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Healthcare 101: ProgrammingHealthcare 101: Programming

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Faculty

James G. Easter, Jr., M. Arch, FAAMAPrincipal, Director Planning and Programming, HFR Design, Brentwood, TN

Gary Vance, AIA, ACHA, LEED APSenior Director of Facility Planning, BSA LifeStructures, Indianapolis, IN

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Outline

Key Questions Plus Topical Areas:1. What is Programming?2. What are the various types of Programming and How are they

linked to the hospital Master Plan and Design process?

3. What are the deliverables in the Programming Process?4. Who is responsible for the Program and how do you prepare

to get started?5. What are the fundamental Programming tools?

Using the Programming Matrix Gathering the Work Loads (Facts) and Making Projections Preparing the Room By Room Space Listing Preparing the Project Budget Preparing the Schedule

6. Programming a Critical Access Hospital (CAH) inpatient care unit,

suggestions for getting started. Research Steps to Follow Illustrations Sample Product and Presentation

7. Questions and Comments

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How and why did Programming evolve?

Programming for healthcare evolved from workcompleted by E. Todd Wheeler,

Willy Pena, CRS and otherswho recognized a need

to organize the project before starting design.

Organizing the project also means organizingthe client to make decisions in

a timely manner.

The key questions will always include, for example;What, Where, When, How

How Many,

Why,How Much and

When Do We Open The Doors?

Therefore, the PROGRAMMING MATRIX(Goals, Facts, Concepts, Needs)

(Function, Form, Economy, Time)

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To Program Any Facility OneMust Understand the Client

and The Building Type.Selection Committee

Board of DirectorsUser Groups

Services and Departments

Hospitals are complex buildings requiring extensive pre-programming analysisand investigation prior to starting the programming process. Fact gathering is

key to successful programming in a healthcare facility.

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Is Programming used only in Healthcare? No.

1. Programming for various buildings should distinguish the specialityaspects of the project type taking into consideration the culture of thecommunity, time, era, place and context.

2. The healthcare project type is distinctly unique from other types of buildings(churches, schools, housing, etc) due to the complexity of the hospital.Hospitals can be compared to planning for a city or a town in many ways.Each departmental area offers a functional challenge.

3. Healthcare can include a myriad of facilities; nursing homes, long termcare, acute care, assisted living, supportive living, medical office buildings,ambulatory care centers, cancer care facilities, research labs, etc.

Buildings Will Be Different but the Programming

Process is similar for all.

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Programming is an iterative (repetitive) process.(Pre-Design, SD, DD, CD, Bid/Negotiate, Open)

Programming is understanding the client.Programming is about listening and looking.

Programming is a road map.

Programming is a decision making instrument.Programming is VISION with reality checks.Programming is pre-design.

Programming is virtual.

Programming is not a big book on someones shelf.

Programming is not static.Programming is not completed in isolation.

Programming is not design.

Programming is does not always produce a project.

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What is Programming?

Understanding the Healthcare Client First and Foremost

Facts Goals Concepts Needs Issues

Gathering the Facts begins with the first RFP,The follow up conversations with the Client,

A Site Visit,Gathering Client Information Carefully,Understanding The Assignment,

Preparing the Proposal andSubmitting the

Proposal.

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In an Evidence Based environment, theFacts become the foundation

for the decisions to be made.

Benchmark comparisonsand research also come

Into play.

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In a Certificate of Need (CON) healthcareenvironment and in most good

client relationships

the program becomes the

justification of need based on work loads,trends, rationale and

defendable projections.

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The Goals are generally developed by the clientearly in the process and may vary from

operational, to systems, to building design.Ideally, the planner/architect gets involvedearly in the goal setting phase.

Programmatic Concepts refer to abstract ideas andFunctional solutions linked to performance.

Design Concepts refer to physical solutions.

