ࡱ> mrla L-bjbjrr 8HL\L\0$ # # # # ####8V#$z#L#X##(###6%6%6%WWWWWWW$Y\|W #6%6%6%6%6%W # ###HW'''6% ## ##W'6%W''R?DP3G#@~*%jEqWW0XE]"&]<3G3G] #G6%6%'6%6%6%6%6%WW&@6%6%6%X6%6%6%6%]6%6%6%6%6%6%6%6%6%> !: Weekly Overview Week One Overview The topics and objectives for Week One focus broadly on the evolution of health care facility design. The desired outcome is for learners to be able to summarize high level processes and drivers associated with facility planning, design, and construction. The goal is to design facilities that meet the needs of a variety of stakeholders (e.g., physicians, nurses, administrators) and perhaps most importantly patients. Patient-centered and evidence-based design are key principles of delivering health care that is effective, efficient, and sustainable. Health care facilities across the country are largely unsustainable and do not meet the comprehensive needs of the population they are intended to serve. Today, patient-centered care focuses more on innovative approaches that include a variety of telemedince, holistic and preventive treatments, ambulatory verses inpatient services, and increasingly long-term care. Additionally, innovations like electronic medical/health records coupled with the proliferation of information technology, data, and global connectivity is transforming health care delivery. What you will cover Health Care Facility Design Explain the evolution of health care facility design since the 1930s. Economic conditions during the 1930s decreased the use of hospitals. New government programs after World War II increased the use of health care. Led to development of medical office buildings (MOBs) Began an emphasis on ambulatory care Outpatient clinics became popular by 1960s Government grants in the 1940s led to construction of newer and larger hospitals. In 1965, the passage of Medicare (Title XVIII) included capital funding reimbursement for hospitals, skilled nursing facilities, and other health care organizations. Resulted in an increase in construction of skilled nursing facilities Most designed based on the hospital model with patient rooms located off double-loaded central corridors Beginning in the 1980s, Medicare began reducing reimbursement to health care organizations. Prospective payment systems paid a fixed amount for services rather than reimbursing costs of care. Reimbursement for capital expenditures was eliminated, which resulted in reduced availability of funds for new equipment, building construction, and renovation. By the early 1980s, dissatisfaction with the skilled nursing model of care led to the development of assisted living facilities that were designed with features from hospitality (hotels); construction of retirement communities proliferated. By the 1990s, the cottage design was introduced as a new model of care for the elderly, developmentally and intellectually disabled, Alzheimers patients, and others. By 2000, newer hospital designs began to focus on the healing environment, evidence-based design, and sustainability. Differentiate the types of health care facilities. Types of health care facilities Hospitals Academic medical centers Trauma center Level of center Level I: highest level, requires full scope of emergent care Level II: augments Level I systems, no ongoing research or surgical residency program required Level III: limited to no resources for emergency resuscitation, surgery, or critical care Level IV: resource constrained in locations in which Level III criteria cant be met Level