Prelims

The Purpose of this Guide

The opening of a new healthcare facility is a once-in-a-lifetime opportunity for most healthcare leaders. The experience gained from each activation that can be applied to “the next one” is often lost because the focus quickly shifts from the planning and activation of the new space to managing the day-to-day operations. As a result of this rapid shift in activities, healthcare leaders transition to their new priorities and may fail to share the knowledge garnered through Dress Rehearsal. We have gathered our collective experiences and lessons learned to develop best practices for application in healthcare projects. This guide details a clear process to instruct the reader to implement an effective Dress Rehearsal program.

This step-by-step framework can be applied to coordinate a Dress Rehearsal event for a project of any size. The tools and processes are scalable and can be tailored to any patient population and acuity level. New healthcare facility projects are complex and require an experienced team with the skills, knowledge, and expertise to facilitate simulations to prepare staff for Day 1 Activation. We recommend that the leaders of the Dress Rehearsal events have experience in education and training as well as in-depth knowledge of the new facility’s planned operations. An adept team is an integral component of the foundation for an organization’s journey in executing successful Dress Rehearsal events.

Paving a New Path to Activation

In 2009, our team was composed of three consultants, green to the consulting industry, with a passion for healthcare operations. One of our first projects included preparing our client to license and activate a newly acquired 143-bed hospital in 90 days. While we had frontline experience in hospital operations and experience with past healthcare facility activations, the challenge of rapidly preparing for Day 1 Activation was something new to us. We asked ourselves, “How do you open a hospital in 90 days?” and even if we managed to prepare the space for opening, “How would we know the staff was ready to care for patients in the new environment?”

After conducting a literature review of various methodologies, we came across the concept of “Day in the Life” simulations used by the military to prepare for Day 1 Activation of their field hospitals. We thought, “If this works for the military, we can make it work for us!” Blending the concepts of “Day in the Life,” adult learning principles, and the Hospital Incident Command System (HICS),1 we drafted the first iteration of our process to validate the new facility readiness for Day 1 Activation.

Our team’s first “Day in the Life” event involved loosely written, unit-based scenarios, and uncoordinated activities with the clinical ancillary and support teams. Our scenarios included frontline staff’s daily activities with many unplanned “drop-in” emergent situations, simulated lab draws, imaging orders, food delivery, code blue events, and fire drills. We planned for an 8-hour day of scenario sessions. However, the day ended at noon due to the unplanned chaos of running simultaneous scenarios and the failure to account for a process to manage identified issues centrally. Staff members were sent back to their departments to work on the issues identified during the scenarios, and the administrative team began triaging more than 200 documented issues. The IT/IS department collected their issues concurrently using a separate process. Despite the less than stellar launch, the staff was resilient and willing to try again. We ultimately completed eight “Day in the Life” events before Day 1 Activation, with each event becoming more streamlined and effective, and the hospital successfully opened in 90 days.

We concluded that the activation was successful and the staff was prepared to perform their jobs in the new facility; however, we knew there had to be a better way to organize these events. Our team grew, and we continued to ask questions and search for best practices. We discovered that several of our team members who had worked as clinical nurses had moved into new spaces without training or practicing in their new environment. These experiences were traumatic for team members as they were frequently losing their way in the new facility and were unfamiliar with the new locations of essential equipment and supplies required to care for patients. We committed to improving the process for staff moving into new facilities.

The move from one 24-bed unit to a new 24-bed unit may seem operationally insignificant on paper, but the level of change associated with new equipment, supplies, and paths of travel are substantial and often underestimated. When introducing the concept and rationale for conducting Dress Rehearsal events, we relate the experience of working in a new space to cooking in someone else’s kitchen. You know how to cook in your kitchen because of your familiarity with the area and flow. Thus, whipping together a meal is second nature as you do not have to think about the location of supplies or ingredients. However, you might become frustrated in a new kitchen because you do not know where the ingredients or cooking utensils are located or how to use the appliances or equipment.

In a healthcare setting, staff can become frustrated if they cannot find supplies or equipment, especially during an emergency. The situation can quickly become dangerous to the patient or staff. Providing staff with the tools and training required to perform their jobs successfully is critical. Dress Rehearsal supports staff in feeling safe and prepared to care for patients in the new environment.

Our Journey

Having facilitated over 300 events for our client partners to date, our team has grown and has gained tremendous experience since our inaugural “Day in the Life” exercise. The term “Day in the Life” was changed to “Dress Rehearsal” in 2018 to provide a more descriptive and precise definition of the activity. When introducing the Day in the Life concept to a new team, “Dress Rehearsal for Day 1 Activation” was always part of the explanation. With that description, heads would nod and light bulbs would illuminate, so we updated the name to reflect the event more accurately.

Yellow Brick has facilitated Dress Rehearsal events throughout North America in healthcare facilities of all sizes and services, including critical access hospitals, clinics, ambulatory and outpatient facilities, community hospitals, specialty hospitals such as children’s hospitals and behavioral health facilities, and large, academic medical centers. We have conducted lessons-learned sessions and developed best practices that we have shared at national conferences, through webinars, on our blog, and in the article, Using Interdisciplinary Dress Rehearsal Events to Ensure Staff Readiness When Opening a New Healthcare Facility (Aguilera, Dickey, & Guzman, 2019). We continue to lead the industry to establish best practices that we share with our clients and the healthcare community.

