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SEPTEMBER 24-26, 2024
Austin Convention Center - Austin, Texas

Removing Barriers: How an Automated Parking System is Improving Patient Care at Fred Hutchinson Cancer Center

By Michelle Wendler, AIA, Principal, Watry Design, Inc.,

The opening of the new outpatient clinic at Fred Hutchinson Cancer Center in Seattle ushered in a new era of care in the areas you would expect, with expanded facilities and state-of-the-art medical equipment, but also somewhere you might not: parking.

Parking in medical centers can be a stressful experience. In addition to confusing layouts with different specialists in different locations, patients often have more physical constraints than the general public. Often, the parking structure is separate from the facility where they will receive care, requiring additional mobility from patients who are highly likely to have mobility limitations. Sloped floors can also pose a hazard to patients at high risk of falling, which creates safety concerns in addition to the mental and physical stress of getting to the right location on time for an appointment.

At Fred Hutch, however, a combination of factors allowed designers of the recently opened outpatient clinic to explore new ways of overcoming these challenges in the form of a fully automated parking system that removes many of these barriers.

 

What is a Fully Automated Parking Structure?

Many types of mechanical and automated parking systems exist, from simple mechanical lifts to fully automated systems, such as the system found at Fred Hutch. As each project is unique, there is no straightforward formula to a successful selection. Choosing the right solution requires careful study, expertise and innovative thinking.

While fully automated parking systems come in many different forms, they all share one notable thing in common: a transfer cabin. The vehicle is driven into a transfer cabin outfitted with sensors. The driver then exits the car and follows a set of instructions to engage the system. Once the door to the transfer cabin closes, no further human involvement is necessary to park the car. The system itself is completely responsible for selecting a space, storing, and later retrieving the vehicle. In the case of Fred Hutch, a robotic shuttle system in the form of a rack and rail system retrieves the car from the transfer cabin and delivers it to an available parking space. What this means for patients is a streamlined, simpler parking process. There is no searching for a space or navigating a large parking structure on foot. Patients deliver their vehicle to the transfer cabin via a valet and can then proceed directly to their care destination.  At Fred Hutch the system is further enhanced because the patient leaves their car outside the transfer cabin for the valet to load into the system so they do not have to park in the automated system at all.

Why Fred Hutch Chose Automated Parking

Automated parking typically becomes viable when site constraints exist that make traditional parking impractical. Deep subterranean excavations, high water tables, and constrained footprints  are all factors that can make automated parking worth exploring.

When the new outpatient facility was under design, early plans called for it to be interconnected to an existing building on the upper floors with a continuous underground layout that would include parking. However, code restrictions made this approach cost prohibitive, which resulted in a very constrained building site. An alley between the planned and existing building contained utilities that could not be relocated. To fit within the available footprint, a traditional parking facility would not only have been saddled with an extremely inefficient layout, but it also would have been difficult to achieve the 160 spaces required to meet the needs of Fred Hutch’s patients without a much deeper excavation. Therefore, the design team turned to automated parking as a possible solution.

This approach solved the space constraint problems by utilizing the available volume to park more cars in the same amount of space and offered the opportunity to create a safer, more user-friendly parking experience to relieve some of the stress patients face when visiting a care facility.

To ensure that the facility design succeeded in meeting patient needs, Fred Hutch engaged a patient care advisory committee to review the project development – including the parking. “The big topics that we got a lot of feedback on concerned ease of use, patient safety, and navigating mobility limitations,” says Alyssa Stein, an associate with ZGF Architects, who designed the project. “Patients were generally in favor of any technology that helped their experience.”

Selecting a System

Deciding to pursue an automated system is only part of the journey. Selecting the right one to meet a project’s unique needs requires a great deal of careful consideration, from both a design and operations standpoint. Engaging parking experts who have experience with these unique systems can help navigate these challenges and ensure they effectively integrate into the building.

From a design perspective, different systems have different requirements, from the number of transfer cabins required to how cars are stored and retrieved and the density of the parking. Adequate queuing and loading areas also need to be considered.

For example, several systems evaluated by the design team required more lift bays than the site could accommodate. Many systems are produced overseas, which introduces other complexities such as coordinating international shipments into the construction schedule and field certification that components make a compliant UL system.

From an operations perspective, a number of logistics had to be taken into account. Unlike traditional parking, in which users can go straight to their car and drive away, automated parking systems have limitations on capacity and throughput, or how many cars a system can handle and how quickly they can be retrieved. Therefore, everyone needed to be on the same page regarding performance expectations at peak times, and how that would impact the patient journey. This included designing lobby areas with ample seating to ensure patients were comfortable while waiting for their car.

Automated parking systems also have ongoing maintenance considerations that need to be factored into both ongoing budget and operations plans. This includes how to handle unexpected system outages, annual costs of preventive maintenance and logistics of repairs. “Fred Hutch took a strong interest in this, because they would ultimately be responsible for maintenance,” Stein explains. “If something breaks, how does it get fixed, and how long will it take?”

The unique maintenance needs of these facilities means that they require a specialized maintenance provider. Understanding who will service and maintain the system, expectations for response times, turnaround time on repairs and how parking will be managed during an outage are all questions that need to be addressed before committing to a system. As Fred Hutch desired valet service to further elevate the patient journey, a valet vendor was selected and trained to operate the system as efficiently as possible.

Ultimately, WÖHR Multiparker 730 was selected to provide the 160 spaces needed to support the project, with the goal of retrieving up to 100 vehicles in an hour with a maximum recall time of 150 seconds.

Design Challenges

While automated parking systems are common elsewhere in the world, they are still relatively new to the US, which poses a number of design challenges, starting with code. “Code requirements are limited in their coverage of fully automated parking, so a lot of communication has to happen in order to get everyone on the same page to build it,” says Stein. Due to the project’s complexity, Watry Design was brought in as a mechanical parking expert to review the design and help navigate the approval process.

One example of the complex code requirements the team tackled was intake and exhaust requirements. Garage ventilation requirements  were created around the needs of traditional parking, in which cars operate within a structure that must also accommodate people. Fully automated systems, however, are designed so that when a car enters the system, it is turned off and unaccompanied by a human, making air change needs minimal. Therefore, the team worked closely with the city, including sharing case studies of similar projects, to find a middle ground that would meet design and budget needs while also satisfying city requirements.

Another common design challenge faced by automated parking is whether or not lifts get classified as elevators. Elevator codes are designed around human safety, however a human never rides in a lift in a fully automated parking system. Therefore, the life and safety considerations typically associated with elevators may not apply. Design teams need to carefully define project terminology to ensure the code interpretation appropriately meets the building needs without triggering unnecessary design criteria. Watry Design and ZGF worked closely with both Fred Hutch and the city to review the design early and keep the approval process as smooth as possible. “We had a lot of conversations with the city to interpret the code and decide what was required,” says Stein. “Ultimately, I think everyone was satisfied and comfortable with where we landed.”

The contractor  also needed to navigate  the constructability of the system with the  mechanical parking vendor and steel subcontractor. A rack and rail automated parking system like the one installed at Fred Hutch utilizes a shuttle that moves along a set of tracks on each floor. The vehicle lift moves vertically to bring the car to each floor. The movement and speed of the lift and shuttle is controlled by lasers that need to be carefully calibrated to ensure the smooth transfer of vehicles from the transfer cabin to the rail system to the vehicle lift. The concrete floor levelness and placement of hundreds of steel embeds had to be meticulously coordinated with little room for error.

This level of design, however, is what makes the system so effective. “The complexity of the design is fascinating,” Stein says. “The palates are so well-engineered that they rotate with just a gentle push of the hand. It’s really special.”

The End Result

The new outpatient clinic building at Fred Hutch opened in March of 2023. When patients arrive, they deliver their vehicle to a valet who then delivers it into the transfer cabin and initiates the parking sequence, taking the stress and logistics of parking away so they can focus on what’s most important: their care.

In addition to convenience, the structure also offers a few extra perks. It is one of the first fully automated parking systems to offer EV charging pallets. Ten of the 160 parking spaces are equipped to autonomously charge electric vehicles, with the ability to expand to additional spaces as needed.

