E3 – But Wait! There’s More! The Functional Program: Tony Ruebsam 

Introduction

Tony Ruebsam, a self-described “cat herder” in the world of project management, warns John and Bridget that projects that get their start at the drawing board are missing a crucial step. Introduced to the functional program early in his career, Tony shares why he’s a firm believer in starting with the functional program before significant design drawings begin. 

About Tony Ruebsam

Tony Ruebsam is a mechanical engineer who began his career with a construction management company. For the past 12 years, he’s been an owner’s representative for Northstar Management Company. 

In his role as an owner’s representative, Tony acts as the liaison between clinicians and the planning, design, and construction team. His goal is to align project design with the organization’s operational and business objectives.   

Tony joined the HGRC for the 2022 cycle. For the 2026 cycle, he is a member of the Steering Committee and chairs the Emergency Conditions Topic Group.   

 

Acronyms Mentioned 

AHJ: Authority having jurisdiction 

CEO: Chief Executive Officer 

CFO: Chief Financial officer 

HGRC: Health Guidelines Revision Committee 

OR: Operating room 

TAV[R]: Transcatheter aortic valve replacement 

 

Mentioned in this episode

Ken Cates: Guest of episode 2 and the co-founder of Northstar Management Company 

Louis Sullivan: Axiom “Form follows function” 

 

AIA self-reporting LUs

Facility Guidelines Institute is a registered provider of AIA-approved continuing education under Provider Number 38744124. All registered AIA CES Providers must comply with the AIA Standards for Continuing Education Programs. Any questions or concerns about this provider or this learning program may be sent to AIA CES (cessupport@aia.org). 

This learning program may be self-reported for LU credit through the AIA Continuing Education System. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA. 

To receive 1 AIA self-reported LU, learners must listen to and self-report on two FGI podcast episodes.

 

Sponsored by

Northstar Management Company:
Smart Builds Start With Us

 

 

 

Show notes (download transcript)

John Williams 
Honestly, you know, that’s—I think—why the Guidelines took this approach—is to sort of paint a picture for the AHJs and say, “Hey, this is how you can approach a regulatory process and not paint people into corners.” You know, hold people accountable, but not create a one-size-fits-all kind of. . . kind of approach. 

Tony Ruebsam  
For the record, I love all the AHJs. Just. . . let me get that on the record. 

John 
Good. 

Bridget  
That’s the sound bite we’re going to pull out and put at the top.  

[Laughs]  

John  
That’s gonna be perfect.

 

Intro 

Bridget  
Welcome to Between the Lines with FGI, the podcast brought to you by the Facility Guidelines Institute. In this podcast series, we invite you to listen in on casual conversations related to health and residential care design and construction. Coming to you from Washington State, birthplace of Bing Crosby and Kurt Cobain from Nirvana—how’s that for a variety?—is John Williams, FGI’s VP of content and outreach and chair of the 2026 Health Guidelines Revision Committee. 

John  
And coming to you from good old St. Louis, birthplace of both Tums and 7UP, is Bridget McDougall, associate editor with FGI. And we’re both here because when we talk about design and construction of places where people receive care, we’re curious, genuinely curious. And our guess is that you are, too. 

Bridget  
That’s because there is a lot to be curious about under the umbrella of health care design and construction. We have the codes that tell you how to build these spaces, but there’s more there, between the lines, so to speak. And that’s what we’ll be exploring on this podcast with the help of invited guests and you along for the ride. 

John  
So, thanks for finding us, and let’s get ready to read between the lines with FGI. 

 

Who is Tony Ruebsam? 

John  
So, Bridget, last episode we spoke with Ken Cates, and that’s a man who’s been involved with the functional program world for decades. Today, we’re gaining another perspective on the same topic from somebody who’s only been at it for around five years. We’ve invited Tony Ruebsam, senior project manager with Northstar Management Company to join the show. 

Bridget  
Yep, in Tony’s role on small projects or big hospitals that have in-house staff, he helps facilitate a project from a napkin sketch, if that’s how it starts, all the way through to occupancy and beyond by engaging with end users. He brings in users to the table, getting information to the design team, managing the design and construction team, and really to make sure that the end user’s needs and goals are being met through the process. 

John  
Or as he puts it, that’s really a long way to say that he is a cat herder, and he manages a lot of different personalities with different goals and different perspectives. 

Bridget  
Yeah, he also says that, you know, he brings in all the different perspectives. He puts them in a big pot, mixes it up, and creates, in his words, “a stew that everybody’s comfortable enough eating,” right?  

John  
I love that analogy. 

Bridget 
What a great way to put it. Welcome today to Tony Ruebsam.  

 

Welcome, Tony  

Bridget  
Tony, welcome to you. It’s great to have you here. 

Tony  
Thanks for having me. I’m excited. 

Bridget  
We are, too. You know that on Episode 2 we talked to Ken Cates and got a lot of the background of the functional program, so we’re excited to have you here to give us some additional takes. Thanks. 

