Space Planning Guide for Community Health Care Facilities

Transcription

1 Space Planning Guide for Community Health Care Facilities DECEMBER 2014

2 Ministry of Health and Long-Term Care Copies of this report can be obtained from Health Capital Investment Branch INFOline: TTY

3 Note The Ministry of Health and Long-Term Care (MOHLTC, the ministry ) develops and issues technical and policy documents to provide information, advice and guidance to Health Service Providers (HSP) and those who plan, design and construct healthcare facilities. This planning document has been developed as a tool to provide information on the space planning and design of community-based healthcare facilities that aligns with and supports the ministry s capital planning review and approval process. This document is not intended to cover entire technical submission requirements for any particular stage in the ministry s capital planning review and approval process; users are cautioned not to use it as a stand-alone document. Contributors This document was developed with input from the Association of Ontario Health Centres, York University Faculty of Health, Ministry of Health and Long-Term Care Health Promotion Division, Local Health Integration Network Liaison Branch and Primary Health Care Branch and Public Health Ontario.

4 Table of Contents 1.0 Introduction About the Guide Purpose Intended Users Development of the Guide Related Documents How to Use the Guide The Ministry s Planning and Design Objectives: OASIS The Guide... 6 Part A: The Facility's Role and Size... 6 A.1 Program and Service Definition...6 A.2 Types of Programs and Services and Space...6 A.3 Programs and Services and Capital Funding Eligibility...7 A.4 Space Needs and Developing a Master Plan...7 Part B: Client Activity and Space Needs... 8 B.1 Types of Spaces...8 B.2 Workload and Effective Room Utilization...8 B.3 Workload Data Table Appendix A...9 B.4 Staffing and Space Needs...9 B.5 Determining a List of Rooms...10 Part C: Determining Total Space Needs C.1 Room Sizes and Functional Room Requirements Net Square Feet (NSF)...12 C.2 Additional Design Factors to Reach the Total Area...12 C.2.1 Future Growth and Flexibility...13 C.2.2 Grossing Factors: Component Gross Square Footage (CGSF) and Building Gross Square Footage (BGSF)...14 C.2.3 Applying the Grossing Factors...15 Part D: Design Considerations D.1 CSA-Z Canadian Health Care Facilities...16 D.2 Infection Prevention and Control (IPAC)...16 D.3 Building Systems for Community-based Healthcare Facilities Class C...16 D.4 Building Legislation, Codes and Standards...17

5 5.0 Conclusion Implementation Bibliography Appendix A Workload Data Table Appendix B - Room Sizes and Requirements (Space Tables)... 20

6 Space Planning Guide for Community Health Care Facilities

7 1.0 Introduction Community health care facilities deliver a range of primary health care services. These are services that the public can access close to home in non-hospital facilities. These services include: health assessment, diagnosis and treatment services, counselling and therapy services, education and support, as well as services to provide linkages to other on-site and outreach programs. These are services that do not need to be administered in a hospital. The ministry provides oversight for the planning and design for the following types of community-based health care facilities: Community Health Centres (CHC) Aboriginal Health Access Centres (AHAC) Community-Based Mental Health Programs Community-Based Substance Abuse (Addictions) Programs Long-term Care Supportive Housing (typically supporting programs for the frail elderly, acquired brain injury, physically disabled and HIV/AIDS) This Space Planning Guide ( Guide ) is a planning tool designed to assist community Health Service Providers (HSP) to develop a proposed capital project for submission to the ministry for approval. The Guide supports current government priorities and recognizes fiscal challenges by assisting HSPs with the effective use of limited capital resources to plan high quality health care environments. The planning principles in this Guide promote right-sizing a facility to support efficient delivery of the HSP s services and to limit excessive operating costs over the facility s lifetime. The Guide will not replace the detailed work of the HSP and its planning and design consultant team to develop a facility; but it provides essential information that reflects the ministry s capital funding structure and outlines the ministry s facility planning expectations for a community health care setting. For Supportive Housing facilities, information in this Guide may be of assistance for clinical interview or counselling rooms, multi-purpose space, administrative spaces and general building support rooms. The Guide does not address resident sleeping rooms, residential and related spaces. 1

8 2.0 About the Guide 2.1 Purpose The purpose of the Guide is to: Establish a basic set of space-related parameters that meet the ministry s planning and design objectives for the operational efficiency, accessibility, safety, security and infection control measures appropriate to the community health care setting; Identify the maximum amount of space that the ministry will provide funding for in an approved community capital project; and, Outline the basic steps to develop the space needs of a community health care facility. The Guide was developed in conjunction with the ministry s Community Health Service Provider Cost Share Guide and it is intended that these two documents are used in tandem when planning proposed community capital projects. These two resources provide the information necessary for HSPs to understand the types and amount of space the ministry will cost share 1 for approved community capital projects to meet program and service delivery needs. The Guide s focus is to provide guidance in defining space allocation and, in doing so, does make reference to some technical building considerations necessary to health care facilities. However, the purpose of the Guide is not to provide complete technical facility design guidance. For technical building requirements such as building codes, electrical /emergency power, heating, ventilation and air conditioning, infection control, sterilization procedures and construction-related issues, the HSP and its design team must refer to the applicable legislation, codes, standards and other best practice industry sources. 2.2 Intended Users The Guide is intended for the following individuals and groups: Administrators to develop an estimate of their facility s space needs; Functional programmers, architects and engineers to ensure that planned space meets best practice design and ministry planning, design and funding requirements; Other technical and health care professionals such as infection control and occupational health and safety personnel; and, Ministry staff to confirm compliance with space and functional requirements that meet the ministry s planning and design objectives ( OASIS see Section 3.0). 1 Cost Share otherwise known as shareable costs (def): The amount of a total project cost that the ministry can provide capital funding for under ministry cost share guidelines (i.e. not all costs in a capital project can be funded by the ministry. The non-shareable costs are the responsibility of the HSP). 2

