INTEGRAL PROCESS DESIGN [IPD]: ABSTRACT
Improved Planning and Operations for Complex Buildings
Starting Point:
Health care systems throughout the world face financial collapse. Costs must be reduced. This study shows a significant cost reduction potential of hospital running costs which account for ca.25-30% of health care budgets in many OECD countries. (CDC, 2009)
Goals:
The goal of Integral Process Design is to liberate sufficient resources due to operational optimization so that the entire construction and refurbishment budget for hospitals could be free of charge.
Avoiding dangerous assumption traps with IPD:
Today’s planning information is based on too optimistic efficacy assumptions which are not coherent with reality in hospitals. Planning has to be more realistic to avoid dangerous ‘Assumption Traps’ which lead to misdirected investments.
Tracing imposed inefficiencies with Grey Performance Analysis:
IPD focuses on externally imposed inefficiencies by targeting avoidable unnecessary work called ‘Grey Performance’.
Architectural consequences of IPD:
IPD significantly influences the organizational structure, functional layout and architectural planning of complex buildings. Health facility architecture must change its focus from optimal use of surfaces to optimal use of human resources.
Enabling more quality through additional revenues:
More revenues are possible by surrounding building design with business design already in the early project conceptualization.
Table of Contents
PART A: OVERVIEW
1 INTEGRAL PROCESS DESIGN [IPD]: STUDY BACKGROUND AND SUMMARY
BACKGROUND: Improved Planning and Operations for Complex Buildings
SUMMARY: Integral Process Design [IPD]
2 INTEGRAL PROCESS DESIGN [IPD] FOR COMPLEX BUILDINGS
2.1 Mission statement
2.2 Problems of complex procedures : The airline example
2.3 Problems of complex procedures : The operating room (OR) example
2.3.1 What are the problems of complex structures in health care?
2.3.2 Conditions in the operating room
2.3.3 Assumption traps in the operating room
2.3.4 Management problems in the operating room
2.4 Integral Process Design response : The Berne OR-Cluster
2.4.1 Concept
2.4.2 Impact of the Berne OR Cluster
2.4.3 Outlook for Integral Process Design
2.5 Cost-free hospital investment: Eight statements for a new approach
2.6 SENIC study: successful implementation of study findings
2.7 From SENIC to IPD: quality improvements and cost reduction
2.7.1 How to approach the non-tangible: effective incentives for health care planning
2.7.2 Structure of Planning for complex buildings today
2.7.3 Goals of IPD : Embedding incentives in today’s structure
2.7.4 Today’s Paradigms in the planning of complex buildings
2.7.5 Today’s Lack in Strategic Options
2.8 Situation analysis summary of health facilities today
2.8.1 Performance problems in the running of health facilities
2.8.2 Sweet dreams of efficiency
2.8.3 The Assumption Trap in health facilities
2.8.4 Financial context summary of health facilities
2.8.5 Demotivating health care remuneration structures
2.8.6 Escaping the downward spiral: Introduction of small scale incentives
2.9 Challenges
2.9.1 Challenges in health care
2.9.2 Challenges in health facility operations
2.9.3 Challenges in planning
2.9.4 Challenges in implementation
2.9.5 From user talks to Transition Assistance
2.10 Complex building business case positioning
2.10.1 “Hospitals are accidents! They should not happen!”
2.10.2 “Hospitals are far too valuable to care only for ill people!”
2.11 INTEGRAL PROCESS DESIGN [IPD] : The concept
2.11.1 Function of IPD in the planning process
2.11.2 Structure and Components of IPD
2.11.3 Interface of IPD with the DRG medical service remuneration concept
2.11.4 Reversing the focus: From maximum use of space to maximum use of personnel
2.11.5 Unique Selling Points of IPD
2.11.6 The Market: Customers of IPD
2.11.7 Added Value
2.11.8 Implementation
2.11.9 Implementation of the IPD concept on a larger scale
PART B: CONSTRAINTS
3 HEALTH FACILITY STRUCTURES : SHORTCOMINGS AND LIMITATIONS
3.1 The “time frame” problem of today’s health facilities
3.2 Lack of transparency during the planning of complex buildings
3.3 The mistakes of the “tailor-fit” solutions in today’s planning
3.4 Consequences of rigid focused plans: Lost flexibility
3.5 Reduced space occupancy and permanent service provision
3.6 Analysis: the limitations of today’s planning processes
3.7 Why do today’s health facilities seem to be outdated faster?
3.8 Strategic Space in hospitals
4 IMPACT OF HEALTH SERVICES FINANCING AND REMUNERATION
4.1 From Patient Classification Systems to Diagnostic Related Groups
4.2 ‘Fee-for-service’ remuneration : a major obstacle for efficacy
4.3 Separated budgets: a key problem for efficient planning
4.4 Hospital capital investment
4.4.1 Could hospital building investment be free of charge?
4.5 Current remuneration systems: “Disincentives” for doctors
4.6 Consolidation of separated investment and operational budgets
4.6.1 Monistic’ a model of unified health facility financing?
4.6.2 The Swiss TARMED catalogue and the German health fund.
4.6.3 The Dutch model of advanced DRG management.
4.6.3.1 From DRG to DTC: Combined hospital and external costs coverage
4.6.3.2 Yardstick competition: gradual adaptation towards higher efficiency
4.6.3.3 Consequences for the planning of health facilities
5 HEALTH FACILITY OPERATIONS : PROBLEMS TO ADDRESS
5.1 Assumption Trap: Working environment
5.2 Assumption Trap: Managerial structures
5.2.1 Potential and limitations of outsourcing: example maintenance
5.2.2 Outsourcing risks
5.2.3 Internal outsourcing: a win-win situation
5.3 Pitfalls within organizational concepts
5.4 Inherent inefficiency due to permanent service provision
PART C: CONCEPT
6 CONCEPTS FOR THE PERFORMANCE MANAGEMENT IN HOSPITALS
6.1 Clinical Path Management [CPM]
6.1.1 Organizational improvements with Clincal Path Management
6.1.2 Lean Process Management in hospitals [LPM]
6.1.3 Pilot-study: Lean management at the University Center of Cardiology, Freiburg
6.1.4 Clinical Path Management: Conclusions
6.2 The OPIK project
6.2.1 Origin and background
6.2.2 Concept and goals of the OPIK model
6.2.3 The OPIK model: Conclusions
6.3 Evidence Based Design [EBD]
6.3.1 Origin and background
6.3.2 Concept and goals of Evidence Based Design
6.3.3 Applied tools of Evidence Based Design
6.3.4 Working with virtual patients to focus on the real needs
6.3.5 EBD focus: Improving the conditions for a healing process
6.3.6 Balancing one-time investment costs and operational costs with EBD
6.3.7 Evidence Based Design: Conclusions
6.4 The CORE-Hospital concept
6.4.1 Origin and concept
6.4.2 Goals and benefits of the CORE Hospital concept
6.4.3 The CORE Hospital concept: Conclusions
6.5 Outlook: A synthesis with Integral Process Design
7 IPD : AN APPLIED STRUCTURE FOR INNOVATIVE PLANNING IMPLEMENTATION AND EVALUATION
7.1 Approach and limitations in the case-oriented evaluation of this study
7.2 Embrace Plan
7.2.1 Today’s strategic limitations of the planning tools
7.2.2 Situation: master plans do not integrate business modeling
7.2.3 Benefits and shortcomings of today’s strategic planning tools
7.2.4 Definition and consideration of business criteria
7.2.5 Recent trends regarding the provision of basic planning information
7.2.6 Additional requirements for strategic planning
7.2.7 The integral hospital business plan: A ‘White spot’ in planning
7.2.8 Effective planning: Early detection, early response
7.2.9 Elements of an Embrace-Plan
7.3 Operational Flow Planning
7.3.1 Overcoming the provision gap: integrating unused resources
7.3.1.1 Making use of off-peak staff availability in accident & emergency
