Design & Construction Process Toolkit

Organizational Readiness

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What is Organizational Readiness?

The proposed capital project should be driven by community and program needs and be consistent with the overall strategic plan. Organizational Readiness includes review of the Strategic Plan (long-term goals and the short-term implementation steps for getting there), assessing organizational capacity (board and volunteer expertise, fundraising capacities, expertise in business planning and financing options, and design and/or construction experience), forming ad hoc committees (i.e. capital campaign committee to cultivate donors/financing, building committee to determine scope and hire design/construction teams), and preparing a budget for planning activities (i.e. space needs study, evaluating fundraising readiness, preliminary schematics, feasibility study).

 

Organizational Readiness Activities

The tasks are also not always sequential and overlap in most cases. Click on the activities tab on the right to see the common activities within the organizational readiness phase and a brief definition or description. Use the resources tab for tools and other publications for this phase.

 

Evidence-Based Design

During organizational readiness, two EBD processes are started: Step One) define EBD goals and objectives; and Step Two) find sources for relevant evidence. Click the Evidence-Based Design Tab for more detail about EBD activities during this phase.

 

Sustainability

Sustainability, as formally achieved through LEED for Healthcare (Leadership in Energy & Environmental Design), an internationally recognized green building certification system through the United States Green Building Council is another aspect to consider for your project.

 

Not all organizations are ready to become carbon neutral or to achieve zero waste. One of the first steps in the sustainability process is to understand the readiness of executive leadership to assume the mantle of sustainability, and how quickly and aggressively that should occur. If your organization is willing and able, start to define goals for building performance (site, water, energy, materials, indoor environment) and determine the impact sustainability and energy efficiency will have on the life-cycle cost of operating the building.

 

At this stage, you should define how the organization’s mission supports sustainability initiatives. Review the LEED and Green Guide for Healthcare checklists in the resources tab.
 

Lean Process

Other aspects to consider for your project during organizational readiness include Lean processes (elimination of “waste,” such as waiting, hunting and gathering, etc.) Is your organization using Lean concepts already or is Lean a cultural change issue? (This ranges from a top management philosophy down to front-line behavior.) Consider a Readiness Assessment for Lean such as:

  1. Standards and norms of the organization
  2. Performance management and measurement
  3. Employees interaction with patients and each other
  4. How employees think about their work
  5. Methods used to identify and solve problems
  6. Other aspects of behavior that must be aligned for continuous improvement.

Design Activities

Print Design Activities

See Evidence Based Design tab for EBD activities during this phase

Define the services to be offered and how care will be delivered. Both may be different from the existing conditions.

Evaluation of the number and type of staff based on services you expect to provide and expected number of patients.

A systematic accounting of each program and/or department that results in a reasonably good estimate of how much space (usable, net square feet) will be required for the envisioned operations. 

The strategic plan is a definition of your organization’s long-term vision and the short-term objectives. It helps align facility design with the organizational mission to best achieve care delivery and business goals. 

The proposed project should be supported by the community. Foster goodwill for the project by creating an understanding of the project scope, services, and potential impact on traffic. Consider how the community and patient perspective will be used to develop the project.

A roadmap that outlines supply, demand, costs, and revenue stream. It also provides insights into how different decisions will affect your return on investment, cash flow, debt load and work processes.

The project mission and vision establishes project goals and objectives - guiding principles that should be used throughout the design and construction to guide decision making.

The team is established to implement the project – with a unified management structure, authority to manage the project and accountability for results.

Sets the stage to obtain financing and includes both sources of funds and how funds will be used, along with hard costs (construction), soft costs (professional fees, permitting) and contingencies (unknowns).

There are multiple financing options, such as conventional loans, community development institutions, federal funding, foundations, or bonds, supplemented by clinic funds reserved for the project, and/or a capital fundraising campaign.

Aside from cost, site selection considerations can include: accessibility to nearby services, topography, size, configuration, water, sewage, and drainage issues. Sites can be purchased or leased.

Visiting others allows you to see what is being done elsewhere in order to benchmark and begin a “wish list” of design features to consider. 

High level goals for major milestones and project completion.

Select a project manager with relevant development experience and an architect with relevant healthcare experience. Orient yourself to the process and conduct a series of informal discussions with the staff to solicit their ideas, desires, and expectations about a potential project.

The team is established to implement the project – with a unified management structure, authority to manage the project and accountability for results.

This includes assessing the facility’s current and anticipated space needs based on programs/services and anticipated volumes and determination of whether to renovate or build new. Sometimes the cost of renovation can exceed the cost of a new building, and an analysis needs to be completed to determine the best option.

Assessing the facility’s current and anticipated space needs based on programs/services and anticipated volumes. Determine whether to renovate or build new - sometimes the cost of renovation can exceed the cost of a new building. An analysis needs to be completed to determine the best option.

 

Lead by: Provider

Evidence-Based Design Activities

Print Evidence-Based Design Activities

At the core of an evidence-based design process is the link between design and desired outcomes. This can be established early in the process through visioning - defining broad goals and objectives for the project that support the organization’s mission and vision. Continually referencing these goals throughout the process helps the team evaluate various design strategies and keep the project on track. Consider the following steps and related questions.

 

As the team begins to develop design guidelines, the search for relevant evidence begins. Knowing what strategies are supported by evidence will depend upon a review of the literature. A resulting set of project priorities is defined in conjunction with the literature review findings. 

FAQs

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Key deliverables during this phase include: project concept and direction, a needs assessment, a business plan, and a preliminary space assessment

The space assessment is usually completed by an architect with input from the Provider on how spaces are used for both tasks and overall workflow. The result is a comprehensive listing of every room and/or space in the facility, its estimated square footage, and additional space required for circulation, mechanical, and utilities that is balanced with codes, guidelines and other requirements. You should consider your future operating vision, as well as several scenarios of what might change in 10 years to understand how your vision differs from the present and what to consider for flexibility.

It is important to define expectations for the participants, including the duration of the project, decision-making authority and processes, and project deliverable responsibilities. Understanding expectations of those participating is also important to encourage an open two-way dialogue.

It typically includes an executive summary, clinic history and operations, management and governance, market analysis and strategy, the facilities project, the financial operations, including historical data, capital needs, and projected performance.

Resources

Print Resources

Created by Western Michigan University.  My Safety-Net Clinic (MySNC) is a tool to help clinics and designers understand the costs associated with various aspects of renovating, or designing a clinic.  Use the tool to calcuate costs for the following areas:

  • Waiting Areas
  • Patient Care Areas
  • Greeen Design
  • Exterior Lighting

Phases and activities related to this tool include:

Organizational Readiness

  • Develop the business plan
  • Develop the project budget
  • Explore various financing options

Pre-Design

  • Determine financial feasability
  • Plan and program
  • Refine project budget/schedule

Created by NCB Capital Impact. Phases and activities related to this resource include:

Organizational Readiness

  • Conduct operational planning
  • Conduct allocation planning/preliminary space assessment
  • Finalize strategic planning
  • Develop community awareness/engagement
  • Develop the business plan (Sect VII)
  • Development of project budget
  • Explore various financing options
  • Develop a preliminary project schedule
  • Hire a project manager and architect (Sect IV)

Pre-Design

  • Determine financial feasability
  • Conduct a market needs analysis and assessment
  • Select/survey sites and evaluate space availability (Sect IV.b)
  • Select an attorney, architect/interior designer, contractor and construction manager
  • Establish the remaining project team
  • Property aquisition/site control
  • Refine project budget/schedule (Sect VIII)

Design

  • Continue conceptual diagramming
  • Design development
  • Permit process
  • Zoning/use processing
  • Furniture, fixtures, equipment (FFE) and technology planning
  • Purchasing plan
  • Construction documents
  • Value engineering (p. 33)
  • Early permit - third party approvals (p. 40-41)
  • Bid and award - this may be phased, based on contract type

Construction

  • Conduct construction inspection and surveillance (p. 43-49)
  • Create the punch list (p. 55)

Created by the California HealthCare Foundation.  Phases and activities related to this resource inlcude:

Organizational Readiness

  • Development of project budget
  • Explore various financing options

Occupancy

  • Liscensing

Study Guide 3: Integrating Evidence-Based Design: Practicing the Healthcare Design Process.

Guide Three pulls together the evidence-based design (EBD) process to walk you through the key steps of the design process in detail from pre-design, design, construction and occupancy. Practical examples demonstrate key areas and show how EBD is practically applied.

