Quick Snapshot: Who, Where, and Why

• Which unit(s) are you exploring for a redesign right now? Options: General medicine / med-surg, Observation unit / same-day care, Surgical post-anesthesia care (PACU), Step-down / telemetry, Mixed-use inpatient-observation floor, Other
• How many beds are on the affected floor(s)? Options: < 20 beds, 20–39 beds, 40–59 beds, 60–79 beds, 80+ beds
• What triggered this exploration? (select all that apply) Options: Capacity analysis showing bottlenecks, CNO reported clinical workarounds, Joint Commission concerns, Financial pressure / CFO ROI target, A recent unsafe event, Other
• What is your target timeline for having a design and phased construction plan in place? Options: Immediate (0–2 months), Near-term (3–6 months), This year (6–12 months), Longer term (12+ months), Unsure
• Who will be the primary internal sponsor for this project? Options: Chief Nursing Officer (CNO), VP of Facilities, Chief Financial Officer (CFO), Director of Nursing / Unit Manager, Chief Medical Officer, Other

If You Could Fix One Thing Today, What Would It Be?

• If you could snap your fingers and eliminate one operational pain on this floor today, what is it and why hasn't it been fully addressed?
• Which of the following workarounds occur most often when rooms don’t support observation workflows? Options: Nursing at stations relying on hallway monitoring, Temporary tubing or extension of medical gas, Equipment staged in clinical sight-lines, Patients cohorted in non-standard rooms, Increased patient transfers between units, Other
• How long have those workarounds been in place? Options: Weeks, Months, 1–2 years, 2+ years, Indefinitely / always
• How do these workarounds show up in daily metrics or staff feedback? Give an example (e.g., delayed discharges, near-miss, nursing overtime).
• On a scale of impact, how much do these issues affect patient safety, staff morale, and throughput respectively? Options: High impact, Moderate impact, Low impact, Not sure

Are the Rooms Helping or Hiding Problems?

• How much do your current room layouts actively prevent the workflows your teams need to care for same‑day observation patients? Options: They actively prevent workflows, They constrain workflows but are workable, They do not noticeably impede workflows, Unsure / need assessment
• Which physical constraints cause the biggest clinical compromises? (select all that apply) Options: Poor sight-lines to patient beds, Inadequate medical gas routing or access, Insufficient equipment clearance (IV pumps, monitors), Door swings and circulation that block workflows, Inappropriate finish / infection-control surfaces, Limited visibility from nurse station
• Do you have current floor plans, as-built drawings, or photos we can review? If yes, please list what’s available and any accuracy concerns. Options: As-built floor plans, Record drawings, Photos of rooms, Equipment layout diagrams, None available
• Which room types or configurations consistently create sight-line or monitoring blind spots? Options: Private rooms with full-height partitions, Rooms with large headwall obstructions, Rooms with alcoves for equipment, Double-occupancy rooms, Rooms with external doors in sight-lines, Other
• Tell a recent story where the physical environment forced a clinical workaround — what happened, who was affected, and what was the outcome?

Who Decides — And What Will It Take To Get Them To Say Yes?

• If the CFO could require only one proof-point before signing off, what must the redesign demonstrate? Options: X% throughput increase (select below), Clear evidence of Joint Commission survey readiness, A phased plan that limits disruption, A defensible ROI projection with payback, Peer references and measured outcomes
• Which stakeholders will be required to approve design milestones and final acceptance? (select all that apply) Options: CNO / Nursing Leadership, VP of Facilities / Engineering, CFO / Finance, Infection Prevention, Clinical Engineering, Safety / Risk Management, Other
• How will the CFO evaluate ROI—by revenue capture, reduced LOS, increased discharges per bed, cost avoidance, or other metric? Options: Increased discharges per bed per month, Reduced average length of stay (LOS), Reduced overtime / agency staffing costs, Increased revenue from higher throughput, Other
• What absolute throughput target would the CFO consider a successful project? (If you have a range, please state it.) Options: 10% increase, 15% increase, 17%+ increase, 20%+ increase, Undecided / needs modeling
• Have you used a scoring rubric for selecting design partners before? What criteria and weightings mattered most?

If a 20% Lift Is Real, What Does That Look and Feel Like?

