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Outline
Key Questions Plus Topical Areas:
1. What is Programming? 2. What are the various types of Programming and How are they linked to the hospital Master Plan and Design process? 3. What are the deliverables in the Programming Process? 4. Who is responsible for the Program and how do you prepare to get started? 5. What are the fundamental Programming tools?
Using the Programming Matrix Gathering the Work Loads (Facts) and Making Projections Preparing the Room By Room Space Listing Preparing the Project Budget Preparing the Schedule
6. Programming a Critical Access Hospital (CAH) inpatient care unit, suggestions for getting started.
Research Steps to Follow Illustrations Sample Product and Presentation
Organizing the project also means organizing the client to make decisions in a timely manner.
The key questions will always include, for example;
What, Where, When, How How Many, Why, How Much and When Do We Open The Doors?
To Program Any Facility One Must Understand the Client and The Building Type.
Selection Committee Board of Directors User Groups Services and Departments
Hospitals are complex buildings requiring extensive pre-programming analysis and investigation prior to starting the programming process. Fact gathering is key to successful programming in a healthcare facility.
No.
1. Programming for various buildings should distinguish the speciality aspects of the project type taking into consideration the culture of the community, time, era, place and context. 2. The healthcare project type is distinctly unique from other types of buildings (churches, schools, housing, etc) due to the complexity of the hospital. Hospitals can be compared to planning for a city or a town in many ways. Each departmental area offers a functional challenge. 3. Healthcare can include a myriad of facilities; nursing homes, long term care, acute care, assisted living, supportive living, medical office buildings, ambulatory care centers, cancer care facilities, research labs, etc.
Programming is understanding the client. Programming is about listening and looking. Programming is a road map. Programming is a decision making instrument. Programming is VISION with reality checks. Programming is pre-design. Programming is virtual.
Programming is not a big book on someones shelf. Programming is not static. Programming is not completed in isolation. Programming is not design. Programming is does not always produce a project.
FACTS
CONCEPTS
NEEDS
ISSUES
FORM
Site Environment Quality Site Elements Land Use Property Ownership Neighbors Individuality Direction Access/Egress Image Quality Level Site Analysis Climate Conditions Code Survey Engineering Survey Soils Analysis FAR/GAC Surroundings Physiological/Psychol. Cost/SF Efficiency Enhancement/QA Climate Control New Image/Character Safety Special Foundations Density Interdependence Home Base Network Orientation/Access Quality (Cost/SF) Environment and Site Influences On Cost Major considerations that will ultimately impact building function and design quality.
ECONOMY
Amount Of Funds Return on Investment Cost Effectiveness Operational Cost Capital Costs Maintenance Capital Expenses Life Cycle Reductions Equipment Systems/Energy Automation Cost Parameters Maximum Budget Time-Use Factors Market Analysis Income/Reimbursement Energy Source/Costs Economic Data Competition Activities/Climate Historical Position Credit Rating Cost Controls Allocation Of Resources Multi-Functional Merchandising JV/Investment Energy Conservation Cost/Benefit Design Related Groups Capital Cost Pass Through Project Budget Operational Costs Debt Capacity Life Cycle Costs Energy Costs Loan Capacity Reserves What is the general attitude? related to the initial budget expectations and real project cost and that relationship to project quality standards?
TIME
Past Present Future Preservation Master Plan Static/Dynamic Change Growth Controls/Limits Occupancy Date Revenue Streams Significance Behind/Ahead Space Parameters Activities Projections Linear Schedule Progress Limiting Factors Adaptability Phased/Staged Tailored/Loose Fit Convertibility Expandability Concurrent Schedules Interchangeability Fast Track Escalation Phasing Plan Workplan Implications Of Change, Growth on the overall long-range performance of service
FACTS
CONCEPTS
NEEDS
ISSUES
What are these factors and how do they apply to determine project feasibility?
