UH St. John Medical Center

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Designs Delivered University Hospitals St. John Medical Center


Table of Contents

Healthcare Planning A Growing Community, A Growing Need

4

6

Strategic Planning & Programming Challenges to Address

8 10

A Warm Welcome 12 Interior Design & Branding

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Integrated Project Delivery Success

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As part of a campus-wide facility assessment and master planning process, we identified deficiencies in surgical suite quantity and configuration, as well as prep and recovery accommodations leading to expansion recommendations. Additional master plan suggestions included zoning the facility to support increased outpatient visits and phasing strategies to enable incremental expansion of the diagnostic and treatment platform. Array also suggested that a new “front door” be created to improve wayfinding and enhance the Medical Center’s image. All suggestions were implemented utilizing an Integrated Project Delivery method.

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Planning Expertise Building on a 35-year heritage of designing for healthcare, Array has refined an integrated project planning process in every project with which we engage. Founded on an awareness that healthcare is changing, and so therefore must the design to support healthcare operations change, we delve deeply into Lean design ethos. We believe 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 there is always room for improvement, and only with 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 established a culture of continuous improvement at all levels of our organization. Our design process using Lean as a foundation for a unique Process-Led approach to best meet the needs of today’s healthcare organizations and tomorrow’s healthcare delivery. 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.

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A Growing Community A Growing Need St. John Medical Center (SJMC) is located in the city of Westlake, just outside of downtown Cleveland, Ohio. It serves the upscale, suburban communities of Cuyahoga and Lorain counties. With a clear vision of becoming the healthcare provider of choice in the region, the full-service, nonprofit acute care hospital was determined to expand and modernize its services to continue to meet the needs of this growing community. Not only did SJMC plan to increase capacity to accommodate growth in inpatient and outpatient surgeries and meet future volumes, it also aimed to revamp its key services and make upgrades throughout the campus to improve the patient experience. Additionally, the Medical Center’s design needed to reflect the brand of its affiliation with University Hospitals (UH). In operation since 1981, SJMC is a Catholic health provider co-owned by University Hospitals and the Sisters of Charity Health System. The hospital has an average of 10,000 admissions and more than 100,000 outpatient visits per year. Currently the largest employer in Westlake, SJMC has more than 1,200 employees along with 500 medical staff and 300 volunteers. Working together to improve efficiency, access and patient care, Array, SJMC and a team of consultants devised a plan to increase the Medical Center’s capacity, expand the surgery platform, centralize outpatient services and re-brand the facility to promote the new management under UH. The 221-bed, 326,885 SF community hospital received two new additions totaling 51,885 SF of space, as well as 234,000 SF of renovation. The South addition includes drop-off canopy, entrance, lobby, patient registration, pre-admission testing, diagnostics, waiting areas and bistro. The West addition includes two new surgical suites, a post-anesthesia care unit (PACU), endoscopy procedure rooms, a pediatric inpatient unit and a clinical decision unit for the emergency department. Other important improvements include a new entry; parking surface with easier access; corridors, family waiting areas and other public amenities renovated to be more efficient and welcoming; and, technology upgrades. Using an integrated project delivery (IPD) approach, Array Architects worked in collaboration with University Hospitals and Donley’s, Inc. (contractor) to create a design that had the flexibility to accommodate additional bed towers and expand services as the healthcare landscape adjusts to new regulations.

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St. John Medical Center | PAGE 7


Strategic Planning & Programming University Hospitals hired Array Architects to perform a facilities assessment and develop a modernization and planning study for the SJMC healthcare campus after the successful completion of UH’s Vision 2010 effort with Array. Upon evaluating SJMC to determine the highest and best use of existing resources, these efforts ultimately developed into a campus-wide modernization plan for SJMC. The master plan highlighted the need to expand some of the Medical Center’s main services and modernize the facility’s infrastructure and ancillary services. Surgery was identified as the key service line in need of major changes. The plan revealed several deficiencies in the surgical suite and prep / recovery areas, suggested re-zoning the facility to handle an increase in outpatient visits, and offered phasing strategies to expand the diagnostic and treatment platform incrementally. Working with a steering committee comprised of representatives from SJMC and UH, Array defined capacity requirements and developed a conceptual design and planning alternatives to meet the project budget and space program requirements. This included laying in zones of renovation and construction to support needed clinical investment. The project goals included expanding and investing in the diagnostic services and surgery platforms, increasing capacity, separating traffic flow, improving inpatient and outpatient circulation paths and enhancing the patient experience. After considering the costs associated with the planned changes to the site, facility and infrastructure, a phasing schedule was set so that the highest yield spaces were implemented first.