• Imagine discharges per bed per month improved by 15–20%—describe how a typical nursing shift changes in three concrete ways.
• What clinical sight-line or equipment placement requirements are non-negotiable for your nursing leadership? Options: Direct line of sight to patient from nurse station, Headwall access with clear equipment zones, Unobstructed pathways for stretcher transfer, Alarm visibility and audible coverage, Other
• What are your Joint Commission non-negotiables for the physical environment on this unit? (select all that apply) Options: Medical gas accessibility and labeling, Clear emergency egress and wayfinding, Infection-control finishes and cleanability, Adequate lighting and sight-lines, Documentation for phased construction
• How will you define acceptance day 1 post‑installation (what measures and who signs off)? Options: Clinical sign-off (CNO), Facilities sign-off (VP Facilities), Infection Prevention approval, Joint Commission mock audit approval, Throughput baseline achieved
• What measurement cadence and dashboards would you need to feel confident the outcome is achieved (e.g., 30/60/90 days, monthly throughput reports)? Options: 30/60/90 days, Monthly for 6 months, Quarterly for 12 months, Real-time dashboard + monthly summary, Other

What Could Stop This Before It Starts?

• What single risk do you quietly worry will derail this project (budget, approvals, vendor delays, infection-control during construction, or something else)? Options: Budget overruns, Clinical sign-off delays, Vendor / long lead times, Phasing impacts on occupied floors, Unexpected construction scope, Other
• For occupied-floor construction, what is your tolerance for clinical disruption during a phase (select one)? Options: Minimal — no patient moves, Low — limited temporary relocations, Moderate — some moves required, High — willing to relocate beds for speed
• What are your typical vendor lead-time constraints for critical items (e.g., headwalls, patient monitors, millwork)? Options: < 4 weeks, 4–8 weeks, 8–12 weeks, 12+ weeks, Varies widely / unsure
• Do you have pre-approved vendors or procurement rules we must follow? Please list constraints or preferred sources. Options: System pre-approved vendors only, Open procurement with approvals, GPO contracts required, State bidding rules apply, Other
• What contingency plans do you expect in our proposal for material or schedule risks?

What Proof Will Make the CFO and CNO Confident?

• Would measured post-occupancy results from comparable projects (same bed count and scope) be decisive in your selection process? Options: Yes—must have, Helpful but not required, Nice to have, No
• Which types of evidence carry the most weight? (select all that apply) Options: Before/after throughput metrics, Independent Joint Commission mock audit reports, Phased construction documentation samples, Client references from similar hospitals, Photographic evidence of sight-line solutions
• What minimum years of healthcare-specific design experience do you expect from the lead designers? Options: 3–5 years, 6–9 years, 10+ years, Experience level less important than outcomes
• Are there particular hospitals, unit types, or bed counts you’d like us to match when presenting case studies?
• What format of proof is easiest for your procurement/CFO team to accept—detailed ROI model, case study with metrics, or a performance guarantee? Options: Detailed ROI model, Case study with metrics, Performance-based acceptance criteria, Combination, Other

A Small Pilot That Proves Big Things — Where Would You Start?

• If we had to deliver one limited-scope change within 8–12 weeks that would visibly reduce clinical workarounds, what would you choose? Options: Reconfigure nurse sight-lines, Headwall and outlet repositioning, Equipment zone creation and storage solutions, Finish upgrades for infection control, Process + training without construction
• Which floor or cluster of rooms would make the best pilot in terms of representativeness and low risk?
• What minimal acceptance criteria would you set for a pilot to be considered a success? Options: Quantified throughput improvement, Clinical sign-off on workflows, No significant patient safety incidents, Stay within pilot budget, All of the above
• What level of disruption is acceptable for a pilot scope (e.g., overnight closures, weekend work)? Options: Night/weekend work only, Short day closures, Temporary patient relocations allowed, No closures allowed
• Who would attend a pilot review and sign off to greenlight wider rollout? Options: CNO, VP Facilities, CFO, Infection Prevention, Clinical Engineering, Other

Operational Readiness: Who Owns What?