7.3.1.2 Coping with the provision gap at accident and emergency departments
7.3.1.3 Combining maternity and early rehabilitation
7.3.1.4 Provision gap and trends for patients’ length of stay
7.4 Healistic design: Quality and healing
7.4.1 Defintion of Healistic Design
7.4.2 Noise control and fear management with Healistic Design
7.4.3 Case in point noise control: Patients’ specific noise separation
7.4.4 Visual control with Healistic Design
7.4.5 Case in point visual control: Specific view control for patients
7.5 Grey Performance Analysis
7.5.1 Challenges: staff works hard but still is not efficient
7.5.2 Benefits: increased efficiency with Grey Performance Analysis
7.5.3 Approach: Structure of Grey Performance Analysis
7.5.4 Trend assessment of the cost saving potential with GPA
7.5.5 Grey Performance analysis: Operating department AOH-08
7.5.6 Return on Design assessment: Operating department AOH-08
7.6 Definition of Joker Areas
7.6.1 Joker Areas: Selection criteria for interfering with a complex system
7.6.2 Joker Areas: Economic and performance criteria
7.7 Business Modeling
7.7.1 IPD: Application of Business Modeling
7.8 Strategic Space Design
7.8.1 The lack of strategic spaces in today’s health facilities
7.8.2 The potential of strategic spaces in health facilities
7.8.3 Strategic Space Design: STEP 1 management of physical spaces
7.8.4 Strategic Space Design: STEP 2 management of healistic resources
7.8.5 Strategic Space Design: STEP 3 allocation management
7.8.6 Harmonizing the Anesthesia workflow
7.8.7 Transparency of wards versus longer ways (the Paris example)
7.9 Integration of additional business: The Joint Business Case
7.9.1 Hospital Care today: A monoculture business environment
7.9.2 Hospitals managed like airports: “And if your hospital was managed by Schiphol airport!”
7.9.3 Planning for complex buildings and the Joint Business Case
7.9.4 The Joint Business Case: An Economic Solidarity Model
7.9.5 The Joint Business Case: A Model for the Dongtan Eco Life City
7.9.6 The Joint Business Case: Elements and concept
7.9.7 The Joint Business Case: A model for Otto Wagner Hospital
7.10 Transition Assistance
7.10.1 Transition workshops and staff empowerment
7.10.2 The Klagenfurt resource model
7.10.3 Beating the assumption trap with continuous education
PART D: IMPLEMENTATION
8 IPD : RETURN ON DESIGN
8.1 Benchmark criteria: Economic design validation with IPD
8.2 Scenario Planning with IPD
8.3 IPD: An instrument to manage the DRG transition
8.4 IPD: Economic and performance impacts of implemented IPD
8.5 IPD: Economic effects of an implemented Joint Business Case
8.5.1 Approach
8.5.2 Investment requirement
8.5.3 Consequences of the variants for the market position of [AOH-02]
8.6 Economic validation of health facility projects with IPD
9 IPD : MODERATING BUSINESS AND ARCHITECTURE
9.1 Challenges to design an efficient hospital.
9.2 From libertarian paternalism to over-regulation
9.2.1 Libertarian paternalism and the paradigm of free choice
9.2.2 Medical quality assurance and the trend for over-regulation
9.2.3 Visualizing process and design coherence
9.3 Creating a ‘choice architecture’
9.3.1 From guidelines to a choice architecture
9.3.2 Nudges for more efficient health facilities’
9.3.3 Design challenge: combining primary and secondary service excellence
9.3.4 Designing a loose-fit default concept
9.4 Default typology considerations
9.4.1 Modular building typologies
9.4.2 Allowing change with modular building elements in care
9.4.3 The ‘Vertical Embracement’ principle
9.4.4 The ‘Sandwich’ typology
9.4.5 Default ‘Sandwich’ layout recommendations
9.4.6 The ‘Slice’ concept
9.4.7 Clustering for optimal use of human resources
9.5 Default structural considerations GDHS (Grid / Depth / Height / Shape)
9.5.1 GDHS, [G]: The building grid
9.5.2 GDHS, [D]: The building depth
9.5.3 GDHS, [H]: The building height
9.5.4 GDHS, [S]: The building shape
9.6 Default organizational considerations
9.6.1 Design coherence: ‘Definitions to allow adaptability’
9.6.2 Team coherence: a challenge during long term projects
9.6.3 Decision coherence: ‘The golden rules’
9.7 The Moderation challenge