Tony  
Sure. 

 

What is the functional program? Tony Ruebsam’s take 

Bridget  
Tony, how would you describe the functional program in your words to folks who maybe have never heard of it before? 

Tony  
The functional program is the overarching document that captures all the reasons why, all the reasons how, and what the purpose of a building is. Louis Sullivan’s attributed with a quote that “form follows function,” and there’s no more perfect explanation for what the functional program is—is that the function is the beginning. It’s the genesis and the form and the structure of the space of the building only is there to serve the purpose of the function. So, without a functional program, there is no form, there is no building, there is no need for a building. So, that’s got to be the genesis. 

 

How did you first encounter it?  

John  
So, I’m curious about the origin story here. How did you first encounter the functional program? How did you two meet?  

Tony  
It’s probably been five to six years ago. I kind of knew it was there in the background. I was implementing a functional program, not necessarily involved in developing it. I just figured that there was some work done on the front end and it was well thought out and smart and, you know, I was just there to do it.  

And as I moved my way up in my career, I got brought in more on the front end, and I was able to see how the sausage was being made to use the disgusting metaphor. There was some logic to it, and it started to help me understand why things were designed the way they were and built the way they were is because of that effort on the front end. 

 

Why can’t planning just start with a drawing?  

Bridget  
Did you at all approach it in the beginning with “Why can’t we just start with a drawing?” 

Tony  
Yeah, I don’t wanna pick on designers, but they always just wanna draw something. It’s like, well, wait a minute, you have to understand more about it before you can go drawing it because whatever you draw is not informed. It has to be informed by something.  

John  
Tony, you said something fascinating that I realized that I do all the time, and that’s to open up the drawings and go, “I can make a whole lot of assumptions about how this building works just by looking at these drawings and reading the names on the rooms.” But that’s not where I should start. I mean, it’s still a knee-jerk reaction for me, but it’s that functional program that really helps us understand what the project goal and idea is. 

Tony  
Yeah, and I think it’s intrinsic in our industry, whether you’re a designer, whether you’re an engineer, whether you’re a builder or any other role in our industry, when you come into it early on, you get thrown in, and all you have to go on is a set of drawings. So, we’re introduced to the industry via having a set of drawings first. The reality is that’s not where a project starts. 

I’ve had an opportunity to watch a TAV[R] [transcatheter aortic valve replacement] being performed in a hybrid OR. It was the most fascinating thing I’ve ever seen, and I had somebody there explaining everything that was going on. I could see I need that monitor there. I need this piece of equipment here. I need that nurse to be able to walk over here and touch this button. So, it’s getting that front line experience, talking to the people, learning how they operate that is way more informative than anything you can do outside of the actual place it happens. 

 

What questions did you initially have? 

Bridget  
So, when you started off, what kind of questions did you have about the functional program?  

Tony  
Let’s start with “Why is this important?” There was a lot of the times where we’re like, “Why are we trying to capture this level of detail? Why do we need to know where they’re gonna store this, that or the other, or why that room needs to be next to that one?”  

It became more and more evident that it was important to go to the front line, if you will, and find out operationally how things were going to be used. And that was the important thing. It wasn’t talking to a CFO about keeping the project cost down or talking to the contractors trying to keep costs down, it was like, how’s the space gonna be used and how do I make it most efficient for you? It needs to be a functional space. It’s gotta work. 

 

Why do people struggle with it? 

John  
A lot of people struggle putting together functional programs. I hear this from designers, I hear this from facilities. Why is that?  

Tony  
It’s not an easy task and people see it as burdensome. They don’t necessarily see the value in it because all you’re doing is writing down what I do day to day. It’s not important to me to share that with you. I just do what I do. But the more you give me about your day to day, the better of a building I can design and make for you.  

 

How do you help people get started? 

John  
So, when you go into this process, do you use a set of tools, like a set of prompts or questions to get people started? Do you start with kind of like an example and say, hey, look at this functional program that somebody else wrote, what’s your approach? 

Tony  
Ideally, my first step is to go walk and breathe and live in their space. This is walk me through your space: point out what you don’t like, point out what you do like, point out what you got to have, point out what you don’t necessarily need to have. And then we start to talk a little bit more about, you know, the nuts and bolts, the operational functionality of their space. 

Honestly, the biggest lesson learned that people need to understand when they go through this process is the people you’re sitting in the room with and you’re asking for their time, it’s really valuable time. And the best thing you can do is be efficient with it. 

 

Who does it start with? 

Bridget  
The functional program starts with who? Who’s person number one that has their brain on it or eyes on it or a hand on the pen or pencil or keyboard? 

Tony  
Ideally or typically?  

Bridget  
Both. How about both? 

John  
Both. 

