In Control

Hospital Command Centers Are Changing How Providers Care for Patients and Coordinate Logistics

December 4, 2019

Partner, NBBJ

Editor’s Note: This post was originally published in Healthcare Design. It was coauthored by Teri Oelrich and Donald Bellefeuille.

Hospitals represent some of the most complex buildings on our planet, monitoring tens of millions of data points, pieces of equipment and people every day. Examining and tracking all these interconnected and critical parts in real time is a great challenge, especially when delays can be a matter of life and death. In response, many health systems, hospitals and outpatient centers are developing command centers — akin to air traffic control centers — to meet the need for monitoring, analyzing and tracking the thousands of pieces of data.

These centers — the so-called “brains” of a facility — take different forms, from a room to a series of rooms, located on- or off-campus depending on scope and space needs. They are equipped with a variety of technologies, powered by artificial intelligence and predictive analytics, to process and display a range of real-time data, from hospital bed availability and patient transfers to equipment tracking and patient monitoring. Housed within these centers is a variety of professionals, including doctors to update care protocols, nurses to monitor patient stats and vitals, technicians skilled at telemetry, and aides to monitor patients. Incorporating environmental, patient transport and material management staff can also ensure efficiencies in bed turnover, patient movement and supply delivery, helping keep costs in check by increasing overall throughput and occupancy.

This setup allows hospitals to be proactive rather than reactive by helping staff address issues as they arise. For example, staff can receive alerts when backups occur in the imaging room and patients are waiting for services, helping to quickly resolve the flow issue. Centers that monitor the physiology of patients can use the algorithms generated to spot patient changes much faster, allowing clinical staff to intervene and treat the issue sooner and avoid medical complications. Command centers can also help unite previously siloed teams, from inpatient room logistics to procedure schedulers to clinical specialists, and enhance communication among employees, enabling staff to coordinate alerts and more easily track follow-ups through a patient’s electronic medical record. Finally, these spaces can also help boost patient and family satisfaction and provide comfort to loved ones who are reassured knowing there are multiple layers of monitoring and care in place.


Design Considerations

When deciding where to locate a hospital command center, it’s important to keep in mind that these facilities don’t require expensive hospital-grade space. This can create flexibility, as both on-site and off-site locations are suitable. For a large hospital network, an off-site command center outside the urban core may help lower costs because it’s less expensive to build and can free up space for clinical care on campus. However, a smaller rural hospital may choose to keep a single-room command center on-site for integrated access and cross-utilization of staff.

Another key issue to consider is the scope and type of command center. Will it serve a single hospital or a whole system? Will the command center include one site or multiple sites with collocation and remote collaboration? Generally, a command center that monitors patient flow would be about 1,500-2,000 square feet, but the overall size depends on the amount of services a hospital plans to incorporate. For example, a command center that intends to include centralized physiological monitoring for a hospital, or for several hospitals, would need at least double or triple the space requirement noted above. Services like remote patient sitters and emergency and disaster response will also require additional square footage. In all respects, command centers should be designed to expand to accommodate future technology and added services, as well.

These variables will also impact the number of staff members who need to be accommodated in the center as well as the size and layout of workstations. For example, while a typical workstation in a medical facility is 6 feet by 8 feet (48 square feet) per person, many other details need to be considered for a command center, such as the number of monitors per station, acoustical or visual privacy, ceiling heights to accommodate large hanging computer screens, and lighting controls that ensure proper screen readability and minimize glare. This means the workstation could be smaller or larger, depending on services and equipment requirements.

Other space needs may need to be accommodated, as well. For example, command centers that incorporate telemedicine capabilities will need private rooms with monitors so the practitioner can have private conversations with patients, much like what occurs in an exam room. Having respite spaces that allow command center staff who work with frequent auditory alarms and visual alerts to get quiet off-screen time is also important to prevent fatigue and burnout. Testing different layout scenarios and building mockups of the physical space to gather feedback from a variety of key stakeholders and decision-makers can help maximize space and lead to more efficient design solutions that work for everyone.