Despite the automated system being closed to people, you can still get a glimpse of it in action. “We realized during construction that this system functioned entirely behind closed doors, which felt like a missed opportunity,” Stein says. “So we designed a viewing window that would let people watch the system in operation. It’s one of the most appreciated parts of the project.”

Looking to the Future

While fully automated parking systems pose many advantages, they are not a blanket replacement for a traditional parking facility, and still face a number of challenges. Each project requires a dedicated review of its programming needs to determine the right parking system, and parking experts with detailed knowledge of how these systems work are invaluable for selecting the right approach.

However, when the conditions are right, they can offer a groundbreaking, innovative solution, and not just for medical centers. These systems are being integrated into residential buildings, public parking and even university housing, and the more common they become, the fewer barriers they will face.

Photography credits: Ben Benschneider.

 

Transition and Activation Budget Planning

Capitalizing on Opportunities to Capitalize Costs

By Jeff Agner, MPH

The delivery of most healthcare services requires regular upkeep, periodic renovation, and the occasional new construction of physical facilities and infrastructure. Construction projects allow a healthcare organization to remain compliant, competitive, and operationally efficient. A formal project is established to plan and execute the work, and the necessary time and resources are allocated. When the cost is high and the useful life of the resulting asset is long (typically more than 10 years), the project is considered to be a “capital project.” Even though these projects likely require a financial investment (often referred to as “capital”), the term “capital” in this context refers to the fact that the resulting asset can be capitalized. Capitalization is an accounting method that allows an organization to break up the full cost of building or purchasing assets into smaller expense activities over the expected life of the asset through processes known as amortization and depreciation.

When an organization can record such a large investment as an asset on its ongoing balance sheet versus an expense on its annual income statement, the financial health of the organization is seen as far more favorable. This means that the organization has greater freedom to borrow money, attract investors, and conduct business. This article will further explain the concept of asset capitalization and will explore its applications in a healthcare construction project.

When can costs be capitalized?

The capitalizable costs of a healthcare project include the amount paid for constructing, acquiring, and/or improving an asset. As expected, this includes the design and construction labor, materials, and fees necessary to deliver the project, but it can also include expenditures for utilities, interest on debt during construction, and other resources engaged in putting the asset into service. In many cases, these costs are not part of the construction budget but are included in a separate Transition and Activation Budget related to the capital project. Regardless of how the activities are funded, a plan to address the accounting requirements is critical.

Per generally accepted accounting principles for new construction, project costs can be capitalized if at least one of the following conditions are met:

  • Costs contribute to the value of the asset
  • Costs enhance the use/value of the asset
  • Costs ensure or extend the useful life of the asset

Additionally, to qualify for capitalization, these expenditures must occur prior to the asset being put into service.

 

What costs are typically capitalized in a construction project?

Each organization must abide by its specific capitalization policies and procedures and comply with state-level mandates or requirements. The following table lists some common costs encountered during a facility renovation or construction project and whether or not they can typically be capitalized. Final determinations of cost capitilization must be made by the financial leadership team.

Manage and track opportunities to capitalize project costs

Once a Transition and Activation Budget is developed, the healthcare organization’s financial leadership team should evaluate all expected costs and categorize them based on their capitalization potential. Separate cost centers can be established if there is no easy mechanism to flag capitalizable costs as they are incurred so they are not mistakenly accounted for as an expense. All costs should be tracked closely and documented clearly so that the accounting treatment can be applied at the conclusion of the project. Once the new space is operational, the organization’s balance sheet should be updated to reflect the full value of the completed capital project as an asset. This action must be performed within a few months (typically 90-120 days) of the asset being put into use; otherwise, taxes and other financial penalties may apply.

Take advantage of the full value of your investment

The purpose of capitalizing costs is to align the cost of using an asset with the length of time in which the asset is providing a benefit to the organization (aka generating revenue). Finance industry and government-level capitalization policies guide organizations on items that should be capitalized versus those that should be expensed on large construction projects. This guidance is intentionally general in nature to be as broadly applicable as possible. It is up to the organization to understand and comply with its specific guidelines to maximize the financial benefits of capitalization when renovating or constructing a healthcare facility.

Illuminating the Path to Healing

Elements of Effective Lighting Design in the Behavioral Health Facilities

By: Ellie Motevalian- Lighting Designer, LC, LEED GA and Toranj Noroozi, Lighting Designer, LC, P2S, a Legence company

 

Lighting design plays a crucial role in creating supportive environments in behavioral health facilities, promoting well-being, and facilitating healing journeys.

Beyond its technical aspects like anti-ligature and vandalism, lighting serves as a companion, subtly influencing wellness. Join us as we explore how this understated element, with its artful touch, profoundly shapes the healing experience in behavioral health facilities.

Biophilic Design:

Biophilic design is an architectural and interior design approach that seeks to reconnect people with nature within the built environment to encourage them to co-exist with it. Rooted in the idea that humans have an innate connection to the natural world, biophilic design incorporates elements and features inspired by nature to enhance the well-being and productivity of occupants.

There is much research supporting the hypothesis that biophilic design will enhance physical, mental, and cognitive health and has positive impacts on stress relief, cognitive skills, and sensitivity both in children and adults.

There are various ways lighting can be incorporated into the biophilic design:

  • Light Therapy
  • Natural Daylight
  • Circadian Rhythm through Artificial Lighting
  • Shapes, Finish and Pattern

Light therapy, also known as phototherapy, has emerged as a crucial tool in addressing Seasonal Affective Disorder (SAD), which is characterized by symptoms such as low energy, mood fluctuations, and a general sense of lethargy. Light therapy involves exposure to a bright light that mimics natural sunlight, stimulating the production of serotonin and regulating melatonin levels to alleviate symptoms of depression. Beyond SAD, the importance of light in treating mental health issues extends to various conditions, as exposure to natural or artificial light influences circadian rhythms and affects neurotransmitter levels. Light therapy has shown promise in treating other forms of depression, bipolar disorder, and sleep disorders. The role of light in regulating mood and overall mental well-being underscores the significance of incorporating light therapy into comprehensive mental health treatment strategies.

Exposure to natural light has been consistently linked to improved mood, enhanced cognitive function, and regulation of circadian rhythms. Integrating daylight into these spaces creates a more pleasant and uplifting environment, reducing feelings of confinement and fostering a sense of connection to the external world.

By introducing daylight, as much as possible into the architecture through windows, light wells, skylights, and clerestories, the therapeutic impacts of natural light can be harnessed to create a supportive atmosphere for individuals seeking behavioral health services.

Given the constraints within architecture and construction, coupled with varying durations of time users spend within interior spaces, the thoughtful integration of architectural lighting becomes pivotal for the enhancement of circadian rhythms. Not all architectural designs allow for abundant natural light to penetrate indoor environments, and users may find themselves exposed to artificial lighting for extended periods. In such cases, leveraging architectural lighting becomes a strategic tool to simulate the effects of natural light on the circadian system. The usage of a diffused indirect lighting approach as an expansion and continuation of daylight perception into the interior space provides an opportunity to integrate biophilic design with architectural lighting.

In applications where the users are deprived of receiving enough natural light throughout the day incorporating human-centric lighting within the architectural lighting to provide the blue wavelength (490nm) for maximum daytime circadian impact is essential. The sky-blue wavelength which mainly lies within the invisible spectrum can be provided for several hours depending on the technology used to balance the circadian rhythm through Melanopic and skin pathways.

Quality sleep plays a crucial role in maintaining good mental and behavioral health. As the sun sets, much of the blue light is scattered, signaling to our bodies that it’s time to wind down and prepare for sleep. In residential and relaxation spaces, lighting can be strategically utilized to promote healthy sleep patterns, particularly through the use of “zero-blue” light fixtures. These fixtures eliminate the blue spectrum of light to mimic the natural pattern of sunlight. Additionally, during nighttime hours, it’s recommended to use amber night lights to illuminate pathways for safety while still supporting the body’s natural sleep-wake cycle.

Another way the lighting can be part of the biophilic design is through effects and forms. One example is in interior nature spaces, by creating lights and shadows, lighting will enhance the vibrant nature-like environment.

