Proceedings of: Workshop on Improving Building Design for Persons with Low Vision
Kurt Knight: Development of VA Standards
I’m just going to give a little overview of VA’s standards website, a little discussion about how we go about developing the standards and implementing them, and a little about the issues involved relative to this particular subject.
Website
First of all, this is the website we have all of our standards at (slide 2). It is called the technical information library (slide 3) and it is accessed through all the VA – the field VA, as well as our consultants – for standards that they design to and incorporate in all of our projects, major and minor. You can get at it, too, by just googling the words “VA technical information library.” It will be the first thing that pops up there.
Design Guides
It’s a series of different type of standards, design guides, design manuals, master specifications, design works and finish schedules (slide 4). Design guides are what we focus on mainly because that’s the document that provides guidance, but not requirements. We have design manuals that have a lot of requirements in it. Design guides try to give a graphic organization of all of those standards in one document.
I think it’s appropriate and may be a method of, in this group, trying to identify guidance separate and apart from requirement, in a graphical context. This is just some coverage of some of our recent design guides (slide 5). And they’re constantly evolving, constantly changing.
We try to update them every five years, and in some cases, more often than that because the [attribute] changes (slide 6) and medical care changes. I mean, VA is rapidly changing – and I mean medical care in general is rapidly changing and it’s hard to keep up with it from a space and function standpoint.
The space criteria that we have is kind of the requirements – in other words, how much space we allocate for each particular function. We have 60-some functions in the VA. We identified specific amounts of space for each of those types of rooms within those functions. The space criteria is a written document, also available as an electronic tool.
Attributes
The design guide is, again, the graphical representation of that space criteria plus key mechanical, electrical, structural issues associated with each group. And the design guide deals with the narrative with a lot of different kinds of design issues that are associated with that particular function that we think are important – adjacency that flows with patients and staff and visitors, et cetera, in those areas. And it’s a basic functional document for the VA.
Then we get into other attributes because this is kind of the basis of our standards and what are we trying to strive to achieve in all of our mechanical, electrical, structural, architectural, et cetera, standards (slide 6). Modularity and flexibility are very important because as health care is constantly evolving and changing – five years from now, I mean, we have to change what we get, especially in certain key areas – outpatient clinics and polytrauma is a new one.
There’s always a new function, a new program, a new medical issue that has to be resolved. And that requires, in many cases, functional cases in the building. So we try to make our system flexible and modular so we can better accommodate that change. Reuse is just another – in older buildings, we often reuse them for some other facility. The average of VA facilities is about 55 years old. They’re going to be around for a long time. They’re going to be used for different things.
Re-use is an important issue. Security: obviously a major issue in government facilities. We have series of rules and manuals associated with that. Sustainability: very important nowadays. Energy reduction – I think we talked about that quite a bit, and the things that go into that issue.
And finding resources, where the money comes from. Governments – there’s always the major-project funding; there’s minor-project funding; there’s maintenance funding and never the twain shall meet. You can’t use one funding for another funding. And that causes significant problems trying to address a lot of these types of issues. It’s very difficult, but nevertheless, that’s an absolute barrier that we run across all the time.
VA Hospital Building System
The VA Hospital Building System (VAHBS) is a method of getting a flexible system that is easily changed and less costly changed over time, again reflecting that need for flexibility and modularity (slide 7). It’s basically got an interstitial deck, a functional zone for pumps and all the mechanical and electrical piping and all that is on the service zone that can go there (slides 8 and 9).
[The VAHBS] allows us to change [systems, such as lighting systems] much more easily and much cheaper because of this particular flexible design approach. We have this [system] in probably three dozen facilities, been using it for some over 20 years.
And all our new facilities, with one exception, have adopted it. We don’t use it in all buildings. We don’t use it in long-term care. We don’t use it in other types of functions that don’t change as rapidly as a clinic building or a bed building.
Security Design Manuals
These are some physical security manuals that have been developed with NIBS over the last few years (slide 10). We’ve had a great deal of assistance and coordination and collaboration with NIBS over a number of areas, and this is one of most successful ones that’s been adopted for all VA medical centers, approved by the secretary. And again, there’s some integrations here with security.
