space planning guide for community health care facilities (2014!12!22) (1)

8/20/2019 Space Planning Guide for Community Health Care Facilities (2014!12!22) (1)

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Space Planning Guide for

Community Health CareFacilities

DECEMBER 2014


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Ministry of Health and Long-Term Care

Copies of this report can be obtained from

Health Capital Investment Branch

Email: [email protected]

INFOline: 1-866-532-3161

TTY 1-800-387-5559

mailto:[email protected]:[email protected]:[email protected]:[email protected]


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NoteThe Ministry of Health and Long-Term Care (MOHLTC, the “ministry”) develops and issues

technical and policy documents to provide information, advice and guidance to Health ServiceProviders (HSP) and those who plan, design and construct healthcare facilities.

This planning document has been developed as a tool to provide information on the space

planning and design of community-based healthcare facilities that aligns with and supports theministry’s capital planning review and approval process. This document is not intended to cover

entire technical submission requirements for any particular stage in the ministry’s capital

planning review and approval process; users are cautioned not to use it as a stand-alone

document.

ContributorsThis document was developed with input from the Association of Ontario Health Centres, YorkUniversity Faculty of Health, Ministry of Health and Long-Term Care Health Promotion

Division, Local Health Integration Network Liaison Branch and Primary Health Care Branch andPublic Health Ontario.


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Table of Contents1.0 Introduction ........................................................................................................... 1

2.0

About the Guide .................................................................................................... 2

2.1 Purpose ..............................................................................................................................2

2.2 Intended Users ..................................................................................................................2 2.3 Development of the Guide ................................................................................................3

2.4 Related Documents ...........................................................................................................3

2.5 How to Use the Guide .......................................................................................................4

3.0 The Ministry’s Planning and Design Objectives: “OASIS” ............................... 5

4.0 The Guide .............................................................................................................. 6

Part A: The Facility's Role and Size .................................................................................. 6

A.1 Program and Service Definition........................................................................................6 A.2 Types of Programs and Services and Space .....................................................................6

A.3 Programs and Services and Capital Funding Eligibility ...................................................7 A.4 Space Needs and Developing a Master Plan.....................................................................7

Part B: Client Activity and Space Needs ........................................................................... 8

B.1 Types of Spaces ................................................................................................................8

B.2 Workload and Effective Room Utilization .......................................................................8

B.3

Workload Data Table – Appendix A ................................................................................9

B.4 Staffing and Space Needs .................................................................................................9

B.5 Determining a List of Rooms ..........................................................................................10

Part C: Determining Total Space Needs ......................................................................... 12

C.1 Room Sizes and Functional Room Requirements – Net Square Feet (NSF) ..................12

C.2 Additional Design Factors to Reach the Total Area .......................................................12 C.2.1 Future Growth and Flexibility ........................................................................................13

C.2.2 Grossing Factors: Component Gross Square Footage (CGSF) and Building Gross

Square Footage (BGSF) ..................................................................................................14

C.2.3 Applying the Grossing Factors .........................................................................................15

Part D: Design Considerations ........................................................................................ 16

D.1 CSA-Z8000-11 Canadian Health Care Facilities ............................................................16

D.2 Infection Prevention and Control (IPAC) .......................................................................16 D.3 Building Systems for Community-based Healthcare Facilities – Class “C” ..................16

D.4 Building Legislation, Codes and Standards ....................................................................17


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Space Planning Guide forCommunity Health Care

Facilities


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1.0 IntroductionCommunity health care facilities deliver a range of primary health care services. These are

services that the public can access close to home in non-hospital facilities. These servicesinclude: health assessment, diagnosis and treatment services, counselling and therapy services,

education and support, as well as services to provide linkages to other on-site and outreach programs. These are services that do not need to be administered in a hospital.

The ministry provides oversight for the planning and design for the following types of

community-based health care facilities:

Community Health Centres (CHC)

Aboriginal Health Access Centres (AHAC)

Community-Based Mental Health Programs

Community-Based Substance Abuse (Addictions) Programs

Long-term Care Supportive Housing (typically supporting programs for the frail elderly,acquired brain injury, physically disabled and HIV/AIDS)

This Space Planning Guide (“Guide”) is a planning tool designed to assist community Health

Service Providers (HSP) to develop a proposed capital project for submission to the ministry forapproval. The Guide supports current government priorities and recognizes fiscal challenges by

assisting HSPs with the effective use of limited capital resources to plan high quality health care

environments. The planning principles in this Guide promote “right-sizing” a facility to support efficient delivery of the HSP’s services and to limit excessive operating costs over the facility’s

lifetime.

The Guide will not replace the detailed work of the HSP and its planning and design consultantteam to develop a facility; but it provides essential information that reflects the ministry’s capital

funding structure and outlines the ministry’s facility planning expectations for a community

health care setting.

For Supportive Housing facilities, information in this Guide may be of assistance for clinical

interview or counselling rooms, multi-purpose space, administrative spaces and general buildingsupport rooms. The Guide does not address resident sleeping rooms, residential and relatedspaces.


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2.0 About the Guide

2.1 PurposeThe purpose of the Guide is to:

Establish a basic set of space-related parameters that meet the ministry’s planning and design objectives for the operational efficiency, accessibility, safety, security andinfection control measures appropriate to the community health care setting;

Identify the maximum amount of space that the ministry will provide funding for in anapproved community capital project; and,

Outline the basic steps to develop the space needs of a community health care facility.

The Guide was developed in conjunction with the ministry’s “Community Health Service

Provider Cost Share Guide” and it is intended that these two documents are used in tandem

when planning proposed community capital projects. These two resources provide the

information necessary for HSPs to understand the types and amount of space the ministry willcost share

1 for approved community capital projects to meet program and service delivery needs.

The Guide’s focus is to provide guidance in defining space allocation and , in doing so, does

make reference to some technical building considerations necessary to health care facilities.

However, the purpose of the Guide is not to provide complete technical facility design guidance.

For technical building requirements such as building codes, electrical /emergency power,heating, ventilation and air conditioning, infection control, sterilization procedures and

construction-related issues, the HSP and its design team must refer to the applicable legislation,

codes, standards and other best practice industry sources.

2.2 Intended UsersThe Guide is intended for the following individuals and groups:

Administrators to develop an estimate of their facility’s space needs;

Functional programmers, architects and engineers to ensure that planned space meets best practice design and ministry planning, design and funding requirements;

Other technical and health care professionals such as infection control and occupationalhealth and safety personnel; and,

Ministry staff to confirm compliance with space and functional requirements that meetthe ministry’s planning and design objectives (“OASIS” – see Section 3.0).

1 Cost Share otherwise known as shareable costs (def): The amount of a total project cost that the

ministry can provide capital funding for under ministry cost share guidelines (i.e. not all costs in a capitalproject can be funded by the ministry. The non-shareable costs are the responsibility of the HSP).


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The Guide is written to provide generic information so that both the principles and specifics can

be applied consistently to a variety of community health care facility types. It is the role of the

HSP to determine which components of the Guide are most applicable to its programs andservices.

2.3 Development of the GuideThe Guide incorporates consultation with community health care facility stakeholders; inputfrom various levels of Health Capital Investment Branch; and, input from other Ontario

government programs such as Local Health Integration Network (LHIN) Liaison Branch,

Primary Health Care Branch, Health Promotion and Public Health.

It also consolidates elements of Canadian health care facility standards and other health care planning guidelines to present a comprehensive set of recommendations for the community-

based, primary health care setting.

2.4 Related DocumentsCapital Plann ing and Approvals Process DocumentsThe ministry’s capital planning review and approvals process consists of various stages. Each

stage builds on the information and level of detail of the previous stage. This Guide should be

used in conjunction with the following ministry documents:

The MOHLTC-LHIN Joint Review Framework for Early Capital Planning StagesToolkit , November 9, 2010 (MOHLTC-LHIN Toolkit)

Community Health Service Provider Cost Share Guide

Capital Planning Manual (1996)

Legislation and Regulati ons

For all capital projects, it is the responsibility of the HSP to ensure that project submissions arecompliant with all legislation, codes and standards, such as, but not limited to the most current

versions of the Ontario Building Code; the Ontario Fire Code; the Electrical Safety Act, other

CSA standards for health care facilities, the Accessibility for Ontarians with Disabilities Act; the

Occupational Health and Safety Act and future issues of these regulations.

