Northern Health Authority delivers healthcare to the residents of 20 different communities that are a mix of settlements, towns, and villages. With many of the existing remote health centers in need of replacement, Northern Health decided to develop a prototype community health center that could be replicated to serve communities of less than 1,500 people — some of which are accessible only by air.
THE CHALLENGE
The challenge was to develop a community-oriented, culturally-sensitive facility focused on wellness to reflect the new “Integrated Service Delivery Model.” This client-centered approach to providing health and social services focuses on health prevention and promotion using a multidisciplinary team of nurses, social workers, mental health and addictions counselors, and other community-based and visiting staff. At the same time, Northern Health needed to provide operational flexibility with generic, multi-use and technically adaptable spaces to allow visiting and rotating staff to function efficiently regardless of which facility they were assigned to.
Northern Health contracted with a facility planning consultant to first prepare operational plans for small, medium, and large community health centers based on a demand analysis and an assessment of the existing health centers. The facility planning consultant then developed a space planning methodology and facility configuration concept that could be scaled-up or scaled-down based on the assigned staff and availability of local and regional services. This would allow a detailed operational and space program to be easily prepared for each new community health center as it is replaced.
A structured planning process was undertaken that included identifying generic spaces to be located within the health center, determining the factors that “drive” the size and number of individual spaces required, and aggregating space by its function to optimize the work flow and circulation and minimize construction costs.
FACILITY PLANNING PRINCIPLES
After review of the planned scope of services, hours of operation, projected staffing, and support service assumptions documented in the operational plan, key facility planning principles were established and include:
- The community health center should be community-oriented, culturally sensitive, and focus on wellness.
- The community health center environment should be safe and secure.
- Advanced technology should be embraced to the extent possible.
- Spaces should be multi-functional, flexible, and adaptable as programs, services, and technology evolve over time.
- All community health centers should be configured similarly to allow staff to easily work in any facility with minimal orientation.
IDENTIFYING GENERIC SPACES
All potential spaces were identified and standardized room layouts and data/specification sheets were developed for generic spaces that accommodate similar functions and can be replicated in each community health care center. This provides future flexibility as well as cost savings as rooms are similarly sized and finished instead of tailored to the occupants at a particular site.
DETERMINING KEY SPACE DRIVERS
A specific space “driver” was determined for each individual room or area to be located in the prototype community health center as illustrated below:
- Staffing dependent. The number of exam/treatment rooms, offices, consult rooms, and administrative workstations are based on the expected daily head count — including nurses, social workers, and mental health/addictions counselors, and support staff.
- Variable. The total number of exam/treatment rooms and office/consult rooms ― in which clients will be routinely scheduled during the day ― will impact the number of waiting room seats and client toilet rooms. At the same time, the size of the mechanical room depends on the overall size of the facility.
- Fixed. All other spaces will generally not vary in either number or size, regardless of the overall scope of activities and projected staffing at a specific community health center.
- Optional. In addition, the decision to include on-site provider apartments versus a single staff sleep room within the community health center will depend on housing availability within a specific community.
ORGANIZING SPACE INTO FUNCTIONAL CATEGORIES
The space planning guidelines for the prototype community health center were organized into five major categories of space which relate to specific activity zones within the prototype facility as follows:
- Public reception zone includes the main entrance to the community health center and associated public spaces and amenities.
- Client care zone includes spaces for client assessment, treatment, and counseling along with associated support space.
- Staff administrative zone is for the exclusive use of the staff assigned to the community health center.
- Building support zone includes housekeeping, storage, mechanical, and other spaces that support the facility but are not routinely occupied by staff.
- Provider housing will be located on-site and include four one-bedroom apartments with a shared entrance and laundry room.
As illustrated in the adjacent diagram, clients and visitors arrive at the community health center, park as necessary, and enter the building via the main entrance leading directly into the public reception zone. From this area, clients will be escorted to the client care zone when the provider is ready. Access to the staff administrative and building support zones will be for the exclusive use of the staff and secured from public access. Dedicated service and staff entrances should not be visible from the main entrance (e.g., at the rear of the facility) to avoid confusion.
FUTURE EXPANSION
The community health center was designed to accommodate future expansion if required. The organization of the facility into distinct “zones” will facilitate the expansion of one or more specific zones ― independent of the others ― although demand for additional client care and staff administrative space will be greatest.
Due to the economies of scale, the planned building support spaces have the capacity to accommodate a significant amount of future growth in client activity volume. Likewise, the public reception zone does not necessary need to expand proportional to the client care zone depending on whether throughput is improved, hours of operation are extended, and other factors. The provider housing can also be expanded independent of the health center itself.
CONCLUSION
By developing a space planning methodology — and a generic space programming template and a conceptual facility layout — the process of preparing an operational and space program and schematic design for each new Northern Health community health center can be expedited. In addition, this approach will result in short-tem operational efficiencies and long-term operational flexibility while minimizing construction and renovation costs.