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Kaiser Final Submission 4 20 11 Small


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Recent competition entry for a small hospital for Kaiser- enjoy!

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Kaiser Final Submission 4 20 11 Small

  1. 1. BIG SMALLIDEA HOSPITAL KP Small Hospital 46983
  3. 3. WHERE DO WE START? THE NEXT GENERATION HOSPITAL WILL LEAP FORWARD ON 2 PARALLEL MISSIONS:The next generation of hospital will be designed to reduce TABLE OF CONTENTSthe need for itself. It will be the first to aggressively producethe conditions for health, not just mitigate disease. It will 1 INTERVENTIONfocus on the origins of cost in an effort to drastically reduce 1.0 Introduction, the intensive outpatient model: “Sites” 1.1 The efficient and connected hospital: Programinpatient activity. Like all complex social phenomena, there 1.2 The Boundless Emergency Departmentis no single technology or technique that can reduce the 1.3 Connecting the neighborhoods: Siteburden. Its about doing many “small” things, coordinated 1.4 An Architecture of Connection: Building format many scales, which culminate to dramatic effect. 1.5 Silo free departments: Plan and Massing 2 PREVENTION 2.0 Design as healing agent: Planning for health 2.1 The first Living Building Challenge© hospital KP Small Hospital 46983
  4. 4. 1 INTERVENTION BLAH BLAH BLAH TITLE 1INTERVENTION THE IDEA is a prototype that removes barriers to migrating care to outpatientHow do you create an affordable, sustainable, and locally settings. Pushing care closer to the most intensive users and reduc-viable healthcare solution that can become a building block ing inpatient activity, not by rationing access, but by shifting its focus.for healthy community growth? 1. Dispersing the “site” into many embedded neighboorhood clinics, in the most intense use areas. 2. Using hospital facilites to mitigate healthy community planning 3. Blurring the distinction between swing departments, especially emergency, outpatient and Pre/Post-Op/PACU of surgery. 4. Breaking down support areas to better facilitate collaboration, leverage visibility, and teaming. KP Small Hospital 46983
  5. 5. 1 INTERVENTIONBOUNDARIES MUST BE BROKEN.THE NEXT HOSPITAL PAST PRESENT FUTUREwill breach several entrenched divisions that block our ability to connect cause and effect.Electronic records, will become sources for data mining. Clinical departments will be combined, blurred and leveraged. Monologue DialogueThe real cost of decisions will be measured. This transparency reveals a closer relationship to health and design: Blog: Team to Team Doctor to Patient Doctor to PatientThe real cost of convenience-On average, super-sizing a fast food meal saves 60 cents, then costs $6.00 in health issues. Expert Authority: Partner Authority:The real cost of ENERGY- Consensus Authority: Data$1 dollar of energy equals $23 dollars of revenue. Profession PersonThe real costs of OBESITY-$116 Billion annually for diabetes alone.If you knew the route to avoid illness, if you could connect the dots that extend wellbeing, Vanquish Nature Learn from Nature Mimic Naturewould you look to a hospital for these answers? Can a hospital inspire you to want something more?THE NEXT HOSPITAL Study & Sort Comfort & House Select and Empowerwill come from a different archetype, one that is retail in philosophy.It will take a marketers understanding of our motivations to induce the behaviorsthat draw us together, and empower positive change.The secret to retail experiences, the reason shopping is recreational, is the pleasure of finding your fit. A public solution to personal needs. Brick Box: Warehouse Glass Box: Hotel Open Grid: MarketOften sharing the event with friends and family. Hospitals must learn to say “yes” to its customers. KP Small Hospital 46983
  6. 6. 1.1 Program PROPORTIONAL DIAGRAM This submission assumes 100 Beds @ 2,500 BGSF/Bed = 250,000 BGSF 1.1 This is aggressive; the normal metric is 2,870 BGSF/bed for a community hospital system.PROGRAM ASSUMPTIONS It also implies a 75% efficiency factor. 