It’s All in the Details
Legend says the phrase “the devil is in the details” was coined by an architect. Whether or not this is true, it’s fitting for the profession, especially those who design healthcare facilities. An enormous amount of coordination and detail is required to design a medical facility. However, many of the details most important to patients, visitors, and staff—such as furniture locations with optimum views; nurse stations with convenient computers, printers, phones, and storage; exam tables with the proper relationship to wall-hung diagnostic instruments and required electrical outlets, etc.—are most often neglected during the project planning phase. These oversights can result in a less-than-stellar final product that is completed late with multiple change orders and budget overages. The best way to secure a successful outcome is to tackle the devil head on and integrate the design of furniture, fixtures, and equipment at the very beginning.
Furniture, fixtures, and equipment (FF&E), which includes everything from tack boards to linear accelerators, are too often viewed as a building’s “finishing touches.” In truth, these items, if not properly orchestrated, can be the root of all evil for a healthcare project. Their absence (or excess) can lead to costly schedule and budget overruns. The key to successful FF&E integration—keeping the devil at bay—is early planning and the proper use of tracking and coordination tools. This requires commitment and input from medical equipment planning, architectural/interior design, dietary planning disciplines, and the increasingly important information technology (IT).
The Tallahassee Memorial Cancer Center is a state-of-the-art medical facility designed by SSOE Group and developed by Health Care REIT. The goal of this project was to create a facility that offered the most advanced treatments and technologies, while providing a relaxing and comfortable environment for patients and their families. Additionally, the cancer center wanted to incorporate sustainable initiatives and achieve LEED certification. To meet these goals, numerous details had to be considered throughout the design process, including the specification and installation of all FF&E required in a comprehensive cancer center. Together, the owner/developer, Health Care REIT, and architect/engineering firm, SSOE Group, devised a unique and disciplined approach to integrate FF&E into the project. Through the use of defined methods and tools, the team was able to deliver the project significantly under budget and ahead of schedule.
Often, Medical Equipment Planners (MEP), interior designers, dietary planners, and IT engineers are not included in the initial planning phases of a project. Frequently, owners, tenants, or project sponsors underestimate FF&E requirements and how they influence the overall building design and budgeting process.
For example, it is necessary to define each room’s function, required equipment, technology, and furniture to determine the room’s size, orientation, and location. When FF&E is not considered up front, architects are forced to make educated guesses, which in the end can lead to rework during design, rework during construction, or, in the worst case scenario, a healthcare facility that does not meet the needs of patients and staff.
To prevent such issues on the Tallahassee facility, Health Care REIT utilized a method of simultaneous development. Each FF&E discipline was considered a key member of the design team and was involved at the very beginning of the project. A representative from each of these disciplines took part in all project team coordination meetings, including design initiation. This ensured that all parties were engaged in the development process and communicating effectively. FF&E disciplines were able to share specific requirements at the beginning of design, which allowed the team to identify efficient energy and space allotments.
For instance, the Tallahassee facility required the purchase of three linear accelerators and the relocation of a CT from the existing treatment facility. It was essential to the success of the project that the specifications, power requirements, and preferred layout for this equipment were included early in the overall design process.
In support of Health Care REIT’s simultaneous development process, SSOE utilized building information modeling (BIM) to coordinate FF&E with the building layout and utilities. All medical equipment from hand sanitizers to architecturally significant components were incorporated into the BIM model. The virtual image of the building, its systems, and FF&E allowed the design team to identify and resolve any conflicts or issues prior to initiation of construction, saving time, trouble, and money.
In some healthcare projects, there is an absence of clear communication when process control and documentation are not made a priority. In these instances, critical design components are most likely missed or duplicated. A defined scope with a clear division of responsibility is essential for successful team integration.
For example, assume the MEP is under contract to the hospital and has been instructed to specify an ice maker, different from the original specification. Purchasing documents are corrected and the new ice maker is delivered. If the MEP fails to communicate this revision to the design team, this breach in communication can result in the equipment not fitting into the designated space, a wrong size water supply, or an incorrectly placed floor drain already cast in concrete.
Prior to assembling the project team for the Tallahassee facility, Health Care REIT and SSOE developed detailed process control documents. These established guidelines were distributed at project initiation to record each design team member’s responsibilities, including budget, specification, procurement, receiving, and installation. The rigorous use of these documents was essential to the project’s success and ensured there were no gaps or overlaps. For example, on the Tallahassee project televisions were the defined responsibility of the IT engineer; however, without the process control documents clearly identifying responsible parties for all items, the televisions could have been mistaken as part of the MEP scope.
Health Care REIT and SSOE’s consistent and detailed oversight of these documents guaranteed proper coordination in the design process, allowed for a seamless transition into the construction and installation phases, and resulted in a highly efficient, aesthetically pleasing, and comprehensive facility that met all of the cancer center’s goals.
In many healthcare projects, owners often wish to rely on their in-house planning and procurement capabilities for portions or all of FF&E without realizing the level of detail and coordination that is required. For example, a hospital with an in-house IT staff will make a seemingly logical decision to assign their IT team the responsibility of designing a new system. However, considering the IT staff already has a full-time job taking care of the hospital’s daily IT needs, it is not typically equipped to provide the full engineering services required for a new project. The result can be last-minute input of critical design information.
The integration of all FF&E disciplines into the design process at the very beginning by Health Care REIT and SSOE helped to alleviate and avoid this issue. On the Tallahassee Memorial Cancer Center, the majority of FF&E implementation responsibilities were given to the project team with final approval by the Tallahassee facility’s staff. Any specifications or installations performed by Tallahassee’s staff were discussed and clearly stated in the project responsibilities matrix.
SSOE and Health Care REIT’s approach to integrate FF&E early, and their extensive quality assurance, proved to be successful for the Tallahassee project. As a result, there were no increased costs or scheduled change orders. In fact, the project was completed well ahead of the contractual schedule and more than 8% under budget. These successes enabled the client to open its doors and generate revenue sooner. Additionally, the early consideration of FF&E allowed the design team to fully understand the goals of the cancer center, as well as the needs of the patients, visitors, and staff, and thus incorporate the required elements into the overall design.
Early project planning and coordination will always reduce stress and confusion. As with the Tallahassee project, considering FF&E requirements at the beginning of a project will eliminate unwanted surprises and unnecessary evils. Keeping the “devil” at bay from the onset reduces everything from schedule worry to dollars spent on the project.
Betty Elrod is the Vice President of Facility and Medical Equipment Planning for Health Care REIT. She can be reached at 615-377-8607 or firstname.lastname@example.org. David Verner, RA, ACHE, is a principal and member of the board of directors for SSOE Group, and leads the Life Sciences Practice. He can be reached at 615-372-7891 or email@example.com. Deborah Suzan Huff, RA, LEED AP, is a Senior Associate and Architectural Department Manager for SSOE Group. She can be reached at 615-372-7884 or firstname.lastname@example.org.