• If governance is weak, projects drift—who in your organization will own project schedule, approvals, and clinical sign-offs? Options: CNO (clinical owner), VP Facilities (operational owner), Project manager from facilities, Co-owned (clinical + facilities), Other
• What cadence of meetings and decision gates do you prefer during design and construction? Options: Weekly design team, Bi-weekly executive updates, Monthly steering committee, Milestone-based only, Other
• Who will be authorized to approve change orders and scope adjustments during construction? Options: VP Facilities, CFO approval required, Designated project manager, Steering committee approval, Other
• What communication channels and file-sharing tools does your team use for rapid reviews (email, SharePoint, GDrive, CMMS, other)? Options: Email + attachments, SharePoint, Google Drive, PM software (Procore, Smartsheet), Other
• Who is responsible for coordinating clinical training and change management post-installation? Options: Nursing education team, Clinical operations, Vendor training teams, Combined ownership, Other

Next Steps: Clear Decisions to Keep Momentum

• If we leave this call without agreeing the next three actions, what will you regret most?
• Which of these next steps should we schedule within the next two weeks? Options: Site visit and measured survey, Stakeholder alignment meeting (CNO, VP Facilities, CFO), Preliminary scope and budget estimate, Mock Joint Commission readiness review, Other
• What budget range should we use for an initial feasibility concept (to avoid wasting time on unrealistic options)? Options: <$250k, $250–500k, $500k–$1M, $1M–$2M, Unsure / need scoping
• What data or artifacts can you share to accelerate our assessment (e.g., discharge logs, throughput reports, floor plans)? Please list what you can provide and an approximate delivery date.
• Are you willing to schedule a 60–90 minute stakeholder alignment workshop with CNO, VP Facilities, and CFO as the formal next step? Options: Yes — schedule now, Yes — needs internal alignment first, Maybe — need more info, No

Tell Us About the Floor You’re Talking About

• Which unit/floor are we mapping (name, service line, and typical census)?
• How many licensed beds are on that floor and how are they typically configured? Options: All private rooms, Mostly private, some semi-private, Mostly semi-private, Open-bay / observation bays, Mixed configurations
• What percent of daily activity on this floor is short-stay observation vs multi-day inpatient (approx)? Options: 0–10%, 11–25%, 26–50%, 51–75%, 76–100%
• Who is the clinical leader we should align with for this unit (CNO, nurse manager, educator) — name and role if available?
• What infrastructure drawings, room data sheets, or photos can you share right away? Options: Floor plans (pdf), Room elevations/photos, Equipment inventories, Medical gas riser info, None available yet

Are You Accepting Risk to Keep Things Running?

• Walk me through one example where a team workaround or shortcut was used to keep throughput moving—what happened?
• How often do those workarounds occur on a typical shift? Options: Multiple times per shift, Once per shift, A few times per week, Rarely
• Who typically authorizes or tolerates those workarounds—frontline staff, charge nurses, or leadership? Options: Frontline staff, Charge nurse, Unit manager, CNO / clinical leadership, Varies
• When a workaround is used, what trade-off does your team make most often (safety, privacy, efficiency, documentation)? Options: Patient safety, Infection-control protocols, Staff efficiency, Patient privacy, Regulatory documentation
• How anxious or concerned does this make your leadership team feel—describe the emotional or reputational impact.

Where the Work Actually Happens — Mapping Day-to-Day Flow

• If I followed a nurse for one hour on this floor, what bottlenecks would I notice first?
• Which tasks consistently force staff to leave sight-lines or unplug monitoring to complete work? Options: Medication prep at non-dedicated stations, Charting away from bedside, Equipment recharging in hallway, Moving patients through doorways with equipment, Other
• How much extra time (minutes) does each workaround add to a typical patient interaction or turnover? Options: <5 minutes, 5–10 minutes, 11–20 minutes, 21+ minutes, Unknown
• Where do supplies, PPE, and clean/dirty workflows break down on this unit?
• Which pieces of equipment or furniture are most frequently moved or re-purposed to make spaces work? Options: Crash cart/portable equipment, Monitors/telemetry, Chairs/rollaway beds, Portable screens/curtains, Other

What Infection-Control Shortcuts Have Become Normal?

