Healthcare Mock-Ups

For high capital healthcare facilities, owners and developers can request mock-up services from architects to simulate a clinic or procedural space for testing layout function and workflow efficiency with end-users. The designers gather input from clinicians, patients, and care companions on how to improve a workspace for immediate use (and to avoid costly, last-minute changes).

“The concepts of the Toyota Production System can be adapted to the design of a hospital,” said Jim Harman, Principal at ZGF Architects. “The idea is to reduce waste and non-productive tasks.”

The most expensive aspect of a healthcare clinic is the cost of the staff, he said. The best way to introduce cost efficiency is to understand clinician work processes and then organize the interior space to suit specific operational needs.

In 2016, the Health Facilities Management (HFM) and American Society for Healthcare Engineering of the American Hospital Association conducted a survey with 3,125 hospital and health system executives. 86% of their survey respondents rated patient satisfaction as “‘very important’ in driving design changes in health facilities or services.” 63% of the survey respondents said they include patients and community members in the design process of their hospitals and healthcare facilities.

ZGF’s design team mocked up the interior space for the Seattle Children’s Building Care expansion project (not a DCI project). This meant finding available warehouse space on campus and creating walls and doors of the spaces out of cardboard, including chairs or mocked-up equipment in the room. This allows the users to walk through the space and see how everything fits. If they normally come into a room and sit at a stool while the patient sits on a bed or chair, is there room for everyone? Does the door swing properly? Is there room for the sink to be used while the patient is also in the room? Newer patient rooms have hallways for the doctors to pass through separately from the patients. Mock-ups are informative in the healthcare industry because the owner and tenant know exactly how they want to use the space before they begin construction, rather than waiting for a tenant to move in and figure out how the space is going to be used later.

Imagine an operating room for a patient. The anesthetic procedure can be done in a room separate from the operating room, allowing the operating room to be prepped for the next patient while anesthesia is being administered in the induction room. This reduces time between procedures and increases productive OR time. When the procedure is done, the patient can be immediately moved into a recovery room, freeing up the OR for more procedures – and more patients can be treated.

Another scenario is designing a patient bed’s headwall to include electrical outlets on both sides of the bed. This configuration allows multiple care givers to operate equipment and tend to a patient at the same time – making the treatment time more efficient.

Healthcare Space Planning & Structure

A healthcare design team can discover space and layout efficiencies when examining work processes and creating a physical interior design. Structural engineers are introduced to the design after a mock-up exercise, Jim said. However, there are ways structural engineers can make framing systems more conducive for healthcare space planning.

• Avoid placing brace frames or shear walls between operating rooms
• Create space with fewer columns
• Provide zones free of vertical structural elements (for example, to improve line of sight)
• Design a floor plan where there is flexibility to locate walls
• Create long clear spans for structural bays
• Build a flexible environment to accommodate support equipment and technology (e.g., patient monitoring systems, computer monitors), which is always being upgraded at a healthcare facility

Since healthcare processes and technology always change, it helps to have adaptable facilities. Creating flexible healthcare spaces begins with the building structure, as mentioned by Barbara Horwitz-Bennett’s article in Healthcare Design. Experienced healthcare space planners think about the reassignment of a facility’s space for the future.

• This is particularly true when accommodating new equipment which require spatial clearances, such as mechanical, electrical, and plumbing infrastructure. CBRE Healthcare recommends 14 feet to 18 feet of floor deck height to allow for MEP and information technology systems.
• CBRE Healthcare also recommends designing structural bays between 28 feet to more than 32 feet for new clinical settings. This would allow appropriate space for surgery, imaging, inpatient, or emergency services, said Curtis Skolnick, managing director of CBRE Healthcare. The space could also be repurposed later with minimal column restrictions. Marguerite Jamieson, principal at Jamieson Architecture in Seattle, added that structural bay sizes depend on whether the facility is an inpatient or outpatient facility.
  
  “For an outpatient building, we generally think in units of 5 feet,” she said. “Exam rooms are 10 ft x 10 ft, procedure rooms are 10 ft x 15 ft or 12 ft 6 inches by 15 ft, and hallways are 5 ft.
  
  “We also think about what’s going to be the most economic space as far as creating leasable floor plan spaces - and consider column placement. We’ve found over the years that the ideal structural bays are 30 feet and 40 feet. As technology progresses adding more equipment to exam rooms, people are using larger, enhanced and more readily accessible electric modes of individual transportation. And codes continue to develop, in particular the FGI [Facilities Guidelines Institute] Guidelines, to accommodate individuals of size - room sizes are increasing, hallway widths are increasing. We are starting to look at a module of 6 feet for a standard planning block which likely alters the most functional structural grid.”
  
  
• A healthcare facility on a small urban site can expand vertically as long as the foundation and structural support system can support the load of additional floors or equipment.

The Takeaway

When designing and planning spaces for healthcare facilities, project teams emphasize intentional floor layouts for medical staff work efficiency, patient safety, comfort, and satisfaction. To achieve a built environment that resonates with end-users requires a commitment to the community – as well as foresight to adapt space for future needs and capacity. Speak to DCI’s healthcare engineering team on how to make a flexible healthcare built environment for space planning and future use.