Health Care Presentation December 2009 (alligator Lasagna)
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AIA Los Angeles, Committee on Architecture for Health
From Alligator Lasagna to Evidence Based Design Presenters: John John Grounds, Grounds, AIA, AIA, LEED LEED AP AP Carlos Carlos Amato, Amato, AIA, AIA, ACHA, ACHA, EDAC, EDAC, LEED LEED AP AP RBB RBB Architects Architects In. In. November November 18, 18, 2009 2009
What is HCD09? • • • • • •
•
The most comprehensive HEALTHCARE DESIGN Conference Over 1000 attendees (4000 last year) Over 60 educational sessions 59 interactive roundtable discussion groups 11 state-of-the-art facility tours 9 pre-conference workshops Keynote Speakers: Michael Graves, FAIA, Blair L. Sadler, JD President Emeritus of the Rady Children's Hospital & Health Center and Christine Malcolm Exhibit Hall with 300 vendors
Learning Objectives 1. 2. 3. 4. 5.
Trends for 2010 Innovation Facility Tours Highlights Q/A
Oh Yeah! And what about the alligator?
Trends for 2010
6 Megatrends for 2010 1. 2. 3. 4. 5. 6.
Safety / Quality Revolution Baby Boomers Mandated Satisfaction Scores Paying for Value Evidence Based Design Stimulus Funds
Safety and Quality Revolution 1. “Never Events” - Nosocomial infections, hospital caused readmissions, wrong surgery, wrong medication. - Federal mandate spreading to private care 2. PHAMA & PHAMP in 2010 Guidelines - Immobility related adverse - Staff Injuries. - Technology isn’t the answer. 3. Medication monitoring & delivery 4. Everything is on-line
Boomers • By 2020 over 16% of U.S. population will be over 65 (compared to 12% in 2007). • Rationale for much of current healthcare expansion, but… Not all aging populations have an equal need for healthcare. Many do not have an increased need for inpatient care. Roemer’s law of demand: “Supply may induce its own demand where a third party practically guarantees reimbursement of usage.”
Mandated Satisfaction Scores • Increasingly a motivator of usage and a critical component of hospital evaluation/marketing. • Design implications in point of discharge, waiting areas, ED. • Is a perception of quality becoming more important than actual outcomes?
Paying for Value • New concept in the reimbursement to hospitals and physicians: value-based purchasing or pay for performance
• Will impact business case for quality improvement • P4P changes physician behavior, ultimately leading to improved quality of care • Emphasis so far has been on Medicare patients • Medicaid and commercial payers will follow
Growth of Evidence Defining Evidence-Based Design • Evidence-based design is the deliberate attempt to:
•
Base Base building building decisions decisions on on the the best best available available evidence evidence Achieve Achieve the the best best possible possible outcomes outcomes for for patients, patients, families families and and staff staff Improve Improve the the utilization utilization of of resources resources
It is becoming integral to “the process”
Clients Clients expect expect design design professionals professionals to to be be aware aware of of latest latest information information and and active active participants participants in in developing developing new new data data Research Research is is becoming becoming pro-active. pro-active. Patient-based Patient-based evidence evidence is is emerging. emerging. Post Post occupancy occupancy evaluation evaluation is is key. key.
Growth of Evidence •• 1. 1.
Ten Key Steps to Implement Evidence-Based Evidence-Based Design: Design:
Create Create aa multidisciplinary multidisciplinary team & develop a clear vision that includes includes measurable measurable quality quality improvement improvement goals goals 2. 2. Select Select an an architect architect with with experience experience in in evidence-based evidence-based design design & & aa proven proven track track record record of of at at least least one one successful successful healthcare healthcare project project 3. 3. Identify Identify & & select select evidence-based evidence-based design design interventions interventions 4. 4. Evaluate Evaluate current current practice practice and and develop develop aa baseline baseline for for each, each, e.g. e.g. infections, infections, transfers, transfers, employee employee turnover turnover (develop (develop baseline baseline costs) costs) 5. 5. Set Set measurable measurable post post occupancy occupancy improvement improvement targets targets & & get get buy buy in in from from all all key key stakeholders stakeholders –– culture culture change change 6. 6. Incorporate Incorporate design design improvements improvements into into capital capital & & operating operating budgets budgets approved approved by by the the board board 7. 7. Widely Widely communicate communicate improvement improvement targets targets internally internally & & externally externally 8. 8. Track and report progress including including Financial Financial 9. 9. Continually Continually incorporate incorporate new new evidence evidence based based design design strategies strategies 10. 10. Publish your results!
Stimulus Funds • 9 months after the signing of the American Recovery & Reinvestment Act, the federal government continues to make progress on several health care provisions included in the federal stimulus package.