 

Purchase >

 

Phases and activities related to this resource include:

Organizational Readiness

Pre-Design

  • Evaluate work flow
  • Start conceptual diagramming

Design

  • Continue conceptual diagramming
  • Design development
  • Bid and award-this may be phased based on contract type

Construction

  • Substantial completion
  • Final completion

Occupancy

 

Created by the Nonprofit Finance Fund who makes loans to nonprofits and pushes for fundamental improvement in how money is given and used in the sector. Phases and activities associated with this resource include:

Organizational Readiness

  • Develop the business plan
  • Development of project budget
  • Explore various financing options

Created by USGBC, last updated in May 2011.  The phases and activities related to this resource include:

Organizational Readiness

  • Develop community awareness/engagment

Pre-Design

  • Select/survey sites and evaluate space availability
  • Plan and program

Design

  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

Created by USGBC, last updated in May 2011.  The phases and activities related to this resource include:

Organizational Readiness

  • Develop community awareness/engagment

Pre-Design

  • Select/survey sites and evaluate space availability
  • Plan and program

Design

  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

Created by NC State University. Phases and activities related to this resource include:

Organizational Readiness

  • Assess project needs and viability: includes operations and finances
  • Conduct operational planning
  • Plan for the project mission/vision
  • Create project organizational leadership

Pre-Design

  • Evaluate work flow

Authored by John E. Kemper. Phase related to this resource is Organziational Readiness.

Created by Anita Addison of La Clinica de la Raza for the Promising Practices Seminar in 2011.  The phases and activities that are applicable to this resource include:

Organizational Readiness

  • Develop a business plan

Created by the USDA. Phases and activities related to this resource include:

Organizational Readiness

  • Develop project budget
  • Exlpore various financing options

Pre-Design

  • Start a capital campaign feasability study
  • Develop a capital process/fiscal plan

Created by the Veterans Administration.  The attached files are guidlines for working with the VA in primary care settings.  Phases and activities that relate to these resources include:

Organizational Readiness

  • Conduct allocation planning/preliminary space assessment
  • Site considerations (note narrative)

Pre-Design

  • Conduct a market needs analysis and assessment
  • Create space function/flow analysis
  • Plan and program

Design

  • Continue conceptual diagramming
  • Design development
  • Furniture fixtures, equipment (FFE) and technology planning

Created by Deloitte. Phases and activities included in this phase include:

Organizational Readiness

  • Conduct operational planning
  • Determine staffing needs
  • Develop a business plan
  • Plan for the project mission/vision

Construction

  • Internal readiness

Created by Gates Family Foundation.  Phases and Activities applicable to this resource include:

Organizational Readiness

  • Conduct operational planning
  • Develop community awareness/engagement
  • Develop a business plan
  • Development of project budget
  • Explore various funding options

Pre-Design

  • Determine financial feasability
  • Start a capital campaign feasibility study
  • Develop a capital process/fiscal planning
  • Continue community engagement and collaboration
  • Refine project budget and schedule

Design

  • Design development

Created by the the Comunnity Clinics Initiative. Phases and Activities applicable to this resource include:

Organizational Readiness

  • Create a business plan

Pre-Design

  • Evaluate work flow
  • Refine project budget and scope

Design

  • Design development

Created by Capital Link. Phases and Activities applicable to this resource include:

Organizational Readiness

  • Develop a business plan

A free resource from Capital Link and Primary Care Development Corporation on developing a health center. Phases and Activities applicable to this resource include:

Organizational Readines

  • Conduct operational planning
  • Conduct allocation planning/preliminary space assessment
  • Finalize strategic planning
  • Create project organizational leadership
  • Development of project budget
  • Explore various financing options
  • Consider sites (see chapter 5)
  • Develop a preliminary project schedule (see chapter 2, and Appendix B)
  • Hire a project manager and architect

Pre-Design

  • Determine financial feasability
  • Select/survey sites and evaluate space availability (see chapter 5)
  • Select an attorney, architect/interior designer, contractor and construction manager (see chapter 3-4, 6 and Appendix D)
  • Establish the remaining project team (see chapter 4, Appedix D and E)
  • Property aquisition/site control 
  • Plan and program
  • Refine project budget/schedule 
  • Start conceptual diagraming

Design

  • Continue conceptual diagraming
  • Schematic design
  • Design development
  • Construction documents
  • Bid and award - this may be phased based on project type (see chapter 7)

Construction

  • Notice of completion
  • Final completion
  • Transition planning

The Community Clinics Initiative and Capital Incubator developed a list of tools and resources for capital development projects.  Phases and Activities applicable to this resource include:

Organizational Readiness

  • Assess project needs and viability: Includes operations and finances
  • Plan for the project mission/vision
  • Development of a project budget
  • Explore various funding options

Pre-Design

  • Determine financial feasability
  • Start a capital campaign feasability study
  • Develop a campital process/fiscal planning

Many ingredients combine to make a successful capital campaign. To help you determine if your organization is well positioned to move into a formal campaign planning process, we’ve developed the following Campaign Readiness Quiz. Answer yes or no to these questions then check your score to see how well you are positioned and what your next step may be. Created by Pathway Associates

 

Phases and Activities applicable to this resource include:

Organizational Readiness

  • Assess project needs and viability: Includes operations and finances
  • Development of project budget
  • Explore various financing options

Pre-Design

  • Determine financial feasability
  • Develop a capital process/fiscal planning
  • Continue community engagement and collaboration

New York State Division of Housing and Community Renewal (DHCR)/Franke Consulting Group developed a checklist for Organizational Readiness.  While the checklist is for housing, most of the questions can be adjusted for clinics.

 

Phases and Activities applicable to this resource include:

Organizational Readiness

  • Conduct operational planning
  • Determine staffing needs
  • Create project organizational leadership

Prepared For the Agency for Healthcare Research and Quality (AHRQ), 2005. The broader and deeper the scope of the redesign effort of a hospital, the more likely redesign produces system-wide transformation. For the purposes of this project, “redesign” and “system transformation” will both be used to describe the desired process outcomes.This project was supported by the Agency for Healthcare Research and Quality.

 

Phases and Activities applicable to this resource include:

Organizational Readiness

  • Assess project needs and viability: Includes operations and finances
  • Develop community awareness and engagement
  • Create project organizational leadership

Pre-Design

  • Evaluate work flow
  • Start conceptual diagramming

Clinic Examples

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Unique feature: New medical model of admission/reception office

 


Through involvement with the Institute for Healthcare Improvement's Re-designing the...

Grace Hill Neighborhood Health Centers is a FQHC, Federally Qualified Health Center, whose mission is to provide a medical home to the uninsured and under insured in St. Louis City. The design...

 

Unique feature: The Clinica de la Raza Community Health Center is a component of a transit-based development village that provides physical renewal and economic...

Pre-Design

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What is Pre-Design?

Pre-design is the phase of analysis that occurs after some form of funding is available and before design begins. During the pre-design phase, studies are done to analyze space requirement issues, the constraints and opportunities of the proposed site, and the cost versus the budget. 

 

The amount of funding available in the pre-design phase varies and is a critical factor in determining which studies take precedence. Funds may be available to develop a detailed project program or only to investigate certain technical issues in order to determine scope, budget, or project schedule.

 

Pre-Design Activities

Activities occurring during pre-design that are led by the healthcare organization include: launching a capital planning campaign, determining financial feasibility (such as debt, equity, insurance/contracts), developing and establishing project team, ensuring community engagement and collaboration is integrated in the planning process, working with neighborhood leaders, obtaining property acquisition and site control, finding out city/county/state requirements, and refining the project budget. 

 

Continuing from Organizational Readiness, Lean processes and sustainability are further developed in pre-design.

 

Evidence-Based Design

During pre-design, you will continue with Step Two:, find sources for relevant evidence; and then move to Step Three: critically interpreting the evidence. See the Evidence-Based Design Tab for more detail about EBD activities during this phase.

 

Sustainability

Define whether your project will achieve LEED status (and at what level) or just follow USGBC or Green Guide for Healthcare (GGHC) recommendations. Review the LEED checklist for site selection and other categories. Determine whether you need an expert in this area to assist your team. An architect or designer with LEED accreditation or experience is a good resource.