1.33 BGSF/DGSF ratio= 1 1.33 = .75 or 75% efficiency x250,000 BGSF = 188,000 DGSF PUBLIC & ADMINISTRATION Assume 10% 188,000 DGSF x .10 = 18,880 DGSFWe have reduced the mean program TOTAL BUILDING AREA Reasons: 250,000 BGSF 1. Leadership H.R. in MOB 2. Electronic Medical Records & Digital Imaging (No archives) 3. Public elevators & circulation shared with MOB TOTAL DEPARTMENTby 12.6% by creating a design with 188,OOO DGSF SUPPORTsurge capacity between the Outpatient 20% (188,000 DGSF) = 38,000 DGSF 10% Includes M.E.P as well as I.T. . Reasons: Assumes system purchasingDepartment, Emergency and Surgical & J.I.T. Supply 20% SUPPORT 43%Pre-Op/PACU. PATIENT BEDS 27% DIAGNOSTICS & TREATMENTKaiser 2010 Master Planning Initiative Survey: DIAGNOSTICS & TREATMENT 70%-43%= 28.45% Total = 50,700 DGSF PATIENT BEDSMean = 2,870 sf/bed Reasons: 1. Leverage D&T with Mobile Modalities 2. MOB attached with basic D&T primary care 100 BEDS @ 800 DGSF / bed Reasons: 1. High acuity general medical surgical 2. Acuity adaptable private rooms with ADA toilet & assistable shower 3. Assume single room maternity C-section leveraged with surgery. 80,000 DGSF = 43% 188,000 DGSF KP Small Hospital 46983
  7. 7. 1.1 Program FROM HOTEL FOR THE SICK TO MARKET OF HEALTH. There are limits to the power of pampering. Our proposal envisions a new archetype for the hospital expere- ince. When looking for health coaches to manage the cases of the most intensive patients, one turns to retail clerks and managers. They understood the default answer was “yes”. They are trained to connect needs and resources under a different philosophy than traditional clinitions. The “retail” hospital will take its architectural hertiage from marketplaces. Where ideas are exchanged with goods. Where optimism and empowerment are tools of the “trade”. KP Small Hospital 46983
  8. 8. 1.2 The Boundless EDTHE BOUNDLESSEMERGENCY DEPARTMENT 1.2 25 20 20At the fulcrum between inpatient and outpatient care,our proposal re-thinks the emergency department. 15 Outpatient Department Use of E.D. Capacity Number of rooms occupied CAPACITYFlexible boundaries between E.D., Outpatient and the prep / recovery of the surgical department allow staff 10to flow. 10The purpose is to allow the surge of patients between these services as need and capacity is available Emergency Department Utilizationthroughout the 24-hr day. 5This also allows the staff to be leveraged between these services as patient to staff ratios allow.The operational implication of these flexible boundaries is an integrated management and staffing of these 1service lines. 5 am 6 am 7 am 8 am 10 am 12 pm 1 pm 2 pm 3 pm 4 pm 5 pm 6 pm 7 pm 8 pm 9 pm 11 pm 12 am 1 am 2 am 3 am 4 am 9 am 10 pm 11 amThis should yield more efficiency, safety, and greater through-put of patients. 24 HOURSOur experience has shown that staff who have cross trained and range across these departments find theexperience fulfilling.Many clinicians have a culture of “helping out” their colleagues, which reinforces their desire for team- Reduced co-pay from scheduled E.D. visit 1 Use of cell phone registration 4work and patient focused care. • 60% 2 Access to EMR • 85% Utilization of 20 E.D. P .T. 3 Internet posted wait time 5 Schedule in OPD end of the continuum KP Small Hospital 46983
  9. 9. 1.2 The Boundless ED                                                                                                                                                     REMOVING THE TRIAGE DISTRIBUTED TEAM STATION BOTTLENECK The team station is the coordination hub of the E.D. Designed to allow maximum visualization of the treatment areas, it works The triage flow takes on new meaning in the boundless in conjunction with the staff coordination room which features E.D. As is also serves as exam and intake for the outpatient smart glazing providing privacy by darkening on command. dept. This forms a permeable membrane which bridges the At the entry of the exam bays, this arrangement encourages scheduled and unscheduled visit mix. detection and coordination of chronic visitors, and creates a venue for briefings. KP Small Hospital 46983
  10. 10. 1.3 SiteHYPOTHETICAL SITELANCASTER, CA 1.3For the purposes of this competition we have selected a site in Lancaster, California, a community alreadyserved by Kaiser. Adjacent to an existing facility, this site seemed positioned to be a bridge betweenresidential andcommercial while dealing with many of the common barriers aften found in communitiesKaiser builds in such as the boundaries often created by freeways. KP Small Hospital 46983
