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.