 

Lean Processes

Lean Processes: Provided your organization is culturally ready to undertake a Lean process initiative, what is the desired future state? Value Stream Mapping looks at the process from the customer's point of view. It shows all steps in a given process and enables the team to identify waste in the process.

 

All types of processes can be mapped, from admitting, discharge, billing, medication requirements, patient procedures, etc. The “map” starts with the first step of the process and continues through to the last step of the process. This is the value stream from which you can simplify work processes, eliminating inefficiencies, improving quality and improving patient care. Consider whether you need an expert in this area to assist your team.

Design Activities

Print Design Activities

See Evidence Based Design tab for EBD activities during this phase

Study the cash flow, profitability potential, and overall desirability of the project. Determine building process to be used (such as design-build, design-bid-build).

Identifying funding sources (people, foundations, etc.) and scale of potential contributions. Create informal financial funding commitments.

Establish the organization's current or potential markets, forecast of directions, and decision on how to expand the volume, services, etc.

Your project will span more than one fiscal year, so it is essential to consider the cash flow and how funds will be committed from year to year. A design professional or construction manager should help establish reasonable timeframes.

Consider program planners, financial experts, real estate advisors and design specialists as needed (wayfinding, for example), as well as staff, patients and families.

Execute contracts with key team members (architect/interior designer for planning activities, and contractor for preliminary cost estimates) and an attorney.
 

Collect views and opinions of those affected by the project

If available and financially feasible, purchase and prepare the site prior to construction. This may also happen in later phases.
 

Determine if analyses and preliminary concepts meet city/county/state requirements

Consider the patient and staff experience and determine why a process is done in a certain way and whether it can be improved.
 

Determine flow for patients, staff, and ancillary services through mapping of movement of people, materials, and information.

Comparing an organization's performance against the "best in the business" to gauge room for improvement and progress toward excellence – aids in “wish list” development.

Identify all the costs you will have to incur to build and start operating your center – an informed guesstimate in the early phases. Include adequate contingencies in both the budget and schedule and evaluate the Return on Investment (ROI) over time. Refine the high-level project schedule to incorporate all major activities during each phase of the project.

The design team will develop large block (or “bubble”) drawings showing the basic concept of a floor plan, major service and/or activity areas, adjacencies and space flow. It should consider how the facility is envisioned to operate through a functional narrative.

Modify the mission and vision if there have been any developments from the Organizational Readiness phase

Conduct preliminary analysis for space requirements. Ensure the design team spends time at the site to observe processes, discuss clinical issues, and understand the values of the organization.

Identify real needs versus “wants” or non-essentials.” Consider staff, volunteer, constituent, and visitor needs and usage.

Evidence-Based Design Activities

Print Evidence-Based Design Activities

Due to the lack of research in clinic-specific environments, it is important to understand how relevant and credible the information is before embarking on any major decisions. Critically interpreting the evidence is achieved in several ways: Date, location, scope, and source. Is the author a recognized expert? Are there other studies on this topic? Is the source reputable? Is it peer reviewed?

As the team begins to develop design guidelines, the search for relevant evidence begins. Knowing what strategies are supported by evidence will depend upon a review of the literature. A resulting set of project priorities is defined in conjunction with the literature review findings.

FAQs

Print FAQs

An attorney is engaged after preliminary planning work is done but before you hire any members of the project team. An attorney should ensure that contracts with team players reflect the business terms you negotiate and protects you. They also negotiate and/or review legal documents for site acquisition and funding, and may represent you in zoning matters. (NCB Planning Guide)

It is critical that you consider new workflow patterns when starting design, as most organizations adapt their process based on the restrictions of space or resource availability. Consider a 10-25-year horizon and evaluate different scenarios to determine what changes in volume, services, or techno logy might do to flow. This can add 10-12 weeks to what people might assume to be 2 sessions; but is essential to understand why it is done this way now and whether it can be improved from both a staff and patient perspective.

Key deliverables include reports to outline the financial and capital campaign feasibility, a market needs assessment, and a functional program with preliminary diagramming to illustrate required adjacencies and workflow requirements.

Resources

Print Resources

Created by Western Michigan University.  My Safety-Net Clinic (MySNC) is a tool to help clinics and designers understand the costs associated with various aspects of renovating, or designing a clinic.  Use the tool to calcuate costs for the following areas:

  • Waiting Areas
  • Patient Care Areas
  • Greeen Design
  • Exterior Lighting

Phases and activities related to this tool include:

Organizational Readiness

  • Develop the business plan
  • Develop the project budget
  • Explore various financing options

Pre-Design

  • Determine financial feasability
  • Plan and program
  • Refine project budget/schedule

Created by KLMK Group. Throughout 2010, Capital Project Solutions ran a series of articles dedicated to Integrated Project Delivery (IPD) exploring all issues related to IPD, from project identification to team selection to contract and incentive development. With three (3) IPD projects currently underway this report shares case studies and lessons learned throughout the series. The phases and activities related to this resource include:

Pre-Design

  • Establish the remaining project team

Created by NCB Capital Impact. Phases and activities related to this resource include:

Organizational Readiness

  • Conduct operational planning
  • Conduct allocation planning/preliminary space assessment
  • Finalize strategic planning
  • Develop community awareness/engagement
  • Develop the business plan (Sect VII)
  • Development of project budget
  • Explore various financing options
  • Develop a preliminary project schedule
  • Hire a project manager and architect (Sect IV)

Pre-Design

  • Determine financial feasability
  • Conduct a market needs analysis and assessment
  • Select/survey sites and evaluate space availability (Sect IV.b)
  • Select an attorney, architect/interior designer, contractor and construction manager
  • Establish the remaining project team
  • Property aquisition/site control
  • Refine project budget/schedule (Sect VIII)

Design

  • Continue conceptual diagramming
  • Design development
  • Permit process
  • Zoning/use processing
  • Furniture, fixtures, equipment (FFE) and technology planning
  • Purchasing plan
  • Construction documents
  • Value engineering (p. 33)
  • Early permit - third party approvals (p. 40-41)
  • Bid and award - this may be phased, based on contract type

Construction

  • Conduct construction inspection and surveillance (p. 43-49)
  • Create the punch list (p. 55)

Written by The Center for Health Design for the California HealthCare Foundation.  The design of the physical environment plays an important role in improving health care quality, work efficiency, and cost-effectiveness. Safety-net clinic design can have a substantial impact on the effectiveness of innovative care delivery models, but guidelines are limited.  To contribute to a better understanding of the topic, this white paper seeks to identify key characteristics of the physical environment design for new care delivery models and to provide preliminary design recommendations.

 

Phases and activities related to this resource include:

Pre-Design

  • Select/survey site and evaluate space availability

Design

  • Continue conceptual diagramming
  • Schematic design
  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

Written by The Center for Health Design for the California HealthCare Foundation. Cultural issues that may affect patients' healthcare interactions include models of health and disease; perception of hospitals, doctors, and other healers; hierarchical vs. egalitarian cultures; family and social relationships; and communication norms. These factors influence patients' health-seeking behavior as well as their relationships with providers and clinics.

 

This paper suggests several design strategies to support culturally sensitive care, including the need for patient and family engagement throughout the planning and design process. Other recommendations include locating the clinic within the community, devising a wayfinding system to enable easy navigation, and designing the waiting areas and exam rooms to support the presence and involvement of families.

 

Phases and activities related to this resource include:

Pre-Design

  • Space function/flow analysis

Design

  • Continue conceptual diagramming
  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

 

 

Created by Construction Management Association of America (CMAA). Phases and activities related to this resource include:

Pre-Design

  • Select an attorney, architect/interior designer, contractor and construction manager

Design

Construction

  • Establish project controls
  • Substantial completion
  • Notice of completion
  • Final completion


.

Study Guide 3: Integrating Evidence-Based Design: Practicing the Healthcare Design Process.

Guide Three pulls together the evidence-based design (EBD) process to walk you through the key steps of the design process in detail from pre-design, design, construction and occupancy. Practical examples demonstrate key areas and show how EBD is practically applied.