Accounting for Costs

The main factors that drive the cost of command centers are construction fees to build the facility, the initial expense of equipment to outfit the center, and then technology upkeep. Selecting an appropriate site for a command center is critical, as the cost to build can hinge on several factors, such as off-site versus on-site locations and urban versus suburban versus rural settings. Backfilling unused, older hospital space with a command center can often be more costly than new construction in non-hospital space due to the difficulties in retrofitting modern technology into old, ill-configured space. Once all the requirements have been established, it’s vital to consider the business case for both options (backfill and new construction) to determine a cost-effective choice that fulfills not only immediate needs but the long-term evolution of the command center.

Additionally, equipment costs, as well as technology maintenance and staff training, need to be considered. Command center designs must support powerful systems that harness the algorithms, predictive analytics and artificial intelligence that can help command center staff coordinate logistics and monitor patients. Therefore, the command center will need emergency power, highly efficient Wi-Fi technology, its own data center and integration into the system’s back-up data storage.


What’s Next?

As healthcare undergoes a technological revolution, hospital command centers, still in their infancy, are paving the way for other smart innovations. For example, with assistance from a command center, what if every hospital could employ artificial intelligence-driven patient monitoring to assist caregivers to create a customized precision medicine plan that’s tailored to a specific patient, and then adjust it in real time?

Additionally, other technologies could be supported via command centers, such as transport robots that deliver automated medical supplies and patient medications throughout a hospital. Cloud-based remote monitoring could provide closer communication between hospitals and patients across the full treatment timeline — from pre-admission to treatment to recovery and long-term care.

Hospital command centers can improve patient outcomes and experiences, optimize care delivery and lower operational costs. By designing spaces that host real-time hospital data and machine learning and unite staff across hospital departments, command centers can improve the ability of staff to care for patients, predict and flag medical risks and streamline patient care.

Banner image courtesy of Tim Griffith/NBBJ.

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A Brand Renew Day

How to Reposition a Building to Meet Changing Expectations

November 18, 2019

Senior Associate / Commercial Market Director, NBBJ

Editor’s Note: An extended version of this post, co-authored by David Yuan, Robert Mankin and Chris Beza, was first published in NAIOP’s Development magazine.


As buildings age, they often need to be renewed to remain competitive at attracting or retaining tenants, employees or residents. The scope of a renewal can vary widely from building to building, but keeping a few important factors in mind can position a building for continued success for years to come.


The building’s established brand
Every building has an existing position in the marketplace, and the most successful renewals build on that. A contemporary intervention in a classic midcentury building, for instance, might feel foreign to that building’s character. For instance, the renewal of 177 Huntington, an I. M. Pei-designed landmark in Boston, focused on activating the lobby with new furnishings, finishes and a cafe, rather than alterations to the building’s bold architectural character. Something radically different can work under the right circumstances, but it has to be intentional. (Photo: 177 Huntington Avenue, Boston, MA © Christian Phillips)


The building’s existing condition
In addition to structural or mechanical upgrades, renewing an older building may require the remediation of hazardous materials like asbestos, lead or PCBs. Sometimes the cost of renewing a building to meet the needs of the market exceeds the cost of demolition and new construction — in which case, it makes more sense to start over. At the same time, older buildings often have historic texture or cultural importance that many tenants value and is worth preserving. (Photo: Maritime Building, Seattle, WA © Sean Airhart/NBBJ)


Your company’s business model and brand
For core real estate investments whose goals are to provide a steady income stream, it would not make sense to invest in a major overhaul. Value-add or opportunistic investments, however, acquire a building for the express purpose of making a significant investment and increasing its value. Also, keep in mind your company’s brand vision for the look and feel of a renewal project — are your properties edgy and creative, or subtle and sophisticated? This also extends to corporate workplaces — how can a renewed building better connect employees to the company’s brand and mission? (Photo: 407 North Maple Drive, Beverly Hills, CA © Sean Airhart/NBBJ)


Your desired tenants
Although nearly every tenant expects more amenities, the exact mix and appearance of amenities that appeals to potential tenants may vary. For instance, the recent renewal of Two Union Square in Seattle created public spaces that perform many of the same functions as a tech workplace — with areas for serendipitous interaction and impromptu gathering — but with a more sophisticated look and feel that is true to the building’s brand and position in the market. As a result, the space appeals to a variety of tenants, from brokerage firms like JLL, to tech firms like Apple. (Photo: Two Union Square, Seattle, WA © Kevin Scott/@K7Scott)


