CORE SERVICES/INFRASTRUCTURE

PHYSICAL FACILITIES DESIGN AND

MANAGEMENT
Contributors: Meena Merali, Amanda Chudak, Rudy Dahdal , Joann Trypuc,
Mary Gospodarowicz

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 CHAPTER

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PHYSICAL FACILITIES DESIGN AND
MANAGEMENT
A. INTRODUCTION ........................................................................................................2
B. OVERVIEW ..............................................................................................................2
C. REQUIREMENTS .......................................................................................................3
1. Planning for Redevelopment or Renovation ...............................................3
2. Standards and Guidelines ..........................................................................5
3. Facilities Management................................................................................6
4. Processes and Structures ..........................................................................9
D. THE FUTURE .........................................................................................................11
E. REFERENCES ........................................................................................................13
 PHYSICAL FACILITIES DESIGN AND MANAGEMENT

A. INTRODUCTION

Cancer centres require physical facilities that foster a healthy environment. By using the
principles of evidence-based design, physical facilities can enable a safe, positive and
therapeutic experience for patients and the healthcare team, and contribute to improved health
outcomes.

Physical facilities should be thoughtfully planned with a view to current and future needs, meet
best practice standards and guidelines, and be properly maintained to support a well-
functioning cancer centre. Poor physical facilities and support services can paralyze the best
clinical services.

In addition to the general physical facilities that enable a whole organization, each cancer
service has specific requirements. These requirements exist regardless of whether the cancer
service is located in a specialized, stand-alone cancer centre or in a larger, full-service hospital
that provides cancer care. For more information about the physical facilities requirements of
each clinical cancer service, see the appropriate Cancerpedia chapter.

This chapter presents the key elements of physical facilities in a cancer centre, as well as the
guiding principles, standards and guidelines, resources, processes and structures that enable
ongoing physical facilities planning, design and operations. It is most relevant to existing
cancer centres that are seeking to redevelop, renovate and maintain facilities in accordance
with best practices and future trends. Detailed information on the planning and construction of
new hospitals can be found through various international and national standard-setting bodies,
as discussed below, and in the World Health Organization’s District Health Facilities:
Guidelines for Development & Operations. 1 This document details the various stages of
planning and designing a hospital, including establishing demand for a new hospital, preparing
a design brief, design, construction and commissioning.

B. OVERVIEW

Physical facilities include buildings, their internal configuration, building support systems and
major equipment.

In a cancer centre, buildings include structures that house the centre’s operations, including
its clinical services, support services, administrative services, parking, etc.

The internal configuration of buildings includes:

• Patient and family areas, such as admitting and registration, waiting rooms and lounges,
inpatient rooms, outpatient clinic rooms, gym and wellness centres, washrooms, etc.
• Clinical cancer service areas, such as medical imaging, laboratory medicine and pathology,
surgery, chemotherapy, radiotherapy, supportive care and palliative care.
• Clinical support service areas, such as emergency care services, pharmacy, and infection
prevention and control.
• Non-clinical service areas, such as patient call centres, health records storage, information
technology, nutrition and food services, laundry services, central sterile supply, clean and

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soiled supply, equipment holding areas, biohazardous waste holding areas, the morgue,
etc.
• Public areas, including lobbies, cafeterias, vending areas, retail space, libraries for patient
and public education, hallways, etc.
• Staff areas, including offices, clinical staff work rooms, meeting rooms, resource libraries,
departmental lounges, lockers and coat rooms, storage space, etc.
• Education areas, such as classrooms, simulation training space, etc.
• Research areas, such as offices, laboratories, meeting rooms, etc.

Building support systems include power supply and backup, heating and ventilation,
plumbing, mechanical systems, waste disposal, emergency management and command
centres, etc.

Equipment includes all clinical cancer services equipment and supplies, telecommunications
and switchboards, non-clinical materials and supplies, research and education equipment,
furniture, etc. For more information, see the Cancerpedia: Equipment and Technology chapter.

C. REQUIREMENTS

1. PLANNING FOR REDEVELOPMENT OR RENOVATION

Decision-makers must go through a number of steps based on a set of guiding principles to

plan well-functioning physical facilities. Master planning supports the execution of the cancer
centre’s strategy and addresses both present and future needs. It indicates what physical
facilities will look like, how care will be provided and how to best organize the internal
configuration of the cancer centre to enable services. Functional planning identifies specific
requirements to support the services and programs of various departments.

Guiding Principles

There are a number of guiding principles for the planning, design and development of physical
facilities. The major guiding principles are described below.

Principles that reflect evidence-based design embrace best practices in design and
construction that result in healthcare-related improvements. For example, the use of sound-
absorbing construction materials, hand sanitizing areas and sinks in every patient room,
maximum natural light, decentralized nursing stations with optimum visibility and accessibility
to patient rooms, and standard design and equipment in every room have resulted in positive
feedback and benefits for patients, families and the healthcare team. 2 The Center for Health
Design demonstrates the value of design for improving health outcomes, the patient
experience, and healthcare team satisfaction and performance. 3

Principles that reflect accessibility and diversity aim to create an inclusive environment that
meets the physical and psychosocial needs of every patient. Examples include ramps for
individuals with mobility aids or assistive devices for patients with sensory impairments.

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Cultural and gender sensitivity may be taken into account through, for example, spaces for
worship or private areas for men and women.

Principles that support flexibility and future growth result in adaptable and convertible
physical facilities that optimize the use of the space and enable future adjustments, as
necessary. Examples include planning zones for growth or robust utilities that can be easily
expanded and upgraded. 4

Principles that guide space and service location decisions help to maximize the use of
space and ensure that services or departments with dependencies or close working
relationships are in proximity to each other. This includes developing ideal flow patterns to
support optimal circulation routes. It also includes designing spaces that meet the needs of
unique patient populations and that support privacy and confidentiality.

Principles related to safety and security result in physical design and materials that support
infection prevention and control, workplace health and safety, and safe patient care. For more
information, see the Cancerpedia: Infection Prevention and Control chapter.

Green principles – such as those reflected in Leadership in Energy and Environmental

Design (LEED) standard – provide guidance for the design, construction, operation and
maintenance of buildings that use resources efficiently and are environmentally responsible. 5,
6

Principles that support patient-centred healing focus on the environment as integral to the
healing process. Examples of healing elements in patient rooms include a comfortable place
for the family, sinks, and control over lighting, temperature and airflow. 7 Other examples of
healing elements are fountains or water features, gardens and alcoves for private
conversations. 8

Master Planning

Effective master planning is a roadmap that translates the cancer centre’s vision and strategy
into a broad picture of physical facilities, while allowing for flexibility and future growth. A high-
quality master plan considers the optimal phasing and grouping of individual buildings, internal
building configuration, access and circulation routes, and the effective functioning of various
services. The master plan may be updated as new needs arise. Detailed considerations for
master planning can be found in World Health Organization’s District Health Facilities:
Guidelines for Development & Operations. 1 Some elements are included below.

The cancer centre must develop site plan and utilization diagrams to document the location
of buildings, their entrances and exits, and the location of utilities. Site planning and utilization
takes into account traffic and pedestrian flow for optimal access routes and circulation. These
diagrams should be retained to enable the location of important building structures for the
purposes of renovation and maintenance.

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Cancer centres should comply with all applicable building codes in their jurisdiction. Local
standards authorities or international review can help to provide context on appropriate
standards for healthcare facilities. Given their unique and immunocompromised patient
population, cancer centres should be designed to a high standard and go above and beyond
applicable building code requirements, where possible.

Within buildings, high‐level space requirements must be determined for each proposed
program, service and department. Decisions regarding space requirements are based on the
centre’s model of care, volumes of activity, staffing and other factors. A cancer centre that is
part of a larger hospital can leverage clinical and non-clinical corporate-wide services. The
internal configuration and layout of spaces within buildings are determined as part of this
decision-making process, taking into account the need for departmental working relationships,
service adjacencies, patient and staff flow, and wayfinding.

Functional Planning

Functional planning results in detailed physical facility requirements for each proposed
program and service. This may include planning for clinical service space, staff areas, and
patient and family areas, and the accommodation of major equipment, furniture and building
support systems. Non-clinical service areas – such as nutrition and food services,
housekeeping and laundry services, administrative areas, research and education areas, and
public areas (e.g., lobbies, cafeterias) – are also included. Functional planning takes into
account the need for direct and convenient departmental and clinical support service area
relationships and adjacencies to support staff and patient flow. Most jurisdictions have
standards and guidelines for health service space requirements. Detailed considerations for
functional planning can be found in World Health Organization’s District Health Facilities:
Guidelines for Development & Operations. 1

Functional planning occurs on an ongoing basis. Integrated modalities tend to have spatial and
servicing requirements that supersede current and previous standards. This is a factor to
consider during the planning phase, so that appropriate considerations are made for the
integration of future modalities that will be larger and more infrastructure-intensive than current
modalities. The transportation of heavier and larger equipment through corridors and access
points should also be considered in functional planning.

2. STANDARDS AND GUIDELINES

Physical facilities must meet best practice standards and guidelines for approval to redevelop
or renovate, and for building design.

Approval to Redevelop or Renovate

Approval to redevelop or renovate standards vary by jurisdiction and usually include local
zoning requirements and impact assessments. For example, standards may require that:
• The purpose of the building complies with the approved use for the property
• The proposed site can be accessed

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• Impacts have been identified and addressed, such as: environmental impacts (e.g., soil
tests, water table range); historical impacts (e.g., the site’s heritage status, historical or
cultural context); aviation flight path impacts (e.g., air rights); and the expected demand on
current utilities and services (e.g., electricity, plumbing, water and sewage)

Building Design

International standards exist for building design, many of which have been adopted and/or
adapted by other jurisdictions. The International Organization for Standardization (ISO)
develops standards for the construction sector. 9

National and subnational organizations (e.g., the Canadian Standards Association 10 may set
standards and guidelines specifically for physical facilities related to cancer care. These
typically include, but are not limited to, requirements in the following areas:
• Construction specifications for safe buildings
• Sizing benchmarks for specific service areas and facilities
• Environmental protection
• Fire protection
• Electrical systems and backup safety
• Heating, ventilation and air conditioning systems and safety
• Plumbing systems
• Wayfinding
• Acoustics
• Facilities that ensure patient and family, staff and public safety
• Infection prevention and control (for more information, see the Cancerpedia: Infection
Prevention and Control chapter)

Other international organizations address specific facility requirements for clinical services; for
example, the International Atomic Energy Agency provides requirements for medical imaging
and radiotherapy. 11 Service-specific physical facility standards and guidelines can be found in
other Cancerpedia chapters.

Detailed considerations for the approval and design of buildings can be found in World Health
Organization’s District Health Facilities: Guidelines for Development & Operations. 1

3. FACILITIES MANAGEMENT

Facilities management should be considered in the planning and design of physical facilities to
ensure optimal functioning of the cancer centre. Facilities management involves various
elements that aim to:
• Maintain a healthy and safe physical environment for staff, patients and families, and the
community
• Ensure the operations and maintenance of structural and architectural elements and
equipment
• Prevent and predict equipment failures
• Reduce downtimes

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• Manage assets
• Track costs

It may also include the teams or structures that are responsible for infrastructure renewal,
replacement and redevelopment.

Below are some elements that may fall under facilities management. For more information,
refer to the World Health Organization’s District Health Facilities: Guidelines for Development
& Operations. 1

Security

Security services are responsible for ensuring the overall safety and security of the hospital.
This includes the protection of the hospital and its property as well as the protection of patients
and families, staff and their property. Security guards require adequate training to deal with
adverse events and situations. The security team also requires appropriate space and may
require a telecommunications infrastructure to carry out its duties. The International
Association for Healthcare Security and Safety provides detailed information on international
security design guidelines for healthcare facilities. 12

Transportation

Transportation services ensure the timely and efficient movement of patients, materials,
supplies and equipment between different areas of the hospital, or between hospitals in a
multi-site organization. Examples of transportation services include the movement of
specimens, drugs, linen and laundry, pumps and stretchers, and wheelchairs, as well as
patient portering. From a design perspective, corridor routes should be able to accommodate
transportation needs (e.g., trolleys, stretchers, medical equipment).

Telecommunications

Telecommunications services enable the effective and efficient sharing of information, both
within the cancer centre and externally. Telecommunications systems include internal and
external telephones, intercoms, emergency alarms, patient call buttons, a public address
system, a mailroom and mail delivery, and access to radio and television, the internet, email
and video conferencing. For more information about the requirements for telecommunications
services in a cancer centre, see Communication Systems in Healthcare. 13

Nutrition and Food

Patients require optimal nutrition and hydration for a healthy recovery. 14 Nutrition and food
services typically plan, prepare, assemble and deliver meals to patients. Where possible, the
service should aim to provide healthy choices based on the dietary and medical needs of the
patient. 15

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The nutrition and food services team may include nutritionists, dietitians and food service staff.
If the service is centralized within a cancer centre, the movement of large food trolleys in
corridor routes should be considered in facilities planning and design. If the service is
decentralized to departments or units, satellite kitchens are necessary for the preparation,
cleaning and storage of food, utensils and equipment. For more information about nutrition and
food services, see Food and nutritional care in hospitals: how to prevent undernutrition–report
and guidelines from the Council of Europe. 16 For more information about food safety, see the
Cancerpedia: Infection Prevention and Control chapter.

Housekeeping and Laundry

Housekeeping services manage a wide range of critical activities that contribute significantly to
maintaining hospital facilities, equipment and supplies, and preventing and controlling
infection. These activities include: 17
• Cleaning patient care areas and rooms every day (e.g., beds, examination tables, furniture,
floors)
• Cleaning equipment
• Cleaning staff working areas and public areas
• Changing, collecting and transporting bedding and linen
• Collecting and transporting waste, including sharps
• Caring for and storing clean supplies
• Attending to utility rooms

Linen and laundry services manage the procurement, washing, cleaning, disinfection and
distribution of linen and laundry to all areas of a cancer centre. This includes all textiles used in
a hospital, such as bed covers, pillow covers, blankets, sheets, towels, gowns, mattresses and
scrubs. Linen and laundry services may be insourced or outsourced, depending on the needs
of the cancer centre. The service should provide a clean, safe and efficient supply of linen and
laundry to promote patient care and reduce the risk of cross-contamination.

For more information about cleaning best practices, see Public Health Ontario’s Best Practices
for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings,
3rd Edition. 17

Water, Sanitation and Waste Management

Water, sanitation and waste management services ensure the provision of an adequate waste
disposal systems and a safe, potable water supply. Facilities design must account for the need
to segregate clean goods from used and contaminated goods. There are a variety of
healthcare waste categories to consider, including infectious waste, sharps, pharmaceutical
waste, chemical waste, pressurized containers and general waste. In jurisdictions where
comprehensive and efficient water and waste management systems are not available,
designers must find other flexible solutions to reduce the risk of infections and water- or food-
borne diseases. For more information, see the World Health Organization’s health-care
facilities and waste resources. 18

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Disinfection and Sterilization

Disinfection and sterilization services ensure that the equipment, instruments and dressings
that come into contact with patients are sterile. Healthcare facilities require a sterile supply
area or disinfection and sterilization unit. Effective sterilization can be provided by steam under
pressure, using an autoclave or even a simple pressure cooker. Some hospitals may have a
more complex medical device reprocessing area to clean, decontaminate, inspect and sterilize
all medical equipment. For more information, see the Cancerpedia: Surgery and Cancerpedia:
Infection Prevention and Control chapters.

Engineering

The role of engineering services is to optimize the reliability and efficiency of cancer centre
operations. Engineers and their support personnel ensure the inspection, maintenance and
repair of facilities, equipment and services. They may be trained in a variety of disciplines,
including mechanical, electrical, civil, systems or biomedical engineering. Mechanical
engineering addresses elements such as energy sources, water, steam services, heating,
ventilation and air conditioning systems, medical gas services and fire protection systems.
Electrical engineering addresses elements such as electricity supply and distribution, interior
and exterior lighting, earthing, substations and standby plants. Civil engineering addresses the
planning, design and building of physical facilities and infrastructure. Systems engineering
addresses the operational management, reliability and logistics of physical facilities and
infrastructure. Finally, biomedical engineering addresses elements of biological and medical
systems, products and devices. Biomedical engineers are specifically trained to maintain and
manage medical equipment. For more information, see the Cancerpedia: Equipment and
Technology chapter.

Administration

The administration leads and supports clinical operations and as well as non-clinical functions,
such as finance, information technology and human resource management. Administrative
spaces may include offices, meeting rooms, convertible and flexible multi-use spaces,
workstations, and an audiovisual infrastructure for effective communication. Staff, patient and
family education and training support may also be offered in convertible multi-use spaces,
such as classrooms. For more information about service-specific administrative space
requirements, see the appropriate Cancerpedia chapter.

4. PROCESSES AND STRUCTURES

Physical facilities require ongoing processes, structures and funding for efficient operations,
maintenance, upgrades and replacements.

Supply Chain Management

Supply chain management includes purchasing and ordering, logistics and inventory
management, contract management and vendor performance management related to the

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resources, supplies, goods and services delivered to patients and providers. In many
jurisdictions, supply chain management is fragmented and inefficient, resulting in significant
costs that could be otherwise reinvested into patient care. Robust and agile supply chains can
provide significant cost savings and result in the improved quality of patient care.

There are various strategies that can be used to optimize the healthcare supply chain. For
example, value-based procurement considers value to the system (e.g., quality, life cycle and
patient outcomes) in purchasing decisions, in addition to costs and technical factors. The use
of value-based procurement is linked to improved patient outcomes and increased integration
in the delivery of products and services. Organizations may also consider consolidating
contracts for all medical equipment to increase buying power and adopting innovative practices
to achieve operational efficiency. 19

Preventative Maintenance

The resources required to install and maintain the mechanical and electrical components of a
hospital can be significant. Appropriate design and planning should consider maintenance
costs and needs to ensure that they are compatible with local resources.

Some examples of processes and structures for ongoing operations and maintenance include:
• Assessing all physical facilities regularly to ensure they are meeting the needs of patients
and staff, and supporting effective, efficient and safe operations
• Maintaining an updated list of all medical equipment, along with maintenance and
replacement schedules that align with the standards set by manufacturers and/or
associations
• Ensuring that all facilities and equipment are in good working order, regularly maintained
according to standards, and upgraded or replaced as required

A number of sample checklists and schedules for planned preventative maintenance are
available in the World Health Organization’s District Health Facilities: Guidelines for
Development & Operations. 1

Fire Safety

All areas should be in compliance with appropriate fire codes to minimize death, injury, loss
and damage to property. Principles of fire safety to consider include: fire avoidance, fire growth
restriction, fire containment, fire detection, fire control, smoke control and escape provisions.
To address fire safety, organizations may consider protective devices in buildings and
structures, fire protection appliances, facilities to stop fire and smoke, fire doors, the
maintenance of fire exits and the use of fire-resistant materials in construction. Organizations
may also consider fire prevention and response training for staff to increase education and
awareness of fire safety. For additional information, see the World Health Organization’s
Building security and fire protection report. 20

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D. THE FUTURE

A number of key trends will influence the design and management of physical facilities into the
future, as described below.

Increasingly, cancer care is being provided through outpatient care models, rather than
through inpatient care. Cancer centres will see design priorities shifting from traditional
inpatient rooms to highly-functional outpatient spaces. Hotelling – the use of clinic space for
multiple purposes – has the potential to reduce the amount of overall space required to deliver
clinics.

In terms of clinic and patient room design, safe design is helping to maximize patient safety. It
includes a broad range of physical facility enhancements, including lighting, acoustics, mobility
aids and lifts, wall and floor surfaces, the positioning of furniture and equipment, and standard
room layouts. Point of care testing (POCT) – which includes selected pathology testing at the
bedside or in outpatient clinics, as well as X-rays and ultrasounds conducted in patient rooms
using mobile and handheld equipment – is reducing the demand on medical imaging suites
and physical laboratories, while simultaneously requiring the design of patient care spaces to
accommodate portable equipment. Finally, smart technologies – such as smart rooms, smart
walls, smart phones and tablet applications – are enabling communication, quick access to
information and decision-making support through digital technology. Smart rooms may have
technologies such as interactive touch screens or ultrasound badges that provide a patient’s
data to the appropriate provider on their smart phone, tablet or computer monitor when they
enter the room. Smart walls are virtual, interactive white boards, where patient information can
be entered and retrieved alongside protocols, tools or checklists for care. These innovations
require sufficient space and investments in new technologies.

Beyond patient care areas, virtual navigation guides are providing wayfinding support
through smart phone applications (or “apps”) and helping to alleviate stress on patients and
visitors. These apps direct users through the building based on their indoor location using a
global positioning system (GPS), and provide suggestions and information about appropriate
parking, hospital entrances and the location of clinics or appointments. Apps may be
customized to provide a platform for deeper engagement with users, providing relevant
information based on the needs of the individual accessing the app. Analysis of information
from these virtual guides may enable hospital leadership to gain insights into how facilities are
being used, and guide decision-making as to where staff and amenities should be located.

Additionally, kiosks are increasingly being used in healthcare facilities for multiple purposes,
such as helping patients and visitors navigate the hospital, access information and education
on health topics, check-in for appointments or complete surveys (e.g., screening surveys for
symptoms and anxiety). Kiosks can also be used to check blood pressure, take a patient’s
weight and height, and provide information on appointments and programs. Although kiosk
space should be incorporated into physical design, kiosks generally require less space than
reception desks and large information and education displays.

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Beyond the cancer centre, telemedicine applications are becoming more advanced and useful
for supporting patients closer to their local communities. Although telemedicine has been
around for quite some time, it continues to be critical for linking cancer centres with facilities
that do not have a specialized physical infrastructure and expertise. More sophisticated
telemedicine stations and connections should be incorporated into physical facilities design to
support highly-specialized diagnostic consultations.

In terms of hospital management, increasingly sophisticated, integrated and computerized

building management systems are being used to control equipment, heating, ventilation and
air conditioning, security systems, power systems and lighting. The use of building
management system can enable resource efficiency and automation, resulting in improved
reliability, flexibility and cost savings. In some areas, particularly in tropical climates, solar
energy may also be used to provide an almost maintenance-free source of supplementary
energy. Low-cost solar heating devices can be beneficial in areas that need a constant supply
of hot water, such as laundry services, kitchens and inpatient units. Finally, inventory
management solutions are being developed and adopted from other industries to improve
efficiency in supply chain management. For example, just-in-time inventory strategies reduce
waste and increase efficiency by receiving goods only as they are needed. Just-in-time
practices require sophisticated demand forecasting and are sensitive to disruptions in the
supply chain; however, if managed well, they can result in significant cost savings and
efficiencies.

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E. REFERENCES

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