A volume/patient visit projection provides hospitals and health systems an understanding of procedural volume and patient visits to strategically plan clinical space and develop net revenue estimates. The inpatient bed need analysis contained four scenarios of different demand; all based on varying assumptions. As depicted in the chart on the right, demand ranged from 170 to 184 beds based upon the different models.

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Challenges to Address Today’s surgery platforms require the latest technology and

OUTPATIENT SERVICES ADDITION

equipment, as well as adequate space, attention to patient flow,

south addition

staff circulation and support space location. Prior to project implementation, SJMC’s suites (ORs) were undersized, poorly configured and in need of equipment and technology upgrades. Combined, these factors began to effect the delivery of patient

Although increasing surgery capacity and optimizing efficiency was at the heart of this project, the team also focused on creating a positive experience for patients, staff and families.

care, including the Medical Center’s ability to meet current and

The outpatient services addition centralizes all of the Medical

projected volumes.

Center’s outpatient services and provides a more intuitive

Though SJMC had 10 ORs, only seven were fully-functional. For the Medical Center to best serve the needs of its community, administration determined that its surgery department would need 10 fully-functional ORs - properly sized and configured ORs for use in general cases - including oversized ORs for specialty cases. Prep/recovery also required study, as these areas had inadequate patient capacities, limited patient privacy and were not well-located to support flow to and from ORs. Additionally, the Medical Center’s imaging, lab and central sterile services also needed improvement to put SJMC on the cutting edge of outpatient surgery.

SURGERY DEPARTMENT IMPROVEMENTS west addition

The first floor of the West Addition houses a pediatric inpatient unit adjacent to the existing UH Rainbow Babies & Children’s Hospital satellite ED. This location is ideal for the pediatric beds, as it consolidates all pediatric services into one location. Recognizing the variation in pediatric inpatient consensus, the impatient unit is also adjacent to ED observation beds, providing the ability to swing the beds when not needed for pediatrics. Relocating the pediatrics inpatient unit allowed the expansion of the step-down unit, providing much needed adult inpatient capacity and supporting discharge from the ICU The second floor of the addition houses one state-of-the-art oversized OR. The adjacent renovated surgery platform has three new oversized ORs for specialty cases, as well as six upgraded ORs. Shell space for a future OR was maintained. Additional program components include a 15-bed PACU featuring five private rooms and 10 oversized bay positions, as well as a three-room endoscopy procedural suite. The new surgical suites and intake/recovery areas allow for added clinical capacity and functionality, creating an efficient surgical service. Conference rooms were also added so that physicians can meet with families for consultations without having to break sterile bounds. PAGE 10 | Designs Delivered

circulation. Included are several new amenities that provide patients and families access to key diagnostic services: a separate outpatient entrance, lobby, family waiting area for sameday surgery and prep/recovery. The new two-story lobby is a starting point from which patients and families can access other key public amenities, such as reception, family gathering areas, coffee shop, gift shop and chapel.


High-quality design is essential to the human experience.

Kent Doss AIA, LEED AP BD+C, Lean Six Sigma Black Belt

Principal, Senior Regional Vice President & Practice Leader, Design The IPD approach, from Time and Material payments to Dynamic Cost Estimating and a different Project Management structure, is a change in culture. Team assembly and education; project cost validation; contract negotiation; collaborative interaction and clear scope definition are necessary components for a successful IPD implementation on any project. Design and construction projects will always have their issues and challenges. A cooperative team motivated by shared goals and working in true partnership can better address these challenges and deliver a more successful project.

Click here to visit Kent’s blog.

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A Warm Welcome One vital aspect of the Medical Center’s new image included creating an identifiable “front door” to welcome patients and support an increasing number of outpatient visits. Previously, the entrance was a nondescript doorway located between two wings that directed patients and visitors to a hallway, which caused confusion and congestion.

