Pre-Design

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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.

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