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Healthcare 101: Programming

Faculty James G. Easter, Jr., M. Arch, FAAMA


Principal, Director Planning and Programming, HFR Design, Brentwood, TN

Gary Vance, AIA, ACHA, LEED AP


Senior Director of Facility Planning, BSA LifeStructures, Indianapolis, IN

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

7. Questions and Comments

How and why did Programming evolve?


Programming for healthcare evolved from work completed by E. Todd Wheeler, Willy Pena, CRS and others who recognized a need to organize the project before starting design.

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?

Therefore, the PROGRAMMING MATRIX


(Goals, Facts, Concepts, Needs) (Function, Form, Economy, Time)

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.

Is Programming used only in Healthcare?

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.

Buildings Will Be Different but the Programming

Process is similar for all.

Programming is an iterative (repetitive) process.


(Pre-Design, SD, DD, CD, Bid/Negotiate, Open)

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.

What is Programming in a Traditional Sense?


Programming for architectural projects is a process that permits the building owner(s) to convey their expectations when preparing to build, expand or renovate a building. The programming matrix below illustrates the key attributes of programming (discuss with group key variables with Q/A).
A PROGRAMMING MATRIX FOR HOSPITAL PLANNING
GOALS FUNCTION
Mission Maximum Number Individual Identity Interaction/Privacy Hierarchy Of Values Security Progression Segregation Encounters Efficiency Statistical Data Area Parameters Manpower/Workloads Utilization Trends User Characteristics Community Value of Loss Time/Motion Studies Behavioral Patterns Space Adequacy 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.

FACTS

CONCEPTS

NEEDS

ISSUES

People Activity Relationships

The existing building is obsolete...should be replaced. Can't recruit physicians

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.

The building is in the wrong Location No land available nearby.

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?

Initial Budget Operating Costs Life Cycle

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

Leadership is key Conservative leadership today.

What Is The Statement Of The Problem....Opportunity?

What is Programming in a Traditional Sense?


A PROGRAMMING MATRIX FOR HOSPITAL PLANNING
GOALS FUNCTION
Mission Maximum Number Individual Identity Interaction/Privacy Hierarchy Of Values Security Progression Segregation Encounters Efficiency

FACTS

CONCEPTS

NEEDS

ISSUES

People Activity Relationships

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

Goals Facts Concepts Needs Function Form Economy Time

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

Quality (Cost/SF) Environment and Site Influences On Cost

Major considerations that will ultimately impact building function and design quality.

The building is in the wrong Location No land available nearby.

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?

Initial Budget Operating Costs Life Cycle

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

Issues and Opportunities

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

Leadership is key

Conservative leadership today.

What Is The Statement Of The Problem....Opportunity?

What is Programming in a Traditional Sense?


A PROGRAMMING MATRIX FOR HOSPITAL PLANNING
GOALS FUNCTION
Mission Maximum Number Individual Identity Tocreate Interaction/Privacy amore Hierarchy Of Values Security efficient Progression hospital Segregation Encounters Efficiency Statistical Data Area Parameters Manpower/Workloads Utilization Trends User Characteristics Community Value of Loss Time/Motion Studies Behavioral Patterns Space Adequacy Service Groups Departmental Groups People Groups We prefer Special Activities Priority the Security Planetree Sequential Flow Concept 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.

FACTS

CONCEPTS

NEEDS

ISSUES

People Activity Relationships

The existing building is obsolete...should be replaced. Can't recruit physicians

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

Initial Budget Operating Costs Life Cycle

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

Leadership is key Conservative leadership today.

What Is The Statement Of The Problem....Opportunity?

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.

