Healthcare Facilities Programming & Planning Process; Ar. Martin Fiset

Healthcare Facilities Programming & Planning Process; Ar. Martin Fiset

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The pavilions are fully dismountable, and the pop-up character is reinforced by the use of unfinished wood. The synergy with the builders pushed the project to a higher level of execution. photographs: Basile Marée

Based on numerous factors, among them demography, a growing middle class and the introduction of healthcare insurance, the need for new healthcare facilities in India will continue to increase both in the public and private sectors.  Administrators and investors are often at a loss on how to proceed when they perceive a need for a new facility or an investment opportunity.  All too often, in their eagerness to see plans and glossy renderings, they skim over or skip altogether the pre-design stage, the actual definition of the project, thinking that by doing so, they will save time. In actual fact, time saved at the beginning is lost during the ensuring stage as the project requirements are ill-defined and the design has to go through needless iterations.

Any construction project, whether it is a renovation of a new building, goes through five specific steps: definitions, design, construction, commissioning and occupancy and operation.  The definition stage as it applies to new construction is the focus of this article.  Project definition comprises two essential steps : strategic planning and programming.  Programming is further divided in master programming and functional programming, essentially the same type of exercise at a different scale. 

In general terms, strategic planning can be defined as the process by which the guiding members of an organization envision its future and develop the necessary procedures to achieve that future. In the case of a new healthcare facility, it comprises two essential components: market analysis and business planning.  The market analysis deals with demographics and epidemiology, with competitors and potential market shares, and with regulatory constraints.  Once he organization has identified the services, it will provide within its future environment; ie: its clinical plan.  The business plan with determine under which financial conditions the project will succeed.

Architectural programming, also known as medical brief, is analysis, problem seeking in the words of William Pena, the father of architectural programming, whereas design is synthesis, problem solving. Why program? The most important incentive should be certainly that it is a powerful tool to control costs, both capital and operational. 

Architectural programming for a new healthcare facility can be divided into 2 stages: first a master program and second, a detailed functional and space program.  The master program is essentially a preliminary functional program, a rough cut to be refined later, an essential part of a project feasibility study that involves minimal investment and yet comprises all the elements necessary to define the overall scope of the project. The master program includes first summaries giving an overall picture of the project such as a description of the clinical program or product lines that the institution will offer, a definition of the major overarching operational systems to be implemented for such items as pharmacy, material handling, food and linen, information technology, anticipated workloads, the number of beds distributed by categories and a summary of all the major rooms. Further on, for each functional component, it provides information about such aspects as a scope of services offered, major policies and procedures, workload and staffing, if available, desirable interdepartmental relationship and finally, the component gross area.

It is important to note that the master program does not include a detailed list of rooms and areas but only components gross area.  A functional component is defined as rooms and spaces geographically grouped together to accommodate specific activities, such as Intensive Care Units, clinics, medical imaging, etc.  A functional component may or may not be a department, since the term ‘department’ refers to an administrative organization rather than a functional organization of space and activities.  A functional component gross area is defined as that portion of a building assigned to specific activities or services, including net areas, internal circulation, partitions, building structures and small mechanical shafts.  Large multi-speciality hospitals may comprise as many as 40-50 functional components.

One of the great advantages of preparing a master program is that it gives enough information to the architects to start conceptual design, or block schematic as it is sometimes called. On block schematics drawings, each component is represented by a block of space as per the area allocated to it in the master program and the whole network of horizontal and vertical circulations with access points link the blocks.

The functional and space program is defined as a written document that describes the services offered, defines policies and procedures that will be implemented, and identifies all the resources necessary to deliver the services. In other words, it must contain all the information necessary to build and operate the facility.

Ideally, future users should be involved in developing the program but it is usually not possible in the case of a new facility that is a replacement of an existing one.  Even then, programmes should be able to interface with surrogate users, experienced people who have the full confidence of the investor and the authority to make decisions.  A hospital is an intricate web of roles and responsibilities among several stakeholders and the program should reflect these diverse requirements.  In regards to its content, the functional program is a ‘fleshed out’ master program. It provides more detailed information and contains a detailed list of rooms and spaces with their respective area.

Once the functional program is complete, design can start. In a traditional process, stages are sequential and each activity is completed before the next one is undertaken. This brief overview of a project definition stage should encourage administrators and investors to devote to the pre-design stages all the time and resources they require: the speed of realization and success depend on it.