The existing building is obsolete...should be replaced. Can't recruit physicians Site Analysis Climate Conditions Code Survey Engineering Survey Soils Analysis FAR/GAC Surroundings Physiological/Psychol. Cost/SF Efficiency
Statistical Data Area Parameters Manpower/Workloads Utilization Trends User Characteristics Community Value of Loss Time/Motion Studies Behavioral Patterns Space Adequacy
FORM
Site Environment Quality Site Elements Land Use Property Ownership Neighbors Individuality Direction Access/Egress Image Quality Level
Service Groups Departmental Groups People Groups Special Activities Priority Security Sequential Flow Separated Flow Linkages/Networks Separated Flow Mixed Flow Relationships
Space Requirements Room By Room Equipment Systems/Services Parking Outdoor Spaces Building Efficiency Functional Alternatives
Unique and important Performance standards that will ultimately shape/drive function and Building design.
Enhancement/QA Climate Control New Image/Character Safety Special Foundations Density Interdependence Home Base Network Orientation/Access
Major considerations that will ultimately impact building function and design quality.
ECONOMY
Amount Of Funds Return on Investment Cost Effectiveness Operational Cost Capital Costs Maintenance Capital Expenses Life Cycle Reductions Equipment Systems/Energy Automation Cost Parameters Maximum Budget Time-Use Factors Market Analysis Income/Reimbursement Energy Source/Costs Economic Data Competition Activities/Climate Historical Position Credit Rating Cost Controls Allocation Of Resources Multi-Functional Merchandising JV/Investment Energy Conservation Cost/Benefit Design Related Groups Capital Cost Pass Through Project Budget Operational Costs Debt Capacity Life Cycle Costs Energy Costs Loan Capacity Reserves What is the general attitude? related to the initial budget expectations and real project cost and that relationship to project quality standards?
TIME
Past Present Future Preservation Master Plan Static/Dynamic Change Growth Controls/Limits Occupancy Date Revenue Streams
Significance Behind/Ahead Space Parameters Activities Projections Linear Schedule Progress Limiting Factors
Adaptability Phased/Staged Tailored/Loose Fit Convertibility Expandability Concurrent Schedules Interchangeability Fast Track
Leadership is key
FACTS
CONCEPTS
NEEDS
ISSUES
FORM
Site Environment Quality Site Elements Land Use Property Ownership Neighbors Individuality Direction Access/Egress Image Quality Level Site Zoning Analysis Climate Conditions requires a50 Code Survey Engineering Survey set back with Soils Analysis a5story FAR/GAC Surroundings max.height Physiological/Psychol. Cost/SF Efficiency Enhancement/QA Climate Control New Image/Character Safety Special Foundations Density Interdependence Home Base Network Orientation/Access Quality (Cost/SF) Environment and Site Influences On Cost Major considerations that What doesLEED will ultimately impact gain our building function and design quality. community,
buildingusers
The building in the wrong andis staff? Location No land available nearby.
ECONOMY
Amount Of Funds Return on Investment Weve Cost Effectiveness Operational Cost converted Capital Costs Maintenance toCAH, Capital Expenses nowwe Life Cycle Reductions Equipment mustdown Systems/Energy size Automation Cost Parameters Maximum Budget Time-Use Factors Market Analysis Income/Reimbursement Energy Source/Costs Economic Data Competition Activities/Climate Historical Position Credit Rating Cost Controls Allocation Of Resources Multi-Functional Merchandising JV/Investment Energy Conservation Cost/Benefit Design Related Groups Capital Cost Pass Through Project Budget Operational Costs Debt Capacity The budget Life Cycle Costs is Energy $50Costs Mtotal Loan Capacity projectcost. Reserves
Doesnt itCost What is the general attitude? related the initial budget moreto to achieve expectations and real project the LEED status? cost and that relationship to project quality standards?
Funding?
