Every Hospital Can Be Modernized

How to Upgrade Aging Facilities to Accommodate State-of-the-Art Operating Rooms

June 12, 2018

Medical Planner, NBBJ

Editor’s Note: This post was originally published by Healthcare Design.

Operating rooms provide a critical component of a hospital’s continuum of care and constitute a substantial slice of annual revenue, not only in direct earnings from procedures, but also in their patients who fill hospital beds. It’s critical that hospital administrators maintain the productivity of their existing OR suites as well as provide procedural flexibility as market demands necessitate.

However, hospital administrators don’t always have the luxury of building new facilities when they need newer or larger ORs to support procedures that are increasingly more technologically complex and clinically demanding.

How can organizations find the space they need to meet these demands within their existing hospitals and avoid costly new construction? One strategy is to improve the productivity of existing surgery space by capturing and repurposing it, both horizontally and vertically.

 

Repurposing Space Horizontally

Most ORs in older hospitals are roughly 400 to 500 square feet. However, new technology demands, increases in the size of surgical teams, and the financial demands for ORs to be multipurpose—with the flexibility to support multiple specialties, such as cardiology, neurology, and oncology—have resulted in general ORs needing to be sized up to 600 to 650 square feet, with some specialty ORs requiring 750 square feet or more.

One way to increase OR square footage is to capture and renovate adjacent “soft” space, such as a clean core or storage space, which can add 100 to 300 square feet. The hospital project team then must develop new processes and operational models to replace the lost space and functional areas.

Another way to create space horizontally is by converting two substandard operating rooms into one highly functional one, which usually gains additional support space, as well. While reducing the number of ORs might seem counterintuitive, it can increase utilization, as one functional OR is preferable to two obsolescent ones. It can also expand a facilities services by making it possible to accommodate multiple specialties and procedures, which can maximize revenue as well as enhance recruitment and retention of the surgical staff.

 

Creating Space Vertically

New equipment competes for space not only in the room but also in the service space above the ceiling. The typical floor-to-floor height in a new facility is 16 to 18 feet, which allows room for changes in the necessary structural and mechanical systems. However, many existing buildings may have as little as 12 feet between each floor.

One strategy to address this issue is to replace large mechanical air ducts with more, smaller-sized ducts. This solution reduces the height of space required above the ceiling, however one tradeoff is that the increased number of ducts can congest overhead space, making it more difficult to arrange other equipment like electrical connections, lighting, boom mounts, and access panels.

A hybrid OR with integrated ceiling, at the University of Washington Medical Center in Seattle. © Sean Airhart/NBBJ

Hybrid OR with integrated ceiling, University of Washington Medical Center. © Sean Airhart/NBBJ

Another option is to use an integrated ceiling in which some or all components are prefabricated and coordinated systematically before being built into the room. Because prefabricated systems can be engineered more precisely than individual systems installed in the field, they yield a more compact, efficient design that can be accommodated in tighter floor-to-floor heights.

Different levels of integrated ceiling systems are available, from units that have all major and minor components integrated and prefabricated as an entire piece of equipment to others that include only the major structural and mechanical systems with space for the smaller components to be added in later.

An integrated ceiling can also be installed on-site quickly and easily, which can shorten construction and installation timelines.

 

Planning Steps

Operating rooms are complex spaces that require meticulous planning and design to successfully add space that will allow for more efficiency. Older hospitals considering updating their ORs need to evaluate their current state and determine which strategy to pursue.

For some facilities, their rooms may have enough square footage, but their ceilings and equipment may be outdated and inflexible. In these cases, innovations like an integrated ceiling can make it possible to update equipment and create flexibility for future technology within the existing walls.

Other facilities seeking to expand their ORs will need to determine which rooms are in a position to be merged to create the right square footage. Some steps to consider in this process include:

  • Understand the needs of surgical staff and the hospital’s surgery business plan.
  • Evaluate the physical plant, from the square footage of standard ORs to floor-to-floor heights and ceiling system infrastructure.
  • Assess room utilization and productivity.
  • Understand departmental support procedures.
  • Get input and involve surgeons in the planning and design process.

Once a facility determines that an upgrade is needed, the design team can develop a strategy to shift an aging group of ORs into high gear with the right amount of space to support the care needs of its patients and staff.

Banner image courtesy Russ Ward/Unsplash.

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Letter to a Young Architect

What I Wish I Had Known When My Career Began

May 23, 2018

Managing Partner, NBBJ

@SteveNBBJ

A friend recently asked if I would write a letter to my younger self and embody advice and insights that I could offer the next generation of architects and design professionals – to capture what I wish I had known the day I graduated from design school. As we welcome summer interns to NBBJ, I thought sharing this letter could be valuable to them, and to everyone striving to impact our world through the limitless potential of design.

Enjoy this lesson from the future. Your comments are encouraged at the bottom of this post. I’d love to hear your thoughts on what you wish you had known or your own wisdom on fulfillment…

 

Dear friends,

My most sincere congratulations on your dedication to learning, exploring, growing. You have arrived at an extraordinary place in life, a trailhead in many ways, with many choices to confront. It is these choices — these turning points — that will have a profound influence on how your career unfolds. Some you will see coming from a distance; others will arise unexpectedly.

Start your career by cultivating your core values. It is these values that will become your compass for the great journey ahead. Commit yourself to these values underpinning every decision you make. Consciously navigate toward the destination of your dreams — and set that destination at unimaginable heights — knowing that fulfillment is not about arriving at the destination, it is how you live the journey itself.