9 The Guide is written to provide generic information so that both the principles and specifics can be applied consistently to a variety of community health care facility types. It is the role of the HSP to determine which components of the Guide are most applicable to its programs and services. 2.3 Development of the Guide The Guide incorporates consultation with community health care facility stakeholders; input from various levels of Health Capital Investment Branch; and, input from other Ontario government programs such as Local Health Integration Network (LHIN) Liaison Branch, Primary Health Care Branch, Health Promotion and Public Health. It also consolidates elements of Canadian health care facility standards and other health care planning guidelines to present a comprehensive set of recommendations for the communitybased, primary health care setting. 2.4 Related Documents Capital Planning and Approvals Process Documents The ministry s capital planning review and approvals process consists of various stages. Each stage builds on the information and level of detail of the previous stage. This Guide should be used in conjunction with the following ministry documents: The MOHLTC-LHIN Joint Review Framework for Early Capital Planning Stages Toolkit, November 9, 2010 (MOHLTC-LHIN Toolkit) Community Health Service Provider Cost Share Guide Capital Planning Manual (1996) Legislation and Regulations For all capital projects, it is the responsibility of the HSP to ensure that project submissions are compliant with all legislation, codes and standards, such as, but not limited to the most current versions of the Ontario Building Code; the Ontario Fire Code; the Electrical Safety Act, other CSA standards for health care facilities, the Accessibility for Ontarians with Disabilities Act; the Occupational Health and Safety Act and future issues of these regulations. CSA Z Canadian Health Care Facilities (CSA Z8000) Appendix B of the Guide incorporates and adapts the applicable components of CSA Z8000 for primary and community health care facilities. Released in November of 2011, CSA Z8000 sets new national standards for the planning and design of a wide range of health care facilities, including acute care, but extending to primary care and ambulatory settings. CSA Z8000 is not legislated; however, it is accepted by the ministry as the best practice standard for Ontario health care facility design. In the absence of another Canadian standard for community health care facilities, this ministry Guide is based on the CSA Z8000 and future issues of it. 3

10 The ministry strongly recommends all HSPs purchase of copy of CSA Z8000 and become familiar with its overarching principles and specific recommendations, as applicable to the HSP s programs and services How to Use the Guide The Guide is organized in four parts: Part A: The Facility's Role and Size Part B: Client Activity and Space Needs Part C: Determining Total Space Needs and Appendix B (Space Tables) Part D: Design Considerations Reference to CSA-Z8000 The sequence of Parts A through D reflects the basic steps of space planning which can be described as: Establishing the program parameters; Developing fundamental spatial relationships to support functional programming; Arriving at a total facility area estimate; and, Refining the space needs to support building systems and meet detailed room functions. The Guide should be able to assist administrators and their consultants to arrive at an initial total space budget/estimate of floor area needed to meet the facility s operational objectives and safely and effectively deliver programs and services. This initial space budget will not replace a detailed functional and operational program and facility design, but it will provide the initial assumptions that reflect the ministry s capital funding policy. Once a space budget is defined, it can be verified through more detailed planning and design with the input of the HSP and its planning and design team including functional programmers, architects, engineers and an infection control professional (ICP). As the design progresses, the planning and design team should refer back to the details of Appendix B: Room Sizes and Requirements to ensure that the final room designs address the necessary technical requirements. These technical requirements incorporate CSA Z8000 and other CSA standards and therefore, reflect current, recognized best practice in Canada. At any time, please contact the ministry for assistance on use and application of the Guide. 4

11 3.0 The Ministry s Planning and Design Objectives: OASIS A fundamental goal in the planning and design of capital health care projects is to create an environment that enables health services to be delivered in a most effective and efficient, accessible and safe manner while respecting the needs of patients or clients, and staff. Capital resources should be used effectively so that all capital projects are built as a long-term investment for the community they serve. The ministry s planning and design goals and objectives are captured under the ministry s OASIS principles. These principles also form the fundamental principles of CSA Z8000. Operational Efficiency; Accessibility, Safety and Security, Infection Prevention and Control; and, Sustainability When undertaking a capital project, the ministry expects that these objectives will be met. Please contact the ministry for more information on the OASIS objectives 5