Architectural Goals and Objectives

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Architectural Goals and Objectives

Major Categories

FORM

FUNCTION

ECONOMY

TIME

Campus Support

Flexible Furniture

Future Expansion

Planetree Concept

Environmentally Friendly

User Friendly and Efficient

Signature Building with

Clock/Bell Tower Features

Art and Sculpture

Landscape

Build New Beds (need

ASAP)

Best Inspector

Casework vs. Millwork

Lab and Emergency

Equipment

Affordability

Early Purchase for Bulk

Items

Warehouse Items

Build in Phases

GMP and Bid Packages

Administration Comments

Positive Image

Concepts

Wayfinding and signage

Hallways

Yes, Within ReasonDiscuss This Carefully

Color Boards From Initial Samples

Common Theme Plus Workbook

Yes, See Local Vendors and Artist Committee

Study and Select Local Landscape AdvisorBegin Site Design With Favorite and Avail Plants(Must Address Buffers and Green BeltsNeed Some Elevated Room and Clock Tower

Design Roofscape along with Key massing Features(Prepare rendering and mass model of building)

Begin Sign and Signage Examples (Marjorie)Discuss sing types, exterior lighting and benches, etc.Discuss flooring materials (carpet, tile and maint)

Must Layout the Pieces for both hospital and MOBHow will the Lake work, be landscaped and maintained

Lab, Pharmacy and Open Plan Office AreasLong term ROI is very important (test and bid options)

Work with Vendors and Test Options/IP Room Mock Up

Must demonstrate ROI and Added ValueShow On A/E Documents and Define the Staging/$/Time

How many18, 20, 25 and What Type (M/S/OB/SS)(Will the Universal Room Be Universal?)

In-house and/or other CQI measures

What, When, Where and How MuchBid/Negotiate?

Procurement for Medical Equipment (I, II, III)

Bulk stores vs. JIT Delivery and LT Holding Needs

A HealingEnvironment(MD + Nurse + Midwife)

Local Cultureand Materials

Set Allowance andDesign With LocalParties for Nurseries

FeaturesTo Be IncludedIn the InteriorDesignPhase ofProject

Form

Function

Economy

Time

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The Needs are fundamental to a successfulprogramming process, for example;

1. What are the space requirements?2. What are the quality/value factors?3. What is the total project budget?

4. What is the project schedule: The Production Schedule The Design Schedule The Construction Schedule The Commissioning and Grand Opening

The Post Occupancy Evaluation

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The Issues and Opportunities most oftenresult from unpredictable forces thatmay not be readily known at the on setthey

can be both positive and negative:

1. Political Factors Impacting Leadership

2. Loss of Funds or New Funds Showing Up3. Loss of Staff or New Staff Being Recruited4. Government Regulations/New Standards5. New Technology, New Systems, New Vision

6. Site Selection and Land Use7. DisastersMan Made and Natural

One Fact Gathering Tool is A Questionnaire

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One Fact Gathering Tool is A Questionnaire(Just One of Many Illustrations Based on Traditional Programming Process)

This is a subtle but effective toolfor gathering information

electronically long distance andbeginning consultant/client

dialogue.

The user/consultant interfaceis key to the effectiveness

of the process!

This is a subtle but effective toolfor gathering information

electronically long distance andbeginning consultant/client

dialogue.

The user/consultant interfaceis key to the effectiveness

of the process!

Another Fact Gathering Tool is Statistical

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g(What Are The Historical Work Loads for Key Clinical and Inpatient Care Areas?)

Mercy HospitalTiffin, Ohio

PMCU/Medical/Surgical

Projections Based on Linear Trending

Historical Data Projected Data

Type of Statistic 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Admissions 1826 1841 2020 2062 1755 1925 1932 1940 1948 1956 1964

Patient Days 6832 6262 6876 7278 6361 6928 6957 6985 7014 7042 7070

Avg. Length of Stay 3.7 3.4 3.4 3.5 3.6 3.6 3.6 3.6 3.6 3.6 3.6

Avg. Daily Census 18.7 17.2 18.8 19.9 17.4 19.0 19.1 19.1 19.2 19.3 19.4

Target Occupancy Rate 65% 65% 65% 65% 65% 65% 65% 65% 65% 65% 65%

Overall Projected Bed Need 29 26 29 31 27 29 29 29 30 30 30

PMCU Bed Need 24 22 24 26 23 25 25 25 25 25 25

Med/Surg Bed Need 5 4 5 5 4 5 5 5 5 5 5

Notes:

1. ALOS assumed to remain at 3.6 days.

2. Per Mercy email, the distribution is Med/Surg 16% and PMCU 84%.

ICU/CCU

Projections Based on Linear TrendingHistorical Data Projected Data

Type of Statistic 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009Admissions 140 143 127 105 89 79 65 51 37 23 9

Patient Days 580 540 530 408 298 307 253 198 144 89 34

Avg. Length of Stay 4.1 3.8 4.2 3.9 3.3 3.9 3.9 3.9 3.9 3.9 3.9

Avg. Daily Census 1.6 1.5 1.5 1.1 0.8 0.8 0.7 0.5 0.4 0.2 0.1

Target Occupancy Rate 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60%

Projected Bed Need 3 2 2 2 1 1 1 1 1 0 0

Notes:

1. ALOS assumed to be 3.9.

Another Fact Gathering Tool is Statistical

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g(What Are The Historical Work Loads for Key Clinical and Inpatient Care Areas?)

2009 Emergency Exam/Treatment Room Needs(Based on 1% Growth Rate from 2003 Volumes)

A B C D E FType Ann Hours %Visits No.Days Peak Shf Util Calc Exist ConsRoom Proc Per Visit Peak Shf of Oper Hours Factor Rooms Rooms Recom

Emergent(Resus/Trau/Card) 1,789 2 61% 365 12.00 60% 0.83 3 3Urgent 4,504 2 68% 365 12.00 65% 2.15 2 2Non-Urgent 9,940 2 69% 365 12.00 65% 4.82 4 4

Totals 16,233 7.80 9.00 9.00

Observation/Clinical Decision 2,435 6 61% 365 12.00 80% 2.54 3 3

Totals with Obsv. Area 18,668 10.34 12.00 12.00

Notes:1. Any dedicated specialty type rooms are added to the above calculations. Examples would beSeclusion/Psychiatric Rooms, Cast Rooms that cannot be used for general exam/treatment, etc.2. Average Hours Per Visit of 2 Hours for all categories provided by staff.

Summary

Exam/Treat. Positions Existing Recom Notes

Trauma - Main 1 1 1Trau/Card/Resusc Bays 2 2 2Exam/Treat - ENT 1 1 3Exam/Treat. - General/Bays 4 4 4Exam/Treat. - GYN 1 1 5Psych Seclusion Room 0 1 6

Sub Total 9 10

Obsv/Treatment Bays 3 3 7

Total Rooms w/Obsvervation 12 13

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What are the precursors to programming a hospital?

The Architectural Program should be a keyaspect of the hospital campus master plan (MP).

Previous Web Seminar Sessions have

addressed Strategic Planningand Campus Master Planning(Brief Background Comments Here)

The precursors to programming include:9 Owner and User Orientation to Process9 Establish a Planning and Programming Leadership Committee9 Completion of a Strategic Plan (Usually by Staff or Consultant)9 Completion of a Campus Master Plan (MP) By Healthcare Consultant/Architect9 Completion of Building Gross Program (All Departments Sized Using Various Methods)9 Formal Approval of the MP and the First Phase Projects to be Programmed

Ideally, the Departments Are ProgrammedSimultaneous With the MP

ProcessBetter Results!(Often a Fee Issue With Owners)

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What is Facility Master Planning (MP)?1. A full service road map for the hospital system and/or campus.

2. A building study based on mission, vision, strategy and actions.3. A process that addresses all issues and then decidesto buildor not to build.

4. A MP reaches closure through consensus on objectives.5. A MP includes more health and healthcare information than the

traditional program6. A comprehensive MP includes a program.

Differences between a MP and a Program:1. Master planning is the road map and quite often the visionary strategy

while the program ties down the details suitable to conduct basic A/E design

services. A MP will also begin early conceptual design and master zoning ofdepartmental services. The MP might reveal strategies other than construction: Sell the facility. Move to a site. Conduct a feasibility study or a fund raising campaign.

