Healthcare facilities are about as complex a building type as you can get, making a career in the healthcare planning and design field far from a cakewalk. And market conditions are only complicating matters. Hospitals and health systems are responding to the financial realities of reform (and remaining unknowns tied to the Affordable Care Act), implementing measures to support population health, and trying to figure out what to do with an aging building stock—each priority shaping expectations for new building projects and, more importantly, the project team members delivering them.

Healthcare A/E/C firms are responding to the new climate that’s been created, one where shorter schedules are the norm, collaboration is key, and expertise is a must. Healthcare Design asked healthcare design leaders to shed light on the business side of the industry today—specifically, what challenges are top of mind, from talent acquisition to streamlining project delivery to answering evolving client expectations.

In this special report, we profile not just those challenges identified, but the drivers behind them and the solutions being implemented. Here, Diane Osan, chief executive officer at FKP, discusses her firm’s efforts to tackle client expectations for availability and responsiveness.

Name: Diane Osan
Title: Chief Executive Officer
Firm: FKP Architects (Houston)
Number of employees: 88
Healthcare revenue in 2016: $32.1 million


Business challenge: Client expectations for availability and responsiveness
Clients’ expectations for project team performance, turnaround times, and 24/7 availability is accelerating burnout and stress. This is especially true for designers with young family obligations. I’m deeply concerned about the impact this could have on the health of the profession. In a design world focused on improving health, we are in many ways doing the opposite.

For example, I recently traveled to meet with a client, landing back home at 10 p.m. on a Friday, only to find a text from that client reporting that leadership needed our presentation completely reworked and back to them by 8 a.m. on Monday. I responded, noting that they weren’t giving us even one business day to perform this task and that while we would do what we could, I wasn’t sure of team availability to rework everything and return it in a quality manner by that deadline. Our client said he understood the challenges, but that they had to have it. Not wanting to fail him, we asked our staff to sacrifice time with their families, and they pulled it off—but at the cost of their restoration time. Then they started the new work week already fatigued, which we know produces lower-quality performance. If this was an isolated incident it wouldn’t be disturbing, but it’s now a frequent behavior from many clients who expect us to always be available and responsive.

What’s behind it
Healthcare has always been a 24/7 operation, so hospital leaders are used to having demands placed upon their personal time. However, the U.S. design/construction industry has not, and we can’t consistently expect individuals in a lower-paid profession to take on similar requests.

With the introduction of smartphones and the internet, the ability to reach individuals immediately and get responses instantaneously has set up expectations that are now behavioral demands. This is compounded by societal pressure on providers from all healthcare consumers to lower cost, while improving quality and experience—all the instant we want or need care. These factors are adding pressure to our collective industry mindset to live by “faster, better, cheaper.” Plus, the number of communication streams that we now work in, monitor, and manage is increasing the time we spend on tracking and responding to communication rather than solving design problems and improving the work quality. It’s a vicious cycle that isn’t good for personal or professional health.

The solution
At FKP, we’ve established a culture that helps employees manage rising industry and societal pressures, while creating time for self-care and family life. It’s an embedded value now that includes offerings like flextime, remote work, and protected focus time. With the use of the cloud, our people can work anywhere and anytime to respond to these increased client demands while balancing family and personal needs.

Recently, we’ve begun new approaches with our clients to set and manage communications and turnaround time expectations, as well as place limits on what constitutes “reasonable business hours.” We found through client satisfaction surveys that our clients have a wide range of expectations—sometimes varying within their own group of managers as well as between institutions—around what constitutes highly responsive performance from their design team. Additionally, we saw variance in what communication tools were preferred—phone, text, or email. One client thinks texting should be used only for the most urgent communication, while another uses it for every communication and at all hours of the day and on the weekends. Another client thinks their architect is being responsive if responding to an email within 24 hours, while another expects email replies within 48 to 72 hours but text messages should be answered within 5 to10 minutes.

In response to this, we’re now kicking off projects with important conversations about response levels and communication preferences. We’re also having open and respectful conversations about boundaries—for example, it may be OK with one team member to be contacted anytime, even while on vacation, but another may have dedicated family time between  5 and 9 p.m. and will respond only after the kids are tucked into bed.

We found that having these conversations and setting boundaries up front help support the values we hold around work-life integration. We also tell our staff that it’s OK to remind business partners of these boundaries in order to preserve restoration time. Conversely, we expect employees to understand when there are times that our clients or construction partners require extraordinary effort from us outside routine business hours. Most clients have been respectful and appreciative—for their own work-life balance, too.

Words of wisdom
As a society, we need to unplug more often and recharge to be our best. Don’t be afraid to set reasonable boundaries while being flexible in support of the team mission.