12 4.0 The Guide Part A: The Facility's Role and Size A.1 Program and Service Definition Creating a list of rooms is the end-product of the early planning phases of a facility. Before beginning to identify individual rooms or the physical layout of the facility, the program/service needs should be developed. The HSP should determine the needs of its client population regarding: the client population; programs and services; a vision of how staff can most effectively deliver the needed programs and services; and, the required staff complement. These parameters are outlined in more detail in the MOHLTC-LHIN Toolkit for the Pre-Capital, Proposal and Functional Program submissions. For more information on defining service delivery, please contact the LHIN. A.2 Types of Programs and Services and Space Definition of the programs and services that will be delivered from the facility is an important step to understanding the general space needs of the facility. The following program and service categories are typically found in community health care facilities: Core Program health care services: These services include: health assessments; diagnosis and treatment; counselling; primary mental health care; chronic disease management; health promotion; family planning; coordination with outreach community care providers, and others. These programs are typically defined through the programs and service agreements that the HSP has with its operating funding agency (LHIN). Allied Health services: These services include a range of clinical support services that complement the clinical care team and contribute to the client s health and well-being as part of an integrated care approach. Services may include: physiotherapy; occupational therapy; speech therapy; social work; chiropody; and, spiritual care. 2 These programs may or may not be defined in the organization s service agreements. Other programs: These programs are commonly referred to as community partners and may include outreach workers from other organizations; community food programs; 2 CSA Z , Canadian Health Care Facilities; November, 2011; CSA; p

13 youth programs; and, many others. In some cases, these programs are not LHIN funded programs (e.g. may receive municipal funding or funded through a charitable foundation or program). A.3 Programs and Services and Capital Funding Eligibility To define early planning space estimates and for budget planning purposes, the HSP should be familiar with which programs receive operational funding from the LHIN and those partner programs that are funded through other sources such as a municipal funding program, charitable foundation, outreach hospital program, another ministry, or other non-ministry, government agency. The capital costs for the construction of space for partner programs that do not receive operational funding from the LHIN are not eligible for ministry funding under the ministry s funding allocation for community projects. In such a case, other sources of funding will need to be secured to build the partner space. Please refer to the Community Health Service Provider Cost Share Guide and consult with the ministry to identify and confirm funding eligibility for partner organizations. It is important for the HSP to understand which programs can receive capital funding from the ministry and which cannot. The total availability of capital funding from all sources will impact the affordability of how much space can be constructed. A.4 Space Needs and Developing a Master Plan A master plan explores the potential for developing a specific site for the facility. When a facility is planning to occupy a site over a period of time, the master plan helps to identify immediate and future needs. Multi-service, large hospitals require a master plan that envisions how the facility will expand and replace itself over a year timeframe, usually on a large campus or across multiple sites. Smaller community health care facilities typically have a year planning term and are often located in leased space within commercial buildings or in single buildings with infrastructure similar to a medical office building. Depending on the size and scale of the community HSP, the master plan may be a plan of a property and a proposed new building; a plan of an existing single building to be renovated; or, a floor layout within a multi-tenant building. The project may be new/purpose built or a tenant leasehold improvement project. If the HSP envisions staged or phased growth over time, the ministry requires a master plan that illustrates the expected growth phases. In either case -- new build or leasehold -- prior to selecting a location, building or space, it is necessary to define the overall amount of space needed to meet the immediate programs/service needs and account for some future growth or flexibility. The next step will describe how to identify the initial space needs to inform the master plan. 7

14 Part B: Client Activity and Space Needs Space needs are typically identified through the creation of a Functional Program, which includes detailed information to describe the programs, workload and staffing and spatial requirements and layout (or block diagrams ). For more information on the Functional Program, please refer to the MOHLTC-LHIN Toolkit. B.1 Types of Spaces This Guide categorizes spaces into two types of activities: 1) Clinical Space*: rooms required for primary health care staff to perform their core functions and clinical support rooms (e.g. general waiting areas, exam rooms, counselling rooms, specialized care rooms, labs, medical staff offices, and medical/clinical utility support rooms). *The term clinical space is not intended for counselling space for interviewing clients and/or families for non-physically based condition treatment or education. 2) Facility Support Space: non-clinical rooms and areas for administration and community activities and functional rooms. These are grouped as follows: Administrative Support Spaces required to support the delivery of primary and allied health care staff (e.g. reception, general waiting areas, work areas, staff facilities) Shared Spaces shared by both core program and allied health staff to deliver programs (e.g. interview, counselling and meeting rooms, kitchens) Cultural Spaces special rooms required for the delivery of core health care programs that are directly related to the culture of a specific patient/client group (e.g. traditional healing, meditative or ceremonial spaces) Building Facility Support Spaces rooms required for the facility to be functional (e.g. garbage, storage, mechanical and electrical) B.2 Workload and Effective Room Utilization The relationship between operations and space should result in most effective usage or rightsizing of physical space; that is, all rooms are used with the least amount of time vacant or down time, while allowing for some flexibility for unexpected or informal use. The ministry does not support assumptions that individual, dedicated rooms are required for single functions or one-time events unless there is clinical or program evidence. 8

