Designing a clutter-free, stress-free imaging department can improve patient satisfaction.
By Dennis Kaiser, AIA, LEED AP
Nothing stays the same in a health care facility environment—except change. With an imaging department, where technology upgrades and procedure volumes are in continual flux, modification needs never cease. With health care reform under way, some experts anticipate an increase in imaging utilization as millions of previously uninsured patients obtain coverage and begin using the health care system.
When future growth is not well planned in a facility, renovations are often improvised. Space is squeaked out of an already tight floor plan and equipment upgrades are shoehorned into procedure rooms. Fender-to-fender wheelchairs and stretchers hug narrow corridors. Supplies billow out of cabinetry and equipment cables are taped to the floor. Overcrowded reading rooms overheat and space for peer consultation is forfeited. Another carbuncle-like protrusion is annexed to the building and corridor additions add further complexity to way-finding.
The ensuing inefficiencies, chaos, and clutter that enshroud these conditions can result in dismay for patients and staff alike. The current design paradigm, driven by cost control, typically dictates that only what is required to meet current needs for procedure volumes should be built.
What if the same budget allotment could be applied to a smarter design that is forward-thinking, strategically streamlined, cost-prudent with future enhancements anticipated, and also considers the patient’s perception? Here are five strategies for designing an imaging department that redesigns corridors as programmable space, encourages future growth, provides flexible functional spaces, eliminates reading room clutter, and optimizes task efficiency.
Redesign Corridors as Programmable Space
Corridor space is often designed as mere throughputs to other spaces. Those that provide intuitive way-finding in lieu of signage are rare. Even more uncommon is a corridor layout that separates public from nonpublic circulation routes.
When planning for a program of “x” net square feet in a health care facility, the net area is multiplied by 30% to 60% to account for an appropriate corridor space allowance. For a radiology department, corridors are typically 8 feet wide and their space allocation is generally factored at 60% of the program’s net space. As such, consider how a 10,000-square-foot programmable net space actually projects to a 16,000 gross square foot space, and with today’s construction costs up to $500 per square foot:
- Five 400-square-feet rooms totaling 2,000 net square feet.
- Control, reading, utility, offices, and infrastructure totaling 6,500 net square feet.
- Waiting, reception, and registration totaling 1,000 net square feet.
- Staff areas totaling 500 net square feet.
- Corridors totaling 6,000 net square feet (10,000 net square feet multiplied by 60%).
- If planners were to design corridors as programmable space, the following could be achieved:
- Increased ratio of programmable space to total gross square footage.
- Improved functionality and efficiency.
- Reduced clutter.
- Maximized use of the construction budget for income generating area.
For instance, in the imaging department areas at St Joseph’s Hospital in Hamilton, Ontario, each had its own reception and waiting space. To accommodate growth, the new department was relocated below grade level in shell space left from a previous development. Here, the new corridor space was programmed to intuitively lead visitors to the department’s center. It varied in width from 8 feet to 12 feet to 20 feet.
At its widest point, visitors encountered one shared reception desk and comfortable seating among adjacent, open-spaced waiting areas. By redefining the consolidated waiting and corridor space, the facility linked all six imaging areas.
Its innovative design and layout consolidated space and function, improved staff efficiency, and alleviated clutter. The intuitive way-finding, with its aesthetically pleasing design touches, put patients and visitors at ease. Finally, the consolidation of the six imaging departments may be a contributor to a greater cohesiveness among staff.
Similarly, at Beth Israel Deaconess Medical Center, located in Boston, the addition of neurointerventional radiology services warranted expansion of its imaging department. Yet there was little available room to expand. In this case, approximately 1,600 square feet of redundant corridor space was re-programmed through a reconfiguration of the placement, flow, and function of corridor spaces throughout the entire floor.
Some corridors were eliminated without forfeiting separate flows of public and nonpublic routes and some storage rooms were converted into corridor space. Alcoves were strategically carved out along the corridors where wheelchairs and stretchers could be tucked away yet easily accessed. By redefining the existing corridors as programmable space, discussions of a million dollar building addition to meet the program’s needs were avoided.
Anticipate and Encourage Future Growth
Soft space is typically office and storage areas clustered separately from procedural areas. For procedure rooms that contain major equipment and utilities, a good design strategy would be to position soft space between those rooms, or nearby, in anticipation of growth in procedure services.
When procedure rooms, especially those containing heavy equipment, are located at the interior of the floor plan, a trail of debris and disruption is created when equipment repair or replacement is required. Technical personnel toting bulky tools and replacement parts must dodge patients and staff just to make their way to the interior to access the equipment. When replacement is required, they must transport it a greater distance, and in some cases a much greater distance.
