Attachment 1 VA Interior Design Manual.pdf

Interior Design manual

NOVEMBER 2020

Office of Construction & Facilities Management

Preface/Introduction - ii

VA Interior Design Manual November 1, 2020

Preface/Introduction General The Interior Design Manual provides comprehensive data sources and design links to enable VA Healthcare Interior Designers (VAHID) and Private Sector Healthcare Interior Designers (HID) the guidance necessary to create professional interior spaces for all healthcare environments including but not limited to Hospitals/Medical Centers, Community Based Outpatient Clinics (CBOC), Long Term Care and Extended Care Facilities and Developer-Led Leased Facilities. This manual provides in-depth information on the VAHID role in the total design and construction project process.

The Healthcare Interior Designer will have access to principles and procedures which when applied to facility design, serve to enhance VA’s commitment to the highest standards of compassion, commitment, excellence, professionalism, integrity, accountability, and stewardship.

VA Outpatient Clinic - Northern Indiana Healthcare System - Mishawaka, IN.

Photo courtesy of Department of Veterans Affairs.

Acknowledgments - iii

Acknowledgments Department of Veterans Affairs

Dr. Michael D. Brennan, Ph.D., AIA, NCARB Executive Director, Construction & Facilities Management Office of Acquisition, Logistics, and Construction U.S. Department of Veterans Affairs

John Bulick Director, Facilities Planning Development Service Office of Construction & Facilities Management Washington, D.C.

Donald L. Myers Director, Facilities Standards Services Office of Construction & Facilities Management Washington, D.C.

Gary Fischer Senior Healthcare Architect Office of Construction & Facilities Management Washington, D.C.

Orest Burdiak Principal Interior Designer Office of Construction & Facilities Management Washington, D.C.

Christine Emanuelson, NCIDQ, CHID Program Manager, Interior Designer Environmental Programs Service (EPS) VHA Health Care Environment and Facilities Programs (HEFP) Washington, D.C.

Calvin Clawson Program Manager, Interior Designer Environmental Programs Service (EPS) VHA Health Care Environment and Facilities Programs (HEFP) Washington, D.C.

Rosilyn (Lyn) Palsson, NCIDQ Supervisory Interior Designer VA Southern Nevada Healthcare System Las Vegas, NV

Anorea Hill Healthcare Interior Designer VA North Texas Health Care System Dallas, TX

Acknowledgments - iv

Kelly Cobb Healthcare Interior Designer James H. Quillen VA Medical Center Mountain Home, TN

Consultants:

Calvin L. Hinz Architects, P.C.

Richard J. Onken, AIA, NCARB, FHFI, EDAC, USAF Lt. Col. (Ret.)

President, Principal-in-Charge Elkhorn, NE

Gary Dubas, AIA Senior Healthcare Architect, Planner, Project Manager Elkhorn, NE

Debra A. Lampshire, NCIDQ Senior Interior Designer Elkhorn, NE

Consultants:

Leo A. Daly

Becky Taylor, RID, NCIDQ, ASID Senior Interior Designer Omaha, NE

“FOR THOSE - WHO SERVED” Main Entry at Orlando VA Medical Center - Orlando, FL.

Photo courtesy of RLF Architecture Engineering Interiors, Orlando, FL.

Overview - v

Overview VA Mission Statement To fulfill President Lincoln’s promise- “To care for him who shall have borne the battle, and for his widow, and his orphan” -by serving and honoring the men and women who are America’s Veterans.

Vision To provide Veterans the world-class benefits and services they have earned and to do so by adhering to the highest standards of compassion, commitment, excellence, professionalism, integrity, accountability, and stewardship.

Executive Summary The VA Interior Design Manual (IDM) will provide VA staff and healthcare interior design teams (HIDT) an understanding of their roles, responsibilities, and the appropriate procedures for creating a safe, accessible, and healing environment

– designs that are enduring and take into consideration durability, feasibility and sustainability. All VAHID and HID supporting new construction, renovation, and developer-led lease projects are expected to follow this manual.

The purpose of the IDM is to aid in the translation of VA design manuals, guides, and master specifications into patient-centric design solutions. VA strives for design solutions that improve the quality of life and productivity as well as protect the health, safety, and welfare of the Veterans, visitors, and staff. Interior design is a major component in establishing and maintaining an environment that is therapeutic, safe, aesthetically pleasing, functionally appropriate and professional.

The IDM will provide tools for understanding current healthcare design industry standards as well as innovative out-of-the-box thinking balanced with a clear awareness of what designing for VA means.

The IDM is a living document that VA staff will support and contribute to in future revisions, therefore creating a sense of ownership and collaboration between the VA staff and VA Central Office.

Internal links are provided to other VA architectural standards and criteria documents to make this manual more user-friendly. The HIDT will utilize VA architectural standards and criteria documents as a basis of design located on the VA Technical Information Library (TIL), and all applicable building codes and industry standards.

The IDM is the resource to help build the rationale for options and challenges to the aforementioned standards and is a companion manual to the Architectural Design Manual (ADM), which provides check lists to organize the design process from preliminary/ conceptual design into architectural criteria and best practice throughout the design approach.

The IDM is also intended to be a companion to the design guides. The design guides provide functional and space criteria that are illustrated with architectural, equipment, and environmental requirements into room templates. See VA Standards and Criteria within this Section 2: Design Principles.