V: basic evaluation, diagnostic and stabilization services Community hospitals For adults For children For specialized services Burn center Birthing center Bariatric Psychiatric hospitals Ambulatory services Medical office building (MOB) Physicians clinics Freestanding diagnostic services Radiology Laboratory services Pharmacies Day surgery centers Sports medicine treatment centers Long-term care (LTC) services Skilled nursing facilities Assisted living facilities Alzheimers and memory care facilities Continuing care retirement communities Adult day care facilities LTC facilities for children or for treating obesity Hospice Home health agencies Rehabilitation and wellness facilities Acute rehabilitation facilities Substance abuse facilities Medical Spas Psychiatric facilities Inpatient Outpatient or day treatment services Dental facilities Veterinary facilities Veterinary clinic Emergency veterinary hospital Describe the role of stakeholders in facility planning and development. Historical perspective on facility planning Facility planning historically project driven Based on staff or donor wishes, or promises to physicians Abundant use of space without understanding of associated costs Not tied to strategic plan, technology investments, or overall capital strategy Approaches to avoid construction rarely considered Todays environment There is now more focus on whether the new facility is patient-centered and sustainable (e.g., environmental and energy efficient). Organizations are using a more comprehensive, integrated, data-driven, and evidence-based process. Many current and future challenges exist that affect the way facilities are used, planned, financed, and built. Fluctuating demand and use Capacity constraints Staffing shortages Focus on patient safety Increased importance of information management Rapid changes in development of new technology Rapidly rising costs Aging facilities Limited access to capital A consumer-driven market: parties who should participate in predesign planning The chief executive officer (CEO) The chief operations officer (COO) The building or facilities committee of the board of directors Members of the management team Key staff and physicians who will use the new facility Architects, engineers, and construction companies Importance of predesign planning At this stage, the health care executive determines the right services, size, location, and financial structure. Identify processes in space and facility planning. The space planning process is robust. Gather information about each departments current space allocation. Identify specific space needs of each department or activity, both current and future. Consider issues related to adequate space, efficient work flow, optimum location, patient privacy, etc. There are a number of tools used in the space planning process. Relationship diagrams Adjacency matrix Interrelationship matrix Bubble diagrams Workload analysis There are 10 facility configuration principles Separate key types of campus traffic. Clearly define the front door. Coordinate and collocate customer intake and access services. Optimize the use of prime real estate (near the front door). Minimize the total number of outpatient destinations; group related clinical services near an intake area. Position diagnostic and treatment services for changing technology and future operational flexibility by collocating services with similar facility needs. Minimize inpatient transfers. Unbundle high-volume, recurring outpatient