Deb Sheehan on Renovating and Expanding Ambulatory Surgery Centers
With more surgeries moving to ambulatory settings and growing demand for updated or expanded ambulatory surgery centers (ASCs), Same-Day Surgery penned a new article featuring our Deb Sheehan highlighting the inherent opportunities, challenges and considerations for these update efforts.
Specifically, Deb shines light on how ASCs can ensure staff can effectively continue surgical work amidst ongoing construction.
She notes insurance companies are currently pushing harder for outpatient procedures over inpatient to save money, be more efficient and improve patient outcomes. But current ASCs weren’t built to handle the number of patients being sent their way—most were built two decades ago – and can’t accommodate a higher patient load or the latest technology that aides in improved outcomes and speedier procedures.
Completing a renovation that isn’t time-consuming, expensive or disruptive to ongoing surgeries is a daunting task. ASCs must phase construction and keep key areas compartmentalized to avoid any crossover with patients or contamination of sterile spaces. Extra steps such as temporary walls or HEPA filters may need to be implemented as extra infection control measures.
“It leaves us with little sequences of construction,” Deb explains. “Maybe we get 500 square feet at a time for the change, which is often the case, to maintain critical flows around construction space.”
Working with ASC staff during the design process helps establish new optimized workflows that can be used in the new facility. One great way to engage ASC staff is via new technology where nurses and surgical teams can virtually “walk through” a space and determine any potential issues an architect or designer might not consider.
Read the complete article here >
Fighting Cancer, DLC and Health Sciences Education – Early Trends in Healthcare 2016
The future of health and healthcare delivery is happening at lightning pace. Just more than a month into the New Year, there are numerous new efforts and developments spanning cancer care, medical research, health education that are both inspiring and exciting. Given our firm’s diversity, almost all of these efforts impact what we focus on with our clients, partners and internal teams.
Here is a look at three key trends defining the early weeks of healthcare in 2016:
The Renewed Fight on Cancer
President Obama’s announcement of the country’s renewed focus on fighting and defeating cancer during his State of the Union address earlier this year is good news for so many of the mission-driven organizations we work with that are focused on the disease. The new focus will bring enhanced resources to those organizations at the cutting edge of the fight, helping them advance their most successful treatment and research efforts. To begin the launch of this new effort to defeat cancer, Vice President Joe Biden toured the Penn Medicine Center for Advanced Celllular Therapies I wrote about last month. He and other leaders see Penn Medicine’s work on personalized medicine as critical to the success of their effort.
Beyond that, other organizations like ProHealth Care are focused on elevating patient engagement strategies to enhance care for cancer patients. The organization’s new freestanding ambulatory cancer center is focused on educating patients about how to avoid ED visits, inpatient stays and missed clinic appointments while also helping them develop strong support groups and increase their strength during chemo treatment. At Kaiser Permanente, the organization has developed its Kraemer Radiation Oncology Center with above ground radiation treatment centers that allow for patients to access natural light, views to nature and soothing interior colors during their difficult treatment sessions. This is a departure from traditional design that always placed these centers below ground to accommodate heavy equipment and to shield radiation. Kaiser is leading the way on tackling these challenges and enhance care for its patients.
All of these efforts – from the President’s declaration to the tireless efforts of health providers around the world to advance research, care and treatment options inspire me as we head further into 2016.
New Delivery Solutions for Health Providers
Health providers face increased pressure to design and construct facilities that are high-quality, high-performance and cost-efficient all wrapped in one. Thankfully, the industry is beginning to advance key single-source delivery options like Design-Led Construction (DLC) that make this possible. In a new piece from Building Design + Construction, my colleague shares reasons the C-Suite should care about DLC relative to its ability to accelerate speed-to-market, achieve guaranteed price, reduce inefficiencies and allow organizations to greatly reduce the risk associated with these projects.