• Describe any routine practices you’ve noticed that conflict with your hospital’s infection-control policy.
• How often does the unit require temporary isolation or extra cleaning because room layout prevents proper separation? Options: Daily, Weekly, Monthly, Rarely, Never
• Are there materials, finishes, or furniture on the floor that staff avoid because they’re hard to clean or maintain? Options: Carpet/rugs, Fabric-upholstered furniture, Open shelving, Porous countertops, None noted
• Have any near-miss infection events been traced to layout or equipment placement? If so, how were they documented and addressed?
• If a Joint Commission surveyor audited this unit today, what would make you most nervous?

Throughput Friction — Where Patients Stall and Why

• Which step in the patient journey on this floor shows the largest delay (admit, assessment, procedure, discharge)? Options: Initial assessment, Imaging/procedures, Medication administration, Discharge paperwork/coordination, Bed turnover/cleaning
• Quantify the average turnover time for an observation bed compared to your target (minutes/hours). Options: <30 minutes, 30–60 minutes, 61–120 minutes, 121–240 minutes, >240 minutes, Unknown
• What downstream constraint most often blocks discharge (transport, pharmacy, documentation, family pickup)? Options: Transport, Pharmacy/meds, Physician sign-off, Social work/care coordination, Family/ride availability
• How does staff scheduling align with peak arrival and discharge times—do staffing patterns contribute to the bottleneck? Options: Well aligned, Somewhat misaligned, Poorly aligned, Unknown
• Share one recent patient flow failure that cost the unit capacity—what happened and how did you recover?

Who Decides, Who Signs Off, and What Truly Matters?

• Who will make the final decision on a redesign (name and role if known) and how do they score vendor proposals? Options: CNO, VP Facilities, CFO, Clinical Committee, Other
• How will the CFO evaluate the project’s success—what metrics are non-negotiable? Options: % discharge increase, Cost per case, Return on renovation investment, Time-to-discharge, Other
• What Joint Commission physical environment issues are a top priority for your facilities team? Options: Medical gas access, Clear sight-lines, Infection-control finishes, Means of egress/doors, Lighting and power redundancy
• How do you prefer trade-offs to be presented—strict compliance-first options, ROI-first phased options, or both side-by-side? Options: Compliance-first, ROI-first (phased), Both together, Unsure
• Are there internal committees or boards (safety, infection control, finance) that must sign off before construction starts? Options: Yes — list required, No, Some but not all

If Constraints Fell Away — What Would This Unit Be?

• Imagine no budget or phasing limits for a moment—what three changes would you make to maximize throughput and safety?
• Which of those three changes would make the biggest measurable impact in the first 3 months after completion?
• What would an ideal patient sight-line, monitoring, and medical gas layout look like for you—describe or attach a sketch/photo.
• How would your frontline staff describe a successful redesign in one sentence?
• How important is maintaining aesthetic continuity with the rest of the unit versus prioritizing sterile-cleanability and function? Options: Function over aesthetics, Balance is important, Aesthetics are important

What Are Acceptable Phases and Where Are the Red Lines?

• Would you accept a phased construction approach that temporarily reduces capacity to accelerate overall completion? Options: Yes — prefer phased, Yes — only small phases, No — must maintain full capacity, Unsure
• What minimum capacity or number of beds must remain operational during any phase? Options: >90% beds operational, 75–90%, 50–74%, <50%
• Are there absolute 'red-line' items that cannot be changed under any circumstances (e.g., single-patient room policy, certain med-gas locations)? Options: Yes — list required, No, Not sure yet
• What is your maximum acceptable number of consecutive days for construction-related disruption on occupied floors? Options: 1–3 days, 4–7 days, 8–14 days, 15+ days
• Which stakeholders must be informed daily during construction (charge nurse, infection control, facilities, leadership)? Options: Charge nurse, Infection control, Facilities, Clinical leadership, Other

How Much Evidence Do You Need to Move Forward?

• Is post-occupancy data demonstrating throughput gains from similar projects a deciding factor for your CFO? Options: Critical, Important but not decisive, Nice to have, Not necessary
• Which proof points matter most—measured discharge % gains, reduced turnover time, or Joint Commission survey success rates? Options: Discharge % gains, Turnover time reduction, Survey pass history, Staff satisfaction, All of the above
• Would you like anonymized case studies from comparable 300–800 bed hospitals that achieved measurable throughput lift? Options: Yes — send benchmarks, Maybe — at later stage, No
• How risk-averse is your hospital to design innovations that deviate from typical inpatient footprints? Options: Highly risk-averse, Moderately, Open to innovation, Actively seeks innovation
• What documentation or validation would make your facilities team comfortable signing off (mock-ups, sight-line diagrams, simulation results)? Options: Mock-ups, Scenario simulations, Detailed construction phasing, Material samples, Other

Early Priorities — What Would You Like Us to Tackle First?