 

Purchase >

 

Phases and activities related to this resource include:

Organizational Readiness

Pre-Design

  • Evaluate work flow
  • Start conceptual diagramming

Design

  • Continue conceptual diagramming
  • Design development
  • Bid and award-this may be phased based on contract type

Construction

  • Substantial completion
  • Final completion

Occupancy

 

Created by the Institute for Healthcare Improvement.  The phases and activites related to this resource include:

Pre-Design

  • Create space function/flow analysis
  • Start conceptual diagramming

Created by IHI, Borgess Health: Borgess Ambulatory Care, Kalamazoo, Michigan, USA. Activities and phases related to this resource include:

Pre-Design

  • Create space function/flow analysis
  • Start conceptual diagramming
     

Created by the AIA. Phases and activities related to this resource include:

Pre-Design

  • Select an attorney, architect/interior designer, contractor and construction manager

Created by USGBC, last updated in May 2011.  The phases and activities related to this resource include:

Organizational Readiness

  • Develop community awareness/engagment

Pre-Design

  • Select/survey sites and evaluate space availability
  • Plan and program

Design

  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

Created by USGBC, last updated in May 2011.  The phases and activities related to this resource include:

Organizational Readiness

  • Develop community awareness/engagment

Pre-Design

  • Select/survey sites and evaluate space availability
  • Plan and program

Design

  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

Created by NC State University. Phases and activities related to this resource include:

Organizational Readiness

  • Assess project needs and viability: includes operations and finances
  • Conduct operational planning
  • Plan for the project mission/vision
  • Create project organizational leadership

Pre-Design

  • Evaluate work flow

Created by the USDA. Phases and activities related to this resource include:

Organizational Readiness

  • Develop project budget
  • Exlpore various financing options

Pre-Design

  • Start a capital campaign feasability study
  • Develop a capital process/fiscal plan

Created by the Veterans Administration.  The attached files are guidlines for working with the VA in primary care settings.  Phases and activities that relate to these resources include:

Organizational Readiness

  • Conduct allocation planning/preliminary space assessment
  • Site considerations (note narrative)

Pre-Design

  • Conduct a market needs analysis and assessment
  • Create space function/flow analysis
  • Plan and program

Design

  • Continue conceptual diagramming
  • Design development
  • Furniture fixtures, equipment (FFE) and technology planning

Created by Labs for the 21st Century/EPA/DoE and covers the entire design process with a focus on sustainability.
 

Created by Labs for the 21st Century/EPA/DoE and covers the entire design process and is mostly related to sustainability.  This specific resource and link is for Pre-Design.  Relevant Pre-Design activities include:

Pre-Design

  • Establish the remaining project team
  • Define city/county/state requirements
  • Benchmark

.

Created by Gates Family Foundation.  Phases and Activities applicable to this resource include:

Organizational Readiness

  • Conduct operational planning
  • Develop community awareness/engagement
  • Develop a business plan
  • Development of project budget
  • Explore various funding options

Pre-Design

  • Determine financial feasability
  • Start a capital campaign feasibility study
  • Develop a capital process/fiscal planning
  • Continue community engagement and collaboration
  • Refine project budget and schedule

Design

  • Design development

Created by the the Comunnity Clinics Initiative. Phases and Activities applicable to this resource include:

Organizational Readiness

  • Create a business plan

Pre-Design

  • Evaluate work flow
  • Refine project budget and scope

Design

  • Design development

Created by Capital Link.

 

Phases and Activities applicable to this resource include:

 

Pre-Design

  • Select/survey sites and evaluate space availability

 

Design

  • Design development

Created by New York State Division of Housing and Community Renewal (DHCR)/Franke Consulting Group.
 

Created by The Center for Health Design for the California HealthCare foundation, this white paper discusses research and best practices around designing clinics spaces that are flexible and adaptable.

 

Phases and Activities applicable to this resource include:

 

Pre-Design

  • Evaluate work flow
  • Plan and program
  • Start conceptual diagramming

Created by the Facility Guidelines Institute, 2010 edition. There is a read only version of the guidelines at the bottom of the linked page. Phases and Activities applicable to this resource include:

Pre-Design

  • Select/survey sites and evaluate space availability
  • Property aquisition/site control
  • Start conceptual diagraming

Design

  • Continue conceptual diagraming
  • Schematic design
  • Design development
  • Permit process
  • Zoning/use processing
  • Construction documents

Construction

  • Notice of completion
  • Final completion
  • Commissiong phase

Occupancy

  • Certificate of occupancy
  • Licensing

Developed by the Whole Building Design Guide a program of the National Institute of Building Sciences.

 

Phases and Activities applicable to this resource include:

Pre-Design

  • Plan and program

Design

  • Schematic design

A free resource from Capital Link and Primary Care Development Corporation on developing a health center. Phases and Activities applicable to this resource include:

Organizational Readines

  • Conduct operational planning
  • Conduct allocation planning/preliminary space assessment
  • Finalize strategic planning
  • Create project organizational leadership
  • Development of project budget
  • Explore various financing options
  • Consider sites (see chapter 5)
  • Develop a preliminary project schedule (see chapter 2, and Appendix B)
  • Hire a project manager and architect

Pre-Design

  • Determine financial feasability
  • Select/survey sites and evaluate space availability (see chapter 5)
  • Select an attorney, architect/interior designer, contractor and construction manager (see chapter 3-4, 6 and Appendix D)
  • Establish the remaining project team (see chapter 4, Appedix D and E)
  • Property aquisition/site control 
  • Plan and program
  • Refine project budget/schedule 
  • Start conceptual diagraming

Design

  • Continue conceptual diagraming
  • Schematic design
  • Design development
  • Construction documents
  • Bid and award - this may be phased based on project type (see chapter 7)

Construction

  • Notice of completion
  • Final completion
  • Transition planning

The Community Clinics Initiative and Capital Incubator developed a list of tools and resources for capital development projects.  Phases and Activities applicable to this resource include:

Organizational Readiness

  • Assess project needs and viability: Includes operations and finances
  • Plan for the project mission/vision
  • Development of a project budget
  • Explore various funding options

Pre-Design

  • Determine financial feasability
  • Start a capital campaign feasability study
  • Develop a campital process/fiscal planning

Many ingredients combine to make a successful capital campaign. To help you determine if your organization is well positioned to move into a formal campaign planning process, we’ve developed the following Campaign Readiness Quiz. Answer yes or no to these questions then check your score to see how well you are positioned and what your next step may be. Created by Pathway Associates

 

Phases and Activities applicable to this resource include:

Organizational Readiness

  • Assess project needs and viability: Includes operations and finances
  • Development of project budget
  • Explore various financing options

Pre-Design

  • Determine financial feasability
  • Develop a capital process/fiscal planning
  • Continue community engagement and collaboration

Prepared For the Agency for Healthcare Research and Quality (AHRQ), 2005. The broader and deeper the scope of the redesign effort of a hospital, the more likely redesign produces system-wide transformation. For the purposes of this project, “redesign” and “system transformation” will both be used to describe the desired process outcomes.This project was supported by the Agency for Healthcare Research and Quality.

 

Phases and Activities applicable to this resource include:

Organizational Readiness

  • Assess project needs and viability: Includes operations and finances
  • Develop community awareness and engagement
  • Create project organizational leadership

Pre-Design

  • Evaluate work flow
  • Start conceptual diagramming

Clinic Examples

Print Clinic Examples

For the past 10 years, Southcentral Foundation has been revisiting the design process for their Anchorage Native Primary Care Clinic. In 2009, 80,000 square feet was added. Informing the design is...

Grace Hill Neighborhood Health Centers is a FQHC, Federally Qualified Health Center, whose mission is to provide a medical home to the uninsured and under insured in St. Louis City. The design...

 

Unique feature: The Clinica de la Raza Community Health Center is a component of a transit-based development village that provides physical renewal and economic...

Unique feature: Pursuing Gold Level LEED Certification

 

La Maestra Community Health Centers, located in the heart of City Heights in central San Diego,...

The Golden Valley Health Centers have been serving the community for 36 years with its first clinic in Merced, California. They have 26 sites and 3 mobile clinics. On the basis of their experience...

What is the Design Phase?

The Design phase includes schematic design (SD), design development (DD), and the creation of construction documents (CDs). The phases range from high-level concepts in schematic design through refinement of details during design development, and providing all information required for bidding and building in construction documents.

 

Depending on how the project is implemented, these phases can overlap. For example, if your project is design-build, certain aspects of the building (such as building infrastructure) may be finalized before others (such as interior details).