15 Opportunities should be identified where staff and group activities can share space based on effective scheduling. The number of common areas should be carefully planned to eliminate down time and facilitate sharing across programs. The following are a few examples of preferred relationship between operations and space: Exam Rooms and Waiting Room Size: Standard exam rooms should be planned to be flexible for different uses and occupied 80% of the time. Using data such as annual visits, appointments or encounters; clinic hours; and, how long patients stay in a room will guide the optimum number of rooms and numbers of people in a waiting room. Clinical Office Space: Collaborative team space with workstations in a shared space with access to a swing or spare office for privacy should be planned as opposed to dedicated, private offices. Meeting Rooms: Effective scheduling of the programs should facilitate sharing of rooms across multiple program groups, or rooms subdivided for flexibility. If the facility s full programming is met and there is still scheduling time available, the space may be considered for use for other community partners. Using data such as number of group types, frequency and length of group sessions and a draft schedule will help determine the optimum number of rooms. Administrative Offices: Number of staff; function (full-time/part-time); hours of use/frequency; and, privacy needs should be used to determine whether private offices, workstations or shared offices are appropriate. B.3 Workload Data Table Appendix A To determine the activity of the facility and effective room utilization, the organization should have information on how many patients it services, the range of services being provided and how patients are being treated, such as on-site or face-to-face visits with health service providers and telephone consultations. The number and types of visits is information needed to determine the type and amount of physical space needed to deliver those services. The Workload Data table in Appendix A is a tool to provide an overview of this information. The ministry will request this table to be completed and submitted as part of the project early planning development process. The ministry will review the table to assist the organization in determining the optimum number of rooms for the appropriate functions. For assistance on completing this table, please contact the ministry. B.4 Staffing and Space Needs Staffing is also an important factor in determining space needs. The ministry is only able to commit capital funding for space that has operational funding committed to it. Typically, community HSP operational staffing budgets are determined by the LHIN. An HSP may find that the LHIN has a fixed operational budget for the staff, despite a projected increase in client volumes. In such as case, where the HSP may be planning for more space to support increased volumes, the ministry recommends that the HSP work with its LHIN to review the relationship of staff to volumes to ensure that the number of funded staff can reasonably 9

16 manage the anticipated volumes. Please refer to the MOHLTC-LHIN Toolkit for the LHIN s process for review, alignment and endorsement of the program and services, which includes service delivery capacity. If the LHIN s review and endorsement confirms an increase to the operational budget for additional staff to meet projected increased volumes, then the ministry is able to support space to accommodate more space to meet those volumes (with the assurance that increased budgets and recruitment will be achieved). If the LHIN cannot endorse operational budget increases for additional staff, the ministry recommends that the organization develop alternative solutions to address demand. For example, increased hours could be considered, or an area for future expansion or future offsite facilities could be envisioned as part of a master plan (should future additional staff funding be approved). B.5 Determining a List of Rooms Once the programs and services, staffing and workload have been assessed and their impact on space determined, a list of rooms can be determined: Clinical and group rooms through analysis of activity, workload and utilization; Efficient administration space determined through evaluation of staff needs; Remaining rooms required for the facility to fully function. See Table B1. The following table is a sample list of rooms that could be found in a community health centre. Each facility will have its own complement of rooms based on specific programs and functions. Table B1. Example of a Room List for a Community Health Centre Reception Area Reception Desk with Intake Interview Area Waiting Room (incl. Child area) Scooter/Stroller Parking Public Washrooms (access to) Medical Records Room Clinical Area Examination Rooms Interview/Counselling Room(s) Medication Area (room, or cupboard) Clean Utility Room Soiled Utility Room Patient Washroom(s) (single, barrier-free) Practitioner Work Spaces Swing Office (with Team model) Shared Meeting/Multipurpose Spaces Meeting Room(s) (# and size based on activity) Storage for meeting room supplies/furniture Refreshment Station (optional) Demonstration Kitchen (Diabetes Programming) Cultural Spaces (specific to functional program) Administration Spaces Administration Offices and workstations/shared areas Building Support Rooms IT Server / Telephone Room(s) Housekeeping Room Electrical and Mechanical Rooms Mechanical Room Garbage / Waste Holding Room Storage 10

17 Table B2. Space Needs Table After all rooms and spaces have been identified, a Total Space Needs Table can be created. Please contact the ministry for a sample Space Needs template table. The table should be organized using the format shown below: Program FTE (related to Program Staff (#) Room Type/ Function Area per Room (SF) Number of Rooms Total Area of Rooms Variance from original planned Area (%) * Room Requirements *add column after initial submission for comparison between planning stages Area per Room - Room Size Appendix B of this Guide presents sizes of each room type that is eligible for capital funding by the ministry. These room sizes reflect the recommended areas as per CSA Z8000 and the limits of ministry funding capacity. The HSP should use the Community Health Service Provider Cost Share Guide as a companion document when developing the space needs table. Please refer to Part C of this Guide for description of Appendix B. The total area of these room sizes will result in the net area of the facility, excluding space needed for circulation. The subsequent development of the net room areas into the total building area of the facility (sometimes referred to as the gross-up ) is described in Part C of the document. A space needs table that identifies the rooms, net areas and eventual total building area is sufficient for the Pre-Capital or Proposal stage as outlined in the MOHLTC-LHIN Toolkit. At the Functional Program stage, the additional sections of the table are to be completed. Space Variance As planning progresses, changes to room size and/or requirements are likely to occur. The planning team must note the difference and provide an explanation in the Variance column. For room size, the variance should be described in both square feet difference and as a percentage from the original Area of Room. This version of the Space Needs table, which tracks the variances should be completed and submitted with each capital stage submission. Please contact the ministry for a sample Space Comparison template table. Room Requirements Each room should have a defined function or range of functions based on the program or services being delivered or performed. In addition to program-specific functional needs, the Requirements and Recommendations in the Appendix B Tables must be included. These Room Requirements can be documented in the Space Needs table or separately. The organization should include an Infection Control Professional (ICP) as part of its planning team. The ICP should be involved at this early stage to ensure infection control measures are accounted for in the early planning decisions and subsequently incorporated in room requirements. The ministry will use Appendix B to review the planning submissions and will request clarification or revision where there are discrepancies. 11

