With your facility plan —let’s work on your operational & space program–pick a component and discuss:

This needs to be a 200 word answer APA format and reference, only one component needs to be discussed from the list below.

1. 1.  Current situation (baseline)
2. 2.  Future Vision and Planning Goals
3. 3.  Current & Projected workloads
4. 4.  Planned hours of operation
5. 5.  Equipment, Technology and Support Systems
6. 6.  Functional Adjacencies and Access
7. 7.  Future Trends and Operational Flexibility
8. 8.  Outstanding issues to be resolved

Chapter reading.

“Beginning Detailed Operational and Space Programming
ETAILED OPERATIONAL (FUNCTIONAL) and space program- ming begins once a specific project has been defined, approved, and funded. This final stage of the predesign plan-
ning process generally begins once consensus has been reached on an appropriate long-range facility investment strategy and a phasing/imple- mentation plan has been prepared. Detailed operational and space pro- grams should be prepared for immediate or short-term projects for which planning needs to commence. This process provides a forum to rethink operational processes and the use of technology such that facility investments enhance operational efficiency and improve customer serv- ice, in addition to providing newer, code-compliant, and aesthetically pleasing facilities. After administrative approval, the operational and space program becomes an “approved” document serving as a control mechanism for all members of the planning and design team during the schematic drawing and design development phases of the architectural design process. The operational and space programming document should provide all necessary information for the design architect to begin schematic design.
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139
D
DEFINING OPERATIONAL AND SPACE PROGRAMMING
Operational and space programming, as it is defined today, includes the two-step process of documenting the operational (functional) plan- ning assumptions and preparing a detailed space listing (space program). Traditionally, a list of spaces and their corresponding sizes was the only written documentation preceding facility design. Today, operational planning precedes space planning, and one document— the operational and space program—combines the results of both processes. Although the terms functional and space programming and functional space programming are commonly used, I prefer to use the term operational and space programming throughout this book to emphasize the rigor that should be involved at this critical point in the facility planning process.
The tasks necessary to develop a detailed operational and space pro- gram are among the most critical in the facility development process. From my experience, long-term operational costs often exceed the initial capital cost of renovation and construction in a couple of years. Efficient planning at this stage will save significant operational dollars in the future. Also, paying careful attention to the development of realistic workload projections and differentiating between actual space needs versus wish lists will guard against the construction of inappro- priate and inflexible space and will eliminate overbuilding.
COMPONENTS OF THE OPERATIONAL PROGRAM
The operational program should provide a description of the scope of services and operational concepts as well as the numbers and categories of people, systems, and equipment necessary to operate the specific department or service line at a projected workload level. The operational program should also address facility layout considerations, necessary and desired physical proximities, and opportunities to achieve operational flexibility and accommodate future growth. Although the outline can be tailored to meet an organization’s specific situation, typical components of the operational program are described below, along with sample text that illustrates the scope and level of detail that should be provided.
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EXAMPLE: OPERATIONAL PROGRAM FOR AN ENDOSCOPY SUITE
Current Situation (Baseline)
The current scope of services, space allocation, and location should be identified, and deficiencies requiring correction should be documented.
Mercy Medical Center (MMC) currently operates two endoscopy suites. One is located on the second floor of the Ambulatory Care Center (ACC) on the MMC main campus, and the other is located on the second floor of the Mercy East Campus (MEC) hospital.
• MMC. This suite currently has seven procedure rooms and occupies approximately 4,580 departmental square feet (DGSF). Only six rooms are used because one of the proce- dure rooms is small and difficult to use. The suite also has 12 patient prep/recovery bays that are undersized, and there is limited area for patient nourishments, linens, supply stor- age, and trash holding. There is no fluoroscopy capability within the suite, so ERCP’s are done within a dedicated fluoroscopy room in the main radiology department. Bronchoscopies are performed in the pulmonary lab with nursing coverage provided by the endoscopy department.
• MEC. This endoscopy suite is composed of five procedure rooms (four endoscopy and one bronchoscopy), occupying 4,470 DGSF. The rooms are adequately sized with contigu- ous patient toilet rooms. Patient prep and recovery func- tions occur within the shared 30-bed ambulatory recovery area on the fourth floor of the hospital.
Future Vision and Planning Goals
Strategic (market) planning and operational performance improve- ment goals pertaining to the specific department or service line should be specified to keep the planning team focused on the expected results.
