Critical Access Hospitals & Rural Business Strategies
“Brains Before Bricks and Mortar”
1
Presentation Team and Introductions
• The Owner’s Perspective: Jeff Prochazka, Director of Strategic Planning, Methodist Health System
“Listening to The Customer”
• The Architect’s Perspective: Patrick Leahy, Director of Planning, Research and Innovation for Holland Basham Architects
“Asking the Right Questions, To The Right People”
• The Planner’s Perspective: Jim Easter, Principal, Easter Healthcare Consulting
“Why Do We Need Business Focused Leadership”
2
Important Video Linkshttp://time.com/3833111/inside-hospital-room-
future/?xid=emailshare
Planetree Story
Patient RoomOf the Future
3
The Planetree Concept Illustration
01. Human Interaction
02. Architectural Design + Healing
03. Nutrition + Diet
04. Patient Empowerment
05. Family, Friends, Social Support
06. Spiritual and Emotional Support
07. Human Touch
08. Healing Arts and Sensory Factors
09. Complementary Therapies
10. Healthy Communities (Youth + Aged) 4
Learning Objectives• O1: The Community Is a Key Partner in The Future of CAH Success. This presentation will discuss
how the “service linkages” and “community health needs analysis” can work most effectively as a win/win effort.
• O2: The involvement and orientation of the Board of Directors, provider staff, physicians and informed consumers continue as a key part of the success factors; case studies will exhibit comparative ideas and winning products for the attendees to consider and offer the opportunity to “share and compare” ideas with attendees.
• 03: The “how and why” of strategic and facility master planning will be discussed to illustrate the winning business strategies evolving from these management approaches. Selection of the “best advisors” is key to effective results…lowest bidder isn’t always cost effective!
• 04: The session will share “innovative ideas and trends” that will be helpful to facilitate discussions and compare/contract ideas with attendees. The future is ours to create and demographic forces are running just ahead of our planning and design…we must understand those factors to design appropriately.
5
Summary of Program Discussion
It has clearly been the CAH program that set in motion better healthcare delivery in America. We believe this because so many communities have re-visited their mission, vision, goals and objectives in the context of an “improved service delivery model” (linked to CAH licensure status).
The evolution of this program has; opened the door to “needs based efforts”, automatically reduced bed capacity, severed physically linked adjacencies to nursing homes, and expanded into broader based community efforts for senior care, extended care, memory care, hospice and greenhouse design nationwide.
Improved Service Delivery(Access, Quality, Cost, Outcomes)
A Needs Based Perspective On Facility and Service Developments
(What, Where, When, Why, How Much)
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Summary of Program Discussion
Facilities that were previously located in the “wrong part of town” have been re-developed to offer better access, more efficient service delivery, and overall more efficient infrastructure and design quality that meets and exceeds consumer expectations. Yes, city/county joint ventures are occurring to permit utility sharing, FQHC partnerships and regional partnerships with secondary and tertiary care partners.
This presentation will EMBRACE THESE WINNING success stories and outline ways to grow farther and faster and more effectively in the future. It is clear to the presentation team that outpatient care and alternative delivery models will evolve for many communities in the future. The next generation of the CAH program is exciting, innovative and cost effective. We hope to illustrate the ADDED VALUE OF CAH efforts and speak to our audience in “creative and positive terms”.
Location and Image(Consumers Are Changing)
Winning Success Stories(Emergency Medicine, Rural Health, Wayfinding)
Process Change7
What is Business Planning In Healthcare?(This Isn’t An Easy Question To Answer)
• Goals and Objectives• Assignments• Fact Gathering • Market Analysis, Strategy and Vision• Budgeting and Aligning Money With Expectations• Taking Risk With Money• Assessing Team Members and Customer Expectations• Measuring Results Carefully• Capital Asset Alignment and Outcomes:
- Human Resources- Facility Assets- Technology- Services
8
Key Elements of a CHNA ProcessIntegrated Strategy and Master Plan(Market Share, Space Needs, Master Plan, Process Change)
Partnership Effort On Strategy and Process
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How To Build Bridges To Other Community Services For CAH Sustainability?