18 Part C: Determining Total Space Needs C.1 Room Sizes and Functional Room Requirements Net Square Feet (NSF) The Room Sizes and Functional Room Requirements Tables ( Space Tables ) in Appendix B are defined in two major categories: Clinical Support Spaces Facility Support Spaces The Space Tables provide a complement of rooms that may occur in a community health care facility. Each room has an assigned Net Square Foot area (NSF) and a list of Room Requirements and Recommendations. The NSF defines the net amount of space for each room type, not including space for circulation or building structure and thickness of walls (building structure and exterior wall thickness is only required to be calculated in new-build projects). The Room Requirements and Recommendations column define the mandatory and advisory. The advisory items are recommended if they are appropriate to the program needs. It is the responsibility of the HSP and its consultants to ensure that the mandatory requirements and appropriate advisory elements are incorporated in the early planning space estimates and at subsequent detailed design. A total Net Square Foot (total NSF) area is the result of adding the total room net areas. The NSF for each room is a guide, representing recommended sizes based on CSA standards for functionality and infection, prevention and control and the ministry s funding limits. If rooms are sized larger than in the space tables in Appendix B, the ministry will require LHINendorsed clinical or program evidence demonstrating the need for the increase and LHIN support for the operating cost impact. Please refer to the Community Health Service Provider Cost Share Guide. C.2 Additional Design Factors to Reach the Total Area Planning factors must be applied to the total NSF to achieve a Total Building Gross Square Footage (BGSF). These include: Future Growth and Flexibility 12

19 Component Grossing Factor Building Grossing Factor C.2.1 Future Growth and Flexibility To accommodate minor changes and/or growth in core programs, the ministry may support up to 5% of the total net area to be added to the total NSF. For Community Health Centres, this space is intended to support growth and flexibility for the primary care or clinical program (as opposed to group space or administrative space). For other community HSPs, it is intended for general program-related areas. The ministry will review a variety of factors in its consideration of the space (e.g. effective utilization of the planned spaces, lease terms, location etc.). Any projected growth above 5% must be submitted to the ministry for review. The HSP should work with the LHIN, using client profile projections and any data that the facility has tracked and can demonstrate as evidence for growth. Soft Space Planning Future growth/flexibility space can be accommodated adjacent to the clinical zone or core program area by using spaces that can be converted with minimal capital investment. For example, storage, office space or interview rooms that can be easily relocated could be planned adjacent to the clinical zone. If the soft space is intended for future clinical functions, the mechanical ventilation of this space should be designed with the potential to provide enhanced ventilation requirements with minimal alteration. Future Growth and Flexibility Up to 5% of the total NSF or an actual area. This number becomes the new total NSF. 13

20 C.2.2 Grossing Factors: Component Gross Square Footage (CGSF) and Building Gross Square Footage (BGSF) The following factors are recommended to be used at early planning stages to estimate overall space budgets. Variables such as existing space configuration, structure or special program needs may change the actual area represented by these factors. As planning progresses into detailed design, the actual areas should be measured and compared against these factors. i) Component Gross Square Footage (CGSF) To account for the space required for circulation between rooms and zones, at early planning stages, a planning factor is applied. This factor results in the Component Gross Square Footage or CGSF. At later design stages, this area can be calculated on the drawings by the design team and compared against the assumed CGSF planning factor. The ministry expects planning to be efficient and balanced to minimize circulation space, yet ensure safety and quality to achieve good patient flow, workflow and staff movement and support accessibility. ii) Building Gross Square Footage (BGSF) To account for the thickness of exterior walls, minor vertical engineering spaces (plumbing, ventilation and electrical) and any vertical spaces such as stairways and elevators, an additional factor is applied to the CGSF. This factor results in the Building Gross Square Footage or BGSF. For new-build projects, the BGSF factor must be applied to ensure that cost estimates account for construction materials and building configuration. For leasehold projects, there is no vertical space or exterior wall thickness to calculate. The extent of the space is the rentable boundary. Therefore, the CGSF = BGSF. Common Space: For leasehold projects, the facility will share some spaces with other tenants (e.g. common lobby / main entrance areas, service rooms, vestibules, stairways and elevators). The lease must clearly define these spaces with an associated area and lease rate. The HSP will be responsible to pay for the use of that space within the agreed-upon rent from its operational budget. Common space is not added to the total area and is not included in the capital funding used to construct the space. The Landlord is responsible for all basic upgrades to those areas, and therefore, any upgrade work should not be included in the capital costs. However, if the facility requires specialized improvements, it should consult with the ministry to determine if the capital improvements to those spaces would be eligible for ministry funding support. 14