MMC is considering consolidation of the endoscopy suite located on the third floor of the MEC with the endoscopy suite located on the second floor of the ACC on the MMC main campus. It is anticipated that the consolidated suite will continue to be located on the second floor of the ACC. Adjacent expansion space is
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potentially available because of the recently vacated dialysis unit (5,350 DGSF); other adjacent space currently used for private physician offices could also be relocated.
Other assumptions include the following:
• Outpatient registration will continue to occur on the first floor of the ACC, and patients will then proceed to the second floor endoscopy waiting area.
• Bronchoscopy procedures will be consolidated at MMC as well. These procedures will continue to be done within the pulmonary lab with nursing coverage provided by the endoscopy staff.
• ERCPs will eventually be moved to the consolidated endoscopy suite with the timing dependent on acquisition of a new digital unit. In the short-term, ERCPs will continue to occur within the main radiology department on the first floor of MMC.
Current and Projected Workloads
A detailed analysis of the current and future workloads for patient care functions can involve evaluation of case mix and scheduling patterns, as well as the interrelationship between the volume and timing of arrivals, desirable waiting times, and the number of procedure rooms or workstations. Identification of average and peak workloads is par- ticularly important for those services whose workload is primarily a random occurrence, such as emergency visits and obstetrics deliveries.
A total of 12,096 patients received gastroscopy or bronchoscopy procedures in 2004:
• 9,222 procedures at MMC (8,853 GI procedures and 369 bronchoscopies)
• 2,874 procedures at MEC (2,759 GI procedures and 115 bronchoscopies)
Approximately 55 percent of the total procedures are colono- scopies and 30 percent are gastro procedures. In addition, flex- ible sigmoidoscopies, ERCP, esophageal motility, TEE, 24- hour pH monitoring, and bronchoscopies are performed. Outpatient procedures represent 90 percent of the total vol- ume. The combined workload is projected to grow at a rate of
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1 percent per year assuming that all physicians from MEC move toward consolidation at MMC.
Assuming an increase to approximately 12,200 procedures (excluding bronchoscopies) over the next five years, a total of six to seven procedure rooms, four prep/holding spaces, and 14 recovery bays are required. Seven procedure rooms have been programmed to provide the flexibility to include other proce- dures (e.g., bronchoscopies) in the future.
Planned Hours of Operation
Assumptions regarding the planned hours of operation by daily shift and by days of the week should be specified.
It is anticipated that the consolidated endoscopy service will operate approximately 12 hours per day, Monday through Friday, 5:30 a.m. to 5:30 p.m. Procedures will generally be scheduled between 6:00 a.m. and 3:00 p.m. as well as on Saturdays (e.g., 8:00 a.m. to 12:00 p.m.) if staff are available.
Current and Future Staffing
The numbers, categories, and work scheduling patterns of people who will be working within the department should be documented. Staffing primarily affects the provision of administrative spaces such as offices, workstations, conference rooms, and lounges. Scheduling patterns are of particular importance in determining the number of people on the day (or primary shift) for which space is planned. Most importantly, the future types and numbers of full-time equivalents (FTEs) should be reviewed relative to projected future workloads to ensure that the new or expanded facilities do not require additional staff that cannot be justified based on workload growth.
A single manager currently oversees the combined department with team leaders at both sites. There are currently 28.95 FTEs (July payroll) as follows:
• 5.25 FTEs at MEC
• 23.70 FTEs at MMC
The proposed staffing for the consolidated department is esti- mated at 26.30 FTEs, resulting in a reduction of 2.65 FTEs even though a 5 percent increase in workload is expected with- in five years.
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Consolidated MEC MMC Staffing
Position FTEs FTEs (Day Shift)
Equipment, Technology, and Support Systems
Major equipment items and support systems should be documented because of their impact on both space need and capital requirements. Equipment units that take up floor space and other items that either represent a significant capital expense or have a direct effect on productivity should be identified. The significance of equipment and support systems will vary depending on the department or service line.
Equipment at both the MEC and MMC endoscopy suites varies relative to its age and usefulness:
• MEC. The scopes used in the four rooms at MEC are eight years old. The department is currently evaluating a lease option for Pentax scopes based on a fee-per-procedure model. The existing equipment can be used as backup equipment.
