Q&A with Bruce Raber: Exploring healthcare industry challenges through collaboration

March 23, 2016

Collaboration is key when it comes to designing long-lasting, forward-thinking healthcare infrastructure.


In 2013, The National Institute of Building Sciences (NIBS) established The Academy for Healthcare Infrastructure to bring together leaders in healthcare to address and explore industry challenges through collaboration. Five interdisciplinary groups have since drafted white papers discussing ways to improve the design and construction of healthcare infrastructure and the delivery of care. Stantec’s Sector Leader for Health, Bruce Raber, was asked to be part of Group 1, which focused on the topic, “The Owner’s Organization for Successful Project Outcomes.” Here Bruce shares his experience participating in this innovative initiative.

How did you become involved in this project?
I was asked to participate on an Academy for Healthcare Infrastructure (AHI) research team in early 2015 by Joe Powell, Program Director. The Academy Teams worked on a number of specific goals, like identifying current best practices in a variety of categories; envisioning the future of the healthcare infrastructure industry; engaging appropriate industry leaders to develop new approaches for solving critical problems; and determining how best to efficiently disseminate the findings of the AHI Teams to the industry and publish critical industry performance metrics.

I was the only Canadian that participated in any of the research groups. While the focus was on the US system, my experiences in Canada and work on US and international facilities proved to be beneficial.

Why did you decide participate in this specific research topic?
Actually, I had a choice on the subject – but this area was the one I was most interested in and where I felt I could make the greatest contribution. I knew our facilitator, Kirk Hamilton, Associate Professor of Architecture at Texas A&M University, and it was just a good fit. It was also a great opportunity. Some of the people in our group represented the brightest brains and most influential healthcare players in North America. The owners (referred to as Health Care Authorities in Canada) are responsible for dramatic innovations in creating, managing, and re-purposing healthcare infrastructure. I felt my perspective and experience would be most valued here. Our white paper identified 12 key principles for how owners need to structure their teams for a project’s success:

  1. Vision on the part of the owner is shared
  2. Clear, documented project objectives
  3. Qualified, experienced staff
  4. A stable of pre-qualified consultants and contractors
  5. Standards that simplify decisions and do not stifle innovation
  6. Hierarchical command structure for the team
  7. Timely, effective communication is crucial
  8. Constant attention to cost and schedule control
  9. Everyone in the same room
  10. Everyone needs to have skin in the game
  11. Personal relationships
  12. Trust is key!

What role does infrastructure play in delivery of care?
The design and construction of healthcare infrastructure takes time. We don’t see a new hospital built every year. It’s a large investment for a facility that will be operating for decades. This means that when you work on a project, it’s more than just keeping things on time and on budget.

We have to look to future changes in technology and delivery of care when designing a facility that will serve our communities for generations. We need to ensure that everyone on the project team understands and supports a clear, strategic plan and vision. Some people will resist change.  But people’s needs have changed, technology has changed, and the delivery of care has changed. We need to create environments that are accommodating.

After over 30 years in healthcare, I’ve seen a lot of change. When a project takes between five to ten years to complete, key decision makers on the owner’s side come and go. Without clear goals and objectives – these changes can take your project off course.

Everyone on the project needs to understand the needs of staff, doctors, patients, and the community – everyone who interacts with the facility. We all must work together, as one team. That collaboration, mutual trust, and accountability within the project team creates a facility that puts patients (and staff) first.

How did your experience contribute to the group?
There was a lot of discussion around P3 or alternative delivery for healthcare infrastructure. Owners are intrigued by the opportunity. Healthcare facilities in the US have not yet explored P3 opportunities. I took a lot of questions on the successes and lessons learned here in Canada.

Two recent projects serve as great examples on how Owner’s teams need to set up user and community engagement to lead to success.. While designing the North Island Hospital, we asked for input from families and patients. We engaged First Nations leaders to learn about the special cultural aspects we could incorporate to make the space as accommodating as possible. We transformed the traditional design of the Labour and Delivery room to an environment that welcomes the family and their traditions, who all take part in the birth of the baby.

Specific customs and traditions dealing with birth, healing, and death are all accommodated. For example, gardens with herbs and berries for traditional healing were planted on site to reflect the complement of traditional healing and western medicine.

During design meetings for the Moose Jaw Hospital replacement, we included former patients and family members as part of the clinical user group consultations. We deliberately engaged these groups to get a sense of their experiences interacting with healthcare facilities. We found that there were some discrepancies between clinical staff recommendations and what the patients wanted.

Overall, it was a great opportunity for me to share how Stantec has been involved in improving the design process to create the complex build environments required to support healthcare delivery in our communities.

The full report on Group 1’s findings and recommendations can be found HERE.

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