In addition to the quality of light and its impact on the space, the shape, form, and finish of the light fixtures are influential design factors in the mental and overall emotional state of the occupants. One of the main driving factors is to implement lighting to create a calm, inviting atmosphere that provides a sense of safety and tranquility. This can be achieved by the implementation of light fixtures that offer soft edges and earthy color tones, with more of a hospitality aesthetic. By opting for fixtures with gentle curves and natural finishes, the overall design can further enhance the soothing ambiance of the space. These fixtures not only provide functional illumination but also contribute to the overall design cohesion, promoting a harmonious environment.

Figure 1 Example of lighting in common spaces, using indirect sources of light to reduce glare, providing multiple layers of light including vertical illumination, in addition to using nature-inspired finishes and shapes.

Figure 1 Example of lighting in common spaces, using indirect sources of light to reduce glare, providing multiple layers of light including vertical illumination, in addition to using nature-inspired finishes and shapes.

Shaping serenity: optimal visual comfort and glare management

In the behavioral health facility setting, where individuals may already have higher sensitivity and emotional challenges, the importance of creating a visually soothing environment should not be ignored. Effective lighting design is characterized by glare reduction, flicker-free illumination, and appropriate color temperature selection. The overall lighting effect should be continuous, soft, and even to minimize any discomfort or agitation. Harsh patterns and shadows created by light should be avoided, as they can exacerbate feelings of anxiety and disorientation. It’s also important to eliminate dark corners and avoid extreme contrasts between light and dark spaces, which can induce feelings of unease. To create a more dynamic and therapeutic environment, it’s recommended to incorporate various layers of light, including vertical illumination and accentuating features and materials.

Indirect lighting, edge-lit light fixtures, and fixtures with louver and diffuser can minimize the harsh glare. One of the metrics to evaluate the light fixture glare is UGR. Many lighting manufacturers provide fixture UGR information on their cut sheets or IES files. Based on some of the standards like LEED Well, UGR below 16 is considered a low-glare fixture and can help with visual comfort in behavioral health facilities. Choosing the appropriate lighting color temperature (in most cases warmer CCT in the patient area) contributes to creating a calming atmosphere that facilitates relaxation and promotes a sense of security for the user.

Some conditions such as autism spectrum disorder are more sensitive to lighting fixtures flicker. Providing flicker-free lighting solutions minimizes visual disturbances that could decrease anxiety and stress levels among the patients. Several key aspects warrant consideration to minimize light fixture flicker, including High-quality drivers with higher frequency, compatibility of the driver and light control, and light fixtures with certifications like Energy Star.

Figure 2 Example of corridor lighting, using an indirect source of light as a continuation of natural lights, to minimize glare and enhance visual comfort, providing even illumination on horizontal and vertical surfaces.

Figure 2 Example of corridor lighting, using an indirect source of light as a continuation of natural lights, to minimize glare and enhance visual comfort, providing even illumination on horizontal and vertical surfaces.

Balancing safety with patient autonomy (independence)

Effective lighting design should consider the specific needs of patients, ensuring adequate visibility for staff while minimizing potential hazards like sharp objects or ligature risks. At the same time, providing patients with control over their environment can significantly reduce their stress and anxiety levels, increase their self-esteem, and improve the patient’s mental well-being.  By collaborating with healthcare professionals this delicate balance can be achieved in the design, and it will enhance the overall quality of care and patient experience.

In high-risk areas of the facility like patient rooms, anti-ligature light fixtures can be considered. Using this type of fixture can reduce the risk of self-harm and ensure the patient’s safety. Design strategies such as using tamper-resistant fixtures, avoiding protruding elements, and selecting durable materials are critical to mitigate the risk of ligature-related incidents.

There are no specific codes or regulations governing anti-ligature fixtures. While various organizations offer guidelines and recommendations, there is no mandated standard applicable across all jurisdictions. One commonly referenced source is the New York State Office of Mental Health recommendation that many lighting manufacturers rely on to design anti-ligature fixtures. Designers can use this reference when selecting fixtures for high-risk areas.

While utilizing anti-ligature fixtures in high-risk areas is critical for patient safety, the design should still provide patients with a degree of control over their environment.  Examples of these controls can be:

  • Adjustable lighting settings to allow individuals to customize the light fixture brightness based on patient preference.
  • Personalized bedside reading light fixture with dimmer switch.
  • Natural light control options like adjustable blinds or curtains.

Figure 3  Typical lighting design for patient room.. Access to daylight, dimmable anti-ligature reading light, and low glare recessed downlight. Tamper-proof dimming switch for controlling the lights.

 

In conclusion, the careful orchestration of lighting design elements explored in this paper underscores the pivotal role played by environmental factors in shaping the healing process within behavioral health facilities. By embracing the principles discussed above, the designers can craft spaces that enhance the well-being of the users and empower individuals in their recovery journey. As we advance in our understanding and implementation of lighting design strategies, designers must remain vigilant in implementing evidence-based practices to foster environments that nurture both physical and psychological healing.

 

References:

  • S. Department of Veterans Affairs (2021), Design Guide for Inpatient Mental Health And Residential Rehabilitation Treatment Program Facilities.
  • New York State Office of Mental Health, 30th edition (2023), Patient Safety Standards, Material and Systems Guidelines.
  • Perkins , Deborah (2024), How Designers can Use Flicker Safe Dimming.
  • Amber Roguski, Philipp Ritter, Daniel J. Smith – Sensitivity to light in bipolar disorder: implications for research and clinical practice (2024. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists)
  • Bios Lighting. (2024). Technology – Bios Lighting. Retrieved from https://bioslighting.com/architectural-lighting/technology-2/

 

 

 

 

 

 

YOU + The Symposium = Better Futures

by Dr. Wayne Ruga 

The Symposium is a resource that supports you in being more effective in the work that interests you.  It is a catalytic cauldron, a crucible for forging the fusion of diverse elements to make better futures for everyone.  You are the passion that fuels this dynamic fusion.

The Symposium, importantly, is not what it may appear to be – although it might look like a conference, if you engage with it like an ordinary conference, its magic will elude you.

Yes – of course, it is a conference, but it is so much more.  Consider this assertion:  the Symposium is an entirely democratic community where you have the explicit liberty and freedom to speak your mind.  In fact, you are encouraged to speak your mind to share your unique perspective on how we can – all – be more effective in our quest to create the best possible healthcare facilities.  The Symposium is a place where your voice is valued.

How would you know that your unique voice is valued?  One of the many unique aspects of the Symposium is that relationship matters, human interaction matters, and someone you strike up a conversation with will listen to you – actively listen to you and genuinely care about what you say.

Jenabeth Ferguson, the Symposium Director, is always open and available to suggestions and feedback.  In fact, since the very first Symposium in 1987, there has been a volunteer Advisory Board representing the many diverse voices comprising the professions and industries the Symposium engages with.  This group is much like the US Congress – it is a formal mechanism representing all stakeholders in healthcare and design, actively seeking to bring current and emerging issues into the Symposium programs.

Think about it – the Symposium is not a membership organization – this is by design.  The first time someone attends, it is because they are hoping to receive returns that exceed their investment.  When they return the next time, it is because they know their returns have exceeded – and will exceed – their investment.  Loyalty is strictly a product of outcomes – if you don’t get what you came for, you won’t return.

The original design vision of the Symposium was for it to be a community.  It was never designed to be a conference.  In fact, this is exactly why it is named a symposium.  It is supposed to be a catalytic experience where we can all – as a cross section of like-minded stakeholders in health, healthcare, and design – share our resources, learn from each other’s perspectives, and collaborate in building a better world.

It only works when YOU do that.

Authentic sharing vitalizes the Symposium experience.  Sharing, not in the sense that – if I give you half of my sandwich, I have now diminished my ability to properly nourish myself.  Rather, in contrast, Symposium-style sharing means that the receiver is better off, and the giver is also better off, having not – in any way – being diminished by the sharing.

 

For example – if I share with you my interest in designing facilities that actively contribute to the reduction of the rate of medical non-adherence, and that also increase the rate that employees give of their discretionary effort – I lose nothing by this sharing, and it may excite you as much as it excites me, encouraging you to go on to become an expert in developing new approaches to design that enables unprecedented improvements to be made – – – we would all be better off, then, and neither of us would be diminished.

As a very practical matter, investing in attending the Symposium is costly – the costs of travel, accommodation, meals, and the registration fee can add up to a sizable sum.  What can you do to maximum the returns you receive on your investment?