• MMC. The Olympus scopes used in the six rooms at MMC are in good condition.
In summary, no additional endoscopy equipment will be required to accommodate the combined workload. The existing radiographic/fluoroscopic room in the radiology department used for ERCP’s is 15 years old. Replacement of the radiograph- ic/fluoroscopic equipment with a digital unit should be consid- ered in the consolidated endoscopy suite.
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Manager
—
1.0
1.0
Team leader
1.0
1.0
1.0
Registered Nurse
—
1.0
1.0
Specialty Registered Nurse I
0.5
3.0
3.0
Specialty Registered Nurse II
1.0
1.9
2.5
Specialty Registered Nurse III
—
4.8
4.8
GI technician
2.75
5.0
7.0
Lead GI tech specialist
—
3.0
3.0
Tech assistant I
—
1.0
1.0
Clerk receptionist
—
1.0
1.0
Surgical services assistant
—
1.0
1.0
Total
5.25
23.7
26.3
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In particular, assumptions regarding institutionwide support sys- tems such as IT, central scheduling, and materials management should be documented and coordinated through central sources within the organization.
Preliminary operational assumptions for the consolidated endoscopy suite include the following:
• Registration. Patients are essentially 100 percent preregis- tered. Patients will complete registration and have insurance verified at the registration area on the first floor of the ACC.
• Scheduling. A centralized scheduling system is in place to optimize patient convenience and staff/physician workflow.
• Cashiering. Payments by credit card and check will be accept- ed at the point of service. Cash payments will be directed to the cashier in the Customer Service Center.
• Telecommunications. The central hospital switchboard will be used and supported by the MMC telecommunication system.
• Information systems. Order entry and results reporting will be fully automated using the ESI system. Patient demographics and archives will be available to support patient registration. Digital dictation will be continued in the consolidated depart- ment using the outsourced Medquest system.
• Medical records. The endoscopy department retrieves med- ical records for clinic patients on the day of the procedure. For all outpatients, the department creates a departmental record that is held for seven years on site.
• Linen. Linen for the endoscopy suite will continue to be pro- vided by the same contract linen service used by MMC and delivered to the department on a routine and requisition basis. With the consolidation, additional inventory will be needed within the suite.
• Medications. The endoscopy suite will be supported from the MMC pharmacy. Limited stock medications (narcotics, antibiotics, antiemetics, etc.) are kept within the suite. Ideally, a Pyxis unit should be used to track medications (MEC currently uses Pyxis.)
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• Scope processing. The endoscopy suite will continue to reprocess endoscopes. No central reprocessing of instru- ments at MMC, in support of the consolidated suite, is anticipated.
• Supply storage. Bulk supplies will be received and stored by the MMC materials management department and delivered to the endoscopy suite in retail form on a routine and req- uisition basis; supplies will be stocked on mobile carts.
• Hazardous waste. Hazardous waste will be bagged and held in the soiled utility areas until picked up by environmental services.
• Patient transportation. The endoscopy suite utilizes aides for transport of inpatients to and from nursing units.
• Food. Food service will be provided from the MMC kitchen as needed (e.g., snacks for outpatients). Staff will utilize the food court on the second floor of the hospital and a staff lounge/break room is provided within the department.
• Parking. It is assumed that sufficient parking capacity will be available at the MMC parking garage to accommodate patients/visitors. Staff will continue to park in the staff parking lot, and physicians will continue to park in the physicians’ parking lot.
Functional Adjacencies and Access
For departments involved in direct patient care, patient access should be defined, including assumptions regarding site access, parking, building access points, and unique signage and wayfinding require- ments. Optimal interdepartmental and intradepartmental functional adjacencies should also be noted.
The existing reception and waiting area on the second floor, with nearby elevator access, can continue to be used, although ideal- ly it should be reconfigured or enlarged to accommodate the additional patient volume.
Outpatients will complete registration and check-in at the regis- tration area on the first floor and then proceed to the second floor reception area of the consolidated suite. Outpatients will change within their prep cubicle or a changing booth. Patient lockers will be provided where changing booths are provided.
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A public/staff corridor connection must be maintained on the second floor to facilitate circulation between the ACC elevators and the rest of the hospital complex (via the East and West Pavilions).
Future Trends and Operational Flexibility
Planning uncertainties as a result of future trends should be identified, and opportunities to achieve flexibility should be noted as well.
