Example of a well-designed PACS reading environment.
BSA LifeStructures

Just as safe, effective imaging requires a team of skilled professionals working with accurately calibrated equipment, planning and designing a successful imaging center or hospital outpatient imaging facility depends on a multidisciplinary team that combines creative vision with accurate facility, operational, satisfaction, and research metrics.

Health care facility building enclosures are typically designed for a life cycle of 50 years or more, 20 years or more for the interior layout, and 7 years or more for the finishes.

With that in mind, for any building plan (new, renovation, or expansion), a facility’s design team not only will utilize current metrics to create a plan for the present, but also will consult and rely on projections for the future to anticipate those inevitable, necessary alterations.

Imaging facilities are particularly sensitive to the need for planning ahead for anticipated changes to their spatial requirements; the design and size of their structural, mechanical, and electrical engineering systems; and strategies for shielding against radiation.

Taking the Measure of a Facility, Planning for Success

Facility metrics constitute the data that define the physical environment. For imaging, this data may include:

  • the number and area in square feet of procedure and support spaces
  • the area of public and private circulation spaces
  • the distances within the imaging suite for radiologist and staff to travel
  • the physical distances between equipment, structures, and furnishings
  • clinical adjacencies and travel distances between imaging and related departments, such as Emergency
  • patient travel distances

This magnetic resonance imaging (MRI) suite at Swedish Covenant Hospital-Galter Medical Pavilion in Chicago was designed to reduce anxiety.
Megan Van Valer, MV2 Photography

Design teams use a variety of sources to obtain these facility metrics. The specifications of equipment manufacturers are collected and analyzed by the design team’s medical technology planners. The American Institute of Architects (AIA) guidelines are consulted on the design and construction of health care facilities. Parameters of the facility are compared against its competitors in the institution’s local and regional markets, and against new facilities that are nationally ranked as the best in their class.

As valuable as these metrics are in space planning, they are best viewed as baseline data, not as variables in a standard formula. In particular, a good economic case can be made for exceeding square footage baselines to provide the flexibility to accommodate new imaging technology for years to come. Even one to two percent additional space can provide needed flexibility in the future, economically and with less disruption to ongoing operations during the renovation process.

Facility metrics provide a guideline for the allocation of space and optimal location for future expansion. For example, the design team will strive to locate “soft” or support spaces adjacent to procedure rooms that are likely to undergo future modifications. In addition, the design team will locate high-acuity modalities, such as MRI, along an exterior wall because their structural, mechanical, electrical, and/or shielding requirements can be met most cost-effectively by new construction.

Moreover, facility metrics help guide decision-making about broader service delivery issues, as well. For an imaging facility, a major planning issue concerns the service delivery model; is this a combined inpatient and outpatient suite, or will there be a separate or additional outpatient suite in a freestanding facility or as part of an attached ambulatory care facility? Certainly, the volume of outpatient procedures is a major driver of economic feasibility. However, patient satisfaction is also critical to the success of outpatient diagnostic imaging. Convenience, accessibility, and ease of wayfinding are major criteria for patient satisfaction, and a consolidated imaging facility may not meet these criteria. Also, many older imaging departments are below par if they are located in the core of a hospital that has been greatly expanded over the decades. Accurate facility metrics provide objective data to guide leaders in deciding this issue. For example, when analyzing travel distances, the design team may conclude that it is too difficult for outpatients to find and reach the existing imaging suite.

BSA LifeStructures, a leader in the practice of evidence-based design, utilized Post Occupancy Studies to demonstrate improvements in operational performance and patient satisfaction at Lakeland Regional Medical Center.

Maximizing Operational Performance

Facility and operational metrics interact to impact the efficiency of the imaging facility. Ideally, the multidisciplinary design team includes operational planning experts who help guide decision-making by analyzing operational, clinical, and quality data collected by the health care institution. Operational data—including the facility’s average length of time for each type of procedure, the staffing model, and the medical center’s projected annual volume—contribute to the baseline for the number of procedure rooms required to efficiently meet those goals.