Seek a systemwide partner or close due to poor market share.

.

What are the basic steps in programming?

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p p g g

1. Situation Assessment:- Review the Owners MP if they have one

- Review the Owners Strategic Plan (SP) if they have one- Survey the Situation with Leadership

2. Goals, Facts, Concepts, Needs:- Move through the matrix beginning with Facts

- Conduct kick off, site tours and interviews- Fact gathering key to process- Follow through on departmental discussions (user interface)- Organize and document findings

3. Form, Function, Economy, Time:

- Measure findings, interview users and test concepts- Build consensus based on Facts, Needs and Opportunities- Create an atmosphere of trust and business driven direction- Focus on mission, vision and service delivery- Healthcare = Patient and Family first

4. Issues and Opportunities:- Collaborate with Leadership on major issues

- Resolve conflicts, key concerns, road blocks- Continue consensus oriented process- Define actions based on business and service

5. Action Strategies based on the situation:- Define first phase projects and gain approval to proceed with programming/design

- Determine most appropriate team to conduct the work (consultant/archiect/other)

What are the different types of Programs?

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What are the different types of Programs?

1. Basic Architectural Program:

The basic program embodies the matrix items defined herein andaddresses a specific building and/or building component:- A Replacement Hospital

- A Renovation Project (Cosmetic Upgrade, Face Lift, etc)

- A Departmental Expansion (Add Space to Surgery, Imaging, etc)

- A New Medical Office Building- A New Surgery Center

2. Functional Program and Possibly Certificate of Need:- A Needs Assessment, Functional Narrative and Systems Interface

- A Full Service Program With Matrix and Work Loads

- A Detailed Operational Plan and Functional Narrative (JCAHO)3. Master Plan and Building Gross Program:

- A Step by Step Campus Master Plan Study

- Looking at the Departmental Relationships and Master Zoning

- A Departmental Gross (DGSF) Program

- A Building Gross (BGSF) Program- A MP Budget and Phasing Strategy

- A MP Site Assessment

4. Other Studies for Comment and Awareness:

- A Life/Safety or ADA Analysis

- A JCAHO Statement of Conditions- A Systems or Equipment Inventory or Assessment

- An Interior Design and Image Upgrade (Cosmetic and Wayfinding Face Lift)

- An Asset Management or Annual Capital Budget Endeavor

Where does one start?

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Where does one start?

Begin with the clients expectations.Respond to the clients request for information (RFI).Respond to the clients request for proposal (RFP).

Respond to governmental requests.

Offer insight and guidance.Visit the site if possible (not always permitted).

Build on the clients knowledge of process.Submit proposal.

Conduct presentation for project.Get selected to conduct work.

Finalize agreement letter.Establish work plan.

Start process based on agreement letter.

Diligently follow the agreed to steps in process.

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Beginning OurBeginning Our

Capital CampaignCapital Campaign

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Whats Important before starting Programming?

1.A site visit and leadership discussion.2.A project work plan week by week with target dates and deliverables.3.A review of the campus master plan (if one is available).4.A review of basic, existing, campus information (history):

- JCAHO reviews- Life/Safety reviews- Department of health surveys- User memos, notes, goals and objectives- Previous studies, design products, concepts, vision- Previous strategic planning efforts

- Previous business plans for special projects (cancer, children, etc, etc)

5.Establish a Planning Committee made up primarily of the client leadership team:- Chief Exec Officer (CEO), Chief Financial Officer (CFO)

- Chief Operation Officer (COO), Director of Nursing (DON)

- Departmental Director or Service Line Manager- Chief of Medical Staff and Possibly Board Member Representative- Facility Manager and Possibly Director of Planning

6.A Start Up Session With All Directors is helpful and relevant to a consensus

oriented programming and planning process

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ProgrammingProgrammingDeliverablesDeliverables

The deliverable products are a

function of Owner expectations,fees for service, type of project,

time and resources.

Wh t th t d deliverables f P i ff t?

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What are the suggested deliverables for a Programming effort?