Architectural Goals and Objectives


Major Categories
Concepts Planetree Concept Environmentally Friendly Administration Comments
Yes, Within ReasonDiscuss This Carefully Color Boards From Initial Samples Common Theme Plus Workbook Yes, See Local Vendors and Artist Committee Study and Select Local Landscape Advisor Begin Site Design With Favorite and Avail Plants (Must Address Buffers and Green Belts Need Some Elevated Room and Clock Tower Design Roofscape along with Key massing Features (Prepare rendering and mass model of building) Begin Sign and Signage Examples (Marjorie) Discuss sing types, exterior lighting and benches, etc. Discuss flooring materials (carpet, tile and maint) Must Layout the Pieces for both hospital and MOB How will the Lake work, be landscaped and maintained Lab, Pharmacy and Open Plan Office Areas Long term ROI is very important (test and bid options) Work with Vendors and Test Options/IP Room Mock Up Must demonstrate ROI and Added Value Show On A/E Documents and Define the Staging/$/Time How many18, 20, 25 and What Type (M/S/OB/SS) (Will the Universal Room Be Universal?) In-house and/or other CQI measures What, When, Where and How MuchBid/Negotiate? Procurement for Medical Equipment (I, II, III) Bulk stores vs. JIT Delivery and LT Holding Needs

A Healing Environment (MD + Nurse + Midwife)

Form

FORM

User Friendly and Efficient Art and Sculpture Landscape Positive Image Signature Building with Clock/Bell Tower Features Wayfinding and signage

Features To Be Included In the Interior Design Phase of Project

Function Local Culture


FUNCTION

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

Set Allowance and Design With Local Parties for Nurseries

Time

TIME

Concept Illustration for CAH Facility


Surgery/Recovery Imaging Suite Laboratory Emergency Department Inpatient PT/Rehabilitation Services Cardiopulmonary/RT Sleep Lab Pharmacy Outpatient Clinical Services Oncology Clinic

IP Bed Pod 22 - 25

Diagnostic and Admin

Dietary/Dining Fast Foods Variety Materials Managment Central Sterile Processing Plant Operations Housekeeping Only (Laundry at Nursing Home) Staff Facilities

OP Clinic

Office + Admin + Education

What is Programming?
Understanding the Healthcare Client First and Foremost

Facts

Goals

Concepts

Needs

Issues

The Needs are fundamental to a successful programming process, for example;


1. 2. 3. 4. What are the space requirements? What are the quality/value factors? What is the total project budget? What is the project schedule:
The Production Schedule The Design Schedule The Construction Schedule The Commissioning and Grand Opening The Post Occupancy Evaluation

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

Time Frames for Each Campus


Years Months
January February March April May June July Aigust September October November

2004 Year One

- Advisoy
Comment Carpman Genesis Agency

Decem

Weeks
EMhc Client Other SSR

Tasks and Actions


First Monday Noted for Each Month

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

0.0 Organize the Project

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

0.3 Establish Reporting and Decision Process

0.0
=====

X (Week of 12th, ideally 19th W/Bed Interviews Only) x (Presentation on January 29th of Findings)

Two Series of Week-Long Interviews for Each of The Three Campuses


30

35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 4 1 29

1.0 Develop Program Planning Assumptions


1.1 Meet with Senior Management 1.2 Clarify Strategic Direction for MFP 1.3 Document "Form Giving Strategies" 1.4 Distribute Q/A and Clinical Data Sets 1.5 Receive and Assimilate Data and Projections 1.6 Finalize Projected Planning Volumes

1.0
A/B/C ( Week of 12th Send Out QA) =====

B
Memorial

C
South

Shoreline

A/B/C (Week of 2nd or 9th QA Back)

2.0 Assess Site, Facility and Infrastructure

o o

2.1 Survey Site 2.2 Architectural Survey 2.3 Engineering and Infrastructure Survey 2.4 Final Report and Composite Plans

2.0 3.0 4.0 5.0

Site A (A/E Start ASAP on Surveys) Site B Site C

X (Composites for Shoreline Due First,


Followed by Memorial, South, etc.)