Health IT Medicaid/FMAP Work Force Training and Development Broadband Community Health Centers Rural Health Prevention and Wellness & Comparative Effectiveness Research
10 New Rules 10. 10. Better Buildings Cost less over time -- Life Life cycle cycle vs. vs. initial initial costs costs -- 5% 5% initial initial cost cost investment investment typically typically repaid repaid within within 33 years. years. 9. 9.
Become Become Bi Bi Multi-Lingual Multi-Lingual -- Design Design Professionals Professionals are are learning learning to to speak speak the the same same language language as as Clinicians/Care Clinicians/Care Givers. Givers. -- Clinicians/Design Clinicians/Design Professionals Professionals need need to to speak speak the the same same language language as as Administrators/Finance Administrators/Finance Officers. Officers. -- Administrators/Finance Administrators/Finance Officers Officers need need to to speak speak the the same same language language as as Staff/Care Staff/Care Givers. Givers. -- Everyone Everyone needs needs to to learn learn to to hear hear the the patient. patient.
8. 8.
Move Move from from Silos Silos to to Synergy Synergy -- Seek Seek out out holistic holistic solutions. solutions. -- Facilitate Facilitate multi-disciplinary multi-disciplinary care. -- Remove Remove walls walls between between “departments”. “departments”. -- Facilitate Facilitate adaptable adaptable care care environments. environments.
10 New Rules 7.
Embrace Radical Transparency - Consumers trust peer recommendations. - Everything is available on-line. - Accept/Admit/Own mistakes and actively seek improvement.
6.
Anticipate Disruptive Innovation - New product, technology or service that emerges and changes a marketplace. i.e.: Ipod
5.
Create an Environment of Care that people really, REALLY want.
10 New Rules 4. Meet and Exceed EXPECTATIONS, not just standards - Competitiveness is about what customers value, not what you are good at. - Spaces are not passive containers. 3. Move healthcare off life support - The “Machine for Healing” is an obsolete concept. 2. Become an Early Adopter.
10 New Rules 1. It’s about best NEXT practice - “Healthcare is not an end, but a means. In and of itself it has no value.” Don Barwick - “Skate to where the puck is going, not to where it is.” Wayne Gretsky
Innovations
Innovations in Healthcare Delivery
IT’S IT’S OKAY OKAY TO TO CHEAT, CHEAT, IF IF YOU YOU REALLY REALLYDON’T DON’T LIKE LIKE TO TO LOSE LOSE
Innovations in Healthcare Delivery • The Hospital of the Future isn’t What You Think It Is Part of a distributed healthcare delivery system Smaller Far less costly Sustainable Part of a larger healthcare reform movement Resource effective, utilization proportionate
Innovations in Healthcare Delivery • The Distributed Hospital Proposal by the Advisory Board Company Inpatient 10% versus Ambulatory 90% • • • • •
Broadening access points. Freestanding ED. Short-stay hospitals. Specialty hospitals. Specialization around key services.
Innovations in Healthcare Delivery • Hospital at Home Pioneered by Johns Hopkins in 1996 Discharge from ED to transport home with nurse/MD. MD/Nurse visit daily until discharge. Statistically significant reductions in cost and ALOS. Limited diagnosis eligibility results in negligible impact on overall inpatient days. UPS !!!! OK-- UPS OOK HO CALL H GICA SSUR URGI
Innovations in Healthcare Delivery • Wearable Hospital VA uses telehealth equipment placed in the home to communicate with 35,500 patients. Current system requires patient activation to send data. Dartmouth received $3m grant to develop systems for monitoring by cell phone and wearable sensors. “Swallow the Surgeon”
“Honey, I Shrunk the Hospital”
Courtesy: Angela Burke, NBBJ Architects
Nanomedicine ••
Scientists Scientists are are working working now now to to create create nanostructures nanostructures that that serve serve as as new new kinds kinds of of drugs drugs for for treating treating cancer, cancer, to to engineer engineer nanomaterials nanomaterials for for use use as as artificial artificial tissues tissues that that would would replace replace diseased diseased kidneys kidneys and and livers, livers, and and even repair nerve damage, and to integrate nanodevices with the even repair nerve damage, and to integrate nanodevices with the nervous nervous system system to to create create implants implants that that restore restore vision vision and and hearing, hearing, and and build build new new prosthetic prosthetic limbs limbs
•• ••
Nanomedicine: Nanomedicine: Future Future Applications: Applications: The The elimination elimination of of bacterial bacterial infection infection in in aa patient patient within within minutes, minutes, instead instead of of using using treatment treatment with with antibiotics antibiotics over over aa period period of of weeks. weeks. The The ability ability to to perform perform surgery surgery at at aa cellular cellular level, level, removing removing individual individual diseased diseased cells cells and and even even repairing repairing defective defective portions portions of of individual individual cells. cells. Qdots: Qdots: that that identify identify the the location location of of cancer cancer cells cells in in the the body body Nanoparticles: Nanoparticles: that that deliver deliver chemotherapy chemotherapy drugs drugs directly directly to to cancer cancer cells cells to minimize damage to healthy cells. to minimize damage to healthy cells. Nanoshells: Nanoshells: that that concentrate concentrate the the heat heat from from infrared infrared light light to to destroy destroy cancer cancer cells cells with with minimal minimal damage damage to to surrounding surrounding healthy healthy cells. cells. For For aa good good visual visual explanation explanation of of nanoshells, nanoshells, see see the the picture picture below. below. Considering Considering the the rapid rapid progress progress in in this this field field itit is is hoped hoped that that nanotechnology nanotechnology will will soon soon be be aa huge huge force force against against diseases diseases in in the the coming days and it will help in wiping away the most lethal diseases coming days and it will help in wiping away the most lethal diseases in in the the current current era. era.
