SpaceMed Newsletter Print (PDF)
Winter 2008
Volume 1, Number 1
Planning an Ambulatory Care
Facility: The Lean Toyota or the
More Generous Hummer
BACKGROUND
Prudent Health System (PHS) planned to construct a new outpatient building to provide space for urgent care, ambulatory surgery, and various hospital-sponsored clinics on its main hospital campus. Space was needed to accommodate the following ten-year workload projections and corresponding clinical services:
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Urgent care center with 32,000 annual visits
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Ambulatory surgery center with 4,200 annual surgical cases
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Hospital-sponsored clinics:
Medicine (23,000 annual visits)
Surgery (15,000 annual visits)
Neurosciences (6,000 annual visits)
Orthopedics (16,000 annual visits)
In addition, a small express testing area was planned to consolidate routine, quick turnaround outpatient testing in a single area ― including X-ray, EKG, and specimen collection ― along with a small satellite laboratory.
A room-by-room space program was prepared based on the projected workload and other functional planning assumptions provided by PHS ambulatory care staff. An initial schematic drawing was developed by the design architect and the project cost was estimated. A business plan was then prepared along with a financial pro forma analysis.
Due to the large amount of space programmed and corresponding high project cost, and high operational costs relative to the projected incremental revenue, PHS’s Chief Financial Officer asked the executive team whether they really needed a “Hummer” when a “Toyota” might suffice. The executive team agreed to evaluate the impact on overall space need (and resulting capital and operational costs) of planning a “lean” facility versus a more “generous” facility.
PLANNING APPROACH
The executive team reviewed the original operational assumptions documented in the functional program. In conjunction with the facility planning consultant, they identified several key factors that could reduce the overall size and cost of the new outpatient facility:
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Operational assumptions. Operational processes were reengineered to increase the exam/procedure room turnaround time and the weekly hours of operation were expanded ― resulting in the need for less exam and procedure rooms. In addition to more efficient space utilization, customer service would also be enhanced.
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Configuration of the clinics. The clinics were originally programmed based on their current organization and located in four distinct physical areas on the hospital campus. By combining the medicine, surgery, and neurology clinics into a single shared clinic, improved space utilization and staffing efficiencies would be possible. The new configuration also allowed the orthopedic clinic to be located on the first floor thus eliminating one of the X-ray rooms and facilitating coverage by the radiology techs working in the express testing area.
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Size of exam/procedure rooms and offices. Based on a review of its existing facilities, PHS determined that it did not need such generously-sized exam rooms and offices ― for example, the clinic exam rooms were re-programmed at 100 net square feet (NSF) versus 120 NSF as originally programmed.
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Facility design and layout. Alternate facility layouts were evaluated that resulted in less space required for intradepartmental and public circulation corridors. Along with two less floors, this substantially reduced the amount of department gross square feet (DGSF) and building gross square feet (BGSF).
COMPARISON OF FACILITY PLANNING ASSUMPTIONS
A summary of the assumptions used for the lean versus the more generous space planning approach is shown below:
| GENEROUS | LEAN | ||
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Urgent Care Center 32,000 Annual Visits |
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Ambulatory 4,200 Annual Surgical Cases |
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|
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Orthopedic Clinic 16,000 Annual Visits
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|
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Other Clinics: Medicine Clinic Surgery Clinic Neurology Clinic 44,000 Annual Visits
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|
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COMPARISON OF SPACE NEED
The resulting space need is summarized in the following table based on the actual room-by-room space programs. In the lean scenario, 40,000 BGSF less space is required to accommodate the same projected annual workload.
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Space Program Summary |
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Facility Component |
GENEROUS |
vs. |
LEAN |
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Urgent Care Center |
15,000 |
8,600 |
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Ambulatory Care Center |
22,000 |
12,000 |
|
|
Orthopedic Clinic |
6,200 |
4,400 |
|
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Medicine Clinic |
7,500 |
--- |
|
|
Surgery Clinic |
5,500 |
--- |
|
|
Neurology Clinic |
5,900 |
--- |
|
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Shared Clinic |
--- |
8,000 |
|
|
Express Testing Area |
3,800 |
3,800 |
|
|
Entrance Lobby |
3,200 |
3,200 |
|
|
Total DGSF |
69,100 |
40,000 |
|
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DGSF to BGSF Conversion Factor |
1.30 |
1.25 |
|
|
Total BGSF |
90,000 |
vs. |
50,000 |
CONCLUSION
With 40,000 BGSF less space required in the lean scenario ― to accommodate the same projected annual workload ― the estimated project cost would be significantly reduced, particularly since the new space program can be accommodated with only two floors versus four as originally planned.
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GENEROUS Ambulatory Care Facility 90,000 BGSF
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Building Section Diagram |
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LEAN Ambulatory Care Facility 50,000 BGSF
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|
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Building Section Diagram |
The PHS executive team eventually decided to construct the smaller, lean facility which would also be less costly to operate over time than the more generous facility. Moreover, the cost savings allowed the building to be designed to facilitate future horizontal as well as vertical expansion as required. back to top
Cynthia Hayward
Case Study 1308.1.1