A MSZ is defined in the literature as a critical area where medications are prescribed, orders are entered into a computer or transcribed onto paper documents, and where medications are prepared, dispensed or administered. Examples include work surfaces of medication cart, nursing units, any location where prescribing decisions are made, work surface of an automated medication dispensing device, pharmacy, and patient bedside.
A strategic plan helps hospitals and systems adapt to market conditions and changes in healthcare environments. The CEO along with the Board of Directors has a leadership role in creating the strategic plan, which includes the development of the organization’s mission, vision, strategy and values statements; defining the critical strategic issues, making the transition from planning to implementation, communicating and rolling out the plan’s findings and recommendations, and conducting an annual strategic plan update as part of an ongoing management process. (Synthesized from Healthcare Strategic Planning, Second Edition, Alan M. Zuckerman, FACHE, FAAHC)
Healthcare master planning is a guide for decision-making prepared by identifying capital improvement needs that accommodate future growth of a facility that includes potential operational and infrastructure needs for delivering quality healthcare. It is a multi-phase process undertaken by healthcare planners, architects and other industry consultants to consider long-term strategies that consider logistical and financial feasibility, as well as flexibility to accommodate future change. It considers site/campus planning, zoning, existing building analysis, departmental analysis, projected workloads and demands, gross area sizes, and options for potential configurations. (Synthesized from AIA AAH Healthcare 101: Master Planning.)
Operational planning reflects current and future business and clinical processes, organizational structure and technology after taking into account existing investments, process priorities opportunities for improvement and change management implications. The operational plan establishes the operational link to strategic objectives by providing a common view and vocabulary of all relevant processes; aligns key metrics that assist the organization in documenting its current state (and track progress over time); ensures agreement between and buy-in from physicians, administration and staff who are accountable for successful execution; and establishes an appropriate organizational/governance model with the authority to implement and sustain the required changes through continual process assessment and design of workflows.
Architectural programming is the research and decision-making process that identifies the issues and problems that a design process must address and resolve. The result is interconnected on both a pragmatic and inspirational level that defines the scope of work to be designed by identifying existing condition evaluation; space requirements; overall building use requirements; zoning and community issues; the relationship between building components; measures for growth and change; and code summaries and regulatory requirements. (Whole Building Design Guide (WBDG)/American Institute for Architects (AIA) Handbook of Professional Practice.) A functional program is required by the Facility Guideline Institute (FGI) Guidelines for the Design and Construction of Healthcare Facilities and is described through 1) the purpose of the project (required services; environment of care components; delivery of care models; facility and service users; systems design; layout and operational planning; physical environment; and design process and implementation), and 2) the functional requirements (demand; space relationships; user needs; operational needs; space and equipment needs; and short- and long-term planning considerations. (FGI Guidelines, 2010).
Design is considered in two phase: schematic design (SD) and design development (DD). During SD, an architect and client establish the scope, conceptual design and scale and relationship of the project components to establish a clearly defined and feasible concept with a reasonable basis for estimating project cost. Design development (DD) uses the documents from the schematic phase and provides additional refinement and coordination. This phase lays out mechanical, electrical, plumbing, structural and architectural details. This phase results in drawings that often specify design elements such as material types; location of windows and doors; interior elevations; wall sections; reflected ceiling plans; pertinent details and; more detailed specifications. Cost estimates are updated. (Summarized from AIA Handbook of Professional Practice.)
When finalizing construction documents (CDs), final materials and systems are selected, while details and dimensions are finalized. (AIA Handbook of Professional Practice.)
Several delivery methods are used for construction. In design-bid-build, a project is designed and documented with drawings and specifications, competitively bid to multiple general contractors, and then built by the general contractor, guided by a contract with the owner of the project. Design-build uses a single entity that holds a single contract with an owner for both the design and construction of a project. Construction management is a method that involves the coordination and management of the entire process via a single entity—from site survey through occupation. It encompasses the evaluation, selection and management of all contractors, as well as the administration of the project budget relative to the implementation of design (WBDG). Construction may include phasing and temporary structures to ensure the safe and continuous operation of an existing facility. Requirements surrounding infection control and risk mitigation are required in many areas.
The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) define commissioning as "a quality-oriented process for achieving, verifying, and documenting that the performance of facilities, systems, and assemblies meets defined objectives and criteria." It is typically used for dynamic systems such as HVAC (heating, ventilation and air conditioning) and certain types of equipment. It is conducted prior to turning over the facility to the owner. The punch list is typically completed by the design team with a walk-through inspection at substantial completion. The punch list identifies incomplete or unsatisfactory work, as defined in the contract documents. The items are usually static in nature, such as drywall or paint irregularities, carpet stains, broken hardware, etc.)
Many states require an inspection prior to issuing a Certificate of Occupancy (CO) or Temporary Certificate of Occupancy (TCO). After issuance, the owner takes control of the building and can begin moving furniture and equipment. In larger healthcare facilities, staff and clinicians use simulations, scenarios and walk-throughs to ensure they are familiar with the new environment prior to full operation of the building, licensing, certification and accepting or moving patients.