3.0 Space Projections for Master Plan Zoning

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

3.6 Assess Potential Size of Future Facilities and Buildings

X 3/30 or 3/31 Tests of Concepts W/System


B - Memorial Interviews 4/20 - 4/22)

4.0 Develop Campus Master Facility Plan (MFP)


4.1 Integrate Task 1 - 3 4.2 Prepare Master Zoning Block Study Models 4.3 Conduct User Group Session Number Two 4.5 Conduct Systemwide Planning Retreat

3/25 Houston Team Meeting A - Shoreline Interviews 4/6 - 4/8 Preparation C - South Interviews 5/4 - 5/6

4.4 Evaluate Physical Development and Zoning Options

Prep. For Retreat

5/26 or 5/27 Retreat

4.6 Apply Criteria and Scenarios to MFP Concepts 4.7 Recommend Preferred MFP Plus Options

5.0 Refine FMP and Prepare Capital Budget


5.1 Refine FMP Concepts Review Priorities and Options Schedule and Phasing Per Campus Order of Magnitude Project Budget

4/15 4/29 5/13 (MP Test Dates for A/B/C) Complete FMP Diagrams Complete Retreat Findings

Master Zoning Diagrams and Systemwide Overlay

6/8 OR 6/9 SYSTEMWIDE TEST

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

One Fact Gathering Tool is A Questionnaire


(Just One of Many Illustrations Based on Traditional Programming Process)

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!

Another Fact Gathering Tool is Statistical


(What Are The Historical Work Loads for Key Clinical and Inpatient Care Areas?)
Mercy Hospital
Tiffin, Ohio

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

1999 1826 6832 3.7 18.7 65% 29 24 5

2000 1841 6262 3.4 17.2 65% 26 22 4

2008 1956 7042 3.6 19.3 65% 30 25 5

2009 1964 7070 3.6 19.4 65% 30 25 5

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.

1999 140 580 4.1 1.6 60% 3

2000 143 540 3.8 1.5 60% 2

2008 23 89 3.9 0.2 60% 0

2009 9 34 3.9 0.1 60% 0

Another Fact Gathering Tool is Statistical


(What Are The Historical Work Loads for Key Clinical and Inpatient Care Areas?)
2009 Emergency Exam/Treatment Room Needs (Based on 1% Growth Rate from 2003 Volumes)
Type Room Emergent(Resus/Trau/Card) Urgent Non-Urgent Totals Observation/Clinical Decision Totals with Obsv. Area A Ann Proc 1,789 4,504 9,940 16,233 2,435 18,668 6 61% 365 12.00 80% B C D E F Hours %Visits No.Days Peak Shf Util Per Visit Peak Shf of Oper Hours Factor 2 2 2 61% 68% 69% 365 365 365 12.00 12.00 12.00 60% 65% 65% Calc Rooms 0.83 2.15 4.82 7.80 2.54 10.34 Exist Cons Rooms Recom 3 2 4 9.00 3 12.00 3 2 4 9.00 3 12.00

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

What are the precursors to programming a hospital?


The Architectural Program should be a key aspect of the hospital campus master plan (MP). Previous Web Seminar Sessions have addressed Strategic Planning and Campus Master Planning
(Brief Background Comments Here)

The precursors to programming include:


9 9 9 9 9 9 Owner and User Orientation to Process Establish a Planning and Programming Leadership Committee Completion of a Strategic Plan (Usually by Staff or Consultant) Completion of a Campus Master Plan (MP) By Healthcare Consultant/Architect Completion of Building Gross Program (All Departments Sized Using Various Methods) Formal Approval of the MP and the First Phase Projects to be Programmed

Ideally, the Departments Are Programmed Simultaneous With the MP ProcessBetter Results!
(Often a Fee Issue With Owners)

What is Facility Master Planning (MP)?


1. 2. 3. 4. 5. 6. A full service road map for the hospital system and/or campus. A building study based on mission, vision, strategy and actions. A process that addresses all issues and then decidesto build or not to build. A MP reaches closure through consensus on objectives. A MP includes more health and healthcare information than the traditional program A comprehensive MP includes a program.

Differences between a MP and a Program:


1. Master planning is the road map and quite often the visionary strategy while the program ties down the details suitable to conduct basic A/E design services. A MP will also begin early conceptual design and master zoning of departmental services. The MP might reveal strategies other than construction: Sell the facility. Move to a site. Conduct a feasibility study or a fund raising campaign. Seek a systemwide partner or close due to poor market share. .

What are the basic steps in programming?