In our experience as Transition and Activation Planners, we find that many healthcare leaders do not have the knowledge or internal expertise to lead and manage the Transition and Activation Planning activities required for a new healthcare facility. The transition to a new facility or department is not as simple as switching off the lights in one facility and turning them on in another. Hospitals operate 24 hours per day, 7 days a week, and cannot pause operations or patient care to activate a new facility. The notion that staff will be performing the same job in the new facility and do not need training or Dress Rehearsal simulations in their new space is simply not accurate. There are always unexpected findings and “ah-ha” moments that require additional consideration or training.

One of the most common staff comments during Dress Rehearsal is, “I’m so glad this isn’t Day 1.” Dress Rehearsal events increase staff familiarity with the new space and provide confidence to care for patients in their new environment. We hope you apply our lessons learned and best practices to your healthcare project to support a safe and successful Day 1 Activation, and we wish you the best on your journey.

How to Use this Guide

This guide was developed for use as a resource throughout your Dress Rehearsal journey. Each chapter builds on the previous chapter and should be read in succession. This introduction outlines how to navigate through this guide and make the best use of each chapter.

Margin Assists

The following icons are placed throughout the guide to assist with learning and to reference the content:

	Definition – Explanation of a term or concept
	Key Point – Important concept
	Tool – Aid to organize or manage work
	Sample – Model to help understand the concept
	Principle – Foundation of a system
	High Risk – Hot topics or critical issues
	Reminder – Provides context to the subject

Why this is Important

Capital projects are strategic initiatives that are high-risk and problem-prone due to the various moving pieces and the nature of construction projects. Much consideration goes into the design and construction process and the resources required to manage the process (hard costs). Equal attention and resources are needed for the transition and activation of the building (soft costs). The activation of a new healthcare department or facility presents a unique opportunity to improve the status quo by implementing innovative approaches and best practices. These projects typically cannot stop operations to orient and train everyone to the new facility at the same time. Developing and implementing detailed plans, including a train-the-trainer model for the Dress Rehearsal events, must account for parallel operations with shared staff and contingency plans for high-risk situations in the new facility.

Facilitating a well-planned and organized Dress Rehearsal event promotes staff confidence through increased exposure to the new space. The opportunity to practice new workflow processes, hear new alerts and sounds, and walk new paths of travel supports the learning experience. These activities allow the organization’s leadership team to assess the training program’s effectiveness and identify additional training requirements. This guide provides the framework to coordinate a Dress Rehearsal event in a new healthcare facility.

Dress Rehearsal Framework

The Dress Rehearsal framework uses principles from the Project Management Book of Knowledge (Project Management Institute, 2017), the nursing model “Assess, Plan, Implement, and Evaluate,” and simulation-based training techniques from the Interactive Sociotechnical Analysis (ISTA) model (Harrison & Koppel, 1970). The ISTA model focuses on the interaction between people and technology in a healthcare setting. We have expanded on the ISTA model to include interactions between people and a new environment. Together, these methods have proven to be successful in developing a Dress Rehearsal program that can be scaled to support projects of various sizes. By creating a framework with recommended timelines, resources, tools, and outputs, the owner has a consistent method to manage the process and evaluate progress towards People Readiness for Day 1 Activation.

The framework for the Dress Rehearsal plan was developed based on the following assumptions:

• The responsibility for the leadership and oversight of Dress Rehearsal is commonly delegated to the Chief Clinical/Nursing Officer or the executive responsible for Education and Training.

• The work associated with Dress Rehearsal planning is typically in addition to the already busy schedules and heavy workloads of those identified to support the Dress Rehearsal activities.

• Not all healthcare leaders are trained or skilled in project management or education and training methodologies.

• Champions who participate in the Dress Rehearsal events must be competent in their department operations and should be positive and resilient team members. Seniority is not always a factor.

  • A Champion is an individual selected from their department to participate in the Dress Rehearsal events to enact the scenario, validate planned workflow, and test the new environment, equipment, and systems.

• An easy-to-follow guide with a roadmap, plan, and tools to execute a Dress Rehearsal event is essential.

These assumptions are the basis for creating the framework and the recommendations presented in this guide. They should be considered when determining the overall project approach, a timeline, and the resources required to manage a project.

Transition and Activation Planning: Where Does Dress Rehearsal Fit in the New Facility Project Lifecycle?

Understanding the continuum of a new facility capital project and its lifecycle is essential to understanding the scope and resources required for a Transition and Activation Planning project, including the Dress Rehearsal activities. The traditional architectural and construction phases and their relationship to Transition and Activation Planning activities are highlighted in Fig. 0.1 New Facility Project Lifecycle. The Dress Rehearsal planning activities, including the budget development, occur during the transition planning phase, and the implementation of the Dress Rehearsal events occur during the activation phase.

Opens in a new window.

Fig. 0.1.

New Facility Project Lifecycle.