One of the earliest parameters considered in health care design is space programming. Programming is based on factors such as operational needs, utilization data, codes and standards, existing conditions, budget, and business strategies. Space programs typically contain multipliers that represent grossing factors. These are based on historical information or industry standards to predict the overall areas required to facilitate the programmatic spaces into a composite plan or building envelope.
For example, building gross square footage (BGSF) represents the programmatic spaces, the space required for circulation, corridors, elevators and staircases, as well as structural elements, mechanical shafts and even wall thickness. Designers and planners use this factor to test efficiencies of the plan layout with the goal to have the actual area at or below the predicted programmatic BGSF. This is an important step in the design process as health care facilities are aiming to reduce underutilized supporting spaces and commit square footage to revenue-producing departments. Each stakeholder in the project has a unique perspective on how BGSF impacts the design process and when engaged early.
Owner: "I'm focused on operational efficiency because the square footage, if designed well, can promote optimal employee workflow patterns. I also consider patient safety and how the location and distance between services impacts a facility. For example, the patient bathroom can impact patient fall rates." — Darlene Wetton, Corona Regional Medical Center
Architect: "I work with the owner to rationalize and tighten the program in order for spaces to serve more than one function and keep the net-gross-area ratio as efficient as possible because building area translates directly into operational dollars spent." —
Forrest McMullen, HMC Architects
Builder: "The goal is to use square footage as efficiently as possible. It is critical to include enough building gross square footage to avoid issues with overly tight tolerances that could interfere with critical dimensions, but it is also important to minimize the square footage to reduce overall project costs and assist the owner in getting more value for their dollar, and minimize underutilized space." — Julie Davis, DPR Construction
Mechanical: "Early mechanical concepts rely on the use of tons per square footage of building for early determination of equipment capacity, as well as distribution elements, such as shaft areas and plenum depths. In health care facilities, where highly environmentally controlled environments which require intensive use of infiltration and cooling are adjacent to transitional spaces, cutting down on redundancy of spaces is imperative to cutting down on primary system capacity, and emergency back-up power." — Karen Mozes, Green Dinosaur
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