Numerous organizations around the globe are considering building or expanding hospital facilities. Unfortunately, as a first step, they often hire an architectural firm to being drawing, and in the end, the product often reflects a previously designed facility that may not meet the specific needs of the organization. In order to develop an operationally efficient hospital appropriate for the local needs, form must follow function. With healthcare technology and models of care changing so rapidly, the facility organization and functional relationships must also change. Therefore, planning an operationally efficient hospital start with careful attention to operational systems and the associated facility requirements to support projected workload volumes.
The proposed approach to designing an operationally efficient hospital consists of a series of specific, organized activities, detailed in the following text, each of which leads logically to the next step. Using this organized, structured process will ensure that the hospital is designed to reflect the demand for services and the most efficient and applicable operational systems.
- Identification of Hospital Vision
In this initial step, the planning team should define the vision, goals, preliminary scope of services, and the organizational structure for the proposed hospital. Ideally, a healthcare operator should guide the planning team in thinking creatively about the key service lines and the optimal configuration of departments to facilitate efficient operations and patient-centered delivery of care. This regrouping and reconfiguration of services will serve as the foundation for subsequent planning activities.
- Conducting Market Analysis and Develop Financial Feasibility Model
This activity develops a planning model to project future workload volume demand for the new hospital. The activity should start with a review of demographic data and utilization trends for the proposed area. Planning assumptions should be developed regarding the future population utilization rates and market share targets. These assumptions ideally will be based on the output of the visioning session, available databases, and the future trends in healthcare delivery within the area or country. Once the market analysis is complete, a financial feasibility model should be developed. The financial feasibility analysis should begin with the projected capital requirements so that the operating and financial assumptions can be documented. Finally, the five-year financial performance and expense projections will be developed. Depending on the analysis, financial assumptions can be altered to ensure financial viability of the facility.
- Determination of Major Room Requirements
In this next step, the previously developed workload volumes will be reviewed. The recommended best practice operational metrics (e.g. length of stay, room turnaround time, utilization target, etc.) will be applied to the workload volumes to determine the number of major rooms required (e.g., inpatient beds, operating rooms, ED bays, etc.). The preliminary departmental space requirements should be developed using standard benchmarks (e.g. square feet or meters per major room). After review by the planning team, the major rooms required and preliminary space requirements are finalized.
- Definition of Hospital-Wide Operating Systems
Prior to more detailed departmental planning, the hospital-wide operational systems should be defined. The hospital operator should review the standard or current systems and recommended systems will be proposed and reviewed with the team. Typical systems to be identified should include patient scheduling/registration/billing, electronic medical record, materials management, waste management, linen, food service, etc.
- Approval of Space Planning StandardsIn order to ensure consistency between all areas of the facility, a preliminary list of space planning standards should be developed for review by the planning team. It is important to set these standards to ensure space is adequately and consistently allocated throughout the facility. The preliminary list of standards typically includes offices and/or workspaces, staff lockers, lounges, conference and/or education rooms, exam room allocation, and others as identified.
- Projection of Preliminary Total Space Requirement
Based on the information and standards developed in the first five activities, a preliminary departmental space projection for the total facility can now be developed. This will serve as an initial space planning budget and will be used for site planning and preliminary budget estimates. The space projection can be revised at this time, if necessary, to address site or budget requirements. This will avoid arbitrarily reducing each department later in the planning due to budget or site issues.
- Development of a Master Plan
At this point in the process, the design architect may be asked to develop a master plan for the site and facility (if not already previously developed) using the operational information and space requirements developed in the previous steps. The plan should reflect the site (especially parking) and building requirements for the next decade. By developing such a plan, the organization can feel confident that the next phase of construction will feed logically into a rational, efficient, and long-term plan.
- Development of Departmental Functional Programs
In this activity, detailed functional or operational programs will be developed for each department or functional area. The focus should be defining the most operationally efficient systems for the new facility. The operational programs will reflect the planning completed in steps one through six. In addition, it is anticipated that several departments may be grouped together or regrouped to improve patient service and maximize operational efficiency.
- Preparation of the Detailed Room-by-Room Space Programs
In this step of the process, the individual room requirements for each department will be identified based on the operational characteristics defined in the functional programs (step seven). This ensures space is planned based on needs, as opposed to generic space or wish lists. The tabular listing will include the room type, the number of rooms required, the recommended size and any special requirements. By focusing on the functional requirements first, the space program will reflect the true space needs.
- Summarize and Transition of Materials to the Design Architect
In the final step, the planning documents should be assembled in a single document. The information can then be reviewed with the design architect and the document will serve as an ongoing reference document to ensure the building can accommodate the projected volumes and reflects the efficient planned operating systems.