And now, time to hold our breath

Last week, the Uber MOB team wrapped up its schematic design submission to Gestalt HMO's main facility planning committee. When you do a project for a healthcare facility that's part of a bigger health system, it's not just about doing the drawings and having a contractor price them (although that's included)--the health system has to review the project too. Healthcare systems/entities have their own sets of standards that projects have to meet that include (but are not limited to):

• are the construction materials the kinds that they, system-wide, know how to clean and maintain?
• are the materials used in the building the best-priced ones that can also do the job?
• are the rooms and spaces in the project too large or too small to deliver good care?
• does the project account for expansion in the near and not-so-near future? Does it also account for any upgrades or small renovations (e.g., adding extra offices, building out more exam rooms or ORs)?
• does the project make the best use of the site, views, etc.?
• does the project have everything it was programmed to have (e.g., ten pre-op bays for five ORs; one doctor's office for every two exam rooms) that will allow them to deliver cost-effective care?
• and finally, is it under budget, and can it be built on schedule?

These extra reviews can be a pain in the butt, but they add an extra layer of checks and balances to a project. If I can't defend why I, the healthcare architect, can't make a certain group of rooms or a department work the way the health system says it "should", then I'm the one who's wrong. However, if I can make a case for doing something unusual or making a room larger or smaller than the powers-that-be say it "should" be, then I may be able to get them to accept it.

This is also the part where I end up defending the users' requests to the owners. The owners are the healthcare system: in this instance, Gestalt HMO. The users are the doctors and nurses that will be treating patients in the spaces. There's a balancing act between these two groups, as they're not always on the same page.

For example, the owners may say that a GI/endoscope procedure department should only have a 75 square foot break room/kitchenette in their department. The reasoning is that the department's staff shouldn't have a full-on "break room" where they can hide from patients; they should use the building's main break room. The users, however, will argue that they do need a proper break room that's closer to twice the programmed size. The case the users make is that in order to make scope procedures make money (and therefore be worth having in a building), they have to run a case every half hour for nine hours a day in six procedure rooms, which is a lot of staff. Plus, running a case every half hour doesn't leave a lot of time for lunch or a real break. If a gastroenterologist and her two procedure nurses only get a half-hour break for lunch between cases, that's not much time to heat up a lunch and eat it without getting heartburn. And at least the physician can go to her office to eat, but if the GI suite is on the fourth floor and the main building break room is on the first floor, the two GI nurses lose nearly ten minutes going downstairs and getting back upstairs, leaving only 20 minutes to scarf something down and try to recover from the awful case they just had where they had to tell a 40-year-old father of two that he has tumors in his colon.

So all the staff for this busy department needs somewhere close by but off-stage to eat and take a moment to recover from the pace and the mental strain required to do a good job every time all the time. So they really really really want a 130-sf break room. And if I can get one to fit in their department, I'm going to do it. And then the owners will tell us that the users aren't our clients, the owners are. And then I remind the owners that if a user works in a building and a department that prevents them from actually delivering good care, they'll leave a facility and go elsewhere and tell everyone they know that XYZ Health is a joke and run by morons, and that Mile High Pixie chick isn't a very good architect either. Good facilities not only deliver good care, but they also help with staff recruitment and retention, which is a big deal in healthcare.

So, we've sent off our drawings and all our documentation to Gestalt for their review, and we're holding our breath and waiting to exhale like Whitney Houston. And I still have work to do on some other small projects for Gestalt, but that's another post.