1. Situation Assessment:
- Review the Owners MP if they have one - Review the Owners Strategic Plan (SP) if they have one - Survey the Situation with Leadership

2. Goals, Facts, Concepts, Needs:


Move through the matrix beginning with Facts Conduct kick off, site tours and interviews Fact gathering key to process Follow through on departmental discussions (user interface) Organize and document findings

3. Form, Function, Economy, Time:


Measure findings, interview users and test concepts Build consensus based on Facts, Needs and Opportunities Create an atmosphere of trust and business driven direction Focus on mission, vision and service delivery Healthcare = Patient and Family first

4. Issues and Opportunities:


Collaborate with Leadership on major issues Resolve conflicts, key concerns, road blocks Continue consensus oriented process Define actions based on business and service

5. Action Strategies based on the situation:


- Define first phase projects and gain approval to proceed with programming/design - Determine most appropriate team to conduct the work (consultant/archiect/other)

What are the different types of Programs?


1. Basic Architectural Program: The basic program embodies the matrix items defined herein and addresses a specific building and/or building component:
A Replacement Hospital A Renovation Project (Cosmetic Upgrade, Face Lift, etc) A Departmental Expansion (Add Space to Surgery, Imaging, etc) A New Medical Office Building A New Surgery Center

2. Functional Program and Possibly Certificate of Need:


- A Needs Assessment, Functional Narrative and Systems Interface - A Full Service Program With Matrix and Work Loads - A Detailed Operational Plan and Functional Narrative (JCAHO)

3. Master Plan and Building Gross Program:


A Step by Step Campus Master Plan Study Looking at the Departmental Relationships and Master Zoning A Departmental Gross (DGSF) Program A Building Gross (BGSF) Program A MP Budget and Phasing Strategy A MP Site Assessment A Life/Safety or ADA Analysis A JCAHO Statement of Conditions A Systems or Equipment Inventory or Assessment An Interior Design and Image Upgrade (Cosmetic and Wayfinding Face Lift) An Asset Management or Annual Capital Budget Endeavor

4. Other Studies for Comment and Awareness:

Where does one start?


Begin with the clients expectations. Respond to the clients request for information (RFI). Respond to the clients request for proposal (RFP). Respond to governmental requests. Offer insight and guidance. Visit the site if possible (not always permitted). Build on the clients knowledge of process. Submit proposal. Conduct presentation for project. Get selected to conduct work. Finalize agreement letter. Establish work plan. Start process based on agreement letter. Diligently follow the agreed

to steps in process.

Beginning Our Capital Campaign

Whats Important before starting Programming?


1.A site visit and leadership discussion. 2.A project work plan week by week with target dates and deliverables. 3.A review of the campus master plan (if one is available). 4.A review of basic, existing, campus information (history):
JCAHO reviews Life/Safety reviews Department of health surveys User memos, notes, goals and objectives Previous studies, design products, concepts, vision Previous strategic planning efforts Previous business plans for special projects (cancer, children, etc, etc)

5.Establish a Planning Committee made up primarily of the client leadership team:


Chief Exec Officer (CEO), Chief Financial Officer (CFO) Chief Operation Officer (COO), Director of Nursing (DON) Departmental Director or Service Line Manager Chief of Medical Staff and Possibly Board Member Representative Facility Manager and Possibly Director of Planning

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.

What are the suggested

deliverables for a Programming effort?

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)

What are the suggested

deliverables for a Programming effort?

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)

Integrated Planning Process


Facility Facility& & Technology This would Technology
(Capital Assets) (Capital Assets)

Strategy, Strategy,Goals Goals & &Objectives Objectives Feedback


Owner Provided Expertise

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

Financial Financial cycle, but, Feasibility Feasibility

Externally Provided Expertise

Implementation Implementation

A Departmental Space Summary


SPACE PROGRAM SUMMARY Department Name
Beds

Inpatient Care Units


Patient Care Unit, M/S/Observation/Isolation Geropsych Unit

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

Sub Total Inpatient Units

35

21,309

Diagnosis and Treatment


Surgery/Recovery/Clinic (1 OR + 1 Endo + 2 Prep + 4 Rec) Imaging Suite (1 CT + 1 R/F + 1 NM + 1 US + 1 Mammo) Laboratory and Sleep Lab Emergency Department (6 Stations + 1 Seclusion) Physical Therapy/Rehabilitation Services Cardiopulmonary/Respiratory Therapy Pharmacy OP Clinic 5,185 7,064 1,976 4,440 1,379 684 1,026 2,337 Must Have Clinic Adjacent Due to Staffing Add In House MRI If Cost Justifiable/Mobile Initiall

