A conversation with Point B’s Rhonda Skallan

What was your customer’s challenge, and how was it affecting people in their organization?

Our customer is a healthcare network in Oregon that was in the planning stage of two construction projects. Their leadership asked us to review their designs with the future in mind. We found that, while the floorplans looked sound, they also looked like everything else that’s been designed in the last 10 to 15 years. That’s what they were afraid of. They had two projects with two architects and teams, but no overarching design principles to apply as an organization.

On March 2, we facilitated a four-hour session with the CEO, CFO, Chief Strategy Officer and a group of physicians and clinicians to develop some common design principles. Then we looked at the floorplans through the lens of those principles—especially their top three principles of efficiency, flexibility and welcoming. We made some changes and worked with the architects to redesign the existing plans.

The pandemic hit in a big way just as they were submitting revised drawings for permits. The CEO asked us if there was time to reassess the designs given their sudden shift to much more telemedicine and remote work. We looked into it and found they had until the end of May to make changes.

That gave us the opportunity to look at where they were with COVID-19. Within a few weeks, 85 percent of their team members were working from home, and 90 percent of patient appointments were virtual. This was a huge change for everyone—the physicians, the staff, and their patients.

Given this new reality, we began a rapid assessment of what was working and what wasn’t. We encouraged a lot of feedback, and we got it. Based on what we heard, we focused our lens on meeting the patient where the patient is. Do they want to come into a clinic? Or meet at a local community center? Do they us to come to their home? What does the patient want, and how do we meet their needs? Given that, what’s working? What’s not? What do we change, add or delete?  

It’s clear that things are changing across the healthcare industry. How would you describe what’s happening and what it means for the future?

The world of healthcare has been trying to do more telemedicine for last five to seven years. But the going has been slow, partially because the Centers for Medicare and Medicaid Services (CMS) and insurance companies have not paid for it. There were a lot of rules around it. If CMS doesn’t pay, most others won’t pay. When the pandemic drove more healthcare to the virtual world, CMS lifted those restrictions. That is the genie that probably won’t go back into the bottle. As long as there’s no negative impact on outcomes and the remote process is secure and HIPPA-compliant, telemedicine is a change that’s here to stay.

Another big change is how much of the nonclinical staff has moved to working from home. For many years, healthcare has had a big physical footprint that includes HR, billing, accounts receivable and administration. Now most of those employees are working remotely. I’ve heard comments from leadership that productivity is down, but people like working remotely, and they don’t feel their productivity is down. That’s another change that will be hard to come back from, especially as many states will reopen for business in pieces. They’ll be bringing back 50 percent of a workforce or no more than 10 people at a time, while the finance department of a hospital might be 150 people. This “getting back to normal” could take many months. And even then, it won’t be the same. Healthcare organizations will have to change the distance between hundreds of workspaces and adopt whole new cleaning standards. Healthcare organizations have been increasing their workspace density inside their physical footprints for years.  But that maximum density is just not going to float anymore. It’s a big change, without a lot of money to deal with the demand for new and different spaces.

There’s a lot more to rethink. Do you need a 30-person conference room anymore? The size and format of meetings are being reassessed. So are different communication styles—even different kinds of leadership.  It takes a different kind of leader to lead a remote team.

Did Point B discover any challenges related to human-centered change that the customer had been unaware of—or underestimated? Any “aha” moments of discovery?   

We’re about mid-way through this engagement as we speak, and we’re still doing a lot research based on our “aha” discoveries.

For example, do you need waiting room space? That’s been a big question. If so, what does it look like? Do you want to separate healthy people from sick people when they arrive? If so, why have a waiting room? There are no codes around this. You could have patients wait in their cars until you call or beep them, and then escort them directly into an examination room. That was a big “aha:” You can make a really big shift and not waste the space of a waiting room. There are organizations doing this now.

Also, what do you need for telemedicine? Do you want a dedicated space on site for your telemedicine providers, where a multi-disciplinary team can all be in one space and lean on each other, especially as everyone is getting up to speed on the process? Or can providers work remotely? The answer is probably some of both. There are lots of questions. How do healthcare providers build relationships with patients as they move to less in-person contact? How do you get the patient data it takes to have a successful telemedicine appointments? What are the privacy concerns? What kind of camera, lighting and clinical resources do you need?

How did your ability to empathize and understand shape your approach to solving this challenge?

I’ve been working in healthcare design and construction for 20 years. I believe in being curious and asking people to think about things from all perspectives—the patient and family, the physician and the staff. I ask a lot of questions. I wouldn’t call them dumb questions, but because I’m in construction and not a clinician, I can get away with asking things like, “Why is this here? Why do you do it that way?” I try to get people to a place of explaining things to me at a more basic level so they too can take a step back and think out of the box creatively. I love the question: “Is that how you’ve always done it? Why?”

How has your ability to empathize and understand led to results? What were those results?        

I’m very transparent and collaborative. I want everyone to be heard. The CEO we’re working with is great about bringing lots of voices to the table and giving ownership to everyone. She also believes they are stronger together.  

When everyone has a voice, you may talk in circles for a little while, but the circle gets smaller and smaller and you’ll get to an answer that everyone buys into. When everyone on a team feels heard, it creates ownership. People can see the pieces they had a part in, and it creates buy-in and a sense of pride.  

What do you think this customer would have missed if they’d underestimated the human dimension of the challenge—and the solution?

A lot of times in healthcare, the challenge is not only to think of all the people involved—the patients, the physicians, the staff – but to give all of them equal weight. That’s what’s often missing, and that’s where it gets hard.

When you get everyone talking and truly listening, you can get people to see they essentially want the same things. They’re just saying it differently. For example, someone might say they need a quiet place where they can rest. Someone else might say they need a place to make a private phone call. What they’re all saying is that they need a place for self-care. We look for the common denominator and how we can meet the fundamental human need.

If you could leave us with just one key message about the power of human-centered change, what would it be?

Everything needs to center around us as human—the design, the process, the digital. Because that’s really the crux. If we aren’t recognized for our humanness, then everything else is going to fall apart. So, we are always human first.

When you remember to put humans first, you can take on the design piece, the physical piece, and the digital piece—each piece is about our humanness. The decision-making is easier when you know “this is my number one thing,” and all decisions come back to it. It’s your signpost in the ground you always come home to:  How does this affect our humanness? How are we keeping it first in our minds?