• Given what we’ve discussed, what’s the one urgent issue you’d want fixed in the first 90 days if possible?
• Which low-cost, high-impact changes would you be willing to authorize quickly (furniture swaps, portable monitoring, storage re-org)? Options: Furniture swaps, Portable monitoring units, Storage reorganization, Temporary partitions, Staff workflow training
• Are there existing vendor contracts or procurement restrictions we should know about that limit material or furniture choices? Options: Yes — list restrictions, No, Unsure
• What timeline would feel realistic to present an initial concept and ROI estimate to your leadership team? Options: 1 week, 2 weeks, 4 weeks, 6+ weeks
• Who should be on a short, cross-functional kickoff call so we can validate facts and next steps? Options: CNO, VP Facilities, CFO, Unit Nurse Manager, Infection Control, Other

Final Check — Uncovering Anything We’ve Missed

• What is one concern you haven’t said out loud yet that could block a project like this?
• If we asked your frontline staff one question about this floor, what should we ask them to get the most honest answer?
• Are there recent incidents, complaints, or survey notes we should review to understand context? Options: Infection control incident, Patient safety event, Regulatory observation, Staff complaint, None
• How would you prefer we deliver our initial findings—short memo, presentation to execs, or a staff workshop? Options: Executive brief (ppt), Detailed memo, Staff workshop/simulation, Interactive CAD walk-through
• Finally, what would make you feel confident that starting a mapping exercise with us was the right next step?

Quick Orientation — Who Are We Working With?

• Which unit(s) are we discussing and what’s the typical bed count per unit? Options: <= 50 beds, 51–150 beds, 151–300 beds, 301–500 beds, 501–800 beds, 800+ beds, Other / multiple
• Who from your organization is already engaged in this conversation? Options: Chief Nursing Officer (CNO), VP Facilities/Engineering, CFO, Infection Prevention/Control, ED Director, Operations/Throughput Lead, Other (please name)
• What triggered you to look at a redesign right now? Options: Capacity analysis showing bottlenecks, CNO clinical concerns / complaints, Joint Commission readiness questions, Throughput decline metrics, Planned renovation window, Other
• Do you have a target timeline for a pilot or initial phase? Options: Immediate (next 1 month), Short (1–3 months), Near (3–6 months), Medium (6–12 months), Flexible/Undecided
• Anything else we should know about your team or timeline right away?

Is the Status Quo Quietly Costing You?

• If nothing changes, how many more patient-days or hours of throughput do you expect to lose each month? Options: <5% of capacity, 5–10%, 10–15%, 15–20%, >20%, Unknown / need help calculating
• How long have the current bottlenecks been affecting your unit’s daily operations? Options: Less than 3 months, 3–6 months, 6–12 months, 1–2 years, Over 2 years
• Tell us about a recent shift where the room layout or process forced a workaround that felt unsafe or inefficient—what happened?
• When those workarounds occur, how do frontline staff typically feel or respond? Options: Frustrated and burned out, Worried about patient safety, Accepting it as normal, Feel powerless to change, Motivated to fix it but lack resources
• What corrective steps have you tried so far and why didn’t they stick? Options: Process training, Temporary equipment changes, Staffing adjustments, Minor layout adjustments, Nothing attempted yet, Other (explain)

Where Exactly Are Patients Getting Stuck?

• Which physical elements on the affected floors most frequently create delays? Options: Room size / footprint, Bed orientation blocking sight-lines, Medical gas access points, Equipment clearance zones, Shared nurse station distance, Handwashing/ante-room placement, Other
• Can you map which specific rooms or zones see the highest delay rates (e.g., rooms 101–112, east wing observation bays)?
• Describe any current infection-control gaps that are tolerated to keep throughput moving—what are they and how often do they occur?
• Are there clinical sight-line or monitoring blind spots that force additional staff checks or equipment workarounds? Options: Yes—multiple locations, Yes—isolated location(s), No, Unsure / need assessment
• Which workflow step—admit, treatment, turnover, discharge—creates the largest time loss today? Options: Admission, Clinical assessment/treatment, Room turnover/cleaning, Discharge processing, Supply/equipment retrieval, Other

What Would Success Actually Feel Like at 2AM on a Busy Day?