CSA Z8000-11 Canadian Health Care Facil it ies (CSA Z8000)

Appendix B of the Guide incorporates and adapts the applicable components of CSA Z8000 for

primary and community health care facilities. Released in November of 2011, CSA Z8000 sets

new national standards for the planning and design of a wide range of health care facilities,including acute care, but extending to primary care and ambulatory settings. CSA Z8000 is not

legislated; however, it is accepted by the ministry as the best practice standard for Ontario health

care facility design. In the absence of another Canadian standard for community health carefacilities, this ministry Guide is based on the CSA Z8000 and future issues of it.


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The ministry strongly recommends all HSPs purchase of copy of CSA Z8000 and become

familiar with its overarching principles and specific recommendations, as applicable to the

HSP’s programs and services.

http://shop.csa.ca/en/canada/landing-pages/z8000-canadian-health-care-

facilities/page/z8000?source=Topsellers_Bestsellers

2.5 How to Use the GuideThe Guide is organized in four parts:

Part A: The Facility's Role and Size

Part B: Client Activity and Space Needs

Part C: Determining Total Space Needs and Appendix B (Space Tables)

Part D: Design Considerations – Reference to CSA-Z8000

The sequence of Parts A through D reflects the basic steps of space planning which can be

described as: Establishing the program parameters;

Developing fundamental spatial relationships to support functional programming;

Arriving at a total facility area estimate; and,

Refining the space needs to support building systems and meet detailed room functions.

The Guide should be able to assist administrators and their consultants to arrive at an initial totalspace budget/estimate of floor area needed to meet the facility’s operational objectives and safely

and effectively deliver programs and services.

This initial space budget will not replace a detailed functional and operational program and

facility design, but it will provide the initial assumptions that reflect the ministry’s capitalfunding policy. Once a space budget is defined, it can be verified through more detailed planning and design with the input of the HSP and its planning and design team including

functional programmers, architects, engineers and an infection control professional (ICP).

As the design progresses, the planning and design team should refer back to the details of

Appendix B: Room Sizes and Requirements to ensure that the final room designs address thenecessary technical requirements. These technical requirements incorporate CSA Z8000 and

other CSA standards and therefore, reflect current, recognized best practice in Canada.

At any time, please contact the ministry for assistance on use and application of the Guide.

http://shop.csa.ca/en/canada/landing-pages/z8000-canadian-health-care-facilities/page/z8000?source=Topsellers_Bestsellershttp://shop.csa.ca/en/canada/landing-pages/z8000-canadian-health-care-facilities/page/z8000?source=Topsellers_Bestsellershttp://shop.csa.ca/en/canada/landing-pages/z8000-canadian-health-care-facilities/page/z8000?source=Topsellers_Bestsellershttp://shop.csa.ca/en/canada/landing-pages/z8000-canadian-health-care-facilities/page/z8000?source=Topsellers_Bestsellershttp://shop.csa.ca/en/canada/landing-pages/z8000-canadian-health-care-facilities/page/z8000?source=Topsellers_Bestsellers


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3.0 The Ministry’s Planning andDesign Objectives: “OASIS” A fundamental goal in the planning and design of capital health care projects is to create anenvironment that enables health services to be delivered in a most effective and efficient,accessible and safe manner while respecting the needs of patients or clients, and staff. Capital

resources should be used effectively so that all capital projects are built as a long-term

investment for the community they serve.

The ministry’s planning and design goals and objectives are captured under the ministry’s“OASIS” principles. These principles also form the fundamental principles of CSA Z8000.

O perational Efficiency; Accessibility, Safety and Security, Infection Prevention and Control;

and, Sustainability

When undertaking a capital project, the ministry expects that these objectives will be met.Please contact the ministry for more information on the OASIS objectives


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4.0 The Guide

Part A: The Facility's Role and Size

A.1 Program and Service DefinitionCreating a “list of rooms” is the end-product of the early planning phases of a facility. Before

beginning to identify individual rooms or the physical layout of the facility, the program/serviceneeds should be developed. The HSP should determine the needs of its client population

regarding: the client population; programs and services; a vision of how staff can most

effectively deliver the needed programs and services; and, the required staff complement. These

parameters are outlined in more detail in the MOHLTC-LHIN Toolkit for the Pre-Capital,Proposal and Functional Program submissions. For more information on defining service

delivery, please contact the LHIN.

A.2 Types of Programs and Services andSpaceDefinition of the programs and services that will be delivered from the facility is an importantstep to understanding the general space needs of the facility.

The following program and service categories are typically found in community health carefacilities:

“Core Program” health care services: These services include: health assessments;diagnosis and treatment; counselling; primary mental health care; chronic disease

management; health promotion; family planning; coordination with outreach community

care providers, and others. These programs are typically defined through the programsand service agreements that the HSP has with its operating funding agency (LHIN).

Allied Health services: These services include a range of clinical support services thatcomplement the clinical care team and contribute to the client’s health and well-being as

part of an integrated care approach. Services may include: physiotherapy; occupational

therapy; speech therapy; social work; chiropody; and, spiritual care.2 These programsmay or may not be defined in the organization’s service agreements.

Other programs: These programs are commonly referred to as “community partners” andmay include outreach workers from other organizations; community food programs;

2 CSA Z8000-11, Canadian Health Care Facilities; November, 2011; CSA; p. 244.


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youth programs; and, many others. In some cases, these programs are not LHIN funded

programs (e.g. may receive municipal funding or funded through a charitable foundation

or program).

A.3 Programs and Services and CapitalFunding EligibilityTo define early planning space estimates and for budget planning purposes, the HSP should be

familiar with which programs receive operational funding from the LHIN and those partner

programs that are funded through other sources such as a municipal funding program, charitablefoundation, outreach hospital program, another ministry, or other non-ministry, government

agency.

The capital costs for the construction of space for partner programs that do not receiveoperational funding from the LHIN are not eligible for ministry funding under the ministry’s

funding allocation for community projects. In such a case, other sources of funding will need to be secured to build the partner space. Please refer to the Community Health Service ProviderCost Share Guide and consult with the ministry to identify and confirm funding eligibility for

partner organizations.

It is important for the HSP to understand which programs can receive capital funding from the

ministry and which cannot. The total availability of capital funding from all sources will impact

the affordability of how much space can be constructed.

A.4 Space Needs and Developing a MasterPlanA master plan explores the potential for developing a specific site for the facility. When a

facility is planning to occupy a site over a period of time, the master plan helps to identifyimmediate and future needs. Multi-service, large hospitals require a master plan that envisions

how the facility will expand and replace itself over a 30 - 50+ year timeframe, usually on a large

campus or across multiple sites. Smaller community health care facilities typically have a 15 -20 year planning term and are often located in leased space within commercial buildings or in

single buildings with infrastructure similar to a medical office building.

Depending on the size and scale of the community HSP, the “master plan” may be a plan of a

property and a proposed new building; a plan of an existing single building to be renovated; or, a

floor layout within a multi-tenant building. The project may be new/purpose built or a tenant

leasehold improvement project. If the HSP envisions staged or phased growth over time, theministry requires a master plan that illustrates the expected growth phases.

In either case -- new build or leasehold -- prior to selecting a location, building or space, it is

necessary to define the overall amount of space needed to meet the immediate programs/service

needs and account for some future growth or flexibility. The next step will describe how toidentify the initial space needs to inform the master plan.


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Part B: Client Activity and SpaceNeedsSpace needs are typically identified through the creation of a Functional Program, whichincludes detailed information to describe the programs, workload and staffing and spatialrequirements and layout (or “block diagrams”). For more information on the Functional

Program, please refer to the MOHLTC-LHIN Toolkit .