21 C.2.3 Applying the Grossing Factors i) CSGF: For leasehold and new-build projects: Component Grossing Factor Apply a factor of 1.35 (+35 %*) to the total NSF to arrive at the total area of the facility (within exterior walls). 35% should accommodate the circulation space necessary to link together the net spaces and area occupied by internal walls. Projects may experience a lower factor once the building design is refined. For leasehold projects: the CGSF is the total gross floor area for the capital project. *35% represents a blend of areas within the facility. Once floor plans have been developed, the actual circulation area should be measured and documented. ii) BGSF: New-build projects For new build projects, an additional grossing factor beyond the 35% factor is required to account for the thickness of exterior walls, minor vertical engineering spaces (plumbing, ventilation and electrical) and any vertical spaces such as stairways and elevators (if more than 2-storeys). Building Grossing Factor Apply a factor of 1.15 (+15 %*) to the CGSF to arrive at the BGSF. The BGSF is now the total building area of the capital project. Projects may experience a lower factor once the building design is refined. *15% represents an approximate building gross up for recent new build projects. Once floor plans have been developed, the actual building gross up area should be measured and documented. 15

22 Part D: Design Considerations D.1 CSA-Z Canadian Health Care Facilities The ministry strongly encourages each HSP and its planning and design team to obtain a copy and be familiar with the standard and future updates. See Section 2.4 of this Guide. D.2 Infection Prevention and Control (IPAC) Understanding the gamut of IPAC planning, from the early identification of the client risk profile with the preparation of an Infection Control Risk Assessment (ICRA), to location of hand hygiene sinks and alcohol-based hand rub stations, is critical to planning a facility. Section 4.5 of CSA Z8000 provides an excellent overview of the principles and issues to be considered. The ministry requires that the IPAC measures of CSA Z8000 are incorporated into community health care facilities and requires the HSP to retain an independent, accredited infection control professional (ICP) as part of the facility planning and design team to lead the implementation of the standards and best practice. D.3 Building Systems for Communitybased Healthcare Facilities Class C Health care facilities require a higher level of building services, such as ventilation, electrical and plumbing services than a commercial building or use. It is the responsibility of the HSP and its consultants to ensure that the facility design meets required health and life safety regulations, and is designed to standards that create the appropriate physical environment for the type of health care that is being provided. As many community health care facilities are located in leased premises, selection of a suitable location and lease terms may be impacted by the feasibility of the existing building system to meet health care facility requirements. Class C Health Care Facilities: Heating, Ventilation, and Air-Conditioning (HVAC) Standards Community health care facilities are classified as Class C facilities, as defined in CAN/CSA Z317.2 Special Requirements for Heating, Ventilation, and Air-Conditioning (HVAC) Systems in Healthcare Facilities (CSA Z317). Class C facilities are described by CSA as ambulatory facilities including outpatient clinics and doctors clinics. The standard requires enhanced ventilation and filtration systems. This standard is embedded in the Ontario Building Code legislation; however, it is often overlooked in early planning of smaller health care facilities, such as community health centres. 16

23 If the ventilation requirements are not addressed in early planning, designing to these standards late in project planning or retrofitting results in unnecessary cost increases and delays. The ministry expects that facilities will be designed to meet the CSA standards and these systems accounted for in early capital cost budgets and more detailed cost estimates. D.4 Building Legislation, Codes and Standards All facilities must be designed to meet applicable legislation, codes and standards. The ministry expects that all facilities will be in compliance with the Ontario Building Code. The Ontario Building Code references many standards as good engineering practice. These include the Fire Code, the Electrical Safety Act and relevant CSA standards for health care facilities. Establishing criteria for items such fire and life safety for building occupants, cabling requirements, emergency power needs and plumbing requirements will impact budget planning and possibly, site selection. Incorporation of the impacts of these requirements should be addressed as early as possible in the planning process. 5.0 Conclusion Through the use of this Guide, health care facility administrators and planners should be able to arrive at a total space requirement for the capital project by applying the progressive steps of program definition, effective room utilization and staffing needs, matched with the careful assignment of rooms to support functions. The ministry encourages that at all capital planning stages, the HSP and its design team strive for the effective use of space to create a safe and quality environment for the delivery of health care. Please contact the ministry with any questions or for assistance in the application of this Guide. 6.0 Implementation This Guide will be distributed by the ministry to community health care sector stakeholders as an approved guidance document for the planning and review of community capital proposals. Comments and/or questions are welcomed and can be directed to the information at the front of the Guide. Feedback will be collected by the ministry for consideration for future revisions. 17

