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Session E09 
Your Aging Patient Bed Tower- Top Ten Considerations When Renovating
Presenters 
Adrian Hagerty, AIA, LEED AP 
Principal, Regional Vice President, National Capital Region 
p , g , p g 
Array ...
Session E09 
Your Aging Patient Bed Tower- Top Ten Considerations When Renovating 
While the benefits of caring for inpati...
Session E09 
Your Aging Patient Bed Tower- Top Ten Considerations When Renovating 
George Costanzamight disagree: 
https:/...
01 operational 
IT 
efficiency 07 infrastructure 
02 logistical 08 accessibility 
03 life safety 09 sustainability 
04 con...
Recognizing “necessity is the mother of invention”
finding the 
BALANCE 
between 
LEAN & MEAN
01 
operational efficiency considerations 
• Using Lean Design principles, test the work flow within a 
ensuremaximum unit...
01 
operational efficiency considerations 
• Engagement with Caregivers and Patients 
• Rapid Testing of Future State Solu...
02 
logistical considerations: feasibility study 
• Determine appropriate level of renovation required 
• Develop a plan t...
03 
life safety considerations 
• Providing a safe environment is utmost 
priority 
• Using ILSM (interim life safety meas...
It’s more than just 
WASHING 
your hands.
04 
infection control considerations 
• 1 in 20 patients acquire an infection during hospital stay 
• Aspergillus- most co...
A nurturing environment = 
HAPPY Patients = 
higher HCAHPS scores
05 
patient safety considerations 
• Patient Unit Design should promote healing and 
collaboration 
foster patient and fam...
06 
engineering considerations 
• HVAC system can account for more than 50% of the 
cost 
• Comprehensive facility conditi...
ARE NOT THE ANSWER
07 
IT infrastructure considerations 
• CINS (Clinical Integration Networks) allow caregivers to 
access the data of patie...
ACCESSibility 
is more than just clearances
08 
accessibility considerations 
• “Barrier-Free Health Care Initiative”- goal of ensuring 
that persons with disabilitie...
Can you make your father’s 
OLDSMOBILE 
run like a 
PRIUS?
09 
sustainability considerations 
• Environmentally-friendly design & system choices 
• Investigate opportunities to recy...
““““We’’’’re all in this 
TOGETHER.””
10 patient/family-involved care 
id ti 
considerations 
• Opportunity to reinvent the patient 
pp y p 
experience 
- Wow F...
OINTS OF IMPACT Mapping the Patient and Visitor Experience 
Wayfinding Clarity… 
I know amgoing 
Patient Centered… 
Family...
So How Do We Get There?
Conventional Approach
Conventional Approach
A New Approach 
PROCESS LED DESIGN 
Solution 
Discovery 
Creation 
Analysis
CASE STUDY 
University Hospitals 
MacDonald Women’s Hospital
Project Drivers: 
• Aging Infrastructure 
• Parity with other University Health System Hospitals 
• Create a patient-cente...
patient and family centered 
1. information sharing 
2. foster collaboration / participation / education 
3. honor patient...
operational ideals 
1. quality / safety initiatives 
2. support UH model-of-care 
3. technology and equipment integration ...
Current State:
Current State:
Inspiration: 
strength .. joy .. trust .. beauty .. promise .. growth .. calm .. warmth
Team 
Station:
Unit Corridor 
& Team Stations:
Private 
Patient Room:
University Hospitals 
MacDonald Women’s Hospital 
PHASE 1 
July 2, 2013 – Page 43 
NICU ACCESS
CASE STUDY 
NewYork-Presbyterian Hospital 
Milstein Tower
overview 
current state 
Milstein Enhancement Bed Unit Renovation 
Typical Floor Project Challenges: 
• Project Scope: 5 F...
Overview 
current state 
Milstein Enhancement Bed Unit Renovation 
existing conditions
Overview 
current state 
Milstein Enhancement Bed Unit Renovation 
existing conditions
current state best practice influencers vision 
current 
state 
• infrastructure deficiencies 
• out of sync with World‐Cl...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
Modern with clean lines, clas...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
58% 39% 3% 
# of respondents ...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
12% 42% 45% 
# of respondents...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
39% 61% 
# of respondents # o...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
27% 73% 
# of respondents # o...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
9% 52% 
39% 
1 2 3 
# of resp...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
How should the Milstein Tower...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
What adjectives describe the ...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
Image Survey Total 
Responses...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
Preferred . Not Preferred 
77...