TIME
Past Present Future Preservation Master Plan Static/Dynamic Change Growth Controls/Limits Occupancy Date Revenue Streams Significance Behind/Ahead Space Parameters Activities Projections Linear Schedule Progress Limiting Factors
UseaCMand
Adaptability prepareearly Phased/Staged release Tailored/Loose Fit Convertibility packageswill Expandability helpus open Concurrent Schedules Interchangeability quicker Fast Track Escalation Phasing Plan Workplan Implications Of Change, Growth on the overall long-range performance of service
What is Programming?
Understanding the Healthcare Client First and Foremost
Facts
Goals
Concepts
Needs
Issues
Gathering the Facts begins with the first RFP, The follow up conversations with the Client, A Site Visit, Gathering Client Information Carefully, Understanding The Assignment, Preparing the Proposal and Submitting the Proposal.
What is Programming?
Understanding the Healthcare Client First and Foremost
Facts
Goals
Concepts
Needs
Issues
In an Evidence Based environment, the Facts become the foundation for the decisions to be made.
Benchmark comparisons
and research also come Into play.
What is Programming?
Understanding the Healthcare Client First and Foremost
Facts
Goals
Concepts
Needs
Issues
In a Certificate of Need (CON) healthcare environment and in most good client relationships the program becomes the justification of need based on work loads, trends, rationale and defendable projections.
What is Programming?
Understanding the Healthcare Client First and Foremost
Facts
Goals
Concepts
Needs
Issues
The Goals are generally developed by the client early in the process and may vary from operational, to systems, to building design. Ideally, the planner/architect gets involved early in the goal setting phase. Programmatic Concepts refer to abstract ideas and Functional solutions linked to performance. Design Concepts refer to physical solutions.
Form
FORM
User Friendly and Efficient Art and Sculpture Landscape Positive Image Signature Building with Clock/Bell Tower Features Wayfinding and signage
Hallways Future Expansion Campus Support Flexible Furniture Casework vs. Millwork Lab and Emergency Equipment Affordability Build in Phases Build New Beds (need ASAP) Best Inspector GMP and Bid Packages Early Purchase for Bulk Items Warehouse Items
and Materials
Economy
ECONOMY
Time
TIME
IP Bed Pod 22 - 25
Dietary/Dining Fast Foods Variety Materials Managment Central Sterile Processing Plant Operations Housekeeping Only (Laundry at Nursing Home) Staff Facilities
OP Clinic
What is Programming?
Understanding the Healthcare Client First and Foremost
Facts
Goals
Concepts
Needs
Issues
Prime Responsibility
Major Responsibility o Supportive Role
Review and Comment Site/Campus A = CHRISTUS Shoreline Site/Campus B = CHRISTUS Memorial Site/Campus C = CHRISTUS South
- Advisoy
Comment Carpman Genesis Agency
Decem
Weeks
EMhc Client Other SSR
1 5
5 2
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 1 5 3 31 5 2
o o
o o o o o o
o o o
0.1 Visit and Tour Each Site 0.2 Confirm Scope and Products 0.4 Assign Responsibilites 0.5 Develop Detailed Schedule 0.6 Conduct Systemwide Kick-Off Meeting 0.7 Address Priority Projects at Shoreline Beds, Classroom and Equipment
0.0
=====
X (Week of 12th, ideally 19th W/Bed Interviews Only) x (Presentation on January 29th of Findings)
35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 4 1 29
1.0
A/B/C ( Week of 12th Send Out QA) =====
B
Memorial
C
South
Shoreline
o o
2.1 Survey Site 2.2 Architectural Survey 2.3 Engineering and Infrastructure Survey 2.4 Final Report and Composite Plans
o -
3.1 Departmental Functional and Environmental Assessment 3.2 Departmental Location/Circulation and Layout 3.3 Calculate Departmental Gross SF (DGSF) Requirements 3.4 Assess Useful Life of Equipment and Buildings 3.5 Conduct User Group Session Number One (A/B/C) 3.7 Test Systemwide Planning Scenarios A - Shoreline Interviews 2/16 - 2/20 B - Memorial Interviews 3/1 - 3/5) C - South Interviews 3/16 - 3/18 - Less Time Required
C
X
3/25 Houston Team Meeting A - Shoreline Interviews 4/6 - 4/8 Preparation C - South Interviews 5/4 - 5/6
4.6 Apply Criteria and Scenarios to MFP Concepts 4.7 Recommend Preferred MFP Plus Options
4/15 4/29 5/13 (MP Test Dates for A/B/C) Complete FMP Diagrams Complete Retreat Findings
5.2 Final Report Preparation 5.3 Final Report Presentation 5.4 Define Priority Action Plan Per Campus Owner Driven Process Based on Findings by Team
FINAL PRES/REPORT
6/22 OR 6/23 OR 6/29 OR 6/30
What is Programming?