B.1 Types of SpacesThis Guide categorizes spaces into two types of activities:

1) Clinical Space*: rooms required for primary health care staff to perform their corefunctions and clinical support rooms (e.g. general waiting areas, exam rooms, counselling

rooms, specialized care rooms, labs, medical staff offices, and medical/clinical utilitysupport rooms).

*The term “clinical space” is not intended for counselling space for interviewing clients

and/or families for non-physically based condition treatment or education.

2) Facility Support Space: non-clinical rooms and areas for administration and communityactivities and functional rooms. These are grouped as follows:

Administrative Support Spaces – required to support the delivery of primary andallied health care staff (e.g. reception, general waiting areas, work areas, staff facilities)

Shared Spaces – shared by both core program and allied health staff to deliver programs (e.g. interview, counselling and meeting rooms, kitchens)

Cultural Spaces – special rooms required for the delivery of core health care programsthat are directly related to the culture of a specific patient/client group (e.g. traditional

healing, meditative or ceremonial spaces)

Building Facility Support Spaces – rooms required for the facility to be functional(e.g. garbage, storage, mechanical and electrical)

B.2 Workload and Effective RoomUtilizationThe relationship between operations and space should result in most effective usage or “right -

sizing” of physical space; that is, all rooms are used with the least amount of time vacant or“down time”, while allowing for some flexibility for unexpected or informal use.

The ministry does not support assumptions that individual, dedicated rooms are required for

single functions or “one-time” events unless there is clinical or program evidence.


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Opportunities should be identified where staff and group activities can share space based on

effective scheduling. The number of common areas should be carefully planned to eliminate

down time and facilitate sharing across programs.

The following are a few examples of preferred relationship between operations and space:

Exam Rooms and Waiting Room Size: Standard exam rooms should be planned to beflexible for different uses and occupied 80% of the time. Using data such as annualvisits, appointments or encounters; clinic hours; and, how long patients stay in a room

will guide the optimum number of rooms and numbers of people in a waiting room.

Clinical Office Space: Collaborative team space with workstations in a shared space withaccess to a swing or spare office for privacy should be planned as opposed to dedicated,

private offices.

Meeting Rooms: Effective scheduling of the programs should facilitate sharing of roomsacross multiple program groups, or rooms subdivided for flexibility. If the facility’s full

programming is met and there is still scheduling time available, the space may be

considered for use for other community partners. Using data such as number of grouptypes, frequency and length of group sessions and a draft schedule will help determine

the optimum number of rooms.

Administrative Offices: Number of staff; function (full-time/part-time); hours ofuse/frequency; and, privacy needs should be used to determine whether private offices,workstations or shared offices are appropriate.

B.3 Workload Data Table – Appendix ATo determine the activity of the facility and effective room utilization, the organization shouldhave information on how many patients it services, the range of services being provided and how

patients are being treated, such as on-site or “face-to-face” visits with health service providers

and telephone consultations. The number and types of visits is information needed to determine

the type and amount of physical space needed to deliver those services. The “Workload Data”table in Appendix A is a tool to provide an overview of this information.

The ministry will request this table to be completed and submitted as part of the project early

planning development process. The ministry will review the table to assist the organization in

determining the optimum number of rooms for the appropriate functions. For assistance oncompleting this table, please contact the ministry.

B.4 Staffing and Space NeedsStaffing is also an important factor in determining space needs. The ministry is only able tocommit capital funding for space that has operational funding committed to it. Typically,

community HSP operational staffing budgets are determined by the LHIN. An HSP may

find that the LHIN has a fixed operational budget for the staff, despite a projected increase in

client volumes. In such as case, where the HSP may be planning for more space to supportincreased volumes, the ministry recommends that the HSP work with its LHIN to review the

relationship of staff to volumes to ensure that the number of funded staff can reasonably


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manage the anticipated volumes. Please refer to the MOHLTC-LHIN Toolkit for the LHIN’s

process for review, alignment and endorsement of the program and services, which includes

service delivery capacity.

If the LHIN’s review and endorsement confirms an increase to the operational budget foradditional staff to meet projected increased volumes, then the ministry is able to support

space to accommodate more space to meet those volumes (with the assurance that increased budgets and recruitment will be achieved).

If the LHIN cannot endorse operational budget increases for additional staff, the ministry

recommends that the organization develop alternative solutions to address demand. Forexample, increased hours could be considered, or an area for future expansion or future off-

site facilities could be envisioned as part of a master plan (should future additional staff

funding be approved).

B.5 Determining a List of RoomsOnce the programs and services, staffing and workload have been assessed and their impact onspace determined, a list of rooms can be determined:

Clinical and group rooms through analysis of activity, workload and utilization;

Efficient administration space determined through evaluation of staff needs;

Remaining rooms required for the facility to fully function. See Table B1.

The following table is a sample list of rooms that could be found in a community health centre.

Each facility will have its own complement of rooms based on specific programs and functions.

Table B1. Example of a Room List for a Community Health Centre

Reception Area Shared Meeting/Multipurpose Spaces

Reception Desk with Intake Interview Area Meeting Room(s) (# and size based on activity)

Waiting Room (incl. Child area) Storage for meeting room supplies/furniture

Scooter/Stroller Parking Refreshment Station (optional)

Public Washrooms (access to) Demonstration Kitchen (Diabetes Programming)

Medical Records Room Cultural Spaces (specific to functional program)

Clinical Area Administration Spaces

Examination Rooms Administration Offices and workstations/shared areas

Interview/Counselling Room(s) Building Support Rooms

Medication Area (room, or cupboard) IT Server / Telephone Room(s)

Clean Utility Room Housekeeping Room

Soiled Utility Room Electrical and Mechanical Rooms

Patient Washroom(s) (single, barrier-free) Mechanical Room

Practitioner Work Spaces Garbage / Waste Holding Room

Swing Office (with Team model) Storage


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Table B2. Space Needs Table

After all rooms and spaces have been identified, a Total Space Needs Table can be created. Please contact the ministry for a sample Space Needs template table.

The table should be organized using the format shown below:

Program FTE(related to

Program

Staff (#) RoomType/

Function

Area perRoom (SF) Number ofRooms Total Areaof Rooms Variance fromoriginal planned

Area (%) *

RoomRequirements

* add column after initial submission for comparison between planning stages

Ar ea per Room - Room Size

Appendix B of this Guide presents sizes of each room type that is eligible for capital funding by

the ministry. These room sizes reflect the recommended areas as per CSA Z8000 and the limits

of ministry funding capacity. The HSP should use the Community Health Service Provider Cost

Share Guide as a companion document when developing the space needs table. Please refer toPart C of this Guide for description of Appendix B.

The total area of these room sizes will result in the “net area” of the facility, excluding spaceneeded for circulation. The subsequent development of the net room areas into the total building

area of the facility (sometimes referred to as “the gross-up”) is described in Part C of the

document.

A space needs table that identifies the rooms, net areas and eventual total building area issufficient for the Pre-Capital or Proposal stage as outlined in the MOHLTC-LHIN Toolkit . At the

Functional Program stage, the additional sections of the table are to be completed.

Space Vari ance

As planning progresses, changes to room size and/or requirements are likely to occur. The

planning team must note the difference and provide an explanation in the Variance column. Forroom size, the variance should be described in both square feet difference and as a percentagefrom the original Area of Room.

This version of the Space Needs table, which “tracks” the variances should be completed andsubmitted with each capital stage submission.

Please contact the ministry for a sample Space Comparison template table.

Room Requir ements

Each room should have a defined function or range of functions based on the program or services being delivered or performed. In addition to program-specific functional needs, the

“Requirements and Recommendations” in the Appendix B Tables must be included. These

Room Requirements can be documented in the Space Needs table or separately.

The organization should include an Infection Control Professional (ICP) as part of its planningteam. The ICP should be involved at this early stage to ensure infection control measures are

accounted for in the early planning decisions and subsequently incorporated in room

requirements. The ministry will use Appendix B to review the planning submissions and will

request clarification or revision where there are discrepancies.


