Ten pounds of program in a five-pound building

One of the hardest things about doing renovations is trying to accommodate all the spaces that the users need. If the renovation project won't allow us to add onto a space (either because of budget or physics), we have just the space we have and no more in order to fit all the program's needs. Sometimes, we have even less space than we started with due to code or growth issues. What makes fitting all these rooms and spaces into a limited space so difficult is helping the users realize that they can't have it all and need to prioritize.

As I pass the 1st floor Gestalt Bierstadt project off to Buster to do CDs, I'm now working through SD/space planning with the 9th floor OB/GYN clinic. OB/GYN includes some other women's subspecialties, like dealing with infertility or ovarian cancer or gestational diabetes, so it's not just Pap smears and pregnancy tests. There are lots of procedures going on up on the 9th, and it's a busy-ass floor. Presently, they say they don't have enough exam rooms, and some of the subspecialties are practically standing on each other for procedure room space. So, Design Associates' first floor plan for them involved shrinking the waiting room to make more exam rooms and then lumping the three nurse practitioners into one larger-than typical office. Next, we were told that the infertility clinic was moving out, so we used its space to make more exams and procedures for the rest of the remaining subspecialties.

Getting the right people in the room for a user group meeting is critical. Too many people or the wrong people can make a space useless once it's built. The goal is to get the one or two (sometimes three) best folks in the room to provide input, and they will share info and questions with the rest of the staff and bring that back to the weekly or bimonthly user group meetings. Our user group meetings for OB/GYN have mostly consisted of the OB/GYN nurse manager, who would occasionally bring along her second-in-command nurse to provide input on the spaces and workflow. This is excellent; nurses are more aware of workflow and staff and patient issues than physicians. That's not to say that the doctors don't know how to put a department together, but it's been my experience that they know a lot about the part that they do, but not as much about the part that the nurses deal with all the time, which affects more of a department's layout. The other problem with having docs at user group meetings is that they can't always make it to the meetings--there's an emergency, they're out, appointments are running late--and the only way to get good feedback on a department is to have the same group of people present every time.

So imagine our surprise when a white-coated OB/GYN doc strolled into the user group meeting a few weeks ago, at five minutes before the meeting's end, took one look at the plan, and pronounced it all wrong--the waiting room was too small, these nurses need to be over here, the NPs can't share an office, etc. I was ready to put my red pen through her eye, but fortunately for me, the doc, and the project manager for Gestalt said that she would meet with the department in a few days and we're out of time for this meeting, so sorry, there's another one about to start. The project manager (who deserves her own post) looked at me and apologized profusely, then asked me to send her a PDF of the plan so that she could talk the department through the plan at their separate meeting. She worked through the plan with them, came up with a few solutions, and then gave the plan to me. When I got it into CAD, she and I then sat down together to work through all the rooms and spaces and...

...it just wasn't going to happen. If you want a room for these four nurses, it has to go in this corner because we can't get a door into this little spot and both of these procedure rooms need to be on an inside wall with no windows. If you want the NPs to have separate offices, you're going to lose two more exam rooms, which you say you so desperately need. If you want space for six nurses at your nurse station, you're not going to have room for a sink, microwave, and fridge. That's it.

User group meetings rarely go past 90 minutes, but the OB/GYN ones go on for two flippin' hours while the nurse manager and the doc and the department head beat the hell out of every square inch of the plan. People, I don't want to do anything that feels good for 90 minutes, so you can imagine how done I am with a 2-hour user group meeting. I'm ready to stab everyone with the red pen, and I give less than one tenth of one crap about a private bathroom for the staff. Go use the big one that's centrally located on the floor and STFU. If you want more waiting room (even though we're giving you more exams and procedure rooms and technically you're not supposed to need a lot of waiting if you have more treatment space, but I'm just the architect), then you're gonna have to give something up, like exams or private offices or an extra storage room or something. What are you willing to give up? What are the biggest priorities for this floor, in descending order? You only have this 12,000 sf that's 98 feet off the ground, so how do you want to use it?

Pass the riesling, please.