Overview current state influencers vision 
Milstein Enhancement Bed Unit Renovation example 
What adjectives describe the ...
CIRCULATION 
VERTICAL CIRCULATION 
Milstein Enhancement Bed Unit 
Renovation 
MER / IT / SHAFTS 
PATIENT BEDS (QUAD) 
PATI...
ELEVATOR 
LOBBY 
SCHEMATIC VIEW
UNIT 
CORRIDOR 
SCHEMATIC VIEW
PRIVATE 
ROOM 
SCHEMATIC VIEW
Milstein Enhancement Bed Unit Renovation 
example
enhancements: overview 
enhancement level comparison example
enhancements: overview 
enhancement level comparison example
enhancements: overview 
enhancement level comparison example
enhancements: overview 
enhancement level comparison example
Milstein Enhancement Bed Unit Renovation 
$154.2M 
TOTAL BED UNIT PROJECT 
$141.1M 
TOTAL BED UNIT PROJECT 
FUNDING INCLUD...
phasing scenario studies - example 
HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH 
9 
MCKEEN MCKEEN 
BEHAVIORAL 
INF...
phasing scenario studies - example 
HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH 
BEHAVIORAL 
HEALTH 9 
ORTHOPEDICS...
QUESTIONS & ANSWERS
Your aging patient bed tower   top ten considerations when renovating
Your aging patient bed tower   top ten considerations when renovating
Your aging patient bed tower   top ten considerations when renovating
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Your aging patient bed tower top ten considerations when renovating

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While the benefits of caring for inpatients within a private room have now been time tested, there are thousands who still receive care outside of this clinically preferred environment on a daily basis.   As is often the case, the benefits may be clear, but the perceived cost of providing more private patient rooms has prevented the wholesale adoption of this basic principle throughout the United States. Building new bed towers has been an option for systems that could afford to build new facilities.  However, many systems do not have that luxury or are landlocked, at capacity and cannot expand or afford to give up beds from their license.  This session will provide a roadmap for the successful renovation of patient units to accommodate all private rooms, or enhanced 2-Bed rooms that incorporate best clinical practices in a cost effective manner.  By breaking down the success factors into ten key considerations, this session will allow designers, managers, and contractors to plan and execute such projects more effectively.   Case studies will be presented to demonstrate how this straightforward approach can increase the success of renovations that convert (primarily) double bedded units into single patient room units.

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Your aging patient bed tower top ten considerations when renovating

  1. 1. Session E09 Your Aging Patient Bed Tower- Top Ten Considerations When Renovating
  2. 2. Presenters Adrian Hagerty, AIA, LEED AP Principal, Regional Vice President, National Capital Region p , g , p g Array Architects Patricia Malick, AAHID, EDAC, Lean Green Belt Principal, Practice Area Leader-Interior Design Array Architects
  3. 3. Session E09 Your Aging Patient Bed Tower- Top Ten Considerations When Renovating While the benefits of caring for inpatients within a private room have now been time tested, there are thousands who still receive care outside of this clinically preferred environment on a daily basis. As is often the case, the benefits may be clear, but the perceived cost of providing more private patient rooms has prevented the wholesale adoption of this basic principle throughout the United States. Building new bed towers has been an option for systems that could afford to build new facilities. However, many systems do not have that luxury or are landlocked, at capacity and cannot expand or afford to give up beds from their license. This session will provide a roadmap for the successful renovation of patient units to accommodate all private rooms, or enhanced 2-Bed rooms that incorporate best clinical practices in a cost effective manner. By breaking down the success factors into ten key considerations, this session will allow designers, managers, and contractors to plan and execute such projects more effectively. Case studies will be presented to demonstrate how this straightforward approach can increase the success of renovations that convert (primarily) double bedded units into single patient room units. Learning Objectives: 1.Explore elements that create a renovated environment that is consistent with patient centered & family centered care. 2.Learn how inpatient renovation projects can improve operational efficiency. 3.Discuss how inpatient unit renovation projects present opportunities to implement sustainable design strategies. 4.Demonstrate the value of integrating infrastructure improvements with inpatient unit renovation projects.