• If you could change one thing overnight that would make the clinical team sleep better, what would it be?
• What specific throughput improvement will satisfy your CFO and be considered a win (choose closest)? Options: 5–9% increase, 10–14% increase, 15–20% increase, 20%+ increase, Focus is on stability not %
• Which Joint Commission physical environment criteria do you most worry this redesign must pass without post-construction modifications? Options: Patient sight-lines/visibility, Medical gas access and labeling, Infection-control finishes/cleanability, Clear egress and corridor widths, Accessibility/ADA, Other
• How will you measure clinical satisfaction after implementation—surveys, incident reports, observational audits, or other? Options: Staff satisfaction surveys, Direct observation audits, Incident/near-miss tracking, Throughput KPIs, Focus groups, Other (describe)
• What would a meaningful post-occupancy success story sound like for your CNO?

Which Assumptions Are Steering the Plan (and Which Are Risky)?

• What are the three biggest assumptions you or your leadership are making about this project right now?
• Which constraints are non-negotiable for this redesign? Options: No disruption to adjacent floors, Budget cap (specify below), Maintain current bed count, Pass Joint Commission without remediation, Complete within a specific window
• Do you have a committed capital or operating budget range for design and phased construction? Options: <$250k, $250k–$750k, $750k–$1.5M, $1.5M–$3M, Undecided / needs approval
• Where do you expect the largest procurement or vendor lead-time risk (e.g., built-in casework, specialty monitors, medical gas manifolds)? Options: Casework/millwork, Specialized medical equipment, Medical gas components, Custom finishes/fabrication, Standard furniture, Unsure
• If a long-lead item is delayed, what contingency outcome would be acceptable—pause, temporary workaround, source alternate, or accelerate other phases? Options: Pause until item arrives, Implement temporary clinical workaround, Source an alternate, Re-sequence phases to continue work, Other (specify)

Show Me Where We Can Move the Needle—Design Tradeoffs and Proof Points

• Which outcomes are absolutely non-negotiable in any proposed design (pick all that apply)? Options: Unobstructed sight-lines to patient beds, Accessible medical gas at point of care, Easily cleanable infection-control surfaces, Maintain or increase bed count, Achieve CFO throughput targets, Phased construction with minimal disruption
• Which trade-offs would you be willing to consider to accelerate implementation or lower cost (e.g., modest finish downgrade, temporary equipment staging)? Options: Lower-tier finishes, Phased rather than single-phase, Temporary clinical workflows, Smaller pilot area first, No trade-offs acceptable
• What types of validation would convince the CNO this design will work—scenario walkthroughs, live simulations, clinician-led mockups, or documented case studies? Options: Scenario-based walkthroughs, Clinical simulation with staff, 3D/AR sight-line validation, Case studies with measured throughput, Vendor mockups of equipment clearances
• Which past redesign or vendor relationship gave you confidence, and what specifically made it successful?
• If we provided a guaranteed throughput uplift backed by acceptance criteria, what acceptance test would you require before final payment? Options: Phased throughput measurement after each phase, Final post-occupancy throughput audit (30–90 days), Joint Commission pre-survey checklist signoff, Clinician acceptance sign-off checklist, Other (describe)

Governance, Risk, and the Things That Keep You Up at Night

• Who will have final sign-off authority for (a) clinical acceptance, (b) facilities acceptance, and (c) commercial acceptance? Options: CNO, VP Facilities, CFO, Infection Prevention lead, Cross-functional committee, Other (name)
• What standard governance or escalation path do you expect if a construction phase affects clinical operations? Options: Weekly standup with escalation to VP, On-call emergency response team, Pre-agreed pause and remediation plan, Immediate stop-work until resolution, Other
• What penalties or remedies would be acceptable to you if a vendor misses a major milestone that risks occupancy? Options: Liquidated damages, Go-to alternate vendor, Cost-share for expedited shipping, Schedule credit, Collaborative remediation plan
• How comfortable are you with accepting phased occupancy with measurable acceptance criteria after each phase? Options: Very comfortable, Somewhat comfortable, Prefer single final acceptance, Unsure—need guidance
• Describe any prior project governance failures we should avoid—what went wrong and how did it affect operations?