Understanding the Healthcare Client First and Foremost
Facts
Goals
Concepts
Needs
Issues
The Issues and Opportunities most often result from unpredictable forces that may not be readily known at the on setthey can be both positive and negative:
1. 2. 3. 4. 5. 6. 7. Political Factors Impacting Leadership Loss of Funds or New Funds Showing Up Loss of Staff or New Staff Being Recruited Government Regulations/New Standards New Technology, New Systems, New Vision Site Selection and Land Use DisastersMan Made and Natural
This is a subtle but effective tool for gathering information electronically long distance and beginning consultant/client dialogue. The user/consultant interface is key to the effectiveness of the process!
PMCU/Medical/Surgical
Projections Based on Linear Trending Historical Data Projected Data 2001 2002 2003 2004 2005 2006 2007 2020 2062 1755 1925 1932 1940 1948 6876 3.4 18.8 65% 29 24 5 7278 3.5 19.9 65% 31 26 5 6361 3.6 17.4 65% 27 23 4 6928 3.6 19.0 65% 29 25 5 6957 3.6 19.1 65% 29 25 5 6985 3.6 19.1 65% 29 25 5 7014 3.6 19.2 65% 30 25 5
Type of Statistic Admissions Patient Days Avg. Length of Stay Avg. Daily Census Target Occupancy Rate Overall Projected Bed Need PMCU Bed Need Med/Surg Bed Need
Notes: 1. ALOS assumed to remain at 3.6 days. 2. Per Mercy email, the distribution is Med/Surg 16% and PMCU 84%.
ICU/CCU
Projections Based on Linear Trending Historical Data 2001 2002 2003 2004 2005 127 105 89 79 65 530 4.2 1.5 60% 2 408 3.9 1.1 60% 2 298 3.3 0.8 60% 1 307 3.9 0.8 60% 1 253 3.9 0.7 60% 1 Projected Data 2006 2007 51 37 198 3.9 0.5 60% 1 144 3.9 0.4 60% 1
Type of Statistic Admissions Patient Days Avg. Length of Stay Avg. Daily Census Target Occupancy Rate Projected Bed Need Notes: 1. ALOS assumed to be 3.9.
Notes: 1. Any dedicated specialty type rooms are added to the above calculations. Examples would be Seclusion/Psychiatric Rooms, Cast Rooms that cannot be used for general exam/treatment, etc. 2. Average Hours Per Visit of 2 Hours for all categories provided by staff.
Summary
Exam/Treat. Positions Trauma - Main Trau/Card/Resusc Bays Exam/Treat - ENT Exam/Treat. - General/Bays Exam/Treat. - GYN Psych Seclusion Room Sub Total Obsv/Treatment Bays Total Rooms w/Obsvervation Existing 1 2 1 4 1 0 9 3 12 Recom 1 2 1 4 1 1 10 3 13 7 Notes 1 2 3 4 5 6
Ideally, the Departments Are Programmed Simultaneous With the MP ProcessBetter Results!
(Often a Fee Issue With Owners)
to steps in process.