Overview - vi

Interior Design is a multi-faceted profession in which creative and technical solutions are applied within a structure to achieve a built interior environment. These solutions are functional, enhance the quality of life and culture of the occupants, and are aesthetically attractive. Designs are created in response to and coordinated with the building shell and acknowledge the physical location and social context of the project. Designs must adhere to code and regulatory requirements and encourage the principles of environmental sustainability. The interior design process follows a systematic and coordinated methodology, including research, analysis, and integration of knowledge into the creative process, whereby the needs and resources of the client are satisfied to produce an interior space that fulfills the project goals.

Interior design includes a scope of services performed by a professional design practitioner, qualified by means of education, experience, and examination, to protect and enhance the life, health, safety, and welfare of the public.

All VA Healthcare Interior Designers (VAHID) and private sector Healthcare Interior Design Teams (HIDT)should reference the National Council for Interior Design Qualifications (NCIDQ) definition of interior design found at www.cidq.org. NCIDQ certification is a means to identify interior designers who have demonstrated a minimum level of competence needed to practice interior design.

Outpatient Waiting Area at the Clinic Addition, VA Biloxi Medical Center, Biloxi, MS.

Photo courtesy of Leo A. Daly, Architects/Engineers, Omaha, NE https://www.cidq.org/

Table of Contents - vii

Table of Contents Preface/Introduction

Acknowledgments

Overview VA Mission Statement

Vision Executive Summary

Table of Contents:

Section 1 Project Foundation

1.1 Project Foundation:

yScope of Work yFunding Structure

1.2 Integrated Design Process and Healthcare Interior Designer’s Roles:

y Integrated Design Process (IDP) y Interior Designer’s Roles yPreliminary/Conceptual Design ySchematic Design yDesign Development yContract Documentation yBidding, Construction, Commissioning yTimeline Development yActivation yPost Occupancy Evaluation

1.3 VA Space and Equipment Planning System (VA SEPS)

yVA SEPS y Joint Schedule Numbers (JSN) yVA Acquisition Codes

1.4 Building Information Modeling (BIM)

Section 2 Design Principles

2.1 VA Standards and Criteria:

yOffice of Construction & Facilities Management (CFM) yTechnical Information Library (TIL) y VA Program Guides, Manuals, and Standards yVA Standards Alerts (SA) and Design Alerts (DA)

2.2 Infection Control

Table of Contents - viii

2.3 Fundamental Design Considerations

yDesign Story yPatient Privacy yPatient Profile yHealing Environments yEvidence-Based Design yPatient-Centered Care yWhole Health Care yPhysical Environment yAccessibility ySustainable Design yDesign Elements of the Healing Environment y Indoor Air Quality yOrganizational Planning yPatient Experience Enhancements yMaterials Appropriateness yBudget Realism

2.4 Emerging Healthcare Design:

yFuture Flexibility ySafety yMinimizing Stress

2.5 Technology

2.6 Core Elements & Other Considerations:

yVision and Intent yDecision Criteria yConcepts yDesign Approach yTeam Structure y Ideas and Innovation y Interior Finishes Options and Presentation ySolutions and Final Presentation yReporting and Approval Structure yStandard Details

2.7 Toolbox

yGeneral yWall Protection yCeilings y Lighting yColor Theory yPattern and Texture yMaterials yCasework, Millwork and Modular ySignage and Wayfinding yFurniture/Textiles yTools for Tracking Cost

2.8 VA Facility-Level Interior Design Standards

Table of Contents - ix

2.9 Acquisition of Artwork and Decorative Items

Section 3 Construction and Projects

3.1 Construction and Projects Support:

yHealthcare Environment and Facilities Programs (HEFP) yCapital Asset Management (CAM) yHealthcare Engineering (HE) yEnvironmental Programs Service (EPS) yOccupational Safety & Health (OSH) yStrategic Capital Investment Process (SCIP)

Section 4 Accreditation and Regulatory Standards

4.1 Accreditation and Regulatory Standards:

yThe Joint Commission (TJC) yCommission on Accreditation of Rehabilitation Facilities (CARF) y Long Term Care Institute (LTCI) yHealth Insurance Portability and Accountability Act (HIPAA) yVA Codes, Regulations, Standards, Directives, Executive Orders, Alerts, and Memorandums

Section 5 Glossary

5.1 Glossary of Terms

5.2 Acronyms and Abbreviations

Section 6 Resources

6.1 Internal Resources

6.2 External Resources

Appendix A

Appendix B

Section 1 - 1

Section 1: Project Foundation

1.1 Project Foundation

Scope of Worky yFunding Structure

1.2 Integrated Design Process and Healthcare Interior Designer’s Roles y Integrated Design Process (IDP) y Interior Designer’s Roles yPreliminary/Conceptual Design ySchematic Design yDesign Development yContract Documentation yBidding, Construction, Commissioning yTimeline Development yActivation yPost Occupancy Evaluation

1.3 VA Space and Equipment Planning System (VA SEPS)

yVA SEPS y Joint Schedule Numbers (JSN) yVA Acquisition Codes

1.4 Building Information Modeling (BIM)

VA Interior Design Manual

Section 1.1 - 2

November 1, 2020

1.1 Project Foundation

Scope of Work VA Staff are responsible for developing a Scope of Work (SOW) for the selection of A/E firms for the full development of the project. The SOW will outline project basics such as department, estimated square feet, design considerations, expectation of materials and finishes, construction budget, and other items specific to the project. The VA Healthcare Interior Designer should participate in the development of the project SOW.