Allegheny Health Network recently leveraged DLC to create its Wexford Health & Wellness Pavilion in western Pennsylvania. DLC helped them achieve a 22-month design and construction schedule (construction completed on time in 18 months) while also adhering to an early established $57.4 million guaranteed maximum price and incurring $0 in error and omission change orders. This kind of streamlined delivery not only makes life easier for health providers, it helps them delivery high-quality care to their communities sooner and at a cost that doesn’t detract from other organizational goals.
Stronger Focus on Health Sciences Education
With the rapid evolution of healthcare comes the need to adapt how we educate students to help them fill the medical jobs of the future. Malcolm X College in Chicago is responding to this need with its new School of Health Sciences. The 1-million sf facility can accommodate up to 20,000 students and houses state-of-the-art technologies and services including:
- A virtual hospital complete with operating and emergency rooms
- Nursing, radiography, respiratory care and science labs
- An ambulance for EMT simulations
- A free dental hygiene clinic to open in 2016
- An exercise and sports sciences area that features a 900-seat gymnasium, two therapy pools and one lap pool
The new School of Health Sciences will help close the gap between the current market of qualified healthcare professionals and the projected 84,000 healthcare jobs in the region over the next decade. The facility is informed by experts spanning education, healthcare, science, urban planning, architecture and engineering– and also required strong collaboration with key partners including AOR Moody Nolan and CM Jacobs Management Co.
These are just a few of the exciting developments already making 2016 a strong year for the advancement of healthcare.
Learn more about our Health Expertise >
Forbes Healthcare Summit: Destroying Brain Tumors and Elevating Big Data
Meeting Challenges at Forbes Healthcare Summit
One of the true joys in spending your career working in healthcare or health design is that you are consistently reminded just how courageous and motivated people can be when they are mission driven to overcome great challenges. Disease incidence, efficacy rates and new science breakthroughs in healthcare can be expressed and studied via statistics – but the experience of battling cancer, caring for a sick child, enduring extensive surgeries – these are remarkably human experiences that fuel the drive and mission underpinning change within our health system.
Last week’s Forbes Healthcare Summit in New York City did a thoughtful and balanced job of keeping this truth front and center. It was inspiring to be in a room with many smart, passionate people focused on improving healthcare for patients. Matthew Herper and the team at Forbes did a remarkable job of assembling senior leaders from health systems (Geisinger Health, North Shore – LIJ Health System and Mayo Clinic to name a few), pharmaceutical companies (Merck, Express Scripts, Allergan, Pfizer, etc.), biotech companies and patient advocates to talk about the key agents influencing health now and into the future.
The group focused on how anticipatory medicine, consumer demands and patient engagement are setting healthcare on a bold new path. I plan to write on these topics in future posts over the months ahead that connect back to our work at CannonDesign. I’m also hopeful to acquire some of the presentations to share with our teams for information and insight.
At the moment though, and since I left the Forbes event, I’ve been inspired as much as educated. Embedded in the smart conversations were very human stories. Two that stood out were Steve Keating’s battle with brain cancer and Rachel Kalmar’s work with wearables. Below are brief glimpses into each person and their story.
Fighting Brain Tumors with Social Media and Data
A unique perspective and engaging presentation during the event came from Steve Keating. He took the stage and talked openly about how he’d learned he had a slight abnormality in his brain in 2007 that he then tracked and monitored until it ultimately became a baseball-sized tumor that needed to be removed. He dove deep into how he’d used social media to connect with others who had or were battling brain tumors and learn more about treatment options. Even after his surgery, Keating has continued to be an advocate for patient access to information and the empowerment of patients in the health experience.
On my plane ride home to Chicago, I read more about Keating and his fight,including this MIT article from earlier this year. A few facts that reinforced his presentation really stand out:
- Keating has always been interested in actively understanding his health. His first brain scan in 2007 happened came about to his sheer curiosity. Rather than just receive summary results, Keating wanted the scan’s raw data which led to the identification of the brain abnormality.