  11. 11. 1.3 Site A G B BCONNECTING THE NODES: EREGIONAL SITE C D B I J I DStarting with the notion of a single site. The next community hospital must operate as a bridge on K Fmany “sites”.The knot of medical data, and trend spotting must be solved so that the most intensive and costly I Gpateints can transition from emergent to home based care. Our proposal includes specific features to Ffoster “medical home” and intensive outpatient concept. We believe the physical designof the facility can greatly engender these encounters by removing specific barriers that are common Htoday. B BThese interventions occur at every scale and “site” of the proposal. C B A VIRTUAL NODES - web-based resources for health information, chat with nurses and doctors B MOBILE NODES - on the go screenings, testing, seasonal shots C YOUNG FAMILY NODES – pre-natal, birthing and pediatric focus D FAITH-BASED NODES – food banks, family counseling, stress management E ASSISTED LIVING NODES – physical therapy, yoga, water aerobics F BUSINESS PARK NODES – screenings, executive health counseling, stress management, occupational therapy G FITNESS CENTER NODES – Nutrition counseling, sports physicals, sports injuries, screenings H SAFETY NET NODES – social worker support, case managers, mental health services, food assistance, housing assistance I SCHOOL NODES – promoting healthy food choices, physical activity, screenings, physicals J GARDEN CENTER NODES – promoting home food growth, cooking classes, healthy food choices K SMALL HOSPITAL NODE - promoting wellness, healthy food, recreation, community gatherings, connecting all other nodes of wellness KP Small Hospital 46983
  12. 12. 1.3 SiteCONNECTING THE NEIGHBORHOOD:LOCAL SITE 4 Site elements 1 bike, running and walking paths 4The next community hospital must operate as a central node within the 2 pv solar covered parking areas 7larger wellness network. 3 aroma therapy and 7 5 1 medicinal herb gardens 3 2The small hospital site becomes the convergence of wellness in the 4 organic orchards 2 6 8neighborhood, bridging disconnections, promoting well being in all aspects 5 farmers market 9of life. It is the center of restorative wellness, promoting recreation, healthy 6 Outdoor gathering amphitheatrefood, physical activity, cultural events and our spiritual connections to each 9 7 Outdoor dining, cooking, picnic areasother. 8 PlaygroundThese activities occur throughout the larger community and converge at the 9 Sports fieldssmall hospital site where all the aspects of a health community merge. 4 KP Small Hospital 46983
  13. 13. 1.4 Building Form 1.4 THE SPACES IN BETWEEN The form of the project is derived not only from the programatic efficiencies of adjacent departments but form the desire to extend the projects reach much like that of an ancient city. Through streets, plazas and gre- enways the project literally reaches out to the community as well as connecting all areas of the hospital. The project creates a dynamic central”square” in which sits the community, meeting and education spaces forthe hospital. wrapping around this greencrescent courtyard are the public circulation “streets” for the project off of which all major public program elements can be accessed. Our memory of great places is largely defined not by the architecture but by these spcaes in between the architecture- the places people occupy, the spaces filed with dappledlight and human interaction. These walls of our project not only define the limits within the building but seek to extend the invitiation the build- ing sends to the community to make it a living part of the place it is is built in . KP Small Hospital 46983
  14. 14. 1.4 Building FormSITE PLANThe small hospital is a “bridge building”. It connects parts of communities which were previously uncon-nected while reducing the typical impervious footprint of a traditional hospital. KP Small Hospital 46983
  15. 15. 1.5 Floorplans and MassingLANDSCAPE ASBUILDING, 1.5BUILDING ASLANDSCAPEIntensive green roofs control water runoff, reduce theheat island affect as well as offering physical links fromone part of the community to another.There is a tangible and unmistakable valuing of Kaiser’sconnection to both community and environment throughthe buildings form. KP Small Hospital 46983
  16. 16. 1.5 Floorplans and MassingLANDSCAPE AS BUILDING,BUILDING AS LANDSCAPETopography in nature has always had the potential to act as a landmark- a symbol for a place, a way toorient yourself to ones surroundings. Architecture has the potential to do the same. Blurring the bound-aries between architecture and topography gives this project a unique potential to represent a new kindof building for Kaiser, one that orients the user to both clinical and local community environments. KP Small Hospital 46983
  17. 17. 1.5 Floorplans and MassingLANDSCAPE AS BUILDING,BUILDING AS LANDSCAPEThe building’s seamless integration into the landscape softens the project’s form on the horizon andcreates an iconic landmark for the community. KP Small Hospital 46983
  18. 18. 1.5 Floorplans and Massing KP Small Hospital 46983
