Deconstructing the Hospital Space Program

By Cynthia Hayward
Originally printed in the
SpaceMed Newsletter
Spring-Summer 2013
www.spacemed.com

The task of developing a room-specific space program (often referred to as the

schedule of accommodation outside the U.S.) can be simplified by aggregating
space by its function, utilizing generic spaces, and recognizing the factors that
drive the size of each individual space.
BACKGROUND
The space programming process begins once the functional program is completed.
The functional program should provide a description of the scope of services and
operational concepts including the numbers and categories of people, processes, equipment, and technology necessary to operate the specific department or
facility component at a projected workload level. The space program based on
the functional program provides a tabulation of every room or area required with
the assigned function, number of rooms, area needed for each room to perform its
function, and total area required for the function. Comments for each space are
typically provided regarding the location of the space relative to other spaces, minimum dimensions, major equipment items to be accommodated in the space, and
special performance or environmental requirements. Generally the process begins
with a draft list of spaces to be reviewed by a designated task force or user group
and concludes with the approval of the space program by the task force members.
Architectural design begins after the task force members sign off on the functional
and space program.
ORGANIZING SPACE INTO FUNCTIONAL CATEGORIES
All spaces within a specific department or spatial component in a healthcare facility
can be organized into one or more major functional categories as follows:

Patient
Treatment
Space

Clinical
Support
Space

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Patient/Visitor
Intake
Space

Staff
Support
Space

Patient/visitor intake space includes the reception area, patient checkin/check-out stations, waiting areas, and toilet facilities. Optional amenities
may also be included such as family conference facilities, educational
resources, and/or a beverage/snack cart.

Patient treatment space includes space for patient encounters with care
providers such as interview/consult rooms, exam/treatment rooms,
diagnostic/procedure rooms, patient recovery bays, and overnight
accommodations.

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Deconstructing the
Hospital Space
Program
Continued

Clinical support space includes the associated space required to support

a given type and number of patient treatment spaces such as a clean
workroom/supply room, soiled workroom/holding room, medication room,
and equipment storage and environmental services rooms. Clinical support
space is used exclusively by hospital staff and only occupied intermittently.

Staff support space for the staff working in the specific department or
facility component may include dedicated and touch-down workstations,
administrative offices, conference rooms, a classroom, a staff lounge and
lockers, and staff toilet facilities.

Although generally limited to academic medical centers, space may also be

provided for research (e.g., wet and dry laboratory space).
A patient care department or nursing unit the primary purpose for the healthcare
facility in the first place would include all major categories of space while specific
departments may be organized to provide a single functional role within the hospital
(e.g., admitting department, pharmacy, medical device reprocessing department).
USING GENERIC SPACES
Any space programming process should incorporate the identification of generic
spaces that accommodate similar functions and can be replicated across departments or facility components within the healthcare facility. This provides future flexibility as well as cost savings as rooms serving comparable functions are similarly
sized and finished instead of tailored to the individual occupants even though the
actual equipment and furnishings may be changed or upgraded over time. Larger
healthcare organizations may already have developed a data base of their own
space standards and room layouts for frequently-used rooms. Examples of generic
spaces include:

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Private inpatient rooms and en suite toilet/shower rooms

Exam/consult rooms for one-on-one provider encounters

Small procedure rooms to be used for minor treatments or diagnostic

procedures using portable equipment (e.g., ultrasound and
echocardiography)

Standard imaging/procedure rooms to be used for procedures requiring a

team of providers and/or where fixed imaging equipment is installed

Large imaging/procedure rooms with contiguous control and ancillary

equipment facilities where large fixed imaging equipment is required for
modalities such as computed tomography (CT), positron emission tomography
(PET), and nuclear medicine

Hybrid surgical/interventional radiology rooms that can accommodate any

advanced technology for invasive surgery or minimally-invasive diagnostic and
therapeutic procedures

Clinical support spaces including clean workroom/supply rooms, soiled

workroom/holding rooms, medication rooms, equipment staging alcoves, and
environmental services rooms

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Deconstructing the
Hospital Space
Program
Continued

Patient/visitor toilet rooms

Administrative workstations, cubicles, private offices, and conference rooms

UNDERSTANDING SPACE DRIVERS

Furthermore, individual rooms or areas in the space program can be organized
based on their space drivers workload dependant, variable, fixed, or optional
as follows:

Workload dependant spaces such as surgical operating rooms and exam

rooms are typically dependant on the projected workload. For example, one
operating room may be planned for every 1,100 annual surgical procedures or
one exam room may be provided for every 1,350 annual outpatient visits.

Variable spaces will vary based on the total number of patient care/treatment
spaces programmed, the number and types of staff planned for the primary
shift, and the specific type of equipment selected. For example, three waiting
area seats may be programmed per exam room in a clinic or two staff touchdown workstations planned per each bed in an intensive care unit. The size of
individual spaces may also vary (e.g., 50 net square feet of equipment storage
space per operating room).

Fixed spaces generally do not vary in either number or size, regardless of the
overall scope of activities of the department or facility component. For example
there would always be one unit clerk workstation for each inpatient nursing unit
or a medication room in a clinic.

Optional spaces depend on the scope of services, specific operational concepts, administrative policy, and desired level of amenities to be provided. Optional spaces also depend on the availability of shared or centralized spaces
elsewhere in the healthcare facility. Examples may include space for instrument
decontamination/sterilization, staff fitness/ exercise facilities, or a coffee shop.

SUMMARY
By deconstructing the space program, the process of preparing a draft document to
be reviewed by stakeholders and its finalization and approval by the organizations leadership can be expedited. In addition, this generally results in efficient
space utilization in the short-term and long-term operational flexibility with minimal
renovation costs.
Cynthia Hayward, AIA, is founder and principal of Hayward & Associates LLC.

2013.6.2

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