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Part C: Determining Total SpaceNeeds

C.1 Room Sizes and Functional RoomRequirements – Net Square Feet (NSF)The Room Sizes and Functional Room Requirements Tables (“Space Tables”) in Appendix B are

defined in two major categories:

Clinical Support Spaces

Facility Support Spaces

The Space Tables provide a complement of rooms that may occur in a community health carefacility. Each room has an assigned Net Square Foot area (NSF) and a list of Room

Requirements and Recommendations.

The NSF defines the net amount of space for each room type, not including space for circulation

or building structure and thickness of walls (building structure and exterior wall thickness is onlyrequired to be calculated in new-build projects).

The Room Requirements and Recommendations column define the ‘mandatory’ and ‘advisory’.

The advisory items are recommended if they are appropriate to the program needs. It is the

responsibility of the HSP and its consultants to ensure that the mandatory requirements and

appropriate advisory elements are incorporated in the early planning space estimates and atsubsequent detailed design.

A total Net Square Foot (total NSF) area is the result of adding the total room net areas.

The NSF for each room is a guide, representing recommended sizes based on CSA standards forfunctionality and infection, prevention and control and the ministry’s funding limits.

If rooms are sized larger than in the space tables in Appendix B, the ministry will require LHIN-

endorsed clinical or program evidence demonstrating the need for the increase and LHIN support

for the operating cost impact. Please refer to the Community Health Service Provider Cost ShareGuide.

C.2 Additional Design Factors to Reachthe Total AreaPlanning factors must be applied to the total NSF to achieve a Total Building Gross SquareFootage (BGSF). These include:

Future Growth and Flexibility


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Component Grossing Factor

Building Grossing Factor

C.2.1 Future Growth and FlexibilityTo accommodate minor changes and/or growth in core programs, the ministry may support up to5% of the total net area to be added to the total NSF. For Community Health Centres, this space

is intended to support growth and flexibility for the primary care or clinical program (as opposed

to group space or administrative space). For other community HSPs, it is intended for general

program-related areas. The ministry will review a variety of factors in its consideration of thespace (e.g. effective utilization of the planned spaces, lease terms, location etc.).

Any projected growth above 5% must be submitted to the ministry for review. The HSP should

work with the LHIN, using client profile projections and any data that the facility has tracked

and can demonstrate as evidence for growth.

Soft Space Planni ngFuture growth/flexibility space can be accommodated adjacent to the clinical zone or core

program area by using spaces that can be converted with minimal capital investment. Forexample, storage, office space or interview rooms that can be easily relocated could be planned

adjacent to the clinical zone. If the soft space is intended for future clinical functions, the

mechanical ventilation of this space should be designed with the potential to provide enhancedventilation requirements with minimal alteration.

Future Growth and Flexibility

Up to 5% of the total NSF or an actual area.

This number becomes the new total NSF.


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C.2.2 Grossing Factors: ComponentGross Square Footage (CGSF) and

Building Gross Square Footage (BGSF)The following factors are recommended to be used at early planning stages to estimate overall

space budgets. Variables such as existing space configuration, structure or special programneeds may change the actual area represented by these factors. As planning progresses into

detailed design, the actual areas should be measured and compared against these factors.

i ) Component Gross Square Footage (CGSF)

To account for the space required for circulation between rooms and zones, at early planning

stages, a planning factor is applied. This factor results in the Component Gross Square

Footage or “CGSF”. At later design stages, this area can be calculated on the drawings by

the design team and compared against the assumed CGSF planning factor.

The ministry expects planning to be efficient and balanced to minimize circulation space, yet

ensure safety and quality to achieve good patient flow, workflow and staff movement and

support accessibility.

i i ) Buil ding Gross Square Footage (BGSF)

To account for the thickness of exterior walls, minor vertical engineering spaces (plumbing,

ventilation and electrical) and any vertical spaces such as stairways and elevators, anadditional factor is applied to the CGSF. This factor results in the Building Gross Square

Footage or “BGSF”.

For new-build projects , the BGSF factor must be applied to ensure that cost estimates

account for construction materials and building configuration.

For leasehold projects, there is no vertical space or exterior wall thickness to calculate. The

extent of the space is the rentable boundary. Therefore, the “CGSF = BGSF”.

Common Space: For leasehold projects, the facility will share some spaces with other

tenants (e.g. common lobby / main entrance areas, service rooms, vestibules, stairways andelevators). The lease must clearly define these spaces with an associated area and lease rate.

The HSP will be responsible to pay for the use of that space within the agreed-upon rent from

its operational budget. Common space is not added to the total area and is not included in thecapital funding used to construct the space.

The Landlord is responsible for all basic upgrades to those areas, and therefore, any upgradework should not be included in the capital costs. However, if the facility requires specialized

improvements, it should consult with the ministry to determine if the capital improvements to

those spaces would be eligible for ministry funding support.


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C.2.3 Applying the Grossing Factorsi ) CSGF: For leasehold and new-bui ld projects:

i i ) BGSF: New-bui ld projects

For new build projects, an additional grossing factor beyond the 35% factor is required toaccount for the thickness of exterior walls, minor vertical engineering spaces (plumbing,

ventilation and electrical) and any vertical spaces such as stairways and elevators (if more

than 2-storeys).

Component Grossing Factor

Apply a factor of 1.35 (+35 %*) to the total NSF to arrive at the total area of thefacility (within exterior walls).

35% should accommodate the circulation space necessary to link together the netspaces and area occupied by internal walls. Projects may experience a lower factor

once the building design is refined.

For leasehold projects: the CGSF is the total gross floor area for the capital project.

*35% represents a blend of areas within the facility. Once floor plans have been developed,the actual circulation area should be measured and documented.

Building Grossing Factor

Apply a factor of 1.15 (+15 %*) to the CGSF to arrive at the BGSF.

The BGSF is now the total building area of the capital project.

Projects may experience a lower factor once the building design is refined.

*15% represents an approximate building gross up for recent new build projects. Once floor

plans have been developed, the actual building gross up area should be measured anddocumented.


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If the ventilation requirements are not addressed in early planning, designing to these standards

late in project planning or retrofitting results in unnecessary cost increases and delays. The

ministry expects that facilities will be designed to meet the CSA standards and these systemsaccounted for in early capital cost budgets and more detailed cost estimates.

D.4 Building Legislation, Codes andStandardsAll facilities must be designed to meet applicable legislation, codes and standards. The ministryexpects that all facilities will be in compliance with the Ontario Building Code.

The Ontario Building Code references many standards as “good engineering practice”. These

include the Fire Code, the Electrical Safety Act and relevant CSA standards for health care

facilities. Establishing criteria for items such fire and life safety for building occupants, cabling

requirements, emergency power needs and plumbing requirements will impact budget planningand possibly, site selection. Incorporation of the impacts of these requirements should be

addressed as early as possible in the planning process.

5.0 ConclusionThrough the use of this Guide, health care facility administrators and planners should be able to

arrive at a total space requirement for the capital project by applying the progressive steps of program definition, effective room utilization and staffing needs, matched with the careful

assignment of rooms to support functions.

The ministry encourages that at all capital planning stages, the HSP and its design team strive for

the effective use of space to create a safe and quality environment for the delivery of health care.

Please contact the ministry with any questions or for assistance in the application of this Guide.

6.0 ImplementationThis Guide will be distributed by the ministry to community health care sector stakeholders as anapproved guidance document for the planning and review of community capital proposals.

Comments and/or questions are welcomed and can be directed to the information at the front of

the Guide. Feedback will be collected by the ministry for consideration for future revisions.


