This is the latest in Prime’s series of articles and reports on how the health and care sector can overcome change paralysis in their estates.
In this article, Prime’s Associate Director Kim Barnes uses her experience as the Partnership Manager for Yeovil District Hospital’s strategic estates partnership (SEP) to reveal how to develop a successful long-term estates masterplan which remains relevant to your ever-evolving business and clinical needs.
Within your trust, GP group or as a care provider, the chances are, you know exactly what your biggest estate issues are. But how to solve those intricate, intertwined issues is another question.
With such complexity and when so many previous projects have no doubt stalled, moving ahead can seem unmanageable, impossible even. Central to getting started and moving in the right direction is having a long-term estates masterplan that is both practical and inspiring. Very few healthcare organisations have one in place. A mandated five-year estate strategy prepared for compliance alone, that stays on the shelf, cannot communicate the vision and inspire the necessary action in the face of big capital challenges.
So, how do you develop a compelling masterplan that will trigger the momentum you need to make genuine change happen?
Step 1. Get everyone on board
When you are developing an estates masterplan, it’s an unfortunate truth that everyone involved will have different perspectives on the direction – even if they’re following the same vision! Every organisation is structured differently but ultimately from board members (including the NEDs) to clinical and back-office staff, everyone needs to contribute to and support the estates masterplan, with all their individual ideas and expertise working together. Everyone stands to gain when no one is left behind.
Even that doesn’t go far enough. Yes, the masterplan is for your organisation, but in today’s world of local partnership working the best masterplans, look system-wide and involve the whole community. It might not be easy, and it might not always work, but you have a much better chance of getting buy-in, creating greater value and genuinely collaborating, if wider stakeholders and potential partners are included in the big picture from the outset.
Step 2. Work out how far forward to project
You might need to look 10, 15 or even 30 years into the future. It depends entirely on the scale of your plans. For instance, if your first task is to build a smaller additional facility to create space, this could take one or two years. If you need to completely rebuild a crumbling 1950s hospital and fix high levels of backlog maintenance issues, you will obviously need to look further forward.
Step 3. Write everything down, without getting stuck in the details
Ask the big questions and map out:
- With the vision in mind, how does the estate need to change?
- What staff do you need to deliver that and what working environment do they need?
- What patient and visitor experience do you want to create? What are the milestones along the way?
- Operationally, how does each service operate? And do they work how you want them to?
- What are the commercial opportunities? How can you generate income and make your estate work as hard as it can?
- How does backlog maintenance link to capital spend?
- What are the most critical issues that are causing a problem now?
Step 4. Break it down into bite-sized chunks
A great masterplan does not outline everything in the minutest of detail because as we know the health service is bound to change in the next 20 years to respond to changing needs. The further away you are looking, the more topline you need to be. Beyond the first 10 years, your plan should aim to be full of ideas rather than dotting every i and crossing every t. That’s where organisations get stuck. Just because you can’t see now how you will deliver something that fits the plan, that doesn’t mean it’s not going to be possible in the future.
Ask instead: what are the most practical steps to take now to first to gain momentum? Prioritise.
Step 5. Establish how elements of the masterplan help your organisation, your staff and your patients
To get all stakeholders really involved, you need to know how your plans affect them. Using Yeovil District Hospital as an example – not having sufficient car parking was clearly stressful for patients and visitors, at often what is already a difficult time. But what about for staff? While parking isn’t a critical clinical service, it makes all the difference because stressed patients are harder to care for and ‘do not attends’ skyrocket if people can’t get to appointments, putting pressure on already stretched resources.
Step 6. Get the wider community involved
The NHS is very precious to us all. It’s a part of the fabric of our country. Everyone has an opinion on their local NHS so a genuine conversation about the plan and how it can support future service delivery is vital. A masterplan which connects to community opens a more productive conversation with Local Authority planners, commissioners and NHSI/E.
Step 7. Make masterplanning part of the everyday
Keep the masterplanning conversation alive to ensure you’re heading in the same direction but also to check that day-to-day decision making aligns with the overall plan. Nurture a single plan with your estates team, to avoid waste when refurbishment and maintenance clashes with your masterplan and vice versa. Consider who will be the best guardian of the plan – know it inside out, retain the strategic view and help fund and deliver it with your partners. Don’t be afraid to look outside your organisation for that commitment and expertise.
With a strong masterplan in place, you can now start that first project from which everything else will follow. That momentum is critical. When redeveloping the site at Yeovil, the trust had their masterplan and everyone knew a new car park was critical. But they had been trying to deal with the issue for 20 years so, by now, nobody really believed change was possible. Once that first step was finally completed, stakeholders, NEDs and the local community were excited about what was next and how they could help to enable it, making it faster and easier for the trust to deliver its next masterplan projects.
If you have any questions on how to develop a pragmatic, commercial and inspiring masterplan, do get in touch.