June 2006
Need for Supplement
In 2004 and 2005 VA undertook advance planning for the first new major hospital projects since
the mid 1990's. Since VA policy for the design of new hospital buildings is to provide for their
continuing adaptability to changing conditions and programs throughout their structural life (VHA
Program Guide PG-18-3, Design and Construction Procedures, Topic 3) and since the VAHBS
concept which provides such adaptability was partially outdated (original issue 1972, revision
1977), VA recognized the need for a Supplement to the Red Book to address significant devel-
opments in construction and healthcare delivery since 1977. In August 2005 VA commissioned
this Supplement Paper as the means to provide uniform guidance to project teams in the appli-
cation of VAHBS principles.
The VA Hospital Building System was successfully applied to major new or replacement hospi-
tal projects completed between 1977 and 1995. The buildings show a variety of design expres-
sions, bay sizes, plan geometries and floor-to-floor heights. Detailed information is provided for
three of the facilities in the Appendices. Photos of several other VA Medical Centers have been
inserted in Sections 2, 3, and 4.
As the projects using the VAHBS were designed, constructed and occupied details of the sys-
tem evolved. A number of refinements in the application of systems integration were discovered
by the designers, contractors, and VA. This Supplement to the Red Book reports on those de-
velopments. There have been numerous and significant changes in the healthcare delivery
model, medical technology, and regulatory requirements since 1977. The VAHBS was intended
to allow for a high degree of functional adaptability and ease of utility (service) modifications. All
of the VAHBS hospital buildings have been occupied for 10 or more years and have undergone
varying degrees of modifications. This Supplement includes reports on the adaptability of sys-
tems at three of the facilities.
Changes in Health Care Models
The prevailing health care model at the time the VAHBS was developed was centered on inpa-
tient care with a relatively small ambulatory component. Bed towers of 700 to 1000 beds were
major components of space in the hospital. Consequently 40 to 60 bed nursing units were the
primary driver for the planning modules presented in the VAHBS. Typical designs included a
preponderance of 4-bed rooms with a mix of 1 and 2-bed rooms.
Beginning in the 1980's there was a major shift in the health care model from inpatient to outpa-
tient or ambulatory services. Trends in patient privacy also moved design to 20-bed nursing
units with all 1-bed rooms.
Existing VAHBS hospitals have proven to be
highly adaptable to these changes in health
care delivery. New designs must address these
changes by designing structural bays and
space modules to meet current functional
needs while maintaining a high degree of
adaptability.
VA Medical Center
Bronx, NY, 1980
SUPPLEMENT TO RESEARCH STUDY REPORT
VA HOSPITAL BUILDING SYSTEM
SECTION 3-1
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