Your existing tenants
It’s difficult to renovate a building while it’s occupied, so it’s essential to align tenants’ expectations regarding the extent and duration of any disruptions. Communication is key. Many owners will deliver presentations to tenants nearing the end of their leases to show why the renovation makes it worthwhile to stay. Some tenants at 1201 Third Avenue in Seattle, for instance, initially disapproved of the contemporary aesthetic of the renewed lobby, until they understood the benefits of a more open building with new amenities. (Photo: 1201 Third Avenue, Seattle, WA © Sean Airhart/NBBJ)


The urban context
The ground floor — and even some of the floors above — can function as a hub for the surrounding neighborhood. Is a property near a hotel, a convention center, an entertainment district, or other offices? Think about how it can contribute to the life of those surrounding uses, perhaps in its retail mix, food and beverage, coworking space or a public plaza where people can congregate. (Photo: 85 Broad Street, New York, NY © Sean Airhart/NBBJ)


Typically a renewal is considered in only three dimensions, but there’s a fourth dimension too: time. Some landlords are even beginning to hire coordinators who program amenity areas with events, whether for tenants only or the public at large. “Experience design” and environmental graphics — encompassing murals and public art, music, VR and augmented reality and more — can also attract tenants and visitors. Think about how a space can change throughout the day or month or year, and provide reasons for people to visit again and again with special events, popups or interactive spaces. (Photo: Confidential Biotech Company, Cambridge, MA © Peter Vanderwarker)


As architects, what excites us most about this shift is that physical space, increasingly, is considered not as overhead but as an asset. Physical space helps employees work smarter, more creatively and more healthily. It generates revenue and brand vision for retailers. It helps residents live fuller lives. And the most successful renewals will be those that enable people to meet these changing expectations for work and life.

Banner image courtesy Umanoide/Unsplash.

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Could Public Space ‘Stitch’ Atlanta Back Together?

A ULI Advisory Panel Investigates How to Reconnect Downtown and Midtown

November 4, 2019

Urban Design Director, NBBJ

Like many cities across the United States, Atlanta is bisected by a highway that separates thriving neighborhoods, depresses surrounding land values, and diminishes residents’ experience of the city. Currently a solution being studied by Central Atlanta Progress and other agencies is “The Stitch,” a ¾-mile long “lid” over the Interstate 75/85 Downtown Connector currently bisecting Atlanta’s Downtown. This “stitch” would both create open space in the heart of the city and provide new development opportunities. Most importantly, it would catalyze socio-economic cohesion — “stitching” — between disparate areas of the city.

The Urban Land Institute recently convened an advisory panel to review the Stitch that included two economic development experts, a planning commissioner, a landscape architect and one other architect/urban designer in addition to myself. The agenda for the five-day panel was intensive: an in-depth briefing day including a site tour, meetings with sponsors, a day of hour-long interviews of some 70 key community representatives, then two days of formulating recommendations.

On the final day of the panel we made an oral presentation of our recommendations to the sponsor:

Scale the Stitch: As proposed, the Stitch is highly ambitious in its physical scope. After conducting an analysis of the economics, land-use context, history, national precedents and financial feasibility, we concluded that a project of the scale initially proposed was neither necessary nor financially feasible to achieve a transformative impact and the highest benefits for the greatest amount of people in Downtown Atlanta. We recommended halving the extent of the highway cover while improving the existing highway bridges nearby.

Honor Your Story: We encouraged local partners to use the opportunity of the Stitch to celebrate the history of Downtown Atlanta.

Align Implementation Actions: At present, the Stitch remains an exercise in visioning. In order to move the project forward, it will be imperative to align efforts relating to governance, funding and development.

Formalize Partnerships for Implementation: We suggested the creation of partnerships with key agencies that address housing, homelessness, wellness and transportation.

We hope the recommendations can provide lessons for Atlanta and other cities who are seeking to mitigate infrastructural severances and knit key pieces of their urban fabric back together. Read the full report here.

Banner image courtesy Joey Kyber/Unsplash.

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