TheSchool
The Hospital
The WorshipCenter
The Housing
TheRecreation
The Retail
Quality of Life + Economic Development = Our Priorities
Who Are The Players In Your Market?10
Who Are The Stakeholders…Implications?• Consumer
• Provider
• Third Party
• Government
• Physician
• Employer
• Banker
• Business
• Politician
• Community Leadership
• Education
Board Balance and Diverse
Representation Is Key!
11
Policy Making and C Suite Interface
• CAH Board Training and Management:• Value of IT and Technology
• Value of Partnership
• Value of Clinical and Physician Linkages and Partnerships
• Value of CEU, Board Awareness and Regular Awareness Efforts
Discuss Montgomery CountyCass CountyIllustrations
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TeamworkHow The CAH/CHNA Links Providers With Overlapping Objectives Into the Service Area (Kicking Ours Off Right Now As We Speak):
• FQHC
• Acute Care Partner (Regional Sponsor of The CAH)
• Fulfilling the CAH Mission and Vision Via Partnership With Care Receivers
• County Health Department
• Local Nursing Care Centers
• Mental Health Association
• Pharmacy
• Local Practitioners
• Public School System
• Business Community
CAH Responsibility.
Who Involved? Why?
Where?13
CHNA – An Overview
• New (2010) Requirements for most Tax Exempt
Hospitals (2,894 of total 4,999)
• Dual eligible (federal NFP) not required to provide
• While required, should be viewed as a useful tool to
determine vulnerable populations and health disparities in
the community
• Most hospitals haven’t utilized the information other than
to meet requirements
• Next wave of assessments to be conducted in 2016 (for
2015)14
ACO Timeline
2007
Elliott Fisher of Dartmouth Medical School publishes “Creating Accountable Care Organizations: The Extended Hospital Medical Staff.” He is generally credited with coining the phrase “Accountable Care Organization.”
2011
• 3/31/11: CMS releases its proposed rules for the “Shared Savings Program,” inviting commentary before rules are finalized.
• 6/6/11 Comment period closes.
• Final rule will be released after all comments have been reviewed.
• CMS will accept applications for ACOs and will approve or reject by 12/31/11.
2014
All first year ACOs will have reached the shared risk stage, if they have continued with the Shared Savings Program.
Beyond2010
PPACA signed into
law
• Outlines a “Shared Savings Program.”
• CMS will determine how this program is to be implemented.
32 Around USA But 1/3 Dropped Out15
Keys to Success
Successful Co-
Management Agreement
Transparency
The Necessary
Tools
A Clearly Defined Plan
Service Line Expert
Established Expectations
Physician Leadership
Active Participation
The Future Physician Relationships(Employment, Co-Management, Other)
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Key Elements of a CHNA Process
1. Data Assessment
- Service Area
Defined
- External and
Internal Sources
- Local Studies
- Community
Inventory
2. Community Input
- Public Health
- Underserved
Populations
- Chronic Disease
Populations
- Others
3. Implementation Strategy
- Summary of Data and
Community Input
- Prioritizing
- Implementation
Strategy for Each
- What is NOT included
and Why?
4. Reporting
- CHNA Summary
Report
- Implementation
Strategy Board
Approval
- Posted on Website
- 990 Reporting
5. Monitoring
- Measurements
- Annual Data
Updates
- Prepare for the
Next CHNA
What do we know? How do we package the
final material?
What are the priorities and
how do we implement?
What are we hearing?
What are we doing to track
results?IRS AuditOf Gaps!
Community Planning – CHNA
Partnership Effort On Finance, Needs and Strategy
Must ShareThe DataTo Work
Effectively!17
Assessing “Common Good” In Society
• Understanding the Basic Business Principles That Have Common Value:
• 2/3rds CAH’s would close if Congress retroactively enforces the 35mile rule.• Nebraska Map of distances between hospitals.