services to an off-site location. Move building support services to less expensive buildings. Provide flexible, generic administrative office space. The end result of the space planning process is a listing of required square footage per department or activity and a diagram of the best location for each activity from which the architect will create the facility layout. Overview of facility planning includes six stages. Predesign planning Schematic design Design development Contract document development Construction Occupancy or move in A rigorous planning process is important to the success of the project. Opportunities to reduce the initial capital cost and the ongoing operational costs are greatest in this stage. Good planning at this stage can assure long-range functional life for the project and future adaptability to changes in medical treatment, practice, technology, or models of care. There is a decision and rationale process for new construction versus renovation New construction (Replacement) New construction offers a clean slate with a design that is constrained only by site, budget, and regulations. Construction can be segregated from ongoing patient treatment activities. The facility can be located where it is easily accessible to patients, physicians, and other stakeholders, which is an important issue if the population has moved away from the current facility. New construction may require a certificate of need (CON) approval in some states. Remodeling (Renovation) an existing facility The design may be constrained by existing construction, location of load-bearing walls, plumbing, site characteristics, etc. Hazardous materials, like asbestos, may need to be removed. Decisions must be made regarding current patients. Reduce population/patients and close down the area until remodeling is complete. Stage remodeling around patient care. This is often necessary in long-term care facilities, but it can be complicated to manage. This may require scheduling some construction activities during the night shift. Planning may require upgrading aspects of the facility that were not originally part of the remodeling project to meet current building codes and regulations. Costs to remodel should be compared to the costs of new construction to determine whether the value received from the completed remodeling project justifies the expense.     Weekly Overview: Week One HCS/446 Version 8 PAGE \* MERGEFORMAT 2 Copyright 2016 by University of Phoenix. All rights reserved. Title ABC/123 Version X PAGE \* MERGEFORMAT 1 Copyright XXXX by University of Phoenix. All rights reserved. $%&*MS[~  &Yy{pd`Y`RK` hY>[haK h|zhaK hhaKhaKh*hKu56CJhS^6hKumH sH hS^6h#xh)UCJmH sH hKuh#xmH sH hmH sH h:hmH sH h)U h~hlhS(mH sH h h)UhlmH sH h;mH sH h1_mH sH hf:hoXhCJhoXhf:CJh6CJ$aJ,mH sH %& < b0 & FgdaK/ & FgdaK. & FgdaK - & F hgdaK3gdKugdKugd~gdgd|gd~#gd]gdF* H$&dPgdQ(XbNw &YyWG[fs2 & FgdaK1 & FgdaK / & F 8gdaK. & FgdaK0 & FgdaK/ & FgdaKs0;OZn 2L/ & FgdaK0 & FgdaK2 & FgdaK1 & FgdaK #-RdzLK_F@o1 & FgdaK. & FgdaK/ & FgdaK0 & FgdaK ,9:_arN$m$$U&V&j&&&&&&''''9'='H'I''''''''''(("(A(D(W(i(s(u(v(w((((((((((())))**9*:*;*D*o*p*t*~******hZjhaK^J hEkhaK hZjhaK hb,haKhaK hKKhaKU C ,<; Q b { 1 & F pgdaK. & FgdaK0 & FgdaK/ & FgdaK1 & FgdaK !O!!!"""9#p#O$$$$$$$$G%%j&&&J''W(1 & FgdaK/ & FgdaK0 & FgdaK 1 & F pgdaKW(((T)))*;***+0,2,3,4,5,7,8,9,:,<,=,>,?,A,B,C,gdF/ & FgdaK0 & FgdaK1 & FgdaK****+(++++++++++.,/,0,1,5,6,:,;,?,@,D,E,T,[,^,_,f,o,p,q,r,,,,,,,,,ƿҠys h)UCJhEVh)UCJ h%h)Ujh)UUmHnHuh9omHnHujh)UUhxh)U5 h9o5 h1_5 h;5 hh)Uh;h#xhh)Uh/0jh/0Uh^ haK0J7hEkhaK0J7 hEkhaKhaK+C,D,E,_,q,,,,,,,id\*$a$gdgd]ikd$$IflF$)|p t6    44 layt(| $IfgdF $$Ifa$gdqT $$Ifa$gdF $Ifgdf: ,,,,,,,,,,----- ---2-H-J-K-L-؟