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).
Pre-Design
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
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
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
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.
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
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...