 

During the design phase, the design intent should illustrate the relationships between project components (adjacencies, forms, size, and overall appearance). Floor plans, sections, ceiling plans, power/communication plans, finish plans, elevations, construction details and written specifications are refined for the project. Coordination with mechanical, electrical, plumbing, fire protection, and other building systems are completed during this phase.

 

Some question you should ask during this phase are:

  • What project components require outside expertise such as lighting design, landscape design, wayfinding, or acoustical design? 
  • How can the site topography be maximized to capture the best views, building access, and landscape features?

 

Many design decisions of varying level of detail need to be made at this stage. Activities occurring during design that are also led by the healthcare organization include: selecting a construction manager/general contractor for estimating, if not already engaged during predesign, determining specialty consultants needed for project, initiating the permit process, and developing a purchase plan for items not included in the design and construction scope of work (often furniture and equipment).

 

Design Activities

Activities developed during this phase that are led by the design team include: refining the space function/flow analysis, confirming the conceptual diagramming developed during pre-design, and architectural design process (schematic design, design development, furniture fixtures, equipment, technology planning, and construction documents).

 

Evidence-Based Design

The evidence to support design concepts gathered during the pre-design phase can be supplemented with additional detailed evidence to answer specific issues or questions that come up during design. Review and interpret any additional evidence for its quality and applicability to your project.

 

As design details are developed, you can create preliminary hypotheses linking the design innovations with potential outcomes—for example, the use of a defined entrance and clear signage will improve access and navigation for patients. Define outcome metrics for the set interests prioritized by your organization and collect baseline data in the existing facility (if relevant).

 

The EBD steps that occur in this phase include: Step Four: create and innovate EBD concepts; Step Five: develop a hypothesis; and Step Six: collect baseline performance measures. See the Evidence-Based Design Tab for detail about the EBD activities during this phase.

Design Activities

Print Design Activities

See Evidence Based Design tab for EBD activities during this phase

Bubble or block drawings, starts in pre-design.

A process of planning, organizing and managing critical tasks to be completed for the safe move and full functionality on the first day.

Expertise for specific functions, such as Lean processes, sustainability, wayfinding, etc. Select consultants based on unique needs of the clinic.

Preliminary building plans, elevations, sections, perspective sketches, statistical summary of building characteristics, and outline specifications.

A clear and well-coordinated description of every design aspect of the building including actual space dimensions, mechanical, plumbing, electrical, fire protection systems, and preliminary specifications.

Regulatory, governmental, or third-party approvals.  Understand requirements for obtaining certificate of occupancy or use permit.

Local requirements established for use, size (footprint and height), parking etc. Get approvals from local zoning authorities.

Moveable/attachable items, furniture, medical, office equipment, computers, telephone, security systems. Many items are not coordinated by the design team, but by the owner.

Purchase of items not included in GC (General Contractor) contract - often surrounding FFE. 

Final and complete drawings and specifications including all work by the builder and by others, actual construction cost estimates based on sub-contractor bids.

Workflows not fully evaluated during pre-design should be finalized. As design progresses, process improvement should include development of training for staff to prepare them to work with the new processes and environment.

"Value Engineering" (or more broadly,  "value enhanced design") is a widely accepted approach to identifying areas for cost savings in the building design by considering less expensive alternatives. A related activity is "design alternatives", a process of considering design options.  This approach enables you to build the facility within the constraints of your budget, but allows for future growth without compromising the project's design.

Typically there are three major types of entities that will review the project and provide approvals: planning and zoning, building permit and life safety, and health.  It is important to understand early on the types of approvals that might be needed for the project and the time involved in obtaining these approvals.

The process of selecting the builder through a competitive bidding process that may be required based on the source of funds. Depending on the process selected, contracts can be awarded to either a general contractor, construction management, design/build firm, or a turnkey developer.

Evidence-Based Design Activities

Print Evidence-Based Design Activities

The team identifies specific topic(s) for research and translates selected research topics into hypothesis(ses) about the relationships between design solution(s) and targeted outcome(s). Not every hypothesis needs to become a formal research project, and the organization should establish how many measures are already collected as part of a standard operating or reporting process.

 

From a clinic perspective, having a team member familiar with evidence-based design or research will help you understand where outside resources and expertise may be required. There may be existing tools and methods available to use, but there may also be new material to be developed. If the clinic is associated with a hospital, there may be an identified process to work through the hospital’s IRB protocols. However, where an affiliation does not exist, there are independent IRBs that approve individual projects. Unlike clinical trials that have a direct clinical impact on patients, research surrounding the built environment is usually considered less invasive, and most often is considered as part of an expedited review process. Most peer-reviewed journals require IRB approvals to publish results.

FAQs

Print FAQs

Ask your design team to develop a detailed schedule outlining major milestones for completion of the different design phases and the related subtasks. Make sure your obligations for attending meetings, providing information, conducting reviews, and approving plans are included in the schedule so you can schedule your resources. Have the design team outline specific items that are not included in their contract so there are no surprises as the design phase draws to a close. These items still require coordination with the design team, so it is important to know how items “Not in Contract” (NIC) are integrated into the schedule. Familiarize yourself with some of the resources on this site to get a better sense of what happens during design.

  • The traditional design-bid-build process is where the Owner contracts with separate entities for each the design and construction of a project. As the most traditional approach, it is well understood, and the design team acts to protect the Owner’s interests. The disadvantage is the ability to work directly with a construction expert on costing and constructability.
  • A design-build approach uses one firm to design the project and construct it, so one benefit is a sole point of responsibility, as well as cost and time savings potential. It can be a more complex process and may be subject to a less balanced view.
  • A construction manager is engaged early in the process and acts as the Owner’s representative providing schedule control, cost control, and coordination in providing or procuring planning, design, and construction services. A CM typically guarantees the price and schedule. A CM provides an extended set of resources for the Owner and can provide assistance with purchasing plans and other items not included in a traditional contract. There is potential for improved constructability, The CM assuming any level of risk will equate to an additional cost, and it is important for the partners to trust one another.
  • A turn-key development project is where the project is constructed by a developer and sold or turned over to a buyer in a ready-to-use condition. There may be a certain lack of control during this process, although it is dependent upon when and how the contract is established. The advantage is that the team usually works together on a consistent basis and can provide an accelerated schedule and some cost benefits.

There are several types of permits to consider during design, and they typically occur at different point in the process. 1) Local planning and zoning codes typically regulate lot size, site layout, building height restrictions, land use, setbacks (from the street), parking, historical landmarks, landscaping, open spaces, and the ratio of building size to lot/site size. These are considered at the onset of the project, even prior to site selection. 2) Building and safety codes regulate structural and foundation matters, construction materials, fireproofing, heating, ventilation and air conditioning systems (HVAC), plumbing fixtures and installation, electrical installation, and emergency egress. These codes must be followed during the design of the building, and are typically reviewed for compliance by state officials prior to construction. 3) Health: This commission (or authority) regulates health and safety issues and may be established by local, state, and/or federal regulatory authorities.

Resources

Print Resources

Created by NCB Capital Impact. Phases and activities related to this resource include:

Organizational Readiness

  • Conduct operational planning
  • Conduct allocation planning/preliminary space assessment
  • Finalize strategic planning
  • Develop community awareness/engagement
  • Develop the business plan (Sect VII)
  • Development of project budget
  • Explore various financing options
  • Develop a preliminary project schedule
  • Hire a project manager and architect (Sect IV)

Pre-Design

  • Determine financial feasability
  • Conduct a market needs analysis and assessment
  • Select/survey sites and evaluate space availability (Sect IV.b)
  • Select an attorney, architect/interior designer, contractor and construction manager
  • Establish the remaining project team
  • Property aquisition/site control
  • Refine project budget/schedule (Sect VIII)

Design

  • Continue conceptual diagramming
  • Design development
  • Permit process
  • Zoning/use processing
  • Furniture, fixtures, equipment (FFE) and technology planning
  • Purchasing plan
  • Construction documents
  • Value engineering (p. 33)
  • Early permit - third party approvals (p. 40-41)
  • Bid and award - this may be phased, based on contract type

Construction

  • Conduct construction inspection and surveillance (p. 43-49)
  • Create the punch list (p. 55)

Written by The Center for Health Design for the California HealthCare Foundation.  The design of the physical environment plays an important role in improving health care quality, work efficiency, and cost-effectiveness. Safety-net clinic design can have a substantial impact on the effectiveness of innovative care delivery models, but guidelines are limited.  To contribute to a better understanding of the topic, this white paper seeks to identify key characteristics of the physical environment design for new care delivery models and to provide preliminary design recommendations.

