What to do before the Architect Comes

 In Articles, Healthcare Architecture, Tips + Advice

The Healthcare Review
Vol. 10, No. 3
March – April, 1997

by Victor Trodella

With the fast-paced changes in healthcare, and the risks of the design and construction process, how does your hospital build or renovate spaces in order to provide the most cost effective care in your community?

Today, facility administrators are under pressure to construct projects much faster and with less margin for error. The traditional approach may have been to hire an architect without first having established a clear definition of your real needs. With the owner, the end-user, and the architect all too eager to move on to the specific plans and proposed drawings, the conceptual development of the project has often been treated as an almost optional step. This approach frequently ends with less than optimum results for your investments of time and money.

The healthcare industry’s growing focus on low cost operations puts new stress on capital resources and the efficient use of space. Under managed care, it will no longer be possible to begin a renovation or a new addition without having evaluated its impact on your strategic plan for the delivery of care. Conformance to your hospital’s strategic vision and facility master plan will become essential to survival and the penetration of your market. A clear understanding of your physical plant, in its supporting role to the strategic vision for healthcare delivery within your community, needs to evolve. As you face a substantially changed model of care, it becomes critical that your physical facility allows a more efficient and cost-effective delivery of that model of care.

In a properly structured planning process, the Conceptual Development Phase of the project is a critical decision-making step that occurs prior to beginning architectural design. Appropriate conceptual development will assure an effective and cost-responsive facility best able to support healthcare delivery for managed care. You must diagnose the problem, determine the goals or objectives, determine the alternative courses of action, analyze the feasibility of each course of action, and then develop the most feasible plan to achieve the most successful solution possible.

Your conceptual development team should include administrative and departmental leadership, staff end-users, and experienced professional consultants; consultants who can translate challenging clinical functions into facility solutions. It is essential for this team to create a focused, intensive process that arrives at solutions quickly. Often the best solutions are arrived at through in-house staff who are challenged by experienced external professionals. The price one pays for that professional leadership is more than worth the investment when the best solutions are found.

An early understanding of what you are willing to spend will facilitate the process, eliminate frustration, and result in proactive planning. In order to balance the “wish list” with the economic reality, you will need to acknowledge the fiscal limitations of your institution and develop a concept for your project that is practical, feasible, and affordable.

Recognize the constancy of change. Efficient programming and flexible planning now often require new approaches to old assumptions about facility planning. The program’s assumptions for space allocation and functional layout need to be tested for optimal efficiency and productivity. This program should be not only a tool for design and estimating but also should be linked closely to the business plan. Increasing demands on available capital as well as changing compensation structures necessitate more efficiency and flexibility in the facilities that deliver these services. Many spaces should be considered to be adaptive space, i.e. space that without significant effort can be converted to other uses in the future. All decisions must be based upon hard data, facts, and figures for space quantities and sizes. Poorly conceived solutions reveal their limitations quickly as healthcare delivery systems evolve and some facilities fall behind.

It is important to recognize the opportunities and limitations of the existing facilities. Coordinate appropriate consultants to establish existing conditions, review code requirements, and select equipment. Make preliminary decisions on major building systems as well as deferred maintenance items. Develop several conceptual design alternatives with cost estimates for the proposed work. The total project budget should include estimated costs for hazardous materials removal, design fees, permits, regulatory approvals, construction, equipment, furnishings, telecommunications, signs, moving, contingencies, and increased staffing requirements.

Conduct in-house reviews by end-users, adjacent and related departments (clinical engineering, infection control, information technology, environmental services, security, etc.). Identify long lead-time items that could affect scheduling, and establish critical schedules for approvals and permits.

Assess the overall feasibility of project with your administration and staff, and decide whether to proceed with the project. Then assemble your project team (administrative and departmental staff, project manager, architect, engineer, professional consultants, and contractors). With a clear definition of your goals, you can now enter the architectural design and construction phases assured that your project is on the right track for success.

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