• See Map
• Partners with Federal Delegation
• Partnership With City/County Leadership
• Collaboration With Utility Providers (Water, Sewer, Electrical)
• Collaboration With Real Estate
• Selecting key Consultants to Support CAH
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Nebraska Impact Considerations
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Wow!93 Counties.
100 Hospitals.50+/- CAHs_?_ FQHCs
2 Medical Schools
Thinking Prior to Design & Construction
The Most Important Phase!
The Master Plan + Program = Choice/Need
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What is integration?Combining two or more elements into an integral whole
Systems IntegrationSoftwareHardware
Inter-departmental IntegrationClinicalITFacilitiesAdmin
Interdisciplinary IntegrationClinicalBusinessResearchReporting
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Why do we integrate? Save time Save money Create efficiencies Better outcomes Regulatory Pressures Staff Expectations Consumer Awareness Precision Benchmarks Transparency Safety and Security Performance Improvement
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Dictation
Nurse Call
OR Integration
Pharmacy Distribution
PACS and other Imaging
Physiological Monitoring
Wireless Communications Systems
Wireless Computers for Bed Side Order Entry
Patient Entertainment and Education Systems
Patient Admitting/Process Flow and Control of Visitors and Patients
Clinical Systems
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Visitor Networks
Voice over IP (VoIP)
All media (optical fiber, copper, coax)
Distributed Antenna Systems of Discrete Wireless Systems
Voice/Data/Wireless Networks (including traditional voice systems)
Pathways and Spaces (tray, comm. Rooms, inside and outside plant)
Cell Phone connectivity in-building including dual-band IP/GSM-CDMA
Convergence Systems
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Simplifying the nurse’s tool belt.
Fundamentals of Design for Totally Integrated IT Systems
Gather Requirements, Goals & Objectives• Plan• Budget• Design• Engineer• Specify• Procure• Install• Interface• Integrate• Test• Train• Turn-over• Manage
DO THIS FIRST!
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Outside PlantRFID and RTLS CATV/SATV/MATVEmployee TimekeepingMaster Clock/GPS Clock SystemsElectronic Signage and Kiosks SystemsAlarm and Event Management for BAS/BMSOverhead Paging and Local Intercom SystemsAudio/Visual -conference facilities, training, and controlCCTV and Access Control, Visitor Control, Intrusion Detection
All of these technologies can/should be integrated and moving toward one primary goal...
“More With Less, Long Distance and Seamlessly”!
Facility Systems To Carefully Consider
27
Departmental & Service Line Communication
Clarify Performance Expectations,Capacity, ROI,and Cost!
28
Construction Processes Considering Integration
Ideally An IPD Arrangement
Is In Process Using BIM Technology.
“Clash Detection”
Finding ProblemsBefore They Happen
29
The integration of
BIM technology at
HFR has allowed us
to explore design
ideas that were once
impossible. Now,
data from the entire
project can be
coordinated into a
single model, giving
us a thorough
understanding of
design and function.
Design Through IPD With BIM
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Money Management
• Business, Finance, Funding and Capital Development Comments
• Cash on Hand• Capital Budgeting• Special Projects• Building For Better Cash Flow• USDA Funding As One Example of Support
31
Strategy + Architecture
• Strategic Planning, Facility Master Planning and Programming Comments
• Staffing, Quality and Change Management (Hospitalists, Intensivists, Robots, Scribes, Technology)
• Step-by-Step Process• Part of Business Plan• Road map • Vision
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Opportunity +
• Innovation and Creative Considerations:• Ambulatory Care Options For Small and Rural Communities• Shifting to Free Standing Emergency Centers, Ambulatory
Surgery Center and Primary / visiting Specialist.• Creative HealthParks• Greenhouse Design for Senior Care• Memory Care and Assisted Living• Nursing Homes
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Trends & Vision(Focus on Patient + Family 1st)
Why Research?Why Plan?
Motives.Needs.
Value Added.Purpose + Perceptions.
Family.Volunteerism.
34
Key Questions
• How Will Population Based Health and Integrated Delivery Systems Impact Technology?
• Why Would “Needs Based Efforts” Apply In The Technology Arena?