6.A Start Up Session With All Directors is helpful and relevant to a consensus oriented programming and planning process
Programming Deliverables
The deliverable products are a function of Owner expectations, fees for service, type of project, time and resources.
From a purely generic perspective, the following might be anticipated deliverables: 1. A Brief Executive Summary 2. A Situation Assessment that embodies, goals, facts, concepts, needs 3. A compilation of existing building plans (site plans, floor plans, elevations, sections, existing DGSF sizes, and other technical data as may be required to fulfill the facts portion of the work up) 4. An environmental assessment that combines an overview of architectural, engineering and building systems (may vary from visual survey to detailed energy audit contingent upon the client situation) 5. An overview of clinical and nursing support systems (EMR, PACs, nurse call, Pyxis, Omnicell, etc, etc) 6. Benchmark comparisons (contextual comparison to industry standards)
7. A summary of user group expectations, goals, facts and concepts (tabulation of electronic surveys with notes from interviews 8. A summary of work loads that define needs vs. wants and wishes 9. Updated as-is drawings illustrating departmental boundaries and present sizes in DGSF format 10. A series of proposed concept drawings (growth and change over time for the area being programmed) 11. A space listing driven by work loads in either DGSF and/or NSF format (discuss illustration herein) 12. A total project budget based on programmatic needs and including all cost variables (discuss illustration herein)
be an planning this isnt always the case for many justifiable reasons (discuss during session).
Facility FacilityConcepts Concepts & &Campus CampusPlans Plans
Test & Refine Alternative Programming and ideal campus master Planning Scenarios
Implementation Implementation
Prop. 25 10
DGSF Prop.
13,958 7,352
Comments
Design to Convert to M/S as Required Over Units Staying Close to 90% Occupied
35
21,309
24,091
Support Services
Dietary/Dining Materials Management Central Sterile Processing Plant Operations And Security Housekeeping/Linen Staff Facilities
Admitting/Outpatient/Registration Administration Nursing Administration Human Resources Information Technology Business Office/Fiscal Services Health Information Management (Medical Records) Medical Staff Services Education/Training/Board Room Outpatient Lobby Main Lobby Volunteer/Gift Shop Vending Religious Functions
The color coding for each service line helps distinguish areas in plan visually..
2,654 2,032 719 911 846 620
7,781
429 1,339 Incl. Above 256 474 1,586 1,423 524 762 1,110 1,453 402 160 207
10,124
63,305
1,500 500 6,331
Incl Above
71,636
A Room-by-Room Listing
(Linked to a Space Summary)
INPATIENT CARE UNIT/ MED-SURG/CCU/PEDS
(19 Privates + 5 Monitored +1 Peds) = 25 Total Beds Space Designation Patient Rm, One Bed Clear Bed Area Fixed Casework, 10LF Couch/Seating Toilet, Pat (WC&Tub/Shwr) Patient Rm, One Bed, Bariatric Clear Bed Area Fixed Casework, 10LF Couch/Seating Toilet, Pat (WC&Tub/Shwr) Nurses Station Comm Sta, Clerk Chart Rack Access (Autoview/Computer) Computer Station Chart Sta, Nurse Charge Nurse Sta (Manager Plus UR/IC/Other) Crash Cart Circulation In Area Doctors Charting Rm Chart Sta/Dictate Sta Chart Rack