Planning ARRAY-ARCHITECTS.COM
Table of Contents Firm Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Planning Expertise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Laser Spine Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Montefiore Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 New York Presbyterian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Master Planning Expertise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 University Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Capital Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 St. John Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Firm Profile We are a team of architects and designers with unique backgrounds, but we all have one thing in common – we share a strong desire to use our expertise and knowledge to design solutions that will help people in moments that matter most. The complex, changing world of healthcare requires a team of effective communicators and true collaborators. Our 35-year+ history of being dedicated to healthcare holds countless stories of discovering optimal solutions with our clients. Our core mission is the same as that of our clients, improve the quality of our work, increase our efficiency, and motivate our staff to reach for success.
After having the privilege of working with heroes who cure, treat and receive care in our environments, I will never underestimate the importance of creating uplifting, inspiring spaces. Lisa N. Lipschutz, RA, ACHA, EDAC, Lean Green Belt Principal and Practice Leader, Planning
Planning Expertise Building on a 30-year heritage of designing for healthcare, Array has, in the recent years, been refining an integrated project planning process in every project we engage. Founded on an awareness that healthcare is changing, and so therefore must the design to support healthcare operations change, we delved deeply into Lean design philosophies to guide us. It is our belief that every facet of the hospital organization should be driven by study around the optimal functionality, efficiency, and effectiveness of that space. A hospital will not function appropriately without standardized, safe, operational sequences. A hospital cannot be efficient without recognizing that there is always room for improvement, and only a focus on continuous improvement can a hospital hope to keep up with evolving trends and standards. The effectiveness is determined by positive outcomes in the health status of all members of the hospital’s community and their perception of the care provided.
At Array, we are establishing a culture of continuous improvement at all levels of our organization. We have re-designed our design process using Lean as a foundation for a unique Process-Led approach that better meets the needs of today’s healthcare organizations. Throughout the history of medicine, healthcare facilities have been designed by providers. This is no longer the case. Patients and their families are now empowered and informed to make choices based on readily available data on outcomes, costs and HCAHPS score. Quality, value, convenience, environment and amenities are now top of the list. The patient is designing today’s healthcare facilities. With this fundamental change, traditional planning processes and many of the lessons learned from past experience have lost their relevance. A new approach is required.
PAGE 7 | Planning
OUR APPROACH
Solution
PROCESS LED DESIGN
• Executing the Design • Coordinating multi-Disciplines • Confirming Quality CHECKPOINT
CHECKPOINT
CHECKPOINT
• Prefabricating where possible • Confirming the Vision • Evaluating the Outcome
Creation
Discovery • Listening
• Applying the Results • Developing the Experience
• Visioning
Analysis
• Testing the Details
• Defining Metrics
• Mapping Current State
• Confirming the Vision
• Target Outcomes
• Collecting Data and Observing
• Confirming the Cost
• Understanding the Future • Mapping the Future • Rapid Testing • Developing Change Roadmaps • Understanding the Systems • Targeting Outcomes
Using Lean principles as a foundation, our process begins by understanding your current operations and clearly defining your project goals before we generate options. Working together with you we map an optimal future workflow and patient experience. We employ a variety of integrated methods, such as process mapping, operational planning, virtual mock-ups, and simulation modeling as we work to develop a comprehensive project that supports your mission of caring for your community.
\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\
Our Toolkit Our Toolkit outlined below is infused with Lean principles. Our process begins by understanding your current operations and clearly defining your project goals. On our way to recommending solutions that will support your mission of caring for your community, we map an optimal future workflow and patient experience.
VISIONING Metrics of Success When we lead our clients through visioning sessions to explore the desired look, feel and functionality of their environments, we use empathy and amenity mapping and top dot exercises to engage clinicians, patients, family members and project leaders in a dynamic conversation around key experience drivers.
EMPATHY MAPPING Engaging the Community Empathy-driven design is particularly relevant in healthcare. Bringing a variety of project stakeholders together to share thoughts can set the tone for a holistic experience, one where our planners and designers gain insight from providers and patients and then the providers and patients understand more wholly the intent behind our proposed design solutions.
OBSERVATION Data Collection Deeply understanding the current state as we work together to define your ideal future state is our next step. Through direct observation and process-flow mapping of your existing services, we work with users to accurately capture the current operational process. This allows us to identify any target areas for process change before design assumptions are made.
PAGE 9 | Planning
\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\
VALUE STREAM MAPPING
VISUAL PROGRAMMING
Workflow
Identifying Space
We map out the current state for each department that
With an idealized process defined and confirmed by simulation,
will be in the facility. Work queues and notification dash-
the types and sizes of rooms identified -a space program is
boards remove the traditional geographic constraints
nearly complete. Array has been contributing to the develop-
of key steps in the patient flow, allowing care teams to
ment of software that allows this information to be captured
decentralize, reduce their travel time and increase col-
and displayed in real-time so users are able to visualize all nec-
laboration at a micro level.
essary spaces within their department.