NEW ENTRANCES AND FLOW Now, an easily visible outpatient entrance with a drop-off

Prior to constructing the new outpatient entrance at the south

canopy leads to a welcoming two-story lobby, featuring natural

end of campus, the north visitor entrance and lobby were

materials, stained glass and seating in intimate, family-centered

renovated. Reception received a new desk and the gift shop was

arrangements. A sweeping staircase and bell tower-like elevator

upgraded. In addition, access to the chapel, cafeteria and visitor

connect the first floor lobby to the second floor surgical services

elevators improved. The reconstructed visitor entrance supported

waiting and intake areas.

hospital access for all patients and visitors during the new

This addition leads visitors to outpatient services, such as

outpatient entrance and lobby construction.

centralized registration, pre-admission testing and diagnostics.

Prior to the renovations, most patients utilized the outpatient

The lobby design vocabulary is a subtle reminder of the Medical

entrance. Having a separate main entrance for visitors and one

Center’s faith-based roots, providing a calming and reassuring

for outpatient services simplifies wayfinding and allows internal

interpretation of the Stations of the Cross.

separation of inpatient, outpatient and visitor circulation routes, causing less congestion and confusion, thereby improving patient experience. This was especially important for a medical center that has a significant number of both in- and outpatients.

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EASE OF ACCESS Many improvements were made to the Medical Center’s public

With the south and west additions situated at opposite ends

spaces to simplify wayfinding and optimize flow. Recognizable

of the main corridor, patients and visitors can easily find the

landmarks, such as the drop-off canopy and beacon-like lobby,

department they need regardless of where they entered.

were added to orient visitors. New exterior and interior signage

Additionally, connecting the Emergency Department to the

also makes navigating easier, regardless of entrance used or

outpatient services addition provides a sense of direction and

services sought.

reduces walking distances for patients.

Circulation within the Medical Center was challenging. The main

Despite many years of growth, the Medical Center had not

corridors accommodated in- and outpatient traffic, as well as

updated its site circulation or parking, adding to the facility’s

staff and vendors, necessitating clear, intuitive wayfinding and

confusing access. By adding parking spaces close to key areas

accessibility to multiple services for visitors and patients. To

of the Medical Center, patients and visitors can intuitively make

separate patient and clinical traffic, two corridors were created on

their way toward their destination. Along with the updates to the

the first floor: one as the main corridor and another for services.

site layout, parking and pedestrian circulation were reworked to be

Additionally, departments were rearranged and relocated along

more convenient, and added landscaping enhanced the cosmetic

the main corridor, enabling easy access for patients and visitors.

changes to the campus.

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Interior Design & Branding The facility felt dated and lacked interior daylight. The recent redesign replaced 1980s era materials with a warm palette of natural and modern materials, transforming it into an uplifting and soothing environment. The two-story lobby now has a natural wood ceiling; a manufactured stone feature wall, accented with bands of pre-cast concrete stone; and, a porcelain tile floor, bringing warmth to the space. Waiting spaces were outfitted with transitional style furnishings to create intimate seating areas. Clerestory windows draw the eye upward, offering daylighting and views for a therapeutic, as well as an aesthetic, effect. Natural materials give the updated space a timeless elegance, while metal details throughout, including the outreaching dropoff canopy, add a much-needed modern touch and keep the design in line with the hospitality-influenced UH brand.

FAITH-INSPIRED DESIGN DETAILS Faith, which plays an integral role in the healing process for patients and families, is very important to SJMC, a Catholic health provider committed to its faith-based mission. With this in mind during the design process, Array incorporated several faithinspired elements. Because the Medical Center caters to families of all denominations, the religious symbolism in the facility design is subtle. The outpatient entrance, for example, includes an elevator shaft made to resemble a church bell tower, while the elliptical shape of the lobby is reminiscent of a church’s nave. Connecting the first and second floors of the outpatient center is a staircase with custom art designed to represent an important Bible story, which wraps along a stone feature wall, recalling the style of old cathedrals. Above, a grouping of three circular skylights and three suspended, decorative lighting pendants symbolize the holy trinity.

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Faith plays an integral role in the healing process for patients and families.

Updates to the first-floor chapel include stone details and warm wood finishes and furnishings, making it a more modern yet still welcoming space. Stained glass windows, reinstalled from the original facility, flank each side of the chapel and are back- and spotlit. Visible from the lobby, the colorful, illuminated glass invites visitors into the chapel while preserving a sense of privacy and intimacy inside.

