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Evaluate with insight During the pre-design evaluation, the owners and project team leaders closely review fi nancial records to determine the highest and most profi table sources of revenue: where is the hospital thriving and where is it merely surviving? Determine if and how a construction project can lead to capitalizing on existing profi t centers, and if it can fi x, minimize or possibly eliminate the services that are a drain on hospital resources. Though fi nancials are a sensitive topic, transparency of both the areas to celebrate and areas to address is essential in order for the project designers to objectively analyze past services, formulate sound future projections and make insightful recommendations. For example, one hospital wanted to increase from two ORs to four. Its surgeons felt there were too few preferred times available for them to work and asked administration to add space. Wanting to keep satisfying their surgeons, as well increase ORs, administrators were favorable to the idea, and reasoned that more ORs would surely generate more revenue to cover the cost. Yet, to their discovery, when the design team reviewed the fi nancials, the metrics simply could not justify doubling the OR capability. Even a best-case scenario (though still not likely) was an increase of a single OR might generate suf cient revenue to cover its cost, but two were unrealistic. As a result, the surgeons worked through strategies involving scheduling operations to optimize available time. Study the strategy Designers also review with administrators the facility's fi ve- to 10-year strategic plan, which inevitably reveals gaps, and may necessitate adding focus and detail before making immediate construction decisions. However, that process, coupled with a realistic analysis of the fi nancials, will help both designers and owners recognize and veer of from pursuing projects that involve excessive and unwise debt. All of the preliminary study evaluation enables designers to credibly advise the owners if it is at all possible to save an existing facility rather than build a new one, or to at least retain and renovate the old building for a reconfi gured mission. Demonstrating this decision-making approach, a community hospital on a robust campus wished to convert its in- ventory of semi-private rooms to private patient rooms without reducing the total number of beds. Owners and designers unsuccessfully looked for where to put a new patient tower to accommodate the additional 100 beds needed, without creating sprawl. The fi nal solution was to convert the physicians' of ce building immediately adjacent to the hospital that was already connected to the patient fl oor. Designers spend extensive time directly observing patient and staff fl ows in order to understand the existing facility inside and out, in order to identify optimal hospital layout planning. Top: The project at Moore County Hospital in Dumas, Texas involves a substantial construction project for all the areas that directly impact patient satisfaction: the emergency room, radiology and surgery. 56 Medical Construction & Design | SEPTEMBER /OCTOBER 2015 | MCDM AG.COM