•• •• •• •• ••
Nanomedicine
Courtesy: Angela Burke, NBBJ Architects
Nanotechnology
Courtesy: Angela Burke, NBBJ Architects
Robotics •• Medical and Non-Medical Robots
Courtesy: Angela Burke, NBBJ Architects
Robotics
Courtesy: Angela Burke, NBBJ Architects
Robotics
Courtesy: Angela Burke, NBBJ Architects
Robotics
Courtesy: Angela Burke, NBBJ Architects
Robotics
Courtesy: Angela Burke, NBBJ Architects
Robotics
Courtesy: Angela Burke, NBBJ Architects
Nano-Robotics
Courtesy: Angela Burke, NBBJ Architects
Innovations in Healthcare Delivery • Cellular care delivery
If a hospital is a set of interrelated activities intended to produce an outcome, then all activities could be configured into multi-disciplinary care cells capable of delivering milestone outcomes in the care pathway. Break-down silos (departments). Deliver care to patient, don’t bring patient to care. Organize line of service around patient need: •• •• •• ••
Intake/Diagnosis Interventional Services Inpatient Services Administrative Services
Adaptable Environments
Innovations in Healthcare Delivery • Other innovative disruptors Globalization and Medical Tourism. Real time video communications. •• Telemedicine & E-ICUs.
Universally accessible electronic health records. Express care clinics. Drive Thru?... LEAN •• •• •• •• ••
Collaborate, really collaborate. Optimize the whole, not the pieces. Develop a network of commitments. Tightly couple learning with action. Increase participant relatedness.
Innovations in Healthcare DESIGN • How do we (planners & architects) fit in? Seek Seek to to design design and and build build less less expensive expensive facilities. facilities. Design Design facilities facilities that that are are efficient efficient to to use use and and access, access, and and cost cost less less to to operate. operate. Design Design facilities facilities that that make make life life easier easier for for caregivers caregivers and and healthier healthier for for patients. patients.
• Where can we contribute? Be Be the the expert expert source source
•• Clients Clients need need architects architects and and planners planners to to be be smarter, smarter, better better informed, active participants in developing new concepts informed, active participants in developing new concepts of of healthcare delivery. healthcare delivery.
Adopt Adopt healthcare healthcare practices. practices. •• •• •• ••
Make Make decisions decisions with with provable provable basis. basis. (Evidence (Evidence Based Based Design) Design) Seek Seek out out user user satisfaction satisfaction data. data. Publish Publish your your results. results. Constantly Constantly incorporate incorporate new new evidence. evidence.
Drink Drink from from the the Running Running Brook. Brook.
Facility Tours
Tampa General – Bayshore Pavilion • Only Level 1 Trauma in Central Florida
Architect: Gresham Smith & Partners
Tampa General – Bayshore Pavilion •
Design Drivers / Highlights: ED Trauma Center: Hurricane Resistant 140 mph wind resistant structure Incorporated PROJECT ER One Principles Scalability for Surge Capacity Dual use of non clinical space Isolation Rooms pod Tier Triage model
Architect: Gresham Smith & Partners
ER One Goals and Objectives The The creation creation of of aa specialized specialized emergency emergency facility facility at at Washington Washington Hospital Hospital Center, Center, already already home home to to Washington’s Washington’s largest largest trauma trauma center, center, emergency emergency department, department, burn burn center, center, and and critical critical care care facility, will address key needs in the region and across the facility, will address key needs in the region and across the nation. nation. ER ER One One will: will: Provide Provide unique unique emergency emergency care care and and response response capability capability designed designed to respond to a full range of threats in the Washington area to respond to a full range of threats in the Washington area and and substantially substantially augment augment the the response response capability capability of of the the National National Capital Capital Region; Region; Serve Serve as as aa model model and and demonstration demonstration facility facility for for other other emergency emergency centers centers in in metropolitan metropolitan areas areas vulnerable vulnerable to to mass mass casualty casualty events; events; and and Become Become aa resource resource for for emergency emergency preparedness preparedness that that will will offer offer ongoing ongoing education education and and training training programs programs nationwide nationwide
•• Robust scalability, Specialized capability to handle contagious and and contaminating contaminating illness illness and and injury, injury, and and security security protection protection from from becoming becoming aa target target of of an an attack attack
Features/Services of ER One Accommodate up to 2,500 patients per day (scaling up from 250/day during routine operations); Accommodate up to 100 critical care patients per day (20/day routinely); Have all rooms equipped with negative pressure isolation with 100% non-recirculated air; Offer decontamination capabilities in many forms throughout the facility; Provide stringent screening controls to protect hospital workers and patients; Deploy a universal patient tracking and ubiquitous information system; Offer comprehensive internal and external communications systems.
