Keep Your Ears Open!

When an ED architectural project comes along you want to make sure you can deliver maximum input from a clinical perspective. You may have insights on future acuity changes, changing demographics of your patients, lean workflow concepts and physical design ideas. What you have to avoid is missing out on the early planning that establishes the size, scope and configuration of your future emergency department. And it’s amazing how many times this happens.

What Happens During Master Planning?

The term “master planning” applies to the work associated with defining the emergency department’s future size (number of rooms, support space, etc.) to support the projected volume (number of future ED visits) and future workflow. It all ties together: The future patient volume will drive the number of patient care spaces you will need based on your proposed operational workflow and expected length of stay times.   Early master planning work will establish the size of your future ED, and then rapidly move into finding the right location for your future department whether this be a renovation project, expansion or complete relocation on your campus. What the “master planning” process is attempting to do is to define the “scope” of a future project which will include the number of treatment rooms, size of total department needed, preferred location and estimated cost of the future project.

Now the Scary Part…

And now the frightening part for you…. many times the master planning work is done with little, or no, clinical input. Many times a facilities director and his/her architect will define the number of patient care spaces, which leads to overall project size, without integrating the clinical staff into the process.   The facilities personnel and architect don’t mean to ignore clinical input, they just may be very old fashioned in the way the go about master planning (i.e. making all of the decisions themselves). And, quite honestly, this was the way master planning was done in the past: Establish the parameters of a project, then ask the clinical people for their input on the detailed design. Of course, I believe this is a recipe for disaster!

It is great to get clinical input on the detailed design, but what if the overall size of the project, or number of rooms, isn’t correct to begin with? I have always worked hard to involve clinical leadership and staff from the very beginning of a project starting with defining a new way of working and understanding the future patient types and volumes that the ED project will need to support. The most successful ED projects integrate the clinical leaders, staff and ancillary department representatives from the earliest stages of a project.   If you are selecting an architect with whom to work, ask them when, and how, they integrate the clinical staff into the process (and I mean the ENTIRE process!)


So, keep your ears open and listen for the word “master planning” as in “don’t worry about the project yet, we are only in the master planning phase now, we will involve you when we get to the design phase.”  Red Alert!! You may also hear the term “programming” which is the architectural term for establishing the number of rooms in the future ED. Or, “utilization projections” which is the work to forecast the future patient visit volume.   All of these terms have to do with establishing the “scope” of a project, and once that project scope is established it is rarely increased! So, in summary, any time you hear that someone is working on defining the “scope” of a future ED project, push your way in and make yourself part of the master planning team! Your early involvement will position the project for long term success.

If you need more insights on the master planning process, please contact Jon Huddy at