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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How Can Healthcare Institutions Become Disaster-Ready?

A Conversation About Healthcare Resiliency and Design in Seattle

September 6, 2017

Healthcare Partner, NBBJ

The Pacific Northwest is a beautiful place to live and work. But with that beauty comes the potential for natural disasters — everything from earthquakes to volcanic eruptions. Combined with the uncertainty associated with climate change, how should local healthcare systems address these issues to protect their patients, safeguard their assets and conserve resources?

We decided to convene a “Disaster Ready” series of panel discussions, design workshops, articles and papers to address this important topic of resiliency. This summer in Seattle, Puget Sound Business Journal healthcare reporter Coral Garnick moderated a lively discussion on the importance of resilient healthcare facilities.

The panelists — John Hooper (Magnusson Klemencic Associates), Christine Kiefer (Harborview Medical Center), Onora Lien (Northwest Healthcare Response Network) and Mackenzie Skene (NBBJ) — shared their expertise, including resiliency best practices from healthcare projects located in areas vulnerable to natural disasters.

The following is an edited recording of that discussion. From designing “upside-down hospitals” that protect against rising sea levels, to advocating for policies that require more from critical care facilities, learn what healthcare systems can do locally and beyond to withstand the unknowns of a changing environment.

 

 

Here are a few highlights from the conversation:

The definition of resiliency
“I’ve also had the chance to work in New Orleans, following up on Katrina and replacing the hospital damaged by Katrina, and it changed my whole view of resiliency at that point, because it was less about buildings, and it was more about the people, and the operations, and the continuity of the mission.”
—Mackenzie Skene

The importance of practice — and community
“The drilling, the practice, the scenarios and learning the communication… I can’t say enough: it shouldn’t just be us practicing in isolation, but the system practicing together.”
—Christine Kiefer

Who’s responsible
“I worry a lot that the work of preparedness often lives with one champion within an organization, one emergency manager or part-time facility person who’s tasked to do a lot of this. While I recognize there’s a lot of competing demands, in order for us to really move the needle, there has to be a more inclusive strategy within the organizations, and the accountability and the responsibility needs to live much broader than just an emergency manager.”
—Onora Lien

What we can fix, today
“There’s one or two [older buildings] on a campus … that the infrastructure may go through, the medical gasses, the power, the water, et cetera. That’s what I worry about. It’s that small percentage that, if you fix that one or two buildings, you’ve improved your resiliency by a factor of two or three. If you’re going to pick a low-hanging fruit, do those.”
—John Hooper

 

Image courtesy of Wikimedia.

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Hurricane Harvey Shows the Danger of Not Planning for Healthcare Resilience

In the Absence of Government Leadership, Healthcare Providers Must Take the Initiative to Secure Their Patients’ Health

August 31, 2017

Partner, NBBJ

Editor’s Note: Portions of this post previously appeared on Modern Healthcare.

President Obama’s Executive Order 13690 — signed in 2015 — made it the official policy of the U.S. government to improve the resilience of communities against the impact of flooding. This included special requirements for federally-funded healthcare projects, including adding three feet to base flood elevation when building federally-funded hospital facilities in flood-prone areas. But it also extended to other types of projects, including assisted living facilities and even power generation facilities.

Unfortunately, President Trump revoked this policy on August 15, 2017 — ten days before Hurricane Harvey made landfall near Houston, Texas, and shut down at least 21 of the region’s hospitals.

Growing research that shows climate change will cause hurricanes of greater intensity, as well as increased risk for flooding, in coastal communities across the United States. In a flood event, every foot counts. Building three feet above flood elevation — as required by President Obama’s regulations — could mean the difference between full hospital functionality and a complete failure of electrical, plumbing and mechanical systems.

Take, for example, Hurricane Katrina. Flooding during that disaster closed more than half of the region’s hospitals — and all of the hospitals within New Orleans itself — immediately after the hurricane. Over a decade later, some of those facilities remain closed. We saw a similar event after Hurricane Sandy in New York City, which damaged numerous hospitals, including five which remained closed a month after the disaster hit.

Even after these storms — which combined killed at least 1,400 people and caused $183 billion in damage — there are relatively few formal protections in place to safeguard healthcare facilities from storms. We believe the solution to creating more resilient healthcare facilities requires a partnership between healthcare institutions, government agencies and professionals in the building industry. We understand that additional regulations are not always the right answer. But we are concerned with President Trump’s decision to revoke the executive order without adding any protections or considerations in their place.

My firm worked on two major hospital replacement projects in New Orleans after Hurricane Katrina. There, we instituted an “upside-down hospital” design strategy which placed critical infrastructure typically relegated to the basement high above flood stage, in some cases seven floors up. At University Medical Center in New Orleans for example, the first “mission critical” floor is located 21 feet above base flood elevation.

While it’s possible the rollback of President Obama’s regulations will save money in the short term, it will likely cost healthcare systems more in the long run. A study by the National Institute of Building Sciences found that every $1 of public funds spent on disaster mitigation saves society $4. LSU’s Hurricane Center also found that stronger building codes related to wind damage before Katrina would have saved $8 billion alone. It is generally cheaper to retool infrastructure before a disaster hits.

One bright spot: only projects with Federal involvement were covered by President Obama’s executive order — and by President Trump’s rescindment of it. We continue to work with private healthcare institutions, particularly on the Eastern Seaboard, who understand the stakes and are willing to make the necessary investments. And even Federal projects, with client approval, are permitted to exceed the current requirements — but they are no longer required to, and therein lies the danger.

Healthcare systems in the United States face a myriad of challenges, including increased operating costs, switching to a value-based reimbursement model, an uncertain political environment and rapidly advancing technologies. So it’s understandable that hardening against climate-caused disasters may fall to the bottom of the priority list. But we’ve seen what can happen when that is the case.

Image courtesy of Pixabay.

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