I've been involved with hundreds of healthcare design projects over the last 30 years, and I can safely say that there is normally not enough money to design the entire program as intended.

There are many reasons for this, and most are valid. So what can be done with the available money to get the most value? How can we design a facility to give our clients the most flexibility in the future? 

One approach is to understand the entire scope of the project, even if the budget will not support it. What are the ultimate goals? What are the intermediate goals?

Armed with this information, the design team can approach the project with a blank check. The design can have the necessary infrastructure, adjacencies, support spaces, pathways, etc. In concept, the project meets the program goals and will work with all the efficiency required to be successful.

But of course, there is no blank check! 

With any project, there are items that are the “pillars” of the design. These include things like the structure, the utility services, and the main system infrastructure. Making sacrifices for cost in these components will inherently limit the opportunity to eventually build the project as programmed. However, identifying these components is the best way to ensure flexibility to meet the project’s goals in the future. 

Other items that enhance the goals of the project but are not the “pillars” might be areas that could be considered for cost savings.

In each case, the question needs to be asked, “What if I don’t install this item now? Can I do it later? What affect will it have on my goals?” 

For example, let’s say one of the goals is to provide 100% emergency power back-up generation, including cooling, for a surgery addition. However, the budget for the surgery center is not adequate to do everything that is programmed.

In this case, the emergency power generation system could be reconfigured to provide 100% back-up generation for all essential loads except cooling. The design should include the infrastructure required to add future generation capacity and electrical distribution equipment when funds become available.

Provisions to protect the welfare of the patients during times when cooling is required and power is lost should be considered. The facility manager could make prior arrangements for a mobile temporary generator to be available in short notice and the design could include the appropriate quick connection hardware.

When funds become available, the remainder of the generation capacity could be added. 

This is just one example of a compromise that can be made to save first costs without sacrificing the long-term goals of a project. Each project is unique, and therefore each project will present a unique solution to the challenge of “when there is not enough money to go around.”