No Stone Unturned for Savings

Posted on June 10, 2011

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Dedicated circulation and room bay sizes are easy targets for more judicious use of precious healthcare square footage. Yet overlooked in the search for big-time facility savings is the administrative area.

The executive suite can be a sign of the times for any facility. I remember doing a courthouse addition in Baltimore early in my career, with the requisite week of site measuring existing conditions. I was amazed to find judge’s chambers as large as racquetball courts, replete with custom wood paneling, each with a private toilet room and shower, walk-in storage room, and more leather than a rodeo. When Jacksonville redesigned its courthouse the first time (it took three times), it was the wishes of the judges that blew the scope and budget. It is my understanding the approved design, now under construction, is more pragmatic than palatial.

What does this mean for hospitals? When the economy was good and resources were plentiful, offices were well-appointed and commodious. In lean times such as these, every square inch gets squeezed. Now that the pendulum is swinging toward minimal, and if waiting areas are being slashed, admin space should be revisited, too.

Research shows office sizes are shrinking. The space programming standards I learned out of school were something like:  workstations (64 s.f.), entry level office (80-100 s.f.), mid-level manager (120-150 s.f.), senior executive (175 – 190 s.f.), and CEO (200+ s.f.). Those same spaces today went on a diet by 20-40%.  Workstations are commonly designed as 6’x6′ now, instead of 8’x8′. Offices above 150 s.f. are considered large, and dedicated offices for employees often out-of-the-office are not a given. Even CEOs have swallowed a slimmer footprint because humble leaders realize they are often absent from their homebases more than 50% of the time. And these days, unoccupied space is wasted space.

At the PDC 2011 Healthcare conference in March, I attended a session focused on a hospital which built what appeared to be an insanely silly project:  a 20′ wide by 400′ long multi-story bar addition to the end of a hospital in a very cramped site condition.  What can you fit in that narrow floor plate, you ask? Administrative space. Yes, the hospital built a new building to house all the support space currently eating up prime real estate in the middle of precious clinical spaces. Offices, equipment storage, staff lounges, lockers, dictation…all were pushed into the new addition, which provided the freedom to re-work several floors to capture this ‘found space.’

The lessons here are two-fold. First, old rules do not apply:  no space is untouchable. Every room is a candidate for improved utility, even the boss-man’s. Second, it takes creativity to rethink opportunities in the face of old rules not applying. For instance, areas with traditional disadvantages—no windows, low floor-to-floor heights, poor access—can still be stars in a master plan; new construction need not be patient treatment space only; off-loading or reorganizing to elminate even one duplicate corridor in an essential area is worth it.

Space is so expensive to build or renovate and finish, any chance to maximize existing facilities should be considered.

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