Tampa General – Bayshore Pavilion •
Stats: Only 6 feet above sea level, 30’ from sea 998 bed Tertiary Hospital 6 story addition, 340,000 SF with 64,500 SF ED. Completed 2008
Architect: Gresham Smith & Partners
Tampa General – Bayshore Pavilion
Tampa General – Bayshore Pavilion
Architect: Gresham Smith & Partners
Tampa General – Bayshore Pavilion
Architect: Gresham Smith & Partners
Tampa General – Bayshore Pavilion
Architect: Gresham Smith & Partners
TGH – Innovative Design Features
Architect: Gresham Smith & Partners
TGH – Innovative Design Features
Architect: Gresham Smith & Partners
Tampa General – Bayshore Pavilion •
Lessons Learned:
Additional Additional upfront upfront costs costs will pay off Overdesigned Overdesigned for for day day to to day day use use Trauma Trauma == Controlled Controlled “Evidence “Evidence Based Based Chaos” Chaos” no no matter matter how how much much space space you you have have Storage, Storage, Storage, Storage, There There is is never never enough… enough… Hospitality Hospitality feel feel Form Form follows follows function function ?? Absolutely! Absolutely! Apply Apply Evidence Evidence Based Based Design Design concepts concepts
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital - Ginsburg Tower •
Design Drivers / Highlights:
“Visually “Visually Arresting” Arresting” “Recognition “Recognition of of Soul Soul and and Spirit Spirit of of Location” Location” Second Second Opinion Opinion Process Process (Hospitality, (Hospitality, Hotel Hotel design, design, Walt Walt Disney Disney Entertainment, Entertainment, The The Center Center for for Health Health Design, Design, environmental environmental psychologists, ambient ambient environments, environments, clinical, clinical, systems, systems, and and specialized specialized HC HC designers designers with with expertise expertise in in Emergency, Emergency, CV CV services services and and EBD. EBD.
Hunton Brady Architects
Florida Hospital - Ginsburg Tower •
Stats: $163 Million, 656,000 SF expansion ($250 / SF 15 Story Building 6 Shelled floors (Overall building flexibility) New pkg garages for over 1,700 cars New Central Plant 50 Bed ED, with dedicated Peds ED 160 seat conference auditorium 440 private beds with CV focus Hunton Brady Architects
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital - Ginsburg Tower
EBD notes: Staff lounge, is at the midpoint of the floor Round Spire at the end of the tower is a Conference / Education Rm.
Hunton Brady Architects
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital – Design Innovation
Hunton Brady Architects
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital - Ginsburg Tower •
Lessons Learned: FL dollars go a longer way than they do in CA (Any guesses as to why?) Ode to thy public spaces Implement a real Art program Hospitality feel to the max Think long term Capitalize on ext. and int. first impression Embrace the contrarians or “Two minds are always better than one”
Florida Hospital – Memorial Medical Center Design Drivers: • • • • • •
Maximize vertical design expression Strong physician accessibility Integrate views of nature Flexible nursing units Future growth Greenfield site Hunton Brady Architects
Florida Hospital – Memorial Medical Center
•
Stats: $170 Million, 600,000 SF ($280 / SF) New 12 Story Facility Structure designed for vertical expansion •
Additional 8 story tower with 300 beds
135 acre Greenfield site 277 Beds, 82 critical care Connected 5 story MOB
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
First Floor
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Second Floor
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Third Floor
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Fourth Floor
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Fifth Floor
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Patient Floors
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Administration
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
•
Lessons Learned: Iconic design statements have value Cost savings is not a substitute for smart design Advanced technology may be optional Need to Embrace the Contrarians
Take Away Concepts
Questions?
