Hospital planning and programming can take years and involves a number of incremental and often very politicized steps. When significant cultural and operational change is desired, the disconnect that ensues from separate and distinct programming and design phases can be difficult to overcome. Some major pitfalls of this disconnect include an underestimation in the programming and planning of the architectural impacts of the program. This often includes restrictions imposed by the building site and a lack of awareness of the inputs users are making to the program without the architectural visualization. As healthcare facilities and systems are increasingly attempting to optimize efficiencies and reduce costs, LEAN process integration, the development of multi-functional spaces and alternate means of delivering services are increasingly being pursued. These issues benefit greatly from a less sequential, more visual and more iterative process of programming and schematic design in parallel.
For a new 200-bed / 20-OR facility project, Capital Health (Halifax) and the Nova Scotia Department of Health and Wellness recognized the pitfalls of this traditional “program first, then plan, then design” sequence and decided to combine the phases into one 7 month fast-tracked combined and simultaneous Programming/Planning/Schematic Design process. The result was a highly iterative, understandable and interactive process that forced major internal and external conflicts inherent in the project to the front of the room. This process increased the frequency of confrontation to resolve issues and the promotion of patient outcomes through space and not just square footage and adjacencies. Benefits included better understanding and buy-in by stakeholders in the process that ultimately would establish the budget for the project going forward.
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Planning Solutions by Design: Reuniting Healthcare Programming and Design
1. Planning Solutions by Design:
Reuniting Healthcare Programming and Design
Noah Epstein, M.Arch., NSAA – William Nycum & Associates Limited, Halifax NS
Mark Patterson, AIA, ACHA, EDAC, LEED AP BD+C – SmithGroupJJR, Phoenix AZ
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2. “One foremost truth I believe: It is the responsibility of the owner
to ensure that a comprehensive program is provided to the design
team prior to the commencement of design.”
The Role of the Architect in Healthcare Facilities Programming:
The Hospital Administrator’s Point of View
Janet Adams
RAIC Seminar, 24 May 1990
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3. Background
• Traditional Model / How It Developed
• Application to Healthcare Projects
• Timelines
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4. History
Healthcare Programming evolved through a need to organize the project before
starting design.
Why?
How Much?
What?
How Many?
When?
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How Long?
Where?
How?
5. Traditional Model / Timeline
Role
Study
4-18 mo.
Master
Program
Site Selection
Master Plan
Functional
Program
SD
DD
CD
TA
CA
Operations
6 mo.
0 -12 mo.
3 - 8 mo.
8 mo.
1 - 3 mo.
12 - 24 mo.
3 mo.
24 - 36 mo.
35 yrs +
4-6 YEARS
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6. Factors That Drive This Model
• PROFESSIONAL: RAIC Canadian Handbook of Practice:
• Programming and Planning part of PreDesign, undertaken as a discreet phase apart from Schematic Design
• Often tied to feasibility studies, financing requests and business case
evaluation/preparation
• BUDGET: Desire for Early Financial Planning / Cost Estimates
• SCOPE DEFINITION: Don’t want to go too far down a path before needing
to change course or delay.
• BENCHMARKS: Want ability to compare with past/other projects
early in a project’s life.
• REGULATORY: Jurisdictional Requirements and Procurement Guidelines.
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7. Traditional Concept
Go/No-Go
Project Brief/
Basic Arch.
Program
Contract 1
or
In-house
Cost Check
Programming/Planning
Contract 2
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Cost Check
Schematic Design
Contract 3
SIMPLIFIED PERCEPTION
DD…
8. Downsides to this Model
• UNDERSTANDING
• CHANGE vs. STATUS QUO
• DISCONTINUITY
• BUDGET
• TIME
• TRANSLATION
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9. “A general precept seems to be that programming should not
predetermine design solutions. Exactly where programming
should end and design begin is unclear.”
The Role of the Architect in Healthcare Facilities Programming:
The Hospital Administrator’s Point of View
Janet Adams
RAIC Seminar, 24 May 1990
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10. Traditional Concept
Go/No-Go
Project Brief/
Basic Arch.
Program
Contract 1
or
In-house
Cost Check
Cost Check
DD…
Programming/Planning
?
?
Schematic Design
?
Contract 2
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Contract 3
SOMEWHAT IMPROVED ITERATION
11. Traditional Concept
Scope Ambiguity
Project Brief/
Basic Arch.