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7.0 BibliographyCHIR (Canadian Institutes of Health Research); http://www.cihr-irsc.gc.ca/e/44079.html

Canadian Standards Association CSAZ317.1-09 - Special Requirements for Plumbing

Installations in Healthcare Facilities

Canadian Standards Association CAN/CSA-Z317.2-10 - Special Requirements for Heating,

Ventilation, and Air-Conditioning (HVAC) Systems in Healthcare Facilities

Canadian Standards Association CSA Z317.13-07 - Infection Control during Construction orRenovation of Healthcare Facilities

Canadian Standards Association CSA Z8000-11 - Canadian Healthcare Facilities

Capital Planning Manual (1996), Ministry of Health and Long-Term Care, 1996

COMMUNITY HEALTH CENTRES TAKE BIG STEP FORWARD Community HealthCentres Will Increase Access to Primary Care, Strengthen Communities; News ReleaseCommuniqué; Ministry of Health and Long-Term Care/ Ministère de la Santé et des Soins de

longue durée, July 17, 2006, 2006/nr-082

Declaration of Alma-Ata, International Conference on Primary Healthcare, Alma-Ata, USSR, 6-

12 September 1978; http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf

Facility Guidelines Institute (FGI) 2010 Guidelines for Healthcare Construction, Facility

Guidelines Institute, Washington D.C.

Generic Output Specifications - Beta GOS (2008). Ministry of Health and Long-Term Care.

Health, Not Healthcare – Changing the Conversation. 2010 Annual Report of the Chief

Medical Officer of Health of Ontario to the Legislative Assembly of Ontario, December 1, 2011

Looking Back, Looking Forward - The Ontario Health Services Restructuring Commission

(1996-2000) A Legacy Report , The Ontario Health Services Restructuring Commission(HSRC), March 2000

MOHLTC‐ LHIN Joint Review Framework for Early Capital Planning Stages Toolkit,

November 9, 2010

Ontario’s Action Plan for Healthcare: Better patient care through better value from ourhealthcare dollars, February 2012, Ministry of Health and Long-Term Care

Ottawa Charter for Health Promotion First International Conference on Health Promotion

Ottawa, 21 November 1986 WHO/HPR/HEP/95.1;

http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf

http://www.cihr-irsc.gc.ca/e/44079.htmlhttp://www.cihr-irsc.gc.ca/e/44079.htmlhttp://www.cihr-irsc.gc.ca/e/44079.htmlhttp://www.who.int/hpr/NPH/docs/declaration_almaata.pdfhttp://www.who.int/hpr/NPH/docs/declaration_almaata.pdfhttp://www.who.int/hpr/NPH/docs/declaration_almaata.pdfhttp://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdfhttp://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdfhttp://www.who.int/hpr/NPH/docs/declaration_almaata.pdfhttp://www.cihr-irsc.gc.ca/e/44079.html


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Appendix A – Workload Data TablePlease contact the ministry for a copy of this form and any questions regarding the form.

Facility Name:Date submitted:

Project Name and HCIS #:Completed by:

Historic Current Projected Variance

previous full

year visit history

Current year

(adjust for full

year)

Opening year

Opening Year

minus Current

Year

Total number of patients with one or more site visits in year

Total number of phone encounters with patients in year


Private Visits

previous full

year visit history

Current year

(adjust for full

year)

Opening year

Opening Year

minus Current

Year

Confirmed

funding for

incremental

FTEs

Program

Transfer

Adding FTEs

within existing

budget

Total Varience Factors (m ust

equal Variance)

MD Primary Care 0 0

Mental Health/Psychiatric Services 0 0

NP Primary Care 0 0

0

Counselling, education and treatment programs (private)

Rehabilitation 0 0

Health Promotion 0 0

Illness prevention/Education 0 0

Diabetes Education 0 0

Maternal/Child 0 0

Social Work 0 0

Traditional Care (e.g. Aboriginal Healer) 0 0

Counselling 0 0

Geriatrics 0 0

0

Allied Health

Physiotherapy 0 0

Occupational Therapy 0 0

Speech Therapy 0 0

Audiology 0 0

Dietician 0 0

Podiatry/Chiropody 0 0

0 0

Other

Diagnostics (blood work, ECG, etc.) 0 0

Total number of site visits 0 0 0 0 0 0 0 0

Group Programs


previous full

year visit history

Current year

(adjust for full

year)

Opening year

Variance Increased

Funding for

more FTE

Program

Transfer

Adding FTEs

within existing

budget

Total Varience Factors (m ust

equal Variance)

Small Group (5-10 participants) 0 0

Medium Group (10-30 participants) 0 0

Large Group (30-100 participants) 0 0

Food-related programs

Small Group (up to 10 participants) 0 0

Large Group (up to 30 participants) 0 0

Draft - June 19, 2014

*Variance Factors (volumes)

Number of Private Site Visits

(per calendar year - Jan1 to Dec 31)

*Variance Factors (volumes)

*Variance Factors- Explanation: If any variance categories have been selected, provide explanation to support projected increased volumes

Group/collaborative programs

Hours of operation per day

SelectStage of Project:

(usedrop down options)

Average visit time

in minutes

(excludingwaiting)

Explanation (short reason for variance)

Variance

Primary Care

Operations Overview Information

Workload Data for Community Health Service Providers

HSP to complete all cells highlighted in yellow

NOTE: Site visit information (one patient may

access one or many services). Populate only

services provided.

Add or delete categor ies as required.

Average program time in minutes

Funding Status

(use drop down options)Select

Operating days per year


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Appendix B - Room Sizes andRequirements (Space Tables)

Appendix B1 - CLINICAL SPACES

Room Name/Item

Net

Area

(SF)

Requirements and Recommendations

CSA Z8000 requires all items as "requirements" or "Mandatory", unless stated under the "Advisory"

heading. Those under "Advisory" are recommendations. The ministry supports the "Mandatory"items as planning and design requirements. If a HCF (Health Care Facility) cannot provide the

space or amenities required, the Functional Program must provide a description why the requirement

cannot be met and the alternative measures to achieve the room function and requirements.

Examination Room -

Standard

120 (a) Each examination/treatment room shall have a minimum clear floor area according tothe space requirements , exclusive of fixed casework.

(b) A wall mounted hand hygiene sink shall be located adjacent to the door along with ahand hygiene station at the exterior of the door on the hallway side.Note: this sink shall be used for washing of hands only and shall not be used for thedisposal of waste or any other substance. See Hand Hygiene Sink requirements.

(c) Privacy curtain shall be located adjacent to the door but away from door swing; anothercurtain dividing space around exam table may be considered.

(d) Exam table shall be required to suit the function of the room.(e) Blood pressure cuff, paper towel dispenser, sharps container and hand hygiene station

shall be mounted next to the exam table.(f) Soiled linen hamper and soiled garbage container shall be provided.(g) The minimum door width shall meet the requirements of the Ontario Building Code

(approximately 900mm or 36") but must be wide enough to support the accessibilityneeds of the client profile. **see Advisory comments.

(h) A minimum 1500 [5'-0"] turning circle shall be provided for standard wheelchairaccessibility on one side of the exam room.

(i) A minimum 1500 [5'-0"] turning circle shall be provided for standard wheelchairaccessibility on one side of the exam room.

(j) Sharps disposal shall be provided in a safe location and near the point of use, inaccordance with Occupational Health and Safety legislation.

(k) If in accordance with the HCF's record management and operational budgets, provisionshall be made within the room for electronic charting and access to health records.

(l) The room arrangement shall provide for access and clearance (800 mm) [2'-6"] on oneside and at the foot of an adult patient as accommodated on an extended examinationtable.

(m) If the HCF has been approved for Ontario Telehealth Network (OTN) access, provisionshould be made for Telehealth through room colour, lighting, acoustics, the selectionand placement of furniture, and adequate space for Telehealth equipment.

(n) An exam light shall be provided over the therapy area.(o) Rooms used for pelvic exams shall allow for the foot of the examination table to face

away from the door.(p) Where renovation work is undertaken, every effort shall be made to meet these

minimum standards. In such cases, each room shall have a minimum clear area of9.0 sq.m. (100 SF), exclusive of fixed or wall-mounted cabinets and built-in shelves.

Adv isory :

(a) Rooms should be laid out in similar configuration.(b) Each room should contain a work counter that can accommodate writing; staff-

accessible supply storage facilities; an examination light.(c) A vision panel adjacent to or in the door may be considered.(d) The door width for examination rooms should be considered to support the HCF's

accessibility plan and client profile: for example, for access to examination rooms bywheelchairs, other mobility devices, bariatric patients, and those that require othermobility support, a door width of 1050mm (41") may be considered.