Selected References • • • • • •
HCD09 Conference Proceedings Blair L. Sadler, JD, Healthcare Estates Welsh Conference & Exhibition Exhibition 2004 2004 Angela Burke, 2030 2030 Nanotechnology Nanotechnology in in hospitals: hospitals: Is Is the the future future smaller?, smaller?, NBBJ NBBJ Architects Architects Gary Burke and Terrie Terrie Kurrasch, Kurrasch, Ratcliff Ratcliff Architects Architects David Chambers, Sutter Healthcare Nanotechnology, nanomedicine and nanosurgery. International Journal of Surgery (2005)
RBB ARCHITECTS INC
From Alligator Lasagna to Evidence Based Design Presenters: John John Grounds, Grounds, AIA, AIA, LEED LEED AP AP Carlos Carlos Amato, Amato, AIA, AIA, ACHA, ACHA, EDAC, EDAC, LEED LEED AP AP RBB RBB Architects Architects In. In. November November 18, 18, 2009 2009
What is HCD09? • • • • • •
•
The most comprehensive HEALTHCARE DESIGN Conference Over 1000 attendees (4000 last year) Over 60 educational sessions 59 interactive roundtable discussion groups 11 state-of-the-art facility tours 9 pre-conference workshops Keynote Speakers: Michael Graves, FAIA, Blair L. Sadler, JD President Emeritus of the Rady Children's Hospital & Health Center and Christine Malcolm Exhibit Hall with 300 vendors
Learning Objectives 1. 2. 3. 4. 5.
Trends for 2010 Innovation Facility Tours Highlights Q/A
Oh Yeah! And what about the alligator?
Trends for 2010
6 Megatrends for 2010 1. 2. 3. 4. 5. 6.
Safety / Quality Revolution Baby Boomers Mandated Satisfaction Scores Paying for Value Evidence Based Design Stimulus Funds
Safety and Quality Revolution 1. “Never Events” - Nosocomial infections, hospital caused readmissions, wrong surgery, wrong medication. - Federal mandate spreading to private care 2. PHAMA & PHAMP in 2010 Guidelines - Immobility related adverse - Staff Injuries. - Technology isn’t the answer. 3. Medication monitoring & delivery 4. Everything is on-line
Boomers • By 2020 over 16% of U.S. population will be over 65 (compared to 12% in 2007). • Rationale for much of current healthcare expansion, but… Not all aging populations have an equal need for healthcare. Many do not have an increased need for inpatient care. Roemer’s law of demand: “Supply may induce its own demand where a third party practically guarantees reimbursement of usage.”
Mandated Satisfaction Scores • Increasingly a motivator of usage and a critical component of hospital evaluation/marketing. • Design implications in point of discharge, waiting areas, ED. • Is a perception of quality becoming more important than actual outcomes?
Paying for Value • New concept in the reimbursement to hospitals and physicians: value-based purchasing or pay for performance
• Will impact business case for quality improvement • P4P changes physician behavior, ultimately leading to improved quality of care • Emphasis so far has been on Medicare patients • Medicaid and commercial payers will follow
Growth of Evidence Defining Evidence-Based Design • Evidence-based design is the deliberate attempt to:
•
Base Base building building decisions decisions on on the the best best available available evidence evidence Achieve Achieve the the best best possible possible outcomes outcomes for for patients, patients, families families and and staff staff Improve Improve the the utilization utilization of of resources resources
It is becoming integral to “the process”
Clients Clients expect expect design design professionals professionals to to be be aware aware of of latest latest information information and and active active participants participants in in developing developing new new data data Research Research is is becoming becoming pro-active. pro-active. Patient-based Patient-based evidence evidence is is emerging. emerging. Post Post occupancy occupancy evaluation evaluation is is key. key.
Growth of Evidence •• 1. 1.
Ten Key Steps to Implement Evidence-Based Evidence-Based Design: Design:
Create Create aa multidisciplinary multidisciplinary team & develop a clear vision that includes includes measurable measurable quality quality improvement improvement goals goals 2. 2. Select Select an an architect architect with with experience experience in in evidence-based evidence-based design design & & aa proven proven track track record record of of at at least least one one successful successful healthcare healthcare project project 3. 3. Identify Identify & & select select evidence-based evidence-based design design interventions interventions 4. 4. Evaluate Evaluate current current practice practice and and develop develop aa baseline baseline for for each, each, e.g. e.g. infections, infections, transfers, transfers, employee employee turnover turnover (develop (develop baseline baseline costs) costs) 5. 5. Set Set measurable measurable post post occupancy occupancy improvement improvement targets targets & & get get buy buy in in from from all all key key stakeholders stakeholders –– culture culture change change 6. 6. Incorporate Incorporate design design improvements improvements into into capital capital & & operating operating budgets budgets approved approved by by the the board board 7. 7. Widely Widely communicate communicate improvement improvement targets targets internally internally & & externally externally 8. 8. Track and report progress including including Financial Financial 9. 9. Continually Continually incorporate incorporate new new evidence evidence based based design design strategies strategies 10. 10. Publish your results!
Stimulus Funds • 9 months after the signing of the American Recovery & Reinvestment Act, the federal government continues to make progress on several health care provisions included in the federal stimulus package.
Health IT Medicaid/FMAP Work Force Training and Development Broadband Community Health Centers Rural Health Prevention and Wellness & Comparative Effectiveness Research
10 New Rules 10. 10. Better Buildings Cost less over time -- Life Life cycle cycle vs. vs. initial initial costs costs -- 5% 5% initial initial cost cost investment investment typically typically repaid repaid within within 33 years. years. 9. 9.
