Healthcare 101 Committee Member James E. Sykes, AIA, LEED AP BD+C MorrisSwitzer Environments for Health, LLC

Transcription

1 Healthcare 101: Master Planning Presenter Eduardo S. Egea, CAAPPR, AIA, NCARB Senior Vice President / Associate Principal Director of Healthcare for the Caribbean and Latin America HKS Architects, Inc. eegea@hksinc.com Healthcare 101 Committee Member James E. Sykes, AIA, LEED AP BD+C MorrisSwitzer Environments for Health, LLC JSykes@MorrisSwitzer.com 1

2 AIA/CES Compliance Statement AIA Knowledge is a Registered Provider with The American Institute of Architects Continuing Education Systems. Credit earned on completion of this program will be reported to CES Records for AIA members. Certificates of Completion for non-aia members are available on request. Please complete Form B provided in your webinar handout package and return to the or fax listed. This program is registered with the AIA/CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product. Questions related to specific materials, methods, and services will be addressed at the conclusion of this presentation. 2

3 AIA/CES Learning Objectives 1. Identify what type of useful informational gathering g is needed from facility and operational assessment 2. Apply information gathered from assessment to organization of site and building 3. Identify patient and staff operational flow patterns to organize plan 4. Identify key department adjacencies 3

4 Why is a Master Plan needed? A Master Plan is a guide for decision making prepared by identifying capital improvement needs that accommodate the future growth of a facility that include potential operational and infrastructure needs for delivering quality healthcare. 4

5 Who prepares the Master Plan? The Master Planning effort will involve a planning team (the team) of healthcare planners and architects along with other healthcare and building industry related consultants in a multiphase process. 5

6 What are the initial steps? 1. Collect the necessary hospital information, data, and drawings that will be required to develop the master plan. 2. Develop the work plan and deliverables that will guide us through this effort. 6

7 What are the initial steps? 3. Mobilize the appropriate team to document, investigate and analyze the existing facility and future planning ideas. 4. Develop concepts and strategies for the campus. 5. Combining the products of the initial phases the planning team can create a comprehensive Master Plan suitable for implementation. 7

8 What is the Intent? The new master plan should feature at least these three key characteristics. The document and plan should be: Implementable. The plan should be capable of being carried out both logistically and financially. Sensitive. The plan must be sensitive to opportunities for efficiencies and cost savings. Flexible. The plan must be able to remain viable despite future developments that may be incompatible with initial programming assumptions. 8

9 Implementation Many times one s best intent goes unrealized. The same goes for master plans that truly cannot be readily implemented. Sometimes circumstances change during the period from conceptualization to execution, other times the plans were simply not logistically ll possible from the onset. 9

10 Implementation Nearly all master plans have preceded architectural projects, therefore we are quite concerned about the validity and practicality or each master plan that we prepare. If the master plan is to be acted upon, we must adequately consider such issues as ongoing operations, integration of new engineering i components, fire and life safety issues during and after construction, and retroactive code compliance. Our record speaks to our ability to convert conceptual plans into reality. 10

11 Cost Sensitivity The typical dilemma with studies of this sort is how to achieve your objectives and goals in the context of a financial, physical, and human resource limitations. To meet this challenge, all resources must be fully and efficiently utilized, and our approach outlines development options and identifies the one that will maximize the value of available resources. 11

12 Cost Sensitivity In order to maximize resources we must identify costs both capital and operating. The team must consists of healthcare architects and engineers that will identify the capital costs consequences of various alternatives, and the hospital planners to understand d associated operating costs consequences as well. These costs will be monitored throughout the project as they relate to the various options under consideration. 12

13 Cost Sensitivity SUMMARY June 6, 2007 COST CATEGORY GROSS SQ FT $/GSF TOTAL COST 0.1 ED Addition (New Hospital Construction) 4,800 $1,486,152 (I-2 Occupancy) 0.2 Remodeling (I-2 Occupancy) 12,000 $3,754,335 16, ,240, Other Building Components 84,000 $18,804, BUILDING COST 100, ,044, Site Development 9.3% of Lines 0.1 $2,236, Site Preparation 3.0% of Lines 0.1 $721, Site Development 2.0% of Lines 0.1 $480, Site Utilities 3.0% of Lines 0.1 $721, Surveys/Test/Borings 0.3% of Lines 0.1 $72, Off-Site Development 1.0% of Lines 0.1 $240, Other 0.0% of Lines 0.1 $0 3.0 Demolition Allowance $500, Fixed Equipment Allowance 5.0% of Line 1.0 $1,202, CONSTRUCTION COST 100,800 $278 $27,983,420 13

14 Flexibility In our years of experience in health services and facility planning, we have found that nothing is as certain as uncertainty. Because the political, social, economic, and technologic circumstances surrounding health care change so rapidly, we believe that t flexibility is an essential ingredient in all planning. 14

15 Flexibility Our plans are founded in concepts and strategies. If the concepts underlying facility organization and growth are valid, the plan will be flexible. Even if the activity and facility projections are contradicted by future events, the plan will adjust to accommodate these changes. 15