Come prepared.  Give thought, in advance, to what you would most value taking home with you.  What are you interested in?  What resources are you looking for?  What is your own unique perspective, or resource, that you can share with others?  What is your passion?

Bring lots of business cards and make an active effort to come home with none left, and a pocket full of cards from people you’ve never met before.  Do not hang out only with people you already know – every time you sit down, sit next to someone you don’t know and introduce yourself.  Ask them where they are from and what they do – you’d be amazed how much you will learn AND how these simple exchanges can change lives.

The Symposium is designed to provide opportunities to continuously meet new people:  from the hosted Happy Hour, to the events in the Expo, the facility tours, the breaks, the concurrent session programs, the Keynotes, and the Awards Luncheon.  Also, if you are a product manufacturer, the Expo is a designed experience that maximizes the potential to meet new individuals with an interest in your products.

The various award programs can put the spotlight on you, becoming an Advisory Board member can engage you with a group that has built friendship spanning decades, writing a Leaflet article can serve as a platform for broadcasting your voice, giving a concurrent session program can open many new doors, and becoming a Symposium sponsor has promotional benefits that benefit you and your organization.

The equation is a simple one:  the more you invest of yourself, the greater the benefits you will receive.  There are a surprising number of individuals who have attended the Symposium, regularly, for decades.  The reason why is simple to understand: the benefits exceed the costs.

The Founder’s Award was first given in 2011, at the 24th annual Symposium.  It is an award that cannot be applied for and there is no nomination process.  It is given to individuals who have, over time, actively given of their own discretionary effort and demonstrated their  support of giving wings to the ideals of what the Symposium aspires to accomplish.

To date, 14 individuals – from every imaginable background, profession, and industry – have received this award and become distinguished Fellows, to their own surprise.  Voluntary community leadership has its costs – nevertheless, the investment of personal energy that produces a more flourishing community, and a better world for everyone, is a personal reward that extends beyond any, and all, financial consideration.

If there is ever any way that you feel the Symposium can better support you, please always feel welcome to discuss this with Jenabeth, an Advisory Board member, or myself.  I hope to see you in Austin, in September, at the 37th annual Symposium.

 

Wayne Ruga is the Founder of the Symposium and a Special Advisor to its management.  He can be reached at:  [email protected] .

 

 

 

 

All’s Well with Single-Source Envelope Solution

By: Ron Laramie, Regional Sales Manager – Business Development, Nucor Insulated Panel Group

St. Michael Medical Center expansion builds on health care legacy rooted in community service

The recent $500 million, 500,000-square-foot acute care expansion of the St. Michael Medical Center (formerly Harrison Medical Center) in Silverdale, Washington, is a project that builds on a caring legacy started by the Harrison family more than a century ago. With a keen focus on providing the best in health and wellness to the Kitsap and Olympic Peninsula communities, the new state-of-the-art medical facility features the latest in technology and patient-centric design—geared toward serving the community “without a trip across the river,” and centralizing the center’s nationally recognized cardiac and surgical care.

The nine-story, light-filled facility can also boast that it is the most energy-efficient hospital in the state. Ketul Patel, CEO of project owner CHI Franciscan Health (now part of Virginia Mason Franciscan Health), is quoted in the Puget Sound Business Journal, sharing, “The facility was … built to use 50% less energy than the average hospital in the Pacific Northwest, use 36% less water and save the carbon output of the equivalent of 700 homes.”

To help meet the ambitious design and sustainability goals, CENTRIA dealer Flynn Group of Companies—an industry leader in North America when it comes to the total building envelope—worked with CENTRIA to incorporate the array of panels, windows, sunshades and louvers that would make the project a stunning success.

Ron Laramie, the CENTRIA district sales manager on the project, recalls that Balfour Beatty, the general contractor, called him in to discuss the design and how CENTRIA’s diversified abilities could support the architectural vision. He says, “They liked the idea that we could not only provide metal panels, but also windows, sunshades, and louvers as a complete envelope package. This is something unique to CENTRIA compared to our competitors—the ability to provide a single source solution for the exterior skin, with one set of details, and typically one installer.”

Essentially becoming part of the design team, the representatives from CENTRIA and Flynn met regularly with the architect, the engineer, and the GC to develop the project specifics and details. In the end, the CENTRIA/Flynn team was successful in securing the project award, ensuring a smooth construction process from start to finish.

CENTRIA provided project management for the insulated metal panels, single-skin panels, and integrated windows, as well as louvers and the design of a special, customized sunshade. Laramie explains, “We partner with Construction Specialties (CS) for sunshades and louvers, which are integrated into our systems. For the St. Michael Medical Center, the architect wanted a sunshade design that didn’t exist. The team at CS designed a sunshade specifically for this project that provided the aesthetic and performance requirements the architect wanted.”

He explains further that sunshades are normally an outrigger, meaning that at the top of the window, there’s a horizontal support to which the sunshades attach, like an eyebrow. “For this project, the design called for individual blades attached vertically to the window. We were able to modify our window system to accommodate the CS custom design.”

The louvers, too, are all integrated, meaning there’s no flashing, extrusion, or anything between the systems. “The joinery of the louvers and windows fit into the joinery of our panel, so it’s all just one system,” Laramie adds.

As for the wall panels, CENTRIA’s Formawall Dimension Series (FWDS) IMPs were used, which are flat panels, as well as FWDS-60, which is a ribbed profile panel. Additionally, the single-skin IW-40A 22-gauge panel, a 12”-wide concealed fastener panel with an 11”- flat and a 1” recess was used on the project. All CENTRIA IW panels share a common lock-joint design, which makes them interchangeable on a project.

 

Another benefit that CENTRIA brings, according to Laramie, is the ability of its products to integrate efficiently into the overall design, which includes other building materials and work with other trades. He says, “One of the interesting features on the front of the building is the incorporation of our foam insulated metal panels with vertical ribbons of CMU block, which looks like stone. From a design perspective, it goes back and forth—panel, window and then the vertical section of stone and then panel, window, etc. Those details required a lot of work and coordination to provide what the architect wanted from both a design and performance perspective, as well as from a thermal standpoint.” He adds that another area of the building is a full glass curtain wall, and again, CENTRIA developed details where they connect into that element as well.

CENTRIA’s integrated windows are exceptionally efficient, Laramie notes, explaining that normally when a window is put in, there is thru flashing around the rough opening where you set the window, and there’s a transfer of heat all the way around that window. “With CENTRIA integrated windows, we don’t have that issue,” says Laramie. “Our window is fully, thermally broken, and the panels are fully, thermally broken, making the complete wall system significantly more thermally efficient than traditional window systems.”

The completed St. Michael Medical Center, which opened in December 2020, is part of Virginia Mason Franciscan Health’s system of 10 hospitals and 230 specialty clinics. With its beautiful appearance, inside and out, along with its superior efficiencies, the facility is ready to welcome and care for its local community members, living up to its “mission to heal, a promise to care.”

Visit www.centria.com to learn more about Formawall Dimension Series IMPs.

 

 

Neuroarchitecture, Biomimicry & Natural Environments for Behavioral Health

By: Stephen Parker & Robyn Linstrom

Often the stress experienced by mental health and addiction patients can be mitigated with access to outdoor spaces. Outdoor spaces should be designed to create a safe, therapeutic environment with a close connection to nature.
Elopement prevention should be discreet and effectively detailed, with limited hand and foot holds on vertical surfaces, especially with relation to building devices and systems in need of coordination by the architect.

Harrel Family Center for Behavioral Wellness Patient Courtyards, Lakeland, FL – HuntonBrady Architects, Stantec (landscape architecture, program management)
Youth Crisis Center Recovery Garden, Confidential Client/Site – Stantec

Natural elements should be safe in case of accidental ingestion while providing a variety of sensory opportunities in terms of color, tactility and olfactory stimulation to mimic biophilia. Trees should be limited in height without easily accessible branches for climbing and prevent elopement while enhancing the feeling of a calming, natural environment. Plants should be selected that prevent their use as weapons or for self-harm while being native species and limit the need for excessive maintenance or irrigation, such as drought tolerance. Materials for walking paths should be selected to avoid loose materials such as small gravel and stones that could be thrown or ingested.

