Industry Q&A: Phil Giuntoli Healthcare Building Ideas Editor-in-Chief Todd Hutlock speaks with CollinsWoerman Principal Phil Giuntoli, whose knowledge of how decisions are made and how resources are allocated within a healthcare organization provides CollinsWoerman with a distinctive perspective and marked edge. An excerpt of the interview appears in the Spring 2010 issue of Healthcare Building Ideas.
By Todd Hutlock, Editor-in-Chief
The leader of CollinsWoerman's healthcare sector work, Phil Giuntoli has nearly 40 years of experience with programming, designing, and managing complex medical projects, including serving as Director of Capital Project Management and Director of Facilities with Group Health Cooperative of Puget Sound. Giuntoli brings an insider’s perspective and client-oriented focus to his work.
Before joining CollinsWoerman, Giuntoli’s career was already concentrated on healthcare design, including master plans for the Veteran’s Administration in Portland, Oregon; Scott and White Hospital in Temple, Texas; and Children’s Hospital, Southern Baptist Hospitals, and Alton Oschner Foundation, all in New Orleans. Healthcare Building Ideas Editor-in-Chief Todd Hutlock spoke with Giuntoli about his experiences and insights as to the state of the healthcare design and construction industry.
Todd Hutlock: You’ve held multiple positions over the course of your career, which gives you some unique perspectives on the healthcare community. What can you tell us about your experience?
Phil Giuntoli: For the first 13 or 14 years of my career, I was a healthcare medical planner and project designer, and I worked on various scaled projects on the outside, so to speak. I wound up going to Group Health Cooperative, which is the largest-staffed HMO here, and working on projects on the inside for them, working with architects on the outside. This helped me understand two things: one was the real value system and what was really important on the inside healthcare institutions. The other thing was the best ways that architectural firms communicated as I was working with half a dozen or more firms as the client.
Hutlock: What has changed in the industry since your career started?
Giuntoli: What I think has changed is that architects were used to being more dominating in the conversations. Many had an attitude of, “We’re the experts, and we know what to do here—you get out of the way and let us do that.” It’s almost become a total collaboration now. The communication has become much more natural and integrated.
For example, CollinsWoerman does a lot of work with Virginia Mason Medical Center, and Virginia Mason is very invested in the Lean design model. We participate in their processes—with their end users, experts, and facilitators—to come up with idealized functional solutions in a very collaborative model. We’re truly part of their team, not third-party consultants.
Hutlock: Looking back, do you see any value in that old system, or is this new model the way it should have been done all along?
Giuntoli: The value in the old system occurs primarily when you have a somewhat naïve user, someone who’s out of the loop in the healthcare game. For example, we have a lot of rural users who only do a new building every 30 or 40 years. Many of them, because of those circumstances, really don’t have a lot of experience, and that experience can be colored by what they have been doing for the last 40 years on that site in that community. Sometimes, they don’t necessarily have a vision outside of their day-to-day, normal way of doing things. Something more like that old model maybe becomes more valuable in cases like this, because you’re able to bring to the table some angles they might not have considered, some things done at other facilities that may fit their situation, or some references they simply weren’t aware of because of their relative isolation. In some cases, they simply don’t have the wherewithal to know some of those things, through no fault of their own, really.
Hutlock: When did you see this transition start to happen? Was it during a specific period or event?
Giuntoli: It really started with the CRS problem-seeking methodology, which was in the late 1960s or early 1970s. Certainly by the time I started practicing in the early 1970s, there were these intense user-group meetings happening on campus, where end-user information would be solicited and documented in real time. I think in the CRS methodology, they called it “squatter sessions,” and they would take over a room in a facility and meet with all the departments.
So I think it started back during that era, but it definitely has evolved over time and become more sophisticated. It has now finally gotten to the point where it is truly a collaboration, with firms “sharing the pen” to get to the right ideas and the right solutions. And it goes both ways—in the early years, the architect was asking clarifying questions; today, they may be actually offering operational suggestions.
Hutlock: In your experience, do the different players seem comfortable in these new roles?
Giuntoli: There is still certainly the occasional butting of heads because there are certain preconceptions that we have about each other’s roles. For example, if I’m an architect, I’ve never passed a scalpel, so what do I really know about that? There are still some credibility issues that you have to work through in that regard.
There is also still a butting of heads within their own teams. In order to be a fully functional professional, you must carry some opinions, and sometimes those opinions vary over what is the best way to do something. I’ve found that from working with surgeons that they are really great at telling you what happens within five feet of the patient, but outside of that sphere, they’re not really all that aware of what’s going on. But that doesn’t mean they don’t have an opinion on it, and so you’ll have to work through that nonetheless.
Hutlock: With that idea in mind, who are the members of the ideal project team?
Giuntoli: The ideal members can be at any level of an organization, but they have to be broad thinkers and be able to see beyond just their own work. As an example, we’re currently doing a project in which we are involved in the admitting process. So we’ve got people from admitting, which is a very precise activity. These people are very detail-oriented, but not very experimental in the way they think about things moving forward. Ideally, you would find someone who understands all of the technical requirements, but can also imagine doing things differently, more efficiently, and not being trapped by the rules but operating within the rules to find a better solution.
Sometimes, these people are frontline staff who may be the lowest members of the pecking order, but they have a real sense of the process and what is going on around them. The bosses may understand what is going on at a high level in a big-picture way, but can’t make a real contribution to improving the process flow.
Generally speaking, it is a real pleasure to work with people in healthcare because everyone has got a can-do and will-do attitude toward doing good for others. Their communication skills are usually very good, and their values are very positive. In the end, you can be cynical and have that attitude that healthcare is a business just like everything else, but everyone in the field went into it because on some level they wanted to give back to the community.
Hutlock: So who specifically needs to be involved on the architecture and engineering sides to make that perfect team?
Giuntoli: On the design side, the perfect team has an experienced medical planner who understands how to draw information out of clients about how they work and be able to make suggestions for improvement in a positive way. Supporting them, you need people that are technically sound in terms of executing the documents and plans—these are very complex buildings.
From the construction side, having someone with a general construction background providing preconstruction services helping you with cost and constructability in real time is invaluable.
From the user side, you need a decision-making structure, and there needs to be a clear distinction made between input and decision making. Everyone can provide input, but not everyone can or should make a decision on how to proceed. We like to have clarity up front as to how this will be done—through one person, through a committee, or what have you.
We don’t design any project now where we don’t use either a project mapping methodology or a Lean design methodology. All of today’s projects are started with the idea of maximizing patient throughput without compromising patient and staff satisfaction.
