Author: Sandy Fazaa

By Robins & Morton Division Manager Eric Groat

Whether you call 2022 the “Great Resignation” or the “Great Reshuffle,” team culture has never been more important than it is now, and with good reason.

Finding qualified and committed people at every level is one of the key challenges facing the construction industry as the labor market remains extremely competitive. At the same time, our clients’ continued emphasis on speed to market, set against volatile supply chains, puts even more emphasis on teamwork.

According to a recent study by MIT, a toxic company culture is the strongest predictor of employee attrition and is 10 times more important than compensation when predicting turnover. The study identified toxic cultures by several elements that included lack of diversity, equity and inclusion; disrespect; unethical behavior; and failure to recognize and reward performance.

All those warning signs of a “bad culture” may seem easily identifiable, but are they as easy to spot in our everyday interactions? More importantly, do we recognize them in time to facilitate change within a team?

To answer this question, our first impulse may be to review the lagging indicators first. In the construction industry, these typically include the critical outcomes, such as staying on-target with the schedule, budget, profitability or employee retention. While these are benchmarks of a successful project, they’re not the first signs of trouble within a culture.

Instead, we should be focusing on leading indicators – Is there trust among our team members? Are we engaged in collaborating? How do we handle unethical behavior? Are team members recognized for their contributions and performances?

When we pivot toward proactively identifying indicators of a healthy or toxic culture, we’re able to determine the proper actions to either maintain that culture or reverse the negative changes we see. However, no matter its state, culture requires work.

While every industry and business is different, there are five red flags that I’ve found most universal in identifying the early stages of a toxic culture:

1. Lack of communication. It’s alarming when two people who are on the same team are working from wildly different sets of information or have a completely different understanding of a goal or outcome. It’s a clear signal that there’s a broken link in the management structure, and that the team doesn’t understand their objective. In addition to chaotic and unproductive exchanges, not understanding desired outcomes also stifles innovation, which limits the potential of the project or work product.
2. Lack of decision-making. Decisions fuel all forward progress. Developing a clear structure of decision makers and processes to tackle particularly challenging questions are foundational for a functional working relationship. When we see environments that don’t encourage timely responses to critical decisions, we could pull back the curtain and find dysfunctional relationships with managers, fear of company leadership, and team members who are unclear about the mission of their organization. Although no employee wants to make an error, positive and learning-focused environments recognize that people are fallible and will make errors. Our reaction to those errors directly reflects our culture.
3. Withholding information or support. Not all information is fit for public consumption – whether it’s unconfirmed, too detailed for most, or simply irrelevant – but there’s a difference between filtering and withholding information. Filtering is done with good intentions to provide a team member with the information they need and clarity to complete their task. Withholding information is adversarial, often used as an instrument to influence power dynamics. If a team member begins withholding information, it’s a warning sign that they don’t want to work together to solve a problem.
4. No action taken as a result of feedback. Feedback is a necessity for improving any workplace or team environment. When people place their trust in a team and provide constructive feedback, it can be a vulnerable experience. Another sign of a toxic culture is expecting team members to enter that vulnerable place with no intention of addressing their concerns.
5. No motivation to improve. The final sign of a toxic culture can be summarized into a single word: apathy. If there’s one thing we can be certain of, it’s that we’ll experience change – personally, professionally and often at an exponential pace. Without a motivation to improve, a culture will become stagnant, leading to dissatisfied and frustrated team members.

While some of these signs may sound familiar, the good news is that it’s never too late to course correct. Here are a few tactics that have been successful in my experience:

1. Provide a platform for feedback. Creating a mechanism for feedback is the first step to building trust with your team. Provide several avenues for team feedback such as performance reviews for one-on-one conversations, team health assessments, and companywide people satisfaction surveys. No matter how the feedback is collected, holding ourselves accountable to be transparent about what we received and how we plan to address it is essential to maintaining culture.
2. Get the right people in the room. When working to address cultural problems, we naturally gravitate to having hard conversations with those whom we already have the greatest rapport. While those conversations may serve as a great sounding board, they’re unlikely to result in meaningful change. Only when we engage everyone and commit to healthy conflict among the team members who can initiate changed behavior can we truly expect an improved outcome.
3. Hire and promote emotionally intelligent leaders. People will always be any organization’s greatest resource and having leaders who can navigate interpersonal relationships will make the difference when facing a culture crisis. One way to support this within your teams is to ensure you’re providing growth opportunities, and the only way to know what that may look like for a team member is by getting to know them. Establish a review structure for all team members, ensuring every employee has a structured touchpoint with their manager, at least twice year. There are also specific mentorship programs within the company that can help them reach their professional goals. However, most team trust is built in the day-to-day conversations – it’s why we emphasize the importance of teambuilding activities. All of these elements will help you get to know the strengths of your existing team members, and you can build a strong management structure as a result.
4. See red flags for what they are. It’s easy to categorize a challenging interaction or an undesirable outcome as a one-off, but harder to admit when it may be a sign of a more significant problem. However, we’re better positioned to tackle incremental change than an entire cultural shift. Surfacing an incident before it becomes a long-term issue is a proactive solution to reduce the red flags, one by one.
5. Pursuing partnerships that are culturally aligned with your organization. Business can be a lot like marriage. The phrase “opposites attract” isn’t often the case – two married people may have different hobbies or social batteries, but it’s rare that they have a completely different value systems. It’s a similar quandary in construction, with numerous long-term project partnerships. Inevitably, there will be friction between teams that don’t share collaborative and transparent practices. Projects are at their best when teams share critical values. While every business partnership won’t be a perfect match, prioritizing working with companies that share fundamental cultural characteristics has a greater opportunity for success.

Although there is no one-size-fits-all approach to developing and maintaining culture, its building blocks are grounded in respect for people – respect for your employees, your business partners and your community. Using that as your culture’s guiding principle can assure a successful foundation for your team – no ping-pong table required.

Eric Groat is the Division Manager of Robins & Morton’s San Antonio office. He has more than 20 years of experience managing complex construction projects and is an advocate of Lean construction principles. Groat believes that an emphasis on culture, partnership and respect for people is key to revolutionizing the construction industry.

By Dr. Wayne Ruga, FAIA, FIIDA, Hon. FASID

In our world that is circumscribed by histories, beliefs, and biases – our true heritage – the natural human agency, to express ourselves freely, that we were each born with, gets increasingly constrained as we progress in our development, an inescapable paradox that most of us are blind to. ‘Structure’ – such as norms, rules, and policies – is the insidious and ever-present constraint to ‘agency’, and for many of us, reproducing and producing more limiting structure is what we unknowingly become practitioners of, and rewarded for, rather than drawing upon our own natural agency to liberate ourselves, and those around us, to become more of who we were originally born to be.

At the Seventh Symposium, our Keynote Speaker was Bernie S. Siegel, a surgeon, who encouraged us to examine how this ‘agency-structure paradox’ creates limitations in our ability to achieve greater personal health, deliver more compassionate healthcare, and live our lives in ways that are more fulfilling. The theme of his presentation was captured in a compellingly simple photographic image, that he presented, of how nature is unstoppable in its pursuit to express its agency – even in the face of the most severe limitations of structure.

Dr. Siegel’s image was of a dandelion that had forced its way up through a newly paved and striped urban roadway – a road where the asphalt was still shiny in its newness and the yellow painted center line was, as yet, untrodden by vehicles – and this dandelion was the only natural element in this sterile urban setting, beaming triumphantly in the rays of the sun, having become the brilliant dandelion that it was created to be. Of course, the point of the image was to encourage us to each become like this dandelion.

Anais Nin expressed this same point with breath-taking eloquence, when she said – ‘And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom’. Through these simple words, we can begin to see the fact that we do have a choice – it’s not an easy choice – but it is a choice that is available to each one of us. Do we choose to remain as a bud – constrained by structure, or blossom – as an expression of our natural agency?

Of course, since we all want to choose to blossom – why is it so challenging and difficult? To suggest that it is simply a matter of beliefs is to oversimplify the situation. However, our beliefs are key to what we choose. For example, in The Doctor and the Soul, by Viktor Frankl, we see a dramatic example of how the power of our believing that we have a choice, and making it, can profoundly inform our experience – even in an extreme situation where pain is involved. In Viktor Frankl’s chilling personal account of being tortured, he describes how he chose to be triumphant over his situation, drawing a direct parallel to Dr. Siegel’s brilliantly radiant dandelion image.

