Architecture: Space Planning and The Development Process Sponsored - PDF document

Architecture: Space Planning and The Development Process Sponsored by: Sponsored by: Aptium Aptium Oncology Oncology Myra Gray Fouts Natalie C. Miovski RN, MSN, OCN, CNAA AIA, LEED AP VP, Medical Affairs Principal Aptium Oncology Inc. EwingCole Natalie C. Miovski, AIA, LEED AP Principal EwingCole � National Healthcare Expertise � 300+ Professionals (Philadelphia, PA, Washington, DC, Irvine, CA, Cleveland, OH � Healthcare Strategic/Master Planning, Planning & Programming, LEED Design, Architecture, Interior Design, Cost Estimating, Program Management, Structural, Mechanical/HVAC, Electrical, Plumbing, Fire Protection/Life Safety Engineering, 2 1

EwingCole Healthcare Representative Clients � Cancer Treatment Centers of � Memorial Sloan-Kettering America Cancer Center � Cedars-Sinai Medical Center � North Shore Long Island � Children’s Hospital of New York Jewish Health System � City of Hope Medical Center � Saint Jude Children's � Clara Maass Medical Center Research Hospital � Deborah Heart and Lung Center � Sanford Children’s Hospital � Fox Chase Cancer Center � SUNY, Stony Brook � Geisinger Health System � University of California, � Loma Linda Cancer Institute Irvine Medical System 3 Myra Gray Fouts, RN, MSN, OCN, CNAA VP, Medical Affairs, Aptium Oncology Inc. Aptium works with hospitals and physicians to design, finance, � build and manage comprehensive cancer centers � Aptium’s comprehensive cancer center model brings all the disciplines and services involved in cancer care under one roof. � They are customized to their market; tailored to their situation. 4 2

The Aptium Network Host Hospitals Include Cedars-Sinai Medical Center CALIFORNIA Alta Bates Summit Medical Center CALIFORNIA St. Vincent’s Hospital Manhattan NEW YORK Desert Regional Medical Center CALIFORNIA Mount Sinai Medical Center FLORIDA Boca Raton Community Hospital FLORIDA New York University Cancer Institute NEW YORK Trinitas Hospital NEW JERSEY 5 Agenda � Demand for Services � How to Measure Success � Team, Team, Team � Approach � Planning/development � Design � Construction � Results: Case Study � Trinitas Comprehensive Cancer Center 6 3

Future of Cancer Care � A growing demand for services � An explosion of treatment options � Uncertain financial climate � Increasing administrative burdens 7 Common Hospital Service Line Goals � Raise the level of cancer care in the community � Increase regional presence � Retain and attract leading physicians � Further enhance research programs and clinical protocols � Increase cancer program profitability and cash flows � Decrease patient out-migration Explore opportunities to partner with a 3 rd party to meet objectives � � Proven expertise � Access to funding 8 4

Pressures on Hospitals CEO Top Concerns Financial Challenges 72% 40% Physician and Hospital Relations 37% Care for Uninsured Personnel Shortages 30% 29% Quality Patient Safety 27% 23% Government Mandates 16% Patient Satisfaction 11% Capacity 0% 20% 40% 60% 80% Source: Modern Healthcare, January 1, 2007 9 How To Measure Success � Patient satisfaction � “I find it very relaxing even though circumstances dictate anxiety.” � “Your staff is the most compassionate, caring and courteous medical staff I have ever encountered; each and everyone of them treats you as a special person.” � “You should be extremely proud of your facility and of your magnificent staff!” 10 5

Results Overall Consensus - Positive 100 97 95.3 95.4 95.4 93.7 90.5 91 90.2 90 80 Mean Score Trinitas 70 PG Database* 60 50 Facility cleanliness Find way around Waiting area comfort Changing room facility with ease privacy *PG Database = All facilities in Press Ganey's Outpatient Oncology Database 11 How To Measure Success? � Patient satisfaction � Staff satisfaction � “Everyone was surprised and delighted with the way it turned out” � “What I need to do my work is convenient to me. I turn around and there’s my supplies, my computer, my pharmacy, my patients.” 12 6

How To Measure Success? � Patient satisfaction � Staff satisfaction � Market share 13 How To Measure Success? � Patient satisfaction � Staff satisfaction � Market share � Revenue Realization 14 7