• What Are The Asset Implications Of An Integrated Healthcare Delivery System?
• How Does IPD and ITD Tie Together, Or Should They?
• Will IT Programs For the Future Show An ROI and What Are The Cost Savings (mapped cost accounting)?
35
Shift From Building Master Planning (MP) to Integrated System-wide Master Planning:
Consolidation Efforts (Impact of MD Employment and Extender Efforts)
Demolition (Combined With Preservation In Some Cases)Community Linkages and Continuity of Care (Needs Based and
Population Health)Real Estate (Re-Alignment of Assets Using Technology and Creative
A/E Design plus Energy is Expensive)Process Improvements (Modular Design, Waste Reduction, Efficiency
Metrics – HCA FacilitiGroup and Ascension Medexcel+ Trimedx Biomedical Support Program)
Technology (EMR, Digital, Remote Telemedicine and Robotics)
Why: More Effective Care With Better Access/Consolidate. GPS,
Onuma, Trelligence and Revit for A/E and IPD applications.
1
36
Emergency Medicine (Industry-wide Trends)No Waiting Emergenuity ModelFree Standing EDs (Trend Driven) Free Standing ED + HealthPark Support ServicesProcess Change and Training plus Performance Focused Clinical Pathways (SA, Children, Seniors, Cardiac)Enhancement of Efficiency + IncentivesRural and CAH Partnerships (Impact of FQHC Programs)
Why: Advanced, Less Expensive, Higher Quality Service Delivery Plus ED’s Need To Be BetterTeam Members. Stronger Data Interface.
2
37
Wayfinding Innovations and Advanced PlanningFunctional and Operational Wayfinding MethodsWayfinding Behaviors, Psycho/Social Factors, Time and
PerformanceSignage, Branding and Image EnhancementWayfinding CommunicationsWayfinding Management and Capital Project
Integration of Wayfinding With PlanningLess Consumer and Provider StressContextual Programming + FunctionalityAttitude AdjustmentsPeople + Ambassadors + StaffThe HUMAN WAYFINDING Chain
Why: Better Interior Design and Less Stress for ALL!
3
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Rural Health and Shifting Service Delivery DynamicsCAH Transition (25 + 10 Utilization Shifts). ADC = 8+/-CAH Move to Free Standing ED and Post Acute ModelHealthPark Applications With Modular and Flexible
Components (Re-Alignments and Re-Purposing for Efficiency Purposes)
Rural Health Linkages to Post Acute, Rehab, Nursing Home, Assisted Living, Memory Care, etc.
CAH Partnerships and FQHCs, Medical Home Models,TeleMedicine, Robotics, Centralized Clinical Support
Centers (Clinical and Asset Implications)Leveraging Regional Partnerships and Economic Development (City, County, State, Public Health,
Industry and Family)
Why: Rural Areas Are Changing, It Is Time To Change.
4
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Sharing Ideas and Impressions(The Future Is Not Here Yet…Hard To Predict, Trends Are Easier)
• Regulatory Impact (ACA and Private Pay – ACO a little too fast…move toward Co-Management with MDs).
• Mergers, Acquisitions and Network Partnerships.
• Community Health Needs Assessment (CHNA).
• Certificate of Need (CON).
• Guidelines and Standards of Practice.
• Research and Regional Implications.
40
Operations + Assets(Strategy, Buildings, Systems, Access, Process and Economics)
Old Fragmented Obsolete Low Tech Poor Environment Non – Compliant Wrong Location Image Safety
PartnershipsResource Re-Alignment
System UpgradesSmaller
Higher CapacityLess Maintenance Dollars
Shorter StaysFriendlier Staff
Safer + Modular + FlexibleSMARTER ARCHITECTURE
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• Understanding The Dynamics and The Situation
• Changing Systems, Processes and Methods
• Community Linkages plus Demands
• Cost Reduction, Waste Reduction and Change
• Real Estate Re-Alignment and Savings (Energy, Rent, etc)
Integrated System-wide Master Plan(Full Continuum, Multiple Sites, 30,000 Foot Perspective)
42
Integrated System-wide Master Plan(Full Continuum, Multiple Sites, 30,000 Foot Perspective)
• Situation
• Cultural Work Up + Data Collection
• Asset Work Up, Inventory + Image
• System Work Up, Capacity + Conditions
• User Perspectives
• Consumer Perspectives
• Clinical Perspectives + Needs
• Size, Time, Money and Priorities
• Debt Capacity
• Decisions + Action
43
The ED Is The WindowTo The Community
(Demand, Exchanges, Convenience, Portal of Entry, Poor PC Support)
LastingImpressions!