Now, in its 35th year, the Symposium has a proud legacy of being a highly fertile field, providing the essential conditions that enable its participants to blossom – the extreme opposite of the newly paved urban roadway or the torturous conditions that Frankl survived. The Symposium is a unique place with an established history of supporting positive beliefs in our ability to improve the world, supporting our choosing to blossom, and actively encouraging our blossoming because of the invigorated agency that our courageous Symposium community supports our access to.

In fact, in support of our belief that we can each improve the world by making better tomorrows – we have compelling evidence that the Symposium accomplishes precisely what Dr. Siegel encouraged us to do: by providing the conditions that support our liberated expressions of agency, the Symposium enables improvements to our personal health, it has championed a more compassionate delivery of healthcare, and has enriched a vast number of human lives. Rather than contributing to the already-too-much-structure, the Symposium supports expressions of agency – bold agency, courageous agency, agency that enables our community of believers-in-better-tomorrows to actually create better tomorrows, day after day, and year after year – in the face of the ever-increasing structure that continuously attempts to constrain our expressions of agency.

As an original creation – unlike anything that existed before it – the Symposium was created to be a community of like-minded individuals. It was intended to be an annual ‘place’ to learn from each other and to share resources. The very name, ‘Symposium’, was carefully chosen to express the value of ‘discussing together’ – the non-hierarchical and inclusive activity that gives its flourishing community an infusion of vitality and a taste of the splendor of openly expressing our uniquely individual agency. As active participants in this experience of ‘discussing together’, we can feel the warmth of acceptance and a valuing of difference.

One of the original hallmarks of the Symposium was its open invitation to all stakeholders in health, healthcare, and design to engage in a new, and very different kind, of collaborative discussion – to provide this new and ever-expanding global community with the opportunity to hear new voices and different perspectives, to learn new ways, as well as for your voice to be heard and appreciated, for you to be seen and recognized, for your ideas to be openly expressed, for your resources to be shared and valued, and for you to learn in ways that open your mind to new possibilities.

The Symposium is a place for YOU to blossom: as an attendee in the 3-day long annual event, with ongoing discussions with Symposium community members between the times of the annual event, through the special relationships that develop through these discussions, and through the positive reinforcement that being in community with like-minded colleagues – those who believe in making better tomorrows – can encourage and support.

As this year’s 2022 Symposium returns ‘home’ to California, the state of its ‘birth’, YOU are invited to return ‘home’ to the fertile conditions of the annual Symposium where you will be encouraged to blossom, and to re-discover being the triumphant active agent that you were born to be. I am looking forward to our further blossoming together in Long Beach, in September.

By Jenni Eschner AIA, EDAC, LEED AP

Telemedicine as a mode of patient care delivery is here to stay. With the $1.5 trillion Consolidated Appropriations Act, 2022, coverage has been extended for telemedicine services, sending a message of support to ensure better healthcare access. Over 80% of surveyed physicians agree that patients have better access to care due to the availability of telemedicine (AMA 2021 Telehealth Survey Report).

Increasing professional satisfaction, telemedicine has allowed providers to find better work-life balance. According to a 2019 survey by American Well there is a correlation between physicians’ interest in using telemedicine and physician burnout. Specialists are among the most burnt out and are also most willing to practice via telemedicine.

Patients like it, too. A Jones Lang LaSalle surveyshows that seventy-six percent of all respondents who have had a telemedicine visit since July 1, 2021 would prefer to use this option in the future. For parents with multiple children, not having to find childcare or not having to take both healthy and sick children in for a clinic visit is a huge satisfier. The ability to do a virtual visit after hours and not have to take time off work for minor illnesses saves precious paid time off.

Architects are asked to help our clients figure out effective and affordable ways to implement this care model. What are best practices when designing telemedicine spaces? It depends on the situation.

Two Scenarios: Care Team Integration

To ensure the continued success of telemedicine, it needs to be integrated into the care team continuum. While technology allows us more mobility and flexibility, it needs to be deliberately planned, tested, and implemented.

Two scenarios need to be considered.

One telemedicine version is where a patient is in-person at a healthcare facility and interacts with care givers at a different location, either on or off site. This might be a visit with their provider and additional care team, such as social workers, pharmacists, psychologists, and other coordinated care. FGI 2018 Guidelines provides requirements for this scenario which include acoustics, lighting, finishes, patient orientation and equipment placement. These will be expanded in the upcoming FGI 2022 version.