  19. 19. 1.5 Floorplans and MassingLEVEL ONEKEY ROOM PLANThe ground floor plancreates a welcoming gesture tothe community- inviting entry to the facility. A grandpublic stret sweeps around the crescent shaped greenspace offering direct acces to the inpatient and outpatientfunctions. KP Small Hospital 46983
  20. 20. 1.5 Floorplans and MassingLEVEL ONEKEY ROOM PLAN KP Small Hospital 46983
  21. 21. 1.5 Floorplans and MassingLEVEL ONE PERMEABLE SURFACE PARKINGDEPARTMENT PLANThe design leverages surge capacity between the OutpatientDepartment, Emergency and Surgical Pre-Op/PACU. surge zones OUTPATIENT EMERGENCY MEDICAL OFFICE BUILDING IMAGING surge zones GARDEN ENTRY PERMEABLE SURFACE PARKING SURGERY ADMIN FOOD SERVICE MAT MGMT MECHANICAL KP Small Hospital 46983
  23. 23. 1.5 Floorplans and Massing At the heart of the building is a crescent shaped outdoor garden in which the copper clad resource center and meeting facility sits. All of the public circulation fronts this garden. KP Small Hospital 46983
  24. 24. 1.5 Floorplans and MassingThe project’s roofscape is an active green-roofed surfuce connecting hospital to community and reducingthe buildings impervious footprint. KP Small Hospital 46983
  25. 25. 2.0 Planning for HealthHEALTHY SITEHEALTHY COMMUNITY 2.0REGION: Connecting many community organizations with focus on promotinghealth and well-being of the area, the small hospital becomes a central node in thelarger community health network.COMMUNITY: Bridging barriers withing the neighborhood site, promoting healthyfood options, outdoor recreation, physical activities and cultural events. The smallhospital becomes a hub of healthy lifestyle activities.DEPARTMENTS: Departments flow together, remove barriers between emergencyand out-patient care. Communication is improved, staff is more fully utilized andflexibility of roles is enhanced.STAFF: Bridging barriers to coordination and visualization of care. KP Small Hospital 46983
  26. 26. 2.0 Planning for HealthHEALTHY BUILDING = HEALTHY COMMUNITY ANNUAL ENERGY CONSUMPTION - ELECTRICITY KWH (X000)ORIENTATION AND DAYLIGHTING: The proposed building uses the optimal orientation and limiteddepth of the building to maximize the potential for daylighting on the upper levels, while using skylightsto bring light into the central areas of the 1st and 2nd floor services. These strategies reduce the light- AREA LIGHTING - 854.1 KWHing load substantially, reducing the lighting to 15% of the total for this facility. 15%ENVELOPE: The proposed building envelope is well insulated and uses high performance glass witha high R value, a low solar heat gain coefficient and a high visible light transmittance. This helps toreduce the heat gain load on the roof, walls and glazed elements of the building while, at the same time SPACE COOLING - 69.8 KWHusing the benefit of day light to its maximum potential. 1%MECHANICAL SYSTEMS: The proposed mechanical system is a highly efficient chiller plant withSmart evaporative condensing chillers and heat recovery for pre-heating hot water. Ventilation air isprovided via.... These strategies reduce the mechanical system load substantially, these loads account 15% AREA LIGHTING VENTILATION FANS - 593.6 KWHfor 13% of the total load for this facility. AREA 11% LTG.WATER EFFICIENCY: The proposed building water fixtures will be highly efficient in flow rates and 11%will help to limit the use of potable water in the facility. The building will also provide all the hot water VENT. FANSneeds of the hospital with solar hot water panels mounted to the roof of the building for maximum effi-ciency. This will greatly reduce the need for natural gas used for hot water heating in the facility. PUMPS & AUXILLARY - 93.7 KWH 71% 2%ENERGY USE AND ON-SITE PRODUCTION: From CBECs data, an average existing hospital build- in the western region has an Energy Use Intensity rating of 246.8 Kbtu/sf. The proposed building EQUIPMENTwas modeled and has an EUI estimated at 75.2 Kbtu/sf. To reach the goal of 75% under the averageCBECs 2003 data, the facility would need to produce some of it’s own energy on site. A photo volatic MISC. EQUIPMENT - 3962.1 KWHarray sized to make up the difference is approximately 6000 KW, about 490,000 sf of surface area. This 71%would allow the facility to operate at 61.7 Kbtu/sf. We propose that portions of the roof, parking areasand portions of the southern facade would be covered in photo voltaic panels in order to generate poweron-site. KP Small Hospital 46983
