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What is the functional program process guide?
  1. An easy to understand guide for communicating an owner’s project requirements to the entire project team.
  2. An effective process for defining and delivering a functional program to meet applicable regulatory requirements for design & construction.
  3. An opportunity to develop a functional program to optimize a project’s design and leverage the physical environment to improve patient outcomes, staff effectiveness and sustainability.
Why use this process guide?
This process guide consists of five broad steps to assist healthcare providers and facilities in the development of a functional program that will optimize subsequent planning, design and construction efforts for proposed capital projects.


Step 1
Create project and determine required information
Step 2
Define purpose, project initiatives and intentions
Step 3
Perform needs assessment, establish project documents and context
Step 4
Define operational and functional requirements
Step 5
Collect data and produce Functional Program
What is the intent of a functional program?
  1. It is a regulatory requirement for most projects depending upon scope, scale and individual state licensing requirements.
  2. Articulating the Health Care Provider’s project requirements, it serves as a bridge between Programming (analysis of data) and Design (Synthesis of data), and can be a vital decision-making tool throughout the entire project development process.
  3. Properly executed, it can encourage innovation, favorably impacting cost and timing, potentially avoiding costly delays and exposure during construction or impacting successful operational out comes.
  4. It can seamlessly add the concept of quality to the traditional assumption of quantity.
  5. It can guide a project throughout the entire development process, as conditions and/or assumptions may change.
What is a functional program?

Based upon the original federal regulations for hospital design and construction, the FGI Guidelines for Design and Construction documents are used by 40+ states in varying degrees to articulate and/or inform state regulations. Therefore this process guide utilizes the FGI’s functional programming format.

According to the FGI Guidelines, “The primary purpose of the functional program shall be to communicate the owner’s intent for the project to the designers of record as a basis for design at the initiation of the project” and “...shall be used to determine the application of the Guidelines when developing facility project”. Beyond these specific requirements, the Guidelines further emphasizes the foundational importance of every project, which is comprehensively impacted by the functional program: “Because the built environment has a profound effect on health, productivity, and the natural environment, hospital shall be designed within a framework that recognizes the primary mission of health care (including ”first, do no harm”) and that considers that larger context of enhanced patient environment, employee effectiveness, and resource stewardship.”

The FGI Guidelines requires these general components for a functional program: purpose of the project, operational requirements, project components & scope, indirect support functions, project type & size, construction type, occupancy & building systems, and executive summary

The seven FGI-required elements of a Functional Program are expanded upon below.

Hover over the elements to see more information about them.
Executive Summary
Purpose of Project
Project Type + Size
Construction Type Occupancy Systems
Project Components + Scope
Indirect Support Functions
Operational Requirements
Functional Program
How to use guide

This Process Guide is intended to be scalable, in recognition of the wide-ranging project complexity possible. Regardless of project scope and scale, the Functional Program must be developed very early in project development to ensure regulatory consistency and compliance, and to maximize its value as the literal foundation of project planning, design, construction and implementation. The owner/governing body/sponsor is responsible for overseeing development of the Functional Program, since that entity is the primary source of legal, functional, clinical, operational and financial elements underlying the project.

There are five (5) broad steps in this process guide.


Hover over the steps to see more information about them.
Step 1
Create project and determine required information


  1. Create project to address shortcoming(s), or to attain desired goal(s); assign project identifiers.
  2. Identify scope, general description of project understanding to define an order of magnitude.
  3. Determine need for Functional Program (Alteration Levels and FGI requirements).
  4. Assemble Multi-Disciplinary Team (MDT or IDT) members including but not limited to:
    • Team Leader
    • Decision makers
    • Directly affected stakeholders
    • Indirectly affected stakeholders
    • Business Members (planning, strategic/ROI, P&L, financial & reimbursement, patient representatives)
    • Professional Team (Strategic planning, architecture, engineering, interior, landscape)
    • Construction Team (construction manager, cost estimating, project management)

FGI Requirements

  • Purpose of Project
  • Executive Summary


Identify functional & clinical information and input required for project and input required to inform the project that has been identified.

Step 2
Define purpose, project initiatives and intentions


  • Define purpose of the project
  • Discuss environment of care components
  • Discuss layout and operations
  • Establish care delivery model
  • Identify infrastructure and system requirements
  • Clearly articulate project requirements, project vision and goals and how these will influence patients, staff, providers and occupants.

FGI Requirements

  • Purpose of Project
  • Executive Summary


A functional program will clearly define the intended purpose of the project and how it will influence facility users, as well as the balance of the organization and local region/community.

Step 3
Perform needs assessment, establish project documents and context


  1. Project Overview
    • Establish time to market, financing
    • Establish design layout key criteria related to buildings, spaces, circulation, organization, etc.
    • Identify energy, sustainability and resiliency requirements
    • Site requirements
    • Establish physical environment, criteria, relationship to nature
    • Identify mock ups and pilot programs
    • Identify primary construction criteria, systems and infrastructure
    • Establish primary FGI Guidelines programmatic requirements
    • Determine indirect support impacts
  2. Determine demand and utilization data necessary to justify and support proposed project
  3. Identify project type, scope and scale

FGI Requirements

  • Operations & Functional requirements
  • Project Components & Scope
  • Indirect Support


Identify applicability of FGI and other standards that govern functional, operational & space requirements

Step 4
Define operational and functional requirements


  • Identify operational requirements, functional support
  • Materials management - how this supports the care model
  • Perform systems evaluation
  • Explore planning efficiencies
  • Explore efficiency & workflow improvements
  • Quality improvement metrics, LEAN
  • Logistics
  • Life cycle cost analysis

FGI Requirements

  • Project Type & Size
  • Construction
  • Occupancy & Building Systems


How will the projects function, what performance improvement benefits are desired?