SIMULATION
BIM
Optimizing Efficiency & Flow
Real Time Coordination
Discrete Event Simulation provides a virtual environment
BIM has helped to integrate design teams in their detailed de-
to track and visualize patients, equipment and providers as
sign, engineering, documentation, project management and
they move through the steps of care. It is an important tool
cost estimation. This progress is having a real impact on our
in supporting Lean Design in the healthcare environment.
ability to create meaningful connections between each phase of the design - from early conception of the design, to construction, through the building’s life cycle - and into renovation or demolition.
EXPERIENCE MAPPING
PROTOTYPING & MOCK UPS
Creating a Healing Environment
Strategies Through Technology
Experience Mapping is meant to be a catalyst, not
As we work with you to develop these key spaces early in the
a conclusion. The takeaways drive the next phase
design process, we use several tools to explore and validate the
of the design or strategy by illuminating the journey
design as it evolves. These quick studies are part of our basic
and helping to identify the opportunities and touch
documentation and allow users to get a clearer understanding
points throughout the facility, creating a healing
of the decisions we are making.
environment.
CONTINUOUS ESTIMATING
COLLABORATION SCHEDULING
Direct Cost Generating
Cloud Based Work Plan
Eliminating the non-value added step of milestone esti-
Using a cloud based platform all team members work from
mates, cost information is generated in direct response
one integrated, live work plan that supports the last planner
to design evaluation while working with the CM to test,
pull schedule. Available on any smart phone, tablet, or touch
challenge and inform decisions as they are being made.
screen, real time collaboration is constant and transparent. Planning | PAGE 10
Programming / Integrated Project Planning
Programming The thorough and systematic evaluation of the interrelated values, goals, facts and needs of a client’s organization, facility users and the surrounding community. A well-conceived program leads to high-quality design.
Array’s goal is to see to it that our clients receive buildings that are
family and staff who will use the facility. Our design process is more
constructed as they were designed, within the allotted budget, at the
effective because we take the time early in our engagement to
expected date and operate efficiently and effectively for years after
understand your goals and priorities.
completion.
Process Mapping
In order to do so, Array must communicate a truly integrated and co-
To best develop a program, it is first important to understand the type
ordinated representation of the design to ensure maximum legibility,
of work to be done in the space. Operational models are evolving
containment of information and minimal need for changes.
out of necessity – as regulations and reimbursement continue to
Beyond its impact on design efficiency, Building Information Modeling (BIM) has helped to extend the usefulness of the architec-
change. Step 1: Observe
tural drawings throughout building construction, fabrication as well
go to where the staff is currently working and develop a better un-
as building management after it is turned over to the client.
derstanding of the culture, patient volume, demographic and needs,
BIM has helped to integrate design teams in their detailed design, en-
the staff’s workflow, operational protocols, and space utilization.
gineering, documentation, project management and cost estimation.
Step 2: Current State
This progress is having a real impact on our ability to create mean-
map the current state of operations with a cross-section of users.
ingful connections between each phase of the design – from early
Observing first, will make the conversation better informed and
conception of the design, to construction, through the building’s
prepare the designer to ask better questions and challenge when
life-cycle – and into renovation or demolition.
necessary. The outcome of these work sessions is an agreed-upon
The profession though, has been lacking in its ability to connect the Program – perhaps the most important aspect of the design – to
diagram of the current workflow with areas for improvement/ process breakdowns highlighted.
the BIM model (and therefore to the final product). The program
Step 3: Future State Mapping
is the seed of the project – the initial conception of the ideas that
A workshop with the same cross-section of users to develop an
every move is built upon. If done well, the Program has the ability
idealized work flow – mapping a process that systematically resolves
to capture the project’s vision, impetus, its original direction, and yet
the breakdowns/challenges of their current state. A natural extension
this valuable information sometimes gets lost in the convolution of
of the process map is the type of spaces that will support this revised
design, adjustment, value engineering and construction. At Array,
workflow – calling out all the critical relationships and adjacencies
we are working to expand Programming beyond the spreadsheet
that are required and preferred.
to capture all of this upfront information – and more importantly – connect that information to the rest of the project.