Natural elements, especially those as part of gardening therapy, have a proven stress-reducing effect per evidence-based design strategies. These concepts can aid in staff respite as well. Green micro breaks facilitate stress reduction for overburdened staff, aiding in staff retention in the process. The use of green houses for these adjunctive therapies should be considered as a balance between therapeutic value and patient safety.

If these outdoor environments create views of nature for patient bedrooms or social spaces, then patient privacy should be addressed. Translucent film on windows or vegetative screening are possible solutions to consider.
Landscaping rocks and features should not be able to be moved, thrown or otherwise used for damage to property, others or self-harm. Ample lighting that is exterior-rated and tamper-resistant should be provided for after-hours monitoring. At the Nanaimo Psychiatric Emergency Department on Vancouver Island, British Columbia, this is pushed further with inclusion of a water feature, raised beds and culturally relevant vegetation.

Nanaimo Regional General Hospital Emergency Department and Psychiatric Emergency Services – Patient Courtyard, Nanaimo, British Columbia – Stantec
Brockville General Hospital Redevelopment – Phase 2: Complex Continuing Care, Mental Health and Rehabilitation, Brockville, Ontario – Stantec

Furniture is often fixed and immovable, so the design of seating arrangements to facilitate patient choice is paramount. These more substantive seating arrangements limit damage while providing comfortable seating for individual self-reflection, one on one conversations or various social gatherings as chosen by patients in a safe manner. Furniture should be sited to mitigate elopement in coordination with other site features. The building could serve as an implicit barrier, defining the space while not aiding in the institutional feel of the mental health hospital. Such outdoor furniture selections should limit contraband opportunities as well as mitigate barricading. All of these considerations should strive to maintain a clear line of sight from staff observation areas to ensure patient safety. Ample camera coverage should be provided in outdoor spaces with clear coverage of exits and entrances, and blind spots should be eliminated. Cameras should be impact-rated for exterior use and coordinated with other outdoor devices and features, such as exit signs, lighting and scuppers to avoid creating a climbing opportunity.

Use of outdoor environments should be considered based on client population, but should include a variety of opportunities. Labyrinths and walking paths allow clients to pace to self soothe and self-regulate helping with de-escalation. Basketball courts and other sports focused areas allow for release of energy or anger. Alternate seating types and areas for reflection all contribute to a healing outdoor environment.

From the bedside to the C-Suite to consulting: Insights from an expert of integrating new technology

By: Caryn Hewitt, MBA, BSN, CENP, CPHQ, Senior Director, Consulting Services at CenTrak

The expression, “It takes a village…” isn’t exclusive to parenting. In my experience, thoughtfully planning, strategizing, and implementing emerging technology and design layouts within a new healthcare facility should take a community mindset. In line with the village advice, healthcare facilities consist of many different groups that must come together, interact positively, and collaborate for the betterment of the goal. To apply the village mindset in a new facility or implementation, various departments in the health system (nursing, IT, security, administrative, etc.) must share their expertise to ensure the facility flourishes and provides a safe environment. The village approach helps understand the direct needs of frontline staff and their patients – which increases the value of the new healthcare facility.

Throughout my career as a registered nurse, IT leader, chief information officer, director of operations, and digital health consultant, I have been given the opportunity to witness first-hand what healthcare professionals and patients want in a healthcare setting. To better understand what our colleagues and patients desire, we must invite them to the table. These individuals, once together, must serve as a sounding board to one another, listening to each other’s concerns and becoming a team when approaching senior leadership.

A recent study with the National Center for Biotechnology Information demonstrates how involving participants with different organizational and clinical backgrounds leads to higher user satisfaction when implementing technology such as electronic health records (EHR). By involving various perspectives when designing shared spaces and tools, there’s a greater chance of employee buy-in, enhanced usability, and improved efficiency and communication. This approach outlines the method personally used when integrating emerging technology and Real-Time Location Systems (RTLS) into a new 400-bed trauma hospital in North Dakota.

Where it all started: Bedside nurse turned IT leader

After a few years as a bedside nurse in the Intensive Care Unit and witnessing first-hand the growing importance of emerging technologies, I felt that I could leverage my knowledge as a nurse to implement technologies that would make a real difference for patients and staff. My goal was to make the clinicians’ lives less stressful and promote better patient care. While I understood it at the time, it’s only become more apparent to me that it is crucial that IT teams have a strong understanding of what clinical personnel do, why they are doing it, the tools used in their day-to-day workflows, and what circumstances health IT aims to solve with the technology we’re implementing.

I joined and remained in an IT role for 25 years, implementing emerging technology and real-time location systems. I found my passion and purpose, demonstrating the positive impact thoughtful technology and workflow design can make for staff and patients. I began training staff with new use cases and highlighting how to apply them in meaningful ways. I’m always aiming to make sure clinicians understand the technology and its purpose. Subsequently, following an acquisition, I was blessed with an opportunity to serve as director of operations for a new state-of-the-art facility and standardize our technologies.

Connecting with “the village” is the first step to developing the plan to implement digital solutions for a new facility or existing department. Aiming for the new hospital to be a space designed for caregivers and patients by caregivers and patients, I connected with all relevant departments to further consider the best technologies for a patient- and caregiver-centric facility.

The importance of working together on a phased assessment

Deciding on the best path forward when implementing new technology involves assessing any challenges within the current facilities and anticipating the overall needs for the next 2-5 years within a new or updated space. I recommend completing the facility analysis through a comprehensive phased approach, which includes stages such as assessment, readiness, and transformation. When stepping into the assessment stage, healthcare decision-makers need to hear input from departments such as equipment distribution, supply chain, IT, and nursing. In my weekly meetings with 100+/- departments during the new hospital development, teams shared updates to reduce siloes and ensure a standardized, purposeful plan moved forward.

Once perspectives are shared in the department manager meetings, teams must gain consensus on the proposed technology use cases to prioritize and develop a strategic roadmap, deployment plan, operational model, and budget summary. This assessment phase enables facilities to take the first step in making impactful changes with emerging technologies. Aiming for a strong ROI and factoring in the needs of the larger “village,” we pursued RTLS; a trusted technology that had been supporting the health system’s overarching goals. For example, we used RTLS data to rightsize equipment needs based on our historical utilization, a key factor when determining the mobile medical assets required to support a new facility. The location technology and sensors powering RTLS platforms use badges, tags, and wearables to provide accurate location information for equipment, patients, residents, and staff. Through an automated workflow system, teams and facility managers maintain synchronized, real-time insights and communication to continuously measure interactions, minimize bottlenecks, monitor patient milestones, evaluate movement patterns for optimal staffing, reduce workplace violence, and increase workflow efficiency throughout the healthcare facility.

Following the assessment period, the operations team should evaluate the readiness of the staff to leverage the technology. When everyone is in a room together during the weekly department meetings, there’s also the opportunity to discuss upcoming training. Following our weekly meetings, 200 Health System leaders offered to assist in department-specific and general training on the new technologies. Through simulations and role-playing, 10,000+ employees received the necessary training. This benefits staff buy-in, creates comradeship, and ensures the relevant team members understand their new devices, equipment, and platforms.

The growing comradeship and support are crucial heading into the next phase: going live and continually monitoring the actionable intelligence from the technology to transform the facility and ensure the desired ROI. Every facility has its own unique challenges as they’re fine-tuning and preparing to go live. When developing a strategic team that incorporates nurses, hospital administrators, and clinic managers as part of the implementation team, challenges can be quickly identified, escalated, and resolved to provide quick time to value for the facility.

Applying director and CIO experience to health IT consulting efforts

Pursuing technology that offers standardized processes provides layers to facilitate caregiver insights – without physically entering the room – and ensures definitive spaces in rooms for patients, staff, and family is crucial when considering patient- and caregiver-centric technology and design. Even so, initial staff support and stakeholder buy-in can present a challenge. The key components for buy-in success when implementing new technology include early transparency, leadership support, and staff education on the technology’s purpose. Successfully deploying location solutions requires incorporating the proper expertise from the healthcare facility’s individual departments and vendor partners.