h^h/0 h%h)Ujh)UUmHnHuh)UmHnHujh)UUhxh)U5 hh)Uh)Uhh)UmH sH hEVh)UCJ h)UCJh+CJmH sH ,,,,--- -I-J-K-L-wo/ & FgdaK*$a$gdLS3(gkd$$IflF$)|F t6    44 laytK4 $$Ifa$gdK4 $IfgdK4 6&P1h:p/ =!"#$% }$$If!vh#v[#v#vF:V l t65|55p/ / yt(|x$$If!vh#v[#v#v:V l t65|55F/ / ytK49s0@2 0@P`p2  0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p0PV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH H`H WNormal1$OJQJ^J_HmH sH tH 2@Q2 ~ Heading 1@&J@J ~ Heading 2@&5CJ^JmHsHtH:!: ~ Heading 3@&6CJDA D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List J/J ~Heading 1 Char56CJOJQJ^JH/H ~Heading 2 Char5CJOJQJ^JHH H Balloon TextCJOJQJ^JaJB' !B rComment ReferenceCJaJ424 r Comment Text6U A6 r Hyperlink >*B*phFV QF rFollowedHyperlink >*B* phHj12H LEComment Subject5OJQJ\>r> T CDG Bullet FhFF Xk APA Citation ^h` B*phROR ^[Assignments Level 1^JmHsHtHT/T ^[Assignments Level 1 Char OJQJ^J~~ _i Table Grid7:V0CJOJQJ_H aJJJ ^[Assignments Level 2  F^hT/T ^[Assignments Level 2 Char OJQJ^JJJ ^[Assignments Level 3  &^T/T ^[Assignments Level 3 Char OJQJ^JJJ !^[Assignments Level 4 &^8T/T ^[Assignments Level 4 Char OJQJ^JH "H^0Revision"OJQJ_HaJmH sH tH D>@D $]Title#a$56CJ^JmHsHtHB/AB #] Title Char56CJOJQJ^JTORT &3 Heading 0 %P56CJ^JmHsHtHJ/aJ %3Heading 0 Char56CJOJQJ^Js EV0UPX Material Table:V'04V4 s>V> sasj 'fa$OJQJD@D )EV0Header (H$^JmHsHtH:/: (EV0 Header Char OJQJ^JD @D +EVFooter *H$^JmHsHtH:/: *EV Footer Char OJQJ^Jo KuUPhx Numbering Heading!, hh@&^h`5CJOJQJ_HmH sH tH \O\ 8KuUPhx Numbered List 1- h<<5CJVOV KuUPhx Numbered List 2. h^VOV KuUPhx Numbered List 3/ h88^8VOV 7KuUPhx Numbered List 40 h^ZOZ KuUPhx Numbered List 51 hp^ZO"Z KuUPhx Numbered List 62 hp p^p^O2^ KuUPhx Heading 33$1$@&56B*CJ^JphhBh KuUPhx Heading 2$4$,x&d1$@&P 56;^J<< TOC 55$ 1$^ a$^JTbT aKUPhx Body Text 26h<<1$^h^JRoqR 0aKUPhx Numbered List 4 CharOJQJR/R -aKUPhx Numbered List 1 CharOJQJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VvnB`2ǃ,!"E3p#9GQd; H xuv 0F[,F᚜K sO'3w #vfSVbsؠyX p5veuw 1z@ l,i!b I jZ2|9L$Z15xl.(zm${d:\@'23œln$^-@^i?D&|#td!6lġB"&63yy@t!HjpU*yeXry3~{s:FXI O5Y[Y!}S˪.7bd|n]671. tn/w/+[t6}PsںsL. J;̊iN $AI)t2 Lmx:(}\-i*xQCJuWl'QyI@ھ m2DBAR4 w¢naQ`ԲɁ W=0#xBdT/.3-F>bYL%׭˓KK 6HhfPQ=h)GBms]_Ԡ'CZѨys v@c])h7Jهic?FS.NP$ e&\Ӏ+I "'%QÕ@c![paAV.9Hd<ӮHVX*%A{Yr Aբ pxSL9":3U5U NC(p%u@;[d`4)]t#9M4W=P5*f̰lk<_X-C wT%Ժ}B% Y,] A̠&oʰŨ; \lc`|,bUvPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!R%theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] L%H ``*,L- "bs W(C,,L-!#AY[!!T # @H 0(  0(  B S  ?HS/$0$4$5$9$:$>$?$C$D$_$o$p$$$$$J%M%0$4$5$9$:$>$?$C$D$$$ %H%J%M%&~/$0$4$5$9$:$>$?$C$D$[$^$_$f$o$p$$$$$4%H%J%M%$%/$M% WJ B3 S xl#o.]m13T7@2TqWb$_`whlPltrKbw2^:tW~flb`*а  hh^h`OJQJo(88^8`OJQJ^Jo(o ^`OJQJo(   ^ `OJQJo(  ^ `OJQJ^Jo(o xx^x`OJQJo( HH^H`OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo( U ^U `OJQJo(%^%`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o e^e`OJQJo( ^`OJQJo(^`OJQJ^Jo(o p^p`OJQJo( @ ^@ `OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o P^P`OJQJo(h^h`5o(h^h`5o(.0^`05o(..0^`05o(... 8^8`5o( .... 8^8`5o( ..... `^``5o( ...... `^``5o(....... ^`5o(........ hh^h`OJQJo(88^8`OJQJ^Jo(o ^`OJQJo(   ^ `OJQJo(  ^ `OJQJ^Jo(o xx^x`OJQJo( HH^H`OJQJo(^`OJQJ^Jo(o ^`OJQJo(^`CJOJQJaJo(``^``OJQJ^Jo(o 00^0`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo( pp^p`OJQJo(@ @ ^@ `OJQJ^Jo(o ^`OJQJo( hh^h`OJQJo(88^8`OJQJ^Jo(o ^`OJQJo(   ^ `OJQJo(  ^ `OJQJ^Jo(o xx^x`OJQJo( HH^H`OJQJo(^`OJQJ^Jo(o ^`OJQJo(hh^h`OJQJo(hHh8^8`OJQJ^Jo(hHoh^`OJQJo(hHh ^ `OJQJo(hHh ^ `OJQJ^Jo(hHohx^x`OJQJo(hHhH^H`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^h`o(hh^h`o(.