44
Emergency Department Planning
45
The Free Standing ED, Urgent Care and New Models For
The Future(12 Hr Turn Around, Less Liability, Case Management Team, Follow Up, Network and Family
Friendly Effort)
Geriatric + W/IMedicine
Clinical Pathway(One Illustration)
46
The Rural Health Situation(CAH, Step Down, Post Acute, ED, Free Standing ED orPossibly Innovative HealthPark Model; Less Costly and No Waste)
47
B Model – M odest Reductions
M ASTER ZON IN G (M Z)
Conceptua l Design Our MP studies have illustrated the OPTIMUM HEALTHPARK but not a “precise application” on behalf
of the TRHMG smaller versions that may be more applicable to suburban and rural areas. In order to
prepare the prototype models, one must make some “gross assumptions” . In this case, we will TEST OUR
concepts with staff early in 2013 (scheduled for February briefings at this time).
Prototype M odels Plus Smaller Components
The development of these models is actually a reasonable way to begin a “prescriptive and iterative
process” which provides both CASE STUDIES and illustrative models that may be creatively adapted to the
TRHMG/ TRHMC regional services. Changes will occur as the MP process evolves due to the system-wide
adjustments in staffing, IT system enhancements and process improvements. These models will combine all
the existing services and “ test” as mentioned previously, new linkages that may not be readily apparent at
the onset. Briefly, each model; the A Model -- Full Scope, B Model -- Modest Reductions and C -- smaller
model all move toward the preferred groupings identified at the start of the MP process. (see representation
at left).
Each illustration decreases in size from 82,547 GSF to 49,586 GSF and finally, 33,988 GSF. The Excel
back up programs have been designed to permit a “careful and methodical selection” of rooms and
services that ultimately build the “preferred prototype” project. Smaller versions of these models can drill
down to the very basic services for example, the following:
A 9 E/ T Physician Clinica l Practice (No Diagnostic Support) New Construction:
o 10,070 BGSF (1,119 per MD)
o $2.0 to $3.0 M Total Project Cost Including All New Equipment
A Free Standing 6-Room Urgent Care Center Only:
o 5,710 BGSF for 6 Rooms plus Support
1. $1 - $1.5 M Total Project Cost Including All New Equipment
C Model – smaller model
Scope
A Model – Full Scope
A Model – Full Scope
Scope
A Model – Full Scope
A – C Models Developed By Size, and Proportional
To Need, Scope and Situation
48
Imaging
ASCSurgery
Pre/Post Recovery
Lab
Women’sService
FSED or Urgent
Care
Pharm
PhysicalRehab/Fitne
ssCompMed
InfantCare
Co
nco
urs
e o
r M
all
MO
BC
afet
eria
CommunityEducation
Eng
SleepCenter
“A Clinically drivenAnd ACO FriendlyCenter”
“Outpatient = Instant Referral”
Spa
ALot of
Parking +ADA
spaces
ConvenienceOptimumVision + GrowthDirectionImpressionsHealthPlace FitnessAlready An IssueRegional ImpactClinical Pathways:
-Seniors-Women-Infants-SA/Pain/Addicition-Education -Prevention
Spiritual
WellnessCtr
CommunityOutreach
ALot of
Parking +ADA spaces
An IDS Friendly HealthPark With ED Hub
Retail:
PharmacyDME
CosmeticApparelPodiatricWellness
Other
An Important Rural Opportunity!Less Expensive + More Appropriate.It’s About The Outpatient Package.