And somebody mentioned it before – lighting for cameras, lighting in the parking lot and to low-vision. I mean, some of these are collaborative. [We] could provide more lighting in our parking lots. There are a number of reasons, security being one of those. And cameras – that also helps in low vision and there needs to be better, say, collaboration and integration between the needs of the two so that we make sure that, if you’re going to provide this lighting anyway, that it serves both needs. So I mean, that’s one area in a number of areas that we could do this collaborative effort.
Energy and Sustainability Requirements
Energy
We’ve talked about a lot of federal laws. This is just a summary of the laws that we have to comply with (slide 11). ESA 2007’s been mentioned, the executive order 13-423, EPAC 2005 and a federal leadership on high-performance sustainable buildings. All those are statutory or executive orders. They’re not optional. Every agency has to comply with them. So 30 percent energy reduction is a requirement.
And it’s a publicized, well-established criteria. Agencies are given scorecards, whether you’re green, red, blue or green, red, yellow or whether you’re fine. So there’s a great deal of emphasis to comply, to be green so that to OMB, you’re saying, we’re meeting all these goals and guidelines.
Sometimes your funding depends on ensuring that you meet some of these goals and guidelines. But this is just a brief summary of the actual statutes themselves. And this is many of the attributes that are designed into all of our new buildings since 2009 (slide 12).
Daylighting
Day lighting – that’s been discussed. How do you do that? Well, that sustainable design means solar is a certified requirement now.
LEED™ or Green Globe Certification
It used to be [LEED ™ Silver certification]. Green Globe is [also] a leading-type organization that VA has used, and sometimes, tends to be a lot cheaper and more flexible. And we’ve talked a lot about the problems code provides, but quite often, from a mechanical engineering standpoint, it’s really been a bonanza, in my opinion – these energy reductions and this memorandum sending.
Building Commissioning
Other agencies have used [building commissioning]. The VA has never done it because it costs. Well, that’s no longer an option. You have to do the commissioning. You have to do retro-commissioning of your buildings. That is a requirement in the law.
I mean, every four years, you’ve got to go back and retro-commission the systems to make sure they’re operating as they were originally intended. Metering of the systems – I mean, that again – these are important measurements that help demonstrate that the buildings you’re building now – and we talk about a post-occupancy evaluation, at least on the energyuse side, the mechanical-system, electrical-system side, especially when the skin (ph) of the buildings is commissioned and other things.
We can track how well we did in the original designs, that yeah, did he really performed this 30 percent reduction? Did he achieve it? Is it maintainable? Can it continue to be identified as a 30 percent reduction? And these laws have – at least, again, from a mechanical engineering standpoint at the VA – been kind of a real bonanza. No longer can they say, oh, we can’t afford that additional sustainability, that additional energy reduction. That’s the end. The conversation is over. It’s a requirement – a statutory requirement.
VA Initiatives
While we talk a lot about these technical aspects of functions of our buildings, the VA did – and again, with the assistance of [NIBS, publish a document on “Innovative 21st Century] Building Environments (slide 13). Basically, [about] health care and how the new building environments can integrate with each other and function together and work better. And it’s been reported to our management and there’s some interest in doing some things.
We had a new reorganization to address some of these issues. It was done with advice from a number of well-known experts in health care, [with a focus on] how the VA is going to provide health care (slide 14). The VA is moving into areas like home care – a great deal of effort – and treating patients by phone and, with the electronic systems, take readings.
Standards Implementation Issues (slide 15)
Electronic medical records has been a part of VA’s requirements for a number of years. It’s been a tremendous asset in using our VA system. And patients can go to any of our 155 medical centers and instantly, the doctors know what he’s been treated for, the medications he’s had and his whole medical history in the blink of an eye. These [records may include] some of the implementation issues strictly related to standards and, kind of, the crux of what we’ve been talking about here.
First of all, as we develop standards, it has to be supported by the VA management and medical staff. Any of the standards we [develop] is a collaborative effort between our medical staff and our technical staff. We often hire consultants to assist us in this effort. We have an advisory team on the medical side to provide what they want.
