By Rhonda Malone Wyskiel, RN, MSN, EDAC, LSSGB
Principal
HORD COPLAN MACHT

At the outset of every healthcare project whether we’re responding to an RFP or celebrating a new project award I find myself scanning for something deeper than the scope, budget, or schedule. I’m searching for the problems they are trying to solve, the story behind the performance goals, the alignment to their strategic objectives. What’s not yet visible in the plan but will define success months or years from now?

My lens is grounded in performance improvement, quality, and safety, but it’s also about curiosity: uncovering how a building can truly perform to support a care delivery system. These complex adaptive systems in healthcare are where the intersection of people, process, technology, and space come to life.

Before a line is drawn, I start with questions.

1. What problem are we really trying to solve?
   Every project comes with a rationale; growth, modernizing, improving access/equity, and compliance. But there’s often a deeper operational challenge beneath it that architects and designers may not see. A lens they may not wear. As a clinician it is second nature for me to clarify the project rationale early on and reframe design as a change strategy rather than a capital project.
2. What outcomes will define success and how will we measure them?
   It’s critical to translate aspiration design and improvements into metrics. Reduced staff travel time and distance, improved response times, decreased HAI risk, more efficient patient throughput. All design choices must ladder up to measurable performance goals. That’s where alignment to strategy is so important.
3. Where are the current friction points in the system?
   Before improving flow with design, we have to understand where it breaks down. Observing patient and staff journeys, process and value stream maps, and staff handoffs helps us diagnose the operational “pain points.”
4. How will this project improve safety and high reliability?
   Safety isn’t simply a checklist; it’s a mindset, a way of doing business. The design team’s role is to ensure we embed principles of human factors, visibility, and standardization into every square foot. We have to understand the way care is delivered now and the way it will be done in the future in order to “design out” the unsafe workflows, and “design in” principles of safe design.
5. How can we design for adaptability and learning?
   Performance improvement doesn’t end at occupancy. Spaces should enable teams to adapt, experiment, and measure what works and what does not, supporting continuous improvement and resilience. Learning through post occupancy evaluation supports the mature process improvement tools and approaches which healthcare has utilized for many years.

Each of these questions shapes the way I listen, analyze, and design. They also help align diverse stakeholders’ clinicians, administrators, improvement specialists, and architects around shared performance goals from day one.

In the end, this curious mindset and these early conversations aren’t just about the look of the building and workflows happening on the inside; they’re about creating the target conditions for high quality safe care delivery.

About the Author:

Rhonda brings over two decades of national leadership in patient safety, quality, and performance improvement to healthcare design. At The Johns Hopkins Hospital and the Armstrong Institute for Patient Safety & Quality, she led national collaboratives that achieved landmark reductions in preventable harm across more than 1,700 ICUs worldwide.

Today, Rhonda applies this expertise to the intersection of healthcare operations, safety science, and the built environment. She helps health systems and design teams translate evidence-based practices, human factors, and Lean principles into spaces that promote reliability, efficiency, and safe, high-performing care.

A recognized voice in healthcare innovation, Rhonda has guided organizations through large-scale performance transformations and helped design and implement successful Lean Management Systems. Her leadership also contributed to one hospital’s receipt of the Malcolm Baldrige National Quality Award. Through her work, Rhonda continues to shape how design and safety unite to advance the future of healthcare delivery.