^`o(.88^8`o()^`o()p^`o(()p ^p`o(()@ @ ^@ `o(.  ^ `o(. hh^h`OJQJo(^`OJQJ^Jo(o pp^p`OJQJo( @ @ ^@ `OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o PP^P`OJQJo(88^8`OJPJQJ^Jo( ^`OJQJo(o   ^ `OJQJo(   ^ `OJQJo( xx^x`OJQJo(o HH^H`OJQJo( ^`OJQJo( ^`OJQJo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o p^p`OJQJo( @ ^@ `OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o P^P`OJQJo( Kbw7@Plb`#o.WJ ]m1qWbtW~3 S xl`wh`wh                                      9>DL^zeO@kH.ZacNd# jv5ERcj +Wf (K4t[p 3?WZzd pqp513Ma[ $.).#] 8 A V H8 p> Lh t { 3  w xl x 9   "   OS i 5 Z)1cIRtp,578`]=x)+8g:BFPw 2NDSX`\oy* **}Sc!ll tT*N~".VKbj#x~!#8=EaNWna-$CJS?v}#JQN|1P3*9Qa8FLmaWL/OuRnqx{{"3%PmTdq"  8 < T l Z(!"Y5"`J"bV"Z"s"(#$J,$D$E_$h$%%& &]4&a&Vf&'K'K'('7(e(j)g')2<*xB*"D*c*sx*+`+,{,.,d,-g/-?4-B-U-!`-He-2.H.~?.W._.Nl.'/"/^5/52J556*6S^6D7@G7'm7s7-#8;28X89}4:6:>:f:E0;82; /<S<o<!=M=Nd=1>}\>9h>x>~>@?YH?BV?%|?@@1@4@?@W@/2A`|AAfB2B7rBCA#CdQC`C!DY_DFdDqEEc$ELE_EFFFJ@FQ~FG7QG&yG~G|bHQnH IJCJcHJLJU[JzJ5K;KaKiKtKuKL:7L MMM8MSEM.wM[cNy0OAOEOHOf^OcOyP!QRE0R1R 4RYDRLRPRVnR S~SS4SCSZSd]SFtSTjTITqTTU)U]6UEUFUVEV^QV[kVnVrVN&WeWhWQ(XY%:YzY{Zu!ZFZMZ2[*E[V[B\o \\,#\a\]!];9]rW] n]p]dC^1_M_$_1._6_L_`_X0`6`9`Z`s`q{`Ma`axaSbz`b0c:c=cm>cd'deeLeye%f_ofOgQg_g!hChii6wijj!jjzjKku,k)6kzk|kl}lhmSnUnVnooy"og'o9oEo7jop4\p`q(qJqkrr7rz[rzarjr*s2s`sns*psHrs*tatKuYuVcuB}uvvKzvTw}wEuxvx-yymyfry.Iz-{R/{4{E{||(|;|a|sc|e|A8}c}~2~8~m|~wM!'):sc~w.W/XJ&8x<C & h'S3hB!gHL^_k"8;A^[ ;Cm`)P2w37L=X",OSu[tzoCZEu*,93E"g-[DJx~%3zwRY&te{P}5/[vh8Weeux2I>| oXRke J$8GYdpM]`uHcNs)=?H:jnz>GVq~ tw[\gI+m0 <2>^e!-<P[e\EkVVej Rrv5;cd q+"^#u6\5KXkQnut|?a%sv<EEp~Cll.l!t2 1RI"Q^_i=S|E^LQk ;^GIami#85+7]w)p-*<CQhT`l&gBd z9AD|gqlCzY67yTcm|*1ETWi$mon2l3$.(#/2c/99A7e2k^lCd/T::UCGtNK4=]wd~!02f Tfj@s2VX Zc<Tn.3%y),,@C+?NI\L9)6M*3 7IqW>H:;_sHO>\%[ex17k\)rS6B#*yBZ^+_cc2st U.Z") S(^/yE s !1my +Vpz>#ou#,CK L+E9;CLi^eQs!D-Z]o{_Hbj/+Zn2H#KR$QRSnFibo^%,/M9|[,9 A2pKr][yK %CUI^Fdlt~oMhOHpt}2"88>wx N/, c ~20>227jF7eo0$2$@8888L%@UnknownG*Ax Times New Roman5Symbol3. *Cx Arial5. .[`)Tahoma7.@Calibri?= *Cx Courier New;WingdingsA$BCambria Math"0 hGJgO*fAfAqdr0$$ OqHP ' ?aY32!xx  Read Me FirstPriscila Hinkle Erica Schmitt<         Oh+'0  8 D P \hpxRead Me FirstPriscila Hinkle Normal.dotmErica Schmitt4Microsoft Office Word@F#@Z&ӊS@&?@dV*f՜.+,D՜.+,H hp  Apollo Group, Inc.A$ Read Me First Title$,@LXp|     (Llx ContentTypeSubject Keywords_Author _Category CategoriesApproval Level _Comments Assigned To URL ContentTypeId <display_urn:schemas-microsoft-com:office:office#ReportOwnerStakeholder PageDocument Category Page SectionDocument Order ReportOwner DocumentPriscila Hinkle,0x010100B97780F1D2982847814907BC8B379BC7 Shane Meyer ;#Natural Science - Health;#Final Material Templates;#Course Materials;#  !"#$&'()*+,./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[]^_`abcefghijknopqtvwxyz{|}~Root Entry F0{*s Data %1Table-V]WordDocument8HSummaryInformation(\DocumentSummaryInformation8dMsoDataStore d*@~*4XJF0BC5TA==2d*`r*Item  PropertiesMLJUR34DWUE==2 d*Pz*Item  u8&Properties GWRSDME0NOH1A==2d*@O|*Item PropertiesSNLYYEMETYSOQ==2d*@~*Item #Properties'OCompObj-r  !"$%&()*+,. This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision. LSchema"/> DocumentLibraryFormDocumentLibraryFormDocumentLibraryForm   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q