Design and Organization Guidelines for Ambulatory Surgery Units: Specific Issues of Concept Design for Ambulatory Surgery Departments

Investigation followed six steps. I: Literature review with focus on excellence cases; array of basic requirements defined. II: Basic cost evaluation (surgery and related costs, structure mortgage, etc) and value analysis; investment timescales, process Work Break Structure (WBS); proposition of Global Cost evaluation models indicating investment profitability front of design, rehabilitation/construction, running, and decommissioning costs; the aim was to match "old" and "new" approach, evaluating costs/benefits of each choice. III: Concept Design (space, relation, technology specifications) was established following data and desiderata by the Medical Staff; this was a critical goal, as a correct set of design requirement is the only way to fulfill intentions and expectations of both health care organization and patients (higher performance/safety, lower costs, lower individual/social impact); this step required strictest disciplinary interaction. IV: General design conditions were investigated, to assure client satisfaction through design review and validation. V: Administrative and financial procedures were defined to support managers. VI: Control and construction-management procedures were suggested, to keep untouched the quality chain throughout the process, including control operations and feedback actions. As research result, a manual for designers, health care officers, medical managers and physicians was conceived, whose scopes and tools are: - investment profitability evaluation following a Global Cost approach; - design consultants and design group individuation, following standard criteria; - design process organization, following basic specifications - design process evaluation following procedures for design review, verification and validation; - bidding and building process planning, through standard construction management procedures. Such tools contribute to: - a solid plan, able to show economic benefits, with untouched or increased medical performance and safety; - a reliable organizational path to complete the whole process with minimum risk.