Program
Contract 1
or
In-house
DD…
Programming/Planning
Schematic Design
Contract 2
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Contract 3
12. Traditional Concept
Approval
to Proceed
Project
Brief/
Basic Arch.
Program
Contract 1
or
In-house
Go/No-Go
Review/Submission/
Review/submission/
Approval/Procurement
!!!
Programming/Planning
!!!
???
Contract 2
???
Transition Continuity.
Rare, especially as time elapses.
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Cost Check /
Value Analysis
Schematic Design
Contract 3
ALL-TOO-COMMON REALITY
DD
13. Reuniting Programming and Design
• Technologies
• Benefits
• Drawbacks
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14. Technologies
• REPRESENTATION
• BUILDING INFORMATION
MODELING (BIM)
• WEB-BASED COLLABORATION
TOOLS AND TELEHEALTH
• ELECTRONIC SURVEYS
• SOCIAL MEDIA
• COMMUNICATION
• METRICS, STANDARDS, EVIDENCE
BASED DESIGN PROCESSES
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15. Merged Concept
Approval
to Proceed
Project
Brief/
Basic Arch.
Program
Contract 1
or
In-house
Cost Check &
Go/No-Go
Review/Submission/
Review/submission/
Approval/Procurement
Schematic Design
!!!
!!!
DD
???
Contract 3
Programming/Planning
???
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Contract 2
16. Benefits to this Model
• VISUALIZATION
• RAPID CONCEPT TESTING
• SPATIAL REALITIES
• INNOVATIVE THINKING
• ENGINEERING INTEGRATION
• COSTING ACCURACY
• SUPPORTS CHANGE
• CONTINUITY OF VISION
• ENGAGEMENT &
UNDERSTANDING
• SPEED
• ENJOYMENT!
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17. Drawbacks to this Model
• “FOREIGN” PROCESS
• Cart before the horse?
• Looser Design Sequence
• TENDENCY TOWARD DETAIL
• EMOTION / ATTACHMENT
• Drawings seen early
• REQUIRES FREQUENT REASSURANCE
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18. Precedents
• Innovative Care Flexible Facilities Project, Halifax NS
• Banner Page Hospital, Page AZ
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19. ICFF Project
• TIME: Very tight timelines
• REGULATORY: Strict Procurement and Public Tendering Policies/Regulations
• OBJECTIVES:
• Organizational Change & Efficiency
• Patient-Centred and Cost Effective Solutions
• Alignment with Concurrent Clinical Services Planning work
• Collaborative, Humble Process
• In-depth User Input and Buy-in
• Public Engagement
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22. Conclusions
• Blurred Lines of the Process = Continuity due to technology and techniques
• Evidence-based Design (EBD) facilitates the process, as current best-practices
are disseminated and adopted more quickly.
• Planning & design standards (e.g. CSA Z8000) provide a framework for critical
discussion of programming.
• Not purely a tool to shorten timelines
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23. Conclusions
• More fluid process allows planning and design to respond quickly to changing
needs and evolving vision.
• Combined process leads to enhanced stakeholder participation and buy-in.
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24. Thank you!
Noah Epstein:
Mark Patterson:
nepstein@nycum.com
mark.patterson@smithgroupjjr.com
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Notes de l'éditeur
Noah Historyof firms (WNAL Halifax, 30+ yrs; SGJJR, Phoenix +, 160 years) Vision/Importance of this presentation gained a lot of clarity from recent joint project. Represents a North American perspective. Interest in global context. Relate back to Clifford Harvey’s slide – design behind the curve. Design needs to catch up – this is one step toward that. ++ Efficiency; -- COST. Need to put everyone in the position of predicting the future.
Mark- Great idea, but… As many here can attest to, this is often not the case.
Mark
Mark Programming is not part of all project types, but is a critical step in Healthcare design. Aims to review, summarize and convey a vast amount of complex project information at the earliest stage of a project. Represents a critical translation step in conveying information from the client/clinical/operations side to the consultant team side.- BIG x BIG x BIG
Mark We all like to think that projects run in an orderly linear fashion through the typical phases. Used to be more the case. Large healthcare projects have a long life
MarkBalance of these drivers, but what about BEAUTY?