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Room Name/Item

Net

Area

(SF)


Examination Room –

Large

(scooter access and/orfamily accommodation)

140 as per requirements for Standard Examination Room but larger for family or forscooter/mobility device access.

The ministry supports one Large Exam Room per facility. For facilities providing

services to populations with specific cultural needs, where the patient is regularlyaccompanied by several people (translator, multiple family members), or, the patient

population includes a large proportion of scooter users, more than one LargeExamination Room may be required. This need must be clearly demonstrated by theFunctional Program, with exam room utilization calculations and patient flowdescriptions to illustrate that all rooms are occupied effectively. The LHIN and ministrymust both provide written agreement that the need directly supports the provision ofPrimary Health Care services for the facility's population. If a HCF identifies the needfor a larger room for more complex procedures than can be accommodated in astandard exam room, consider an additional Large Exam Room, as supported by theroom utilization model.

(a) Clearance shall be provided for a scooter turning circle of 1800mm [6'-0"].(b) Depending on the clinic model and space availability, consideration should be given to

two points of entry: from a patient corridor/waiting zone and from a staff/clinical workzone.

Hand Hygiene Sink(HHS)

10 See "Hand Hygiene Requirements" for full requirements for the HHS and waterless hand hygienestations as required by CSA (see Appendix B4).

Interview Room /

Counselling

120 Counselling rooms can be sized as interview rooms (2-4 people). The room should befurnished to meet the needs of the patient type. The required furnishings andarrangements to support the patient care needs and ensure staff safety should bedetermined by the Functional Program.

Please refer to Facility Support Spaces for requirements for Interview/CounsellingRooms.

Examination Isolation

Room (Airborne

Precaution Room or

"APR")

In general, community health care facilities should not require the inclusion of an APR.Patients with respiratory infections can be managed through prescribed InfectionControl Management procedures such as separated waiting areas, masking andgowning, and protection of health care workers through correct use of PersonalProtective Equipment (PPE). Refer to Public Health Ontario for recommended

procedures.

The need for an APR must be demonstrated by the Infection Control Risk Assessment(ICRA) and presented in the Functional Program with a business case/rationale thatdemonstrates need for isolation and enhanced negative pressure air handling system,based on patient population risk and access, or lack of access to other health careservices for transportation and holding of an infectious patient. Inclusion of an APRmust be coordinated with the Emergency Management Ontario (EMO) and the LHIN, forexample, if the HCF is a designated influenza assessment clinic. Written confirmationfrom EMO and the LHIN that a HCF warrants an APR must be provided to the ministry.

The following requirements apply in addit ion to Examination Room-Standard.

(a) Ventilation must meet CSA Z317.2 for Heating, Ventilation and Air Conditioning (HVAC)requirements (in addition to enhanced ventilation for the clinical area).

(b) Prep Alcove: A clean area for staff to put on PPE before entering the room shall beprovided.

(c) A contained soiled area shall be provided outside the procedure room for staff to

remove PPE and clean hands prior to entering a public corridor. (d) Layout and service requirements shall conform to current infection prevention and

control guidelines (refer to CSA Z8000-11 and Public Health Ontario resources). (e) Depending on the Functional Program, a two-piece barrier-free washroom, directly

accessible from within the examination room and for the exclusive use of the IsolationRoom and its patient, may be considered.

• examination room 120

• ante room 55

• prep alcove 22


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Room Name/Item

Net

Area

(SF)


Specialized Rooms

The ministry supports the use of generic, standardized rooms for treatment. The need for treatment rooms with specialized requirements must

be demonstrated in the Functional Program through patient profile data, volumes and room utilization. The following is provided for guidance, should a standard or larger examination room be demonstrated that it is clinically and/or functionally unsuitable for specific

treatments.

Chiropody Assessment /

Therapy /

Treatment Room

180 Combined assessment, examination and procedure room for foot care, usuallyassociated with a diabetes program. The Functional Program should describe theextent of foot care procedures of the program.

(a) Room to comply with common requirements and recommendations for anexamination/procedure/treatment room.

(b) Space within the room shall be adequate to permit the treatment chair to be reclined.(c) Room shall be located close to clean and soiled utility rooms.(d) Room shall meet required ventilation and Infection, Prevention and Control

requirements of the College of Chiropodists of Ontario.http://www.cocoo.on.ca/inffection-control.html

Advisory:

(a) Room should be located near other diabetes program-related rooms.(b) Room should be located with convenient access to the reception/waiting area, staff

workstations, photocopy room.

Physiotherapy /

Recreational /

Occupational Therapy

Office with combined

Treatment Area

170 Office is intended for examinations/assessments with sufficient storage fordemonstration equipment and educational material.

If practitioners are partial FTEs, the office should be designed to be shared, tomaximize utilization.

(a) Office shall include a hand hygiene sink (see Appendix B4)

Physiotherapy /

Occupational / Therapy

Activity Room

if no administrativespace provided, oneworkstation for therapistadministrative functionsmay be required.

250

50

The ministry supports shared use of one Physiotherapy / Occupational Room to serveboth programs.

(a) Room shall include a hand hygiene sink.(b) Room shall be located close to clean and soiled utility rooms.

Diagnostics Area

(such as bloodwork, EKG,specimen collection)

space per chair forblood taking

120

80

Size to be determined by Functional Program and shall meet infection prevention andcontrol requirements. Need for a dedicated diagnostic area must be demonstrated inthe Functional Program that other diagnostic services cannot be met by other serviceswithin the immediate area (such as a hospital or testing labs).

The ministry supports patient-centered care practices that bring services to the patient.Diagnostics should be accommodated within the client visit in the examination room.For a dedicated Diagnostics area, the Functional Program must demonstrate whydiagnostic services cannot be provided in the examination room.

(a) Space shall include hand hygiene sink (if multiple stations, not less than one sink forevery four places).

(b) A separate clinical technique sink shall be provided.(c) Space shall be provided for storage of phlebotomy supply carts and for preparation of

biopsy procedure trays (as applicable to services provided/performed).

Dental Examination/Operating Suits

DentalPractitioner'sOffice

Clinical dental programs within a community HCF typically receive operational fundingfrom municipal or regional public health unit or other ministry-funded programs. TheHSP must provide written confirmation of ongoing funding commitment from theorganization and demonstrate volumes and room utilization to the ministry.

Sizes of rooms and functional requirements vary across practitioners and should bedeveloped in collaboration with the user group. The space allocations presented hereare for early planning assumptions only and must be reviewed and modified asnecessary by the user group.

type 1: one desk, nomeeting space

100

type 2: one desk,2 visitor chairs

110

Dental Records Area 100 Planners and designers must comply with all guidelines and regulations as available

http://www.cocoo.on.ca/inffection-control.htmlhttp://www.cocoo.on.ca/inffection-control.htmlhttp://www.cocoo.on.ca/inffection-control.html


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Room Name/Item

Net

Area

(SF)


/ Storage from The Royal College of Dental Surgeons of Ontario (RCDSO), as the regulatorybody for dentistry practice in Ontario, as well as any other requirements by the agency

providing operational funding.

Dental ExamRoom/Operatory

100 Compliance with all technical requirements relating to (but not limited to) such asventilation, lead lining / protection, water temperature and instruments is required. It isthe responsibility of the planners and designers to ensure that all regulations andrequirements are satisfied.

(a) The rooms must be organized as a suite of rooms, adjacent to each other for goodpatient wayfinding and workflow. Final room sizes to be determined based on technicalrequirements. Size is proposed for early planning purposes.

(b) Operatory rooms should have access to daylight if possible. Support rooms that do notrequire daylight should be strategically organized to maximize access to daylight forclient areas.

(c) The Dental Mechanical area may require an electrical panel dedicated to the DentalSuite. Room to be sized according to technical requirements. Size is proposed for earlyplanning purposes.