Step 5
Collect data and produce Functional Program


  1. Synthesize information from steps 1-4 (compile, document, identify care model, prioritize project initiatives)
  2. Integrate needs assessment (step 2) with project requirements (step 3) to create most reasonable project
  3. Formulate a functional program that:
    • is shareable & understandable by all MDT/IDT Members
    • is a clear & concise definition of project needs, demands, justification, scope, scale, impacts & cost
    • is adaptable to revision as necessary
    • is clear as to primary action as well as second & third order effects

FGI Requirements

  • ALL


The published functional program and executive summary should clearly identify the Who, What, Why and How a project will be created. Ideally the functional program should be in a format that is:

  • Readily accessible to all project team members
  • Easily updated to reflect changes in conditions and/or circumstances to ensure continuous relevance
Frequently Asked Questions


YES, for the many jurisdictions utilizing the FGI Guidelines, all new construction and any project that changes the functional use of existing space requires the development of a functional program to communicate critical programmatic details of the owner’s intent to the project team. Additionally, individual states may also require a functional program to establish the regulatory basis for applicable state regulations and policy.


The project owner/governing body is responsible for ensuring that project requirements are clearly communicated to the project team, and the FGI Guidelines states that the governing body is responsible for having the functional program developed, documented and updated, though the correlation process and logistics of developing the program may be contracted out. In very broad terms, the multidisciplinary project team shares responsibility for their respective content as well as the overall combined content. However, it remains the governing body’s obligation to ensure that the resulting functional/clinical/operational content is an accurate reflection of its program/project requirements.


NO, while the FGI Guidelines includes an outline for basic information necessary for functional programs, governing bodies are free to reduce or expand that outline commensurate with scope & scale of the proposed project, as long as the basic information is clearly indicated. Furthermore, there is no mandated format for functional programs, whether analog or digital, as long as the necessary information is clearly articulated, readily available to the project team, and capable of being updated and revised as necessary.


The time required to develop an effective functional program, as well as the extent and complexity of the resulting program, depends upon the scope and scale of the project. The functional program typically serves as the basis for strategic planning, establishing time-frame & cost parameters, and subsequent project design & construction. As documentation of the governing body’s project requirements, the functional program must have sufficient clinical, programmatic, and operational detail to ensure the regulatory compliance, financial feasibility, and programmatic conformity required of all successful projects.


YES, the functional program is a valuable resource to guide & inform the entire project team throughout planning, design, construction, and occupancy of the project. As such it must be adaptable to changing conditions that may occur during project development to ensure that the governing body’s core program requirements are ensured.


As defined by the FGI Guidelines, the governing body is the person or persons who have the overall legal responsibility for the operation of a health care facility. Often, the owner is the governing body. This may be inclusive of several individuals, or an executive team.

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The Center for Health Design would like to acknowledge assistance from the Facility Guidelines Institute, which is responsible for the development and publication of the Guidelines, providing research-informed guidance for health and residential-care facilities. The Center for Health Design would also like to acknowledge its Environmental Standards Council, an all-volunteer group of dedicated professionals who have been working since 1994 to ensure that the Center’s mission is reflected in applicable standards. ESC members who are responsible for this functional program process guide are:

  • Gloria Cascarino, CEO, Medical Equipment Consulting, LLC
  • Cathy Dolan-Schweitzer, MA, President, Health Well Done
  • Charles Gianfagna, Consultant, Principal of Charles Gianfagna , LLC
  • Jill Glaser, Project Manager, The Center for Health Design
  • Robin Guenther, FAIA, LEED AP, EDAC, Principal, Perkins + Will
  • Andrea V. Hyde, CID, CHID, NCIDQ, Senior Project Manager-Interiors, Stanford Health Care System
  • Thomas M. Jung, M.Arch, Retired
  • Debra Levin, MA, EDAC, President And CEO, The Center For Health Design
  • Melissa Milano, NCIDQ, Interior Designer, Cama, Inc.
  • Chase Miller, RA, NCARB, Planner/Project Manager, BSA LifeStructures
  • Patricia A. Moore, PhD, President, Moore Design Associates
  • Guy Oron, Web Developer, The Center For Health Design
  • Saya Morris, Pomarico Design Studio Architecture, PLLC
  • Michael A. Pomarico, Architect, NCARB, ASHE, Pomarico Design Studio Architecture, PLLC
  • Alberto Salvatore, AIA, NCARB, EDAC, Associate Principal, Harley Ellis Devereaux
  • Jerry Smith, FASLA, LEED AP, EDAC, Principal, Smith\GreenHealth Consulting, LLC
  • Ana Szyld, NCIDQ, Interiors Coordinator, New York Presbyterian Hospital
  • Ellen Taylor, PhD, AIA, EDAC, Vice President For Research, The Center For Health Design
  • Richard S. Thomas, AIA, MBA, Owner Thomas Advisors


This Functional Program Process Guide is dedicated with great admiration & affection to Richard Thomas, who chaired the Environmental Standards Council for decades, and who was both a leader and contributor for the creation of this resource.

The funding for the website development of this tool was provided by: