HCS 529 Week 2 Facility Selection and Needs Assessment Example

A Warehouse by the Interstate, an Old Office Building or Bare Land: Needs Assessment and Site Selection for a Four-Room Suburban Surgery Center

[Student Name]

University of Phoenix

HCS/529: Contemporary Health Care Facility Design

Week 2 Assignment

[Instructor Name]

[Date]

The health system, county, volumes and sites are composites written for a model paper; national data and federal requirements come from the sources listed.

Directors of the composite nonprofit system, which runs three hospitals, have asked its planning team to recommend, within 60 days, how large a new ambulatory surgery center should be and where it should go. The previous paper explained why a freestanding center fits the trends in surgery. This paper assesses the need, turns it into a facility program and compares three possible sites.

The Community

The system serves a suburban county of about 410,000 residents that has grown about 1.8% a year for a decade, faster than the state. Growth is concentrated in the northern half of the county, near the interstate, where young families and retirees have moved into new developments. About 16% of residents are 65 or older, and the share is rising. The system's main hospital sits in the older southern half, 11 miles from the fastest-growing area.

Demand From National Rates

The 2010 federal survey estimate of 28.6 million same-day surgery visits nationwide (Hall et al., 2017) works out to about 93 visits per 1,000 people. Applied to the county's population, that rate suggests roughly 38,000 ambulatory surgery visits a year across all providers, and the rate has likely risen since as more procedures have moved to outpatient settings. Nationally, the number of surgery centers grew more than 2% a year from 2019 to 2024, and about 94% are in urban areas (Medicare Payment Advisory Commission, 2026).

Demand From the System's Own Cases

The main hospital's outpatient department performed 9,800 cases last year. Surgeons and the planning team reviewed them and identified 5,200 that could safely move to a freestanding center: cataract and other eye surgery, knee and shoulder arthroscopy, hand surgery, selected joint replacements, colonoscopy and upper endoscopy and pain procedures. Four orthopedic surgeons and two ophthalmologists who operate at a competitor's center have said they would move some cases to a system center closer to their patients, adding an estimated 1,400 cases. Projected first-year volume is about 6,600 cases, rising to 8,000 by year five with population growth.

From Cases to Rooms

The team separated operating room cases from procedure room cases. About 3,900 cases a year need an operating room, averaging 75 minutes including turnover. At eight hours a day, 250 days a year and a target use of 80%, one room provides about 1,600 usable hours, or about 1,280 cases. Four operating rooms provide capacity for about 5,100 cases, enough for year five with room for growth. The remaining 2,700 endoscopy and pain cases average about 35 minutes including turnover; two procedure rooms provide capacity for about 5,400 cases, allowing the center to add a second gastroenterology group.

From Rooms to Space

Operating rooms cannot run faster than patients can be prepared and recovered. Using a planning ratio of three preoperative and recovery bays per operating room and two per procedure room, the center needs 16 bays, designed as flexible spaces usable for either purpose. Other space includes sterile processing sized for orthopedic instrument sets, clean and soiled holding, anesthesia workroom, equipment storage, staff lockers and lounge, a waiting area, registration, offices, a family consultation room and mechanical space. The architect's preliminary program totals about 24,000 square feet.

Regulatory Requirements

Several requirements shape both the building and the site. Medicare will pay only if the building satisfies federal conditions for coverage, which require that each operating room be designed and equipped for the surgery performed, that the center have a separate recovery room and waiting area and that it meet the Life Safety Code provisions for ambulatory health care occupancies regardless of the number of patients (Centers for Medicare & Medicaid Services, 2026). The state licenses surgery centers and has adopted the Facility Guidelines Institute guidelines for outpatient facilities as its design standard. Surgery centers in this state need no certificate of need, a policy that removes one approval but also means competitors may build nearby.

Site Criteria and Weights

Before visiting sites, the team agreed on eight criteria and their weights out of 100:

access from the growing north county and the interstate (20)

building structure, including floor-to-structure height, column spacing and floor loading (20)

time to opening (15)

total project cost (15)

parking and a covered patient drop-off (10)

zoning and approvals (10)

proximity to the main hospital for transfers (5)

room for future expansion (5)

Site A: The Warehouse

A 34,000-square-foot former distribution warehouse, built in 2004, sits one mile from an interstate exit in the north county. It has 24 feet of clear height, which easily fits operating room ceiling systems and mechanical equipment, wide column spacing and a concrete slab. It has parking for 140 cars and space for a canopy. It requires rezoning from light industrial to medical use and is 13 miles from the main hospital, though a fire station with advanced life support ambulances is two miles away.

Site B: The Office Building

A two-story 1978 medical office building across from the main hospital has 18,000 square feet per floor. Its floor-to-structure height of 12 feet is too low for operating room ceilings and ductwork without major work, its columns are closely spaced and it would require an elevator suitable for stretchers. It is zoned correctly and ideally placed for transfers but far from the growing north county.

Site C: Undeveloped Land

Six acres of land at a north county intersection could hold a purpose-built center with room to expand. It would take about 18 months longer to open and cost more, though the design would be unconstrained.

Scoring the Sites

The team rated every site on a five-point scale for each criterion and multiplied each rating by the criterion's weight. Site A scored 412 of a possible 500, with high marks for structure, access, time and parking. Site C scored 368, strong on access and expansion but weak on time and cost. Site B scored 281, strong on proximity and zoning but weak on structure and access. The office building next door was the obvious choice until the team measured the ceilings.

Risks of the Warehouse

Three risks must be tested before a lease is signed. A structural engineer must confirm that the roof can carry new mechanical units and that the slab can be cut for plumbing without cracking. The rezoning hearing is scheduled in four months, and neighbors could object to traffic. A transfer agreement with the system's northern campus emergency department, 9 miles away, and a written transfer protocol with the fire department are needed to address the distance from the main hospital.

Recommendation

The team recommends a center with four operating rooms, two procedure rooms and 16 preoperative and recovery bays in about 24,000 square feet, located in the warehouse, subject to a structural assessment and rezoning approval. The remaining 10,000 square feet allows future expansion or a physical therapy clinic.

Conclusion

Demand drawn from national rates and the system's own cases supports a mid-sized center in the growing north county. A capacity calculation turned cases into rooms, and rooms into space. Federal and state requirements set building standards, and weighted criteria made the site choice transparent. The warehouse is the best of three options, provided its structure and zoning pass the tests described.

References

Centers for Medicare & Medicaid Services. (2026). Ambulatory surgical services, 42 C.F.R. pt. 416. Electronic Code of Federal Regulations. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-416

Hall, M. J., Schwartzman, A., Zhang, J., & Liu, X. (2017). Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010 (National Health Statistics Reports No. 102). National Center for Health Statistics. https://www.cdc.gov/nchs/data/nhsr/nhsr102.pdf

Medicare Payment Advisory Commission. (2026). Ambulatory surgical center services: Status report. In Report to the Congress: Medicare payment policy (pp. 325-342). https://www.medpac.gov/wp-content/uploads/2026/03/Mar26_Ch11_MedPAC_Report_To_Congress_SEC.pdf