The second telemedicine option is when a provider and/or staff interact with a patient and either the patient or both patient and caregiver are remote. According to the AMA 2021 Telehealth Survey Report, 80% of physicians are in a clinic during a virtual visit, while 64% are at home. 95% of patients typically connect from their home setting.

Three Models: The Comparison

There are three programmatic areas architects plan with clients to achieve this integration.

Model 1: Existing Exam Room

This option gives providers the ability to do both virtual and in-person clinical visits within the same work period without having to physically relocate. The same support staff is available to the provider during these visits and the same clinical supplies and tools are also available without duplication. This is a familiar and branded experience for the patient since the visual background they see is the same as during an in-person visit.

There are downsides to using an existing exam room. Renovations may be required to provide the right environment and infrastructure for connectivity. This might mean that additional equipment such as a microphone or camera would need to be added. Using an existing exam room also ties up space that could be used for in-person visits. And our clients are sharing that it can be challenging for providers to switch back and forth between a synchronous virtual visit to an in-person visit. The fact that you don’t need as much physical space for a telemedicine visit also makes this an inefficient option for a healthcare facility from a $/SF standpoint. Along with the size of the room, a virtual visit would not require the same medical equipment/amenities in the existing exam room for telemedicine.

Model 2: Dedicated Telemedicine Room

A dedicated room can be smaller and simpler, so organizations don’t overspend on equipment, millwork, and plumbing. Having these rooms also frees up traditional exam rooms so that more care can be provided at the same time. As with using an existing exam room, the same support staff and supplies are readily available.

What gets omitted from projects when clients can’t afford everything they want? Often, it’s staff support areas. We’ve been riding the prioritization wave of “patients’ needs first” for the past 15+ years in healthcare planning. There is now a shift to a more holistic systems approach, in which the entire life cycle of providing quality healthcare is considered and prioritized. When not in use as telemedicine space, these rooms can flex as multi-purpose use, small meeting, dictation, off-stage or staff respite space.

While simpler and less expensive, in an existing facility there is still the cost of space reallocation and renovation in creating dedicated telemedicine rooms. These rooms are ideally near the provider. In a new project, this can change the planning module of the department and add additional space to the overall footprint.

Model 3: Separated Space/Call Center

The final option we look at with our clients is a separate or off-site facility. This can range on a spectrum of one provider working out of their home to a large call center type of office space. The lower cost of construction and overhead for this space type makes it worth investigating and it (or the provider) can be located anywhere. This is a big advantage for facilities with a limited footprint, as they can prioritize available square feet for higher acuity care.

Another benefit to a physically separated space is that it can more easily adjust to varying volume demand. When rent is cheap and lease terms are short, it is not difficult to relocate. Because of this scalability, healthcare organizations can more easily increase quantities of providers and potentially reach new patients, even outside of a demographic area.

However, expanded access of virtual care to a wider population increases the responsibility of healthcare organizations to ensure their providers’ licenses and credentials are in good standing (“Managing provider licensure amid expanding Telehealth” April 2022). During the Public Health Emergency of COVID-19, all 50 states waived state licensure requirements. Now that most states have reinstated them, healthcare systems that want to use a large call center to reach patients in various states need to monitor that their physicians on staff are licensed in those locations.

The demands of technology on an organization can be a barrier to having off-site virtual visit locations. A healthcare system’s IT department may not be set up to manage the demands that arise, especially when it occurs in a provider’s residence.

Another drawback to a separated virtual visit model is that the support team and resources are not all in the same location. It may not be practical to use a synchronous care team approach (MA + Physician in one visit) from a staffing and scheduling standpoint. This could lead to additional work for staff. There is also the risk of less oversight and accountability.

And finally, patient experience might be diminished if there are too many steps or transitions in the virtual visit process or if it feels disconnected from the healthcare organization. Sure, it is convenient to be able to speak with a physician at 9:00 p.m. while they are in their living room. But doesn’t it feel just a little weird and unprofessional? For this reason, health systems need to work hard on the technology piece to make sure it feels familiar and consistent with the quality of care one would get during an in-person visit.

Takeaways

There is no one-size-fits-all solution for telemedicine. My recommendation is that as stewards of our clients’ buildings, we should “be flexible but stick to [our] principles” (Eleanor Roosevelt). Design spaces so they can adapt to new technologies and uses, but don’t overbuild. Work with your clients to help them figure out what will serve their needs best. If one thing has become clearer over the past couple of years, it’s that we are scrappy and resilient and need to do more with less. And we can!