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8 Considerations For Benchmarking

By Katie Fricke | August 30, 2017
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Benchmarking is a practice that compares a metric back to a standard in a particular industry. In

healthcare design, this process allows designers and architects to
compare existing or proposed building performance data against best
practices. The purpose is to understand differences in multiple designs,
between facilities or competitors. Ultimately, benchmarking provides a
quantitative tool to align decisions and selections with established
project objectives.

Common planning benchmarks used in healthcare design involve square

feet per key planning unit (KPU), such as a patient bed, imaging
modality, or operating room. These benchmarks are based on codes,
research, and precedent, and factor in a certain amount of space
necessary to support one KPU in a hospital. However, these metrics
should also consider functionality and operations. For example, a
hospital that elects to have a patient/family-centered care designation
requires a larger patient room and more family sleeping space, which
drives up the typical benchmark ratios for square feet per patient room.

Benchmarks can be an incredibly helpful design tool, whether sizing an entire campus or informing a
departmental study. However, when benchmarking is performed in a vacuum without a standardized
process, the results can be misleading. Both the American Institute of Architects and Building Owners
and Managers Association offer guidance on standardizing processes for calculating areas. The simple
mechanics of determining the amount of space per KPU is very important; in order to compare designs,
the process of performing the area calculations should be handled the same. Are all comparisons using
the inside face of demising walls or do some go to the mid-point of the walls? Are shafts, stairs, and
elevators included or excluded?

For example, take the traditional rule of thumb of 2,500 square feet per bed for overall sizing of a
hospital. In a nutshell, this benchmark implies that all the support spaces necessary to deliver inpatient
TRADE SHOWS
care, including food, logistics, and diagnostic and treatment areas, have been tallied and divided by the
total number of beds supported. For a 120-bed community hospital, 300,000 square feet (2,500 square Oct. 23-26, 2021
feet X 120 beds) may be the sweet spot for enough programmed area to support each bed, without being Cleveland, Ohio
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oversized. A 25-bed critical access hospital, however, may need to be more efficient than a benchmark of Find Out More 
62,500 square feet to meet the cost-based reimbursement models for Medicaid and Medicare. Similarly, a
380-bed teaching facility using this benchmark may not have enough space per bed to support team
rounding, consultations, and the provider work spaces necessary for both patient care and academics. So
how can we make benchmarking a less blunt, more meaningful tool for any scale?

Benchmarking in practice Aug. 28-31, 2021

Chattanooga
Convention
Using the 2,500-square-feet-per-bed benchmark as an example, here are eight things to consider when Center,
evaluating healthcare design benchmarks: Chattanooga,
Tenn.
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1. Space in the right place. If an area has “hit the target” in terms of square footage, the space must be
well designed and fully functional, right? Actually, this is the number one misconception of
benchmarking. At such a high level, this benchmark only indicates there might be enough space. It
doesn’t tell us if the space is in the right places to be functional. For example, if sterile processing is a
large area, but the operating rooms are small and antiquated, the functionality may be compromised—
even if the surgery department benchmark is right on target.
L AT E S T I S S U E
2. Quantity versus quality. Facility benchmarks based on area per KPU can be used to identify the
appropriate amount of space, but they rarely communicate the quality of space, a shortcoming that Subscribe
should be recognized up front. For example, if the patient rooms are still semiprivate, the overall
appropriate amount of space may be accurate, but the quality of the patient experience might suffer. Read Online
Other tools like parametric modeling, which is a computer simulation that illustrates how several
variables are related and interact with each other, can be incorporated to better articulate quality. To Archives
best understand the experience of a patient in accessing natural light from the bed, benchmarking will
simply provide a number, such as area of window glazing per room, while parametric modeling can
compare designs based on multiple facets, including area of windows as well as sill heights, solar
orientation, and distance of the beds from the exterior wall.

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3. Context. Are you using this square-foot-per-bed benchmark for an academic medical center or a
community hospital? Is the facility a for-profit model in a national network or an independent not-for-
profit in a community health system? Benchmarks should always be tied to comparable data sources. It
isn’t accurate to benchmark the support spaces needed for residents by comparing a teaching facility
with the needs of a community hospital. Different models will benchmark differently, and the targets for
the best practice benchmarks must adjust accordingly.

4. Apples to apples. Statistics can be manipulated (intentionally or inadvertently) and benchmarks are
no different. If multiple facilities are being compared, then the data that make up the total square
footage must be derived in the same way. If one facility’s area-per-KPU number includes a central utility
plant and the others exclude it, then the benchmark is not comparing apples to apples. If one hospital
runs semiprivate rooms and another facility is all private, the total bed complement may be the same,
but the space needed per bed would vary significantly. The detailed composition of the benchmark must
be clear to ensure you’re comparing like entities.

5. Building era. The age of the facility can also impact benchmarks. A modern facility is probably more NEWSLETTERS
efficient in utilizing space for current operations than one built long ago. Therefore, a renovation
benchmark might be scaled back from a new construction benchmark when existing facility constraints,
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such as a small column grid, make it impossible to reach best-practice targets.

6. Operations. As noted previously, a benchmark must take into account functionality and an
understanding of how a space is intended to be used from an operational perspective. For example, a
portion of the 2,500-square-foot-per-bed benchmark includes materials management. But if supplies are
stored in an off-site warehouse, this requires less space than if a hospital is planning to store all
materials on-site (though the benchmark may need to factor in space for staging and distribution).
Registration is another good example: If bedside registration is implemented, the square footage for a
centralized registration department could be reduced in the overall hospital benchmark.

7. Cultural variations. Just as a benchmark should adjust for the type of facility it represents, it should
also vary based on cultural differences. In the Middle East, gender separation and duplication of spaces
may affect the typical benchmark but could be offset somewhat by a ward arrangement. In the United
States, some areas of the country tend to experience larger familial support needs for patients in the
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hospital, impacting the size of lobbies and waiting rooms to accommodate larger groups of family
members, which may increase the overall benchmark.

8. Cataloged data. To determine whether 2,500 square feet per bed is an appropriate best practice for a
project, an organization needs to collect and record numerous data points of area calculations for similar
facilities or departments. Being able to see trends in the data and identify outliers in square feet
allocated for projects requires a database of multiple projects that’s accessible and consistently
generated. Typical data collected and maintained for a full hospital may include overall area per bed,
grossing ratios, percentage of space allocated to engineering infrastructure, and total KPUs by service
line. Additional department-specific data, such as square feet per KPU as well as departmental grossing
ratios, are also helpful in understanding the amount of circulation needed for various departments. For
example, the ability to query multiple academic medical center metrics would illustrate the challenge in
planning around 2,500 square feet per bed for this facility type and help build a case for additional space
allocation in future planning. Then, department-level benchmarking would help identify the specific
units that may be undersized.

Use it wisely

Based on these considerations, a benchmark like 2,500 square feet per bed can vary significantly from
hospital to hospital. An organization’s facility should be carefully compared to hospitals of a similar size
and context, and the details around the composition of the benchmark should be known and
documented to make sure that an apples-to-apples comparison is realistic. What may first appear to be a
single, static target is actually a fluid number that adjusts within a range of square feet to reflect
operational decisions, culture, and building era. This refined benchmark can then provide a quantitative
comparison that meaningfully conveys best practice for a specific application, crafting a much better tool
for project decision-making.

Katie Fricke, AIA, NCARB, LEED AP, is a healthcare planning principal for HDR (Charlotte, N.C.). She can
be reached at katie.fricke@hdrinc.com. 

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