Access (Autoview/Computer) Medication Room Shelving Units Medication Supplies (UC Refrigerator) IV Fluid Holding/Other Fluids Utility Station w/sink Clean Util/Nour Rm (With Ice Machine) Clean Stor Rm Clean Supply Cart Clean Linen Shelving Supply Shelf Unit, 4 LF Equipment Storage Rm Soiled Utility Rm Contaminated Trash Room No. of Rooms 24 1@ 1@ 1@ 195 SF 20 SF 15 SF 24 1 1@ 1@ 1@ 210 SF 20 SF 15 SF 1 1 1 1 1 3 1 1 @ @ @ @ @ @ = 35 25 25 25 35 15 120 SF SF SF SF SF SF SF 1 4@ 1@ 1 1 1 1 @ @ @ @ 20 SF 10 SF 1 20 20 10 20 SF SF SF SF 1 1 2@ 2@ 1@ 25 SF 20 SF 20 SF 1 1 1 500 95 15 500 95 15 95 110 95 110 Covered Carts 70 70 90 90 60 330 60 330 ADA Position Near Emergency N/S Electronic Medical Record (EMR) (Wire For Future Electronic) 60 245 1440 245 NSF/ Room 230 Total NSF 5520 Comments Same Handed Inboard Toilet/Shower Chart Counter, Wardrobe, Lavatory For family ADA Negative pressure
MedSelect Stations (3 Towers) PACs Viewing Provided Transition to EMR Over Time
A Room-by-Room Listing
(Linked to a Space Summary)
INPATIENT CARE UNIT/ MED-SURG/CCU/PEDS (Cont)
(19 Privates + 5 CCU +1 Peds) = 25 Total Beds Space Designation Staff Conf/Work Rm Seats Box Lockers Coffee Bar Toilet, Staf f(WC&Lav) Office, Case Manager/Shared Public Waiting Alcove Seats Drinking Fountain, HC Telephone Alcove, HC Coffee Bar Waiting/Comfort Room/Family and Guest Toilet, Public (WC&Lav), HC Housekeeping Closet Communications Closet Dept. Net Square Feet Dept. Circulation @ 40% Dept. Walls @ 10% No. of Rooms 1 4@ 30 @ 1@ 15 SF 1 SF 20 SF 1 1 1 8 1 1 1 @ @ @ @ 15 10 10 10 SF SF SF SF 1 1 1 1 150 45 40 120 150 45 40 120 9,305 3,722 931 Bereavement and Consultation ADA; New 30 90 150 30 90 150 NSF/ Room 110 Total NSF 110 Comments Currently Using Patient Room Half Size Purse Lockers
13,958
Note: Programmed spaces are based on current HHS criteria. If using existing spaces may be less square footage due to "grandfathering".
Category of Cost
A. Raw Const Light Demolition New Const Service New Const MOB New Construction Structured Parking B. Fixed HVAC/El Equip C. Site Development/Preparation Site Development/Signage
Area/Unit
0 0 0 71,636
Cost per S
$0 $0 $0 $250
Sub-Total
$0.00 $0.00 $0.00 $17,908,897.00
Remarks
71,636
(Allowance All New ) (Allowance) (Allowance) N/A N/A N/A None Required $1,500,000.00 $0.00
D.
CONSTRUCTION COST (SUM of A-C) Size Linked to Cost Key Factor $19,408,897.00
E. Professional Fees Architect/Engineer Interior Designer CM Cost Allowance CM Fee/Costs F. Furnishings & Furniture G. Moveable/Fixed Equipment Communications Equip. H. Administrative Costs I. Contingency J. Debt. Service On Loan K. Inflation To Mid Point (Assume 6% x D) (Assume 1% xD)) (Assume Fixed Fee) (Assume 03% x D) (Assume 6% x D) (Assume 30% x D) (Assume 2% x D) (Assume 1% x D) (Assume 6% x D) (Separate Budget) (Separate Budget) $1,164,533.82 $194,088.97 $0.00 $0.00 $1,164,533.82 $5,822,669.10 $388,177.94 $194,088.97 $1,164,533.82 $0.00 W/Line A Above For Budgeting Purposes Only Assume 1% for Discussions
Early Estimate For Budgeting Only Some Credit for Existing Items
Permits, Legal and Admin. Support Assumes No Complications At Site By Owner Assume 4 Years (2 Yrs. Inflation) (6% Over 2 Years to Mid Construction Budget For Discussion
$29,501,523.44
Contact:
Jim Easter - jeaster@hfrdesign.com Gary Vance - gvance@bsalifestructures.com