Endoscopy workload fluctuations, physician scheduling pat- terns, and reimbursement changes should be closely monitored to detect their potential impact on future utilization of the MMC endoscopy suite. Because outpatients represent 90 percent of the current workload, the workload could fluctuate substantially over time depending on the physicians’ continued interest in performing these procedures at MMC versus in their office suites.
Outstanding Issues to Be Resolved
Issues that require additional input from senior management or physician leaders should be documented along with a time frame for resolution.
It is assumed that bronchoscopies will continue to be performed in the pulmonary lab at MMC. Additional procedure room capacity may be needed within the endoscopy suite if it is decid- ed that these procedures will be performed within the suite. Bronchoscopy volume is projected to be approximately 500 per year (two patients per day).
Although it appears that there is adequate procedure space for consolidating the services at the MMC campus, the existing suite is extremely deficient in support space. Relocating the prep and recovery function to the vacated dialysis area (or other vacat- ed space) and providing additional support space within the existing suite should be considered.
Although eventual relocation of the radiographic/fluoroscopic unit from the main radiology department to the endoscopy suite is planned, this move should occur at such time that the equip- ment is replaced with a digital unit (within two years). An addi- tional procedure room has been programmed that can be shelled until the equipment is replaced and the decision to relo- cate this service to the endoscopy suite is confirmed.
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Preparation of the operational program is typically an iterative process beginning with the accumulation of baseline data for the spe- cific department or functional area to be programmed—for example, current and projected workloads, staffing, equipment, space allocation, and existing deficiencies. A listing of preliminary functional and opera- tional assumptions can be developed for initial review by a designated task force charged with its development. The task force, or user group, should include department or service line leadership as well as other key stakeholders. The draft operational (functional) program narrative is refined at subsequent task force meetings (typically three meetings) and finalized. At this point, the preparation of the space program can begin.
PREPARING THE SPACE PROGRAM
Space programming is the process by which the operational program is translated into room-specific space requirements, and it can begin once the functional and operational planning assumptions are docu- mented. The space program should provide a tabulation of every room or area required with the assigned function, number (or units), area needed for each unit to perform the function, and total area required for the function. Comments for each space should also be provided regarding the location of the space relative to other spaces, the mini- mum dimensions, the major equipment items to be accommodated in the space, and any special performance or environmental require- ments as shown in Table 8.1.
Generally, the process begins with a list of spaces to be included for a selected department or functional area, proceeds to the preparation of a draft space program to be reviewed by the designated task force, and concludes with the approval of the space program by the task force members. Architectural design (schematic design) should only begin after task force members approve and sign-off on the operational and space program.
ORGANIZING THE SPACE PROGRAM
The space program should be organized by major category of space to facilitate review by different constituencies, such as the following:
• Patient intake space, including reception, registration, patient and visitor waiting, and related amenities
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TABLE 8.1 EXAMPLE: DETAILED SPACE PROGRAM
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TABLE 8.1 (CONTINUED)
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• Patient care, diagnostic, and treatment space, such as inpatient rooms, exam rooms, procedure rooms, and treatment bays
• Support space, including clean and soiled utility rooms, medication rooms, and equipment storage areas that are neither used by patients nor occupied by staff on a full-time basis
• Staff and administrative areas, such as administrative offices and workstations, conference rooms, and staff lounges
For example, physician leaders will want to pay close attention to the patient care spaces and procedure rooms, while central registration, scheduling, and information systems staff will want to focus on patient intake space. Facilities management staff will need to review the num- ber of procedure rooms that need to be equipped, and hospital leader- ship will want to review the staffing assumptions that drive the number of offices, workstations, and conference rooms.
KEY SPACE DRIVERS
A number of factors influence the type, size, and number of spaces in a given department or functional area. Key space drivers include the following:
• Workload composition, patient mix, and scheduling patterns primarily affect the type, number, and sizes of procedure rooms and patient preparation and recovery spaces.
• Equipment and technology affect the throughput of procedure rooms, which in turn affects the need for patient intake, waiting, preparation, and recovery spaces. Electronic management of information will affect the need for record storage space and will influence the flow of patients, staff, and materials throughout the department.
• Staffing and scheduling affect the number of staff offices and workstations needed as well as staff support facilities such as conference rooms, lockers, lounges, and toilet facilities.
