The 34-Room Promise: Programming a Warehouse Clinic
Your client, a federally qualified health center, wants to convert a 1922 brick-and-timber warehouse into a 2,400 m² clinic. The board has fixed the program at 34 exam rooms at 12 m² each, six departments, a central registration desk, and a 40-seat classroom. The existing structure is a 7.2 m × 7.2 m column grid with 4.2 m floor-to-floor and a 900 mm deep timber beam zone; one 3.0 m wide stair serves the second floor. Your test fit yields 28 exam rooms, two departments that cannot be adjacent, and a registration desk that blocks the only accessible route from the new entry to the stair. The budget is fixed at $4.6 million, your fee is 6.5% of construction cost, and the board expects construction documents in five months. At the programming review, the board chair calls the test fit "just a drawing problem" and directs you to make the 34 rooms work.
1. What should you do before any further design work, and how do you present the shortfall to the board?
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Do not redraw yet - convert the conflict into a written program variance. Six missing exam rooms at 12 m² is 72 m² net; add sinks, clinician zones, and clearance and the gross loss is roughly 100–110 m². That is not recoverable by linework: a 7.2 m bay yields two 3.4 m rooms plus a partition zone, so room count is set by the structural rhythm, not by drafting skill.
Separate net from gross. 34 × 12 = 408 m² net of exam rooms alone; support space (nurse stations, clean/soiled, waiting, toilets, circulation) typically runs 55–65% of net, so the exam suite implies 650–700 m² gross before the classroom or registration.
Bring three tested options with cost, schedule, and clinical impact: (A) 28 rooms at 12 m² as tested; (B) 34 rooms at 10.5 m² on a revised two-room-per-bay module with shared provider pods; (C) 34 rooms using a mezzanine over the low bay, adding about $600,000 and six weeks. Ask the board to rank exam-room count, room size, classroom, and department separation, then record the ranking in a signed program document. A fee based on 6.5% does not include redesigning a program the client has not actually fixed.
2. The chair then directs you to shrink exam rooms to 9 m² and delete the second stair to gain area. How do you respond, and what do you put in writing?
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Treat the two instructions separately, because they carry different risk.
9 m² exam rooms: this is a client-standard and functional issue, not automatically a code violation, but it is below the client's own stated standard and below typical exam-room planning of 11–13 m² once door swing, sink, and a 750 mm clinician clearance are counted. Model one room at 9 m² and show the door swing colliding with the exam table; let the clinical director decide with that drawing in front of them.
Deleting the second stair: this is a life-safety issue and is not the client's to waive. The second floor carries well over 49 occupants, so two means of egress are required; a single 3.0 m stair also concentrates the entire floor's egress width in one shaft. Do not seal drawings showing one stair. Write a short letter stating the code basis, the options (restore the second stair, add an exterior stair, or reduce second-floor occupant load so the floor is legitimately single-exit), and the fee and schedule impact of each. Offer to attend the board meeting. If the chair insists, decline to proceed on that basis and document the direction - silence will be read later as agreement.