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How Comprehensive Design Can Drive Long-Term Success

Designing with Day-to-Day Operations in Mind

Comprehensive Design

Another common discussion during the OPR process is related to operational efficiencies. These concepts are usually straightforward, common-sense ideas which are frequently overlooked by designers lacking operational experience in the industry or environment they’re designing for.

Real-Life Example

Typical hospital inpatient units might contain a single Environmental Services closet, or if they’re lucky, perhaps two. When an architect designs an inpatient unit, their primary goal is to create a sensible patient room layout offering efficient traffic flow for nurses. Support spaces, while certainly not an afterthought, tend to be squeezed in wherever they fit, or eliminated to accommodate additional clinical demands. Environmental Services staff require quick and easy access to their closet, which generally contains a mop sink, a cleaning solution dispensing station, and other supplies. They also need easy access to a trash closet. These types of spaces are an integral part of the design. These operational elements may not improve revenue, however eliminating them from a design or placing them in an inconvenient location could negatively impact revenue due to delays in room cleaning and turnover.

Hospital teams will struggle providing appropriate care to patients and achieving positive patient outcomes without these efficiencies. Poor patient outcomes will lead to low patient satisfaction scores, which negatively impacts Medicare reimbursement rates.

Environmental Services

If an Environmental Services worker has an opportunity during the OPR process to say “the EVS closets in our current inpatient units are too small” or “it takes too long to deliver trash to a trash closet, which makes me fall behind in turning patient rooms over”, their leader can either support or oppose those claims. When room turnover is delayed, patient admissions are delayed, which frequently causes overflows and back-ups in observation units and emergency departments. Once a decision is made to include something in the OPR document, the design should reflect those expectations.

Facilities Management

A Facilities Management team is required to perform both corrective (when something breaks or fails) and preventative maintenance on the physical plant infrastructure and equipment. Many HVAC systems were traditionally designed with individual components, such as Variable Air Volume (VAV) boxes, which are accessible in the most unpractical locations possible, such as over a lab table or over an inpatient

During the OPR process, an HVAC technician might ask, “Is there any way the VAV boxes can be located outside the patient rooms so we do not have to disturb a patient when maintenance is required? Also, could you make sure the VAVs can be easily accessed so the maintenance technicians don’t have to contort themselves around pipes and over ductwork to access the equipment which most commonly requires maintenance?”

Documenting Team Contributions

The answer to these questions is simple and should always be included in an OPR document. In this type of situation, the design engineer should ensure that all VAV boxes are located outside the patient rooms or away from lab work areas, and are easily accessible. Years down the road, the maintenance technician who made the initial request, along with his or her peers, will remember that they were invited to participate, and that their voices were heard during the planning phase of the project, because each time one of them has to repair or replace a VAV box, they’ll be able to do so without disturbing a patient or researcher and without putting themselves at risk due to a hard-to-reach VAV box.


The key takeaway is that only when the entire team is consulted and given a voice through the OPR process, will the designer avoid missing subtle, yet critical details in the design.

“It doesn’t make sense to hire smart people and then tell them what to do; we hire smart people so they can tell us what to do.”

-Steve Jobs

This quote applies to the OPR process.

More from the OPR Series

About the Author: Wes Pooler

Wes Pooler is Pintail Solutions’ Vice President of Facilities Services and offers more than 20 years of experience serving in leadership roles for both for-profit and not-for-profit organizations alike. With nearly 15 years as a healthcare executive, Wes has overseen projects in excess of $150 million, and served as the Operations Section Chief of a hospital incident command system through the first two years of the COVID-19 pandemic.


Wes Pooler | VP of Facilities Services | | tel: 207.660.5352

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