Rapid Testing Simulation. A strategic plan/ business plan (provided by the client)
Follows are facets of our design approach that demonstrate some of
defines the projected/expected volume of patients. Simulation
how our integrative project planning approach has provided value to
modeling can map how the idealized process will support those
our clients:
goals. The simulation generates the number of rooms required to
Visioning Array believes that all projects should begin with process analysis before design solutions are explored. Working with senior leadership, we will facilitate a visioning workshop including a broad a range
accommodate the revised process/workflow. Simulation modeling is also used to identify a preferred mode of operations by comparing throughput and efficiency of various processes and spatial arrangements.
of stakeholders. This session will focus on defining aspirations, key goals for the project, target outcomes and measures of success. We employ a variety of activities for this session, all centered on developing the appropriate empathetic perspective for the patients, Planning | PAGE 12
Early Mock-ups Once the overall idealized process has been established, the environment to support that process can be considered. One key ingredient to developing that understanding of work is to concentrate on the rooms that will have the greatest impact on care delivery: most typically the rooms that are replicated many times in the facility where patients and staff inhabit (e.g. exam rooms, operating rooms, patient bed-rooms, etc). While sometimes perceived as a pause to the design process, mock-ups are a critical first step. (Fight the urge to say: “just make the exam room 100 SF and move on – we’ll figure out what goes in it later). There are many different types of mock-ups – varying in their complexity, usefulness and timeliness. Tape mock-ups: Used very early on to develop a micro-understanding of the work to be completed within the room. Bring the equipment and furniture into a large room and arrange to support the tasks performed on a daily basis – only then start to define walls with tape on the floor. Push the users to be efficiency-minded, reminding them that more steps – even across the room for supplies – is wasted time/effort. It’s also important to remember that all space comes with a price – if the exam room can be 10’-3” instead of 10’-6”, those 3” per exam room can add up to a staff respite room later on down the road. No project has unlimited funds to support it. Cardboard Mock-ups: To more fully comprehend the space, sometimes it is necessary to build walls vertically. It’s always interesting to note the difference in one’s perspective after vertical walls start to define the space. Whenever possible, it is important to have the actual equipment that will be in the room. Anything that can’t be the actual item, should be constructed out of cardboard to its actual size and shape. Panoramic mock-ups: At an early stage in the design, Array builds virtual models of the major spaces and renders them in a way that allows for 360° panoramic visualization. When some users can’t be present at the physical mock-up, a virtual mock-up allows for remote visualization and feedback. Panoramic mock-ups are designed in BIM, and can therefore be used later as the base building blocks of the BIM model.
Mock-ups continue to be useful beyond Programming, as they solidify consensus and reduce costly changes. Rendered Digital Mock-ups can help the users visualize details such as finish, furniture and lighting options to ensure functionality and aesthetic design intent. Many clients will also choose to fully build a sample of the room that is to be replicated many times in the facility to iron out any last details and build full consensus around the design concepts by constructing Full Built-out Mock-ups. These rooms can be built to include functioning lighting, booms, casework, outlets, etc. so users can perform mock-testing of the room and all its details. (They are also great for fun-raising.) Visual Programming With an idealized process defined and confirmed by simulation, the types and sizes of rooms identified- along with their requisite adjacencies and relationships, a space program is nearly complete. Array has been contributing to the development of software that allows this information to be captured and displayed in real-time with the users to be able to visualize all necessary spaces within their department. At our programming meetings, instead of reviewing long (boring) spreadsheets to illustrate space need, the users see all spaces in the department as bubbles or blocks arranged by their critical relationships.
Laser Spine Institute Nationwide
SURGERY DEPARTMENT (OR, PRE-OP & RECOVERY) 11,898 sqft
FOOD & NUTRITION 4,395 sqft
MATERIALS MANAGEMENT 2,059 sqft
ADMITTING/ REGISTRATION 748 sqft
LOBBY 725 sqft
CONSULT DEPARTMENT 805 sqft
CLINIC DEPARTMENT 4,947 sqft
DIAGNOSTIC IMAGING 4,515 sqft CENTRALIZED SCHEDULING 689 sqft
Top: Nurse Stations Left: Visual Programming Diagram Right: Call Center Map Photography: Scott Pease
Laser Spine Institute has experienced exponential growth in their existing locations that has necessitated excessive premature renovation and cost. As the demand for laser spine surgery increases, LSI intends to build several more ambulatory surgery centers in different cities across the country as soon as possible. They recognized that refinement to their approach was necessary though – they realize they need to build an environment that supports their needs for an extended period of time. The new driving goal is to conceive a flexible care model, define the ideal process to deliver the best care to their patients in an efficient manner, and to develop the most appropriate environment to support these operations. In addition, LSI decided to take their patient-centered approach one step further, and has resolved to be the first Planetree designated for-profit healthcare organization in the country. The Laser Spine Institute has entrusted Array to lead them through the design process in support of these goals. Array led the users through a series of exercises that defined a workflow and a specific environment that matches the company’s longterm vision. From surgeons to patients, from administrators to medical assistants, from nurses to the IT representatives – everyone who interacts with the various spaces of the building provided the critical feedback necessary to define the ideal environment. Data was collected and assessed, driving a well-conceived environment that serves the needs of all those involved – with particular emphasis placed on the satisfaction of the patient and their family. Visual programming, several iterations of physical mock-ups, panoramic renderings, and relationship mapping were all tools that contributed to an idealized prototypical environment that LSI can now take and replicate across the country and feel confident that their longterm needs will be met.
