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1. JONA
Volume 38, Number 10, pp 409-413
Copyright B 2008 Wolters Kluwer Health |
Lippincott Williams & Wilkins
An Operational Guide for
Transition Planning
Kelly Guzman, MN, RN
Hilda Nering, MSN, RN
Johanna Salamandra, MSN, RN
Nearly $200 billion of healthcare
construction is expected by the
year 2015, and nurse leaders
must expand their knowledge
and capabilities in healthcare
design. This bimonthly depart-
ment, edited by Jaynelle F. Stichler,
DNSc, RN, FACHE, prepares
nurse leaders to use the evidence-
based design process to ensure that
new, expanded, and renovated
hospitals facilitate optimal patient
outcomes, enhance the work envi-
ronment for healthcare providers,
and improve organizational per-
formance. In this article, the guest
authors describe a process for suc-
cessful transition planning to a
new facility.
When renovating or building,
transition planning should be-
gin with the initial vision for the
new facility and continue through-
out the design and construction
phases of the project. The crux of
transition planning, also known as
occupancy or activation planning,
is project and workflow manage-
ment. Effective transition plan-
ning provides communication
and coordination of resources
throughout the life of the new
hospital construction project,
which may span more than 3
years. The gravitas of this type of
endeavor demands strict applica-
tion of specific project manage-
ment tools to ensure success.
Essential tools for the job
include (1) identification and de-
velopment of critical task lists
delineating due dates and re-
sponsible parties, (2) committee
development and meeting man-
agement, (3) timelines to reflect
critical path issues and identify
contingencies, (4) architectural
drawings and mock-ups illustrat-
ing important aspects of the floor
plans for workflow and space plan-
ning, and (5) a database to track
and manage the thousands of
pieces of information and logistics
related to furniture, fixtures, and
equipment (FF&E), including the
procurement, delivery, installation,
sign-off, and hospital-required
checks to ensure room readiness
for licensing and move-in.
A successful transition plan-
ning process promotes involve-
ment of all departments and
personnel in a safe, smooth, and
on-time move into the new facility.
Because of the nursing profession’s
natural patient-centered focus and
the ability to broadly apply the
nursing process (to assess, plan,
implement, and evaluate), nurse
leaders are particularly well suited
for transition planning roles.
Assess
Before developing a critical task log
(CTL), the transition team must
have a clear understanding of the
scope of the project, the key play-
ers, and the construction timeline.
This requires a thorough assess-
ment and understanding of the
healthcare organization, includ-
ing which stakeholders will be
impacted and how they have re-
sponded to change initiatives in the
past. With this information, inter-
views are conducted with appro-
priate and knowledgeable staff
from all departments involved to
identify the scope and sequence of
work that needs to be completed
for a successful move. The result of
the interview process is a compre-
hensive CTL of all essential tasks.
The CTL tracks the following in-
formation: start dates, end dates,
task owners, team members, and
responsible committees.
JONA Vol. 38, No. 10 October 2008 409
Health Facility Design
Authors’ Affiliations: Executive Direc-
tor of Transition Planning (Ms Guzman);
Project Manager (Ms Nering), Healthcare
Technical Services, Los Angeles, California;
Independent Consultant (Ms Salamandra),
Salamandra Consulting, Los Angeles, Califor-
nia; Preceptor (Ms Guzman), School of Nurs-
ing, University of California, Los Angeles.
Corresponding author: Ms Guzman,
Healthcare Technical Services, Suite 303,
1145 Gayley Ave, Los Angeles, CA 90024
(kguzman@consulthts.com).
Copyright @ 2008 Lippincott Williams Wilkins. Unauthorized reproduction of this article is prohibited.

2. Plan
The CTL is reviewed for thorough-
ness, and tasks are assigned to
responsible parties. The executive
team of the hospital has the ulti-
mate responsibility of ensuring that
the CTL is completed on time and
that any issues are referred to the
appropriate committee for prompt
resolution. The executive team
determines the transition commit-
tee infrastructure and identifies co-
chairs to lead subcommittees. The
committee chairs should be an
interdisciplinary group, which may
include members from executive
administration, nursing, medicine,
finance, support services, materials
management, human resources and
education, engineering, informa-
tion systems, telecommunications,
and marketing.1
The CTL becomes the plan
and, as such, drives and directs all
transition planning activities. Easy
sorting of the document (ie, by
topic, committee, due dates) can
be accomplished using a database
or spreadsheet along with meticu-
lous record keeping. Depending on
the categorization of the tasks on
the CTL, the executive committee
creates appropriate subcommittees
and appoints chairpersons charged
with oversight, reporting, comple-
tion, and documentation of the
tasks according to schedule. A proj-
ect manager or transition director
should be appointed to oversee and
direct the work of the transition
team members and subcommit-
tees.2
Using the CTL as the plan
serves to inform all participants of
their roles. The tasks contained in
the CTL define the hospital’s
course toward a safe move.
