Brenda K. Byrd

Designing for Health: Programming Beyond Space Needs

Contract Design, June 3, 2015

Programming ultimately defines the scope of design work. In the context of a healthcare provider’s complex needs, however, how does one come to understand the client beyond the shortcomings of the current facility? And as quickly as healthcare needs change, how does one incorporate flexibility to enable quick response to those needs?

Beyond space needs, there is a requirement to understand the client’s culture, technology, operations, and opportunities for innovation. Successful programming requires a project vision, effective facilitators, comprehensive data collection, and enthusiastic stakeholder involvement. In its most basic understanding, the exercise of programming involves gathering and analyzing existing data, discussing client needs, and assessing facilities. The final product is a list of departments and space needs with criteria that meet code requirements. However, healthcare spaces are arguably the most complex of any building type because life is often in the hands of caregivers working within them.

Though a space may not necessarily cause healthcare mistakes or change unwanted staff behavior, places may support or conflict with expected behavior. As designers and programmers, it is a privilege and opportunity to conceive a healthcare environment that supports its caregivers and is designed for health and healing—a place flexible enough for the future, while serving brilliantly today.

Visioning

The first objective of programming is to clearly define vision and goals with client leadership. Patient experience, operations, sustainability, and other values should be addressed during the early stages of goal setting, as they will serve as the foundation for all future decisions, design solutions, and conflict resolution. This efficiency will allow for decisions to be made early. Programming is the most cost-effective time to make decisions, so the more decisions that can be made early the better.

For example, creating value was a prioritized goal for a recently built hospital client. One of their successes was “right sizing” the patient rooms, which reduced the overall footprint by 7,000 square feet and saved more than $2 million in construction costs. The hospital now has the system’s highest patient satisfaction scores. Yes, value was achieved.

Data Collection

High-performance healthcare buildings require an integrated design approach involving all of the stakeholders on both the client and design teams. While the need to talk and ask questions in user and focus groups is inherent, other potential techniques for gathering data include:

• Badge data: This technique provides utilization data by space type throughout the study period.
• Observational studies: These are conducted to document the activities observed, typically for a full day, with 6 to 8 observations tracked.
• Raven: Using iBeacon technology, this data collection triangulates location, activity, and satisfaction through short surveys prompted on employee cell phones.
• Workflow Analysis: Compares staffing and/or space requirements for varying operational models.

Additional data allows for a better understanding of user activities, use of space, as well as how patients and materials flow; a better understanding of process and culture ultimately equates to a better solution. In addition to gathering data about the existing facilities and understanding aspirations, developing a matrix of best practices and trends provides context for decisions the client is considering. Similarly, engage the client in site tours and benchmarking, visiting—both virtually and physically—projects that contain features of interest. The results are married with the quantitative assessment of each department’s criteria and issues.

Stakeholder Agreement

Finally, a pre-design concept and program is created. The team develops implementation criteria for the space, equipment, furniture, technology, practice, and culture: a program beyond space considerations. Concepts considered will challenge the range of possible costs, time frames, and results while uncovering opportunities for innovation. Once a direction for the design is agreed upon, a validation step is highly recommended and can be fulfilled in numerous ways, including design renderings, a video walkthrough, simulation modeling, and/or Town Hall presentations and follow-up conversations.

Even a mock-up may help validate the potential design solution. Recently at a Greenfield hospital, for instance, patient room foam board mock-ups allowed the users to agree on a patient room configuration early on while programming. The stakeholders were able to make a quick, unanimous decision for mid-board toilet rooms. Therefore, mock-up rooms were incredibly effective in helping to visualize potential room options.

Design Solutions

With client feedback, the preferred ideas are further developed into drawings through blocking and stacking drawings, site development, and circulation. As the building massing develops, the team works through phasing of departmental programs. The results become the basis for design in schematic design. In addition to the analytical process, programming creates immediate and long-term value by helping clients channel their assets, people, processes, and facilities to best support their long-term goals and to encourage innovation. Programming is beyond space.