MarkBenefits to This Model:DesignBudget: Least design/consultant fees spent before financial/regulatory approval receivedCosts: Early snap-shot of costs and opportunitiesContract 1 and Programming/Planning can sometimes be undertaken by dedicated facilities/planning staffDoes not always occupy end-users and staff time or get hopes up until project is a reasonable possibilityModel makes more sense for private projects than public ones
MarkDifficulty understanding Programming without visualizationDifficulty implementing significant culture or organizational change through programming aloneTends to fall back on the existing/old way of doing thingsDiscontinuity between Programming and DesignOn the consultant side, often separate procurement processes and different, independent sets of consultantsOn the client side, often different sets of staff are consulted and different government oversight (e.g. DHW, DTIR)Program drives the Project BudgetOmissions in program often don’t become apparent until drawing startsOften, other program aspects need to be sacrificed to accommodate the omissions under the same budgetOften, significant time has elapsed between the Programming/Planning and Schematic DesignClinical needs and standards change quicklyOverall time for the process is lengthened due to discreet packaging and procurement of workConcepts and feedback can be “lost in translation” between the programming work and the translation into formI believe it is nearly impossible to achieve an optimal experience without an integrated approach.
NoahBudget usually set from Program. Either NOT ENOUGH or TOO MUCH. When done as part of two separate and distinct phases, the line is actually very clear, and THIS IS A BAD THING!
NoahAttempts have been made to address this issue.Overlap the phases…
Noah The Review/Submission/Approval/Procurement phases may happen at many different places along the timeline, so this can be even more confusing! Length of review stages can be very lengthy and appear to be getting longer.
Noah
Noah (first 3) & MarkREPRESENTATION: New technologies allow easy representation of information and rapid visualization of space in readily understandable formats (e.g. SketchUp, Revit, Database tools).BUILDING INFORMATION MODELING (BIM) technologies allow program data to readily take physical form in the planning and programming process.Shortening the feedback/iteration loop between programming and schematic designWEB-BASED COLLABORATION TOOLS AND TELEHEALTH equipment allow wider client/user involvement in design process and allow virtual facility tours and collaboration for facilitating culture-change and organizational change during early planning and design.ON-LINE SURVEYS of user groups facilitate data gathering and tracking.SOCIAL MEDIA: Allows wider informal engagement and feedback.COMMUNICATION: Constant & immediate (email, text, mobile).Ultimately, these technologies have the potential to allow early project phases to progress quickly without relying on the status quo.
Noah
Mark (first 5), Noah (second 5)As Cliff stated earlier, design must move forward in the overall process:VISUALIZATION: Can visualize the problem as it evolvesRAPID TESTING: Can test questions and show not just areas but FORMSPATIAL REALITIES: Addresses site realities in the Programming phaseINNOVATIVETHINKING: Gets everyone thinking critically – System based approachENGINEERING INTEGRATION: part of systems type approachCOSTING: More accurate costingSUPPORTS CHANGE: Can more readily implement desired culture change and organizational changeCONTINUITY: Continuity of vision between programming, concept development and designENGAGEMENT & UNDERSTANDING: Better user buy-in, engagement and understanding. Allows meaningful Public Engagement during the earliest planning and design stagesSPEED: Faster than sequential/separate PreDesign and Schematic DesignENJOYMENT: More enjoyable!
NoahPROCESS can feel foreign to those used to the Traditional ModelCan feel like putting cart before the horseStarting designing before you know the total area of the building can be uncomfortableDETAIL: Can get bogged down in higher level of detail than warranted due to introduction of drawings earlyEMOTION / ATTACHMENT: Risks clients getting “emotionally” attached to a design that is abandoned due to evolving programmatic needs.Drawings can be interpreted as decisions being made.REQUIRES FREQUENT REASSURANCECan lead to cynicism regarding the process if the process is not carefully introduced and reinforcedIf timelines are compressed too much, opportunities to think through methods are reduced.
Noah
NoahVery tight timelines (7 Months for Planning, Programming, Concept Design, Schematic Design and Business Case Development and Submission to Government)Team led by Nycum & SmithGroupJJR awarded the contract after lengthy public RFP process in Oct. 2012.Submission to Government slated for early June 2013.Strict Procurement and Public Tendering Policies/RegulationsObjectives:Organizational Change and Alignment with concurrent Clinical Services Planning workIn-depth user input and consensus-building in the planning and design processPublic Engagement in whole process
