Resources for OR Design & Construction

Whether it’s a new building or a major renovation, an OR construction project should be a highlight of your career. That is, of course, if you can survive all the phases of construction. These phases can be divided into three parts:

• planning
• programming
• design.

To end up with an environment that supports the mission, vision, and strategic plan of the entire hospital organization, the operating room manager should know these phases like the back of his or her hand. The phases should not be rushed but placed into a timeline that is realistic and progressive.

The executive management team, the OR management team, the OR staff, and the medical staff must participate in all of the phases. For larger projects, outside resources may be used at various points in the process, or throughout planning to construction. These outside resources include consultants with skills ranging from strategic planning to implementation of operational change as well as architects and construction managers. Many larger health care organizations also have facilities staff who can greatly assist in most projects. Simulation modeling can be used to map the flow of existing operations and to validate how the design will impact future operations.

One key thing to remember is that phases sometimes overlap, depending on the overall scope of the project. The phases move from the broad conceptual drawings in the planning phase to the very detailed design of every aspect in the construction documents. Cost estimates will also become more precise as you move through the phases.

Though this is often the most overlooked part of a construction project, it is the foundation on which the design should be built. This phase will determine the functions that will drive the design form. An analysis of the strategy of the organization, market demographics, competition, technology, existing patient flow, and utilization should take place prior to any thought about the design.

This phase culminates in a business plan that clearly outlines the goals of the project, the cost versus the benefits, and most importantly, the flow of patients through surgery. The flow through the operative process must take into account the impact of all support services on the operating room, physician activities, and all the steps of each operating room staff member. The entire time from when the patient arrives in the OR until he or she is discharged to a bed or ambulatory care unit should be broken down into preoperative, procedure, and postoperative times to identify bottlenecks in the patient flow.

Now the fun begins! Put yourself into the future OR and lead the committee to dream about how they want things to be for the patient and themselves. Make certain not to think of this brainstorming as the solution, but it will enable you to get the very best ideas on the table. Then, take these ideas and begin to develop the patient flow for the new area. Recognize there are many alternatives, and sometimes everything cannot be done during this one project.

An architect needs to be chosen who has health care experience and fits well into the culture of the organization. There are national firms that will work with local architects to bring that experience to the table if your organization should desire. Make sure there is a project manager from the firm who will be your point of contact. This is not the time for a revolving door, especially on big projects.

A space program, which identifies square footages for the individual components, is prepared at this time. This space program should be carefully evaluated for volume demands and various activity levels. The drawings in this phase are sometimes called "bubble diagrams," which show broad areas of functionality.

If surgical operations will be interrupted for renovation, there needs to be a discussion of the phases of construction along with the safety of patients. This discussion needs to include interim infection control measures and possible risk management issues.

Any construction project may include many regulatory agencies. The architect will assist you through this maze of requirements.

The plans produced by the architect at this point will identify each individual room, departmental space locations, building circulation, and mechanical spaces. The plans will reflect the workflow and clinical operation of the department. The task force should agree on these individualized documents before proceeding to design development. Once again, the desired patient flow should be carefully evaluated. Make sure everyone involved in using the OR sees these plans. Many changes occur at this point as you begin to realize that the project is really going to happen. New and better ideas will surface, sometimes from unexpected people, and now is the time to make those changes happen.

If a construction manager has already been selected, this is an excellent time to bring that person on board to at least attend the design team meetings. This person can help guide the OR manager through the many implications of a major construction project and will assist the architect in refining cost estimates.

If a new building is being developed, the exterior building features will be seen on the plans along with the placement on the site. Even special site features such as roads and parking will become apparent.

Each room including equipment placement and interior finishes will be completed. You will be able to see where lighting fixtures are to be placed along with the types of recommended storage millwork. Once again, the task force should approve these layouts. Don’t forget to get staff input on a regular basis.

The equipment plan with costs should be finalized at this point, and the OR Manager should have fun with the staff looking at furniture selections and interior finishes.

These are very detailed documents that include drawings and specifications that will be given to the contractor to build the operating room. The task force will be given a final opportunity to approve such details as equipment layouts and interior finishes. This phase could contain well over 100 sheets of details.

You are now ready to go into the bidding phase for a contractor. The bid documents will include not only the architectural drawings but also a great deal of very specific information regarding the required qualifications of a construction company and the bid process. The construction manager and the architect will help you establish guidelines to evaluate the general contractor.

The keys to success are effective communications both within and outside the organization. Sometimes even the community is involved if such issues as interim parking solutions must be devised. Newsletters, which update the surgical department staff and physicians, are an excellent way to keep everyone apprised of milestones and to ask for their input.

Meetings with clear agendas throughout the planning, design, and building process show respect for everyone’s time and will help you keep key players involved. Consensus building is needed to have everyone feel prepared to sign off at every phase. Change orders during construction can cost your organization a lot of money, so make sure to check the details.

Site visits and mock operating rooms can help you and the staff envision size and placement of equipment.

Don’t forget to yell for help when you need it! Few OR managers, or even hospital vice presidents have the experience and expertise to manage a sizable construction project from beginning to end. Get the resources you need to bring this to a successful conclusion.

—Jane Stuckey RN, BSN, MS, CHE, Senior Healthcare Consultant, FreemanWhite, Inc.
E-mail: info@freemanwhite.com . 
Web address www.freemanwhite.com