Readiness Check — What Do We Need to Get Started?

• Which of these data and artifacts can you share right away to accelerate discovery? Options: Floor plans / as-builts, Throughput and discharge metrics, Infection prevention reports, Incident/near-miss logs, Medical gas riser diagrams, None available yet
• How soon can you commit to a 1–2 day on-site discovery workshop with clinical leaders? Options: Within 1 week, 1–2 weeks, 3–4 weeks, More than a month, Unsure
• What internal decision criteria will the CFO use to score proposals (rank importance): clinical fit, ROI evidence, Joint Commission track record, phased construction capability, past project references? Options: Clinical fit, ROI evidence, Joint Commission experience, Phased construction docs, Post-occupancy KPIs, Other
• Who should be our primary point of contact for day-to-day coordination, and who will receive executive updates?
• What would a comfortable next step look like to you—an initial proposal, an on-site assessment, or a pilot redesign of a single pod? Options: Initial proposal and scope, On-site assessment/discovery, Pilot redesign of one pod, Proof-of-concept walkthrough, Other

Starting Where You Are — Who's in the Room?

• Which people and roles will actively shape decisions for this unit redesign? Options: Chief Nursing Officer (CNO), VP of Facilities/Operations, Chief Financial Officer (CFO), Nurse Manager/Clinical Lead, Director of Infection Prevention, Procurement/Purchasing, Other (please name)
• How many beds are in the affected floors and what is the current configuration mix (e.g., 1:1 rooms, semi-private, observation bays)?
• Right now, what percent of those beds are used for same-day observation vs multi-day inpatient care? Options: 0–10%, 11–25%, 26–50%, 51–75%, 76–100%
• What are the primary clinical goals for this redesign (pick up to three)? Options: Increase discharges per bed/month, Improve line-of-sight monitoring, Meet Joint Commission readiness, Reduce infection risk, Enable ambulatory procedures, Shorten length of stay, Other
• Do you already have baseline throughput and compliance data we can use (e.g., discharges per bed/month, turnover times, last Joint Commission findings)? If yes, summarize key numbers or attach a source. Options: Yes — metrics attached, Yes — summary below, No — but can obtain, No — unavailable

If We Leave It Alone, What Will Break Next?

• Which single outcome worries you most if throughput and layout issues remain unaddressed—lost revenue, staff burnout, regulatory exposure, patient safety, or something else? Options: Lost revenue/throughput, Staff burnout/retention, Patient safety incidents, Joint Commission citation/failure, Escalating retrofit costs, Other
• How often in the past 6–12 months have layout-related workarounds (e.g., portable monitoring, blocked sight-lines, equipment stored in circulation paths) caused a safety or throughput incident? Options: Weekly or more, Monthly, A few times in 6–12 months, Rarely, Never documented
• Tell us about a recent event where the room layout directly disrupted patient flow or compliance—what happened and what was the impact?
• What would a 15–20% increase in discharges per bed/month mean for your unit—financially, operationally, and for staff morale?
• How long have you been managing these layout/workflow compromises? (e.g., months, years) — and how has the tolerance for them changed over time? Options: Less than 6 months, 6–12 months, 1–3 years, Over 3 years

Which Bottleneck Is Secretly the Worst?

• If you had to name the single biggest physical constraint slowing throughput today, what would it be? Options: Line-of-sight to patient beds, Medical gas access/locations, Equipment clearance zones, Infection-control material gaps, Supply/medication staging areas, Construction/maintenance constraints, Other
• For the constraint you selected, describe a typical scenario where it creates delay or extra steps for staff.
• How much extra time (on average) does that constraint add to a patient turnover or observation episode? Options: Under 5 minutes, 5–15 minutes, 15–30 minutes, More than 30 minutes, Unknown
• Who on your clinical team is most vocal about this problem—and what have they tried so far to workaround it?
• Have you documented infection-control or Joint Commission concerns tied to physical layout (e.g., survey notes, IPC memos)? If yes, please summarize the findings or citation areas. Options: Yes — formal documentation available, Yes — informal notes only, No formal documentation, Unknown

When Have You Seen a Redesign Actually Deliver?