24 7.0 Bibliography CHIR (Canadian Institutes of Health Research); Canadian Standards Association CSAZ Special Requirements for Plumbing Installations in Healthcare Facilities Canadian Standards Association CAN/CSA-Z Special Requirements for Heating, Ventilation, and Air-Conditioning (HVAC) Systems in Healthcare Facilities Canadian Standards Association CSA Z Infection Control during Construction or Renovation of Healthcare Facilities Canadian Standards Association CSA Z Canadian Healthcare Facilities Capital Planning Manual (1996), Ministry of Health and Long-Term Care, 1996 COMMUNITY HEALTH CENTRES TAKE BIG STEP FORWARD Community Health Centres Will Increase Access to Primary Care, Strengthen Communities; News Release Communiqué; Ministry of Health and Long-Term Care/ Ministère de la Santé et des Soins de longue durée, July 17, 2006, 2006/nr-082 Declaration of Alma-Ata, International Conference on Primary Healthcare, Alma-Ata, USSR, 6-12 September 1978; Facility Guidelines Institute (FGI) 2010 Guidelines for Healthcare Construction, Facility Guidelines Institute, Washington D.C. Generic Output Specifications - Beta GOS (2008). Ministry of Health and Long-Term Care. Health, Not Healthcare Changing the Conversation Annual Report of the Chief Medical Officer of Health of Ontario to the Legislative Assembly of Ontario, December 1, 2011 Looking Back, Looking Forward - The Ontario Health Services Restructuring Commission ( ) A Legacy Report, The Ontario Health Services Restructuring Commission (HSRC), March 2000 MOHLTC LHIN Joint Review Framework for Early Capital Planning Stages Toolkit, November 9, 2010 Ontario s Action Plan for Healthcare: Better patient care through better value from our healthcare dollars, February 2012, Ministry of Health and Long-Term Care Ottawa Charter for Health Promotion First International Conference on Health Promotion Ottawa, 21 November 1986 WHO/HPR/HEP/95.1; 18

25 Appendix A Workload Data Table Please contact the ministry for a copy of this form and any questions regarding the form. Facility Name: Project Name and HCIS #: Date submitted: Completed by: Workload Data for Community Health Service Providers HSP to complete all cells highlighted in yellow Funding Status (use drop down options) Stage of Project: (usedrop down options) Select Select Historic Current Projected Variance Variance Operations Overview Information Total number of patients with one or more site visits in year Total number of phone encounters with patients in year Operating days per year Hours of operation per day previous full year visit history Current year (adjust for full year) Opening year Opening Year minus Current Year Explanation (short reason for variance) NOTE: Site visit information (one patient may access one or many services). Populate only services provided. Add or delete categories as required. Historic Current Projected Variance previous full year visit history Current year (adjust for full year) Opening year Opening Year minus Current Year Confirmed funding for incremental FTEs Program Transfer Adding FTEs within existing budget Total Varience Factors (must equal Variance) Private Visits Primary Care MD Primary Care 0 0 Mental Health/Psychiatric Services 0 0 NP Primary Care Counselling, education and treatment programs (private) Rehabilitation 0 0 Health Promotion 0 0 Illness prevention/education 0 0 Diabetes Education 0 0 Maternal/Child 0 0 Social Work 0 0 Traditional Care (e.g. Aboriginal Healer) 0 0 Counselling 0 0 Geriatrics Allied Health Physiotherapy 0 0 Occupational Therapy 0 0 Speech Therapy 0 0 Audiology 0 0 Dietician 0 0 Podiatry/Chiropody Other Diagnostics (blood work, ECG, etc.) 0 0 Total number of site visits Group Programs Group/collaborative programs Food-related programs Average visit time in minutes (excluding waiting) Historic Current Projected Variance previous full year visit history Current year (adjust for full year) Average program time in minutes Opening year Number of Private Site Visits (per calendar year - Jan1 to Dec 31) Variance Increased Funding for more FTE Program Transfer *Variance Factors (volumes) *Variance Factors (volumes) Adding FTEs within existing budget Total Varience Factors (must equal Variance) Small Group (5-10 participants) 0 0 Medium Group (10-30 participants) 0 0 Large Group ( participants) 0 0 Small Group (up to 10 participants) 0 0 Large Group (up to 30 participants) 0 0 *Variance Factors- Explanation: If any variance categories have been selected, provide explanation to support projected increased volumes Draft - June 19,