Implement
To engage senior participants and
foster team commitment and coop-
eration, kick-off meetings are held.
At the kick-off meeting, the new
hospital project is described, the
committees’ structure and cochairs
are presented, and the CTL is
reviewed. The transition planning
process is presented and discussed.
These meetings provide an oppor-
tunity to formalize the purpose and
rules of committee involvement and
participation and to establish work-
flow and CTL expectations. By the
end of the meeting, the participants
have a good understanding of their
roles and responsibilities for tran-
sitioning into the new hospital.
Thereafter, the meeting schedule is
similar to preparing for a significant
survey, such as that done by The
JointCommission:2yearsout,there
are monthly or bimonthly meetings;
1yearout,high-risk,problem-prone
areas have biweekly and monthly
meetings; 6 months out, weekly
meetings and then daily meetings
the monthor week before the move,
duringthemove,andafterthemove.
Almostasimportantasadherenceto
a strict schedule is maintenance of
precise meeting minutes and CTL
change or completion data.
Evaluate
Critical task log oversight is essen-
tial to identify areas that need at-
tention, support, or resources; to
measure progress; and to keep the
project and team on schedule.
Timelines marry the construction
schedule with the CTL and provide
a visual cue and schedule shorthand
for all team members. Those in-
volved anywhere in the project can
readily view the course and con-
tingencies and anticipate upcoming
plans. When unanticipated schedule
changes arise, the timeline can be
adjusted to the right or left, along
with associated tasks and contin-
gencies. The committee chairs’
responsibilities include (a) ensuring
that timelines are met, (b) referring
issues for timely resolution, (c)
identifying unrealistic tasks, and
(d) adding new tasks as needed.
Workflow Planning and Tools
to Complement the Work
Architectural floor plans are the 2-
dimensional views of the project
that provide critical information to
the transition team planning the
new hospital (Figure 1). A study
of the floor plans can uncover po-
tential problems, thereby allowing
early correction. Process workflows
can be revised, as needed, to fit the
new facility in advance of the staff
and patient move. The information
gleaned from the architectural floor
plans is also vital to the orientation
and training of the staff.
Typically the purview of build-
ing and construction professionals,
architectural drawings may be dif-
ficult for staff to understand, lead-
ing to frustration. This frustration,
combined with the resistance to
change that is normally experi-
enced with all new planning proj-
ects, may cause staff to delay
workflow planning until they are
in their new space. However, to
ensure a safe and successful tran-
sition, planning for workflow must
occur early, preferably when the
steel is erected, so that major design
problems can be mitigated. De-
laying the workflow planning proc-
ess until staff ‘‘walk’’ their area can
lead to significant cost overruns
from change orders, safety and
licensing issues, and an undermin-
ing of staff confidence and morale.
Colorized floor plans are visual
tools created from the architectural
drawings that allow easy orienta-
tion to the new space and thus pro-
mote the operationalization of the
410 JONA Vol. 38, No. 10 October 2008
Health Facility Design
Copyright @ 2008 Lippincott Williams Wilkins. Unauthorized reproduction of this article is prohibited.

3. design features into new and neces-
sary workflow processes (Figure 2).
Colorization of the drawings en-
hances specific aspects of interest
for committees and individual de-
partments, simplifying their inter-
pretation. The more simplified the
drawings are, the less intimidated
and more engaged staff become.
Using color, staff can easily identify
issues that impact their daily work
lives, such as (a) who their neigh-
bors will be, (b) the location of
essential workspaces (eg, clean util-
ity rooms, medication rooms, etc),
and (c) the location of staff rest-
rooms, lounges, and offices (very
important to the staff). Once they
understand their space, they will be
anxious to participate in planning
the day-to-day operations. Staff
should be involved with the plan-
ning of such things as elevator use;
workflow; unit access for staff,
visitors, and patients; the location
of secured versus public corridors;
waiting areas; and any other areas
where their buy-in is essential.