Dental Dark Room (ifrequired)

80

Dental Laboratory /"Clean" area

120

Dental Sterilization /"Dirty" area

120

DentalMechanical/"Pump"

50

Clinical Area Administration Spaces

Charting Alcove 20 A dedicated area for intermittent charting/administration may be required for largerclinics, as demonstrated by the Functional Program.

Health Practitioner

Workstation (open)

65 Assign one workstation to each part-time practitioner/staff member for administrativefunctions. Counselling or care-related functions shall be assigned space to suit thefunction (i.e. A part-time counsellor may require access to an enclosedinterview/counselling room).

If the area is designed as a collaborative, "open workstation" model, access to a "swingoffice" can be included for privacy/small meetings.

(a) Adequate space and lockable storage is required for each user.(b) If the space is a collaborative area, acoustic privacy shall be considered.

Post-Secondary Student /

Learner Workstation

(open)

65 The need for an additional administrative work area to be used by clinical Learners orvolunteer staff must be demonstrated by the Functional Program and linked to the directdelivery of an ongoing post-secondary primary health care related program.

For Learners, the facility must demonstrate a formal relationship with a post-secondary

institution and provide a Clinical Teaching Plan to identify link to the primary care program, Learner activities, frequency and administrative space needs. Dedicatedclinical and/or examination rooms for Learners, is not supported.

Clinical Administrative

Spaces Private office space is supported only for health care practitioners who do not have

access to an examination room (such as Allied Health Workers), or require an enclosedoffice to conduct combined administration and examination/counselling functions. Foradministrative clinical work, a collaborative team/hub model in a workstation zone orroom is supported. The Functional Program must demonstrate need and utilization of

private offices.

If a private office is used for treatment, or giving of injection (such as insulin), a HandHygiene Sink is required.

Offices not used for treatment are recommended to be located adjacent to and withinthe "Class C HCF" ventilation zone of the clinical area to support future flexibility.

Advisory:

(a) Patient care areas should have priority for exterior views and access to daylight.However, if possible, staff offices should have an exterior view.

(b) All offices should be acoustically insulated for confidentiality.(c) The entry door should have a vision panel with blinds.(d) Office users should have a sightline to the door when seated at their workstations.(e) For a combined Office/Exam room, the treatment area is designed as per requirements

for Standard Examination Room but with additional space for a workstation of 50SF(circulation included within the 120 SF of the Exam space).

workstation 65

combined Office /Exam Roomcombined > see (e)

160

for other office sizes,please refer to

Appendix B2, FacilitySupport Spaces

Hotelling Workstation -

Visiting Specialists or

Volunteers

65 One generic workstation as a flexible work area for occasional administrative tasks forvisiting specialists and/or volunteers.

Medical Library (for staff) 0 Shelving for storage of medical books/volumes is to be included in workstation


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Room Name/Item

Net

Area

(SF)


areas/offices/meeting rooms that are conveniently accessible to users, as determinedthrough the design process. Dedicated space is not supported.

Clinical Area Support Spaces

Client/Patient Washroom

(single, two-piece,

barrier-free)

Refer to Ontario BuildingCode for barrier free standards

and requirements

50 Each clinical area or zone shall have one patient-dedicated washroom. A secondwashroom may be considered as determined by the Functional Program and number ofexamination rooms.

(a) The toilet and sink shall be hands free operation.(b) Dispensers for paper towels shall be hands free (i.e., the hands only touch the towel).(c) A mirror and coat hooks shall be provided.(d) Toilets with tanks shall not be used, due to the risk of condensation.(e) If urine specimens are being provided in the HCF, procedures for pick-up/transport shal

ensure that no cross contamination occurs into the general clinic area.(f) The door shall be easily accessible by staff, while allowing privacy.(g) There shall be sufficient space for a 1500 mm [5'-0"] wheelchair turning radius.(h) The washroom shall be barrier-free and meet all building code requirements for

accessibility.(i) The toilet, sink and grab bars shall be capable of supporting 250kg [500 lb].

(j) If bariatric clients are included in the demographic and space needs demonstrated inthe Functional Program, washroom fixtures and related physical design must beadequately specified.

Client/Patient Washroom

with Shower

(single, three-piece,

barrier-free)

75 One client/patient washroom can contain a shower, if required for infection, preventionand control purposes to allow staff to safely examine the client/patient. The need mustbe demonstrated by the Functional Program that it serves the HCF's target populationand that operational measures (e.g. staffing, utilities and maintenance) are in place.Written LHIN endorsement for provision of a client/shower is required with theFunctional Program.

(a) As integrated with a two-piece washroom, the shower area shall be open to the toiletarea and a minimum dimension of 1200x1500mm [4'-0" x 5'-0"].

(b) Showers shall have no floor lip, but the entire room shall be sloped to a drain; the floorshall have a non-slip finish with an integral cove base.

(c) The shower shall have grab bars and a fold-down seat.(d) A readily accessible emergency call device shall be provided, with shut-off only at

source.(e) The washroom shall be barrier-free and meet all building code requirements for

accessibility.(f) The washroom shall accommodate storage for soiled clothes, clean linens, and

shelving.(g) If bariatric clients are included in the demographic and space needs demonstrated in

the Functional Program, washroom fixtures and related physical design must beadequately specified.

Medication / Medical

Storage

Depending on theamount of medicationheld/administered in theHCF, a locked cupboard

may be sufficient, asdetermined by theFunctional Program.

100 (a) A scientific refrigerator/freezer shall be provided, as determined by the FunctionalProgram. Alarms and emergency power needs for refrigeration shall also bedetermined by the Functional Program. Built-in battery backup systems are preferred.

(b) The room/area shall be secure with access restricted to clinical staff.(c) A hand-hygiene sink shall be mounted on the wall adjacent to the door.

If medication is being prepared, the sink shall be mounted away from the medicationarea due to risk of splashing and aerosolization.

(d) Ease of access and observation of the area should be considered.(e) Ensure necessary area and clearances for access to refrigerators.


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Room Name/Item

Net

Area

(SF)


Clean Storage/Supplies

can be an enclosedroom or alcove withdouble doors

120min(ifroom)

(a) An enclosed room shall not be less than 120 SF. An alcove with double doors may besufficient, as determined by the Functional Program.

(b) Clean and soiled utility rooms shall be separated spaces.

(c) Decontamination of or cleaning up supplies shall not be permitted in the clean utilityroom.

(d) Areas for storage of clean and sterile supplies shall conform to CSA Z314.15.

(e) Clean utility rooms shall not include a hand hygiene sink in the room. There shall be ahand hygiene station located outside the room.

(f) The room or area shall be secure with access limited to clinical and support staff.

(g) If reprocessing of medical equipment is performed, the space shall meet therequirements of CSA Z314.8, CSA Z314.2 and CSA Z314.3 as applicable.

(h) The room shall have designated locations for the types of items being stored e.g. (i)clean and sterile supplies (ii) clean linen (iii) crash carts*, as determined by theFunctional Program. *Crash carts are not usually required in for primary care, as thefacility does not provide emergency or acute services for patients. Need for use,maintenance and storage of a crash cart(s) should be determined through theFunctional Program, with a description of why crash carts are required for that facility.

(i) The room should be located close to the centre of the care area.

(j) Shelving units or cart surfaces shall have cleanable, smooth and non-porous surfacestolerant of hospital-grade disinfectants.

(k) Storage of equipment and supplies shall not be exposed to direct airflow from the HVACsystem in accordance with CSA Z314.15 and CSA Z314.3. Storage should be awayfrom the window, due to the risk of condensation.

(l) Flooring shall be of seamless impermeable, non-slip material. Wall base and flooredges should be an integral cove base, tightly sealed against the wall and constructedwithout any gaps.

(m) The principles of ergonomics shall be addressed when designing the storage space andlocations of supplies.

(n) Shelving for clean and sterile supplies shall be at least:(i) 230 mm off the floor;

(ii) 450 mm from the ceiling; and(iii) 50 mm from outside walls.

Soiled Utility / Holding

• small (minimum)

• medium

130

150

(a) Clean and soiled utility rooms shall be separated spaces.

(b) Soiled utility rooms shall only be used for temporary storage or supplies and equipmentthat will be removed for cleaning, reprocessing or destruction.