“I’ve designed, developed, built and managed multiple ASCs from the dirt ground up through licensing and accreditation, and this is by far the best process I’ve ever been through. If I would have had mockup built to spec to work on before, I can’t tell you how many design flaws, over sites, mis-steps would have been avoided. I think this is genius and I love this approach.” – Kim Howse, Executive Director Laser Spine Institute, Tampa
Laser Spine Institute • Designed/designing ambulatory surgery centers in Arizona, Florida, Missouri, New Hampshire, Ohio, Oklahoma and Pennsylvania • For each surgery suite within the Center, approximately 3,000 SF is required • All LSI Outpatient Surgery centers include: • Operating Suites • Clinic • Diagnostic Imaging • Step-Down Lounges • High-End Finishes • Surgery Waiting • Clinic Exam Rooms & Waiting • Administrative Areas, Offices and Conference Room • Public Lobbies/Corridors • Staff Lounges • Cafe
Top Center: Community Area Top Right: Nurse Substation Middle Left: Reception Bottom Left: Exterior Bottom Right: Nurse Stations Photography: Scott Pease
Collaborators: Benchmark Construction The Procz Group
Purposeful Design
“The biggest reward I find is when a design meets more than the client’s expectations. It needs to go beyond what they could imagine and fulfill their business goals and budget simultaneously.”
Annette Giuffrida-Levesque, RA, Lean Practitioner Healthcare Planner & Project Architect
DESIGN BY THE NUMBERS: DISCRETE EVENT SIMULATION AT LASER SPINE INSTITUTE By: Laura Silvoy
The role of Industrial Engineers does not traditionally involve work in
future growth in the form of an additional surgeon and patients. As a
the architecture or healthcare industries. Presently, however, given the
simulation model would be the best tool for finding a solution to this
high rate of healthcare costs in America, the industry is experimenting
problem, Array engaged their healthcare systems engineer to study
with a marriage of process engineers and architects to create more
solutions.
cost-effective environments with higher quality care. One recent example of architectural optimization in healthcare was conducted under the auspices of Array Architects for Laser Spine Institute. To accommodate a growing volume of patients, this health system is going to open several satellite facilities across the country, testing a smaller community-focused model that would serve as a template for their growth. These smaller facilities will require a set amount of pre-operative care spaces (PRE-OP), post-anesthesia care spaces (PACU), and other necessary support areas to function. This study centered on the use of discrete event simulation modeling for layout and process planning purposes.
The key aspects of a simulation model are the data it runs on and its ability to accurately represent the parts of the system that relate directly to the project goals. Direct visual observations of the current work flow was arranged to validate the existing process map provided by Array and speak with front-line employees from the headquarters facility. Process time data compiled from a previous time study performed at the headquarters facility was used to generate distributions that powered the simulation. These process times were combined with the process map to create a simulation model using Arena Simulation software. To ensure the accuracy of the model, a paired-t confidence test was administered, in addition to other methods of
When architects are designing new healthcare facilities, they typical-
validation and verification. It turned out that the actual values and the
ly follow accepted design guidelines and client recommendations
simulated values were almost perfectly correlated, resulting in 99.95%
regarding the amount of space necessary in a specific facility. Due
confidence that no statistically significant difference existed between
to the space utilization of the current facility, Array and the client
the simulated and actual data, as can be seen in Figure 1. From this,
were both interested in challenging these conventional guidelines by
it could be concluded that the processes in the simulated model
designing a space that most efficiently and precisely matched their
were running almost exactly the same as the processes at the actual
specific function. In addition to this alternative space plan, the client
healthcare facility.
was also interested in altering the current patient flow to improve the patient experience. In the current system, patients are transferred from Stage I recovery rooms to discharge recliners (Stage II) as they transition through the levels of recovery. The newly proposed model would allow the patient to fully recover in the PACU, with family members present, without moving to another location. The challenge would be to accommodate patients in the PACU for the duration of their recovery without causing backup in the ORs. These requests were translated into two major goals: 1) establishing an adequate number of recovery and PRE-OP rooms necessary to support the new patient recovery configuration without adding patient waiting time and 2) determining whether the space was large enough to support
PAGE 21 | Planning
Once the simulation model was accurately representing the actual system, small changes could be made to see how they would impact the system. The simulation model was reconstructed for three different patient recovery scenarios — complete recovery in PACU with no overflow; complete recovery in PACU with overflow directly from surgery to PRE-OP; and complete recovery in PACU with overflow from PACU to discharge chair for phase two recovery. Each of these PACU overflow scenarios was paired with one of three options which tested the capacity limits of the surgery center, including adding a recovery room, adding a surgeon, and adding a recovery room and a surgeon.
