Efficient rightsizing

Striking a design balance between the vast program elements of the new Hualapai Mountain Medical Center facility and the budget required a well-choreographed process. The design team listened carefully to the client to provide a custom functioning hospital, but also contributed to the owner's efforts to save dollars without affecting functionality. This process started at the block planning phase and continued through the construction process.

In order to produce a simple, elegant solution the design team demonstrated its understanding of the challenges and complexities of healthcare operations and design-scrutinizing the overall operational model of care, workflow analysis, patient throughput, staff efficiency, and safety concepts. To optimize space at Hualapai, operational designs were analyzed allowing for wasteful space and processes to be removed prior to committing to floor-planning layouts. The design team's efforts centered on giving the client the most value for their money.

HKS and MedCath, Inc. led the planning effort from programming through schematic design, design development, and construction. Corporate executives, physicians, key clinicians, and community advocates were involved throughout the process to assure that the facility meets the projected demand, patient and staff needs, and community desires. The experienced team, including Jay Hornung, vice-president of market development with MedCath, Inc., had worked together on similar projects with HKS and Lott Brothers Construction. This prior experience helped when establishing lean design protocols and goals.

Operational lean strategies

The current standard in healthcare design is to provide a completely flexible space that can accommodate any critical scenario. This approach can result in over-programmed, excessive square footage rooms that have an extreme impact on the overall cost of the hospital. At Hualapai, the following lean concepts were applied, contributing to efficient space allocation:

• Hualapai integrated inpatient/outpatient services within a single department to reduce duplicated key spaces and allowed for the sharing of support spaces.

• A medical record, or electronic chart, protocol that facilitated a lean process was developed. This helped reduce waiting room time, thereby reducing waiting room space requirements.

• A just-in-time delivery model for all support services was developed. The materials management department is smaller because the space needed to store supplies was greatly reduced; supplies are not stored onsite.

• Caregiver-patient time was increased by reducing travel distances from support rooms and nurse stations to patient areas

• Similar rooms such as operating, imaging, ICU, and acute care rooms were standardized to promote patient safety as well as to increase the ease and speed of construction.

• Square footage was reduced by co-locating general lobby waiting with surgery and imaging waiting.

• Pre-op and post-op patient rooms were combined. Rooms used in the morning by pre-op patients can be used by post-op patients later in the afternoon.

• Separate circulation patterns were provided for staff, patients, and materials to improve workflow. This project used the “on-stage/off-stage” concept with separate public and staff corridors.

• Inpatient units were organized by patient acuity to improve both staff efficiency and patient safety.

Design lean strategies

Successful architecture involves listening to client expectations and respecting architectural integrity while balancing budget and schedule. The Hualapai design team brought to the table a sound general knowledge of how basic design decisions affect construction cost, and successfully applied cost-saving concepts without affecting overall function.

On the Hualapai project, the owner realized cost savings when the design team employed these basic design principles:

• The location of Hualapai in a hot, arid climate near mountains called for positioning the building to minimize heat gain, thereby reducing mechanical system loads and maximizing natural landscape views.

• Simple building shapes facilitated efficient layouts and ease of construction. This reduced square footage and compressed the construction schedule.

• Native plants and low-maintenance plantings used in the landscape contributed to sustainable design practices.

• Hualapai used local sandstone to reduce carbon footprint and transportation costs.

• The “racetrack” circulation configuration provided the most efficient perimeter-to-core ratio, and affords direct corridor sightlines for caregivers and patients.

• Departments and spaces placed in proximity reduced staff travel distance and the overall building envelope area, which directly affected the overall cost.

• Hualapai's rooms were designed to be typical in size and layout. This facilitated standardized construction processes and improved the overall construction schedule

• Hualapai's inboard toilet rooms create better room privacy, were easier to construct, and allowed for more exterior window area for patient views.

• The Hualapai project was designed with horizontal growth paths for high-growth areas, to enable future efficient expansion.

MEP/Structural lean strategies

On the Hualapai project, early decisions were made about communications, IT, and mechanical, electrical, and plumbing (MEP) systems as well as medical equipment. This allowed the project team to start coordinating these systems and obtain contractor feedback early in the process, rather than during construction when changes cost more to implement. This upfront process also supported Hualapai's fast-track schedule.

Below are MEP considerations included into the project:

• Hualapai's electrical and data rooms were stacked on multiple floors, reducing wire and cabling cost.

• Air handler units were placed to serve single smoke compartment zones, thereby reducing the quantity of fire and smoke dampers required when ducts cross smoke compartment barriers.

• Hualapai's central plant was located within the diagnostic and treatment block, minimizing site disturbance and the length of utility runs.

• The main electrical room is located as close to the center of the facility as possible to reduce electrical service runs.

• Locating plumbing back-to-back or within proximity of other plumbing reduced the amount of piping needed.

  
  Blake Marvin/HKS, Inc
  
  
  Patients and families enter a beautifully appointed lobby featuring floor-to-ceiling glass, rich wood paneling, slabs of slate in desert hues, and etched glass dividers
  
  
  
  Blake Marvin/HKS, Inc
  
  
  Rooms used in the morning by pre-op patients can be used by post-op patients later in the afternoon
  
  

Selecting structural systems aligned to the shape of the building and the internal function of the facility is crucial when designing a new healthcare facility. Before committing to a structural system at Hualapai, the following items were analyzed: bay spacing relative to the functional design, and the cost of concrete versus steel, as well as the availability of these materials. An appropriate structural system was then selected to increase the speed of construction, provide long spans for flexibility, enable better coordination between trades, and provide flexibility above the ceiling for future changes.

• The bed tower was suited to a concrete flat slab system due to the rigid layout of patient rooms and column spacing. This method reduced the overall building height and structural depth required. In addition, the MEP systems were easier to coordinate and quicker to install due to the absence of structural beams

• Over the diagnostic areas, a long span roof system provided a large column-free space for flexible floor plan layouts as well as increased the speed of erection to improve the construction schedule.

A fast-track construction schedule is an essential part of a project's cost-saving strategy. On Hualapai, the design team established a working relationship with Lott Brothers Construction early in the design process to define document-issue milestones that melded with the construction schedule. The documents were issued using a just-in-time method to maximize coordination efforts, while at the same time keeping all of the contracting trades working as efficiently as possible without scheduling gaps between subcontract scopes.

The contractor's early involvement facilitated feedback from subcontractors bidding on the job. Resulting revisions or changes to the design of building components or MEP systems cost less during design than in the field during construction. This fast-track schedule required close coordination of all team members to keep the schedule on track and realize the maximum savings offered by a shorter schedule.

The new Hualapai Mountain Medical Center is a distinct example of balancing operational effectiveness and rightsizing square footage without sacrificing the customer experience. Based on a patient- and family-focused design, the cost-effectively designed hospital is committed to setting the standard for healthcare delivery in Kingman and northwest Arizona. HBI