- The raw data from the original scan further fueled Keating’s curiosity in his own health. Years later as an MIT graduate student, Keating continued to engage his doctors on treatment options. Even during the 10-hour surgery to remove the brain tumor, Keating was sedated but kept awake so he could converse with doctors and ensure they were not damaging the brain’s language center. The entire surgery was captured on video, per Keating’s request.
- Now, Keating has become a powerful advocate for open health data. He believes the access to his personal data and the curiosity it sparked ultimately saved his life – and he’d like to see others have the same chance.
While designers can’t overtly grant access to personal health data, Keating’s presentation left me thinking about new ideas and ways we might encourage providers to engage patients in the design of health spaces. We’ve seen success with this for organizations like ProHealth and other providers. If access to data can help patients, engagement in the creation of the spaces where health care is delivered is another key component.
Wearables from Head to Toe
Another fascinating story shared at Forbes Health Summit was Rachel Kalmar’s efforts to help wearable health technology and the data it generates be more meaningful. Kalmar has worn between one and 38 devices each day for the past three years. She’s done this to see how the technologies compare, what people can and should learn from them and what the data looks like.
The biggest thing I learned,” Kalmar said during her presentation. “Is how difficult it is to get access to all this data.
Through her presentation, Kalmar expressed that she believes we’re in the early days of understanding how we can leverage wearable health tech. She sees challenges related to the lack of a common infrastructure, battery life issues, and the lack of common language across the different platforms. Robert Glatter provided a thorough recap with video excerpts of Kalmar’s presentation for Forbes.
The group at the Forbes event was in agreement on Kalmar’s thought that we’re in the early days with wearables. There was a sense that we are definitely moving from precision medicine to anticipatory medicine and that wearables have a robust role to contribute in that future.
It’s been a week since I left NYC after the Forbes event and I already look forward to 2016. No doubt, the ideas and inspiration I gained at the event will impact my work with CannonDesign and the trajectory of our practice in the year ahead.
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Less Space, More Patients, Better Health Outcomes at UMN Health
There’s no such thing as an easy challenge in healthcare. As health organizations seek to improve care and health outcomes, reduce costs, keep up with rapid innovation, etc. – they’re also being pushed to achieve big goals within less real estate than ever before.
Project: University of Minnesota
University of Minnesota Health (UMN Health) sees this challenge as an opportunity to rethink and improve how healthcare is delivered. Set to open its Clinics and Surgery Center in early 2016, UMN Health has created a facility that will accommodate 40% more annual visits despite being 25% smaller than its predecessor. That said, UMN Health isn’t solely focused on efficiency as its new facility is designed to enhance the patient experience, improve care and health outcomes while also creating new opportunities for staff training and collaboration. UMN Health believes it has created a future-focused center that will strengthen its brand and market position in the years ahead.
Creating a cutting-edge facility capable of achieving these outcomes is no simple effort. It required months of planning and collaboration between UMN Health and CannonDesign. Here are three key areas we focused on to create an ambulatory care center up to the challenge.
Defining the Optimum Patient Experience
One of the first things the UMN Health team realized is that it would need to approach this design effort differently than others in the past. Rather than mold a patient experience to meet an existing building framework, they stepped back and defined the ideal patient experience and then created a building that could make it a reality. Our team participated in cross-functional, inter-professional team workshops with more than 250 UMN Health providers and staff to design new workflows and processes for the different phases of the patient visit. Specifically, we focused on pre-appointment management, patient arrival and check-in, in-clinic experience and patient departure and experience.
Everyone’s collective creative energy helped us take multiple value streams and find opportunities for efficiency, collaboration and redundancy elimination across the board. Ultimately, UMN Health walked away with one future-focused path for the optimal patient experience. This path outlines how patients will engage the organization and its facility from the outset of illness or injury through treatment. Bringing everyone together in this manner enabled UMN Health to knock out the silos that often impede such visioning and achieve a unified vision for its future that focuses on patient experience.
