Expanding a health-care provider's services invariably requires the modification of an existing structure or the construction of a new one. Because engineers tend to minimize their involvement during the programming, conceptual, and schematic phases of facility projects, space plans often are developed and approved without engineering input, and given constraints typically are accepted. This article discusses a more integrated approach to space planning through a stronger and more dynamic collaboration between architects and engineers.

MISSION ANALYSIS

For a facility owner to determine whether a new or a renovated building is more suitable and which new systems need to be installed, a project's architect and engineers must analyze and understand the owner's requirements as well as design conceptual plans.

First, an extensive survey and code analysis of the existing structure being considered for renovation must be completed to identify any required upgrades. Schedules and estimated expenses, such as life-cycle costs, then can be developed for various renovation scenarios.

At the same time, the architect and engineers should analyze new-facility requirements to create a building plan that will optimize the owner's needs. There may be more than one solution for some of the required systems, particularly the mechanical and electrical ones, all of which should be included in the review. To eliminate system or building-type bias, a new-facility analysis should not refer to the possibility of building reutilization.

The analyses should maximize the owner's ability to provide medical care efficiently at the lowest possible cost while creating a sustainable building that maximizes the energy efficiency of all of the integrated systems. Conceptual plans that incorporate spatial needs as well as mechanical and electrical systems should be used to evaluate the adaptability of an existing building. The plans also should be used to create a new-building outline that complies with the owner's needs in all respects.

Typical of an older-building retrofit, these cross sections of supply and return ductwork in hung ceilings illustrate the cramped conditions of buildings with low floor-to-floor height. Completing repair work in these areas post-construction is difficult. Areas with little workspace can increase system-installation costs when projects take more time to finish.

ADVANTAGES AND DISADVANTAGES OF EXISTING-BUILDING RENOVATION

There are several advantages to renovating an existing building, including:

• Occupancy can occur more quickly than it can with new construction.

• Site acquisition and related costs are eliminated.

• Long-term-site-use, wetlands, and environmental approvals are unnecessary.

• Reutilization of various building components can decrease costs.

• Demolition volume and its impact on neighbors is reduced.

There are, of course, several disadvantages as well, including:

• The aesthetics of the completed building's interior will be the result of compromises made in the modification process and may distract from the goal of quality medical care.

• There may be costs associated with health- and safety-code compliance; structural issues, such as reinforcing floors; upgrading existing walls/windows; and integrating existing mechanical, electrical, and plumbing (MEP) systems into new systems, including expenses associated with inadequate headroom, which can increase MEP-system installation costs.

• Low-hung ceilings can limit lighting-fixture selection and contribute to a poor building image.