7.1 Project Setup: Early Capital Planning, Context & Culture, and the EBD Budget
Key Takeaways
- CHD's exam content outline says EBD should be discussed early in the strategic capital planning process and that incorporating it during planning could increase the proposed scope and estimated budget.
- Defining the project's context and culture includes selecting a researcher, benchmarking, understanding current operations through tools such as a Gemba walk, mock-ups, pilot testing, and setting up pre- and post-studies.
- The outline lists EBD cost and value factors for the business plan: schedule time, research costs, first costs of unbudgeted EBD strategies, measurement of multiyear improvements and savings, and accountability to leadership.
- Teams develop a preliminary total project budget to obtain capital funding plus additional funding for EBD strategies and research, while understanding the upper limit on available funds.
- Project metrics should be tied to the organization's business goals and objectives so results can be judged against what leaders set out to achieve.
Project Setup: Early Capital Planning, Context & Culture, and the EBD Budget
EDAC Core Concept: Domain 3 of CHD's current Detailed Content Outline—Project Setup and Predesign—begins before a project has a vision statement or a program. It asks why EBD must enter the strategic capital planning process early, how to define the context and culture of the project, and how the cost and value of an EBD process affect the business plan and preliminary total project budget.
Capital projects are usually defined—scope, schedule, budget—long before architects draw. If evidence-based design is added only after those numbers are fixed, there is no time for research, no money for measurement, and no room for features that cost more up front. Project setup is where that is prevented.
Why EBD Must Start in Strategic Capital Planning
The outline gives five linked reasons and actions:
| Outline Item | Why It Matters |
|---|---|
| Begin discussing EBD for future projects early in strategic capital planning | Scope, schedule, and funding are set early; late additions compete with a fixed budget |
| Educate executive leadership and key stakeholders about research | Leaders who understand the link between design and outcomes are more likely to fund and protect EBD features |
| Recognize that incorporating EBD during planning could increase the proposed scope and estimated budget | Research, measurement, and some interventions add cost that must be planned, not discovered later |
| Establish an interdisciplinary team at conception or before the project starts | Clinical, operational, research, and design input shapes scope before it is locked |
| Incorporate the benefits of using an EBD process into the project business plan | The plan approved by leadership carries the rationale and resources forward |
Defining the Context and Culture of the Project
The outline asks teams to define the context and culture within which the project will be undertaken, and lists practical actions:
| Action | What It Involves | Example |
|---|---|---|
| Integrate the EBD process with the project team | Make evidence tasks part of the team's normal workplan | EBD milestones appear in the master schedule |
| Select or hire a researcher or consultant | Bring research expertise onto the team early | An in-house nurse researcher and an academic partner |
| Benchmark | Compare current performance internally and externally | Fall rates compared across units and with a national database |
| Understand current practices and operations (e.g., a Gemba walk) | Go to where the work happens to observe it directly | Leaders and designers walk a night shift to see supply trips and workarounds |
| Conduct iterative mock-ups, simulations, and evaluations | Test ideas early and repeatedly | Taped floor layouts of two room options |
| Conduct pilot testing | Try an intervention on a small scale before committing | Decentralized supply carts piloted on one existing unit |
| Set up pre- and post-studies | Plan measurement before the change so results can be compared | Baseline noise and sleep data collected before relocation |
A Gemba walk comes from Lean management: gemba is Japanese for "the actual place." Instead of relying on reports, leaders and team members go to the place where care is delivered, observe the process, and ask the people doing the work why things happen the way they do. For EBD, Gemba walks reveal operational realities—distances, interruptions, storage problems—that should shape goals and hypotheses.
Strategic capital plan ──► Team at conception ──► Context & culture defined
│ (benchmark · Gemba walk · pilot · pre-study)
▼
Business plan with EBD costs & value ──► Preliminary total project budget ──► Capital funding decision
How EBD Costs and Value Enter the Business Plan
The outline says the cost and value of an EBD process could directly impact the operational and capital cost calculations of the business plan. It names five factors:
- Scheduling impacts — adequate time during planning and design for research, mock-ups, and stakeholder engagement.
- Research costs — resources, data collection, analysis, and publication.
- Construction first costs — for EBD strategies or interventions that were not in the original budget.
- Measurement of multiyear safety and quality improvements and cost savings — to determine return on investment.
- Accountability to the board and executive team — leaders expect evidence that the investment delivered.
The Preliminary Total Project Budget and the Upper Limit of Funds
The team develops a preliminary total project budget to obtain capital funding and additional funding for EBD strategies and research costs. At the same time, the team must understand the upper limit on available funds. That ceiling is why prioritization, non-negotiables, and business cases for specific interventions matter later (Sections 8.3 and 8.4).
| Budget Element | Examples |
|---|---|
| Base construction and design | Building, systems, fees |
| EBD interventions beyond the base scope | Ceiling lifts, additional daylighting, decentralized supply servers |
| Research and measurement | Researcher time, baseline data collection, POE, publication |
| Process costs | Mock-ups, simulations, pilot tests |
| Contingency | Allowance for changes and value-engineering decisions |
Project Metrics Tied to Business Goals
Finally, the outline asks teams to identify project metrics that support the business goals and objectives. If the organization's goal is workforce stability, a relevant metric is RN turnover or first-year retention; if the goal is safety, falls with injury or hospital-onset infections. Metrics chosen here carry into Step 1 goals, Step 5 hypotheses, and Step 6 baselines.
Exam Watch: High-Yield Traps & Pitfalls
[!WARNING] Trap 1: EBD adds no cost. The outline acknowledges that incorporating EBD during planning could increase scope and budget; the answer is to plan and justify it, not to hide it.
[!WARNING] Trap 2: A Gemba walk is a design review. A Gemba walk observes current work where it happens; it is not a review of drawings.
[!WARNING] Trap 3: Research funding later. Research, measurement, and publication costs belong in the preliminary budget, not in a request after opening.
A project director and two clinical leaders spend an overnight shift on an existing unit, watching how nurses retrieve supplies and asking why workarounds occur. In CHD's exam content outline, this is an example of which project-setup activity?
Why does CHD's exam content outline call for discussing evidence-based design early in the strategic capital planning process?
A team preparing its preliminary total project budget lists base construction, design fees, and contingency. According to the exam content outline, which EBD-related item is most clearly missing?