• Think of any redesign—inside or outside your organization—that improved throughput or compliance. What change made the biggest difference?
• Did that project include post-occupancy measurement? If so, what metrics improved and by how much? Options: Yes — throughput metrics and % improvement, Yes — qualitative clinician feedback only, No post-occupancy measurement, Not sure
• What do you believe were the critical success factors in that project (pick all that apply)? Options: Strong clinical leadership buy-in, Phased construction plan, Vendor/contractor coordination, Clear acceptance criteria tied to KPIs, Reliable post-occupancy data collection, Other
• Conversely, if a redesign failed to deliver, what were the top reasons it fell short (budget creep, poor clinician input, missed equipment clearances, change fatigue, other)? Options: Budget overruns, Insufficient clinical validation, Construction disruptions, Late procurement, Unmeasured outcomes, Other
• If you haven't had a successful example, what would give you confidence that a redesign would deliver measurable gains?

What Would 'Win' Actually Feel Like Here?

• Imagine we deliver a design that meets Joint Commission standards and achieves your throughput target—what changes do you expect to see in a typical 24-hour shift?
• Which acceptance criteria matter most to you and your team (select up to three)? Options: Measured % increase in discharges/bed/month, All patient sight-lines verified, Medical gas access validated at bedside, No unplanned construction rework after survey, Clinical staff satisfaction score, Minimal disruption during phased construction
• What ROI threshold will your CFO require to sign off (e.g., payback period, net gain per bed/month)? Please specify numbers if available.
• Beyond KPIs, how should success be communicated internally so operations, clinical teams, and finance all feel confident? Options: Regular post-occupancy reports, Clinician testimonials, Before/after throughput dashboards, Executive summary with financials, On-site validation walks
• If success requires behavior change at the bedside, what supports would help staff adopt new workflows (training, simulation, quick-reference guides, on-floor champions)? Options: Hands-on training/simulations, Digital quick-guides, Unit-based champions, Shadowing during roll-out, Other

What Rules Are We Better Off Questioning?

• Which 'requirements' do you suspect exist because 'we've always done it that way' rather than because of clinical necessity? Options: Fixed furniture locations, Existing medical gas riser placements, Number of sinks/handwashing stations, Door swing directions, Fixed nursing stations, Other
• For any item you flagged, what would be the upside of relaxing or rethinking that constraint?
• Are there hard constraints we must respect (e.g., structural columns, risers, infection-control zoning, budget ceilings)? Please list and prioritize.
• How flexible is your timeline—are you aiming for a target occupancy date (e.g., tied to fiscal year or accreditation)? Options: Fixed date — non-negotiable, Prefer a date but flexible, No fixed date — open to phased approach, Unsure
• What is the maximum practical construction disruption your clinical teams will tolerate on occupied floors (e.g., weekend-only, overnight, day closures, phased single-room closures)? Options: No patient movement, weekend-only work, Overnight/after-hours allowed, Phased single-room closures okay, Partial floor closures acceptable, Unsure

What Will It Take to Move Forward — Now?

• What's the smallest pilot or proof step that would let you evaluate our approach with minimal risk? Options: Mock-up room / sight-line test, One-floor pilot redesign, Equipment clearance verification, Procurement and install timeline test, Joint Commission pre-walk
• Which documents or decisions must be in place before design work can begin (budget approval, clinician sign-off, structural drawings, mechanical riser info)? Options: Budget approval, Clinical leadership sign-off, Architectural/structural drawings, MEP/medical gas riser drawings, Other
• Who will be the day-to-day owner for fast decisions during design and construction, and what is their availability for weekly checkpoints?
• What commercial or governance conditions would make you comfortable signing a phased agreement (e.g., acceptance tied to KPIs, holdback for post-occupancy performance, phased pay schedule)? Options: Performance holdback, Phased payment tied to milestones, Acceptance criteria tied to throughput/JCAHO, Pilot-first contract, Other
• Realistically, when could you make a go/no-go decision on a pilot or scoped redesign—immediately, in a few weeks, or tied to a fiscal milestone? Options: Immediately, Within 2–4 weeks, In 1–3 months, Later this fiscal year, Unsure