49
What is Programming in a Traditional Sense? A PROGRAMMING MATRIX FOR HOSPITAL PLANNING
GOALS FACTS CONCEPTS NEEDS ISSUES
FUNCTIONMission Statistical Data Service Groups Space Requirements Unique and important
Maximum Number Area Parameters Departmental Groups Room By Room Performance standards
Individual Identity Manpower/Workloads People Groups Equipment that will ultimately
People Interaction/Privacy Utilization Trends Special Activities Systems/Services shape/drive function and
Hierarchy Of Values User Characteristics Priority Parking Building design.
Activity Security Community Security Outdoor Spaces
Progression Value of Loss Sequential Flow Building Efficiency
Relationships Segregation Time/Motion Studies Separated Flow Functional Alternatives The existing building is
Encounters Behavioral Patterns Linkages/Networks obsolete...should be
Efficiency Space Adequacy Separated Flow replaced.
Mixed Flow
Relationships Can't recruit physicians
FORMSite Elements Site Analysis Enhancement/QA Quality (Cost/SF) Major considerations that
Site Land Use Climate Conditions Climate Control Environment and Site will ultimately impact
Property Ownership Code Survey New Image/Character Influences On Cost building function and
Environment Neighbors Engineering Survey Safety design quality.
Individuality Soils Analysis Special Foundations
Quality Direction FAR/GAC Density
Access/Egress Surroundings Interdependence The building is in the wrong
Image Physiological/Psychol. Home Base Location
Quality Level Cost/SF Network
Efficiency Orientation/Access No land available nearby.
ECONOMYAmount Of Funds Cost Parameters Cost Controls Project Budget What is the general attitude?
Return on Investment Maximum Budget Allocation Of Resources Operational Costs related to the initial budget
Cost Effectiveness Time-Use Factors Multi-Functional Debt Capacity expectations and real project
Initial Budget Operational Cost Market Analysis Merchandising Life Cycle Costs cost and that relationship
Capital Costs Income/Reimbursement JV/Investment Energy Costs to project quality standards?
Operating Costs Maintenance Energy Source/Costs Energy Conservation Loan Capacity
Capital Expenses Economic Data Cost/Benefit Reserves
Life Cycle Life Cycle Reductions Competition
Equipment Activities/Climate Design Related Groups
Systems/Energy Historical Position Capital Cost Pass Through
Automation Credit Rating
TIME Preservation Significance Adaptability Escalation Implications Of Change, Growth
Master Plan Behind/Ahead Phased/Staged Phasing Plan on the overall long-range
Past Static/Dynamic Space Parameters Tailored/Loose Fit Workplan performance of service
Change Activities Convertibility
Present Growth Projections Expandability
Controls/Limits Linear Schedule Concurrent Schedules Leadership is key
Future Occupancy Date Progress Interchangeability
Revenue Streams Limiting Factors Fast Track Conservative leadership today.
What Is The Statement Of The Problem....Opportunity?
To create a more
efficient hospital
Zoning requires a 50’ set back with
a 5 story max. height
The budget is $50 M total project cost.
Funding?
Use a CM and prepare early
release packages will help us open
quicker
What does LEED gain our
community, building users
and staff?
Doesn’t it Cost more to achieve the LEED status?
We’ve converted
to CAH, now we
must down-size
We prefer the
PlanetreeConcept
Is
GreenhouseDesignMore
Expensive?
56
Integrated ProjectDelivery (IPD)
Is On The Horizon
For The Future.
CAH Concept and Development Options
Diagnostic
and Admin
OP
Clinic
Office +
Admin +
Education
Surgery/Recovery
Imaging Suite
Laboratory
Emergency Department
Inpatient PT/Rehabilitation Services
Cardiopulmonary/RT
Sleep Lab
Pharmacy
Outpatient Clinical Services
Oncology Clinic
Dietary/Dining Fast Foods Variety
Materials Managment
Central Sterile Processing
Plant Operations
Housekeeping Only (Laundry at Nursing Home)
Staff Facilities
123
A
Three Building
Mall Concept…
IP Bed Pod2 – 25+
63
Program + Master Plan = Design
Excellence
The Architectural Program should be a key
aspect of the hospital campus master plan (MP).