After modeling each of the scenarios combined with all of the options, output data was analyzed and it was determined that the desired future state Array proposed could indeed be achieved. In the ideal future operating state, patients recover fully in the PACU and a patient would never be required to wait for a recovery room to become vacant. The combination of scenarios and options that best meets these criteria allows complete recovery in the PACU with patients moving from surgery directly into a PRE-OP room when all recovery rooms are occupied.
LAURA SILVOY
According to the standard ratio of recovery rooms to operating rooms, there should be six recovery rooms and extra room for discharging patients. The proposed design solution
As a Healthcare Systems Engineer, Laura
suggests four recovery rooms are adequate. In the current operating state, on average,
collaborates on projects firm-wide,
patients will wait 30 seconds after surgery before being placed in a recovery room. If the
enhancing our team’s ability to deliver
altered process was applied to the same layout, on average, every patient would wait 9.9
enhanced project results through more
minutes, with a maximum average of 36 minutes per patient. The final solution requires
rigorous data analysis. As an integral part of the Process Improvement Team for
This solution leads to an improved patient experience, a more effective use of surgery center space, and a decrease in patient waiting times.
Array, Laura works with clients and staff to promote a philosophy towards, and implementation strategies for, continued process improvement. Laura’s energetic approach to investigation and her insight on how data can be deciphered and lead
that the PRE-OP rooms be used for recovery in case of a full PACU, which led to a 0
to improved patient environments will
minute wait for patients exiting the operating room. The simulation model was used to
have definable results for Array’s health-
test these different options and scenarios. Careful output analysis resulted in choosing a
care clients and their efforts to affect the
model with an efficient patient flow plan that involves zero waiting time after surgery and
health improvement in the communities
meets both goals set by the client.
they serve.
While the results of the simulation prove viability of the proposed solution, we recognize that other factors contribute to a care model’s effectiveness. More rigorous prototyping and simulation modeling might study the areas of maximum patient capacity, ideal scheduling, personnel utilization, and cost analysis, to definitively determine the most efficacious operational scheme for the health institution. Nevertheless, the work conducted by Array for the surgery center is a prime example of the way systems engineering and architecture can come together to help the healthcare industry function more efficiently.
View Laura’s Slideshare about this study to learn more
Click here to visit Laura’s Thoughts page.
Montefiore Medical Center Ambulatory Care Center Bronx, NY
“A lean design approach collaboration with Montefiore’s industrial engineers was imperative to understand how clinicians and staff work and how information and patients flow to maximize efficiency in this unique space.” – Jason Lee, LEED AP, Lean Green Belt
Principal and Studio Director, Northeast Region
Array was retained to provide planning and design services for the complete fitout of 12 stories at the newly developed Hutch 2 Tower – part of a Class A office complex convenient to the Medical Center. Ambulatory surgery and support services are split between three floors and as well as waiting, prep/recovery, physician lockers and Central Sterile Processing. The ORs needed to be distributed between several floors with great care taken to properly connect them to achieve maximum efficiency and patient safety. The Ambulatory Center incorporates a full imaging suite with two MRIs, two CTs, four Radiology rooms, mammography and ultrasound rooms on the 2nd floor of the building. The seven upper clinical floors are based on modules and pods so that space can easily be increased or decreased between groups as needed. Rooms can easily swing from office to consult to exam rooms due to standardized configurations and provided infrastructure. Multiple points of entry were also carefully monitored due to patients who self-park, patients who take mass transit, and patients who are dropped off. With these conditions, came additional requirements for security and emergency preparedness.
Exterior Photography: Halkin Mason Photography
Top: Waiting Bottom Left: Nurse Station Bottom Right: MRI Photography: Halkin Mason Photography
Collaborators: BR+A Cauldwell Wingate Reuther + Bowen
Project Information • 280,000 SF Ambulatory Care Center • 12 ORs / 4 Procedure Rooms • 64 Bay Recovery Area • 20,000 SF imaging suite • On-site Pathology with elevator that connects directly to ORs • Plastic Surgery • Dermatology • Cardiovascular with Nuclear Medicine • Pain center with four treatment rooms and eight recovery beds • Urology with three treatment rooms • ORL with five audio booths • Ophthalmology with two laser treatment rooms and 12 exam rooms • Internal Medicine with dedicated Pediatrics • 177 exam rooms throughout building • Ten total elevators, five to serve all 12 floors, three dedicated for OR transport two dedicated for CSS • Large cantilevered entry canopy to protect multiple cars during drop off • RFID equipment and personal tracking system throughout • Electronic bed side registration and charting • Central sterile with four lines • Pharmacy with 797 lab • Article 28 compliant
New York Presbyterian Children’s Hospital of New York New York, NY
PICU / Nurse Stations Photography: Halkin Mason Photography
In addition to experiences, quality and safety, adjacencies and future space requirements need to be considered when Pediatric spaces are being moved and improved. The completeness of planning scenarios and phasing is of the utmost importance when the projects will affect many departments across several floors of more than one bed tower. Located at New York Presbyterian’s (NYP) Columbia Campus, the Morgan Stanley Children’s Hospital of New York (CHoNY) is comprised of three buildings, ranging in age from 10 to 90 years. The owner chose to embark on a series of feasibility studies to map out the most effective plan to implement modernization projects in four key areas of the two older buildings and one location in the newest tower building. Critical care bed demand and surgical services growth were key drivers along with maternity capacity and the creation of single family rooms. The projects are donorfunded with defined funding schedules. Each department’s improvement plan is phased to accommodate the dominoeffect of planning multiple moves within occupied spaces. Implementation is also dependent on timing of new infrastructure installation. Feasibility studies were prepared with input from a diverse group of stakeholders and user groups to confirm volumes, census levels and operations. A program of requirements was prepared and test fits developed to ensure that each unit would meet current codes, incorporate evidence-based design tenets and respond to volume projections. The team worked closely with hospital personnel to ensure continuity of identity and wayfinding with the goal of maintaining systemwide parity and compatibility with the Hospital’s design of interior finishes and construction standards.