 

Phases and activities related to this resource include:

Pre-Design

  • Select/survey site and evaluate space availability

Design

  • Continue conceptual diagramming
  • Schematic design
  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

Written by The Center for Health Design for the California HealthCare Foundation. Cultural issues that may affect patients' healthcare interactions include models of health and disease; perception of hospitals, doctors, and other healers; hierarchical vs. egalitarian cultures; family and social relationships; and communication norms. These factors influence patients' health-seeking behavior as well as their relationships with providers and clinics.

 

This paper suggests several design strategies to support culturally sensitive care, including the need for patient and family engagement throughout the planning and design process. Other recommendations include locating the clinic within the community, devising a wayfinding system to enable easy navigation, and designing the waiting areas and exam rooms to support the presence and involvement of families.

 

Phases and activities related to this resource include:

Pre-Design

  • Space function/flow analysis

Design

  • Continue conceptual diagramming
  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

 

 

The WBDG is the only web-based portal providing government and industry practitioners with one-stop access to up-to-date information on a wide range of building-related guidance, criteria and technology from a 'whole buildings' perspective. Currently organized into three major categories—Design Guidance, Project Management and Operations & Maintenance—at the heart of the WBDG are Resource Pages, reductive summaries on particular topics. Phases and resources specific to this resource include:

Design

  • Design development
  • Early permit-third party approvals

Authored by Jain Malkin.  Phases and activities related to this resource include:

Design

  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

 

Authored by Canfield, B.T. Phases and activities related to this resource include:

Design

  • Begin transition planning


 

Created by Construction Management Association of America (CMAA). Phases and activities related to this resource include:

Pre-Design

  • Select an attorney, architect/interior designer, contractor and construction manager

Design

Construction

  • Establish project controls
  • Substantial completion
  • Notice of completion
  • Final completion


.

Guidlines and questions to ask when hiring a consultant. Phases and activities related to this resource include:

Design

  • Select specialty consultants

 

Study Guide 3: Integrating Evidence-Based Design: Practicing the Healthcare Design Process.

Guide Three pulls together the evidence-based design (EBD) process to walk you through the key steps of the design process in detail from pre-design, design, construction and occupancy. Practical examples demonstrate key areas and show how EBD is practically applied.

 

Purchase >

 

Phases and activities related to this resource include:

Organizational Readiness

Pre-Design

  • Evaluate work flow
  • Start conceptual diagramming

Design

  • Continue conceptual diagramming
  • Design development
  • Bid and award-this may be phased based on contract type

Construction

  • Substantial completion
  • Final completion

Occupancy

 

Created by USGBC, last updated in May 2011.  The phases and activities related to this resource include:

Organizational Readiness

  • Develop community awareness/engagment

Pre-Design

  • Select/survey sites and evaluate space availability
  • Plan and program

Design

  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

Created by USGBC, last updated in May 2011.  The phases and activities related to this resource include:

Organizational Readiness

  • Develop community awareness/engagment

Pre-Design

  • Select/survey sites and evaluate space availability
  • Plan and program

Design

  • Design development
  • Furniture, fixtures, equipment (FFE) and technology planning

Created by the Veterans Administration.  The attached files are guidlines for working with the VA in primary care settings.  Phases and activities that relate to these resources include:

Organizational Readiness

  • Conduct allocation planning/preliminary space assessment
  • Site considerations (note narrative)

Pre-Design

  • Conduct a market needs analysis and assessment
  • Create space function/flow analysis
  • Plan and program

Design

  • Continue conceptual diagramming
  • Design development
  • Furniture fixtures, equipment (FFE) and technology planning

Created by Labs for the 21st Century/EPA/DoE and covers the entire design process with a focus on sustainability. This resource is specific to the construction documents activity within the design phase.

Design

  • Construction document
     

Created by Labs for the 21st Century/EPA/DoE and covers the entire design process with a focus on sustainability.  This resource is specific to the design development activity within the Design phase.

Design

  • Design development
     

Created by Labs for the 21st Century/EPA/DoE and covers the entire design process with a focus on sustainability.  This resources is specific to Schematic Design.  The Phases and actives relevant to this resource include:

Design

  • Schematic design
     


 

Created by Gates Family Foundation.  Phases and Activities applicable to this resource include:

Organizational Readiness

  • Conduct operational planning
  • Develop community awareness/engagement
  • Develop a business plan
  • Development of project budget
  • Explore various funding options

Pre-Design

  • Determine financial feasability
  • Start a capital campaign feasibility study
  • Develop a capital process/fiscal planning
  • Continue community engagement and collaboration
  • Refine project budget and schedule

Design

  • Design development

Created by the the Comunnity Clinics Initiative. Phases and Activities applicable to this resource include:

Organizational Readiness

  • Create a business plan

Pre-Design

  • Evaluate work flow
  • Refine project budget and scope

Design

  • Design development

Created by Capital Link.

 

Phases and Activities applicable to this resource include:

 

Pre-Design

  • Select/survey sites and evaluate space availability

 

Design

  • Design development

Created by New York State Division of Housing and Community Renewal (DHCR)/Franke Consulting Group.
 

Created by the Facility Guidelines Institute, 2010 edition. There is a read only version of the guidelines at the bottom of the linked page. Phases and Activities applicable to this resource include:

Pre-Design

  • Select/survey sites and evaluate space availability
  • Property aquisition/site control
  • Start conceptual diagraming

Design

  • Continue conceptual diagraming
  • Schematic design
  • Design development
  • Permit process
  • Zoning/use processing
  • Construction documents

Construction

  • Notice of completion
  • Final completion
  • Commissiong phase

Occupancy

  • Certificate of occupancy
  • Licensing

Developed by the Whole Building Design Guide a program of the National Institute of Building Sciences.

 

Phases and Activities applicable to this resource include:

Pre-Design

  • Plan and program

Design

  • Schematic design

A free resource from Capital Link and Primary Care Development Corporation on developing a health center. Phases and Activities applicable to this resource include:

Organizational Readines

  • Conduct operational planning
  • Conduct allocation planning/preliminary space assessment
  • Finalize strategic planning
  • Create project organizational leadership
  • Development of project budget
  • Explore various financing options
  • Consider sites (see chapter 5)
  • Develop a preliminary project schedule (see chapter 2, and Appendix B)
  • Hire a project manager and architect

Pre-Design

  • Determine financial feasability
  • Select/survey sites and evaluate space availability (see chapter 5)
  • Select an attorney, architect/interior designer, contractor and construction manager (see chapter 3-4, 6 and Appendix D)
  • Establish the remaining project team (see chapter 4, Appedix D and E)
  • Property aquisition/site control 
  • Plan and program
  • Refine project budget/schedule 
  • Start conceptual diagraming

Design

  • Continue conceptual diagraming
  • Schematic design
  • Design development
  • Construction documents
  • Bid and award - this may be phased based on project type (see chapter 7)

Construction

  • Notice of completion
  • Final completion
  • Transition planning

Clinic Examples

Print Clinic Examples

Unique feature: New medical model of admission/reception office

 


Through involvement with the Institute for Healthcare Improvement's Re-designing the...

With 16 health centers and 54 different locations, Clinica Sierra Vista provides health care services to a large, underserved Hispanic population spread over 6,000 square miles. According to Doug...

Parkland Health & Hospital System and their Community Oriented Primary Care division (COPC), are a group of outpatient clinics, including 11 facilities and 11 youth and family-school based...

Bolinas is a town in Marin County at the southern tip of the Point Reyes National Seashore. It is 30 miles north of San Francisco and is...

For the past 10 years, Southcentral Foundation has been revisiting the design process for their Anchorage Native Primary Care Clinic. In 2009, 80,000 square feet was added. Informing the design is...

Unique feature: Pursuing Gold Level LEED Certification

 

La Maestra Community Health Centers, located in the heart of City Heights in central San Diego,...

Construction

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What is Construction?

There are several approaches to constructing a building. Using a design-build or construction management approach means the contractor will already be well-versed in your project. In a traditional design-bid-build process, the project is put out to bid, and a general contractor is selected according to pre-established factors, such as experience, schedule, and cost.

