Traditionally, the functional program has been developed by a group that is separate and distinct from the group that will ultimately be responsible for the design and implementation of a project. This segmented approach creates gaps and inconsistencies in what the program should address and what it does address.

Only worsening this situation is the fact that, commonly, stakeholders for each functional area included in a project develops requirements for their own area, independent from others also affected by the project and without consideration of how these changes in one area may affect the others  and the overall project, organization, or building as a whole.

This assembly line approach increases the potential for duplicative spaces and staffing. It also increases the potential for inefficiencies in operations. It may also reduce the project’s ability to improve patient satisfaction, experience, and clinical outcomes.

The most common inconsistencies with this approach are found between the narrative (describing the concepts and design objectives) and the description of the quantity, type, and size of spaces to be designed. For example, the narrative for a patient room project may indicate that patient comfort, support, and privacy are important. And then as space is allocated, you might find that the square footage required to achieve those goals isn’t provided.

This usually happens because the separate groups developing this information don’t realize the direct relationship between the goals of a project and the functional requirements necessary to meet those goals, specifically what space is required to create the characteristics that they’re setting out to achieve. Also, if the budget isn’t part of the functional program to allow a design that supports the intended functions, the likelihood of success is very limited.

Unfortunately, this is usually the outcome of the traditional process, so it’s imperative that we reach beyond a siloed approach to a more rigorous, systemic approach to assure that all aspects of the project are appropriately addressed by creating a total environment of care.

This environment of care concept is based on a system of interrelated components that is scalable and can be used in the design of a department, facility, or campus. Undertaken with an interdisciplinary design team, the approach will maximize the relationships between each of the functional areas in a project.

The environment of care concept should assess six components: people, systems, layout/operations, physical environment, and implementation. When addressed simultaneously, each component directly impacts and informs the other to allow the functional program to capture the requirements that should be used as the basis for design.

Alberto Salvatore, AIA, NCARB, EDAC, is principal of Salvatore Architecture. He can be reached at For more information about Salvatore Architecture, visit

Read Alberto Salvatore's first blog in this two-part series: "What The Functional Program Is And Why It Matters."