1. Planning Facilities for Flexibility

2. Planning Facilities for Flexibility l 2 What is… FLEXIBILITY The Ability to Expand or Adapt

3. Planning Facilities for Flexibility l 3 To Accommodate Future Workloads. To Allow For Operational Changes. To Modernize With New Building Systems. WHY PLAN FOR FLEXIBILITY

4. Planning Facilities for Flexibility l 4 PLANNING CONSIDERATIONS PLANNING FOR EXPANSION – Programming and Planning – Design and Construction PLANNING FOR ADAPTABILITY – Programming and Planning – Design and Construction

5. Planning Facilities for Flexibility l 5 PLANNING FOR EXPANSION Programming and Planning Considerations

6. Planning Facilities for Flexibility l 6 PLANNING FOR EXPANSION 1. ESTABLISH A CLEAR CIRCULATION TO SET THE THE GROWTH PATTERN 2. UNDERSTAND HOW SERVICES EXPAND 3. PLACE LARGE, HIGH-TECH, LIKELY TO EXPAND SERVICES ON AN EXTERIOR WALL 4. VERTICALLY STACK SERVICES LIKELY TO EXPAND 5. LAYOUT SERVICES FOR EASE OF EXPANSION

7. Planning Facilities for Flexibility l 7 6. LOCATE EASY TO RELOCATE SERVICES ADJACENT TO SERVICES THAT SHOULD REMAIN STATIONARY 7. PLAN FOR PLUG-IN MOBILE SERVICES 8. USE VACANT SPACE TO AID WITH EXPANSION 9. LOCATE IMMOVABLE ELEMENTS SO EXPANSION OF OTHER STRUCTURES IS NOT BLOCKED PLANNING FOR EXPANSION

8. Planning Facilities for Flexibility l 8 Emergency Entrance Circulation Network Establishes Growth Pattern Main Entrance

9. Planning Facilities for Flexibility l 9 EXPANSION CHARACTERISTICS OF SERVICES INPATIENT UNITS – Whole Units are Added or Replaced DIAGNOSTIC & TREATMENT SERVICES – Incremental – Space for New Equipment – Building Systems are Modified SUPPORT SERVICES – Expansion Delayed Until Substantial Expansion is Required ADMINISTRATIVE SERVICES – Miscellaneous Available Space is Filled Until Consolidation is Required CLINCS – Support Space is Converted Into Clinical Space – Whole Modules are Added

10. Planning Facilities for Flexibility l 10 Main Entrance Emergency Entrance Large High-Tech Services on Exterior Wall MED/ SURG NURSING UNIT ICU MECH. ADMIN. PATIENT SERVICES RADIOLOGY EMERGENGY SURGERY D&T CONF.

11. Planning Facilities for Flexibility l 11 Layout Services for Ease of Expansion

12. Planning Facilities for Flexibility l 12 Main Entrance Emergency Entrance MED/ SURG NURSING UNIT ICU MECH. ADMIN. PATIENT SERVICES RADIOLOGY EMERGENGY SURGERY D&T CONF. Soft Space Provides Expansion for High-Tech Services

13. Planning Facilities for Flexibility l 13 PLANNING FOR EXPANSION Design and Construction Considerations

14. Planning Facilities for Flexibility l 14 1. STRUCTURE FOR VERTICAL EXPANSION 2. LOCATE MAJOR BUILDING EQUIPMENT, SO THAT ADDITIONAL EQUIPMENT CAN BE ADDED 3. DESIGN BUILDING SYSTEMS FOR EASE OF EXPANSION 4. DESIGN AND CONSTRUCT TO MINIMIZE THE DISRUPTION OF EXPANSION 5. CONSIDER BUILDING LIFE-CYCLE: SHORT TERM, MID-TERM, LONG TERM PLANNING FOR EXPANSION

15. Planning Facilities for Flexibility l 15 PLANNING FOR ADAPTABILITY Programming and Planning Considerations

16. Planning Facilities for Flexibility l 16 1. USE STANDARD PLANING MODULES 2. MAXIMIZE OPEN SPACE, DO NOT ENCUMBER WITH FIXED ELEMENTS 3. POSITION SOFT SPACE WHERE FUTURE HIGH TECH ROOMS WILL BE NEEDED 4. SHARE OR SWING SPACE WITH LOW UTILIZATION 5. DEVELOP DESIGN CONCEPTS TO ACCOMMODATE EXPECTED FUTURE OPERATONAL CHANGES 6. ENCOURAGE OPEN SPACE PLANS 7. DOCUMENT PLANNED FLEXIBILITY PLANNING FOR ADAPTABILITY

17. Planning Facilities for Flexibility l 17 EXAM ROOMADMIN. OFFICE Standard Planning Module - Room

18. Planning Facilities for Flexibility l 18 Standard Planning Module - Clinic

19. Planning Facilities for Flexibility l 19 Clinics Swing Exam Rooms to Meet Demand Fluctuations

20. Planning Facilities for Flexibility l 20 Fixed Elements Encumber Open Space

21. Planning Facilities for Flexibility l 21 Fixed Elements on Perimeter

22. Planning Facilities for Flexibility l 22 Soft Space Becomes Future High-Tech Room

23. Planning Facilities for Flexibility l 23 Acute Care Unit Converts to Intensive Care Nurse Station (12) Bed Acute Care Pod Becomes an ICU

24. Planning Facilities for Flexibility l 24 PLANNING FOR ADAPTABILITY Design and Construction Considerations

25. Planning Facilities for Flexibility l 25 1. SIZE STRUCTURAL BAYS FOR FLEXIBILITY 2. FLOOR TO FLOOR HEIGHT THAT ALLOW FOR ADDITIONAL OR NEW SYSTEMS 3. DESIGN BUILDING SYSTEM SPACE FOR ACCESS AND ADDITIONAL SYSTEMS 4. ZONE BUILDING SYSTEMS 5. USE BUILDING COMPONENTS THAT CAN BE RECONFIGURED 6. USE CHANGEABLE, MOVEABLE, AND PORTABLE EQUIPMENT 7. PROVIDE ADDITIONAL OUTLETS SO ROOM FURNISHINGS CAN BE RECONFIGURED PLANNING FOR ADAPTABILITY

26. Planning Facilities for Flexibility l 26 Building Section with Interstitial Space

27. Planning Facilities for Flexibility l 27 First Cost Premium + Operating Cost Premium -VS- Future Cost Savings + Mitigated Disruption First Cost Premium – Additional Cost of Flexibility Operating cost Premium – Additional Operating Cost Future Cost Savings – Savings Derived from Flexibility at Time of Modifications Mitigated Disruption – Disruption not Experienced due to Build-in Flexibility VALUE OF FLEXIBILITY

28. Planning Facilities for Flexibility l 28 WHERE IS FLEXIBILITY IMPORTANT TODAY? ABILITY TO ADD HIGH-TECH DIAGNOSTIC EQUIPMENT EXPANSION OF OUTPATIENT SERVICES EXPANSION FOR INPATIENT BEDS INSTALLATION OF COMMUNICATION/ INFORMATON SYSTEMS ABILITY TO ADAPT FOR ACTIVITY ABILITY TO SURGE FOR UNEXPECTED HIGH VOLUMES ABILITY TO ADD INCREMENTALLY EXPANDING SERVICES DOWN-SIZING SERVICES EVERYWHERE