 

During the construction phase, the goal of the project team is to monitor the implementation of the design into construction to ensure that the original intent has not been compromised. Activities occurring during construction that are led by the healthcare organization include: launching internal readiness and process improvement plans, obtaining zoning and use permits, establishing early permit and third party approvals, and beginning transition planning, and obtaining the Certificate of Occupancy (CO). 

 

Construction Activities

Activities developed during this phase that are design team-led processes include: coordinating construction administration documents, developing punch lists, and completing project close-out.

 

Evidence-Based Design

The team should monitor implementation of design (Step Seven) to ensure EBD innovations are implemented as envisioned during the design phase.

Design Activities

Print Design Activities

See Evidence Based Design tab for EBD activities during this phase

A related term is operational readiness: an organization is operationally ready to provide care and services if it has the right people at the right place at the right time, working with the right equipment and technology in accordance with the right policies and protocols.

The purpose of the manual is to maintain all key information related to the project in a single location, so that once the development team has been disbanded, the clinic staff has the information necessary to manage the building.

Effective management of the project includes maintenance of project correspondence, conducting progress meeting, handling submittals and requests for information, documentation of progress, review of pay requests, schedule reviews and schedule updates.

 

This involves negotiation of change orders with the contractor, coordination with the designer over design changes, determination of responsibility for changed conditions or coordination conflict, and review of price and schedule changes.

Review the project to ensure orderly and timely completion, including development of punchlists; monitoring of implementation, training and warranty periods; resolution of outstanding issues; review and analysis of claims or disputed issues.

The CM and/or architect usually examines project performance on a continuous or periodic basis to review progress, ensure compliance with specifications and plans, to review housekeeping and safety issues. 

When the project is nearing completion, the architect will conduct a walk-through with the contractor, project manager and clinic representative, creating what is known as the “punch-list,” unfinished tasks that are listed as conditions to be completed by the contractor prior to final payment.

Substantial completion is evaluated by the architect and is where the Owner assumes responsibility for the building. It is set from the beginning of construction, and is significant as it is a transfer point of risk and liability from the Contractor to the Owner. It is the beginning of project closeout, but work is still required, such as punch list items.

Part of a state's mechanics' lien law system. Signed by the owner, it is legally recorded with the proper authority within 10 days after completion of construction. 

This is after the punch list work is complete, and after the owner, the builder, the architect, and often the lender make a final inspection of the site. When the final inspection is successfully completed, the architect issues a certificate for final payment, allowing the builder to collect payments still due.

Establish the activation and move plan to determine the specific of how the new facility or renovation will be operational on Day One with considerations such a staff moves, equipment moves, use of temporary space, and technology testing.

Commissioning ensures that upon occupancy, the new building systems (HVAC, lighting, water) operate as intended and that building staff are prepared to operate and maintain its systems and equipment. Enhanced commissioning can include additional items. 

Project closeout is initiated when the contractor notifies the Owner, that the building is sufficiently completed (according to the Certificate of Substantial Completion) and is ready for occupancy. The closeout includes resolution of change orders and the final payment, completion of punch-list items, training and maintenance manuals/warranties for building systems, and the creation of lien waivers. 

Evidence-Based Design Activities

Print Evidence-Based Design Activities

As construction starts, it is the role of the project team to monitor the EBD interventions to ensure that the original intent has not been compromised. If alternates or substitutions are proposed to reduce costs, it is essential to refer to the project’s EBD goals and objectives to ensure that the integrity of the project is maintained while the project is made more cost effective.

 

FAQs

Print FAQs

There are two types of Construction Managers (CMs). Through an agency CM, construction cost management is a fee-based service in which CM is responsible exclusively to the owner and acts in the owner's interests at every stage of the project. The construction manager offers advice on matters such as:

 

  • Optimum use of available funds;
  • Control of the scope of the work;
  • Project scheduling;
  • Optimum use of design and construction firms' skills and talents;
  • Avoidance of delays, changes and disputes;
  • Enhancing project design and construction quality;
  • Optimum flexibility in contracting and procurement;
  • Cash flow Management.

 

An Agency CM provides management of every stage of the project, beginning with the original concept and project definition and can represent the owner by helping to select the design team as well as the construction team and manage the design preventing scope creep, helping the owner stay within a pre-determined budget by performing Value Engineering, Cost/Benefit Analysis and Best Value Comparisons.

 

A second type of CM is a CM at-risk. This is a delivery method which entails a commitment by the construction manager to deliver the project within a Guaranteed Maximum Price (GMP. The construction manager acts as consultant to the owner in the development and design phases, (often referred to as "Preconstruction Services"), but as the equivalent of a general contractor during the construction phase. When a construction manager is bound to a GMP, the most fundamental character of the relationship is changed. In addition to acting in the owner's interest, the construction manager must manage and control construction costs to not exceed the GMP. (Source: adapted from http://en.wikipedia.org/wiki/Construction_management)
 

Operational readiness includes:

  • Redesigned models of patient care and workflow
  • Human resources strategy including physician strategy
  • IT/IS and telecom strategy and implementation
  • Opening day definition and ramp down and up plans
  • Financial plans and operating budget
  • Stakeholder relations and meeting expectations
  • Internal and external communications
  • Orientation and training

Related activities include a change readiness assessment that can be conducted to understand barriers to change. This includes which stakeholder groups are most resistant to change, their specific concerns, and how those concerns can be addressed. It also provides a quantitative measure to monitor readiness and alignment over time
 

Resources

Print Resources

Created by the Construction Management Association of America (CMAA).  The phases and activities related to this resource include:

Construction

  • Conduct construction inspection and surveillance
  • Substantial completion
  • Notice of completion
  • Final completion

Authored by Sydney M. Levy. Phases and activities related to this resource include:

Construction

  • Conduct construction inspection and surveillance
  • Substaintial completion
  • Notice of completion
  • Final completion

Created by NCB Capital Impact. Phases and activities related to this resource include:

Organizational Readiness

  • Conduct operational planning
  • Conduct allocation planning/preliminary space assessment
  • Finalize strategic planning
  • Develop community awareness/engagement
  • Develop the business plan (Sect VII)
  • Development of project budget
  • Explore various financing options
  • Develop a preliminary project schedule
  • Hire a project manager and architect (Sect IV)

Pre-Design

  • Determine financial feasability
  • Conduct a market needs analysis and assessment
  • Select/survey sites and evaluate space availability (Sect IV.b)
  • Select an attorney, architect/interior designer, contractor and construction manager
  • Establish the remaining project team
  • Property aquisition/site control
  • Refine project budget/schedule (Sect VIII)

Design

  • Continue conceptual diagramming
  • Design development
  • Permit process
  • Zoning/use processing
  • Furniture, fixtures, equipment (FFE) and technology planning
  • Purchasing plan
  • Construction documents
  • Value engineering (p. 33)
  • Early permit - third party approvals (p. 40-41)
  • Bid and award - this may be phased, based on contract type

Construction

  • Conduct construction inspection and surveillance (p. 43-49)
  • Create the punch list (p. 55)

Created by Clinica Sierra Vista. Phases and activites related to this resource include:
Construction

  • Transition planning
  • Project close out 

Occupancy

  • Marketing/Outreach planning

Created by Construction Management Association of America (CMAA). Phases and activities related to this resource include:

Pre-Design

  • Select an attorney, architect/interior designer, contractor and construction manager

Design

Construction

  • Establish project controls
  • Substantial completion
  • Notice of completion
  • Final completion


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Study Guide 3: Integrating Evidence-Based Design: Practicing the Healthcare Design Process.

Guide Three pulls together the evidence-based design (EBD) process to walk you through the key steps of the design process in detail from pre-design, design, construction and occupancy. Practical examples demonstrate key areas and show how EBD is practically applied.

 

Purchase >

 

Phases and activities related to this resource include:

Organizational Readiness

Pre-Design

  • Evaluate work flow
  • Start conceptual diagramming

Design

  • Continue conceptual diagramming
  • Design development
  • Bid and award-this may be phased based on contract type

Construction

  • Substantial completion
  • Final completion

Occupancy

 

Created by Labs for the 21st Century/EPA/DoE and covers the entire design process with a focus on sustainability. Phases and activities associated with this resource include:

Construction

  • Commissioning phase
     

Created by Deloitte. Phases and activities included in this phase include:

Organizational Readiness

  • Conduct operational planning
  • Determine staffing needs
  • Develop a business plan
  • Plan for the project mission/vision

Construction

  • Internal readiness

Created by New York State Division of Housing and Community Renewal (DHCR)/Franke Consulting Group.
 