To enhance the ROI following implementation, leadership should consider pursuing an ongoing staff buy-in campaign. Video education and video learning can be beneficial tools that provide small bites of information, making the information easier to digest. It also helps to continue in the mindset that RTLS and emerging technology programs start at the top, which means leadership should wear their IoT-enabled badges to show their support and belief in the program. Team leadership should also showcase RTLS staff duress tools at daily floor huddles and discuss the purpose behind the location technology.

Staff duress and/or asset management solutions are often the first step for healthcare leaders moving through a journey with RTLS. When health system leadership collaborates with “the village” to assess top pain points, decision-makers typically pursue the need to better monitor the mobile medical equipment (MME) or provide greater support to staff who may experience duress. These scalable implementations can be done step-by-step as they’re beneficial instead of requiring a full system overhaul, ensuring the technology is more accessible to all health systems. Health systems can leverage scalable technology to follow the path that best fits their needs, facility size, location, and 2–5-year plan.

After the initial selection of RTLS, teams can continue to scale the technology with various system add-ons as desired. Since implementing its real-time location system, a hospital in North Carolina has over time successfully implemented over 50 use cases leveraging real-time visibility data and reports more than $10 million in overall benefits. The healthcare facility even continues to collaborate with its RTLS partner for consulting insights to ensure the technology is used to its fullest potential. Through the scalability plan, the hospital experiences savings of more than $900,000 per year simply by deciding to additionally implement an automated temperature monitoring system. Some additional benefits include asset management, which adds a savings of $2 million per year, and an increase in staff productivity, which is valued at over $2 million savings per year for the North Carolina hospital.

Take the time to consider the road ahead

The best way to achieve a substantial increase in value and efficiency across an entire healthcare campus or within a new facility is through a personalized approach that combines a strong patient- and caregiver-focused design with a strategic roadmap that considers the goals for the future. A well-rounded internal “village” team from the health system paired with expert-led consulting and training services can develop the most accurate roadmap to ensure the right technology is implemented to drive greater workflow efficiency, higher safety standards, the ultimate patient and staff experiences, and substantial ROI. By factoring in a range of experienced input, healthcare teams can maximize emerging technologies and RTLS to drive meaningful change throughout their enterprise using practical guidance from within their “village.”

Caryn Hewitt is the Senior Director, Consulting Services at CenTrak, which offers locating, sensing, and security solutions for the healthcare industry. CenTrak has helped more than 2,000 healthcare organizations around the world build a safer, more efficient enterprise. For more information: visit centrak.com.

Rethinking Healthcare Facility Designs for Increased Patient- and Family-Centered Care

By: Matt Goche, CEO of Uniguest

When it comes to the patient experience, first impressions are crucial. Healthcare systems seek to develop long-lasting relationships with new and existing healthcare consumers and initial encounters can make or break an experience. New patients, existing patients, and loved ones often take measures to ensure they’re prepared for a visit before stepping into a facility, including confirming directions, parking information, and travel time. I have certainly experienced this mindset when preparing for an appointment or supporting family. Once patients are physically in the healthcare facility, effective visual communications assist in creating a welcoming environment. This is important. The use of digital signage, patient engagement tools, and wayfinding empowers patients and visitors during a time when they may feel a lack of control. Reducing the stress associated with a hospital visit and increasing patient engagement is essential to elevating the overall experience.

As healthcare becomes increasingly competitive, the line between patient and customer blurs. Healthcare facilities must anticipate needs and meet expectations in a timely manner with intuitive solutions and clear communication. Patient expectations are constantly evolving, and leadership, architects, and facilities managers must upgrade designs and technologies to meet these needs while accommodating staff as well. The growing reliance on technology in everyday life is leading to an increase in demand for digital solutions throughout the healthcare journey for all stakeholders. In fact, 84% of healthcare leadership surveyed by HIMSS Research agree that their patients are demanding a “more personalized, holistic digital experience” and the Deloitte 2022 Consumer & Physician Survey revealed that 90% of patients want digital engagement and navigation options. At the same time, Experian Health survey results reveal that 100% of respondents feel staffing shortages have affected patient engagement efforts.

The solution? Thoughtful facility designs and comprehensive engagement systems that help staff reallocate time to patient care. Through this approach, caregivers gain more collaboration with patients to focus on their unique needs and achieve higher-quality outcomes.

Patient Engagement and Family-Centered Care Go Hand-in-Hand

Impactful patient engagement calls for an approach that considers the patient and loved ones at each step of care (planning, delivery, and evaluation) to mutually benefit relationships among patients, providers, and families. It is about better engaging care partners and positioning support around each unique family to drive better outcomes. Increasingly prevalent, the Institute for Patient- and Family-Centered Care says this approach “redefines the relationships in healthcare by placing an emphasis on collaborating” and serves to “promote the health and well-being of individuals and families.”

Leveraging family-centered care allows for a more human experience for everyone and creates greater trust for a smoother care journey. I envision the utilization of the family-centered care model increasing throughout the industry as health system leadership works to implement new technologies within their facility designs. This can be supported in large part at the point of care by implementing a digital engagement strategy that incorporates touchpoints throughout the care journey for improved experiences and outcomes.

Digital Engagement Platforms Guide and Support Patients

Technology is reshaping how consumers access healthcare services and communicate with their providers. From accessing “Doctor Google” to gain insights on what may be ailing us to connecting through a myriad of available digital front doors and making online bill payments, we live in a digital-first, self-service world. Therefore, when patients and families visit facilities for care, the design has to fit this ethos in order to drive engagement, collaboration, and comfort. Patients of all ages are more likely to interact with a system that’s intuitive and familiar. We need to make it easy to ensure the best level of engagement and create a sense of control for patients every step of the way.

Hospitals can be both intimidating and confusing. Some medical centers cover multiple city blocks, causing navigation challenges for first-time and repeat patients alike. Medical campuses often change over time and each new unit or building can disrupt a patient’s previously known path. Navigating the floors and hallways can be equally daunting and add to an already elevated stress level. Consumer-accessible digital wayfinding solutions develop a clear route to guide the user through the navigation process step by step, creating a sense of comfort and control for patients and loved ones at first encounter. Building floorplans are overlaid onto a private, intuitive Google Maps-type interface, allowing users to have a sense of familiarity while gaining contextual information regarding their location and destination. Through interactive maps or directional displays, digital wayfinding solutions foster the independence that is required to manage your health. It’s subtle but it matters.

Once acclimated, a digital engagement platform can guide the family throughout their journey. Large-format video walls welcome arriving patients in a lobby, atrium, and common areas with healing and relaxing imagery that can be placed in rotation with other messaging throughout the day. Common content for signage in common areas includes population health-focused messaging such as reminders to schedule wellness visits, information on getting vaccinations and screenings; seasonally-focused messages such as details on flu shots or managing the heat; and program promotions for at-risk populations that reinforce the system’s commitment to supporting health at all times.

For outpatient visitors, location-specific digital signage solutions in waiting rooms can provide wait times, staff bios, related services, and relevant patient education and discharge content. By proactively providing the answers to the frequently asked questions, stress is reduced while self-efficacy is built. For hospital staff, it is worth noting that each of these endpoints can be easily managed from a central content management system.

Design Health Systems According to Patient Comfort

In the patient room, an Interactive Patient Care System (IPS) transforms the latest smart TV technology into a communication hub for education, empowerment, and, of course, entertainment. Back-end integrations from a range of health information technology (HIT) including the EHR, dietary, engineering, and facilities, allow access to directed patient education, meal ordering, room controls, and service requests conveniently through the device of a patient’s choosing, including a traditional pillow speaker, a hospital provided tablet, or a personal device paired to the system. Again, by providing access through the easy and familiar, system usage increases as families become more comfortable in an unfamiliar environment during an unsettling time.

More advanced IPS systems include additional communication endpoints beyond the TV. The set of HIT integrations can be leveraged to communicate information directly to the patient, family, and staff through a digital whiteboard and to the clinician through a digital door sign. These implementations are designed to build trust and allow each party to remain on the same page throughout the care process. For example, such tools can be set to include the patient’s schedule for the day. This information shows the patient and family what to expect, how to prepare for their daily activities, and where and when key elements are taking place. Through these insights, patients know when they’d like loved ones to be present without the nurse providing a manual rundown.