Managers may hang large
poster-size, colorized floor plans in
their staff areas to engage active
participation of their entire unit and
provide a forum where questions
can be answered and myths dis-
pelled. The end result is effective
and efficient workflow planning.
The floor plans can thus serve as
the master occupancy plan, and
everyone will know where they
are going.
In addition to colorized archi-
tectural drawings, mock-up rooms,
built to actual specifications, allow
staff to orient to their new envi-
ronment of care, test fixtures,
furniture, and equipment and un-
cover logistical problems ahead
of move-in. The realistic room
models are powerful motivating
tools for increasing excitement,
confidence, and participation in
the project on the part of staff and
management.
Advance Use of Technology for
Transition Planning
Furniture, fixtures, and equip-
ment account for a significant
portion of any new-facility bud-
get.3
A database with real-time
Figure 1. Typical architectural drawings.
JONA Vol. 38, No. 10 October 2008 411
Health Facility Design
Copyright @ 2008 Lippincott Williams Wilkins. Unauthorized reproduction of this article is prohibited.

4. data is critically needed to track
and manage the thousands of
pieces of information and logis-
tics related to FFE, including
the procurement, delivery, instal-
lation, sign-off, and hospital-
required checks to ensure room
readiness for licensing/move-in.
Online databases are essential be-
cause the real-time information
is accessible to several different
workgroups whose work evolves
around the input from other
workgroups. For example, a
computer desktop cannot be in-
stalled until the desk is installed,
and the desk cannot be installed
until the flooring is complete. All
the aforementioned tasks are
interdependent, and communica-
tion among the workgroups is
critical.
Online databases facilitate
these activities and ensure timely
communication of room readi-
ness statuses. An online database
that can collect, store, and pro-
cess FFE and room fit-up infor-
mation to and from all members of
the team is an invaluable real-time
resource that improves communi-
cation and decreases confusion and
cost. Online databases can deliver
customized reports, forms, check-
lists, and colorized floor plans that
can illustrate the overall room
readiness or fit-up of a room
and the entire building. In this
way, reporting and communica-
tion are facilitated from the front-
line staff up to the executive
team.
The Scope of Transition
Planning
Creating and implementing a suc-
cessful transition plan requires
focused and sustained attention
to many logistical and operational
details. The transition plan must
address (a) the roles and responsi-
bilities of the transition team mem-
bers, (b) licensing and regulatory
requirements, (c) the development
of a transition budget, (d) move
planning (from substantial comple-
tion through decommissioning),
Figure 2. Colorized floor plans (depicted here for publication with shading and textured fill) of the architectural
drawings from Figure 1.
412 JONA Vol. 38, No. 10 October 2008
Health Facility Design
Copyright @ 2008 Lippincott Williams Wilkins. Unauthorized reproduction of this article is prohibited.

5. and (e) management of change
related specifically to transition.
Each of these topics warrants fur-
ther discussion outside the scope of
this report. However, the transition
plan that starts with a solidly
structured operational approach,
such as the one de scribed above,
will be equipped to manage any
issues that arise throughout the
project.
Summary
Success in transition planning
translates to patient safety, work-
place safety and efficiency, and
adherence to time and budget
allocations. Whether transition-
ing a unit or an entire hospital
into a new facility, a concerted,
integrated, and precise plan is
critical to success. Transition
teams must understand and com-
mit to the lengthy process in-
volved. In addition, team members
must motivate staff to accept the
inevitable changes and participate
in making the changes a success-
ful reality. The reward is an in-
frastructure and environment that
better support the health and well-
being of its patients, staff, and
community.
REFERENCES
1. Stichler J. Leadership roles for nurses
in healthcare design. J Nurs Adm.
2007;37(12):527-530.
2. Wilson MN, Hejna WJ, Hosking JE.
Activation and operational planning:
ensuring a successful transition. J
Healthc Manag. 2004;49(6):358-362.
3. Stichler J. Calculating the cost of a
healthcare project. J Nurs Adm. 2008;
38(2):53-57.
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JONA Vol. 38, No. 10 October 2008 413
Health Facility Design
Copyright @ 2008 Lippincott Williams Wilkins. Unauthorized reproduction of this article is prohibited.