Prudent Health System planned to construct a new ambulatory care facility on its main hospital campus to provide space for urgent care, ambulatory surgery, and various hospital-sponsored clinics. The organization needed space to accommodate the following ten-year workload projections and corresponding clinical services:
- Urgent care center with 32,000 annual visits
- Ambulatory surgery center with 4,200 annual surgical cases
- Hospital-sponsored clinics: medicine (23,000 annual visits), surgery (15,000 annual visits), neurosciences (6,000 annual visits), orthopedics (16,000 annual visits)
In addition, Prudent Health planned a small express testing area to consolidate routine, quick-turnaround outpatient testing in a single area — including X-ray, electrocardiogram, and specimen collection — along with a small satellite laboratory.
A room-by-room space program was prepared based on the projected workload and other functional planning assumptions provided by ambulatory care staff. The design architect developed an initial schematic drawing and the project cost was estimated. The Prudent Health staff then developed a business plan and a financial pro forma analysis.
Because of the large amount of space programmed and corresponding high project cost, as well as high operational costs relative to the projected incremental revenue, Prudent Health’s chief financial officer asked the executive team whether it “really need a Hummer when a compact Toyota might suffice.” The executive team agreed to evaluate the impact on overall space need (and resulting capital and operational costs) of planning a lean facility.
PLANNING APPROACH
(Section Diagram)
The executive team reviewed the original operational assumptions documented in the functional program. In conjunction with the facility planning consultant, it identified several key factors that could reduce the overall size and cost of the new outpatient facility:
- Operational assumptions. Operational processes were reengineered to increase the exam and procedure room turnaround time. Weekly hours of operation were expanded, resulting in the need for fewer exam and procedure rooms. In addition to more efficient space utilization, the changes would also enhance customer service.
- Configuration of the clinics. The clinics were originally programmed based on their current organization and located in four distinct physical areas on the hospital campus. By combining the medicine, surgery, and neurology clinics into a single shared clinic, improved space use and staffing efficiencies would be possible. The new configuration also allowed the orthopedic clinic to be located on the first floor, thus eliminating one of the X-ray rooms and facilitating coverage by the radiology technicians working in the express testing area.
- Size of exam and procedure rooms and offices. Based on a review of its existing facilities, Prudent Health determined that it did not need such generously sized exam rooms and offices — for example, the clinic exam rooms were reprogrammed at 100 net square feet (NSF) versus 120 NSF.
- Facility design and layout. Alternate facility layouts were chosen that resulted in less space required for intradepartmental and public circulation corridors. Along with two fewer floors, this change substantially reduced the amount of department gross square feet (DGSF) and building gross square feet (BGSF).
COMPARISON OF FACILITY PLANNING ASSUMPTIONS AND SPACE NEED
The resulting space need is summarized in the table below. In the lean scenario, 40,000 BGSF less space is required to accommodate the same projected annual workload.
| Facility Component | Lean | Generous |
|---|---|---|
| Urgent Care Center | 8,600 | 15,000 |
| Ambulatory Surgery Center | 13,100 | 22,000 |
| Orthopedic Clinic | 3,700 | 6,200 |
| Medicine Clinic | 0 | 7,500 |
| Surgery Clinic | 0 | 5,500 |
| Neurology Clinic | 0 | 5,900 |
| Shared Clinic | 8,000 | 0 |
| Express Testing Area | 3,400 | 3,800 |
| Entrance Lobby | 3,200 | 3,200 |
| Total DGSF | 40,000 | 69,100 |
| DGSF to BGSF Factor | 1.25 | 1.30 |
| Total BGSF | 50,000 | 90,000 |
CONCLUSION
(Section Diagram)
With 40,000 BGSF less space required in the lean scenario to accommodate the same projected annual workload, the estimated project cost would be significantly reduced, particularly since the new space program required only two floors versus four, as originally planned. The Prudent Health executive team eventually decided to construct the smaller lean facility, which would also be less costly to operate than the more generous facility. Moreover, the cost savings allowed the facility to be designed to accommodate horizontal and vertical expansion in the future, as required.
Note: Detailed calculations for determining the number of exam/procedure rooms and associated support space can be found in the SpaceMed Guide.