Some CP in Imaging Area (Discuss Later)

Sub Total D/T Services

24,091

Support Services

Dietary/Dining Materials Management Central Sterile Processing Plant Operations And Security Housekeeping/Linen Staff Facilities

Sub Total General Support

Administrative and Public

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

Stroudwater 356+192SF (Laundry/Hkg)

7,781

429 1,339 Incl. Above 256 474 1,586 1,423 524 762 1,110 1,453 402 160 207

Emergency and Acute Care Patients (80% from ER)

Locate Near Main Lobby Entry/Shared By Public

Locate Near Emergency Area

Sub Total Administrative and Public Spaces

10,124

TOTAL DEPARTMENTAL GROSS AREA


Central Power Plant Air Handling Rooms/Penthouses Building Support Plus Primary Circulation @ 10% BGSF Grossing Factor of 1.2

63,305
1,500 500 6,331
Incl Above

TOTAL BUILDING GROSS AREA REQUIRED

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

Hold For Future Consideration As Needed

TOTAL DEPARTMENTAL GROSS AREA

13,958

Note: Programmed spaces are based on current HHS criteria. If using existing spaces may be less square footage due to "grandfathering".

Linked to DGSF Summary

An Illustrative Budget Summary

Replacement Project Budget Illustration


Preliminary Order of Magnitude PROJECT BUDGET First Test for Discussion ANALYSIS

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

Need Estimator Review Hospital Only W/O MOB

71,636
(Allowance All New ) (Allowance) (Allowance) N/A N/A N/A None Required $1,500,000.00 $0.00

12 - 15 Acres Range of Development (TBD) (Parking, Sewers, Landscape, Misc)

D.

CONSTRUCTION COST (SUM of A-C) Size Linked to Cost Key Factor $19,408,897.00

Requires Architect Verification

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

TOTAL ESTIMATED BUDGET (Line "D" plus "E" - "K")

$29,501,523.44

Site Plan Study With Illustrations

Other Site Plan Studies For Campus Plan

Key Impact Factors


A Case Study to Illustrate Impact of Incorrect Programming

Impact of Incorrect Programming


Assume: Project is programmed 1,000 net square feet short of what is required. Impact 1. Net Square Feet to include Grossing Factors # % for General Circulation Not Within Departments # % for Vertical Circulation and Unassignable Areas # % for Overhangs and Canopies (Usually at ) # % for Interstitial Space (Working MEP Areas) # % for MEP Areas # Gross Square Feet (BGSF) Impact 2. Total Gross Square Feet by Construction Cost Per Square Feet # 1,320 GSF x $250.00 per square feet # $330,000 additional construction cost impact Impact 3. Contingency Impact on Additional Construction Cost # $330,000 x 15% contingency (Typ. at Programming Phase) # $379,500 additional construction cost impact

Impact of Incorrect Programming


Impact 4. Project Development Cost Impact (Soft Costs) # Depending on the type of healthcare project, the percent range is generally accepted as 30%-40% of the construction cost (assume the midpoint of this range) # $379,000 x 1.35 = $512,325 Impact 5. Architectural / Engineering Professional Fee Impact # $330,000 additional construction cost # $330,000 x 7.5% A/E fee (Typ. for Healthcare projects) # $24,750 additional fees based on additional square feet Impact Summary # 1,000 Net SF not programmed correctly may have a $512,325 additional cost impact to the total project cost # 1,000 Net SF not programmed correctly may have a $24,750 additional Architectural / Engineering Fee Impact

Questions and Comments


There are no wrong questions, please feel free to speak up.

Contact:
Jim Easter - jeaster@hfrdesign.com Gary Vance - gvance@bsalifestructures.com

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