Locating procedure rooms at the perimeter not only minimizes disruption to the operational flow of services during renovation, but also creates easier access for technical personnel. Ideally, the design would include a separate entrance for these personnel, one that is near these rooms and wide enough for moving large equipment.
Designing soft space between rooms facilitates cost-effective future conversion or expansion by way of adjacency. In addition, dual entry to each procedure area through those soft spaces can be created.
For both the St Joseph’s Hospital and Beth Israel Deaconess projects, procedure rooms were arrayed around a central control room that housed multiple workstations. The arrangement also maximized the lines of sight between the control room and procedure rooms. Staff efficiency increased and clutter was reduced.
Provide Flexible Functional Spaces
Cable route restrictions, power and floor loads, equipment facing toward or away from a window, unobstructed signal sending, and receiving requirements. These are all factors that need to be considered as procedure rooms often are designed to a particular make and model of imaging equipment. When equipment is upgraded or replaced, and accommodations for runs and adequate air change for the newer technology are unavailable, work-arounds are improvised. As a result, taping cables to the floor, walls, and ceiling creates both a visual clutter and a tripping hazard.
To maximize flexibility and minimize clutter, the design should address multiple utility distribution routes for future system integration. Providing routes under the floor, overhead, and along wall chases gives the owner the greatest purchasing flexibility over time and alleviates costly future renovations.
Technological advances in imaging equipment are inevitable. The trends suggest that image quality will increase, size and space needs will decrease, wireless technology will become standard, and portable equipment will add convenience and access for patients. Even then, there will be the need to marry the existing equipment with the newer technology; so designing for future flexibility throughout the infrastructure’s cavities is key to minimizing clutter related to power and communication requirements.
Eliminate Reading Room Clutter
Consider how some hospitals have ballroom-sized procedure rooms, yet have just one closet-sized reading room. In turn, radiologists are forced to find nooks and crannies for space to do their most important work.
Why doesn’t an imaging department design anticipate the need for evolution and expansion of reading rooms? Reading room planning is steeped in complexities that are derived from a review of whether the rooms are for short- or long-term use; how the rooms functioned in the past; and how the department’s culture regards these rooms.
With evolving technologies, the need for reading rooms may diminish as diagnostic tasks continue to become less tethered to the imaging department itself. Small, spot locations can be located adjacent to each specific type of imaging procedure. Reading also can be performed with portable devices, as well as remotely with Internet and cloud-computing collaboration.
Even so, an imaging department requires ample space for digital reading and remains an area of design that must avoid inefficiencies, discomfort, and clutter. In poorly designed reading rooms, workstations are shoehorned into place, or located on parallel walls where the screens reflect each other as well as ceiling light fixtures and windows; user space is cramped; and, when air flow is inadequate, the room can get too hot.
In an academic institution, additional space must be provided for residents and fellows to gather. Workstations should all face the same direction or array along the room’s center back to back. The arrangement also should be ergonomic and adjustable. Reading rooms are no longer mere workstations, but have become program-driven areas of design.
Optimize Efficiency and Appeal
When planning a renovation, expansion, or new facility, it is essential to itemize all things that occupy space in addition to systems infrastructure and equipment. Itemization must include everything from carts, wheelchairs, and stretchers to waste baskets and hand sanitizer dispensers. Details include the length, width, and height of each item, as well as an accurate forecast of increases to the inventory.
With everything accounted for, the design can more accurately determine whether it will fit nicely or create clutter. The design approach should be holistically driven, rather than room-driven. Instead of positioning items according to what the item’s manufacturer designates as “best practice” in the context of a particular room’s purpose, position them according to efficiency or best utilization for the department.
For instance, instead of each room having its own supply-storage cabinet, provide one common storage area to be accessed from three or four procedure rooms. This will also provide savings in terms of inventory management. Provide designated space for stretchers and wheelchairs so they aren’t lined up along narrow corridors.
A well-designed imaging department is much like a well-planned city. Its traffic flow pattern limits congestion, essential services are located for recognition and accessibility, and open spaces and cultural attractions are provided. In turn, it draws residents, visitors, and businesses, generates city revenue, and prepares well for future expansion.
A clutter-free imaging department can create a stress-free patient, greatly improving their sense of satisfaction and outcomes. That satisfaction is reflected through higher Press Ganey scores for the facility. Meanwhile, technological advances and procedure volumes will continue to evolve, so it’s important that architectural permanence not be sought in lieu of flexible functional spaces. An imaging department, by design, creates plenty of clutter-free space so everything is in its place.
Dennis Kaiser, AIA, LEED AP, is a Principal with Perkins + Will. He can be reached in the Boston office at [email protected].
