Decisions made at the early stages of a hospital project can have a huge impact on its life cycle value. To make sure that a hospital will be a good investment, its future users should be involved in helping set out the design requirements. A Finnish team of experts wanted to see if they could improve the process and set up an experiment to see how it could be done digitally.
Currently, over one billion euros are budgeted to hospital construction and renovation in Finland. Globally, the sum is around US$400 billion. You would imagine that the design for such large investments would be very efficient from the start. Unfortunately, that is not the case.
During the design phase, doctors, specialists, nurses, and other stakeholders take part in workshops in which they express their needs and requirements. For a large hospital project, 40 to 100 workshops are the norm. The work is done with a variety of tools, with sticky notes being the predominant technique.
Design professionals seldom facilitate the workshops. Further, without a systematic model and method, it’s extremely difficult to manage the multitude of requirements. Even worse, the outcome may not serve designers as it should.
Setting Up the Experiment
“In 2017 and 2018, we did a definition project on the strategic requirements for Lappi Central Hospital. During the process, we discovered several opportunities and challenges regarding hospital design. We decided to start a project to experiment with our ideas,” says Pekka Kähkönen, Partner and Solution Designer at Gordionpro.
Gordionpro is a systems engineering and requirements management consultancy. For the experimentation project, they partnered with Gravicon, an AEC software firm, and Granlund, a MEP design consultancy. Both had solid experience in healthcare design and its information management. 3D Talo joined in to provide virtual models for simulation purposes.
The project got funding from the governmental KIRA-digi program and was completed by the end of 2018. The project team carried out several interviews, developed a process and tools for requirements management, and piloted their system in a number of hospitals.
The New Process Model
The project team considered concept design as a good starting point for the hospital requirements management. However, they found little support for that approach in the professional literature and design guidelines. Teemu Kurkela, an architect at JKMM, had studied concept design over five years ago and he suggested that concept design should constitute a discrete phase in hospital construction. Unfortunately, his idea has not yet caught on.
“From a requirements management point of view, concepts are essential. Requirements, per se, are unconnected. We must understand the context and concepts that they belong to,” Kähkönen explains.
The project team defined a new, early stage design process with the following phases:
- Concept Design
- Functional Design
- Logistics Design
- Architectural and Spatial Design
- Technical Design
The outcome of the process is a collection of well-organized requirements, ranging from strategic goals and project scope to economic and functional requirements as well as healthcare results. In addition, there are requirements for space distribution and use, adaptability, and access.
Tools for Information Management
There is no industry standard for the representation and classification of requirement information, which currently tends to be stored in Word documents, Power Point slides, and spreadsheets.
The experimentation team devised an information model for hospital requirements management to help manage the information and any changes during the whole life cycle of a hospital. The project team used Gravicon’s ModelSpace as the practical tool for implementing the model.
Physical, life-sized models of hospital rooms are used to verify their usability and dimensioning. However, building a similar model of an operating room is costly. Virtual reality is a cost-efficient alternative. 3D Talo had previously created virtual operating rooms for Kuopio Hospital and their VR skills came into use in the current experimentation as well.
“You can use prototypes and demos to check out how well specific requirements have been taken into account in the design,” says Kähkönen. “That’s why we wanted to include VR in the project.”
Benefits for All Stakeholders
Using the new process and digital tools, owners can be more confident that a hospital meets its strategic goals. Users and other stakeholders can have their voices heard, adding their relevant requirements to the other requirements, which are systematically documented for designers to consider. Designers will, thus, have sufficient information as a starting point and in a usable format when they start the design process.
The pilot testing with hospitals has even continued after the initial experimentation project ended. The pilots will continue to give valuable feedback about the new process and indicate what kind of tool development is needed.
“A new generation of hospital designers is emerging. I think that the design culture and tools will change accordingly,” Kähkönen concludes.