From a purely generic perspective, the following might be anticipated deliverables:

1. A Brief Executive Summary

2. A Situation Assessment that embodies, goals, facts, concepts, needs

3. A compilation of existing building plans (site plans, floor plans, elevations,sections, existing DGSF sizes, and other technical data as may berequired to fulfill the facts portion of the work up)

4. An environmental assessment that combines an overview of architectural,engineering and building systems (may vary from visual survey todetailed energy audit contingent upon the client situation)

5. An overview of clinical and nursing support systems (EMR, PACs,nurse call, Pyxis, Omnicell, etc, etc)

6. Benchmark comparisons (contextual comparison to industry standards)

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7. A summary of user group expectations, goals, facts andconcepts (tabulation of electronic surveys with notes frominterviews

8. A summary of work loads that define needs vs. wants andwishes

9. Updated as-is drawings illustrating departmental boundaries

and present sizes in DGSF format

10. A series of proposed concept drawings (growth andchange over time for the area being programmed)

11. A space listing driven by work loads in either DGSF and/orNSF format (discuss illustration herein)

12. A total project budget based on programmatic needs and

including all cost variables (discuss illustration herein)

What are the suggested deliverables for a Programming effort?

S G

Strategy Goals

IntegratedIntegrated

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Test & RefineAlternative

Programming andPlanning Scenarios

Facility Concepts& Campus Plans

Facility Concepts& Campus Plans

ImplementationImplementation

Feedback

Strategy, Goals

& Objectives

Strategy, Goals

& Objectives

Financial

Feasibility

Financial

Feasibility

Facility &Technology(Capital Assets)

Facility &Technology(Capital Assets)

IntegratedIntegrated

PlanningPlanningProcessProcess Owner ProvidedExpertise

Externally Provided

Expertise

This would be an ideal campus master planning cycle, but,

this isnt always the case for manyjustifiable reasons (discuss during session).

A Departmental Space Summary

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A Departmental Space SummarySPACE PROGRAM SUMMARY

Department NameBeds DGSF

Inpatient Care Units Prop. Prop. CommentsPatient Care Unit, M/S/Observation/Isolation 25 13,958

Geropsych Unit 10 7,352 Design to Convert to M/S as Required Over

Sub Total Inpatient Units 35 21,309 Units Staying Close to 90% Occupied

Diagnosis and TreatmentSurgery/Recovery/Clinic (1 OR + 1 Endo + 2 Prep + 4 Rec) 5,185 Must Have Clinic Adjacent Due to Staffing

Imaging Suite (1 CT + 1 R/F + 1 NM + 1 US + 1 Mammo) 7,064 Add In House MRI If Cost Justifiable/Mobile Initiall

Laboratory and Sleep Lab 1,976

Emergency Department (6 Stations + 1 Seclusion) 4,440

Physical Therapy/Rehabilitation Services 1,379

Cardiopulmonary/Respiratory Therapy 684 Some CP in Imaging Area (Discuss Later)

Pharmacy 1,026

OP Clinic 2,337

Sub Total D/T Services 24,091

Support ServicesDietary/Dining 2,654

Materials Management 2,032

Central Sterile Processing 719

Plant Operations And Security 911

Housekeeping/Linen 846 Stroudwater 356+192SF (Laundry/Hkg)

Staff Facilities 620

Sub Total General Support 7,781

Administrative and PublicAdmitting/Outpatient/Registration 429 Emergency and Acute Care Patients (80% from ER)

Administration 1,339

Nursing Administration Incl. Above

Human Resources 256

Information Technology 474

Business Office/Fiscal Services 1,586

Health Information Management (Medical Records) 1,423

Medical Staff Services 524

Education/Training/Board Room 762 Locate Near Main Lobby Entry/Shared By PublicOutpatient Lobby 1,110

Main Lobby 1,453

Volunteer/Gift Shop 402

Vending 160 Locate Near Emergency Area

Religious Functions 207

Sub Total Administrative and Public Spaces 10,124

TOTAL DEPARTMENTAL GROSS AREA 63,305

Central Power Plant 1,500Air Handling Rooms/Penthouses 500

Building Support Plus Primary Circulation @ 10% 6,331

BGSF Grossing Factor of 1.2 Incl Above

TOTAL BUILDING GROSS AREA REQUIRED 0 71,636

The color coding foreach service linehelps distinguish

areas in plan

visually..