16 Summary Master plans often identify short-term term measures that are consistent with long-term strategies. They also respond to immediate needs in concert with the development of a long-range plan. This tactic enables you to initiate change and dimprovement, while reserving future policy decisions. This is particularly important with the health care industry as unsettled as it is today. 16

17 Summary With this approach in mind the master planning process will apply these three key characteristics as appropriate. The following section describes the individual tasks required to execute the multi-phase process referenced above. Specific deliverables are indicated along with the corresponding activity. 17

18 Task 1: Data Collection Collect all relevant data to the master planning effort. The list of information includes, but is not limited to: Organizational structure with names and titles of the hospital from administration to department directors and key personnel that will ultimately be responsible in user group meetings; Physical space inventory by department and floor, licensed and operational bed counts and distribution, workload data and projections; Previous campus master planning documents; 18

19 Task 1: Data Collection Existing hospital building names and construction dates, applicable code information, area of site, site ownership, any adjacent property ownership, parking counts, building area and site coverage; Aerial photographs and building images; AutoCAD drawings of surveys, topography, civil, utilities, and site plans along with any zoning, height, and setback information; AutoCAD drawings of floor plans, elevations, sections of all buildings on the campus; Any existing statement of conditions, surveys from MEP engineers, traffic studies, reports from state or local authorities having jurisdiction, and the latest JCAH reviews; FAA information concerning flight path restrictions and guidelines. 19

20 Task 2: Project Organization Reconfirm the facility representative s ti goals for the project. Establish a detailed work plan for project execution. Finalize tasks, responsibilities, participants and schedules. 20

21 Task 3: Retreat for Leadership Present current trends and directions in health care design as they relate to the existing and proposed new projects. The architect will explore opportunities on the existing campus to meet these trends while building a consensus among the leadership. Establish conceptual direction for the functional and space program from the leadership of the institution. Although conceptual, this direction will be formative on the development of the program. 21

22 Task 4: Site Planning Determine the opportunities and constraints site conditions present for future facility development. Identify site conditions requiring corrective action. 22

23 Task 4: Site Planning This information is an important ingredient in subsequently determining the best use of the Hospital s land resources: Utilize provided base maps of the existing ste site and its vicinity. Analyze documented conditions to ascertain their current deficiencies and their implications for future development. 23

24 Task 5: Existing Building Analysis Assess the adequacy and appropriateness of the existing physical plant to accommodate current and future programs. Review drawings provided by the Hospital. Tour the facilities to confirm and observe major building materials and systems. 24

25 Task 6: Master Zoning Analysis Document and evaluate the appropriateness of current space allocations and the circulation systems they imply. Determine the extent to which departmental affinities are achieved, and the improvements future development could provide. 25

26 Task 7: Departmental Analysis Conduct a functional analysis of each department or unit comprising the institution. Determine the adequacy of the facilities housing each department. 26

27 Task 7: Departmental Analysis Analyze existing departmental facilities in terms of appropriateness of interdepartmental relationships: Accessibility / adequacy of functional units, support spaces and total area to accommodate current workload; Configuration; Physical condition and potential for expansion or conversion. 27

28 Task 8: Confirm Workload Projections The basis for estimating future departmental space requirements, the building block of facilities planning, is departmental workload. Workload is determined d by projected utilization, and the relationship between utilization and workload. The utilization projections should include outpatient visits, inpatient admissions and patient days by major service. These projections should be performed for 5 and 10 year horizons. 28

29 Task 9: Facility Requirement Projections Project the facilities required to support anticipated departmental activity levels. This is accomplished through a variety of techniques, depending on the departments involved. For clinical departments, the team will determine the number of functional units (operating rooms, exam rooms, etc.) required to support the projected workload. General Medical Center Operating Room Time Requirements March 29, 2007 (A) (B) (C) (D) (E) (F) (G) FY 2012 Length of Room Total Procedure Total After Hour Procedure Procedure Clean-Up Time of Procedure Type Procedures 1 - Volumes 1 = on Day Shift x (Minutes) 1 + (Minutes) = (Minutes) General - Inpatient 1, , ,300 - Outpatient 2, , ,000 4, ,300 Subtotal Vascular - Inpatient ,700 - Outpatient , ,200 Subtotal Orthopedics - Inpatient 2, , ,200 - Outpatient 1, , ,600 3, ,800 Subtotal GYN - Inpatient ,900 - Outpatient ,000 1, ,900 Subtotal Neuro - Inpatient ,250 - Outpatient ,500 1, ,750 Subtotal Total 10,700 1,191,950 Planning Assumptions 1 FY 2012 Admissions provided by GMC General Medical Center Operating Room Need March 29, 2007 (A) (B) (C) (D) (E) (F) (G) 2012 Total Procedure Operating Room Time Operating Minutes/ Capacity Rooms Rooms Type of Procedure (Minutes) Days x Day = (Minutes) Required Provided General 354, , Vascular 98, , Orthopedics 471, , GYN 103, , Neuro 163, , Total 1,191, Planning Assumptions 1 8 hours per 75% efficiency 2 10 hours per 75% efficiency 29

