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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.

Evidence-Based Design Activities

EBD Step 3: Critically Interpret Evidence

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?

Determine relevance of evidence collected (P,D)

Is the information credible (a defined scope from a reliable source), actionable (suited to your organization), and generalizable (are outcomes transferable to a clinic setting)?.

Hierarchy of credible evidence (P,D)

Consider the quality of the research design and measurement tools. The range of hierarchy spans from very subjective and context specific, such as opinions, through Post-Occupancy Evaluations, Case Studies, Surveys, and through to more objective types of studies, such as Controlled Observational Studies, Quasi-Experimental Studies, and Randomized Control Trials. Systematic Reviews can be a good resource to understand the breadth of studies within a topic area, as well as an overview of the consistency of findings.

Reliability and validity (P)

When considering evidence, reliability and validity are key considerations. Validity is the extent to which a measurement tool measure what it should, and reliability is the degree to which the tool will yield similar results at different times or with different people. For example on a more subjective scale, opinions may not be valid or reliable, but a survey using a validated survey instrument may provide more meaningful results.

Identify any conflicting findings and confounding variables (P)

Consider multiple studies (when available) with differing results or other changes (multiple simultaneous interventions) that could affect study outcomes. Before making decisions, ask the team to whether there were conflicting findings or confounding variables.

Refine project budget/ revisit the business case (P,D)

Based upon the available research, there may be some design ideas you want to incorporate into the facility. This may affect the capital budget, but should be evaluated against the long-term benefits and operating costs. Establishing a life-cycle analysis of ROI should support your business case.

EBD Step 2: Find Sources for Relevant Evidence

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.

Inform design challenge and formulate research questions (P, R)

In addition to defining the issues and problems, consider what additional questions need to be raised and the evidence that might be used to inform decisions. Learn about what others have done through benchmarking visits or interviews to establish some early ideas to guide the project.

In a clinic setting, this may include better understanding models of care, their delivery, and how this affects the building layout and space requirements. Your questions may focus on how effectively you are able to deliver care in the new model by measuring throughput times, compliance, and satisfaction. You may want to engage a researcher to help identify research questions, but you may be able to identify certain questions and related metrics on your own through information you already gather.

Identify types of evidence (P, R)

Initially, it is important to identify all types of evidence, such as published papers, case studies, peer interviews, site visits, and structured benchmarking. The type of evidence may be tied to the type of information your team is trying to learn – newer information may only be found while conducting a site visit, rather than in a published format.

There are very few peer-reviewed published papers that will identify conditions specific to clinic settings, however, information can often be extrapolated from other environments, whether acute care or ambulatory care. It is important to get help understanding how less rigorous sources can still be applied to a clinic setting. This may be through a researcher or someone well-versed in the EBD process who can establish some guidelines for how you might best use the information collected.

Pre-Design

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Pre-Design

What is Pre-Design?

Pre-Design Activities

Evidence-Based Design

Sustainability

Lean Processes

Evidence-Based Design Activities

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