Click on the below image to read a detailed case study on Array’s CHoNY Improvement projects
Top Left: Waiting Top Right: Nurse Station Middle Left: Waiting / Reception Bottom Right: Patient Room Photography: Halkin Mason Photography
Project Information Subspecialties Clinic • 7,300 SF • 14 exam rooms, one procedure room • Open, curved registration/waiting area with decentralized work areas opens clinic to more light and provides welcoming entrance Neonatal ICU • 12,500 SF Renovation/ 17 beds with ability to flex-up to 22 • 7 private rooms/5 two-bed pods each with a flex-up position • Decentralized nursing model • Integrated ECMO service on unit Pediatric ICU • 10, 750 SF Renovation • 14 private rooms • Decentralized nursing model • In-room family amenities including oversized day-bed for two, in-room refrigerator and safe AntePartum • 10,500 SF Renovation • 14 exam rooms, one procedure room
Master Planning Expertise Healthcare is a complex and diverse business enterprise that is in incredible flux. Each facility struggles to know the best next step to take, however each facility knows their next step must offer an appropriate ROI. We help clients by implementing a process that drives critical information through rigorous testing. Master Planning is not project planning – it is its own unique discipline – a discipline which provides a specific calculation of the practical steps needed to achieve an institution’s goals over an extended period of time. With a unique take on Master Planning, we help clients see where they need to go. Healthcare has shifted from a volume-driven practice to a value-driven practice. Array has done the same. Smart frontend thinking goes a long way. Array goes to great lengths to substantiate our solutions with hard data. Our pragmatic process, intensified by our unique planning toolkit, enables more informed decisions to maximize flexibility, efficiency, and return on investment. Once a strategic, programmatic direction is formulated, it serves as a springboard and checkpoint for designing the most appropriate solution. Facility investment is significant. Proper planning ensures maximum return. Our advisory services ensure that critical investment decisions are framed by the optimal breadth and depth of thinking through strategic planning, market assessment, demand projection, business planning, service line analyses and tracking key market trends and indicators. Our planning exercises explore areas of strategic growth, pinpoint potential problems, and develop alternative solutions to unique challenges.
Philosophy We define a Facilities Master Plan as “a comprehensive framework for the organized and financially responsible development of facilities over time.” The purpose of a Facilities Master Plan is to ensure that: • Strategic and financial objectives drive facilities investment decisions • Facilities “project” plans respect an overall long-term planning framework • Functionality and operational efficiency are maximized • Site(s) and facilities remain viable and flexible in the long run • Risks associated with facilities development investments are minimized The absence of a Master Plan often leads to poorly located, configured and/or sized facilities projects which will result in: • Short project life • Lost capital due to ary service relocations • Excessive construction costs due to a mismatch of service use and building type • Negative impact on operations and operating cost • Capacity issues Clearly defined business strategies lead to intelligent planning decisions. To ensure that we deliver results, our talent includes experts in strategic planning, program planning, performance improvement, technology, finance, market analysis, and medical equipment. Array’s master planning activities focus on solutions that maximize short-term and long-term use of facilities consistent with and supportive of the organization’s chosen strategic direction. PAGE 33 | Planning
"Watch and listen, then think and imagine, then test it, kick it, turn it upside down...and repeat. Only after rigorous study can we sketch something out that might get us close to where we want to go." -Noah Tolson, AIA, LEED AP BC+C, Lean Green Belt Principal and Practice Leader, Planning
Array has extensive planning experience with a proven success record spanning 30+ years. Below are notable clients we have collaborated with: Notable Clients: • Capital Health, Trenton, NJ • Baltimore Washington Medical Center, Glen Burnie, MD • Barnabas Health, Livingston, NJ • Delaware Psychiatric Center, Wilmington, DE • Franklin Square Hospital Center, Baltimore, MD • Hunterdon Medical Center, Flemington, NJ • Huntsville Hospital System, Huntsville, AL • Inspira Health Network, Mullica Hill, NJ • Laser Spine Institute, Tampa, FL • Miami Children’s Hospital, Miami, FL • Mercy Medical Center, Toledo, OH • Montefiore Medical Center, Bronx, NY • Nazareth Hospital, Philadelphia, PA • Nemours/ Alfred I. duPont Hospital for Children, Wilmington, DE • New York Presbyterian, New York, NY • Rex Hospital, Raleigh, NC • St. Elizabeth Healthcare, Covington, KY • Saint Joseph Hospital & Medical Center, Phoenix, AZ • St. John Medical Center, Westlake, OH • Somerset Medical Center, Somerville, NJ • University Hospitals, Cleveland, OH • Veterans Affairs Medical Center, Nationwide • Wheaton Franciscan Healthcare System, Milwaukee, WI
Planning | PAGE 34
University Hospitals
Facilities Master Plan & Implementation Cleveland, OH
Providing more than 1,500 beds, University Hospitals is one of the largest and most respected health systems in the country. With the goal of increasing quality, market share, efficiency and improving their Centers of Excellence, University Hospitals recognized the need for a System-Wide Facilities Master Plan that would pinpoint areas for strategic growth, identify obsolete facilities and provide a phasing and implementation plan that would align their facilities with their long term growth strategies.