Eliminating Everything That Doesn’t Add Value
One of the keys to maximizing efficiency is eliminating everything that doesn’t add value. Unfortunately, the historical precedents that have driven health facility design over time weren’t calibrated to achieve efficiency. So much of the patient journey – checking in, completing forms on paper, waiting in the lobby, waiting in the exam room, waiting to cash out – simply doesn’t add value to the experience.
The new ambulatory care center eliminates these wasteful efforts by modeling itself after best practices from the world of retail. The UMN Health Clinics and Surgery Center has no waiting rooms and check-in desks that we’re akin to seeing in such environments. Instead, the facility takes inspiration from Apple Stores. When patients arrive at the center, they’ll be greeted by a staff member who can check them in, find their exam room and notify the corresponding medical staff of their arrival all via handheld mobile technology. On the other end, this mobile technology also helps staff cash patients out, schedule follow-up appointments, send prescriptions to the in-house pharmacy and call for the patient’s car.
Borrowing Strategy from Corporate Workplaces
One of the biggest weaknesses of traditional health and research facilities is that they’re bogged down by office space that usually takes up 30 to 40% of a facility’s real estate despite being unoccupied 90% of the time. With doctors and researchers spending most of their days in exam rooms with patients or in labs with their studies, the model is remarkably ineffective.
UMN Health looked to key trends from corporate workplaces to help them think differently about how they efficiently allocate such real estate. The center has significantly fewer private office spaces than other facilities of its type and none of them are assigned to specific individuals. Instead, the spaces can be reserved for those needing to have private conversations or do quiet, focused work. Additionally, the center is filled with open, collaborative workplaces at various points where staff can sit down, plug in and complete tasks while they’re on the go. Not only does this conserve real estate, but it also makes staff more efficient as it eliminates tedious trips back and forth to office space throughout the day and allows them to work anywhere, anytime in the facility.
UMN Health’s new Clinics and Surgery Center is a facility focused on the future of health delivery. It recognizes that being asked to do more with less is much more an opportunity for innovation and improvement than cause for concern.
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Accelerating Innovation in the Pharmaceutical Industry
Four Strategies for the Future
The key to success in the pharmaceutical industry is innovation. Despite stronger cost pressures than in previous decades, organizations are expected to innovate, develop new products and bring them to market at an accelerated rate. Surprisingly, many of the industry’s leaders are trying to navigate this complex and challenging industry with stale business models. Although science has consistently led the knowledge economy, its siloed nature, underfunding and linear processes have progressively reduced it to a transactional operation.
Not surprisingly, the R&D facilities at the center of these dated business models are also behind the times. Modern scientists may be pursuing cutting-edge solutions, but they’re often doing so in uninspiring facilities and hierarchical organizations. They’re often separated from one another in formally arranged spaces, reflecting linear process and static functionality. Such facilities and structures simply don’t sync with the needs of “new science.”
Project: Kaleida Health, Clinical and Medical Research Building: Gates Vascular Institute (GVI) and UB Clinical Translational Research
With over 50% of today’s scientists born after 1980 and over 70% of existing labs more than 50 years old, the current and emerging R&D workforce seek new solutions. These highly collaborative, generationally diverse scientists are demanding radically new open source workplaces where the walls between disciplines are removed, the boundaries between discovery and commercialization are blurred and real-world problems are addressed in collaborative coexistence.
Pharmaceutical companies looking to create R&D facilities responsive to “new science” may find a leading example from the world of academic medicine. The Gates Vascular Institute and Clinical Translational Research Center (GVI/CTRC) in Buffalo, NY, is the result of a unique public/private partnership between Kaleida Health and the University of Buffalo (UB). The first-of-its-kind facility stacks a research building over a vascular institute and connects them via a BioSciences Incubator to drive innovation forward. Since opening, GVI/CTRC has driven more than $130 million of economic impact, created new jobs, launched biomedical start-ups and helped both organizations recruit Tier 1 Placements.
