Best Practices for Project Management, Design, and Construction of ...

the length of time necessary to implement hospital projects in California and the quick evolution of
technology, potential changes/reactions from healthcare reform, changes in future workloads
(increased or decreased) and evolution of models of care…building designs need to build in
flexibility in as many ways as possible to help address necessary modifications to the building as
planned.
A few of the of the best methods to accomplish this important goal is the inclusion of shell or
unassigned space, the use of a “universal” structural grid, the planning in of soft functions around
critical departments for future expansion, utilization of standard size rooms, and consideration of
adaptable rooms. These should not be afterthoughts in the project or only part of a value
engineering effort but carefully integrated as part of the planning process.
There are varying degrees of shelling (cold shell, warm shell, built out but not equipped, etc.) as
well as different opinions on what is soft space vs critical but the point is clear…plan into the
project ways to adapt and adjust to the unknown changes in the future. If considering
standardizing or multi use rooms, ensure that the size is inclusive of all the potential uses…exam
rooms that can be easily converted to minor procedure rooms, or Medical / Surgical patient rooms
that can be easily modified to ICU. Ensure that the infrastructure to support future build outs of
shell or conversion of soft space or adapting rooms to higher functionality is built into the project
(air changes, filtration, code requirements, etc).
Another creative variation is to fully design and permit the project knowing that you may well shell
some of the building. Develop a shelling strategy, which could be implemented either as an
alternate approved design or as an amended construction document. Design of systems should
be planned to accommodate this plan.
As a peripheral perspective, sustainable design and disaster planning need to be considered in
designing flexibility into a hospital. Facilities currently in design in California need to meet the
2030 Energy Challenge mandate. Health facilities will continue to be challenged by constantly
changing industry environmental standards. Planning for various threats (man-made or acts of
God) requires careful infrastructure design considerations. Facilities must consider these threats
as part of their overall infrastructure strategy. These events may be unique with unusual risk
factors such as major earthquake, chemical, radiation and biological attacks, or unique to
healthcare such as pandemic flu. In either case facility infrastructure must be designed with
consideration to these risk factors. Design interventions range from providing ED / inpatient bed
surge capacity, mechanically isolating areas of the building, creating major outdoor triage /
decontamination spaces, accommodating additional staff, etcetera.
Best Practice 9: Submit a geotechnical report, when needed, in a timely manner
Some projects require geotechnical reports except as noted in CAC, Section 7-117 and CBC,
Section 1603A. Approval for a geotechnical report takes a long time. Owners should plan for this
and submit the report at least six months ahead of the preliminary submittal.
(OSHPD Best Practices) Page 96 DRAFT FINAL, Sept. 2011