Array provided facilities master planning, corporate architecture, design and interior design for over 50 projects across the University Hospitals system. We conducted comprehensive site, facilities and infrastructure analysis of every building at each of University Hospitals’ 15 campuses, and ranked each building based on its value for future use. Building upon a strategic plan prioritizing services, we provided programming, test-fit planning, detailed project budgeting and identification of enabling projects that resulted in the construction of four new projects totaling $500 million. The System-Wide Facilities Master Plan allowed UH to identify the locations for multiple projects including a new Cancer Hospital, sited to increase efficiency and interface with the hospital services in order to reduce redundancy. A location for an expanded Emergency Department was identified that improved connectivity to the hospital, increased patient through-put and reduced wait times. Overcoming the limitation of available contiguous space, a new Level 3 NICU was planned in an area that spanned three adjacent buildings.
Top Left: Infusion Top Center: Reception / Waiting Top Right: Nurse Station Bottom Right: 3d Plan Bottom Right: Exterior Photography: Kevin Reeves
Facilities Master Plan System Includes: • 1,500 total beds • Full academic medical center (Case Medical Center) • Two critical access hospitals • Four community hospitals • Thirteen ambulatory care sites • Several major building projects resulted from the master planning effort including: • A new, greenfield Hospital • A new, freestanding Cancer Hospital • A major renovation/expansion for the NICU program • An expanded and renovated ED • A new 800-space parking garage • Improved site circulation; Improved Branding and Patient Experience
Seidman Cancer Center • 375,000 SF, 10-story new construction • 120 inpatient beds (Transplant, Medical and Surgical Oncology) with dedicated Pharmacy (expandable to 150)
"Array has been instrumental in managing our master plan strategies, supporting UH’s fundamental mission, and has been a true partner and resource for leading our major building campaign." - Steven Standley, Senior Vice President
University Hospitals
• Radiation Oncology with two Linear Accelerators, one Cyber Knife, one Gamma Knife, one Tomo Therapy Suite and four Simulators (two CT) • 42 Infusion Bays with dedicated Pharmacy • Ambulatory Clinic with 40 Exam Rooms • Cancer Surgery Prep/Recovery (10 bays) and four new Operating Rooms including intra-operative MRI; attached to existing 22 OR Surgical Service • Other services including Survivor Center, Phlebotomy and Lab Services, Imaging Services, Breast Care, Clinical Research Center and dedicated Pharmacy • Amenities include Gift Shop, Café, Meditation Room and Family Welcome Center • LEED Certified
Ahuja Medical Center • First healthcare project in the country certified Silver under the LEED NC 2009 rating system • 144-bed greenfield site hospital Phase 1; planned for 600 beds in future expansion • Hospital Facility 375,000 SF • Central Plant 20,290 SF • MOB 56,545 SF • 22-bed Emergency Department (including 6 dedicated pediatric beds) • Collocated Outpatient and Interventional Medicine Platforms • Noninvasive and Interventional Platforms
Environments have the power to set our expectations, lift our spirits and inspire hope. This is what motivates me to create spaces that mitigate the challenges faced by all who enter a healthcare facility. Patricia D. Malick, CHID, EDAC, IIDA, Lean Green Belt Principal and Practice Leader, Interior Design
Capital Health Facilities Master Plan Pennington, NJ
As part of a 30-year relationship with Capital Health, Array master planned and renovated their clinical facilities to respond to an increased demand for patient care services at their urban Regional Medical Center while planning for the suburban, Greenfield hospital where may services were being relocated from a second urban facility to be shuttered. Relocation of such services as the Regional Perinatal Center (RPC) and expansion of Pediatric Beds was requested as part of a Certificate of Need. The RPC reactivated 10 LDRP Beds, two Postpartum Beds, a 10 Well Baby Nursery, and two C-Section Rooms. An adjacent area was renovated into a 15 Bassinet NICU and seven Bassinet Intermediate Care Nursery. The existing six Bed Pediatrics Unit
was relocated and expanded to 10 Beds. Several functions were displaced by these services being renovated. This resulted in a challenging, phased renovation of a number of other areas to provide new space for the displaced inpatient rooms. New inpatient units were constructed in existing space, including a 12 bed Intermediate Care Unit and a 36 Bed Med/Surgical Unit. Work was phased, with construction completing on schedule at the end of September 2011 to allow for patient transfer at the planned shuttering of the other urban campus/ opening of the new suburban campus.