9.7.1 Achieving coherence within complexity: who is not at the table?
9.7.2 IPD early stage moderation for better use of human resources
9.8 Potential for further research
10 IPD : CONCLUSIONS AND OUTLOOK
10.1 Goals, characteristics and benefits of IPD
10.1.1 Integral Process Design: A toolbox for higher efficiency in complex buildings
10.1.2 Cost-neutral hospital investment: A real perspective or just a dream?
10.1.3 Cost-neutral hospital maintenance and refurbishment
10.1.4 Strategies to avoid the misdirection of IPD cost savings
10.1.5 Design coherence: A key factor for the success of IPD
10.2 Market for IPD: Clients and Added Value
10.3 Implementation strategies for IPD
10.4 IPD proposals for the design of complex buildings
10.5 Integral Process Design: Conclusions and outlook
Objectives and Core Topics
The primary objective of this study is to introduce "Integral Process Design" (IPD) as a transformative methodology for the planning and operation of complex health facilities. By bridging the gap between business management and architectural design at the earliest conceptual stages, the work seeks to convert operational inefficiencies into financial resources, with the ambitious goal of making hospital capital investments effectively cost-neutral through long-term performance gains.
- The critical analysis of traditional, reactive health facility planning and its inherent "assumption traps."
- The development of performance-based design tools, such as the "Embrace Plan," "Grey Performance Analysis," and "Strategic Space Design."
- The integration of health facility planning with business modeling to optimize staff utilization and resource allocation.
- The application of "Joker Areas" to achieve high-impact efficiency improvements with minimal negative collateral effects.
- The strategic implementation of "Joint Business Cases" to diversify revenue streams for hospitals, including wellness and prevention services.
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2.2 Problems of complex procedures : The airline example
Have you ever experienced having to wait exceptionally long for a meal on a long distance flight? It is exhausting to fly long hours, hence it is nice to fly for example a famous renowned Asian airline. The ambience is great and the cost performance ratio in economy class is good.
But if you take e.g. a flight around 12:30 from Frankfurt to Asia in order to arrive early morning next day and you happen to sit in the aircraft in row ten or further down from the kitchen block, you had better go to sleep right away or take with you a sandwich and some drink. This is because on average it will take 1½ to 2 hours after take-off before you will receive your meal in the plane. And this is not on a one-time experience, it is a pattern!
What are the underlying process management problems? When you finally receive your lunch the exhaustion is written in the faces of the friendly personnel and it is quite obvious what went wrong in process management: Special meals (on request prior to flight) are served first and cause enormous delays because individual time consuming processes which serve only few customers are preceding standardized efficient processes which serve many.
Summary of Chapters
1 INTEGRAL PROCESS DESIGN [IPD]: STUDY BACKGROUND AND SUMMARY: This chapter defines the core purpose of IPD as a bridge between business strategy and architectural planning to achieve long-term efficiency in complex buildings.
2 INTEGRAL PROCESS DESIGN [IPD] FOR COMPLEX BUILDINGS: It explores the structural and procedural problems in current health facilities, using the airline and operating room examples to demonstrate how traditional, reactive planning leads to inefficiencies.
3 HEALTH FACILITY STRUCTURES : SHORTCOMINGS AND LIMITATIONS: This section details how rigid, "tailor-fit" planning solutions prevent future adaptation, advocating instead for flexible, loose-fit architectural structures.
4 IMPACT OF HEALTH SERVICES FINANCING AND REMUNERATION: It analyzes how current remuneration systems like DRGs often disincentivize efficient operation and how separating capital and operational budgets hinders sustainable development.