  4. 4. Session E09 Your Aging Patient Bed Tower- Top Ten Considerations When Renovating George Costanzamight disagree: https://www.youtube.com/watch?v=VfvKc_9YbCs
  5. 5. 01 operational IT efficiency 07 infrastructure 02 logistical 08 accessibility 03 life safety 09 sustainability 04 control infection y 10 i l d patient/family 05 patient involved care safety Array’s 06 i i Lean Process Approach lean process engineering • University Hospitals • New York Presbyterian case studies
  6. 6. Recognizing “necessity is the mother of invention”
  7. 7. finding the BALANCE between LEAN & MEAN
  8. 8. 01 operational efficiency considerations • Using Lean Design principles, test the work flow within a ensuremaximum unit to ensure maximum efficiency • Define Current State & Map Future State • Observe, , Envision, Model, Build Consensus Value Stream Mapping Spaghetti Mapping Diagrams
  9. 9. 01 operational efficiency considerations • Engagement with Caregivers and Patients • Rapid Testing of Future State Solutions • Data-driven Decisions Rapid Testing Empathy Mapping
  10. 10. 02 logistical considerations: feasibility study • Determine appropriate level of renovation required • Develop a plan to effectively execute renovation that minimizes day-to-day disruptions to hospital operations • Proper Phasing is essential to success (vertical vs. horizontal stacked phasing, cost of escalation) • BIM can be used to assist Stacked Phasing decisions Vertical Stacked Phasing Horizontal Stacked Phasing
  11. 11. 03 life safety considerations • Providing a safe environment is utmost priority • Using ILSM (interim life safety measures) will result in ZERO disruption to operations • 3 main steps in planning and implementation of ILSMs: (1) Pre-Construction Assessment (2) Development and Daily Monitoring of an ILSM Compliance Checklist (1) Close-out of the ILSM to transition back to standard operating procedures.
  12. 12. It’s more than just WASHING your hands.
  13. 13. 04 infection control considerations • 1 in 20 patients acquire an infection during hospital stay • Aspergillus- most common microbes associated with construction • ICRA (infection control risk assessment)-multidisciplinary, documented assessment process to proactively identify and mitigate risks from infection that could occur during construction activities • Process should begin in early stages with stakeholders; CM with strong track record
  14. 14. A nurturing environment = HAPPY Patients = higher HCAHPS scores
  15. 15. 05 patient safety considerations • Patient Unit Design should promote healing and collaboration foster patient and family • Provide adequate support zones to reduce hazards • Consider proximity of bed to bathroom; lifts • Install multi-function lighting options & controls • Provide patient control of shading, education and entertainment • Incorporate noise reducing design elements • Integrate equipment and alarm configuration • Provide materials which are easily cleaned AND maintained
  16. 16. 06 engineering considerations • HVAC system can account for more than 50% of the cost • Comprehensive facility condition assessment is necessary- surprises can be expensive • Ideal opportunity to correct facility deficiencies= improved operational costs over the life of the facility
  17. 17. ARE NOT THE ANSWER
  18. 18. 07 IT infrastructure considerations • CINS (Clinical Integration Networks) allow caregivers to access the data of patients • EMR access becomes hub for all activity on floor • Provide Access to Point of Care (POC) Mobile Technology, Nurse Call Innovations • Patient Entertainment, Education, Communication & Surveys
  19. 19. ACCESSibility is more than just clearances
  20. 20. 08 accessibility considerations • “Barrier-Free Health Care Initiative”- goal of ensuring that persons with disabilities have access to medical information as well as physical access • “ADA Path of Travel” requirement- visualize entire path of travel from the drop off point to patient’s destination • Verify that constructed solution meets design criteria and ADAG requirements.
  21. 21. Can you make your father’s OLDSMOBILE run like a PRIUS?