A Room-by-Room Listing

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y g(Linked to a Space Summary)

INPATIENT CARE UNIT/ MED-SURG/CCU/PEDS(19 Privates + 5 Monitored +1 Peds) = 25 Total Beds

No. of NSF/ Total

Space Designation Rooms Room NSF Comments

Patient Rm, One Bed 24 230 5520 Same Handed Inboard Toilet/Shower

Clear Bed Area 1 @ 195 SF

Fixed Casework, 10LF 1 @ 20 SF Chart Counter, Wardrobe, Lavatory

Couch/Seating 1 @ 15 SF For familyToilet, Pat (WC&Tub/Shwr) 24 60 1440 ADA

Patient Rm, One Bed, Bariatric 1 245 245 Negative pressure

Clear Bed Area 1 @ 210 SF

Fixed Casework, 10LF 1 @ 20 SF

Couch/Seating 1 @ 15 SFToilet, Pat (WC&Tub/Shwr) 1 60 60 ADA

Nurses Station 1 330 330 Position Near Emergency N/S

Comm Sta, Clerk 1 @ 35 SF Electronic Medical Record (EMR)

Chart Rack Access (Autoview/Computer) 1 @ 25 SF (Wire For Future Electronic)Computer Station 1 @ 25 SF

Chart Sta, Nurse 3 @ 25 SF

Charge Nurse Sta (Manager Plus UR/IC/Other) 1 @ 35 SF

Crash Cart 1 @ 15 SF

Circulation In Area = 120 SF MedSelect Stations (3 Towers)

Doctors Charting Rm 1 90 90 PACs Viewing Provided

Chart Sta/Dictate Sta 4 @ 20 SF

Chart Rack Access (Autoview/Computer) 1 @ 10 SF Transition to EMR Over TimeMedication Room 1 70 70

Shelving Units 1 @ 20 SF

Medication Supplies (UC Refrigerator) 1 @ 20 SF

IV Fluid Holding/Other Fluids 1 @ 10 SF

Utility Station w/sink 1 @ 20 SF

Clean Util/Nour Rm (With Ice Machine) 1 95 95

Clean Stor Rm 1 110 110 Covered Carts

Clean Supply Cart 2 @ 25 SF

Clean Linen Shelving 2 @ 20 SFSupply Shelf Unit, 4 LF 1 @ 20 SF

Equipment Storage Rm 1 500 500

Soiled Utility Rm 1 95 95

Contaminated Trash Room 1 15 15

A Room-by-Room Listing

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y g(Linked to a Space Summary)

INPATIENT CARE UNIT/ MED-SURG/CCU/PEDS (Cont)(19 Privates + 5 CCU +1 Peds) = 25 Total Beds

No. of NSF/ Total

Space Designation Rooms Room NSF Comments

Staff Conf/Work Rm 1 110 110 Currently Using Patient Room

Seats 4 @ 15 SFBox Lockers 30 @ 1 SF Half Size Purse Lockers

Coffee Bar 1 @ 20 SF

Toilet, Staf f(WC&Lav) 1 30 30

Office, Case Manager/Shared 1 90 90

Public Waiting Alcove 1 150 150 Hold For Future Consideration As Needed

Seats 8 @ 15 SF

Drinking Fountain, HC 1 @ 10 SF

Telephone Alcove, HC 1 @ 10 SFCoffee Bar 1 @ 10 SF

Waiting/Comfort Room/Family and Guest 1 150 150 Bereavement and Consultation

Toilet, Public (WC&Lav), HC 1 45 45 ADA; New

Housekeeping Closet 1 40 40

Communications Closet 1 120 120

Dept. Net Square Feet 9,305

Dept. Circulation @ 40% 3,722Dept. Walls @ 10% 931

TOTAL DEPARTMENTAL GROSS AREA 13,958

Note: Programmed spaces are based on current HHS criteria. If using existing spaces may be less square footage due to "grandfathering".

Linked to DGSF Summary

An Illustrative Budget Summary

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Category of Cost Area/Unit Cost per S Sub-Total RemarksA. Raw Const Light

0 $0 $0.00

0 $0 $0.000 $0 $0.00

71,636 $250 $17,908,897.00 Need Estimator Review

71,636 Hospital Only W/O MOBB. (Allowance All New ) N/A None Required

C. (Allowance) N/A $1,500,000.00 12 - 15 Acres Range of Development (TBD)

(Allowance) N/A $0.00 (Parking, Sewers, Landscape, Misc)

D. $19,408,897.00 Requires Architect Verification

E.

$1,164,533.82 For Budgeting Purposes Only

$194,088.97 Assume 1% for Discussions

$0.00CM Fee/Costs $0.00

F. (Assume 6% x D) $1,164,533.82 Early Estimate For Budgeting Only

G. $5,822,669.10 Some Credit for Existing Items$388,177.94

H. $194,088.97 Permits, Legal and Admin. Support

I. Contingency $1,164,533.82 Assumes No Complications At Site

J. $0.00 By Owner

K. W/Line A Above Assume 4 Years (2 Yrs. Inflation)

$29,501,523.44 Budget For DiscussionTOTAL ESTIMATED BUDGET(Line "D" plus "E" - "K")

(Assume 6% x D)

Debt. Service On Loan (Separate Budget)

Inflation To Mid Point (Separate Budget)(6% Over 2 Years to Mid Constructio

Moveable/Fixed Equipment (Assume 30% x D)Communications Equip. (Assume 2% x D)

Administrative Costs (Assume 1% x D)

Interior Designer (Assume 1% xD))CM Cost Allowance (Assume Fixed Fee)

(Assume 03% x D)

Furnishings & Furniture

CONSTRUCTION COST (SUM of A-C)

Professional Fees

Architect/Engineer (Assume 6% x D)

New Const MOB

New ConstructionStructured Parking

Fixed HVAC/El Equip

Site Development/Preparation

Site Development/Signage

Replacement Project Budget Illustration

Preliminary Order of Magnitude

P R O J E C T B U D G E T A N A L Y S I S

First Test for Discussion

DemolitionNew Const Service

Size Linked to Cost Key Factor

Site Plan Study With Illustrations

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Other Site Plan Studies For Campus Plan

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Other Site Plan Studies For Campus Plan

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Key ImpactKey Impact

FactorsFactorsA Case Study to Illustrate

Impact of Incorrect

Programming

Impact of Incorrect Programming

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p g gAssume: Project is programmed 1,000 net square feet short of what is required.

Impact 1. Net Square Feet to include Grossing Factors

# % for General Circulation Not Within Departments

# % for Vertical Circulation and Unassignable Areas# % for Overhangs and Canopies (Usually at )# % for Interstitial Space (Working MEP Areas)# % for MEP Areas# Gross Square Feet (BGSF)

Impact 2. Total Gross Square Feet by Construction Cost Per Square Feet

# 1,320 GSF x $250.00 per square feet

# $330,000 additional construction cost impact

Impact 3. Contingency Impact on Additional Construction Cost

# $330,000 x 15% contingency (Typ. at Programming Phase)# $379,500 additional construction cost impact

Impact of Incorrect Programming

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p g g

Impact 4. Project Development Cost Impact (Soft Costs)

# Depending on the type of healthcare project, the percent rangeis generally accepted as 30%-40% of the construction cost(assume the midpoint of this range)

# $379,000 x 1.35 = $512,325

Impact 5. Architectural / Engineering Professional Fee Impact

# $330,000 additional construction cost# $330,000 x 7.5% A/E fee (Typ. for Healthcare projects)# $24,750 additional fees based on additional square feet

Impact Summary

# 1,000 Net SF not programmed correctly may have a $512,325additional cost impact to the total project cost

# 1,000 Net SF not programmed correctly may have a $24,750

additional Architectural / Engineering Fee Impact

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Questions andQuestions andCommentsComments

There are no wrong questions,please feel free to speak up.

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