Building the Hospital of the
Future
Turning the Page on Planning and Design for New Healthcare
Facilities in Canada: The New CSA Z8000 Standard
Clifford Harvey, OAA,MRAIC
Senior Architect
Health Capital Investment Branch
Ministry of Health and Long-Term Care
AGENDA
1.  Questions
2.  National Perspective: Health Care Infrastructure
3.  Tools and Resources
4.  The Future for Health Infrastructure in Canada
5.  Health and the Built Environment of Care
6.  CSA Z8000 Health Care Facilities
7.  Questions
2
HIDDEN AGENDA
1.  Research
2.  Best Practices
3.  Sharing
4.  Best Practices
5.  Research
6.  Best Practices
7.  Knowledge Transfer
8.  Best Practices
9.  Questions
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QUESTION
If I use the CSA Z8000 standard in Ontario will I get my project’s
design documentation approved by the ministry.
4
QUESTION
YES
5
QUESTION
MAYBE
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NATIONAL PERSPECTIVE
History and Legislation
•  Federal Responsibility (1950’s-1970’s)
•
Provincial Responsibility
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QUESTIONS
•
•
What about procurement?
What about construction?
•
What about implementation?
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INTRODUCTION: DESIGN AS A VERB
•
Why is this important?
•
Design Thinking: Business Planning evolution through LEAN to
Design Thinking
•
Medical Planning evolution through specialization to Integrated
Planning
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QUESTIONS
•
Are standards an inhibitor to innovation?
•
Is it possible to have an national standard?
•
What is a health care facility?
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QUESTIONS
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INTRODUCTION: CSA PRINCIPLES
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INTRODUCTION: CSA PRINCIPLES
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INTRODUCTION: CSA PRINCIPLES
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INTRODUCTION: CSA PRINCIPLES
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INTRODUCTION: FGI PRINCIPLES
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Innovation in Hospital Architecture
Stephen Verderber (2010)
“ A Hospital is a complex, contradictory building type, a system of
systems”
“There is no definition that succinctly sums up the many types of
hospitals, nor the diverse geographic context, populations
served, or cultural determinants that shape and continually
reshape them”
“Due to the vast variations across cultures and across geographic
regions of the world, it is virtually impossible to attempt to
comparatively assess the efficacy of one region or locality’s
minimum planning and design standards compared to any
other”
Innovation in Hospital Architecture
Stephen Verderber (2010)
“Important determinants in identifying these highest ideals include:
•
Local cultural traditions and demographic characteristics of the population
•
Community attitudes towards sickness, disease and health
•
•
Identification of obstacles to the establishment of sustainable healthcare environment
An expectation in the local community that minimum standards will be set and
exceeded for the design and construction of healthcare delivery environments
•
•
Adherence to building codes and regulatory agency licensing protocols
Building and sustaining strong community support for local healthcare institutions
•
•
Establishing sustainable partnerships between not-for-profit and for-profit healthcare
institutions
Setting and maintaining progressive yet realistic funding and budgeting objectives
•
Establishing and periodically reappraising the organization's strategic future goals.
Canada: Health Authorities
Legend (c.2010)
HA
Z
HR
RHA
LHIN
HN
DHA
Health Authority
Zone
Health Regions
Regional Health Authority
Local Health Integration Network
Health Network
District Health Authority
1 HA
1 HA
1 HA
4 HA
6 HA
11 RHA
5 Z
1 HA
18 HR
13 HR
1 HA
14 LHIN
9 DHA
2 HN
Health Infrastructure Planning and Design:
Canada’s Provinces and Territories
Health Infrastructure Planning:
•  Level 1: Provincial / Territorial Budget
•  Level 2: Network
•  Level 3: Program
•  Level 4: Project
  Health Design
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Health Infrastructure Planning and Design:
P/T Resources: Planning
?
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Health Infrastructure Planning and Design:
P/T Resources: Design
?
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Health Infrastructure Planning and Design:
Resources
•
Lack of Tools: Why?
•
Lack of Benchmarks? Why?
•  Culture x Measurement = Performance
•
Lack of Research and Education? Why?
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Health Infrastructure Planning and Design:
Design Thinking
•
Culture of Health Care
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Health and the Environment of Care
•  Health Program
•  Environment of Care
•
Network: Home-Primary-Secondary … back Home
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Health Infrastructure Planning and Design:
Standards
•
CSA Standards: Z8000 Approach:
•
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Objective Focus
Process Focus
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Program Focus
•
Building Focus
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Health Infrastructure Planning and Design:
CSA Z8000 Health Care Facilities
Section 4: OASIS
O pera%ons A ccessibility S afety and Security I nfec%on Preven%on and Control S ustainability 32
Health Infrastructure Planning and Design:
CSA Z8000 Health Care Facilities
Clause 5 Planning Process
5.1 Initial Planning
5.1.1 Project process
5.1.2 Initial assessment
5.1.3 Role review
5.1.4 Master program
5.1.5 Master planning and assessment
5.1.6 Functional program
5.1.7 Furniture and Equipment Planning
5.1.8 Complementary plans
5.1.9 Test fit
5.1.10 Operational model
5.1.11 Site evaluation
5.1.12 Existing infrastructure assessment
5.2 Design
5.2.1 Schematic design
5.2.2 Design development
5.2.3 Work planning
5.2.4 Mock-ups
5.2.5 Contract documents
5.2.6 Classification of areas
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Health Infrastructure Planning and Design:
CSA Z8000 Health Care Facilities
Clause 5 Planning Process
5.3 Construction
5.3.1 General
5.3.2 Risk management planning and mitigation
5.3.3 Phase Planning
5.3.4 Qualification of contractors
and construction personnel
5.3.5 Contractor orientation
5.3.6 Infection prevention and control
5.3.7 Noise and vibration management
5.3.8 Dust and odour mitigation
5.3.9 Service tie-ins and shutdown coordination
5.3.10 Site access management
5.3.11 Stop work process
5.3.12 Signage
5.4 Commissioning
5.4.1 General
5.4.2 Operational commissioning
5.5 Take-over and occupancy
5.5.1 Take-over
5.5.2 Occupancy
5.3.13 Temporary provisions for life safety and emergency response
5.3.14 Coordination and interferences
5.3.15 Change management
5.3.16 As-built documentation
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Health Infrastructure Planning and Design:
CSA Z8000 Health Care Facilities
Clause 5 Planning Process
5.6 Post-Occupancy Evaluation (POE)
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Health Infrastructure Planning and Design:
CSA Z8000 Health Care Facilities
Clause 5 Planning Process
5.6 Post-Occupancy Evaluation (POE)
Health Design
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Health Infrastructure Planning and Design:
CSA Z8000 Health Care Facilities
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Clause 6: Site
Clause 7: General
•
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Clause 8: Inpatient
Clause 9: Diagnostics and Treatment
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Clause 10: Support Services
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Clause 11: Common Requirements
Clause 12: Building Services
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FUTURE IDEAS FOR STANDARDS
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Blue ‘H’
Red Tape on Floor
•
Stuff on Walls
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Health Infrastructure Planning and Design:
CSA Z8000 Health Care Facilities
Questions?
Cliff Harvey, OAA, MRAIC
Senior Architect
MOHLTC
clifford.harvey@ontario.ca
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