Developing a master plan of any kind is familiar territory for a healthcare organization. As everyone who has gone through it knows, the process requires assessing who you are as an institution, determining the vision you have for yourself and where you are going, and then setting a road map to get there. One valuable but often overlooked type of master plan is the “Interior Master Plan.”

An Interior Master Plan is a comprehensive, structured framework for decision making with regard to the interior environment. This plan parallels the master plans for the campus and the facility, as well as the strategic master plan for the organization, by addressing critical issues impacting the bottom line through a process involving research, study, prognostication, and logic.

The Interior Master Plan addresses a variety of interiors in the facility and the multiple products used within those interiors. The projects involved can include interiors of expansions, additions, and/or renovations, and can address changed or refined branding and identity goals. The plan also includes logically structured reference materials and specifications for use in project implementation.

Defining the hierarchy of spaces is most important to developing a successful Interior Master Plan. Areas or spaces included in a well-structured plan need to be defined in a way that makes sense to the organization and can be easily understood by the plan's users. One logical format for such a plan, for instance, is based on the path a patient/visitor typically follows while entering and passing through the facility. Each area will get different levels of use driven by differing lengths of occupancy and patient acuity, and this impacts performance standards and types of products used. In this format, the path unfolds as follows:

Major public spaces: These are typically points of entry accommodating the greatest volume of people, i.e., the main lobby and emergency entry. These spaces also might include specialty services with their own entries, such as Women's Services, Ambulatory or Day Surgery, or Cancer Care.

Primary public/patient areas: These consist of locations accommodating a mix of patients with visitors, family members, and some staff—e.g., departmental and general corridors and family accommodations, such as outpatient waiting areas.

Patient/staff areas: These areas get less traffic from visitors and those not directly involved with healthcare delivery, i.e., diagnostic and treatment areas of the facility.

Patient areas: These are the patient rooms, requiring attention to acuity and length of stay (e.g., the ICU versus rooms for med/surg patients).

Other “specialty” spaces accommodate food services, spiritual needs, and special populations, such as pediatrics. These areas will, of course, have different requirements for both build-out products and furnishings products, because of variations in intensity of use and design intent.

As alluded to above, project implementation has two components: products for build-out, as supplied by contractors and subcontractors, and furnishings products provided by dealerships and suppliers. The broad categories of products included in build-out include floor finishes, wall finishes, wall protection, door finishes, hardware finishes, ceilings, and lighting. The broad categories of dealer-supplied products include seating, casework (desks, office equipment, and storage), tables, office lighting, and accessories (e.g., magazine racks, clocks, and computer accessories).

While these two components start together in terms of planning and design, they must diverge during scheduling and construction. For the development of the Interior Master Plan, the team is the same for both components, to ensure comprehensive and consistent decision making. This team would include, at its core, designers and the client's designated decision makers. It can, and should, be supplemented with additional personnel as specific issues relating to quality, purchasing, product durability, and specific function arise.

Implementing the Plan

Three basic methods can be used for implementing an Interior Master Plan, but without clarity, commitment, and support none will succeed. Keys to success, regardless of which of the three methods is employed, are:

  1. a vision shared by everyone on the team;

  2. top-to-bottom support of the plan;

  3. establishment of clear and unequivocal objectives;

  4. realistic and doable objectives;

  5. flexibility for expansion, modification, and updating; and

  6. maintainability

Method 1: Comprehensive Implementation.

This method develops the full Interior Master Plan for all areas of the facility and all products to be used in an already-planned project (figure 1). These projects tend to be major in terms of size and scope. This method requires an up-front effort that works through the steps and processes noted above, and results in a collection of specifications for all build-out and furnishings products included in the plan. With an adequate set of reference materials and database information in place, any project of any size can be budgeted, scheduled, built, and installed autonomously by the organization, without outside assistance (excluding required engineering, permit, and other regulatory documentation). In short, the “deliverables” for this method are a set of reference materials (typically multiple manuals) and database information that include all specs, samples, and images for products for every area, by area. This detailed and comprehensive implementation method requires an initial financial outlay that might well be beyond the resources of many organizations.

Comprehensive implementation (Duchoissois Center for Advanced Medicine at the University of Chicago). This is the initial project from which hospital-wide interior standards are being adapted (see “Method 1” on p. 33).

Method 2: Segmented Implementation.

More financially feasible, this approach involves developing the Interior Master Plan as individual projects are approved and implemented (figure 2, A-D). This approach requires a thoughtful advance planning process that examines specific projects and schedules to ensure that all areas and products are included as needed, and it requires the development of contingency plans for areas that might not yet be on any capital project agendas.

Segmented implementation (Sherman Hospital, Elgin, Illinois). A: Note curved-wood reception desk with rail (imitating curved soffit), with down lights and floor pattern at the new ambulatory entrance. This vocabulary of materials and configurations is repeated throughout. B: Note reception desk materials and configuration, and curved soffit in family waiting area. C: Nurses’ station, soffit, and flooring in pre- and post-op area of cardiology. D: Flooring and modified soffit in the infusion area of oncology. These projects were developed sequentially (see “Method 2” on p. 33).

This approach typically involves significant renovation of existing spaces, as well as an assessment of any existing conditions that may need to stay unchanged for some period of time. New products and solutions are implemented as the need occurs. This requires wise decisions concerning the foreseeable future, to avoid perpetuating mistakes from one stage to the next, and preparedness to adapt to changing conditions. The deliverables here are reference materials that document specific project solutions that are formatted for comprehensive and future use. Again, the principal vehicles are multiple manuals and database information.

Method 3: Conceptual Implementation.

The “concepts only” method is the least concretely detailed and demands the most clearly defined branded identity and image; the goals are defined through narratives and sketches (figure 3, A and B). In the categories of both construction and furnishings, this method establishes performance standards that support the branded identity and image goals. This is a method for “the brave and the bold.” In other words, because there is more room for interpretation, the organization selecting this method must have confidence in the technical and aesthetic strengths of everyone involved. This method works for institutions with a major project on the horizon that want to test and evaluate ideas, products, and solutions in advance of a major capital investment.

Conceptual implementation (University of Chicago Children's Hospital). A and B: Interim design standards were created to enable cohesive renovation to the existing children's hospital awaiting the replacement hospital (see “Method 3,” below).

Whichever method is adopted, it is important to anticipate the process early and to logically evaluate the Interior Master Plan's scope and the type of internal team needed to achieve it. A thoroughly developed plan of this type can be a strategic key to controlling costs, saving time, and reducing the headaches intrinsic to any major development project. HD