The precursors to programming include: Owner and User Orientation to Process
Establish a Planning and Programming Leadership Committee
Completion of a Strategic Plan (Usually by Staff or Consultant)
Completion of a Campus Master Plan (MP) By Healthcare Consultant/Architect
Completion of Building Gross Program (All Departments Sized Using Various
Methods)
Formal Approval of the MP and the First Phase Projects to be Programmed
Ideally, the Departments Are Programmed
Simultaneous With the MP
Process…Better Results! (Often a Fee Issue With Owners) 65
What is Facility Master Planning (MP)?1. A “full service” road map for the hospital system and/or campus.
2. A “building study” based on mission, vision, strategy and actions.
3. A process that addresses all issues and then decides…to “build
or not to build”.
4. A MP reaches closure through “consensus” on objectives.
5. A MP includes more “health and healthcare information” than the
“traditional program”
6. A comprehensive MP includes a program.
Differences between a MP and a Program:1. Master planning is the “road map” and quite often the “visionary strategy”
while the program ties down the details suitable to conduct basic A/E design
services. A MP will also begin “early conceptual design and master zoning of
departmental services”. The MP might reveal strategies other than construction:
• Sell the facility.
• Move to a site.
• Conduct a feasibility study or a fund raising campaign.
• Seek a “systemwide partner” or close due to poor market share.
.66
Beginning Our
Capital Campaign
67
An Illustrative Budget Summary
Category of Cost Area/Unit Cost per SF Sub-Total RemarksA. Raw Const Light
0 $0 $0.00
0 $0 $0.00
0 $0 $0.00
71,636 $250 $17,908,897.00 Need Estimator Review
71,636 Hospital Only W/O MOB
B. (Allowance All New ) N/A None Required
C. (Allowance) N/A $1,500,000.00 12 - 15 Acres Range of Development (TBD)
(Allowance) N/A $0.00 (Parking, Sewers, Landscape, Misc)
D. $19,408,897.00 Requires Architect Verification
E.
$1,164,533.82 For Budgeting Purposes Only
$194,088.97 Assume 1% for Discussions
$0.00
CM Fee/Costs $0.00
F. (Assume 6% x D) $1,164,533.82 Early Estimate For Budgeting Only
G. $5,822,669.10 Some Credit for Existing Items
$388,177.94
H. $194,088.97 Permits, Legal and Admin. Support
I. Contingency $1,164,533.82 Assumes No Complications At Site
J. $0.00 By Owner
K. W/Line A Above Assume 4 Years (2 Yrs. Inflation)
$29,501,523.44 Budget For DiscussionTOTAL ESTIMATED BUDGET
(Line "D" plus "E" - "K")
(Assume 6% x D)
Debt. Service On Loan (Separate Budget)
Inflation To Mid Point (Separate Budget)
(6% Over 2 Years to Mid Construction)
Moveable/Fixed Equipment (Assume 30% x D)
Communications Equip. (Assume 2% x D)
Administrative Costs (Assume 1% x D)
Interior Designer (Assume 1% xD))
CM Cost Allowance (Assume Fixed Fee)
(Assume 03% x D)
Furnishings & Furniture
CONSTRUCTION COST (SUM of A-C)
Professional Fees
Architect/Engineer (Assume 6% x D)
New Const MOB
New Construction
Structured Parking
Fixed HVAC/El Equip
Site Development/Preparation
Site Development/Signage
Replacement Project Budget Illustration
Preliminary Order of Magnitude
P R O J E C T B U D G E T A N A L Y S I S
First Test for Discussion
Demolition
New Const Service
Size Linked to Cost Key Factor
70
Other Site Plan
Studies For
Campus Plan…
Location
Access
Growth
Image
Value
ROI
71
Other Site Plan Studies For Campus Plan
72
73
Thank YouQuestions, Thoughts and Suggestions
75