Bubble or block drawings, starts in pre-design.
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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
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
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
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.
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
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,...