Equally important is the design team’s understanding of the organizational culture and its analysis of staff workflows. To be successful, the imaging suite must be designed to enable optimal workflows and avoid inefficient work-arounds. Clinical leaders and representatives of the nursing, imaging technology, and support staff make a crucial contribution to the ultimate success of the design in this regard, and they should be part of the planning phase. If the design team includes specialists trained in Lean Six Sigma strategy, the team can also suggest design and operational solutions to improve performance.

The design team will want to consider the hospital’s quality infection rates, patient fall rates, and staff injury rates. While these metrics are typically associated with inpatient nursing units, they are also valuable in designing the imaging suite. For example, while most hospitals have a lift program in the nursing units to reduce the incidence of staff back injuries, incorporating lift equipment into the imaging department can also reduce workplace injuries.

Two issues can easily be overlooked as health care leaders and designers focus on operational efficiency in the imaging suite: creating a healing environment for patients and creating a positive environment for staff recruitment and retention.

While imaging procedures typically are brief, especially when compared with the overall experience of an inpatient, they may be associated with anxiety and discomfort. At the most basic level, it is important to use design strategies to create an imaging department that provides privacy and physical comfort in waiting and dressing areas. A soothing environment also includes use of warm, natural materials, such as wood cabinetry; soft flooring material, such as carpeting or simulated wood; a combination of bright task lighting for staff and indirect lighting on the patient; ceiling treatments that are interesting and comforting for patients lying on a treatment table; and speakers for music. Design can also help to reduce anxiety that may be associated with certain modalities. For example, use of acoustic walls and ceiling treatments can reduce the impact of the sound associated with MRI.

While patients have always been the priority, the needs of physicians, staff, and other caregivers have become equally important because of the economics associated with staff recruitment and retention. Imaging facilities that are designed to improve staff efficiency, reduce fatigue, and enhance wellness can improve the health system’s competitiveness in recruitment and retention. Leading institutions have taken a step beyond the typical lounges and break rooms, incorporating respite spaces for staff—quiet, private spaces that enable staff to relax and return to their work refreshed. Thoughtful designers strive to locate these to provide views of the outdoors whenever possible.

Monte Hoover, AIA, ACHA, EDAC, BSA LifeStructures

Enhancing Patient, Visitor, and Staff Satisfaction

Data from patient, visitor, and staff satisfaction surveys also drive design of the imaging suite. Using data from the previous 5 years provides a good baseline for identifying satisfaction issues that may be improved through design to meet the institution’s goals.

A few indicators of satisfaction have been noted above, including convenient access and wayfinding for outpatients, a healing environment for inpatients and outpatients, and a workplace that is conducive to staff recruitment and retention. In particular, key indicators of patient satisfaction with the imaging department are ambient temperature and privacy. In an imaging suite, physician and staff satisfaction metrics include noise and light levels in reading rooms.

As the only design firm in the country in a strategic partnership with Press Ganey, BSA LifeStructures has leveraged access to their regional and national database to identify the best-in-class in various health care categories. At Lakeland Regional Medical Center in St Joseph, Mich, BSA LifeStructures tapped Press Ganey data on national trends and the hospital’s patient satisfaction survey data for 5 years to craft a series of design responses to help meet their goal to be best-in-class. They have since received some of the highest patient satisfaction scores in their region.

Tony Frederick, CS Kern Photography

Using Research to Inform Design

Finally, leading designers use objective evidence gained from research to inform design of the imaging suite. For example, BSA LifeStructures follows Health Environments Research and Design Journal (HERD), an interdisciplinary, peer-reviewed journal that serves as a source of research findings on user experiences and outcomes that provide a basis for evidence-based health care design.

BSA LifeStructures has also initiated and collaborated on research into the design of health care environments. For example, the firm worked with the Indiana University School of Medicine’s Department of Radiology on a research project identifying the components of a well-designed PACS reading room. The department used the results to inform design of their own facilities, and the study was published in 2005.

Leading health care facility designers improve facilities and enhance outcomes through effective design informed by future expectations. Facility, operational, satisfaction, and research metrics contribute to a body of evidence that takes a creative vision for the imaging department and makes it work.

Monte Hoover, AIA, ACHA, EDAC, is a principal at BSA LifeStructures based in Indianapolis. With more than 30 years of experience, Hoover specializes in an evidence-based design approach to planning and design for health care facilities. He can be reached in Indianapolis at .