Team, Team, Team � Vision and Mission � Charged with: � Fiscal accountability � Operational efficiencies, flow � Evaluating and challenging design concepts � Enhance user group participation � Powerful voice/cheerleader 15 Team, Team, Team Multi-Disciplinary Think Tank � Management � Healthcare architect � Finance / medicine / nursing / � Quality management cancer center administration people � Project champion / forward � Guest services thinkers � Facilities management � Executive leadership representative 16 8

Approach Model Cancer Key Center Program Influencers Patient & Staff Processes Satisfaction Design Post-Occupancy Development Construction/ Timeline Costs 17 Approach: Program � Develop detailed business case including � Clinical program recommendations � Staffing � Equipment � Space requirements 18 9

Approach Model Cancer Key Center Program Influencers Patient & Staff Processes Satisfaction Design Post-Occupancy Development Construction/ Timeline Costs 19 Approach: Model Cancer Center Recognized Convention Patient Staff � Views of nature, daylight and sunlight � Patient visibility � Control of local environment � Minimal footsteps to key areas � Social support � Single point access to pharmacy � Privacy � Collaboration with other nurses � Nurse visibility � Space for private conversations � Places for family/guests � Ample supplies near at hand � Tranquil, state-of-the-art environment � Places for personal effects � Ergonomics 20 10

Approach: Model Cancer Center Recognized Convention “It is the unqualified result of all my experiences with the sick, that second only to the need of fresh air is their need of light; that, after a close room, what hurts them most is a dark room.” – Florence Nightingale 21 Approach: Model Cancer Center Recognized Convention Physicians Equipment & Technology � Convenience, convenience, � Latest, greatest, fastest, smallest, convenience lightest � Efficiency � Flexible � Privacy � Comprehensive & user friendly � Marketable Architecture � High-technology � Appropriate image Administration/Executive � Cost sensitive Leadership � Revenue generating spaces 22 11

Approach: Model Cancer Center Recognized Convention The Advisory Board – Oncology Roundtable Data 23 Approach: Model Cancer Center Inherent Contradictions Privacy � Individual dignity vs staff supervision � Care giving � Incorporation of family responsibilities vs. solo staff tasks Lighting � Dim vs bright Noise control � Sound attenuation vs hard, cleanable surfaces Views of nature � Window vs interior view � Patients vs staff Art � Nature vs modern/abstract 24 12

Approach Model Cancer Key Center Program Influencers Patient & Staff Processes Satisfaction Design Post-Occupancy Development Construction/ Timeline Costs 25 Approach: Key Facility Influencers 26 13

Approach: Key Facility Influencers Clinical Programs Market � Psychosocial services/ palliative � Competitive environment � Patient expectation/quality care � Research Physician Considerations � Integrative medicine � Physician practice pattern � Comprehensive center � Tumor site program � Number of physicians Technology Staff � Electronic medical records � Recruitment � Retention � Computer savvy � Patient tracking Space/Regulation � Expansion potential � JCAHO/DOH/DCA/OSHPD � Site considerations 27 Approach: Key Facility Influencers 28 14

Approach: Market & Space/Regulation Privacy Expectations URBAN RURAL 29 Approach: Physician Consideration & Staff Physician Practice Pattern & Staff Flow URBAN RURAL 30 15

Approach: Clinical Program Multi-Disciplinary Environment URBAN RURAL 31 Approach: Technology Information/Patient Tracking URBAN RURAL 32 16

Approach Model Cancer Key Center Program Influencers Patient & Staff Processes Satisfaction Design Post-Occupancy Development Construction/ Timeline Costs 33 Approach: Processes � Improved efficiencies � Process re-engineering � Cultural transformation opportunity 34 17

Approach: Processes “The flow for the patients has been well thought out, not only to reduce patient apprehension, but to help the staff coordinate their care.” Chief, Radiation Oncology 35 Approach Model Cancer Key Center Program Influencers Patient & Staff Processes Satisfaction Design Post-Occupancy Development Construction/ Timeline Costs 36 18

Approach: Design Development Percentage of Work/Fee by Architecture Firm � Schematic design (planning) 15% � Design clarifications 25% � Construction documents 40% � Construction administration 20% 37 Approach: Design Development Room & Equipment Planning Pharmacy � Regulatory - sterile compounding (USP 797) � Engineering – clean room ISO class 05 � Material management - storage, deliveries � Environmental services - patient/pharmacy safety � Architecture – door, millwork, ceiling, lights, aesthetics 38 19