In the current industry climate, architects and designers can expect healthcare clients to challenge practices-even best practices-if they lead to higher costs. Case in point: Pittsburgh’s UPMC expected every square foot of its new UPMC East hospital, completed in July 2012, to contribute value to the organization, reflecting a broad industry trend in response to changing reimbursement models under the Affordable Care Act. Healthcare organizations are seeking projects that are economically viable from the start and offer value over the long term. For many, any potentially wasted square footage, especially in the patient room, is a luxury that’s no longer sustainable.
The patient room is one of the largest investments a hospital will make, with the design decision multiplied dozens, even hundreds, of times. For UPMC East, the challenge for BBH Design (Raleigh) was to balance performance and cost, assuming that at some point there are diminishing returns on how much performance is enhanced by an increase in size. Additionally, value for UPMC East was also defined by introducing smart technology into patient rooms, specifically a system that prompts nurses to initiate care activities and provides patient education.
Putting a guidelines-driven approach to patient room square footage aside in favor of a design research approach, the team addressed a list of functional and experiential criteria with the client. After dozens of iterations, UPMC selected a right-sized patient room for its needs. Here’s a look at how the research informed the design.
Balancing objectives The 2010 Facility Guidelines Institute’s Guidelines for Design and Construction of Health Care Facilities (FGI) suggests that patient/family-centered patient rooms should include 250 square feet of clear floor area, exclusive of toilet rooms, closets, lockers, wardrobes, alcoves, or vestibules. The layout should also provide a minimum clear dimension of 15 feet, with an additional 30 square feet of clear floor area for each family member permitted by the facility to be in the room.
For the UPMC East project, the first challenge was to find the right size and layout that would be patient/family-centered and ultimately deliver capital and operational savings. Ownership indicated early in the schematic phase that many of the existing UPMC facilities with rooms smaller than FGI’s suggestion had been determined to be sufficient for patient-centered care, which led the design team to begin the project by benchmarking patient rooms’ square footages across UPMC and non-UPMC facilities, finding the average room size to be 183 net square feet. This average was very low due to the number of pre-2000 UPMC facilities in the sample. While UPMC East recognized that 183 square feet was too small to be a target for new hospital construction, it was still committed to the idea of a more space-efficient option.
The next step involved the construction of a series of progressive patient room mock-ups, allowing the team to test room performance against a list of criteria developed with UPMC East. Initially, the most important criterion was a small floor area. Other criteria included ample space around the patient bed, maximum natural light, toilet access from the headwall, and the capacity to accommodate bariatric patients. Interestingly, the final design was not the smallest, but it outperformed in patient-centric criteria such as visibility of the patient from the corridor, ample space around the patient, and patient privacy.