  22. 22. 09 sustainability considerations • Environmentally-friendly design & system choices • Investigate opportunities to recycle construction waste •• Identify design and engineering options that reduce electricity and water use • Focus on selecting sustainable project materials that support high indoor environment quality (IEQ), and green cleaning
  23. 23. ““““We’’’’re all in this TOGETHER.””
  24. 24. 10 patient/family-involved care id ti considerations • Opportunity to reinvent the patient pp y p experience - Wow Factor – Inspire Confidence - Create Generative Spaces - Promise, Deliver, Delight! • Use Amenity & Touchpointmapping to elevate the patient/family experience
  25. 25. OINTS OF IMPACT Mapping the Patient and Visitor Experience Wayfinding Clarity… I know amgoing Patient Centered… Family Focused where I am going WELCOME DISCOVER RESPITE RECOVER First Impressions… I made the right choice Gathering Zones… I need a breather
  26. 26. So How Do We Get There?
  27. 27. Conventional Approach
  28. 28. Conventional Approach
  29. 29. A New Approach PROCESS LED DESIGN Solution Discovery Creation Analysis
  30. 30. CASE STUDY University Hospitals MacDonald Women’s Hospital
  31. 31. Project Drivers: • Aging Infrastructure • Parity with other University Health System Hospitals • Create a patient-centered, healing environment for high-risk maternity patients
  32. 32. patient and family centered 1. information sharing 2. foster collaboration / participation / education 3. honor patient and family perspectives 4. accommodate diversity – (cultural; socio-economic) 5. right support/right place/right time 6. proximity to Level III NICU
  33. 33. operational ideals 1. quality / safety initiatives 2. support UH model-of-care 3. technology and equipment integration 4. de-centralized caregiver zones 5. improve acoustics / ergonomics 6. exceptional ‘‘guest’ service
  34. 34. Current State:
  35. 35. Current State:
  36. 36. Inspiration: strength .. joy .. trust .. beauty .. promise .. growth .. calm .. warmth
  37. 37. Team Station:
  38. 38. Unit Corridor & Team Stations:
  39. 39. Private Patient Room:
  40. 40. University Hospitals MacDonald Women’s Hospital PHASE 1 July 2, 2013 – Page 43 NICU ACCESS
  41. 41. CASE STUDY NewYork-Presbyterian Hospital Milstein Tower
  42. 42. overview current state Milstein Enhancement Bed Unit Renovation Typical Floor Project Challenges: • Project Scope: 5 Floors, 20 Bed Units, 680 Beds • Construction Start: 4Q 2012 • Construction Complete: 1Q 2018 • Project Cost: 160Million
  43. 43. Overview current state Milstein Enhancement Bed Unit Renovation existing conditions
  44. 44. Overview current state Milstein Enhancement Bed Unit Renovation existing conditions
  45. 45. current state best practice influencers vision current state • infrastructure deficiencies • out of sync with World‐Class reputation • patient and family perspective best • safe, equitable • patient and family centered • operational ideals practice i fl • patient experience improvement strategies • HCAPHS, patient satisfaction scores influencers • evidence based design • “patients first” mission • building vision towards an experience • stakeholder survey, amenity mapping, image dialogue
  46. 46. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example Modern with clean lines, classic & natural elements Perceived as a place of science while having the warmth of a home. image survey results: design vocabulary
  47. 47. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example 58% 39% 3% # of respondents # of respondents # of respondents 19 A 13 B 1 C image survey results: art
  48. 48. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example 12% 42% 45% # of respondents # of respondents # of respondents 4 1 14 2 15 3 image survey results: cars
  49. 49. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example 39% 61% # of respondents # of respondents 13 1 20 2 image survey results: home