30 Task 9: Facility Requirement Projections Estimate gross departmental area requirements. The resulting requirements will be compared to industry standard relationships between workload and area. For administrative departments, the primary space determinant is personnel accommodated. For some diagnostic and logistical departments, it is area productivity, e.g., g, meals prepared p per square foot or lab procedures performed per square foot. General Medical Center Operating Room Time Requirements March 29, 2007 (A) (B) (C) (D) (E) (F) (G) FY 2012 Length of Room Total Procedure Total After Hour Procedure Procedure Clean-Up Time of Procedure Type Procedures 1 - Volumes 1 = on Day Shift x (Minutes) 1 + (Minutes) = (Minutes) General - Inpatient 1, , ,300 - Outpatient 2, , ,000 4, ,300 Subtotal Vascular - Inpatient ,700 - Outpatient , ,200 Subtotal Orthopedics - Inpatient 2, , ,200 - Outpatient 1, , ,600 3, ,800 Subtotal GYN - Inpatient ,900 - Outpatient ,000 1, ,900 Subtotal Neuro - Inpatient ,250 - Outpatient ,500 1, ,750 Subtotal Total 10,700 1,191,950 Planning Assumptions 1 FY 2012 Admissions provided by GMC General Medical Center Operating Room Need March 29, 2007 (A) (B) (C) (D) (E) (F) (G) 2012 Total Procedure Operating Room Time Operating Minutes/ Capacity Rooms Rooms Type of Procedure (Minutes) Days x Day = (Minutes) Required Provided General 354, , Vascular 98, , Orthopedics 471, , GYN 103, , Neuro 163, , Total 1,191, Planning Assumptions 1 8 hours per 75% efficiency 2 10 hours per 75% efficiency 30

31 Task 10: Facility Development Concepts Documentation and understanding di of the concepts underlying facility development greatly enhances plan acceptance. Invite user participation in developing these concepts and introduce the concepts developed over the course of many previous master plans and architectural projects. 31

32 Task 10: Facility Development Concepts The concepts themselves will deal with such issues as: Growth options; Centralization vs. decentralization; Traffic segregation; Inter-departmental affinities; Operating systems and access. Materials flow and handling systems. 32

33 Task 11: Alternative e Development e e Strategies es Identify alternative strategies for fulfilling projected facility requirements founded on the facility requirements and development concepts established previously. Evaluate the financial logistical, operating, and long-term growth consequences of each strategy. Review strategies with Hospital representatives for selection of a final course of action. 33

34 Task 12: Master Zoning Plan Based on the selected development strategy, adopted development concepts and projected requirements, we will prepare preliminary diagrams depicting proposed departmental t locations. Review with facility representatives ti in "gaming" " sessions to provide users with opportunity to comment on the proposed configurations and explore alternatives. 34

35 Task 12: Master Zoning Plan Refine the products of the gaming g sessions into a Master Zoning Plan. Depict departmental location and expansion, internal circulation and material movement systems, external access points and future expansion directions. Document characteristics in presentation format for subsequent review. If it appears helpful, prepare models of resulting building massing or internal zoning. 35

36 Task 14: Implementation Planning Prepare the development strategy and Master Zoning Plan with an eye to subsequent implementation. When approved, develop a step-wise implementation plan. Reflect the anticipated funding, phased land acquisition, ongoing operations, program phase-in, and necessary prerequisites to each phase. Depict graphically and in narrative form the areas renovated or constructed during each phase, along with associated activities and estimated costs. 36

37 Task 15: Final Master Plan Production Prepare the final report depicting the solutions to the studies graphically and in a narrative format mutually agreed upon. 37

38 Thank you for joining us for Healthcare 101: Master Planning Presenter Eduardo S. Egea, CAAPPR, AIA, NCARB Senior Vice President / Associate Principal Director of Healthcare for the Caribbean and Latin America HKS Architects, Inc. eegea@hksinc.com Healthcare 101 Committee Member James E. Sykes, AIA, LEED AP BD+C MorrisSwitzer Environments for Health, LLC JSykes@MorrisSwitzer.com 38

39 2010 Program Completion Form Registered Providers are responsible for reporting to the AIA/CES the names of ALL AIA members. Healthcare 101 Master Planning Program Title (same as on Form A) B100 A10101 AIA Knowledge Provider Number Program Number (same as on Form A) Provider Name Name of Person submitting this report: Phone number: Date of Program Completion: City/State: Participants at this program: (Please print or type) AIA Member AIA Member Number or Name of Participant Yes or No Non-member s 1. Yes No 2. Yes No 3. Yes No 4. Yes No 5. Yes No 6. Yes No 7. Yes No 8. Yes No 9. Yes No 10. Yes No 11. Yes No 12. Yes No 13. Yes No 14. Yes No 15. Yes No Return this form by 5pm ET the day after your program to: justinmadigan@aia.org or (fax). * Non-members who require a certificate please contact justinmadigan@aia.org.