It's always fun to view old and not-so-old movies to get a technological fix—that is, an appreciation of the wonderful technologies that we have at our daily beck-and-call today. One need only go back to films circa 1990 to see characters clunk themselves upside the head with a device the size of a shoebox to make a cell phone call. Today my cell phone is so compact that it fits easily inside a pocket—so snugly, in fact, that it is all but impossible to hurriedly extract without nearly breaking a finger (hey, nothing's perfect!).

These images come to mind as I reflect on one of the most fascinating aspects of healthcare design: space/equipment planning for the future. Those reflections were prompted by an article by Douglas Gordon, AIA, in this issue on surgical-suite design (page 32). In it you will find the author pondering with almost Hamlet-like ambivalence the “ideal size” of a modern surgical suite. How does 650 square feet grab you—too big? Not big enough? In a series of “ifs,” “ands,” “buts,” and “on the other hands,” the author carefully weighs all the factors that must go into this complex decision. A lot of it has to do with, Nostradamus-like, predicting the future of technology.

That's never an easy matter, and this is particularly true of the healthcare field. It seems that all the latest and greatest in technologies waste no time finding themselves in healthcare facilities, evolving and combining in unheard-of ways and creating space-planning headaches. In April 2006, HEALTHCARE DESIGN published a showcase featuring the M.D. Anderson Cancer Center Ambulatory Care Clinical Building. Project Director Janet Sisolak and Executive Director of Capital Planning and Management Services Susan Lipka, MD, discussed the difficulties of, among other things, rightsizing breast-imaging services that were transitioning from diagnostic mammography to MRI; of combining CT with linear accelerators (too space-consuming until late-breaking technology saved the day); and accommodating the migration from PET to PET-CT. The necessary planning adjustments involved a constant interplay, they said, among designers, physicians, and manufacturers working in close collaboration to get the timing anywhere near right.

Future articles will address planning for computer-controlled technology (e.g., rooms versus closets? On-site versus off-site?) and for the latest MEP equipment (e.g., how much ceiling height? What size ducts and piping? What the heck is a microturbine farm and how much space does it need?). Do you go by a rule-of-thumb fixed percentage in “oversizing” support space for new technology? Can you assume that newer hardware, like today's furnaces or HVAC systems, will be smaller? Will you be able to hang or suspend things out of the way that heretofore were earthbound and in the way?

Bottom line: How will these adjustments affect staff functioning and overall construction/operational costs?

As a confirmed journalist, I'm glad I don't have to make these calls. But it sure is fun to kibitz. Inspiring and educational, too. HD