Healthcare Facility Planning Tools and Guidelines
Fall 2017Volume 10, Number 3
IN THIS ISSUE
By Cynthia Hayward
University Hospital (UH) planned to replace three outpatient clinics, currently in different locations, in a new freestanding building. Although the number of annual visits (30,000) was not expected to grow significantly, there was considerable debate among the physician leadership regarding the planning of the new facility. Some wished to maintain the status quo regarding their current productivity and wanted to simply replace the three separate clinics in new construction. Others wanted to consolidate the clinics into a single, efficient ambulatory care space — recognizing that reducing their staff and facility costs would make them more profitable while potentially improving customer service with more streamlined and better coordinated processes. The physician leadership agreed to evaluate the impact on overall space need (and resulting construction cost) of planning a lean facility versus a more generous facility.
To see how the potential building size more than doubles depending on the operational and facility planning assumptions >>
A number of factors were identified that would ultimately impact the overall size of the new clinic facility as follows:
- Annual visits per exam room. Currently, the three clinics averaged only 1,000 annual visits per exam room. By extending clinic hours into the early evening (and possibly Saturday) and leveling out the scheduling of physician and resident clinic sessions during the week, a target of 1,650 annual visits per exam room was deemed appropriate.
- Number of exam rooms. A total of 30 exam rooms were currently used at the three locations; only 18 exam rooms would be needed if annual visits per exam room were increased.
- Exam rooms per module. Two modules of nine exam rooms each were considered for the new facility — versus the current clinic configuration of four modules with six to eight exam rooms per module. Using two modules, in lieu of the current four, results in a reduction of the overall clinic net square feet (NSF) due to shared patient intake/reception space, staff amenities, and other support space.
- NSF per exam room. Alternate exam room layouts were considered as the clinic standard; these ranged from a more compact exam room with 95 net square feet (NSF) to a more spacious exam room at 120 NSF.
- NSF to DGSF factor. Alternate clinic layouts were evaluated that resulted in varying amounts of department gross square feet (DGSF) to accommodate the projected NSF; the higher factor included additional internal corridors to accommodate the three separate clinics.
- DGSF to BGSF factor. Alternate architectural designs were evaluated that resulted in varying amounts of total building gross square feet (BGSF) — the overall building footprint — to accommodate the DGSF; the higher factor assumed an atrium, expanded lobby space, and additional space for shared public corridors, elevators/stairs, and mechanical/electrical equipment.
- Annual visits per BGSF. The resulting annual visits per total BGSF varied from 3.1 in the lean model to only 1.4 in the generous model.
CALCULATION OF CLINIC SPACE FOR 30,000 ANNUAL VISITS
The comparison of the lean versus more generous approach to planning the clinic space is shown below:
|Annual Visits/Exam Room||1,650||1,000|
|Number of Exam Rooms||18||30|
|Exam Rooms Per Module||8 to 12||6 to 8|
|NSF Per Exam Room||95||120|
|NSF to DGSF Factor||1.30||1.45|
|DGSF to BGSF Factor||1.20||1.30|
Using the lean approach, operational processes would be reengineered to improve exam room utilization thus increasing the average annual visits per exam room. By combining three distinct clinics into a single flexible space, only 18 exam rooms would be required in lieu of the 30 at present. The current exam room size of 95 NSF was used in the lean model versus planning all the new exam rooms at 120 NSF. The more generous space layout required additional internal corridors to accommodate the three separate clinics resulting in a larger NSF to DGSF factor. A larger DGSF to BGSF factor was required with the more generous approach to accommodate an atrium, expanded lobby space, and additional space for shared public corridors, elevators/stairs, and mechanical space due to the larger footprint.
Assuming an overall project cost of approximately $250 per BGSF, the generous approach would require $3 million more (over two times as much) to construct the new clinic building than with the lean approach. Ultimately, the physician leadership decided to consolidate the three clinics using the lean approach which they felt would both increase their profitability and improve customer service. They decided, however, to increase the size of the exam rooms to 110 NSF to better accommodate the needs of different specialties and patient populations.
IN THE NEWS
CHI Franciscan Health System’s eight hospitals are scattered across Western Washington but they are all tethered to a virtual hub located in a former bank building in Tacoma. In this clinical operations center, teams of technicians, nurses, and caregivers use technology to provide an extra set of eyes across its regional health system, from miles away, for busy physicians and nurses on the ground.