26 Appendix B - Room Sizes and Requirements (Space Tables) Room Name/Item Examination Room - Standard Net Area (SF) Appendix B1 - CLINICAL SPACES Requirements and Recommendations CSA Z8000 requires all items as "requirements" or "Mandatory", unless stated under the "Advisory" heading. Those under "Advisory" are recommendations. The ministry supports the "Mandatory" items as planning and design requirements. If a HCF (Health Care Facility) cannot provide the space or amenities required, the Functional Program must provide a description why the requirement cannot be met and the alternative measures to achieve the room function and requirements. 120 (a) Each examination/treatment room shall have a minimum clear floor area according to the space requirements, exclusive of fixed casework. (b) A wall mounted hand hygiene sink shall be located adjacent to the door along with a hand hygiene station at the exterior of the door on the hallway side. Note: this sink shall be used for washing of hands only and shall not be used for the disposal of waste or any other substance. See Hand Hygiene Sink requirements. (c) Privacy curtain shall be located adjacent to the door but away from door swing; another curtain dividing space around exam table may be considered. (d) Exam table shall be required to suit the function of the room. (e) Blood pressure cuff, paper towel dispenser, sharps container and hand hygiene station shall be mounted next to the exam table. (f) Soiled linen hamper and soiled garbage container shall be provided. (g) The minimum door width shall meet the requirements of the Ontario Building Code (approximately 900mm or 36") but must be wide enough to support the accessibility needs of the client profile. **see Advisory comments. (h) A minimum 1500 [5'-0"] turning circle shall be provided for standard wheelchair accessibility on one side of the exam room. (i) A minimum 1500 [5'-0"] turning circle shall be provided for standard wheelchair accessibility on one side of the exam room. (j) Sharps disposal shall be provided in a safe location and near the point of use, in accordance with Occupational Health and Safety legislation. (k) If in accordance with the HCF's record management and operational budgets, provision (l) shall be made within the room for electronic charting and access to health records. The room arrangement shall provide for access and clearance (800 mm) [2'-6"] on one side and at the foot of an adult patient as accommodated on an extended examination table. (m) If the HCF has been approved for Ontario Telehealth Network (OTN) access, provision should be made for Telehealth through room colour, lighting, acoustics, the selection and placement of furniture, and adequate space for Telehealth equipment. (n) An exam light shall be provided over the therapy area. (o) Rooms used for pelvic exams shall allow for the foot of the examination table to face away from the door. (p) Where renovation work is undertaken, every effort shall be made to meet these minimum standards. In such cases, each room shall have a minimum clear area of 9.0 sq.m. (100 SF), exclusive of fixed or wall-mounted cabinets and built-in shelves. Advisory: (a) Rooms should be laid out in similar configuration. (b) Each room should contain a work counter that can accommodate writing; staffaccessible supply storage facilities; an examination light. (c) A vision panel adjacent to or in the door may be considered. (d) The door width for examination rooms should be considered to support the HCF's accessibility plan and client profile: for example, for access to examination rooms by wheelchairs, other mobility devices, bariatric patients, and those that require other mobility support, a door width of 1050mm (41") may be considered. 20

27 Room Name/Item Examination Room Large (scooter access and/or family accommodation) Hand Hygiene Sink (HHS) Interview Room / Counselling Examination Isolation Room (Airborne Precaution Room or "APR") examination room 120 ante room 55 prep alcove 22 Appendix B1 - CLINICAL SPACES Net Area Requirements and Recommendations (SF) 140 as per requirements for Standard Examination Room but larger for family or for scooter/mobility device access. The ministry supports one Large Exam Room per facility. For facilities providing services to populations with specific cultural needs, where the patient is regularly accompanied by several people (translator, multiple family members), or, the patient population includes a large proportion of scooter users, more than one Large Examination Room may be required. This need must be clearly demonstrated by the Functional Program, with exam room utilization calculations and patient flow descriptions to illustrate that all rooms are occupied effectively. The LHIN and ministry must both provide written agreement that the need directly supports the provision of Primary Health Care services for the facility's population. If a HCF identifies the need for a larger room for more complex procedures than can be accommodated in a standard exam room, consider an additional Large Exam Room, as supported by the room utilization model. (a) Clearance shall be provided for a scooter turning circle of 1800mm [6'-0"]. (b) Depending on the clinic model and space availability, consideration should be given to two points of entry: from a patient corridor/waiting zone and from a staff/clinical work zone. 10 See "Hand Hygiene Requirements" for full requirements for the HHS and waterless hand hygiene stations as required by CSA (see Appendix B4). 120 Counselling rooms can be sized as interview rooms (2-4 people). The room should be furnished to meet the needs of the patient type. The required furnishings and arrangements to support the patient care needs and ensure staff safety should be determined by the Functional Program. Please refer to Facility Support Spaces for requirements for Interview/Counselling Rooms. In general, community health care facilities should not require the inclusion of an APR. Patients with respiratory infections can be managed through prescribed Infection Control Management procedures such as separated waiting areas, masking and gowning, and protection of health care workers through correct use of Personal Protective Equipment (PPE). Refer to Public Health Ontario for recommended procedures. The need for an APR must be demonstrated by the Infection Control Risk Assessment (ICRA) and presented in the Functional Program with a business case/rationale that demonstrates need for isolation and enhanced negative pressure air handling system, based on patient population risk and access, or lack of access to other health care services for transportation and holding of an infectious patient. Inclusion of an APR must be coordinated with the Emergency Management Ontario (EMO) and the LHIN, for example, if the HCF is a designated influenza assessment clinic. Written confirmation from EMO and the LHIN that a HCF warrants an APR must be provided to the ministry. The following requirements apply in addition to Examination Room-Standard. (a) Ventilation must meet CSA Z317.2 for Heating, Ventilation and Air Conditioning (HVAC) requirements (in addition to enhanced ventilation for the clinical area). (b) Prep Alcove: A clean area for staff to put on PPE before entering the room shall be provided. (c) A contained soiled area shall be provided outside the procedure room for staff to remove PPE and clean hands prior to entering a public corridor. (d) Layout and service requirements shall conform to current infection prevention and control guidelines (refer to CSA Z and Public Health Ontario resources). (e) Depending on the Functional Program, a two-piece barrier-free washroom, directly accessible from within the examination room and for the exclusive use of the Isolation Room and its patient, may be considered. 21