The IPS also provides advantages for overworked and resource-constrained staff. By automating repetitive tasks such as documenting patient education in the EHR or updating dry-erase boards and offloading non-clinical tasks like adjusting room lighting and heat or ordering a meal, nurses have the opportunity to be more efficient, gain additional time with patients, and practice at the top of their license. More importantly, with less “drudgery,” job satisfaction is increased and employee turnover is decreased.

Digital Engagement Encourages Human-Centered Care

Rising consumerism and increasing competition in healthcare have created a demand for quick access to the information and experiences desired by the patient. Additionally, technological advances have also changed the way providers want to access information and deliver care. Every step of the care journey is essential as healthcare teams strive to deliver high-quality outcomes, reduce avoidable readmissions, and build long-lasting relationships with patients. A comprehensive digital engagement platform incorporated into facility designs helps a healthcare organization stand out as a provider of superior, high-quality, family-centered care.

 

Matt Goche is the Chief Executive Officer of Uniguest. He brings extensive technology and cybersecurity background to Uniguest with a track record of growing revenue and achieving business results. Since Matt joined Uniguest in 2016 as Chief Operating Officer, later as President, and now as Chief Executive Officer, Uniguest has dramatically grown revenue, expanded the employee base, acquired marquee companies, and moved into new markets with new product offerings. Uniguest now has 15 offices across the globe and supports a customer base of over 20,000 customers.

Better Together Like Peanut Butter and Jelly: Delivering High-Impact Functional Programming in Healthcare Design through Collaboration

By: Christopher K. Gargala MSN, RN-BC, CCRN-K, Sheila M. Kelty DHA, MBA, LSSBB and Paul L. Macheske FAIA, FACHA, LEED AP

Crafting the perfect sandwich comes down to ingredient selection, balance of each, and complementary flavors. The peanut butter and jelly sandwich is arguably the most recognized sandwich in the United States, and one that enables people to grow and sustain themselves. Peanut butter provides protein and substance, whereas jelly provides a complementary flavor, texture, and balance. In a similar way, health systems that are focused on growth and sustaining the organization can find complementary, balanced, and joyful outcomes for their projects by bringing together independent teams (ingredients) with specialized experience.

Synergy of Collaboration

Healthcare organizations engaging in building projects desire a facility with both form and function – a building’s peanut butter and jelly. They are looking for a building that delights the senses, inspires hope, welcomes patients and family members upon arrival, and enables the orchestration of efficient workflows for caregivers, physicians, and staff. Traditionally, a healthcare organization may use their architect firm as the sole vendor for the functional programming phase of design. This methodology inadvertently creates gaps that often must be addressed by the organization later in the project. Utilizing a functional programming planner with healthcare experience including clinical, ancillary, and support operations as well as executive leadership experience enhances the expertise the architect brings to the project by invoking user groups to translate their needs to individuals that are their peers and who have the experience of mastering built projects. Including a multidisciplinary team from the healthcare organization at the onset provides insight into the culture of the organization. Each of these groups has their own expertise and although they are knowledgeable about some areas that overlap, many would benefit from the expertise of those who can help to translate their operational skillset into rooms, space, and buildings. We will explore more about each of these groups— AHCA Board Certified Architects, Healthcare Operations Consultants, and Healthcare Organizations—and their expertise and the gaps in their ability related to the functional programming phase of a new building project.

AHCA Board Certified Architects

Expertise

The architect is a vital part of the project from beginning to end; one who brings tactile definition to the project framed by the client’s vision and goals, while holding the liability to comply with complex codes and life safety regulations and incorporate best practices as licensed professionals. Architects who specialize in healthcare are board certified by the American College of Healthcare Architects (ACHA) and have demonstrated expertise.[1] Similar to medical professionals who obtain board certifications for Neurosurgery or Cardiology, ACHA Board Certified Healthcare Architects meet or exceed high thresholds in experience and testing and thereby are credentialed by their organization, lead development of best practices and approaches, meet rigorous standards, and demonstrate competence in a highly complex field. Just as you would not consider receiving brain surgery by a non-board-certified neurosurgeon, hospitals should seek healthcare architects that are ACHA certified. Healthcare Architects recognize the challenges that healthcare systems face, from declining reimbursements to higher operational costs. Instituting innovative technology in building materials can help your building be more sustainable, lower your energy costs, and reduce your carbon footprint. Healthcare Architects utilize renderings, departmental and room use floor plans, and other deliverables to obtain user approval at design phase milestones.

Gaps

Not all architects who offer design services are ACHA Board Certified Healthcare Architects and many architects do not have boots-on-the-ground experience in hospital operations. Generally, their experiences do not include caring for patients nor family members in a healthcare setting. Understandably, most practicing architects have not personally experienced the daily staffing of a clinical unit with a declining workforce and excessive cost of travelers and locums and can benefit by the balance of jelly to the peanut butter they provide.

Healthcare Operations Consultants Expertise

The Healthcare Operations Consultants balances patient focus, employee focus, and operational throughput based on real-life healthcare experience. Building projects are not the primary focus of healthcare organizations. The organization may have a small team of people who have roles in building and construction, but healthcare operations team members are not released from their clinical role to plan, develop, and build buildings over what is sure to be an extensive period.

Healthcare Operations Consultants with deep, personal experience working in the healthcare sector have worked with—and have had their organizations impacted by—state department of health requirements and accreditation requirements. They have faced the challenges of staffing and operational budgets. Healthcare Operations Consultants have often had the privilege of working in or with numerous healthcare organizations and have had a hand in building projects of all sizes and budgets. The consultants also have access to evidence-based best practices and a diversity of experience in Lean processes. Utilizing this experience in conjunction with the healthcare architect can help the healthcare client identify risks and potential workflow issues in the initial stages of programming, thus shortening future design phases. Their vast personal experience, membership in professional organizations, and deep understanding of healthcare processes are paramount to the role and value they bring to functional programming. And just like the many potential flavors of jelly that can complement peanut butter, Healthcare Operations Consultants come with a wide variety of credentials from registered nurses, physicians, imaging technicians, and therapists to non-clinical backgrounds such as patient access, financial services, administration, and other ancillary and support areas.

Gaps

Healthcare Operations Consultants are not architects. They do not have the level of design experience that the architect is contractually bound to uphold. Although they participate in building projects in many cities and states, their knowledge of building codes may not be current or may not pertain to the geographic location of the client. They have myriad experience in many healthcare organizations, but still need to understand the culture, vision, and patient base of the client to support programming.

Healthcare Organizations (Client) Expertise

Many times, functional programming efforts include executive management but lack involvement from direct care staff members. Incorporating the hands-on staff from the beginning of the functional programming process allows the programming team to ascertain what is going well and should be replicated in the new build. Doing so also allows the team to determine operational areas and processes that do not work well in the existing facility and need to be reimagined for the new facility. Listening carefully to the current staff during programming helps bring the complete operational picture into focus and reduces the risk of change orders later in the process. The hands-on or front-line staff from the client organization can be likened to the bread that is the main ingredient in the peanut butter and jelly sandwich.  Without the bread, there is no sandwich.

Gaps

The healthcare organization leaders may have functional programming duties for the project without removing any of their current workload, which adds to their day and presents competing priorities. Their primary focus remains the day-to-day clinical focus for their patients. Similarly, they may be siloed in their view of the care or service they provide. Or, when asked by the architect what their needs are to inform the design of a new facility, the default may be to replicate what they have grown accustomed to within current space. Unintentionally, representatives of a particular service or care area may prioritize their portion of the continuum of care over other services. The information provided by each service areas’ team members must be addressed holistically in programming to align with the operational requirements of other departments and services lines.

Collaboration creates a complete package

Constructive collaboration between a Healthcare Operations Consultant, an AHCA Board Certified Healthcare Architect, and representatives of the Healthcare Organization that begins in the earliest stages of the project allows for a 360-degree view of the healthcare organization’s needs. This collaboration allows for simultaneous review and updates to processes that result in the infrastructure to develop service lines, departmental space designs, and overall building designs meeting the needs of the healthcare organization. A workshop-based process allows teams to work both separately and collaboratively throughout functional programming.

Workshops and Communication

The modern healthcare environment provides opportunities for Healthcare Organizations to partner with entities who are geographically distant through virtual synchronous and asynchronous means such as virtual meetings and cloud file sharing. While virtual synchronous and asynchronous collaboration offers extraordinary benefits for communication and collaboration, the programming process requires an elevated level of engagement that benefits from face-to-face meetings. Architects, Healthcare Operations Consultants, and Healthcare Organizations achieve great benefit with primarily in-person collaboration augmented by virtual modalities.

