Identifying Space Issues and Establishing Priorities

By Cynthia Hayward
Originally printed in the
SpaceMed Newsletter
Winter 2014
www.spacemed.com

For most healthcare organizations, it is not feasible to solve all facility problems
within a given planning horizon. To make capital investment decisions during the
facility master planning process, an organization must be able to understand both
the magnitude and relative urgency of its facility problems. Ideally, all departments
and services should be evaluated against a common set of criteria to ensure that
investments are not just directed toward the squeaky wheel and to identify issues
that have not yet been identified. These criteria may range from operational concerns to issues with a departments location and internal layout, along with specific
physical plant issues. Evaluation criteria can be separated into overall facility planning issues and specific space deficiencies.
IDENTIFYING FACILITY PLANNING ISSUES
Facility planning issues for most hospital services or functional components
include:

Workload capacity the current facilities cannot accommodate recent

workload growth or where surplus capacity exists.

Operational processes such as inappropriate policies or difficulties with

staff recruiting that prevent efficient scheduling or limit the use of procedure
rooms.

Poor functional layout the internal department layout impedes smooth and
efficient work flow.

Inappropriate location the space and functional layout may be adequate

but the location is remote from related patient and support services.

Equipment/technology issues equipment is outdated or unreliable or

outdated information technology systems are still employed.

Poor image/interior design the furnishings are worn out and the interior
dcor is outdated.

Physical plant/environmental issues including issues related to

temperature control, electrical shortages, plumbing leaks, and vibration.

Code/regulatory issues where code non-compliances have been cited by

regulatory agencies and a plan for rectification must be developed.

Each of the potential issues listed above has very different cost and timing
implications for the healthcare organization.
SPECIFIC SPACE DEFICIENCIES
Specific space issues can be categorized according to the type of space that is deficient such as:

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Patient care/treatment space including prep, exam/consult, procedure, and

recovery space as well as inpatient rooms to provide an appropriate work
environment for clinicians, accommodate new equipment and technology, and
assure patient safety, privacy, and comfort.

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Identifying Space
Issues and
Establishing Priorities
Continued

Clinical support space such as clean and soiled workrooms, medication

rooms, and equipment storage space.

Staff support space such as staff offices, workstations, conference rooms,

lounges, and toilet facilities.

Customer intake space and amenities including reception, registration,

waiting areas, and other amenities (e.g., toilet facilities, food service).

Additional issues uniquely related to inpatient nursing units may include a lack of
private patient rooms, the size of the patient room, inadequate toilet and bathing
facilities, and accommodations for special patient populations (e.g., handicapped,
bariatric, geriatric, infectious disease).
The types of facility issues and space deficiencies have different implications as
well. Inappropriately-sized and configured treatment areas with outdated equipment
and technology may impact the quality of care and increase medical errors while
inadequate staff workstations may negatively impact staff recruiting and retention.
The lack of patient and visitor support space and amenities, and outdated interior
dcor and furnishings, may promote a negative first impression among the organizations customers and defeat efforts to expand market share and increase workload volumes and revenues.
USING MATRICES
As shown below, a matrix format is often used to present key facility issues in a
concise manner to identify common issues and to facilitate setting priorities during
the facility master planning process.

Customer Intake
Space/Amenities

Staff
Support Space

Clinical
Support Space

Patient Care/
Treatment Space

Space Deficiencies

Code/
Regulatory

Physical Plan/
Environment

Image/
Interior Dcor

Equipment/
Technology

Location/
Linkages

Functional
Layout

Operational
Processes

Workload
Capacity

Overall Facility Planning Issues

Emergency Department
Medical Imaging
Surgery
Physical Therapy
Laboratory
Designates Major Issue
Designates Minor Issue

As each department is evaluated against a common set of criteria, major versus

minor issues may be delineated. Each department or service can also be prioritized
according to scale that is relevant to the specific organization. For example, departments may be assigned a priority of:

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High priority requiring that an immediate or short-term solution be developed

and implemented within two years.

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Identifying Space
Issues and
Establishing Priorities
Continued

Medium priority requiring that a solution be developed and implemented within two to five years.

Low priority where the status quo is assumed or a solution does not need to
be developed or implemented within a five-year planning horizon.

The primary goal of this type of analysis is to separate those departments or services with more critical facility issues from those that require little attention over a
specific time period. This allows the facility planning effort to proceed efficiently and
in a logical and focused manner. It should be noted, however, that a department
with no facility issues may still need to be relocated or reconfigured to allow another
departments high-priority issues to be resolved.
SEPARATING PERCEPTION FROM REALITY
As shown in the graphic below, there are many reasons why department staff and
physicians may perceive that their facilities are inadequate ranging from outdated equipment or furnishings to actual code non-compliances. In many cases, the
solution is not necessarily an expanded facility. Separating staff perceptions from
actual facility needs is critical to a successful facility master planning process.

Code/
Regulatory
Noncompliances?

Physical
Plant/
HVAC
Problems?

Operational/
Information Systems
Problems?
Customer Service/
Marketing
Issues?

Perception of
Inadequate
Facilities

Inconvenient
Location?

Inappropriate
Functional
Layout?

Image/
Interior Design
Concerns?
Equipment/
Technology
Constraints?

Inappropriate
Traffic Mix?
Inadequate
Signage?

From the patient and visitor perspective, the initial first impression is also important which is why the hospitality industry invests so many dollars in its entrance
facades and lobbies. Patients may also have different perceptions and expectations
depending on their age, socioeconomic status, cultural diversity, education, and
exposure to the media. Research indicates, however, that the patients perception
of high-quality care may require more than contemporary, state-of-art facilities.
Good design should also facilitate efficient processes, eliminate clutter, and create
a productive work environment for care providers. Staff attitudes may ultimately
impact patient satisfaction more than facilities. This is why it is important to understand the actual facility issues before investing millions of dollars in renovation or
new construction.
Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC.

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