SUSTAINABLE DESIGN HIGHLIGHTS Array considered and included sustainability in every step of the project. The team reviewed energy studies for efficiency in heating and cooling costs, as well as water and energy usage, to update the facility’s outdated systems and reduce its carbon footprint. Sustainable details included daylighting; maximizing open space; preserving trees and outdoor spaces; energy-efficient HVAC systems; reducing electrical and water usage; occupancy sensor-controlled lighting; water-efficient landscaping; reusing building walls, floors and roof; using low- and no-VOC materials; sourcing regional materials; and, recycling demolition and construction waste. With the LEED certification process nearly complete, the project has been awarded 54 points and is expected to receive LEED Silver status.

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Integrated Project Delivery Results The SJMC project utilized an integrated project delivery (IPD)

SETTING AND ACHIEVING GOALS

approach; an AIA C191-2009 Standard Form Multi-Party

Project goals were set in the early design phases and

Agreement between the owner, architect and contractor; and is

incorporated into the contract in the Target Criteria Amendments.

the second IPD project completed by Array’s Cleveland office.

The primary goals were budget and schedule achievement.

Under the agreement, the three parties set a goal achievement

However, renovating while keeping the fully occupied Medical

strategy and detailed metrics to meet the standard of quality for

Center operational presented the biggest challenge to completing

design, construction, sustainability and project implementation.

the project on time. By renovating and building in multiple phases,

Through a selection process that emphasized collaboration, innovation and willingness to perform, the IPD team was assembled. Within the team were three committees: the Project

the Medical Center kept the occupied spaces operational during construction with no downtime in any departments, and without disrupting patients and staff.

Executive Team (PET), the Project Management Team (PMT) and

Due to a lack of available space, the team focused on building the

the Project Implementation Team (PIT).

additions first, allowing enough space to relocate departments and vacate spaces in need of renovation. Beginning with the

TEAMWORK The three-tiered management approach is a key concept in the IPD model. The team needs to understand the functions of the PET, PMT and PIT groups. An important aspect is that each level serves as a sounding board and conflict-resolution group for the

surgery prep / recovery areas, as one department moved out, another department occupied the newly remodeled space. This continued through the completion of all construction phases, concluding with the ORs and Intermediate Care Unit.

next level down. The PET has an executive-level focus, the PMT

PROJECT SUCCESS

deals with larger issues affecting the scope, schedule and goals

The team accomplished the goals it had set out to achieve:

of the project, and the PIT focuses on the day-to-day details

modernize and expand the Medical Center’s key service lines

of designing and building a project. This system of checks and

in need of major updating; add capacity; maximize efficiency of

balances is a key function of the enhanced communication and

the facility and operations; renovate the facility’s public spaces;

decision-making approach.

and give the campus a hospitality-influenced makeover. With

The PMT and PIT met weekly to discuss project issues, while the PET was scheduled to meet monthly. It took time for the team to achieve the level of trust and respect required for a successful IPD, but open and honest communications became the norm and

the additions and improvements, SJMC is now in a position to accommodate the needs of its growing community with top-quality patient care well into the future with potential for further growth.

refining the project progressed well. This provided the opportunity

In addition to operating more efficiently, the overall aesthetic and

for the contractors to offer regular project budget updates as the

feel of the Medical Center is a complete transformation. Not only

design progressed, enabling the implementation of any necessary

does its new image reflect a sense of optimism and corporate

budget adjustments. Then the team could strategize the best

brand, it has become a more positive experience for patients,

ways to maintain the owner’s budget, as well as develop the

visitors and staff, which is expected to enhance the quality of

project schedule.

patient care and improve patient outcomes.

BROWSE Our Thoughts Click here to view our thought leadership on the IPD process.

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GOALS TO ACCOMPLISH MODERNIZE AND EXPAND KEY SERVICE LINES SURGERY DEPARTMENT IMPROVEMENTS OUTPATIENT SERVICES ADDITION MAXIMIZE FACILITY AND OPERATION EFFICIENCY INCREASE CAPACITY

SEPARATE TRAFFIC FLOW ENHANCE / RENOVATE PUBLIC SPACES HOSPITALITYINFLUENCED MAKEOVER


Boca Raton / Boston / New York City / Philadelphia / Washington


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