They are [the] customers, per se, and they have a great deal of input in the kind of systems, and especially in the space area and the functional areas – our space criteria design guide. They’re very instrumental on that, but not as much on the technical issues.
Compliance with national codes is a given. We comply with national codes. We have a set of VA criteria standards that are in excess of the codes. But in no cases, to our knowledge, would we not be in compliance with national codes, and also, compliance with national institute standards, in excess of [those], in many cases.
ANSI was mentioned as a guide here. If an ANSI document is out there, unless there’s some reason that we don’t feel it’s appropriate, we would generally adopt those types of national [standards]. And again, I mentioned earlier, that’s a law that says that the goal of government standards is to use national standards and industry standards where appropriate.
I think we have been a leader in accessibility standards, and often in excess of what the codes say – ADA and accessibility, et cetera, et cetera. I think we’re ahead in all that.
Our standards have to be practical, enforceable, cost-efficient, flexible and long lasting. I mean, our buildings are going to be in place 50-plus years. That’s a given. That’s the history. And again, flexibility is important. We’ve got to make them understandable. We can’t put a bunch of standards out there that are field-engineered if we don’t understand the reasons why we did things.
Low Vision Issue
If we’re going to make changes in our standards regarding low vision, we have to have some description of why we did it, so that you have an advisory team that, when you’re planning a project, you work quite closely with a medical center. And some of these issues, especially in architecture, you know, everybody’s an architect. Everybody knows what they’re doing.
And that may be good and bad. I mean certainly, some of their needs are absolutely essential. In other cases, they just don’t understand so you have to have some description or reason or justification of, hey, we’re using all these different colors and contrast issues for a reason, not just because we think they’re pretty. That’s an important part of it.
Again, our standards are nationally applied across a wide range. It has to be somewhat flexible for areas of the country and whatnot. We don’t have to comply with state building codes, however we, in all cases, try to do that although it’s not a requirement if it’s a facility built on federal property.
Multiple Levels of Oversight and Review
There’s a lot of people with oversight of the VA, from Congress right on down to the local veterans organizations of all types. And they’re often involved – in the vast majority of cases, they’re often involved in the development of our projects at the early levels. There’s a lot of scrutiny so if we want to do standards, we have to make sure that they’re appropriate – that they pass the test of feasible and appropriateness because we know they’re going to be criticized at some level. So we have to have a firm basis and background on what we do and how we do it, and again, the project teams are very important with individual projects. Every routine, every hospital has a project team when we develop a project.
VA Signage Manual
We have a signage manual I think that’s worth looking at for this group. It has a lot of detail in it, types of signs, wayfinding, where the signs are located, the lighting on the signs, how far they are away, entrance signs, exit signs, biosafety signs.
It’s a very voluminous book that has a great deal of development and detail in it. It doesn’t specifically say that it addresses this low vision issue but in the development of it, that was one of the attributes that we built into it. But it probably doesn’t stipulate it as strongly and probably should be looked at again. It’s about 3 years old or 4 years old. Actually we have a taskforce underway to upgrade it, to redo it.
Summary and Commitment
So we’re certainly going to try to incorporate some of the ideas that come out of this committee into that update.
We have a new design guide for community living centers, which are nursing homes now. VA has had a tremendous change in their approach medically to our nursing homes; it’s a much more homelike environment, and it has a more national emphasis because VA funds, to the tune of about $300 million a year, are to state nursing homes.
And this design guide we’ve developed generally would apply to those state nursing homes. Now, they have to comply with some local codes but in a general way they have to at least comply with our VA standard of care, which in this case has changed dramatically from what it was five years ago, and it’s really quite a change in the way that we provide that sort of care.
I always end my presentations with what we do: we provide care (slide 16). That’s what we do and we can never forget that. And we have all these technical issues and energy conservations but the bottom line, we provide medical care, and you always have to keep that in the forefront of everything you do. And just my contact information (slide 17). Thank you very much.
User Comments/Questions
Add Comment/Question