From clinician to campus change manager

Change is notoriously difficult to manage, particularly when the stakes are high. And rarely are the stakes higher than a multi-million-dollar healthcare education building that will serve students and faculty for decades.

The deans and other leaders who oversee the client side of the building process are typically trained as clinicians, not as change managers. As they guide their teams through design exercises for new building projects, they’re likely to encounter conflicting opinions, future uncertainty, budget constraints, and other challenges.

The experience can be a rigorous test of leadership. Here are 12 insights and lessons learned from health education leaders who have successfully navigated the process.

“We like to think that we’re analytical beings, but we’re actually very emotional beings,” says Ken Johnson, D.O., executive dean of the Heritage College of Osteopathic Medicine and chief medical affairs officer, Ohio University. When he began working on his first building project, he observed the anxiety that his colleagues felt about the transformational change on the horizon, and he prioritized gaining design input from them.

“We created a process that engaged as many people as possible and we put out as much information as we could,” he says. “We focused on space: How much space do we need? How will it be used? What will it look like? Anxiety and fear decreased and the excitement and engagement increased because they could start to see it.”

“With any big project, there are people who will agree and disagree,” says Paul Wallach, executive associate dean for educational affairs and institutional improvement at Indiana University’s medical school. “I think it’s helpful to manage that by staying focused on the goal. Sometimes I needed to ask everyone to step back and say, ‘We’re all here together in this meeting. We all agree that we want the best building to serve this crucial purpose. There are things we’ll be able to do and some things that we won’t.’ Most people got it really fast.”

He also stressed the need to acknowledge that change is difficult. “Everybody has at least some issue with changing, so you have to start by expressing why you want to change and understanding why others are reluctant,” he says. “Listen carefully because no one has the monopoly on being right. When you listen to a discussion, you may find that your idea isn’t the best, and you need to be open to that. But also be bold and brave and willing to move forward and do new things.”

Johnson agrees. “When people can understand the purpose behind what we’re trying to do, it helps them on the vision side,” he says. “We kept reminding them that we need this building to offer these experiences to our students, to elevate the medical school and Ohio University, to help patients and the community. When people start understanding that deeper burning why, then they see that we aren’t just building a building. They see what it will help us accomplish.”

“We often design for what we’re comfortable with, but we shouldn’t settle for that,” says Jill Sand, health sciences dean at Southeast Community College in Nebraska, who led the client-side design of a new building that houses 18 specialties. “You really need to push your people to think about how the space will work for students in ten or fifteen years and design something they will grow into. Not only will it be a space that will last longer, but the process of researching and thinking things through will also challenge your teams and create curiosity right now.”

During the concepting phase for the new building, Sand asked teams to develop design recommendations for their areas. If they came to her with essentially the same equipment and layout they already had, she sent them back to the drawing board. “I would say, ‘I’m giving this back to you and you need to improve it in three different ways. It needs to look different; it needs to function differently. If we’re building something that looks like what we already have, why are we building it?’”

Although some goals might seem like a given, it’s still important to enunciate them clearly. “I threw out principles that were the opposite of what I thought would happen, just to test things with people,” Johnson says. “For instance, I said, ‘As healthcare moves forward, how likely do you think it will be non-team-based?’ I said it even though I knew healthcare is increasingly about functioning in teams, leading teams, being a follower on a team, and everybody practicing at the height of their licensure. But I felt like we all needed to explicitly acknowledge that.”

Center your curriculum rather than chasing trends or blindly following accepted norms. “I was constantly told that a simulation control room was absolutely essential, but I think they’re a thing of the past,” Sand says. “We can run our simulations from anywhere, even from home if we need to. Eliminating the control room uses space more effectively, and students can run simulations anytime, not only during scheduled classes. Our setup empowers people to give it a try.”

Wallach agrees that conventional wisdom doesn’t always apply. “We’re building a very large anatomy space in this building, even though that’s not the current trend in most medical education facilities,” he says. “We’re doing it because we have a PhD program in anatomy education, in which we educate the people who will be anatomy faculty at medical schools in the future. It’s a novel program, and we couldn’t envision building a small anatomy space. You have to make sure you’re designing a program that fits your institution’s philosophy, because otherwise there’s a mismatch between building and program.”

That said, it’s still a good idea to understand how other institutions have addressed common design challenges. As a site visitor for an accreditation service, Sand had the opportunity to see a variety of colleges and universities first-hand before the design process began. “I started really thinking about our new building five or six years before we even started the process,” she says. “If I went on a site visit or if a group of us went to a conference, we used it as an opportunity to start forming a picture of what could be possible and what we liked and didn’t like.”

“We named project managers on our side who were analogous to people on the design and construction side,” Johnson says. “That helped us communicate what was really important to us as the process unfolded. We took a high level of ownership over every part of the project, and it was so much better than silos of folks doing their own work. They were talking together and solving problems, and people blended so well that each group was seen as a single team.”

Wallach agrees that professional expertise and the spark of personal connection combine to create outstanding results. “It’s crucial to have solid relationships between content experts in the discipline and the architects, planners, and designers. That chemistry has to be there, and if it’s not, you lose half the fun. It’s very helpful to have terrific architects to inform the discussions.”

If your team is inspired to try something new, it’s a good idea to test it out first. Earlier in his career, Johnson and his team rejected the “sage on a stage” style of lecture hall in favor of a more hands-on environment. “We designed a space that was a model of what we wanted, and for a year we delivered curriculum in that space, which was connected to our more traditional spaces on either side. Faculty could directly observe how it was working and suggest improvements. It helped inform a lot of the initial design and then each of our subsequent building projects built on that concept.”

The tower at Indiana University’s new medical school is designed with entire floors that can convert from office space to research space as needed. Other areas are flexible, too. Referring to the school’s unusually large anatomy space, Wallach says, “Let’s say in a decade someone goes, ‘What were those people thinking? This anatomy lab is triple the size of what we need now!’ They’ll be able to take segments of that lab and partition them out. The entire space has high-capacity HVAC and it’s designed for flexibility, so it could be a different kind of classroom in the future. It could be a different kind of lab.”

To optimize space throughout the new building, consider the times of day different spaces will be used. “One of my goals was to never have any space be ‘dark,’ or underutilized, at any time,” Johnson says. “We did a time use study, which showed us we had two rooms that would never be used at the same time. They were relatively the same size. One was a debriefing space for our standardized patient program, and the other was a wet lab for microbiology and other functions.” Designing one room to serve both functions freed up enough space to incorporate a clinical practice into the building.

After the design process is finished, good leaders help their teams anticipate and plan for problems that could arise during construction. “I do what some call the ‘parade of horribles,’ which is marching out the worst scenarios that could possibly happen,” Johnson says. In one of the first projects he oversaw, tensions were running high as he and his team faced a tight opening deadline. “We thought of all the things that could go wrong and came up with different options and multi-stage management plans for each one. It actually lowered the level of anxiety because we felt more prepared to handle even the worst problems that might arise.”

With so many priorities to accommodate, it can be difficult to know where to begin. But keeping students’ needs top of mind will help ensure that design solutions will unite in a building that stands the test of time.

“I’d encourage newcomers to the building process to start by focusing on the learner: the learner of today, and the learner of a decade from now,” Wallach says. “Think about how they will learn into the future, the content that needs to be shared, and the pedagogical approach. Really think deliberately about those three things and let them help guide the development of what the physical structure looks like in a new medical education facility. They should be linked. When that happens, it’s a real joy.”