A collaborative workshop approach assists the functional programming process. Initial workshops should focus on building a cohesive project team, establishing guiding principles, and gaining executive leadership buy-in and support. Subsequent workshops should be service-line specific and include key front-line staff members and appropriate decision makers. Service-line specific workshops should include a current state analysis (including opportunities to improve) to create a thorough understanding. The remainder of the functional programming process should then focus on future state space needs and wants as related to staffing, departmental spaces, technologies, and equipment. Though the Healthcare Operations Consultants lead these workshops, it is crucial that the Architects are engaged in an active listening and analysis mode. Real-time input and space program editing can occur from an architectural perspective. Furthermore, engaging dialogue often surfaces the most collaborative solutions to the most complex problems.

Communication is a challenge waiting for an optimized solution with every project; functional programming is no exception. Not only is leveraging collaborative project management tools (synchronous and asynchronous) imperative to a successful functional program, but it is also crucial to minimize the number of tools in use. At the beginning of the engagement, there should be clear expectations about which tools the team will utilize, and in which instances they will use each tool. The Healthcare Organization should be a part of this vital conversation; doing so will streamline processes and reduce rework in the future.

Final Product

The Healthcare Operations Consultants and the Architects have distinct responsibilities for the final functional programming deliverable. Generally, Architects define the space program and, in some cases, draw bubble (adjacency) diagrams with concurrent and collaborative input from Healthcare Operations Consultants. Healthcare Operations Consultants, on the other hand, write the functional program document, which is an owner-required deliverable under the FGI Guidelines for the Design of Healthcare Facilities[2]. The Healthcare Operations Consultants synthesize the relevant information from all the preceding workshops and present it in a compelling, comprehensive way that meets the needs and vision of the Healthcare Organization. The Healthcare Organization’s needs, vision, and service to patients must be at the center of all discussions and decisions related to the functional program. Given that design and construction is not the primary daily focus of healthcare systems, concurrent collaboration utilizing the skills and expertise of both the Architect and the Healthcare Operations Consultant allows for the creation of a well-rounded and effective functional program.

The final functional program serves as a starting point for the remainder of the construction project. It is a living document that when consulted, should point the client and project team toward their desired future state. This lengthy document could collect dust on the COO’s bookshelf, but we would caution against that. Instead, it should operate as a go-to resource for the entirety of the project. A well-crafted, and often-referenced, functional program will help clients shorten future design phases, ensure front-line voices were heard, identify risks and decisions early, reduce the propensity of change orders, and, ultimately, deliver the best peanut butter and jelly sandwich: a healthcare facility that attracts top talent and changes a community for future generations.

[1] About ACHA. ACHA. (2023, April 17). https://healtharchitects.org/about/

[2] Facility Guidelines Institute. (n.d.). https://fgiguidelines.org/

 

Rethinking Healthcare Design to Appeal the Workforce Shortage

By Julian Lopez, NCIDQ, IIDA, Senior Project Designer at HMC Architects.

When it comes to healthcare design, the vernacular among architects and designers must revolve around the patient experience, healing environments, and promoting healthier local communities. This common verse among healthcare professionals has not only been mastered, but it has also, from time-and-time again, been regurgitated by the formulations of evidence-based design, positioning architect and design firms to create the next best healthcare facility. Then came Covid-19 and, healthcare facilities have had to reinvent themselves multiple times over the course of the pandemic. How times have changed.

As Covid-19 emerged, not only were entities forced to shut down elective services, but they became the imminent forefront for humanity. Quickly, they found themselves in survival mode for their operating budgets and the lives of their own professionals.
The world has not been the same, and neither has the healthcare workforce after the exhaustion and burnout of facing Covid-19 head-on since early 2020. As a result, the healthcare workforce crisis continues to threaten organizations while hospital employment continues to decline.

“Prioritizing design around the patient experience is no longer the only priority,” said CEO of Alta Hospitals, Hector Hernandez, MD, MBA. “For the first time in my 30 years in healthcare administration, I have had to become extra creative by finding ways to retain nursing and clinical ancillary staff. This has included providing additional break rooms, Zen-type meditation rooms, spaces to provide pet therapy for employees and physicians, while enhancing cafeteria services that operate 24/7, not to mention increasing morgue capacity and providing accommodations for those not wanting to go home due to fear of getting their family sick. Design cannot be ignored because now it accounts for what nurses and staff are looking for when making a decision to join Alta Hospitals.”

What does this ultimately mean for healthcare designers?
More than ever, designing those support areas for healthcare providers such as staff lounges, staff dining facilities and physician on-call rooms, among other spaces, must be closely analyzed and programmatically defined to account for the healthcare workforce incentive factor.
The design-build team of Hensel Phelps | HMC Architects | CO Architects is leading the design and construction of Harbor UCLA Medical Center Replacement Program, one of HMC Architects’ largest healthcare projects. The new 468,000 SF inpatient care tower with 346 beds, as well as a 403,000 SF outpatient treatment center and support building is not only looking closely at what the design means for patient care, the project is analyzing how the design also supports those who care for the patients.
While staff safety has always been crucial for HMC, taking a closer look at what this means coming out of a pandemic has reactivated design efforts into actual checklist of items. At Harbor-UCLA, patient-and-staff interaction hubs such as check-in and registration areas are being designed with aesthetic precaution. Desking must include privacy panels while other areas are divided with transaction glass windows where color and graphics help soothe environments. Taming design to not only care for patient privacy but to now account for enhanced staff protection has meant rethinking space planning layouts where social distance is layered and preferred. Waiting areas where tandem seating once allowed for maximizing occupancy loads are now becoming dispersed and accounting for safety versus overcrowding.
While HMC continues to design in support of enhanced patient care, and operational and sustainable efficiency, the design-build team’s efforts with Harbor-UCLA are consequently addressing the importance for employee mental health as well.

The project is aiming for LEED Gold Certification. Ensuring sustainability goals are met throughout the entire campus program results in strong design efforts that support employee wellness and reducing burnout and turnover.

Aesthetically, the design incorporates the surrounding environment. Local textures and colors of the harbor and calm local South Bay are reminiscent through material textures and curved finishes. Biophilic design concepts are used throughout; expanded visibility of the native landscape and natural light that seeps into the main lobby and other employee and patient areas provide staff and visitors the opportunity to mentally reset and restore.

Hernandez, CEO of three Alta Hospitals in Southern California not only recommends focusing on spaces dictated by our local labor force and younger generations, but emphasized on how we must also address diversity, equity and inclusion for the thousands of nurses and healthcare professional coming from countries such as the Philippines, India, Canada, and Mexico, among others. Their cultural differences must be addressed for their better adaptation and cultural transgression issues related to their relocation to the United States.
According to YM Careers Network, one of many recruiting organizations connecting Millennials and Gen Z healthcare talent with healthcare systems, it is important to have modern, tech-friendly systems in place to attract today’s candidates. It’s important to design for technology systems that support staff communication and efficiency such as remote interview areas, intentional kiosk locations within hospitals, and mobile-friendly interfaces and communication, all of which serve as part of the recipe for a tech-friendly recruitment approach.

For designers, this means having to heighten our knowledge on how we view and design around technology and cultural barriers. Design for the healthcare professional coming from another country and cultural background, must account for religion, gender identification and ethnicity to make them feel welcomed and diminish possible barriers.
At Harbor-UCLA, designing around technology to support staff communication and operating efficiencies means keeping an outlook for future technological needs and not ignoring how future healthcare talent will approach technology. This means not designing wall niches for queuing monitors or a television in public waiting areas, as we are used to doing because we don’t know what the future holds for queuing system technologies or if a television of a specific display size will continue to serve an entire waiting area.
So, what does this all mean for healthcare designers and architects acclimating to this new healthcare era?
The answer is simple. Designing in post-pandemic times requires that we address not only the immediate urgencies that will mitigate a dwindled workforce but that we continue to design for future generations while not overlooking to tune up the true healthcare engine—the healthcare workforce, a locomotive force that served us when we needed them most.