(c) The room shall be located and arranged to provide easy access for staff to depositsoiled supplies.

(d) Soiled utility rooms shall be designed and equipped to minimize/contain theaerosolization of waste.

(e) A hand hygiene sink shall be provided. Note: This sink shall be separate from theutility/cleaning sink.

(f) Space shall be provided at the point of use for rinsing of gross soil or debris fromreusable devices.

(g) Easy access shall be provided for closed human waste container, cleaning devices ordisposable human waste container devices.

(h) Flooring shall be of seamless impermeable, non-slip material.

(i) Splash protection shall be provided on walls near water supply, sinks or human wastemanagement systems.

(j) Counter tops shall be of non-porous material, free from seams and tolerant of routinedaily cleaning with hospital grade disinfectants.

(k) The room shall be secure with access restricted to clinical and support staff.

(l) Doors shall be kept closed and not propped open.

(m) The room shall be designed to minimize exposure of patients, staff, and visitors toodour, noise and the visual impact of medical waste operations.


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Room Name/Item

Net

Area

(SF)


Soiled Utility / Holding

(cont'd)

(n) The room shall have the capacity to:(i) segregate wastes into HCF approved containers;(ii) hold soiled linen and items for return to outsource service;

(iii) contain a human waste management system - if required/detailed by need inFunctional Program;(iv) contain supplies associated with waste management systems; and,(v) provide for cleaning soiled patient equipment that is not returned to outsourcing forsterilization.

(o) Spray wands shall not be used for rinsing of items. Equipment used for removal ofgross soiling shall minimize aerosolization of particulates.

(p) Space shall be provided for separate mobile containers for soiled linen, general waste,medical/hazardous waste, confidential waste, and recycling, etc.

(q) The room shall provide storage for carts that will be used to move the soiled materialfrom the room.

(r) Hoppers should not be required in a primary care setting. Need must be demonstratedthrough the Functional Program. If they are used, they shall be designed to contain anysplash and the controls shall be located so as not to expose staff to contaminants.

(s) A washer / disinfector shall be provided in accordance with the Functional Program.

Housekeeping /Janitorial Closet or

Room

Refer to Appendix B2-Facility Support Spaces


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Appendix B2 - FACILITY SUPPORT SPACES

Room Name/Item

Net

Area

(SF)


CSA Z8000 requires all items as "requirements" or "Mandatory", unless stated under the "Advisory" heading. Those under "Advisory" are

recommendations. The ministry supports the "Mandatory" items as planning and design requirements. If a HCF (Health Care Facility) cannot provide the space or amenities required, the Functional Program must provide a description why the requirement cannot be met and thealternative measures to achieve the room function and requirements.

Administrative Support Spaces for the Clinical Zone/Area

Reception / Control Desk

provide an additional30% of total FTE areafor storage

provide an additional50SF for a small

triage/interview areafor confidentiality thatprovides accessibility

65 per FTE

Workstation space to be calculated using FTEs as opposed to occupants, as multiplereceptionists may share workstation(s) depending on scheduling/ work planning.Functional Program to demonstrate utilization of workstations and FTE / Staffassignments. Additional work space may be considered for peak-time staff ifdemonstrated in the Functional Program.

(a) The reception/control desk shall be positioned so that there is security control and staffcan easily provide and receive information.

(b) The area shall be designed according to accessibility, ergonomic and occupationalhealth and safety principles. Refer to Accessibility Directorate of Ontario for staff andvisitor accessibility requirements.

(c) The station shall be designed to ensure personal security for staff. Security can beachieved through engineering controls such as:(a) desk height;(b) transparent screen:(i) A screen shall be erected at the reception desk to provide protection for staff

during the triage function from patients who may be or are infectious. The screenalso provides separation of contact with surface materials (i.e. shared pens, othermaterials). Provision of a screen is a key component of the ICRA and must bereviewed with the HCF, ICP and architect during the design phase. The screencan be made of a transparent material that can sustain regular cleaning withcleaners and disinfectants. The patient intake process and planning of the deskand screen area shall consider confidentiality and privacy needs.

(ii) If a screen is not provided, the ICP must provide to the ministry an explanation ofthe reason why it is not deemed required and what alternative screening measureswill be implemented. The ministry reserves the right to require installation of a

screen.Note: a screen may not be appropriate for community-based mental healthprograms that are based on a model of integration; however, the HCF mustprovide written confirmation of alternative infection control and staff safety/securitymeasures.

(d) All entry points to the clinical area beyond the Reception Desk shall be secure andrequire controlled access. Consider operations so that staff do not need to leave thearea to escort patients (such as intercom, "runners", volunteers).

(e) Plan the Reception Area to accommodate a patient screening process that enablesstaff to determine if patients are infectious and require to be seated in the separatedarea of the Waiting Area.

Advisory:

(a) Depending on workflow model, consideration should be given to create a secondary,designated area (workstation) for re-booking appointments to ease congestion /

crowding at the intake area.(b) A counter should be provided at the back of the workstation for storage of paper andother procedural material. This material should not be laying on the front counter that isapproached by patients.

(c) Consideration should be given to create a secondary entry for the movement ofsupplies and garbage.

(d) The placement of the computer should be convenient to allow for easy input, but not toobstruct visual connection between staff and patient, nor to be visible by the patient.

(e) Staff shall have easy access to a hand-hygiene station. This can be a wall-hung sink inthe area or an alcohol-based sanitizer.

(f) An alcohol-based sanitizer shall be easily accessible to patients at the counter.(g) Planning of the desk and shall address confidentiality and privacy.(h) Consider space for charting, as determined by the workflow model.


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Appendix B2 - FACILITY SUPPORT SPACES

Room Name/Item

Net

Area

(SF)


Waiting Area For early planning purposes, allocate two seats per treatment space (exam roomand/or counselling)

For early planning purposes, of the total number of seats, include 10% forwheelchair/scooter/bariatric places. If more than 10% is required, provide explanationin Functional Program as related to patient population profile.

For early planning purposes, of the total number of seats, include 20% forseparated/infectious patients (once screened and masked). Determine the anticipatednumber of spaces based on Infection Control Risk Assessment (ICRA).

If the HCF includes a dental program, consider seating based on clinic scheduling andworkflow.

(a) Waiting rooms for patients and accompanying persons shall be located close to theentrance.

(b) Waiting rooms should be located such that they can be observed by the reception /appropriate staff at all times.

(c) Zones shall be created so more infectious persons can be directed to a separate area.Note: Zones can be established through seating, air flow, colors, walls, etc.

(d) Public washrooms shall be provided in close proximity. (e) Waiting areas shall be sized to accommodate wheelchairs, scooters, and/or strollers. (f) Different seating types that include chairs with arms, armless chairs, and bariatric

seating shall be provided as appropriate to the expected patient population. (g) Seating should be able to be cleared readily except where client demographic/program

requires non-movable furniture. (h) A telephone should be provided with local calling access and accessibility functions. (i) Consider a charging station for scooters if not accommodated elsewhere.

general seating 15 per seat

wheelchair/scooter/bariatric

30 per chair

separated area forinfectiouspatients(oncescreened andmasked)

20perseat

Children's Waiting Zone

(open to Waiting Area)

up to 45

15 per child

For early planning purposes, assume space for three children.

Area is in addition to Waiting Area calculations. Inclusion of a child waiting zone isconditional on supervision of children in this area being the responsibility of adult clientcaregiver(s) and not HCF staff.

The area should be located adjacent to and open to the general Waiting Room / Area.(a) The walls shall be of impact-resistant materials.(b) The floor shall be of resilient, water-resistant material; area should be able to be

cleared readily.(c) Parents are encouraged to bring their own books/toys for the short waiting period. The

HCF is recommended not to provide toys or play equipment. Please refer to CHICA-CANADA PRACTICE RECOMMENDATIONS-Toys, October 2011.

Visitors' Coat Area

1 lineal foot for 2coats

up to 20 Assume an open coat hook area to contain 20 coats; space is in addition to Waiting Area se