relative cost of size and construction options.

In the end, this is what ensures that building design follows organizational mission and purpose.

Victor Lane Rose, NHA, is director of operations at Souderton Mennonite Homes, a CCRC in Souderton, Pa.