Created by the Facility Guidelines Institute, 2010 edition. There is a read only version of the guidelines at the bottom of the linked page. Phases and Activities applicable to this resource include:

Pre-Design

  • Select/survey sites and evaluate space availability
  • Property aquisition/site control
  • Start conceptual diagraming

Design

  • Continue conceptual diagraming
  • Schematic design
  • Design development
  • Permit process
  • Zoning/use processing
  • Construction documents

Construction

  • Notice of completion
  • Final completion
  • Commissiong phase

Occupancy

  • Certificate of occupancy
  • Licensing

A free resource from Capital Link and Primary Care Development Corporation on developing a health center. Phases and Activities applicable to this resource include:

Organizational Readines

  • Conduct operational planning
  • Conduct allocation planning/preliminary space assessment
  • Finalize strategic planning
  • Create project organizational leadership
  • Development of project budget
  • Explore various financing options
  • Consider sites (see chapter 5)
  • Develop a preliminary project schedule (see chapter 2, and Appendix B)
  • Hire a project manager and architect

Pre-Design

  • Determine financial feasability
  • Select/survey sites and evaluate space availability (see chapter 5)
  • Select an attorney, architect/interior designer, contractor and construction manager (see chapter 3-4, 6 and Appendix D)
  • Establish the remaining project team (see chapter 4, Appedix D and E)
  • Property aquisition/site control 
  • Plan and program
  • Refine project budget/schedule 
  • Start conceptual diagraming

Design

  • Continue conceptual diagraming
  • Schematic design
  • Design development
  • Construction documents
  • Bid and award - this may be phased based on project type (see chapter 7)

Construction

  • Notice of completion
  • Final completion
  • Transition planning

Clinic Examples

Print Clinic Examples

With 16 health centers and 54 different locations, Clinica Sierra Vista provides health care services to a large, underserved Hispanic population spread over 6,000 square miles. According to Doug...

 

Unique feature: The Clinica de la Raza Community Health Center is a component of a transit-based development village that provides physical renewal and economic...

Occupancy

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What is Occupancy?

After construction is complete, departments and staff are moved into the new facility and/or renovated space for a fully operational facility. While it is encouraged to engage staff throughout the entire design process, it is crucial to provide an orientation to the new facility and/or renovated space, its design features, and equipment to improve the transition from old practices to new.

 

Occupancy Activities

Activities occurring during occupancy that are led by the healthcare organization include: obtaining feedback from neighborhood leaders, performing community outreach, and planning marketing activities. Activities occurring during occupancy that are led by the design team include licensing.

 

Evidence-Based Design

In an EBD process, data is often collected after occupancy to evaluate whether hypothesized outcomes have been achieved. After you occupy the building you will complete Step Eight: post-occupancy evaluation.

 

Design Activities

Print Design Activities

See Evidence Based Design tab for EBD activities during this phase

Obtain certificate of occupancy; identify and resolve potential problems; make adjustments and modifications when needed.

Coordination of inspection and licensure reviews; If LEED status was pursued, finalize the LEED certification process - complete all documentation, checklist, LEED credit templates, project narrative; submit documentation to USGBC.

Performing community outreach; notify the local community about the opening of the new facility; obtain feedback from neighborhood leaders.

Conduct open-house and marketing activities.

Prior to accepting patients, it is helpful to have the staff practice typical functions and scenarios so they are not performing basic tasks for the first time where patient care is involved.

Evidence-Based Design Activities

Print Evidence-Based Design Activities

The final stage of design process is post-occupancy evaluation (POE). This is the time to measure and share the results from your project based on the goals and hypotheses developed at the beginning of the project.

FAQs

Print FAQs

Feedback can be obtained from public meetings, interviews, focus groups, or surveys. Opinions should be evaluated by a team for the impact on both operations and the patient experience. There are often suggestions which have a minimal impact and little cost to implement, but other suggestions may be out of scope from a financial or strategic perspective. Expectations should be set relative to how suggestions will be evaluated, and in some instances it will be important to follow up directly with those making suggestions to ensure they know their opinions are heard and valued, even if not implemented.

A Temporary Certificate of Occupancy (TCO) is for a temporary period of time and is usually obtained when there is a certain portion of the building the is determined to be habitable while another section is still under construction, or where minor construction is still underway, but it is safe for non-construction personnel to occupy the area.

The procedure and requirements for the Certificate of Occupancy (CO) vary widely from jurisdiction to jurisdiction, but this information is often available online. There are typically timeframes associated with both the time from the request for an inspection, as well as the intended occupancy date. The inspection request is made by the Contractor, the Owner, or the Owner’s representative.

Resources

Print Resources

Marketing dental services to low income/underserved populations may seem unnecessary, considering that most safety net clinic patients have no other places to obtain dental care and most clinics have long waiting lists for appointments. However, lenders don't necessarily know that. The safety net dental clinic equivalent of a for-profit business "promotion" is the clinic's "outreach" to attract patients. Generally, this amounts to just getting the word out when the clinic first opens. The outreach plan should demonstrate to lenders and others that the organization's services will be adequately utilized.

 

Phases and activities related to this resource include:

Occupancy

  • Marketing/outreach planning

Created by the California HealthCare Foundation.  Phases and activities related to this resource include:

Occupancy

  • Liscencing

Created by the California HealthCare Foundation.  Phases and activities related to this resource inlcude:

Organizational Readiness

  • Development of project budget
  • Explore various financing options

Occupancy

  • Liscensing

Created by Clinica Sierra Vista. Phases and activites related to this resource include:
Construction

  • Transition planning
  • Project close out 

Occupancy

  • Marketing/Outreach planning

Study Guide 3: Integrating Evidence-Based Design: Practicing the Healthcare Design Process.

Guide Three pulls together the evidence-based design (EBD) process to walk you through the key steps of the design process in detail from pre-design, design, construction and occupancy. Practical examples demonstrate key areas and show how EBD is practically applied.

 

Purchase >

 

Phases and activities related to this resource include:

Organizational Readiness

Pre-Design

  • Evaluate work flow
  • Start conceptual diagramming

Design

  • Continue conceptual diagramming
  • Design development
  • Bid and award-this may be phased based on contract type

Construction

  • Substantial completion
  • Final completion

Occupancy

 

Created by Labs for the 21st Century/EPA/DoE and covers the entire design process with a focus on sustainability.  This resource specifically covers the Occupancy phase.
 

Created by New York State Division of Housing and Community Renewal (DHCR)/Franke Consulting Group.
 

Created by the Facility Guidelines Institute, 2010 edition. There is a read only version of the guidelines at the bottom of the linked page. Phases and Activities applicable to this resource include:

Pre-Design

  • Select/survey sites and evaluate space availability
  • Property aquisition/site control
  • Start conceptual diagraming

Design

  • Continue conceptual diagraming
  • Schematic design
  • Design development
  • Permit process
  • Zoning/use processing
  • Construction documents

Construction

  • Notice of completion
  • Final completion
  • Commissiong phase

Occupancy

  • Certificate of occupancy
  • Licensing

Clinicia Sierra Vista, basked in Bakersfield, California shared a pre-move checklist example with us to help other clinics think about the items that need to be addressed before occupying your new building.

Clinic Examples

Print Clinic Examples

With 16 health centers and 54 different locations, Clinica Sierra Vista provides health care services to a large, underserved Hispanic population spread over 6,000 square miles. According to Doug...

 

Note: To use the Design & Construction Process Toolkit click on the phase above and scroll through the tabs and subsequent phases.  Activities are noted with the teams that are involved--(C) is clinic team, (D) is design team, (R) is researcher.  

 

Take a short survey and share your feedback on the toolkit.


With the increasing focus on providing patient-centered care in primary care clinics and community health centers, it’s even more important than ever to align care models, technology, and the built environment to achieve the best outcomes for your patients and staff.

 

Part of this integrated approach is to examine the built environment and think about how it can better meet the needs of your patients, visitors, and staff. With that in mind, the purpose of the Clinic Design website and this Design & Construction Process Toolkit is to support your clinic team as you embark on your journey to build new clinics or renovate existing spaces.

 

The resources and case study examples on this website will help you understand how the environments you are creating may impact patients, families, and staff. You can then incorporate this information into your own design decision-making process.