Review of the Guidelines for Design and Construction of Healthcare Facilities, 2010 Edition
Debajyoti Pati, Thomas Harvey, Jennie Evans, Laura Thielen, Robin Allen, Betsy Berg, and Deb Sweetland
Facility Guidelines Institute and HKS Inc.
The results of this clinical review of the 2010 Guidelines produced nearly 500 proposals submitted directly to the FGI website. More than 150 topics were recommended to be added to the Glossary in order to better communicate between architects, engineers, owners and Authorities Having Jurisdiction. The review by CADRE identified a number of topics for which writing of proposals would be inappropriate or inefficient until some discussion of the topic and consensus on a direction to take occurs. An additional 150 topics of this nature were identified and set aside until the HGRC or the FGI Board draw conclusions on the questions raised. The questions raised are discussed in the section of this report entitled Global Topic Commentary. In brief, these topics are highlighted as follows:
Functional Program (FP) – Requirement for submittal of and reliance on a Functional Program is an excellent component of the Guidelines. CADRE recommends that the content of the FP as described in Part 1 needs to be rationalized and simplified, and the expectations of its content need to be more realistic relative to it point in time in the design process when it is created. Then, the references to the FP throughout the Guidelines need to be edited for more consistent application (deleted in some areas; added in others).
Infection Control Risk Assessment (ICRA) – Requirements for an ICRA are well conceived and mature. Clarification as to when this report is required is needed. CADRE recommends adding requirements for this report at the beginning of every building type chapter within every Part. If consistently provided in the Guidelines outline, the requirements can easily be noted consistent in each chapter.
Patient Handling and Movement Assessment (PHAMA) – The white paper on this topic appears to be well conceived, if not more details thatn ultimately necessary for inclusion in the Guidelines. CADRE recommends that the White Paper be incorporated in some fashion as part of the next edition of the Guidelines. We would also encourage further research that can support recommendations on door widths, clearances, surfaces and so forth that can show improved patient outcomes.
HIPAA Considerations – Given the responsibility placed on an Owner’s staff members to assure patient privacy and confidentiality of information, CADRE has noted that several key areas of healthcare facilities still allowed design conditions that compromise the staff’s ability to meet the intent of HIPPA. Areas where patient problems, personal information and procedure confirmation occur must provide for more deliberate privacy. This includes the ED, Prep areas for procedures, and semi-private exam/treatment or patient rooms. CADRE recommends that all of these areas be at minimum three-walled spaces if not private.
Bariatrics Terminology – The use of the term “bariatric” throughout the Guidelines seems problematic and inappropriate. Use of this term should be abandoned in a Guidelines. CADRE recommends considering a new term – High Body Mass Index or HBMI – as the reference to large patients requirements special considerations and accommodation. Furthermore, there are design considerations relative to HBMI individuals within the public, family and staff populations as well. Accommodations for these categories of users, who incidentally do not need a label, should be incorporated into the general Guidelines recommendations to recognize the growing average size of our U.S. population in general.
Renovation versus New Construction Minimum Requirements – CADRE firmly recommends the elimination of allowances for any reason that permit a specific space having a minimum space standard established for new construction within the Guidelines. A minimum is THE minimum. This opinion is independent of, and not to to associated with, the discussion relative to how much renovation triggers a requirement to upgrade existing space to current standards. If a new room having a minimum size is created within renovated space, it should absolutely meet the minimum Guideline requirement.
Standardized Guidelines – There extensive inconsistency in language throughout the Guidelines relative to highly repetitive support spaces. Such spaces as hand-washing stations; patient toilets; medication rooms; clean workroom/holding rooms; soiled workroom/holding rooms; linen holding areas; nourishment areas; housekeeping closets and multipurpose rooms are highly repetitive and could be standardized across all Parts to the benefit of all users of this resource.
Finishes - CADRE recommends that the blank Finish Table provided in the Guidelines as a worksheet be completed by with the performance criteria expected within that Table, so that it serves as a one page reference for finish selection. Also, there is terminology used throughout the Guidelines when referring to finish performance that needs a more precise definition in the Glossary so that selection of materials that meet the criteria may be more easily accomplished.
CADRE has recommended a considerable expansion of the Glossary within the Guidelines to improve common understanding of the terminology used throughout the reference. Furthermore, there are a number of repetitive spaces for which it is assumed that the industry knows what is included in those spaces (.e.g, Soiled Utility Room). Our research associates note that there should be a standard identification of typically expected contents of these spaces to improve communications as well as to assist in research efforts toward evidence-based design studies.
Finally, while the new outline for the Guidelines is well conceived, and is providing consistent structure within the document, there are improvements to this format that could easily be applied to make comprehension and navigation more intuitive. IN its current form, it may appear to be clear to frequent users such as the HGRC, but occasional users still have difficulty in readily conceiving the hierarchy. Indentations or tabs, use of italics or underlining, or application of color are all tools that could dramatically improve understanding of the hierarchy. Additionally, some editorial scrubbing of the content to be sure it adheres to the outline would be beneficial. More use of the term “Reserved”, coupled with assurance that there is text for every bolded new number would improve understanding. It is the hope of the CADRE team that these observations will be beneficial in generating important discussions leading to a highly germane and well organized 2014 generation of the Guidelines.