  50. 50. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example 27% 73% # of respondents # of respondents 9 1 24 2 image survey results: hotel
  51. 51. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example 9% 52% 39% 1 2 3 # of respondents # of respondents # of respondents 3 17 13 image survey results: front door
  52. 52. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example How should the Milstein Tower be perceived by patients and families? 1st choice 1st choice 1st choice 58% 9% 33% 3rd choice 58% # of respondents # of p respondents # of respondents 18 place of science 1 1 temporary home 3 spa / resort
  53. 53. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example What adjectives describe the aesthetic goals the enhanced bed unit? a) sleek and modern 4 b) warm and cozy 2 c) quiet and peaceful 9 d) educational and engaging 1 e) ______________________ 17
  54. 54. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example Image Survey Total Responses Preferred #1 Preferred #2 Preferred #3 Preferred #4 Preferred #5 77% A ‐ Wood Stone/Textures/Tones 31 14 10 3 1 3 B Simplicity/Clean Lines 31 7 6 3 5 10 ‐ 23% 32% C ‐ Luxe/Amenity Rich 31 3 4 6 7 58% 11 D ‐ Color Saturated 31 4 6 13 8 0 68% E ‐ Patterns/Shape/Texture 31 2 5 4 12 8 65% image results survey
  55. 55. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example Preferred . Not Preferred 77% 23% 32% 58% 68% 65% image results survey
  56. 56. Overview current state influencers vision Milstein Enhancement Bed Unit Renovation example What adjectives describe the aesthetic goals the enhanced bed unit? a) sleek and modern 4 b) warm and cozy 2 c) quiet and peaceful 9 d) educational and engaging 1 e) f) Write in: “All of the above” 6 Write in: “A+C” 6 Write in: “welcoming” or “technology” 4
  57. 57. CIRCULATION VERTICAL CIRCULATION Milstein Enhancement Bed Unit Renovation MER / IT / SHAFTS PATIENT BEDS (QUAD) PATIENT BEDS (ISO) PATIENT BEDS (DOUBLE) PATIENT BEDS (SINGLE) CLINICAL SUPPORT OFFICE / ADMIN SUPPORT IMAGING
  58. 58. ELEVATOR LOBBY SCHEMATIC VIEW
  59. 59. UNIT CORRIDOR SCHEMATIC VIEW
  60. 60. PRIVATE ROOM SCHEMATIC VIEW
  61. 61. Milstein Enhancement Bed Unit Renovation example
  62. 62. enhancements: overview enhancement level comparison example
  63. 63. enhancements: overview enhancement level comparison example
  64. 64. enhancements: overview enhancement level comparison example
  65. 65. enhancements: overview enhancement level comparison example
  66. 66. Milstein Enhancement Bed Unit Renovation $154.2M TOTAL BED UNIT PROJECT $141.1M TOTAL BED UNIT PROJECT FUNDING INCLUDING INFRASTRUCTURE AND IT FUNDING EXCLUDING INFRASTRUCTURE AND IT Bed Unit Enhancements FACE Program Contingency Alignment Infrastructure IT
  67. 67. phasing scenario studies - example HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH 9 MCKEEN MCKEEN BEHAVIORAL INFECTIOUS HEALTH DISEASE NEUROSURGERY NEUROLOGY / 8 EPILEPSY REHABILITATION NEURO ICU SURGERY TRANSPLANT SURGERY / ORTHOPEDICS HOSPITALIST MEDICAL SURGICAL GENERAL GENERAL 7 6 ONCOLOGY ONCOLOGY MEDICINE MEDICINE CARDIAC SURGERY STEP CARDIAC ICU CARDIOLOGY CARDIAC 5 PHASE 0: CONSTRUCTION COMPLETION: PROJECT COSTS: EXISTING STACKING NA NA STEP-DOWN DIAGRAM
  68. 68. phasing scenario studies - example HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH BEHAVIORAL HEALTH 9 ORTHOPEDICS / TRANSPLANT TRANSPLANT MCKEEN NEUROLOGY / 8 EPILEPSY NEUROSURGERY REHABILITATION NEURO ICU MEDICAL ONCOLOGY SURGICAL ONCOLOGY GENERAL GENERAL 7 6 INFECTIOUS SURGERY SWING SPACE RENOVATE FOR CARDIAC HOSPITALIST MEDICINE MEDICINE 5 DISEASE CARDIAC SURGERY STEP CARDIAC ICU CARDIOLOGY CCAARRDDIIAACC PHASE 16: CONSTRUCTION COMPLETION: PROJECT COSTS: 1Q2019 $154 2M STEP-DOWN RENOVATE CARDIAC 154.2M
  69. 69. QUESTIONS & ANSWERS

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