For some working in the world of healthcare planning, design, and construction, the definition of "putting the cart before the horse" is building a new facility without first creating a functional program. 
 
Exploring the merits of allowing form to follow function, a multidisciplinary panel spoke on the topic at the ASHE PDC Summit in Orlando during the plenary session "FGI Guidelines: Maximizing the Benefit of the Functional Program." While the Facility Guidelines Institute provides minimum standards for the practice, Ken Cates, principal of Northstar Management, said it remains a hot topic, with proponents recommending going beyond the minimum to create a more holistic planning process for new buildings or renovations of spaces that change how they function.
 
Brent VanConia, president of SSM St Mary's Health Center, shared how functional programming was performed on his hospital's in-progress 370,000-square-foot, 178-bed $220 million building. Understanding that oftentimes once approval to build is gained, organizations may immediately want to progress next to breaking ground, VanConia saw the value in going in another direction. "You end up with a facility that doesn't function the way you want it to," he said. 
 
For the St. Mary's project, a multidisciplinary team was engaged in the process before schematic design, focusing on the desired future state and how to support that with the physical space. It allowed time for thoughtful consideration of proposed layouts, with visioning sessions informing initial designs that were then built out in mock-ups.
 
"I can't imagine how anybody would spend $200 million on a project without mocking-up rooms," VanConia said, adding that the total cost of the functional programming was $1.5 million, less than 1 percent of the total project cost. So far, it's yielded a reduction in schedule by two months, a 4 percent decrease in budget, and minimal change orders for the project set to open in November.
 
On hand to discuss how this process can be explored across acute care facilities was Alberto Salvatore, principal of Salvatore Associates, who said to first determine what's expected out of a project in terms of quantity, size, and spaces in the program. Then, a multidisciplinary team should next explore what goals are for the experience of patients, family, and staff in the space. "This is just as important as quantity, type, and size," he said. And, finally, opportunities for innovation should be assessed, as well.
 
Components of functional programming, shared Salvatore and Deborah H. Smith, principal of Deborah H. Smith Architectural Consulting, are similar for both inpatient and outpatient spaces. They include the physical environment, layout and operations, concepts, implementation, and systems. And while each hold their own value--such as concepts like private versus semiprivate rooms or the implementation of proper training for a new space--Salvatore said the program should consider how each one affects the others, too. 
 
However, how much of this should be explored is left to debate, Cates noted. "When does talking about how a layout is going to work and drawing it in schematic design overlap?" He added that there's an industry disconnect about how much information should be included at the beginning of a program, though there's a general agreement that a discussion of goals should take place at the start.
 
Jane Rohde, principal of JSR Associates Inc., rounded out the discussion by looking at how functional programming can be approached in long-term care, as well. For example, if you build a bathroom without thinking about the purpose of the space and the patients who will use it, you could end up with grab bars in the wrong space to support a resident while bathing. 
 
"It's the who, what, when, where, and how. That's what you want to accomplish in the functional programming process," she said.