University Hospital (UH) planned to replace three outpatient clinics, currently in different locations, in a new freestanding building. Although the number of annual visits (30,000) was not expected to grow significantly, there was considerable debate among the physician leadership regarding the planning of the new facility. Some wished to maintain the status quo regarding their current productivity and wanted to simply replace the three separate clinics in new construction. Others wanted to consolidate the clinics into a single, efficient ambulatory care space ― recognizing that reducing their staff and facility costs would make them more profitable while potentially improving customer service with more streamlined and better coordinated processes. The physician leadership agreed to evaluate the impact on overall space need (and resulting construction cost) of planning a lean facility versus a more generous facility.
PLANNING APPROACH
A number of factors were identified that would ultimately impact the overall size of the new clinic facility as follows:
- Annual visits per exam room. Currently, the three clinics averaged only 1,000 annual visits per exam room. By extending clinic hours into the early evening (and possibly Saturday) and leveling out the scheduling of physician and resident clinic sessions during the week, a target of 1,650 annual visits per exam room was deemed appropriate.
- Number of exam rooms. A total of 30 exam rooms were currently used at the three locations; only 18 exam rooms would be needed if annual visits per exam room were increased.
- Exam rooms per module. Two modules of nine exam rooms each were considered for the new facility ― versus the current clinic configuration of four modules with six to eight exam rooms per module. Using two modules, in lieu of the current four, results in a reduction of the overall clinic net square feet (NSF) due to shared patient intake/reception space, staff amenities, and other support space.
- NSF per exam room. Alternate exam room layouts were considered as the clinic standard; these ranged from a more compact exam room with 95 net square feet (NSF) to a more spacious exam room at 120 NSF.
- NSF to DGSF factor. Alternate clinic layouts were evaluated that resulted in varying amounts of department gross square feet (DGSF) to accommodate the projected NSF; the higher factor included additional internal corridors to accommodate the three separate clinics.
- DGSF to BGSF factor. Alternate architectural designs were evaluated that resulted in varying amounts of total building gross square feet (BGSF) ― the overall building footprint ― to accommodate the DGSF; the higher factor assumed an atrium, expanded lobby space, and additional space for shared public corridors, elevators/stairs, and mechanical/electrical equipment.
- Annual visits per BGSF. The resulting annual visits per total BGSF varied from 3.1 in the lean model to only 1.4 in the generous model.
CALCULATION OF CLINIC SPACE
The comparison of the lean versus more generous approach to planning the clinic space assuming the same number of clinic visits is shown below:
| 30,000 Annual Clinic Visits | Lean | Generous |
|---|---|---|
| Annual Visits Per Exam Room | 1,650 | 1,000 |
| Number of Exam Rooms | 18 | 30 |
| Exam Rooms Per Module | 8 to 12 | 6 to 8 |
| NSF Per Exam Room | 95 | 120 |
| Total Department Net Square Feet | 6,200 | 11,400 |
| NSF to DGSF Factor | 1.30 | 1.45 |
| Department Gross Square Feet (DGSF) | 8,100 | 16,500 |
| DGSF to BGSF Factor | 1.20 | 1.30 |
| Building Gross Square Feet (BGSF) | 9,700 | 21,500 |
| Annual Visits Per BGSF | 3.1 | 1.4 |
CONCLUSION
Using the lean approach, operational processes would be re-engineered to improve exam room utilization thus increasing the average annual visits per exam room. By combining three distinct clinics into a single flexible space, only 18 exam rooms would be required in lieu of the 30 at present. The current exam room size of 95 NSF was used in the lean model versus planning all the new exam rooms at 120 NSF. The more generous space layout required additional internal corridors to accommodate the three separate clinics resulting in a larger NSF to DGSF factor. A larger DGSF to BGSF factor was required with the more generous approach to accommodate an atrium, expanded lobby space, and additional space for shared public corridors, elevators/stairs, and mechanical space due to the larger footprint.
Assuming an overall project cost of approximately $250 per BGSF, the generous approach would require $3 million more (over two times as much) to construct the new clinic building than with the lean approach. Ultimately, the physician leadership decided to consolidate the three clinics using the lean approach which they felt would both increase their profitability and improve customer service. They decided, however, to increase the size of the exam rooms to 110 NSF to better accommodate the needs of different specialties and patient populations.
Note: Detailed calculations for determining the number of exam rooms and overall clinic space can be found in the SpaceMed Guide.
This article is an update of a previous post.