Funding Structure VA has five levels of funding construction projects. Each level is defined by size and cost. VA staff and the Healthcare Interior Design Team (HIDT) participating in design projects should be aware that some or all of the funding structures may be affected.

Station Level Projects - Construction, renovation, or Non-Recurring Maintenance and repair projects where there is minor improvement, not a minor project. Station level projects are funded as a lump sum figure in the Non- Recurring Maintenance program.

Non-Recurring Maintenance (NRM) - Renovations, repairs, maintenance, and modernizations of the existing infrastructures. NRM focuses on correcting the Facility Condition Assessment (FCA), ensuring the medical center meets applicable codes. NRM modernizes within the existing constraints of the infrastructure to comply with current standards of care and allows for stand-alone demolition, new surface parking, and roads. Funding threshold is capped at $20M. Veterans Equitable Resource Allocation (VERA) is approved by Veterans Integrated Service Network (VISN). Special program funds are approved by Veterans Health Administration Central Office (VHACO)

Minor Projects - Minor construction projects that expand the existing facility by 1,000 GSF or more; projects addressing workload gaps, providing access to care for Veterans, parking structures, and seismic projects. The decision level for selection of minor projects are made at VHACO through national prioritization and is executed by the medical center. The funding threshold is capped at $20M and approved by VISN and VHACO.

Major Projects - New construction, new hospitals and 100% renovation improvements to medical centers to provide state-of-the-art health care. The decision level for selection is made at VHACO. Major projects are those over $20M and funding is appropriated annually by Congress.

Main pedestrian concourse at Rocky Mountain Regional VA Medical Center - Denver, CO.

Photo courtesy of SOM © Christopher Barrett Photography.

Section 1.2 - 3

1.2 Integrated Design Process and Healthcare Interior

Designer’s Roles

Integrated Design Process

(IDP)

VA utilizes the Integrated Design Process (IDP) during the architectural planning and design of VA facilities. The IDP process interlaces the disciplines to provide full and constructive participation of all members of the design and project delivery team with a focus on collaboration ensuring the best results. The IDP facilitates the increase of project efficiency by bringing all stakeholders to the table.

Interior Designer’s Roles Preparation for a project is led by the VA who identifies the program needs for the facility renovation or expansion for design/construction projects based on quantifiable requirements for space and budgetary capacity to undertake the activity. The VA prepares a needs assessment that describes the space use; develops estimates of requirements both spatial and technical; initiates assessment of possible environmental impacts and arrives at a Space and Equipment Planning System (SEPS) generated Program for Design (PFD) around which design activity can develop. It is critical that VA Healthcare Interior Designers are involved in the project preparation stage.

The following sections detail the VAHID role in the typical facility design/ developmental process.

Preliminary/Conceptual Design

As a key participant at the kickoff meeting, it is appropriate for the VAHID to come prepared with a full understanding of the project scope, space requirements, SEPS generated program for design, and associated CFM design standards. In addition, the VAHID provides the design team a copy of the established material and facility finish standards. Additional guidance and/or emphasis on critical design-related concerns should be shared and addressed at this early stage of the project. Examples of interior design-related goals:

yParticipation of VAHID throughout full design and planning process yEfficient space allocation and planning yVisual and or ambient enhancement of the interior space y Implementation of VA Interior Design standards within the design yDevelopment of lighting design ySignage and wayfinding design yEnsuring the integrity of the interior design goals are maintained as the process of estimating, design, and construction proceeds.

Schematic Design Once the preliminary/conceptual design is complete, the Schematic Design phase begins with the design team providing an initial block plan layout based on the appropriate facility VA design guide/manual, the approved SEPS program requirements, and any pertinent project information ascertained during the project kickoff meeting. The intent of this phase is to stimulate thought, discussion, and bring structure to the stakeholders’ understanding of the project requirements and limitations, not necessarily to produce the final outcome.

Involvement of the project design team is a critical element of the process. The project design team includes VA SMEs’ such as Program Office Leadership, EMS, Logistics, A/E of Record, HID’s and other consultants that may be involved. Such as but not limited to the VA design team, Owner/Developer for lease projects, Architect, Section 1.2 - 4

Healthcare Interior Designer, Engineers, and Builders. Their individual insights can prevent costly changes further along in the process. Gradually, a design evolves which embodies the vision and requirements of all participants while also meeting the project requirements established during preliminary design. The resulting schematic design solutions produced at this stage show site location and organization, general building shape, space allocation, and include an outline specification which makes an initial list of components and systems to be designed and/or specified for the final project design. A preliminary cost estimate by a professional cost estimator is recommended.

During this phase, the Healthcare Interior Designer collaborates with the VAHID to develop solutions to meet the team requirements. These could include meeting the established goals pertaining to but not limited to the function, accessibility, sustainability, material selections to achieve the defined aesthetic of the spaces, identifying design elements, and developing Furniture, Fixture, & Equipment (FF&E) layouts.

Primary Care Clinic at VA Southern Nevada Healthcare System - Las Vegas, NV.

Photo courtesy of Apogee Consulting Group.

Design Development Design Development further defines and refines the schematic design with greater detail for all aspects of the project. During this phase, the HID works integrally with the project design team and VA stakeholders to enhance the function, desired aesthetic of the various spaces, refine the proposed material selections and assist with the estimates/ life cycle cost analysis to determine the impact of the desired material choices.

Room numbering methodology following the VA Signage Design Manual should be established by the end of this phase. During this phase, branding initiatives, wayfinding themes, and navigational strategies are developed and presented to executive leadership for approval. It is recommended to “socialize” the design approach of the project with the end-users and Veterans to encourage their feedback and buy-in to the project.

Section 1.2 - 5

The conclusion of this phase is a detailed design on which all VA stakeholders agree and may be asked to sign-off/approve the documentation.

All interior design tasks will require collaboration between the VAHID and HID. The formal development of documentation is reflected in the table below. All documents require review and acceptance by the VAHID.

Design Development - Interior Design Tasks VAHID HID

Refines the project design to ensure compliance with VA design guides and manuals. Consults Reviews

Develops furniture plans utilizing JSN and/or MTR codes as the furniture schedule identifier.

Consults Develops

Develops procurement package utilizing MTRs codes, furniture plans, finish schedules and other related documents.

Develops

Details signage and wayfinding as it relates to the overall space plan and navigation. Consults Develops

Formalizes finish details (plans, schedules, and specifications) and incorporates into the architectural documentation.

Develops

Prepares color boards and final design concept drawing. Develops

Identifies reflected ceiling and lighting design concepts. Consults Develops

Ensures electrical and data plans coordinate with furniture and equipment layouts with potential for future expansion.

Consults Develops

Ensures project compliance with VA directives, codes, standards, and Executive Orders. Consults Develops

Plans for clear, open wall spaces for artwork, and mandatory postings. Consults Develops

Public Zone at VA Charlotte Health Care Center - Charlotte, NC.

Photo courtesy of Apogee - RPA JV, LLC.

Section 1.2 - 6

Contract Documentation The development of Contract Documents is a further evolution of the design development documentation, with the addition of other documents as necessary to execute construction acquisition. High-quality contract documents can be achieved by adhering to the initial program needs developed by the VA. Contract documentation should be carefully coordinated among the technical consultants on the design team. Decisions/refinements are made with the appropriate contributions of all team members.

During this phase, the Healthcare Interior Designer tasks associated with this phase include but are not limited to:

yAll original interior design related goals and sustainable design features are included yMaterial and finish selections are well documented in the construction drawings and specifications yA complete review of the final construction documents is conducted focusing on the related elements of the whole interior package

Contract Documentation - Interior Design Tasks VAHID HID

Confirm that all original design-related goals and sustainable design features are included.

Consults Develops

Confirm that material and finish selections are well-documented in the construction drawings and specifications.

Consults Develops

Review door and hardware schedules. Consults Develops

Review wall protection, handrails, and wall blocking. Consults Develops

Review reflected ceiling plans. Consults Develops

Review interior finish plan and schedule. Consults Develops

Review electrical and data plans. Consults Develops

Review flooring design plans and schedules. Consults Develops

Ensure furniture, fixtures, and equipment referenced as JSN identifiers for equipment and MTR codes for furniture.

Consults Develops

Confirm owner furnished/contractor installed items take priority in procurement process as it relates to construction document coordination such as audiology booths, technical medical equipment, and specialized casework such as dental suites, etc.

Consults Develops

Review Signage and Wayfinding. Consults Develops

Confirm Artwork and mandatory posting proposed locations identified. Consults Develops

Bidding, Construction, Commissioning

After the award of the project to the general contractor, the HIDT must remain fully involved. Decisions previously made may require clarification, supplier information must be reviewed for compliance with the contract documents, and substitutions must be evaluated. If changes affect the operation of the project and/or material maintenance and performance, it is especially important that the VA stakeholders be involved, including the Contracting Officer (CO). User requirements may change, necessitating changes in the project. These changes require broad consultation among the VA project manager, Contracting Officer’s Representative (COR), CO, Section 1.2 - 7 consultants, and sub-consultants. The VA Contracting Officer is the only official that can approve changes that affect the existing contract.

The A/E team and HID works closely with the project manager, COR, VAHID, and contractor to ensure:

yCompliance with the established construction documents yCompliance with specifications and material selections and any substitution requests due to availability of contractor provided items such as materials, finishes, and equipment yAdherence to timelines

The HIDT is responsible for assuring that the project meets the requirements of the contract documents; but, the project success at meeting the requirements of the original program can be assessed by the construction management team or third parties through the commissioning process. A full range of functions in the building should be evaluated and the design and construction team can be called upon to make changes and adjustments as needed.

Timeline Development Project timeline development is an important aspect of the procurement process. VA Healthcare Interior Designers need to be aware that Project Timelines have a range of about 155 days at a minimum to 420 days for larger projects. Time frames are estimates and may be impacted by project size and scope and as well total workload of the VA Healthcare Interior Design Staff.

Programming Procurement Package Solicitation Product

Manufacturing Installation Move

Meet with end users to gather requirements.

30-90 days

Development of the procurement package

30 -60 days

Move of staff, supplies and small equipment

5-30 days

Delivery, installation and punch list corrections

30-60 days

Manufacturing lead times.

Custom products may take longer 30 - 90 days

Contracting review, solicitation, and award

30-90 days

Project Timeline Range from 155 days minimum to 420 days for larger projects

Activation Activation is the process of taking the building from design and construction and turning it into a live, operational building. The VAHID plays a key role in the project through all stages beginning from project development to ‘First Patient Seen’ opening day. Each project can be multi-faceted and keeping track of who is responsible for the various tasks requires continual review. It is recommended that some method of tracking responsibilities is developed based on the complexity of the project. Typical activation tasks may include:

yProject Management yTransition planning yFurniture, Fixtures, and Equipment (FF&E) planning yDesign

Section 1.2 - 8 yMock-up yAcquisition yWarehousing yTesting yDelivery and installation yTraining yStaff and property relocation yFinal turnover, close-out, and post occupancy evaluation

The key is to clearly identify at the beginning of a project who is responsible for the planning/design (the decision-maker), the procurement, and installation responsibility. As the project develops the responsibility for the tasks above should be determined and documented.

For additional activations support, engage with the VHA Activation Program posted on the Healthcare Environment & Facilities Programs (HEFP) website. http://vaww.

hefp.va.gov/

Post Occupancy Evaluation After the project is fully operational, a Post Occupancy Evaluation (POE) should be conducted no earlier than twelve months after the space is commissioned. The POE assesses how the building meets the original and emerging requirements.

Such information is useful for VA when additional construction of the same type is considered. Mistakes can be prevented, and successes repeated. The POE should be submitted to CFM for performance assessment. POEs are also informative in addressing planning/design/construction standards to meet evolving users’ needs, healthcare trends, and technology developments.

The VAHID will participate in the POE and review and discuss findings with the team.

The integrated project team’s success depends on clear and continuous communication, rigorous attention to detail, and active collaboration with all team members throughout all phases of the project.

Reception Area at Madison Regional Health System - Madison, SD.

Photo courtesy of Apogee - RPA

JV, LLC

http://vaww.hefp.va.gov/ http://vaww.hefp.va.gov/

Section 1.3 - 9

1.3 VA Space and Equipment Planning System (VA SEPS)

VA SEPS VA SEPS is an automated Space and Equipment Planning tool for healthcare facility planning and design developed jointly by the Department of Defense and the Department of Veterans Affairs. Based on data input questions, a VA/VHA approved baseline Program for Design (PFD) is generated that governs the allowable space permitted.

VA SEPS guides architects, planners, and designers in planning projects that accurately conform to VA criteria standards. SEPS generates a baseline Program for Design (PFD) and Project Room Contents (PRC) reports for the Department of Veterans Affairs and Defense Health Agency (DHA) projects.

VA SEPS incorporates the VA Space Planning Criteria and Equipment Guide List which can be found on the TIL. http://www.cfm.va.gov/TIL/planning.asp

Joint Schedule Numbers

(JSN)

The project team will need to become familiar with the PRC and the associated Joint Schedule Numbers (JSN) identification numbers for FF&E.

JSNs fall into several acquisition categories and responsibility for those items requires careful coordination. JSN acquisition categories can change based on specifics for the project. The JSN is a five alphanumeric number used to identify FF&E during planning, design, and activation. The number consists of an alpha character followed by four additional characters. The first alpha character denotes the group category an item represents.

Group Category Description

A Architectural

C Fixed Casework

D Dental

E Modular Casework

F Furniture and Furnishings

G Physical Therapy and Gym Equipment

K Food Service Equipment

L Laboratory Equipment

M Miscellaneous Medical Equipment

P Plumbing

R Refrigeration Equipment

S Sterilizers, Decontamination, and Associated Equipment

T Shop Equipment and Tools

U User-Defined Items (Used in SEPS only)

V Veterinary Equipment

X X-Ray Equipment http://www.cfm.va.gov/TIL/planning.asp

Section 1.3 - 10

VA Acquisition Codes The VA Acquisition Codes used are indicated in the PRC in the responsibility column and is a typical short acronym or term to identify the responsibility of the Government or contractor relative to purchase and installation. The code provides a definition of the acquisition code.

Acquisition Code

Description

CC Contractor Furnished Contractor Installed. Equipment purchased and installed by the contractor.

VC VA Furnished Contractor Installed. Equipment is provided by the Government and installed by the Contractor (used for major imaging and OR equipment).

VV VA Furnished VA Installed. Equipment purchased and installed by the Government.

L_RE Other. Equipment Leased or rented and installed by the Government

R Reuse. These are existing equipment assets that will be transferred and reused and may be a relocation cost associated with them.

PACT Exam Room at VA Charlotte Health Care Center - Charlotte, NC.

Section 1.4 - 11

1.4 Building Information Modeling (BIM)

Building Information Modeling (BIM) is an integrated database of coordinated information to which many VA and private-sector participants in the design process contribute. BIM is an intelligent 3-D model-based process. When an element is changed, every view is updated in sections, elevations, and sheet views allowing all designers to see changes in real-time. BIM modeling provides for continuous and immediate analysis of project design, scope, schedule, cost information, and other matters. VA adopted BIM for design on Major Construction projects in 2009 and issued the BIM Guide requirements for use on all VA construction in 2010. VA encourages all Architect-Engineer (AE) and General Contractor (GC) teams to drive inefficiencies out of their workflow by employing BIM methodologies to increase delivery efficiencies in relation to faster delivery, and increased quality of design and construction.

VA BIM Standards may be accessed on the VA TIL. https://www.cfm.va.gov/til/projReq.asp

BIM identifies and enhances design documentation and brings numerous attributes and benefits such as:

yHigher quality of work performance yBetter coordination among design and engineering disciplines yCost savings in the design and engineering work y Increased speed of delivery

BIM enhances the collaborative process utilized by architects, engineers, construction companies, and interior designers to efficiently visualize, plan, and design new construction and renovations of VA facilities. It provides an integrated database of coordinated information among the contributors to the design and engineering of a building. In addition to graphically depicting the project, BIM offers key information such as the physical and functional characteristics of the building that can be used to analyze its performance. The use of coordinated, consistent, computable information results in a reliable, digital representation of the building that can be used during the design decision process, production of contract documents, planning, and building performance. BIM allows information to be kept up to date and accessible to architects, engineers, contractors, and others.

From a Healthcare Interior Designer’s perspective, BIM provides a variety of improvements and efficiencies in the design process, including contract documentation, preconstruction

BIM-generated interior 3-D rendering for Renovate Inpatient Kitchen at the Omaha VA Medical Center Image courtesy of CLH Architects, Elkhorn, NE https://www.cfm.va.gov/til/projReq.asp

Section 1.4 - 12 estimating, procurement, scheduling, coordination, cost efficiency, and closeout documents for finishes, furniture, and equipment that are all integral to the environment of care.

ICU Renovation at VA Salt Lake City Health Care System - Salt Lake City, UT.

Image courtesy of Apogee Consulting Group.

Section 2 - 13

Section 2: Design Principles

2.1 VA Standards and Criteria

yOffice of Construction & Facilities Management (CFM) yTechnical Information Library (TIL) y VA Program Guides, Manuals, and Standards yVA Standards Alerts (SA) and Design Alerts (DA)

2.2 Infection Control

2.3 Fundamental Design Considerations

yDesign Story yPatient Privacy yPatient Profile yHealing Environments yEvidence-Based Design yPatient-Centered Care yWhole Health Care yPhysical Environment yAccessibility ySustainable Design yDesign Elements of the Healing Environment y Indoor Air Quality yOrganizational Planning yPatient Experience Enhancements yMaterials Appropriateness yBudget Realism

2.4 Emerging Healthcare Design

yFuture Flexibility ySafety yMinimizing Stress

2.5 Technology

2.6 Core Elements & Other Considerations

yVision and Intent yDecision Criteria yConcepts yDesign Approach yTeam Structure y Ideas and Innovation y Interior Finishes Options and Presentation ySolutions and Final Presentation yReporting and Approval Structure yStandard Details

Section 2 - 14

2.7 Toolbox

yGeneral yWall Protection yCeilings y Lighting yColor Theory yPattern and Texture yMaterials yCasework, Millwork, and Modular ySignage and Wayfinding yFurniture/Textiles yTools for Tracking Cost

2.8 VA Facility-Level Interior Design Standards

2.9 Acquisition of Artwork and Decorative Items

Section 2.1 - 15

2.1 VA Standards and Criteria

The VA TIL Manuals serve as the reference documents that are expected to be followed in the planning and design of VA medical facilities.

The Interior Design Manual and the current editions of the following documents, also found in VA Technical Information Library (TIL) (https://www.cfm.va.gov/Til/), comprise VA’s standards and criteria.

Office of Construction & Facilities Management

(CFM)

CFM is responsible for the planning, design, and construction of all major construction projects greater than $20 million. Additionally, CFM acquires real property for use by VA facilities through the purchase of land and buildings, as well as long-term lease acquisitions.

Through the construction and real property programs, CFM delivers high-quality buildings, additions, large scale renovations, and structural enhancements. CFM also develops facility standards and manages facility sustainability, seismic corrections, physical security, and historic preservation of VA facilities. https://www.cfm.va.gov/

Technical Information Library (TIL)

Technical Information Library (TIL) is the resource for the VA design and construction information. https://www.cfm.va.gov/til/index.asp

VA Program Guides, Manuals, and Standards

The most current VA Program Guides, Manuals, and Standards are the basis of design for each project at the time the contract notice to proceed is issued. These requirements continue to apply for the life of that project and is a best practice to keep documentation for later reference. PG-18-1 Master Construction Specifications are used for construction projects. https://www.cfm.va.gov/til/spec.asp. These specification set performance standards that will aid design staff participating in the project development of interior design projects

PG-18-3, Design and Construction Procedures (https://www.cfm.va.gov/TIL/ sDetail.asp). Design and Construction Procedures establish consistent design and construction practices and are the minimum acceptable standards for the design and construction of VA facilities. For VA’s general drawing requirements, including organization, size, scales, and CAD format, see Design and Construction Procedures, Topic 2, “Drawings”.

PG-18-4, Standard Details and CAD Standards (https://www.cfm.va.gov/TIL/ cPro.asp) – VA standard details include scale drawings of many specific items and conditions and are to be used as a guide only, with exception to standard details specifically stipulated by PG-18-3, VA Design and Construction Procedures.

PG-18-5, Equipment Guide List (https://www.cfm.va.gov/til/equip/equipIndex.pdf)

– A list of VA approved equipment, room contents, and furnishings for each space in a department.

PG-18-9, VA Approved Space Planning Criteria (https://www.cfm.va.gov/ TIL/planning.asp) – This includes VA approved space criteria for each room in a department, design considerations, space relationship diagrams, and inter-functional https://www.cfm.va.gov/Til/ https://www.cfm.va.gov/ https://www.cfm.va.gov/til/index.asp https://www.cfm.va.gov/til/spec.asp https://www.cfm.va.gov/TIL/sDetail.asp https://www.cfm.va.gov/TIL/sDetail.asp https://www.cfm.va.gov/TIL/cPro.asp https://www.cfm.va.gov/TIL/cPro.asp https://www.cfm.va.gov/til/equip/equipIndex.pdf https://www.cfm.va.gov/TIL/planning.asp https://www.cfm.va.gov/TIL/planning.asp

Section 2.1 - 16 relationship matrices. VA Approved Space Criteria is the metric that determines the space allocation for each department in a facility. The Space Criteria is also the space calculation driver contained within the SEPS application for developing a Program for Design.

PG-18-10, Design Manuals (https://www.cfm.va.gov/til/dManual.asp) - There are a number of design manuals in regards to: Architectural, Asbestos Abatement, CPM Schedule, and Risk Management, Electrical, Elevator, Estimating, Fire Protection, HVAC, Interior Design, Lighting Design, Physical Security and Resiliency, Plumbing, Signage and Wayfinding, Site, Steam VA Heating, Hot Water and Outside Distribution Systems, Structural, Sustainable Design, Telecommunications, and Special Telecommunications Systems. The design manuals are to serve as the master reference document that is expected to be followed in the planning and design of, but not limited to, local level remodels, in-house construction, research, new construction, and administration areas of medical facilities for VA.

PG-18-12, Design Guides (https://www.cfm.va.gov/til/dGuide.asp) – These documents address planning criteria for specific departments that are functional and integrated with architectural, equipment, and environmental requirements.

Room Templates are available within these guides that illustrate the design approach for more complex room types. Design Guides have been carefully and expertly developed to give specialty design information and criteria for complex design areas, such as Hemodialysis, Spinal Cord Injury, Pulmonary Medicine, and PACT (Patient Aligned Care Team) Space Module, just to name a few. Not all departments have a design guide. Focus has been placed on clinical care spaces. Design guides are intended to help speed the design process, control cost, avoid errors and omissions, and get the best value for dollars spent. The design guides were developed in partnership with the specific departmental /clinical function/building type and are https://www.cfm.va.gov/til/dManual.asp https://www.cfm.va.gov/til/dGuide.asp

Section 2.1 - 17 benchmarked with similar private-sector guides. They are to be applied as a basis of design, not as rigid standards.

PG-18-13, Barrier Free Design Standard (https://www.cfm.va.gov/til/accessibility.

asp) – The accessibility design standards that Architects, Engineers, Interior Designers, and Contractors must provide for a VA facility.

PG-18-14, Room Finishes, Door & Hardware Schedule (https://www.cfm.va.gov/ til/room/RoomFinishes.pdf ) – This document provides standards for interior finishes, doors, and hardware for new or renovated facilities constructed within the Department of Veterans Affairs. The essential criteria for the selection of these materials are their appropriateness for function and space, sustainability, life cycle costs, durability, and ease of maintenance. Refer to Section 1 “General” for the abbreviations related to finishes and doors as well as other requirements.

PG-18-15, A/E Submission Requirements (https://www.cfm.va.gov/til/ aeDesSubReq.asp) – This includes all Architectural / Engineering minimum submittal requirements for the following:

yMajor New Facilities, Major Additions, and Major Renovations yMinor and NRM Projects yCemetery Projects yRequest for Proposals Design/Build Projects ySeismic Upgrade Projects and other potential projects such as Clinical Specific Initiatives CSI

Major Checklist - Refer to Appendix A

VHA Program Guides – VHA/EPS Program guides provide documentation of the responsibilities for that particular subject such as EPS Interior Design Program Guide, EPS Mental Health Product Guide, and others. The guides are available upon request.

https://www.cfm.va.gov/til/aeDesSubReq.asp https://www.cfm.va.gov/til/aeDesSubReq.asp https://www.cfm.va.gov/til/accessibility.asp https://www.cfm.va.gov/til/accessibility.asp https://www.cfm.va.gov/til/room/RoomFinishes.pdf

Section 2.1 - 18

VA Standards Alerts (SA) and Design Alerts (DA)

Standards Alerts serves to identify innovative and broad-ranging standards and design processes and procedures that have a major impact on the VA’s goal of delivering world-class facilities. Whereas Design Alerts are issued to reduce construction change orders and for addressing construction-related issues. The Standards and Design Alerts supersede original guidance and are eventually incorporated into the revised design guides and design manuals. The VAHID and the HIDs during the Design Development phase adhere to the most up to date requirements, criteria, and details. https://www.cfm.va.gov/til/alert.asp

Hematology/Oncology Cancer Treatment Center Renovation, James H. Quillen VAMC - Mountain Home, TN.

Photo courtesy of American Structurepoint, Inc. A/E, Columbus, OH.

https://www.cfm.va.gov/til/alert.asp

Section 2.2 - 19

2.2 Infection Control

Architectural standards do not explicitly address infection control. Basic healthcare design consideration is underlying in VA’s standards and planning criteria. VHA Directive 1131(3) Management of Infectious Diseases and Infection Prevention and Control Programs should be reviewed. https://www.va.gov/vhapublications/ publications.cfm?pub=1

Examples include:

yBasic separation of clean and soiled materials and activities as guided by the Space Planning Criteria, particularly by the design considerations and relationship matrices and diagrams.

yFrequent hand washing is promoted by adequate and appropriately located lavatories and sinks, as per PG-18-9 Space Planning Criteria and VA-Space Planning equipment System (VA-SEPS) and the PG-18-5 Equipment Guide list.

y Isolation of contagious or especially vulnerable patients is provide by isolation rooms or spaces in accordance with Space Planning Criteria.

ySelect textiles that are compatible with local EMS cleaners and disinfectants.

ySelect finishes that are appropriate for each space, adhering to PG-18-14 Room Finishes, Door & hardware Schedule.

yDevelop specifications of features such as door frames, casework , and finish transitions to avoid dirt-catching and hard to clean crevices and surfaces, adhering to standard details.

yProvide adequate and appropriately located housekeeping spaces, adhering to Space Planning Criteria and the Equipment Guide List.

Patient/Family Waiting at Greenville VA Outpatient Clinic - Greenville, SC.

Photo Courtesy of Photos © Tze Chen and Array Architects, Conshohocken, PA https://www.va.gov/vhapublications/publications.cfm?pub=1 https://www.va.gov/vhapublications/publications.cfm?pub=1

Section 2.3 - 20

2.3 Fundamental Design Considerations

Design Story The design story is a tool for designers to build rationale, consensus, and gain approval for their design solutions.

It should be conceptualized early in the project and become enhanced during all design phases. The design story should be inspired by a patient-centered care delivery model and the whole health of the Veteran. It should also recognize the cultural, regional, and ethnic differences, military service, and should follow VA standards, directives, and executive orders. The design story should be inspired and driven by emerging healthcare design, technology, evidence-based design, sustainability, and collaborative resources. In every project, the entire project team can contribute to the design story. The design story justifies the design and provides validation, benchmarking, and lessons learned rationalization.

Patient Privacy The health care environment affects the quality of care provided to Veterans. Privacy affects comfort, sense of security, and perception of care. All VA medical facilities must ensure that these environments support Veterans’ dignity, privacy, safety, and security, whether in planning new construction, remodeling older facilities, or improving patient care programming. VA CFM Design Alert #149 provides additional guidance and clarity on VHA Directive 1330.01 which provides requirements for Veteran privacy.

Patient Profile VA staff and the HIDT should create a patient profile for each project patient demographic. The patient profile is a description of the unique characteristics and needs of the various Veteran patient users and may include cultural, regional, and ethnic characteristics. The description should address both mental health and physical characteristics. This profile will help the designer create patient-focused design solutions.

In a patient-centered environment, design solutions will respond to the needs of the patient profile through architecture and interior design. When VA staff members and the HIDT participating in the development of design solutions, they should discuss the patient profile impact. In patient-centered environments, caregivers include the patients in the decision-making of their care; therefore, the benefits of understanding the patient profile affect both the patient and the caregivers. This information allows the designer to better understand the Veteran as an individual.

Below are examples of patient profiles.

Patient Profile 1: Post-Traumatic Stress Disorder (PTSD) patients who typically arrive alone and have a greater need for privacy would require smaller separated waiting areas instead of large waiting rooms.

Patient Profile 2: Patients with conditions ranging from limited mobility to complete paralysis such as Spinal Cord Injury/Disorders (SCI/D) would require wireless systems to control light, temperature, nurse call, TV, etc.

Section 2.3 - 21

Healing Environments During all phases of the project, creating a healing environment is important in a patient-centered care delivery approach. All designs should be judged against the industry and VA best practices to validate that the solution meets the goals and principles of the Healing Environment. Refer to the Healing Environments design guidelines: https://www.cfm.va.gov/til/etc/HealEnvir.pdf

Additional information on healing environments can be found in healthcare design industry publications. These resources include books, magazines, articles, conferences, and symposiums on healing environments.

The VA healing environment principles should focus on:

yBalance between new and familiar yBeauty yCulture yEnvironmental stewardship y Interaction with outside world y Link to nature yPeople ySpace for relaxation yPositive self-awareness yMeaningful/diverse stimuli ySense of privacy

Reception Desk at the Boise VA Medical Center, Boise, ID.

Photo courtesy of Department of Veteran Affairs.

https://www.cfm.va.gov/til/etc/HealEnvir.pdf

Section 2.3 - 22

Labyrinth at Dixie Regional Medical Center - St. George, UT.

Photo courtesy of Department of Veterans Affairs.

Evidence-Based Design Evidence-Based Design (EBD) is the design of healthcare facilities based on research and documented evidence and outcomes applied to the environment to make it more supportive of healing and well-being. The key players in the research of EBD are supported by The Center for Health Design, The Institute of Healthcare Improvements, and The National Academies of Sciences Engineering Medicine. The physical environment affects well-being and is poised to emulate evidence-based medicine and positive outcomes.

VA staff and the HIDT should understand the effects of EBD on design decisions.

Healthcare environments that use research data to improve medical outcomes focus on:

yEnvironmental Controls – Empowers patients to reduce stress and increase satisfaction ySocial support – Speeds recovery with the support of loved ones yAccess to nature – Use of natural light and healing gardens yElimination of environmental stressors – Use of positive distractions such as color, art, views of nature

Patient-Centered Care The VA provides a full spectrum of healthcare services for Veterans and embraces the principles, spirits, and intent of EBD in the creation of healing environments.

Awareness of these principles can assist in identifying standards and solutions to the Veteran/Patient-Centered Care (PCC) approach to health care.

PCC design should be the guiding principle utilizing EBD during the design process, ensuring the patient is the central focus of the design.

PCC considers the patient’s cultural traditions, personal preferences, and values.