Thursday, February 10, 2011

Architectural grocery lists

In the recent hubbub of finishing SD for the Uber MOB, many of the departments find that the programs for their departments are wanting--some rooms are too small, others were left off the program, and now and again there are too many of some rooms. So as we're making sure the departments flow properly, we're also having to do this addition, subtraction, and massaging of rooms and spaces.

A program is like a detailed grocery list. First, it lists what rooms and spaces (and how many of each of those rooms and spaces) are needed. (Space doesn't necessarily have walls on all of its sides--it might be a wider area in a hallway, or it might be an alcove tucked in off of a hallway but open to it as well, or it might be an open area inside a larger room, which has walls on three or four of its sides and often, but not always, a door.) Then it tells you how big each of those rooms needs to be (square feet), and sometimes the program will indicate a minimum dimension for these spaces. (For example, a CT scan might be specified to be 350 sf, but the program might also indicate that the room must be at least 14 feet wide.) If it's a well-written program, it will also provide details on how the spaces relate to each other: do some of them need to be close to each other or accessed directly from one another, or do some need to be as far from each other as possible? Do some of these spaces need to account for a huge piece of equipment or need to have direct access to the outdoors? Finally, a good program will also account for things like circulation (the space needed to get between the rooms and to move around in open rooms with lots of smaller spaces in them, as well as stairs and elevators), walls and structure, and utility spaces (tele/data rooms, electrical rooms, mechanical rooms and shafts, housekeeping closets, elevator machine room, etc.).

While these programs for Uber MOB were put together almost a year ago with the users and the higher-ups at Gestalt, there are now more users in the room when we go through these plans who weren't involved in the initial programming. Some of these users are the ones treating patients every day, so they have a different perspective on how many of what spaces are needed. These daily users are the ones who provide us with real, useful information like, "the reason we can function with three exam rooms now is because we use two of [neighboring department]'s exams on Tuesdays and Thursdays. We really need at least five exams, preferably six, if we're not gonna be able to share exams with someone else." Or they might say, "By the time a patient gets to us, there's no need to weigh them--we'd rather use the patient weighing/vitals alcove for equipment storage." We the architects then make notes on the program and send those user-requested changes to Gestalt National in the mid-west so that they can approve or disapprove of the changes.

It would be easy to get mad at the users (and/or the client) for underestimating a department's needs, but programming is a gift that architects sometimes take for granted, I think. It's our job to take users through the course of treating a patient and get them to think about the spaces they use and need. It's out job to help a client think through if they do something a certain way now because it's how they want to do it or if there's something about the existing building that makes them do it that way. It's our job to help a client understand space and really know what it means to have a 7'-0" x 14'-0" storage room. So instead of getting pissed when clients say, "Oh, good Lord, we need another four exam rooms and a lab!", I try to remember that they're having to play catchup to the way I already think, just as I probably remember important symptoms at the last minute during visits with my own physician.


Marshall said...

That post was very refreshing. Too often I hear people complain about their clients. Teachers complain about students, waiters complain about diners, etc. I like your self awareness to the fact that even though your clients can be aggravating, they don't have your perspective and they have their own set of problems. We could all benefit by having some empathy to those we work with or for.

John said...

I agree that we as architects need to have patience with so called "unsophisticated" clients (those that are not up to speed on construction schedules and vocabulary because they do not build often). That being said, we also need to educate our clients as to the timeline of design and construction.

By the looks of it, your clients are making appropriate comments for a schematic design phase. Those types of comments do not generally aggravate me, unless they change the scope so radically our budgets are no longer in line. The ones that I dislike and complain about are the ones that come while you are late in CD's, trying to finish the project so you can meet a deadline. It might be because someone new came in who has a different insight or it might be that someone just now decided to look at your drawings. Either way, it can be a huge hassle to incorporate comments like "we need 5 labs not 3" at a late phase.

Contractors are good about ensuring that any change made by the owner or architect comes with additional fee and, where appropriate, additional time. Architects are hesitant to make that same request. We typically will just grumble and bend over backwards to make the client happy.

It's all about education, I say.

Scarlett said...

yet, a client should be able to articulate how they do their job and what space they need it. That should be a job requirement of SOMEONE in the god.d. office - be it the office manager or a savy Dr or nurse.

Failure to be able to do this should not be on you.

That said, architects are likely kick ass facilitators for this type of verbal communication.

Seriously though - in order to be considered "competent" in one's profession, one should be able to list what they need to do the job, including work area.

you are continuing to reinforce my idea that our medical system does not know WTF they are doing.

Mile High Pixie said...

Marshall: Empathy is the key, I find, in working with people who don't do what I do every day. For the rad techs, this is the only chance they'll get in a 30-year career to design a new radiology suite, but this is my 5th suite in 10 years.

John: Absolutely. While empathy is key (see Marshall's comment), we also have to be the ones to deliver hard truths like, "If you make changes starting next week, it will quite literally cost you money and time." I've never understood why architects are so afraid to grow an additional services backbone like the contractors. We're both important, after all.

Scarlett: I know! You'd think someone knows how they do what they do and what they need, but this phenomenon isn't endemic to just healthcare--it's a problem for anyone who doesn't build new buildings on a regular basis. The museum director wants different things than the docents than the curator than the housekeeping and maintenance staff. It's our job, sometimes, to make them face each other and say "you two/three/twelve need to duke this out a bit before I move one effing wall on this plan again."