• Codes and regulations affect the size of patient rooms, patient toilet/shower facilities, specific procedures rooms, and other space described below.
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• The organization’s mission and policies may have a significant impact on the built environment at a healthcare center. Examples that often result in increased space allocation and construction costs include the following:
â–  Decisions to invest in expansive lobbies and atriums to achieve an upscale (although sometimes ostentatious) image for the organization
â–  Degree of commitment within the organization to optimize the use of expensive diagnostic and treatment equipment such as MRI, CT, and PET by promoting extended hours of operation
â–  Inability to establish and enforce institutionwide space standards regarding office sizes by staff hierarchy, size and use of conference rooms, staff lounges, etc.
â–  Commitment to provide enhanced amenities for patients and visitors, such as comfortable lounges; dining areas; conference and education facilities; and other retail services such as gift shops, coffee shops, and an outpatient pharmacy
â–  Commitment to provide enhanced amenities for physicians and employees, such as fitness centers, education and training facilities, and daycare centers
â–  Education mission of the organization that requires classrooms, student lounges, and faculty offices
â–  Research mission of the organization that requires space for clinical trials, offices for researchers, and dry and wet lab space
ABOUT BUILDING CODES
The space program must comply with applicable building codes. The following codes vary by state or local municipality and should be reviewed and incorporated into the final space program:
• State hospital licensing rules
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• • • •
State health agency codes State and local building codes State and local fire codes State and local handicap accessibility standards
Many building codes specify minimum sizes for traditional inpa- tient rooms, procedure rooms, and other related patient care spaces (AIA and FGI 2001). The primary intent is to ensure public safety dur- ing the treatment or procedure, expedite egress for nonambulatory patients in case of a fire or other disasters, and provide accessibility for handicapped patients. Some examples of spaces for which minimum sizes are generally mandated include ED treatment cubicles, exam rooms, surgical operating rooms, labor and delivery rooms, recovery cubicles, patient toilet rooms, and private and multiple-bed inpatient rooms. The actual design and configuration of a specific room—for example, the direction of door swing or the length and width of room— and the equipment and furnishings may require minor adjustments to the space program during the design development stage.
DEVELOPING SUPPLEMENTARY CONCEPTUAL DIAGRAMS
The operational and space program will often contain supplemental “bubble” diagrams that may be drawn to scale or may simply be conceptual in nature. The intent is to illustrate department workflow, physical space proximities and adjacencies, and other concepts to educate the task force members and to communicate the intent of the operational and space program to the design architect. Figure 8.1 presents an example of a conceptual diagram that may accompany the operational and space program.
ENSURING AN EFFECTIVE PLANNING PROCESS
Historically, facility planning was often based on the wish lists of physi- cians and department managers. Unfortunately, some of the individuals who dominate the planning process move on to other organizations by the time the new or expanded facilities are ready for occupancy. Today, healthcare organizations realize that investments in facility expansion
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FIGURE 8.1 EXAMPLE: CONCEPTUAL DIAGRAM FOR AN EMERGENCY DEPARTMENT
and reconfiguration must meet the needs of changing patient popula- tions and providers during the life of the building. They cannot allow the planning process to be driven by the idiosyncrasies of a few individuals. Some healthcare organizations are challenging the more traditional bottom-up approach to operational and space planning and are choosing to embark on a more top-down approach as shown in Figure 8.2 (Hayward 2004).
Bottom-Up Approach
The traditional bottom-up approach involves the establishment of department user groups based on strict adherence to the organization’s existing organizational structure. For the traditional bottom-up approach to be successful, healthcare organizations must do the following:
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FIGURE 8.2 OPERATIONAL AND SPACE PROGRAMMING APPROACHES
• Deploy a multidisciplinary team or task force to encourage department staff to think outside of their individual silos. Cross-departmental task forces, focused on common operational processes and patient needs, facilitate the planning of flexible healthcare space.
• Prevent specific individuals from dominating the operational and space planning process.
• Use some of the new collaborative planning tools to facilitate the gathering of input and the review of preliminary outputs. This allows multiple constituencies to participate in the process—for example, construct a project web site that can accommodate online publishing of draft documents, a 24/7 review at the partici- pant’s convenience, and easy integration of their comments.
• Use industry benchmarks and external consulting expertise to validate internally generated space requirements and to introduce the planning team to new concepts and best practices in the industry.
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