Here are four unique design strategies that define GVI/CTRC and position it at the forefront of “new science.”
Integrated Design Plan
Successful modern R&D facilities can no longer be driven by lab design expertise alone. The GVI/CTRC required a remarkably synchronized design effort spanning leaders from science, higher education, healthcare, architecture, engineering, cost estimating, business consulting, interior design and construction management. This diverse team helped Kaleida Health and the University of Buffalo move beyond an original plan that called for two separate facilities and realize the value of combining their resources in one facility. Once this breakthrough was realized, the team then worked with leaders from both organizations to enhance every aspect of this dual-client’s physical and enterprise success. At the core of GVI/CTRC’s success was the realization that myriad perspectives would need to influence the design in order to achieve optimal outcomes.
Kaleida Health, Clinical and Medical Research Building Technology
Sandwiched between the GVI and the CTRC is a collaborative core containing education and conferences spaces, along with a 4,000 sf business incubator that allows doctors, researchers and entrepreneurs to meet in a variety of dynamic situations to accelerate medical discoveries. This creative design solution literally moves science from the bench to the bedside. Within GVI/CTRC, researchers can monitor real-time surgical procedures and then simply walk upstairs to begin testing ideas for new medical applications or products. Conversely, doctors are able to share challenges and needs with world-class researchers during opportunistic and informal meetings throughout the day.
This culture of collaboration is enhanced further by open-plan laboratories that allow for increased flexibility, innovation and collaboration. Open-plan laboratories eliminate the physical and figurative barriers between researchers and disciplines to promote the open exchange of ideas and cross-disciplinary collaboration required to best solve today’s medical challenges.
This is a visionary, translational place where – under one roof – physician scientists have the facilities and tools to conduct new forms of basic and translational research and are provided with the opportunities to commercialize their discoveries.
– Timothy Murphy, MD, Senior Associate for Clinical and Translational Research for the University of Buffalo of the GVI/CTRC.
Gates Vascular Institute (GVI) and UB Clinical Translational Research Lab
Traditional laboratories are remarkably inefficient. Research over the past few years indicates scientists spend less than 40% of their time in the lab and that 50% of lab space is incorrectly used. Oftentimes, this inefficiency is exacerbated by technology and communications systems that aren’t synchronized – leading to researchers wasting time while duplicating communication efforts or repeatedly walking from lab to office to record progress and updates. GVI/CTRC embraces modern technology and empowers its users to record information and communicate with each other at any time from any place within the facility. Seamless connectivity to technology systems that house data and analytics at strategically located work benches, touch down areas and collaboration zones inspired by best practices from corporate workplaces allow researchers to complete their work as they move from one effort to the next. This reduces time wasted, improves efficiency, and creates a continuous platform for real-time solutions
Ready for the Future
Everything moves rapidly in the pharmaceutical world. The challenges faced, the solutions needed, emerging sciences and technologies all change constantly. The GVI/CTRC will be able to endure and thrive amidst this change thanks to the universal grid design application– a standardized structural grid consisting of the optimum set of vertical and horizontal dimensions for a building’s structure to allow for radical adaptability to medical, science and research functions. This grid makes GVI/CTRC almost infinitely adaptable and will significantly extend the building’s valuable life by accommodating the wide range of potential sciences and technologies it will need to support. This prototype design strategy proved a key driver for the building’s fast-track delivery, under budgeted cost and achieves a reduction in the engineering needs of HVAC, plumbing and electrical systems operational costs by $10 per sf. All of these features will help GVI/CTRC deliver valuable ideas for global health at lower expense for the next century.
The GVI/CTRC represents a breakthrough model for accelerating medical discovery that leading pharmaceutical companies should look to for guidance as they restructure their R&D departments and facilities. The future of the industry will be driven by those organizations that embrace new science and organize themselves to maximize its potential. GVI/CTRC is powerful look at where medical science is headed – and a guidepost for pharmaceutical organizations eager to lead the charge.
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