Top: Exterior Left: Atrium Right: Infusion Right: Photography: Blake Marvin
Top Left: Patient Room Top Center: Healing Garden Top Right: Waiting / Reception Bottom Right: Dining Photography: Blake Marvin
Collaborators: AKF Engineers Anchor Health Properties HKS, Inc. O’Donnell & Naccarato Skanska Target Building Construction The Lighting Practice Wells Appel
Greenfield Hospital Master Plan • 925,000 SF replacement hospital and MOB on greenfield site • 223-bed, five-story patient tower featuring single-occupant patient care rooms • 4 Med/Surgical floors including 24-bed ICU • 18-bed PICU (17 Bed Pediatric Unit-including 4-Bed Intermediate Care) • 12-bed NICU (Level II), expanding to 31 beds (all private) • 14-bed LDR • Features 36,000 SF Emergency Department with dedicated Pediatric Care Unit • 20,000 SF Diagnostic Treatment and Patient Support Building • 80,000 SF Cancer Treatment Center adjacent to new hospital • HKS, Inc. is the Architect of Record (exterior image credit); Array provided programming, corporate architecture and interior design services on this project.
Regional Medical Center • 97,000 SF renovation with all private rooms • Rooms designed with bariatric patient lifts/ accessibility • Women’s Obstetrical Program - 22-bassinet (15 Level III / 7 Level II bassinets) NICU - 10 LDRP beds - two Postpartum Beds - 10 Well Baby Nursery - two C-Section Rooms
• Trauma Intensive Care Unit - 14 ICU beds supporting the Level II Trauma Unit • Step-Down Unit - 12 beds supporting ICU step-down patients • Medical/Surgical Units - 96 beds over four nursing units • Laboratory - Pathology, Histology, Specimen Processing & Blood Bank
St. John Medical Center
Facilities Master Plan & Implementation Westlake, OH
Due to the growing populations of Cuyahoga and Lorain Counties, St. John Medical Center (SJMC) decided to modernize and expand their services to accommodate growth and remain the healthcare provider of choice on the west side of Cleveland and increase University Hospitals’ image and competitive edge in the community. They engaged Array to perform a Facilities Assessment and develop a Modernization and Planning Study that evolved into a Campus-wide Facilities Master Plan. The Master Plan determined that key Medical Center services were in need of expansion and modernization to support the quantitative demand and qualitative vision for the future. Array worked with a Steering Committee comprised of SJMC and University Hospitals representatives to define capacity requirements and develop planning alternatives in support of the agreed upon drivers and project budget target, including space program of requirements (PoR), development of test-fits, and detailed project budgeting and phased implementation.
Click on our Thought Leader below to learn more about project visioning.
Waiting Photography: Kevin Reeves
Top Left: Exterior Top Right: Reception Bottom Left: Floor Plans Center Right: Operating Room Bottom Right: Nurse Station Photography: Blake Marvin
Collaborators: Barber & Hoffman Donley’s MCM Company Osborn Engineering Company Sandhu & Associates
Center
2
Level 1 Floor Plan
Level 2 Floor Plan
Facilities Master Plan • New Ambulatory addition with Patient Access function, Diagnostic Services and Same Day Surgery intake and main lobby • Renovation of Non-Invasive Diagnostic Services including Imaging, Respiratory Therapy Biometrics, Phlebotomy, Preadmission Testing • Expansion of Surgical Suite, PACU, Same Day Surgery Prep and Recovery, Endoscopy and the Pathology Lab • Renovation of Visitor Entrance with new canopy and renovated Lobby, Gift Shop and Café • Increased inpatient capacity with addition of Pediatric Inpatient Unit and Clinical Decision Unit adjacent to ED • Renovation to existing Inpatient Nursing Units • Improved wayfinding and separation of inpatient, service and public flow • Site and infrastructure improvements including a relocated helicopter landing pad
Boca Raton / Boston / New York City / Philadelphia / Washington