5 HEALTH FACILITY OPERATIONS : PROBLEMS TO ADDRESS: This chapter focuses on "assumption traps" in managerial structures and the complexities of outsourcing, suggesting internal alternatives to improve overall efficiency.
6 CONCEPTS FOR THE PERFORMANCE MANAGEMENT IN HOSPITALS: An evaluation of existing management tools such as Clinical Path Management and Evidence Based Design, highlighting their benefits and their limitations regarding architectural integration.
7 IPD : AN APPLIED STRUCTURE FOR INNOVATIVE PLANNING IMPLEMENTATION AND EVALUATION: This comprehensive section provides the practical toolkit for IPD, detailing elements like the Embrace Plan, Operational Flow Planning, and the Joint Business Case.
8 IPD : RETURN ON DESIGN: This chapter demonstrates how to economically validate design decisions using ROI and Net Present Value models to justify investments in operational improvements.
9 IPD : MODERATING BUSINESS AND ARCHITECTURE: It discusses the challenge of designing efficient hospitals amidst over-regulation, proposing a "choice architecture" and new typologies like the "Sandwich" and "Slice" concepts.
10 IPD : CONCLUSIONS AND OUTLOOK: A synthesis of the study’s findings, reaffirming that holistic IPD strategies can successfully align building design with business performance to ensure the long-term viability of health facilities.
Keywords
Integral Process Design, Health Facility Planning, Hospital Efficiency, Assumption Trap, Grey Performance, Joint Business Case, Strategic Space Design, Architectural Typology, Operational Performance, Return on Design, Healthcare Financing, Clinical Path Management, Evidence Based Design, Performance Management, Sustainable Planning
Frequently Asked Questions
What is the core purpose of this study?
The study introduces "Integral Process Design" (IPD), a management and planning methodology designed to bridge the gap between business objectives and architectural design in complex buildings, specifically targeting the health care sector to improve efficiency and reduce operational costs.
What are the primary themes covered in this work?
The work centers on strategic planning, business modeling, facility performance, the reconciliation of separated financial budgets, and the architectural design of flexible, high-performance hospital environments.
What is the primary goal of the IPD methodology?
The primary goal is to liberate sufficient financial resources through operational and interdepartmental efficiency improvements so that the total cost of construction and refurbishment for complex buildings can effectively be covered by these savings.
Which scientific methods does the author employ?
The author uses a case-oriented approach, analyzing existing situations in various international health facilities, evaluating performance data, and developing strategic modeling tools—such as "Grey Performance Analysis" and "Return on Design"—to visualize the impact of design changes on business outcomes.
What is the focus of the main section of the book?
The main sections cover the background of IPD, the constraints of current health facility structures, concepts for hospital performance management, and practical application strategies for innovative planning and evaluation, including detailed financial assessment frameworks.
Which keywords best characterize the research?
Key terms include Integral Process Design, Grey Performance, Assumption Trap, Joint Business Case, Return on Design, and Healthcare Facility Planning.
What is the "Assumption Trap" in hospital planning?
The "Assumption Trap" refers to the common but flawed planning practice of basing design decisions on optimistic, static assumptions about future operational conditions, rather than acknowledging dynamic complexities, leading to rigid buildings that quickly become inefficient.
How does the "Joint Business Case" benefit a hospital?
The "Joint Business Case" integrates additional revenue-generating activities—such as wellness, prevention, and hospitality services—into the traditional hospital model, creating an "Economic Solidarity Model" that uses these extra profits to subsidize necessary but potentially deficit-creating core medical services.
What is "Grey Performance" and how does IPD address it?
Grey Performance represents avoidable operational inefficiencies caused by external influences and poor interdepartmental coordination. IPD addresses this by using "Grey Performance Analysis" to trace and eliminate these inefficiencies, turning hidden waste into measurable productivity.
- Citar trabajo
- Tom Guthknecht (Autor), 2010, INTEGRAL PROCESS DESIGN. Synthesizing Building and Business Design of Health Care Buildings, Múnich, GRIN Verlag, https://www.grin.com/document/283799