Become Become Bi Bi Multi-Lingual Multi-Lingual -- Design Design Professionals Professionals are are learning learning to to speak speak the the same same language language as as Clinicians/Care Clinicians/Care Givers. Givers. -- Clinicians/Design Clinicians/Design Professionals Professionals need need to to speak speak the the same same language language as as Administrators/Finance Administrators/Finance Officers. Officers. -- Administrators/Finance Administrators/Finance Officers Officers need need to to speak speak the the same same language language as as Staff/Care Staff/Care Givers. Givers. -- Everyone Everyone needs needs to to learn learn to to hear hear the the patient. patient.
8. 8.
Move Move from from Silos Silos to to Synergy Synergy -- Seek Seek out out holistic holistic solutions. solutions. -- Facilitate Facilitate multi-disciplinary multi-disciplinary care. -- Remove Remove walls walls between between “departments”. “departments”. -- Facilitate Facilitate adaptable adaptable care care environments. environments.
10 New Rules 7.
Embrace Radical Transparency - Consumers trust peer recommendations. - Everything is available on-line. - Accept/Admit/Own mistakes and actively seek improvement.
6.
Anticipate Disruptive Innovation - New product, technology or service that emerges and changes a marketplace. i.e.: Ipod
5.
Create an Environment of Care that people really, REALLY want.
10 New Rules 4. Meet and Exceed EXPECTATIONS, not just standards - Competitiveness is about what customers value, not what you are good at. - Spaces are not passive containers. 3. Move healthcare off life support - The “Machine for Healing” is an obsolete concept. 2. Become an Early Adopter.
10 New Rules 1. It’s about best NEXT practice - “Healthcare is not an end, but a means. In and of itself it has no value.” Don Barwick - “Skate to where the puck is going, not to where it is.” Wayne Gretsky
Innovations
Innovations in Healthcare Delivery
IT’S IT’S OKAY OKAY TO TO CHEAT, CHEAT, IF IF YOU YOU REALLY REALLYDON’T DON’T LIKE LIKE TO TO LOSE LOSE
Innovations in Healthcare Delivery • The Hospital of the Future isn’t What You Think It Is Part of a distributed healthcare delivery system Smaller Far less costly Sustainable Part of a larger healthcare reform movement Resource effective, utilization proportionate
Innovations in Healthcare Delivery • The Distributed Hospital Proposal by the Advisory Board Company Inpatient 10% versus Ambulatory 90% • • • • •
Broadening access points. Freestanding ED. Short-stay hospitals. Specialty hospitals. Specialization around key services.
Innovations in Healthcare Delivery • Hospital at Home Pioneered by Johns Hopkins in 1996 Discharge from ED to transport home with nurse/MD. MD/Nurse visit daily until discharge. Statistically significant reductions in cost and ALOS. Limited diagnosis eligibility results in negligible impact on overall inpatient days. UPS !!!! OK-- UPS OOK HO CALL H GICA SSUR URGI
Innovations in Healthcare Delivery • Wearable Hospital VA uses telehealth equipment placed in the home to communicate with 35,500 patients. Current system requires patient activation to send data. Dartmouth received $3m grant to develop systems for monitoring by cell phone and wearable sensors. “Swallow the Surgeon”
“Honey, I Shrunk the Hospital”
Courtesy: Angela Burke, NBBJ Architects
Nanomedicine ••
Scientists Scientists are are working working now now to to create create nanostructures nanostructures that that serve serve as as new new kinds kinds of of drugs drugs for for treating treating cancer, cancer, to to engineer engineer nanomaterials nanomaterials for for use use as as artificial artificial tissues tissues that that would would replace replace diseased diseased kidneys kidneys and and livers, livers, and and even repair nerve damage, and to integrate nanodevices with the even repair nerve damage, and to integrate nanodevices with the nervous nervous system system to to create create implants implants that that restore restore vision vision and and hearing, hearing, and and build build new new prosthetic prosthetic limbs limbs
•• ••
Nanomedicine: Nanomedicine: Future Future Applications: Applications: The The elimination elimination of of bacterial bacterial infection infection in in aa patient patient within within minutes, minutes, instead instead of of using using treatment treatment with with antibiotics antibiotics over over aa period period of of weeks. weeks. The The ability ability to to perform perform surgery surgery at at aa cellular cellular level, level, removing removing individual individual diseased diseased cells cells and and even even repairing repairing defective defective portions portions of of individual individual cells. cells. Qdots: Qdots: that that identify identify the the location location of of cancer cancer cells cells in in the the body body Nanoparticles: Nanoparticles: that that deliver deliver chemotherapy chemotherapy drugs drugs directly directly to to cancer cancer cells cells to minimize damage to healthy cells. to minimize damage to healthy cells. Nanoshells: Nanoshells: that that concentrate concentrate the the heat heat from from infrared infrared light light to to destroy destroy cancer cancer cells cells with with minimal minimal damage damage to to surrounding surrounding healthy healthy cells. cells. For For aa good good visual visual explanation explanation of of nanoshells, nanoshells, see see the the picture picture below. below. Considering Considering the the rapid rapid progress progress in in this this field field itit is is hoped hoped that that nanotechnology nanotechnology will will soon soon be be aa huge huge force force against against diseases diseases in in the the coming days and it will help in wiping away the most lethal diseases coming days and it will help in wiping away the most lethal diseases in in the the current current era. era.
