Ask The Right Questions, Get The Right Architect

An RFP, or Request for Proposal, can set the course for either a successful or disappointing new construction or expansion project, before the selection of a design team. That’s because to get the right answers, healthcare providers must ask the right questions. Writing a good RFP can make or break a project. Why? According to The Request for Proposal Handbook by John Adler, many RFPs have serious flaws. For example, they don't structure the evaluation process so that it’s fair and open, they omit major requirements, and they don’t ask for risk management information. Viewed as an early planning tool, the RFP can help determine the design team with the best credentials, the footprint and design features, as well as the time and money commitment required of the owner. A good RFP, therefore, will uncover a variety of ways to implement the finished project, and hammer out how to get there. On the other hand, if an RFP is written poorly, the owner can be exposed to a number of trapdoors. Among the pitfalls are undersized labs that can’t be expanded, labs that don’t adhere to current standards/code guidelines, or labs that result in costly change orders. Because equipment can significantly change every seven years on average and cardiology is a growing and thriving subspecialty, designs implemented today must allow for flexibility tomorrow. A host of questions should be posed in an RFP to expose the prospective architectural and engineering firm’s depth of knowledge and experience at each phase of the design and construction process. A few of those recommendations are as follows. Functional and Space Programming The questions posed by the RFP will identify a firm’s ability to program catheterization spaces (including the lab itself), control areas, computer or cold rooms, pre-procedure holding, post-op recovery, and patient intake/changing. During this phase, all spaces that affect square footage will be identified, and a list of rooms should be presented to the lab owner in a spreadsheet. Therefore, answers to the programming question will also give the healthcare institution a gauge for required departmental gross square footage needed. The RFP should ask the design team how it will determine square footage. An experienced architect, for example, will have a strong understanding of space, function, and the relationship to other spaces and functions within the healthcare facility. Master Planning Questions regarding master planning will help a healthcare institution identify firms who hold an understanding of patient flow into the cath lab areas as being either a part of surgery, radiology or a cardiology suite, including the required adjacency to other departments, such as the emergency department. A planning firm that doesn’t have a thorough grasp on how a patient arrived at a certain point doesn’t have an overall cohesive understanding of and plan for a facility. As the name implies, a good master plan looks at the whole department and/or campus plan not only for today but also into the future. Since cardiology is a thriving subspecialty in U.S. hospitals today, cardiology departments can be expected to increase over the next several years. If the master plan does not build in expandability if it’s landlocked or if the mechanical and electrical systems cannot grow along with space the facility will suffer down the road in growth capacity, efficiency and/or financially. Therefore, master planning must include not only space for expansion, but also room for the supporting infrastructure. Schematic Design This RFP question will identify a firm’s knowledge and understanding not only of a cath lab proper but also how it fits into the entire facility. Moreover, it will help the healthcare institution understand the architect’s vision of the meeting process, i.e., how they will orchestrate the process with users, as well as what will be required of the healthcare team. At this point, the architect will begin to graphically flesh out, or bubble diagram, functional spaces. While it’s inconsequential if the designer uses drafts sketched on paper, whiteboards or electronic CAD programs, it is crucial that feedback from user groups is incorporated into the process. A good architectural firm will involve equipment vendors, radiology, cardiology, anesthesiology, nursing, ED, central supply and possibly others to assist in determining optimal numbers, square footage and adjacencies of ORs, scrub rooms, ED, etc. But with so many stakeholders involved in the decision-making process, it is difficult to come to a solid conclusion. To avoid the project stalling at this critical juncture, the architectural firm must have a strong understanding of space, as well as the medical diagnostic and invasive procedures that will be performed. They also must have strong negotiation skills to whittle away the differences of multiple users in disparate departments and reach a collective conclusion. This firm must be counted on to gain consensus from all at this point. At the same time, the firm’s engineers should have a plan in place to test the infrastructure backbone that will support the proposed architectural design and master plan. Thus, the RFP may query the design team’s experience and understanding of patient flow, support areas, etc., as well as the ways in which it will build consensus and infrastructure requirements. Design Development The design development process begins to detail each associated space in the cardiac cath lab and also initiates specification work with the equipment vendor. Architects meet with user groups separately to define all criteria more specifically, such as placement of the cath equipment iso-center, medical and anesthesia gases, power (normal and critical) requirements, placement of casework, clean supply storage cabinets, and specialty lighting. The RFP should allow the healthcare institution to see what will be required of it and to discover the architect’s understanding of the amount of detail that will go into each area. The response document should include vendor-specific questions, lead-shielding requirements, communication ability from lab to lab or lab to another viewing area, such as surgical suites, staff area requirements, type of patient and/or room, i.e. pediatric, pacemaker, EP, etc., adjacencies to cardiac surgery suites, and travel distances. The RFP should determine the overall process, including estimated design timeframe, and the number and duration of meetings. This, in turn, will help in understanding the time commitment necessary from hospital team members in order to to resolve design issues. Construction Documents As technical documents are designed and drawn, the selected firm must have in-depth engineering knowledge, such as HVAC requirements, including air changes, computer or cold room systems and isolation requirements, medical gases, critical power, lighting design, point-to-point wire ways, and low voltage system needs. An RFP should uncover potential deficiencies in the architectural and engineering team’s expertise, particularly in cath lab design. It’s the appropriate time to ask for the firm’s report card. The RFP should inquire about the firm’s history of change-orders in doing this type of design. In addition, it should ask the firm to illustrate, in detail, how it has successfully completed all aspects of A/E construction document services. Interior Design Cardiac catherization procedures are performed when the patient is conscious. Consequently, a cath lab must take special care to provide a healing environment for the patient, who may be frightened and overwhelmed. What has the firm done to lessen stress levels and to enhance the patient’s feeling of security? On the practical side, interior design also should contain slip-resistant and sustainable floors because of spills from blood, dyes and chemicals, as well as scrubbable walls. The interior should have the durability of an OR but the feeling of a living room. Conclusion Cardiology is a thriving subspecialty in most hospitals. If space is not allotted for anticipated expansion in both treatment and support space, the healthcare institution may be thwarted in its desire for future growth. A detailed RFP helps a cath lab administrator choose a firm that has successfully accomplished this task in the past. A good RFP proves that arriving at the right answers is frequently a function of asking the right questions. Bernie Gehrki can be reached at bernie.gehrki@hdrinc.com.

NULL