It happens every day: hospitals and surgical centers make the commitment to redefine their outpatient surgery areas to meet new demands for surgical procedures and stay current with technological advances in equipment. In the world of health care, change is constant. The keys to successful facility remodels are to create a vision for a surgical department and choose a methodology that ensures space planning and budgets will reflect that vision.

An example: while discussing the status of an upcoming, free-standing, satellite ambulatory surgery project, a health care system executive expressed his frustration at the way the conceptual planning was developed: "We presented the plan the architect developed working with the surgery director to a group of senior management and they picked the plan apart. Each manager brought a bias to the discussion, criticizing the space allocated to various functions as well as the total space proposed." Furthermore, he explained, the managers focused on operational and patient-care planning issues in patient services and material management, which were not among the priorities set by the surgery staff charged with directing the design effort. As a result of the managers' review, additional consulting and design services were needed on the project, which meant delays and additional expenses. According to the executive:

"It was clear we lacked a unifying vision that could enable us to focus on the same effort. We need to all get on the same page and work toward the same goal. In the design process, we were seeking input and participation from hospital departments that may or may not operate the new satellite facility. Each department created its own space program and operational concept. The result was an overall facility program too big to afford and one that lacked a unified vision. We need to be able to define the space program in terms of our vision so that our budgets and pro-formas reflect the space needed to implement the vision, but this needs to occur before we commit to the project design and prior to engaging our staff in a detailed programming and planning effort."