•• •• •• •• ••
Nanomedicine
Courtesy: Angela Burke, NBBJ Architects
Nanotechnology
Courtesy: Angela Burke, NBBJ Architects
Robotics •• Medical and Non-Medical Robots
Courtesy: Angela Burke, NBBJ Architects
Robotics
Courtesy: Angela Burke, NBBJ Architects
Robotics
Courtesy: Angela Burke, NBBJ Architects
Robotics
Courtesy: Angela Burke, NBBJ Architects
Robotics
Courtesy: Angela Burke, NBBJ Architects
Robotics
Courtesy: Angela Burke, NBBJ Architects
Nano-Robotics
Courtesy: Angela Burke, NBBJ Architects
Innovations in Healthcare Delivery • Cellular care delivery
If a hospital is a set of interrelated activities intended to produce an outcome, then all activities could be configured into multi-disciplinary care cells capable of delivering milestone outcomes in the care pathway. Break-down silos (departments). Deliver care to patient, don’t bring patient to care. Organize line of service around patient need: •• •• •• ••
Intake/Diagnosis Interventional Services Inpatient Services Administrative Services
Adaptable Environments
Innovations in Healthcare Delivery • Other innovative disruptors Globalization and Medical Tourism. Real time video communications. •• Telemedicine & E-ICUs.
Universally accessible electronic health records. Express care clinics. Drive Thru?... LEAN •• •• •• •• ••
Collaborate, really collaborate. Optimize the whole, not the pieces. Develop a network of commitments. Tightly couple learning with action. Increase participant relatedness.
Innovations in Healthcare DESIGN • How do we (planners & architects) fit in? Seek Seek to to design design and and build build less less expensive expensive facilities. facilities. Design Design facilities facilities that that are are efficient efficient to to use use and and access, access, and and cost cost less less to to operate. operate. Design Design facilities facilities that that make make life life easier easier for for caregivers caregivers and and healthier healthier for for patients. patients.
• Where can we contribute? Be Be the the expert expert source source
•• Clients Clients need need architects architects and and planners planners to to be be smarter, smarter, better better informed, active participants in developing new concepts informed, active participants in developing new concepts of of healthcare delivery. healthcare delivery.
Adopt Adopt healthcare healthcare practices. practices. •• •• •• ••
Make Make decisions decisions with with provable provable basis. basis. (Evidence (Evidence Based Based Design) Design) Seek Seek out out user user satisfaction satisfaction data. data. Publish Publish your your results. results. Constantly Constantly incorporate incorporate new new evidence. evidence.
Drink Drink from from the the Running Running Brook. Brook.
Facility Tours
Tampa General – Bayshore Pavilion • Only Level 1 Trauma in Central Florida
Architect: Gresham Smith & Partners
Tampa General – Bayshore Pavilion •
Design Drivers / Highlights: ED Trauma Center: Hurricane Resistant 140 mph wind resistant structure Incorporated PROJECT ER One Principles Scalability for Surge Capacity Dual use of non clinical space Isolation Rooms pod Tier Triage model
Architect: Gresham Smith & Partners
ER One Goals and Objectives The The creation creation of of aa specialized specialized emergency emergency facility facility at at Washington Washington Hospital Hospital Center, Center, already already home home to to Washington’s Washington’s largest largest trauma trauma center, center, emergency emergency department, department, burn burn center, center, and and critical critical care care facility, will address key needs in the region and across the facility, will address key needs in the region and across the nation. nation. ER ER One One will: will: Provide Provide unique unique emergency emergency care care and and response response capability capability designed designed to respond to a full range of threats in the Washington area to respond to a full range of threats in the Washington area and and substantially substantially augment augment the the response response capability capability of of the the National National Capital Capital Region; Region; Serve Serve as as aa model model and and demonstration demonstration facility facility for for other other emergency emergency centers centers in in metropolitan metropolitan areas areas vulnerable vulnerable to to mass mass casualty casualty events; events; and and Become Become aa resource resource for for emergency emergency preparedness preparedness that that will will offer offer ongoing ongoing education education and and training training programs programs nationwide nationwide
•• Robust scalability, Specialized capability to handle contagious and and contaminating contaminating illness illness and and injury, injury, and and security security protection protection from from becoming becoming aa target target of of an an attack attack
Features/Services of ER One Accommodate up to 2,500 patients per day (scaling up from 250/day during routine operations); Accommodate up to 100 critical care patients per day (20/day routinely); Have all rooms equipped with negative pressure isolation with 100% non-recirculated air; Offer decontamination capabilities in many forms throughout the facility; Provide stringent screening controls to protect hospital workers and patients; Deploy a universal patient tracking and ubiquitous information system; Offer comprehensive internal and external communications systems.