  27. 27. 2.1 Planning for HealthON THE WAY TO NET ZERO ENERGY: 70% reduction 10% 2.1 Well insulated envelope Maximum R value glass Ultra low Solar heat gain coefficient glass Maximum visible tranmittance glass Very low lighting power density in all non-critical spaces 0.8 w/sf 30% Highly efficient ventilation air handlers and fans Energy recovery on all exhaust sources 75% 30% Highly efficient chiller plant with Smart evaporative condensing chillers Heat recovery for pre-heating hot water Solar hot water heating array on roof for hot water needs Photo voltaic arrays, wind turbines, fuel cell boxes and other on-site energy sources will help to 30% generation generate enough power to get the facility on the road to net zero energy. KP Small Hospital 46983
  28. 28. APPENDIX KP Small Hospital 46983
  29. 29. 3.0 AppendixMajor Healthcare Trends and 3.0 The rate of change in healthcare will accelerate. Planning and design should integrate flexibility and adaptabilityImplications on Hospital Design In order to achieve quality and opportunities. For example, site planning should allow for anticipated parking expansion and hospital expansion to ensure optimal connectivity and functioning of the hospital in the future. Facility design throughput goals, care delivery must and sizing must consider ways in which aspects of the hospital can adapt to different uses or incorporate new technologies. be organized around the patient. Facilities should not be organized based on ‘departmental’ efficiencies, butThe following key trends will shape how care is provided in the future, informing new operational ‘patient flow efficiencies.’paradigms and hospital design requirements. These trends are borne out of macroeconomic and Small scale programs rely onregulatory/political dynamics, such as downward reimbursement pressures, quality incentives/ sharing resources to achievedisincentives, push to insure more people, worker supply shortage (particularly physicians), and agreater emphasis on work/life balance to name a few. efficiency. The small hospital will be the ‘head Particularly with a relatively small hospital initially, small scale functions – Standard and routine work will follow best practice models, care plan templates or services should maximize resource sharing opportunities related to quarters’ for health and wellness in staff, facilities, equipment, etc. For example, are there opportunities to – Advancing diagnostic capabilities will surface more complex diseases requiring a team of physician experts to determine the most effective treatment regimen share resources based on differences in time-of-day demand? the community. Services and resources (e.g., nurses, technology, etc) will be dispatched from – Advances in genomics will allow for more personalized medicine that will enhance outcomes the hospital to serve the community, for example, in the areas of preventive – Increasing transparency related to key metrics such as clinical quality, cost, and service Integration of Health System care, care management, and follow-up care. – Patients are increasingly more informed about diseases and purchasing healthcare resources will be essential.– Providers will more actively manage patients/diseases and anticipate care needs Fully leveraging the resources of the Health System will be vitally – Patient-centric care processes will evolve due to requirements for better clinical quality, outcomes, important to the success of the small hospital. Leveraging central Healthcare delivery will increasingly laboratory resources, technology systems, purchasing contracts, etc cost, service, etc. will enable the small hospital to be as efficient as possible. rely on high-technology solutions. The care environment should correspondingly be ‘high-touch’ from the – Increasing integration of physicians and alignment of incentives and mission will support high standpoint of customer service, environmental design, etc. quality, patient-centered care In the future, care will be delivered in a highly collaborative, team-based environment. Team rooms for multiple clinicians Technology to connect various experts in the hospital, health system, etc KP Small Hospital 46983
  30. 30. 3.0 AppendixPATIENT ROOMSThe patient room is a key elementof a hospital. The optimum design for the patientroom should include consideration of healthcaretrends that will influence the room’s features,including characteristics of future patients, resourcelimitations, rising costs and technology.Three distinct zones are under considerationduring design, one each for caregivers, thepatient and family members. KP Small Hospital 46983
  31. 31. 3.0 Appendix KP Small Hospital 46983
  32. 32. 3.0 Appendix KP Small Hospital 46983