Nurses who used to spend all day on their feet in an intensive care unit now spend 12-hour shifts watching a screen where they monitor the vital signs of dozens of the health system’s most fragile patients. From a computer, nurses can check blood oxygen levels and read the patients’ medical charts. A camera can take them inside a patient’s room with a click of the mouse. However, the virtual ICU is just one part of this hub. In another area, virtual companions sit at computer stations with six monitors watching over patients who need extra supervision like those at risk of falling. Cameras provide live video feeds of the patients’ rooms and allow the virtual companions to chat directly with the patients using speakers and wall-mounted computer screens. Nurses on the ground can be summoned to the patient’s room if they need help. From the clinical operations center, staff can troubleshoot anything at the spur of the moment with the push of a button and significantly enhance the quality of care.
Source: “Virtual Hospital Provides Second Set of Eyes on Harrison Patients” by Tad Sooter, Kitsap Sun News, July 16, 2017.
By Cynthia Hayward
For several decades, healthcare organizations have been developing Centers of Excellence to better compete for market share, research dollars, philanthropy, and scarce subspecialists. Promoting a specific program within the healthcare organization’s broader portfolio of services helps to attract the critical mass and resources required to make it successful.
To read about new approaches for planning centers of excellence >>
Centers of Excellence are commonly developed for cardiac care, cancer treatment, neurosciences, orthopedics, pediatrics, and women's health, although various other clinical programs and specialties may also be candidates. Historically, these centers were envisioned as freestanding facilities with the name prominently displayed on the building’s facade. Before high-speed internet and intranet connections, this concept was promoted to improve collaboration and communication among the healthcare providers as well as to provide one-stop-shopping for the customer.
Healthcare organizations are increasingly looking for more cost-effective ways to achieve a similar result while spending fewer capital dollars. To accomplish this, they are focusing on the specific elements that give customers the perception of arriving at the “center” or “hub” and then connecting the “spokes” — other functional components and services that may be connected either physically or electronically.
Unless the center is being constructed as a freestanding facility on a new site, some services could be located within existing space while others may be in a new addition. The trade-offs between the cost (both the initial capital investment and ongoing operational cost) of achieving physical adjacency, versus settling for less-than-perfect convenience for the customer, need to be reviewed and weighed carefully. The potential for increased revenue, reimbursement, and the demands of donors, partners, or investors may also impact the physical design. Unfortunately, physicians often have difficulty imagining a center that is not an imposing edifice or at least a freestanding building
HEART CENTER AS AN EXAMPLE
For example, a Heart Center may be developed on an existing hospital campus by creating a dedicated patient entrance that leads directly to the Heart Center reception desk and intake area, a comfortable lounge and resource center for patients and family members, and a conference room for group education on various aspects of heart disease. The new lobby may be used for health promotion and assessment activities, enrolling patients in clinical trials, and for fund raising. However, all other Heart Center components may be located within existing space and accessed via an elevator or a short walk down an adjacent corridor — including cardiologist and cardiac surgeon offices, non-invasive cardiac diagnostics, cardiac catheterization lab, cardiac rehabilitation, and other related services.
From the patients’ perspective, once they arrive at a well-identified entrance and are greeted by a friendly and competent receptionist, they are generally oblivious to where they are treated as long as signage is effective and they are not asked to walk a great distance. Using this hub-and-spoke approach can result in significant cost savings without compromising customer service.
Facilitating observation without compromising patient safety and privacy is a major challenge for hospitals. Curtains are used in many areas — including viewing walls of operating rooms, sliding doors in ICUs, and for windows between patient rooms and corridors — but they can become contaminated with drug-resistant bacteria and are difficult to sterilize.
A new technology playing a pivotal role in providing observation without contamination and enhancing patient privacy is liquid crystal privacy glass. This electrically activated, switchable glazing technology instantly changes from transparent to frosted white, creating 100 percent privacy. It can be activated with a power button, remote control, or a smartphone as well as automatically using light and motion sensors. When in the powered state, the panels are clear, allowing full view and daylight to pass through. When unpowered, the view is completely obscured. Privacy glass is well suited to conference rooms, partitions, hospitals, front entrance ways, sidelights, toilet and bathrooms, and windows. It can also be installed alongside existing security glass or fire resistant glass panels to ensure maximum security and patient safety.
Source: Innovative Glass Corporation, exclusive manufacturer of LC Privacy Glass powered with eGlass brand technology.
Endoscopy procedures — using a rigid or flexible scope to examine the interior of a hollow organ or cavity in the body — may involve the upper gastrointestinal tract (GI endoscopies), large intestine (colonoscopies and sigmoidoscopies), lower respiratory tract (bronchoscopies) and the urinary tract (cystoscopies) along with a variety of other specialized procedures.
I appreciate any comments that you have about the SpaceMed Newsletter.
— Cynthia Hayward