Tampa General – Bayshore Pavilion •
Stats: Only 6 feet above sea level, 30’ from sea 998 bed Tertiary Hospital 6 story addition, 340,000 SF with 64,500 SF ED. Completed 2008
Architect: Gresham Smith & Partners
Tampa General – Bayshore Pavilion
Tampa General – Bayshore Pavilion
Architect: Gresham Smith & Partners
Tampa General – Bayshore Pavilion
Architect: Gresham Smith & Partners
Tampa General – Bayshore Pavilion
Architect: Gresham Smith & Partners
TGH – Innovative Design Features
Architect: Gresham Smith & Partners
TGH – Innovative Design Features
Architect: Gresham Smith & Partners
Tampa General – Bayshore Pavilion •
Lessons Learned:
Additional Additional upfront upfront costs costs will pay off Overdesigned Overdesigned for for day day to to day day use use Trauma Trauma == Controlled Controlled “Evidence “Evidence Based Based Chaos” Chaos” no no matter matter how how much much space space you you have have Storage, Storage, Storage, Storage, There There is is never never enough… enough… Hospitality Hospitality feel feel Form Form follows follows function function ?? Absolutely! Absolutely! Apply Apply Evidence Evidence Based Based Design Design concepts concepts
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital - Ginsburg Tower •
Design Drivers / Highlights:
“Visually “Visually Arresting” Arresting” “Recognition “Recognition of of Soul Soul and and Spirit Spirit of of Location” Location” Second Second Opinion Opinion Process Process (Hospitality, (Hospitality, Hotel Hotel design, design, Walt Walt Disney Disney Entertainment, Entertainment, The The Center Center for for Health Health Design, Design, environmental environmental psychologists, ambient ambient environments, environments, clinical, clinical, systems, systems, and and specialized specialized HC HC designers designers with with expertise expertise in in Emergency, Emergency, CV CV services services and and EBD. EBD.
Hunton Brady Architects
Florida Hospital - Ginsburg Tower •
Stats: $163 Million, 656,000 SF expansion ($250 / SF 15 Story Building 6 Shelled floors (Overall building flexibility) New pkg garages for over 1,700 cars New Central Plant 50 Bed ED, with dedicated Peds ED 160 seat conference auditorium 440 private beds with CV focus Hunton Brady Architects
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital - Ginsburg Tower
EBD notes: Staff lounge, is at the midpoint of the floor Round Spire at the end of the tower is a Conference / Education Rm.
Hunton Brady Architects
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital – Design Innovation
Hunton Brady Architects
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital - Ginsburg Tower
Hunton Brady Architects
Florida Hospital - Ginsburg Tower •
Lessons Learned: FL dollars go a longer way than they do in CA (Any guesses as to why?) Ode to thy public spaces Implement a real Art program Hospitality feel to the max Think long term Capitalize on ext. and int. first impression Embrace the contrarians or “Two minds are always better than one”
Florida Hospital – Memorial Medical Center Design Drivers: • • • • • •
Maximize vertical design expression Strong physician accessibility Integrate views of nature Flexible nursing units Future growth Greenfield site Hunton Brady Architects
Florida Hospital – Memorial Medical Center
•
Stats: $170 Million, 600,000 SF ($280 / SF) New 12 Story Facility Structure designed for vertical expansion •
Additional 8 story tower with 300 beds
135 acre Greenfield site 277 Beds, 82 critical care Connected 5 story MOB
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
First Floor
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Second Floor
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Third Floor
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Fourth Floor
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Fifth Floor
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Patient Floors
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
Administration
Hunton Brady Architects
Florida Hospital – Memorial Medical Center
•
Lessons Learned: Iconic design statements have value Cost savings is not a substitute for smart design Advanced technology may be optional Need to Embrace the Contrarians
Take Away Concepts
Questions?
Selected References • • • • • •
HCD09 Conference Proceedings Blair L. Sadler, JD, Healthcare Estates Welsh Conference & Exhibition Exhibition 2004 2004 Angela Burke, 2030 2030 Nanotechnology Nanotechnology in in hospitals: hospitals: Is Is the the future future smaller?, smaller?, NBBJ NBBJ Architects Architects Gary Burke and Terrie Terrie Kurrasch, Kurrasch, Ratcliff Ratcliff Architects Architects David Chambers, Sutter Healthcare Nanotechnology, nanomedicine and nanosurgery. International Journal of Surgery (2005)
RBB ARCHITECTS INC
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