Tony  
Both, both. Well, ideally, it’s somebody in the program manager’s role like me, but it’ll start with the facility itself. And it needs to [be] because they’re the ones that understand the function. Too often, it falls in the hands of the architect. If the owner of the building doesn’t take the onus, then, you know, the architect’s left starting the process and developing it.   

Ideally, it’s the owner because they know it will be more information. They’re the ones who are gonna provide the information. Really, you want it to be in the hands of the owner. 

 

Do you help with the writing process? 

John  
People who typically work as clinicians or CEOs, CFOs aren’t writers. So, they need somebody to help shepherd them through that writing process. Is that something that you do? 

Tony  
So, the writing portion, yes. Typically the people that are put in charge of the narrative portion aren’t the best of writers. So, we try to identify a strong writer that can communicate narratively what the functional program is.  

I am responsible at times for some portions of that narrative, but when it comes down to developing specifics about the functions and the operations, what we tend to do is lean on our clinicians. 

 

Exam room? Procedure room? Operating Room? What’s the functional program’s role in making determinations? 

Bridget  
So, what kind of rooms do we need? Who answers that? And what’s a functional program’s role in determining that?  

Tony  
I . . . we ask them. I’m not a clinician, I’m not a nurse, I’m not a doctor, I have no idea. You tell me how you operate, and I’ll provide the space for you to do it. I’m not gonna tell you . . . I’m not the expert here. I’m on the design and construction side. You’re the people that are using the space. 

Bridget 
So, back to why you need to have so many different folks involved in the functional program process, right? Because it’s the experts that are . . . the clinicians that are in that space doing those types of procedures or operations. Those are the folks you want to hear from when determining what kind of rooms you need to have. Yeah? Got it. 

Tony  
Absolutely. I go in as a blank slate. I go in knowing nothing. It’s “Tell me how you do it, and we’ll build you a space to support that.” You know, form follows function. It’s the crux. It’s the basis of everything. 

 

How do AHJs use it? 

John  
All right, so let’s say we get the right people around the table; we have great conversations; you embed in the facility; and you know what their needs and wants are; and we do a really good job of documenting it. Then you take that to the AHJ. From your experience, how do you see AHJs using the functional program? 

Tony  
That varies. For some, it’s a box to check. Other times there are those that wanna understand it and look at it.  

Really, what I wanna say is it comes in with variances or exceptions. It’s “I see what the Guidelines says. I see what they recommend. We have an operational model that doesn’t necessarily agree with that. And I think we can do things differently.” The functional program is your ability to explain that—to show to the AHJ, “Hey, we do things a little differently, and here’s our justification. Do you agree that we don’t need to meet the stringent requirement because we do things this way? We’re still meeting the intent of the Guidelines, but we do it in a different way.”  

And it gives the AHJ a chance to look at that and consider it and say, “Yeah, you know what? I’m going to grant you that exemption.” It’s a conversation starter. And it’s a way to document and justify it so that the AHJ can get it really succinctly and not have to go down the rabbit hole with all the information that it took to develop it. 

Bridget  
AHJ John Williams, what’s your reaction to what Tony just shared? 

John  
I love how you described it as a conversation starter. I think that the Guidelines has had a really good history of recognizing that health care is complex. It moves fast. And different people mitigate risks inside of the environment in a multitude of ways. 

So, if I can go to a functional program and I can understand, yes, they’re just not ignoring the Guidelines or the requirements. They’ve talked about it. They recognize the risk, and they understand a way of providing an equivalent level of safety or mitigating that risk. And you document that? And you show me there? You’re taking me down that path. You’re telling me the story and it helps me get to that decision point a lot quicker. 

Tony  
John, are you available to go work in every state in the Union?  

Bridget/John  
[laugh] 

 

Cautionary tales for new folks 

Bridget  
Tony, regarding your early days with the functional program, do you have any cautionary tales for new folks that might be starting out? 

Tony  
I’m not gonna necessarily give an example of a cautionary tale. I will give advice. Don’t be frightened of it. It is a valuable tool. The more you understand operations and how things work, the more value you will see in it. So, don’t discount it. Don’t push it off to the side and think it’s another set of paperwork—you know, embrace it, learn as much as you can.  

And like I said, the most valuable thing I’ve done is actually gotten in the middle of it—not necessarily gotten my hands dirty, but seeing others get their hands dirty and understand how things actually work. And that the value of that is immeasurable.  

 

Wrap up/Goodbye 

John  
Tony, that’s some great advice. And I feel like you have just taken us through this process where we’re seeing where the tires hit the road. I’m smelling burning rubber here where you are describing how to make this happen. 

Tony  
That’s just people getting away from me as fast as they can in their cars.  

[All laugh] 

Bridget  
Thanks, Tony. We cannot thank you enough for being here and taking time with us today. We appreciate having you as a guest on our podcast. 

John  
And thanks for all your leadership in the HGRC. 

Tony  
Yeah. No, appreciate it. Thank you guys. It was a lot of fun.