Consciously think about what you stand for in professional practice and how you will impact the lives of others through design. Start this process now and return to these questions time and time again to hone your skills. Cultivate your confidence. Suspend your insecurities, not to be ignored, but to limit the ways in which they might impede your progress. Beware of acquiescence. Be proactive, taking one step at a time. Persevere — now and forever.

Seek and create speaking opportunities to discover your voice, and in so doing to become comfortable with that voice. Learn to be a skillful and passionate communicator. Learn to allow your mind to be open and free in service to your ideas. And never forget that listening is active, not passive. Clients will choose you because they trust you, and at the heart of that trust is their belief that they are understood. Learn how to build trust and be empathetic.

Step into your career every day. Be courageous, and know that being too comfortable or holding back is to play the game too safely. It is when we are uncomfortable that we stretch and grow the most. Learn to be comfortable with being uncomfortable. Take care of yourself in health and fitness, for this is the longest of journeys that you now embark upon — it is the journey of your life.

Looking back some 40 years after my career began by running blueprints for a local architect, I recognize I was blessed with untold opportunities to design dozens of momentous works — corporate headquarters, courthouses, stadiums, towers, global institutions and so much more. Yet beyond any talent or favor nothing was more important than my drive and belief in myself against the tide of the commonplace. And it is this belief more than any other thing that opened the doors to a magical career journey.

Believe in yourself.

Steve

 

Editor’s Note: This essay by Steve McConnell was recently published in Lessons from the Future, a book given to M.Arch. students upon their graduation. Sixty-five leading architects around the world participated in creating the book, answering the question, “if you were to start out in architecture all over again, what would you do differently?” In essence: advice to a younger self. It is edited by James P. Cramer and Scott Simpson.

Image © NBBJ.

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A Balanced Mix: The Story of Four Learners

How Colleges and Universities Can Provide Environments to Meet Diverse Learning Needs

December 7, 2017

Architect, NBBJ

As pedagogies evolve from traditional lectures to a more active, team-based learning approach, higher education institutions are beginning to allocate space to emphasize active learning interactions both inside and outside the classroom, with the belief that this will help students learn and retain more. Colleges and universities are beginning to recognize the need for learning environments outside the classroom, but many times these manifest themselves as “in-between” spaces in corridors and student lounges, without specific attention to the kinds of environments that better foster learning.

As curriculum expands beyond the scheduled classroom, the demand for these spaces increases. Therefore, it is necessary to narrow in on the students who use these spaces, who they are and how they learn, in order to increase retention rates and produce successful graduates. Then institutions, in partnership with architects and designers, can begin to tailor learning environments outside of the scheduled classroom to a more targeted user scope.

 

Who Are the Learners?

The first step in defining these spaces is to understand who these learners are and how they learn. There are many types of learners and hybrids of sorts. Pedagogy experts Peter Honey and Alan Mumford of the University of Leicester identity four types of learners: Explorers, Thinkers, Observers and Testers.

Explorers try anything once. They like to tackle problems by brainstorming and fully immersing themselves in the moment. They are open-minded and not skeptical.

Thinkers assimilate disparate facts into coherent theories. They have a linear thought process that follows a step-by-step procedure. They are logical, detached, and analytical.

Observers collect data through their own experiences and observations of others. They consider all possible outcomes and angles before making a decision. Their philosophy is to be cautious.

Testers experiment with application. They seek links between training and current needs in the search for immediate applicable benefits. They are practical.

 

How to Design for the Learners?

Classroom learning environments will continue to be a mix of traditional and team-based space types. However, as the four types of learners digest knowledge in very different ways, they need different types of spaces outside the classroom.

An Explorer seeks variety as they act on impulse. They may be perfectly adaptable in any environment they happen to be in; however, they may be drawn to an environment that allows for open thought and brainstorming with a team, such as an active, open student area with writing surfaces. They are not habitual and may try different environments each day.

A Thinker seeks a logical rationale and may be drawn to an internal reflective space that secludes them from the outside world. This provides a focused environment that is consistent and reliable. They may be content in a small enclosed room or nook that provides a sense of privacy with acoustic isolation and visual separation.

An Observer seeks all information possible and may position themselves in a space that allows for conducting research through observation of others and reflection on their own experiences. They may be drawn to a more active team-based room where they can work with others and exchange information based on past experiences. They may also require access to research information, either analog or digital. These environments may be best positioned within a library or learning center.

A Tester seeks learning through action and will be more drawn to environments that allow for hands-on application, whether in a laboratory, studio or maker space. They may require more space and tools to allow for simulation or making.

How-to-enable-learners_171031

Institutions may struggle with the idea of providing such individualized space within the constraints of money and space allocations. A key to finding this balance and allowing for such user-centric spaces outside the classroom is to provide a level of flexibility and user-adaptability within the range of the learner-defined environments, in order to encompass the larger variety of learners.

For instance, a student lounge may appeal to a larger range of learners with the addition of mobile furniture, writing surfaces and movable walls. Spaces can also be made more flexible by allowing the room use to shift throughout the day: scheduled breakout rooms become team project rooms; faculty huddle rooms become enclosed study rooms. Small shifts in the programming and details of these spaces can provide flexibility and user-adaptability to address the range of learners.

Colleges and universities will help the broad range of learners to be more successful and encourage retention by understanding the inherent qualities of how students learn and by implementing, in partnership with architects and designers, a balanced mix of learning environments in and outside of the classroom that speak to these learning traits.

All images courtesy of NBBJ (photo by Benjamin Benschneider).

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