Extending relationship-based care to construction
Rainbow Babies & Children's (RBC) Hospital, located on the University Hospitals Case Medical Center campus in Cleveland, Ohio, will open a newly renovated neonatal intensive care unit (NICU) later this spring. The new 38-bed unit will combine with the hospital's existing NICU bed count for a total of 82 Level III beds. Reinforcing the family's central role in caregiving, the new NICU provides extra privacy and special accommodations for parents and other loved ones.
Construction included the renovation of more than 27,000 square feet in the heart of the existing operational hospital, the installation of a new pedestrian bridge above an enclosed courtyard (figure 1), and the installation of a new elevator to connect the second level of labor and delivery to the fourth floor home of the new NICU (figure 2).
The new pedestrian bridge installed by Rainbow Babies & Children's (RBC) Hospital, located on the University Hospitals Case Medical campus in Cleveland, Ohio
The inside of one of RBC's new, high-tech NICU rooms
Designed by Parkin Architects, Ltd., the facility features the latest advances in diagnostics, surgery, and patient care, further securing RBC's ranking among the top two hospitals in the country for neonatal care. The expanded diagnostic capabilities will mean patients do not have to be moved around the hospital for tests and procedures. Communication systems will alert nurses to patient problems without sounding loud alarms that can disturb babies and their families.
The NICU is the first part of University Hospitals' Vision 2010, a multiphased expansion program for the hospital system. Being the “kickoff” project, the NICU's construction team had to work through the learning curve and develop the initial relationship with the owner.
RBC's philosophy, at its core, is all about transparency and empowering its patients to ask questions. This philosophy extends beyond the patients' rooms and treatment to every aspect of their RBC experience-even to the process by which the NICU was built. The shared goals of the community, the owner, and the construction manager are the real story behind this inspirational facility.
Transparency in all aspects of care
As many of RBC's patients-ages 0-21 years-are under the hospital's care for an extended period with chronic illnesses, hospital operations revolve around an approach called relationship-based care. This family-centered system links the patients and their families to everyone in the institution and encourages interaction among families and hospital staff. RBC did not depart from this approach upon undertaking an intricate and potentially disruptive construction project.
RBC partnered with Gilbane Building Company to make construction as transparent as possible with nontraditional approaches to engaging patients and families. Instead of putting up walls and keeping construction activities out of site for 12 months, Gilbane and RBC involved the patients wherever possible.
RBC approached Gilbane early on in the planning stages about finding a way to involve the kids in the construction process. Of course, this type of transparency isn't easy in the midst of a construction zone. But RBC's needs came first and the Gilbane staff began devising ways to allow the children to take part in the process while still maintaining a safe environment.
Led by Gilbane's project superintendent Bill Barbis, Gilbane held walk-throughs with RBC staff while providing updates on the progress of the facility. RBC even helped develop a cartoon likeness of Barbis; “Bill the Builder” was born (figure 3). Barbis would give educational lessons and demonstrations about various construction tasks, which were filmed and produced into Bill the Builder episodes and broadcasted on RBC's 24-hour television station to all of the children. Many of the patients came to know Barbis as Bill the Builder, strengthening their comfort level with all of the surrounding construction.
To increase transparency and patient interaction, Gilbane's project superintendent Bill Barbis was made into an animated character named “Bill the Builder.”
Mitigating patient impact in an occupied space
Since the project was located in the heart of the existing hospital, mitigating impact to patients and staff was a tall order. Hospitals, by their nature, are 24-hour facilities, and the renovations demanded some major structural work that inevitably produced noise and dust. There were more than 70 workers on-site on any given day, creating a lot of activity.
Part of the project called for the reinforcement of columns from the basement of the existing hospital-work that had to be performed right next door to very fragile patients. During construction of the pedestrian bridge, the project team basically had to open up the façade of the building, exposing existing steel beams and columns that the bridge would have to tie into.
On a typical hospital job, the construction team usually gets a build-out space and has the whole floor to perform necessary work. However, the NICU was situated directly between patient areas, making it hard to avoid inconveniencing patients. Infection control barriers were put up to control noise and dust, and construction workers worked around RBC's schedule so as not to perform work too early in the morning or late at night. Barbis kept in constant contact with the nurses on the floor so the team could be made aware of any schedule changes.
Through all the challenges, the kids remained the top priority. There were some initial concerns with the construction of the pedestrian bridge, which spans between two buildings and a courtyard, that the arch welding would affect the children's eyesight if they tried to watch the process from their windows.
Gilbane enlisted the help of a local company to come in and tint the patient room windows using a film system. That way, the kids would still be able to view what was going on but their eyes would be protected. Normally welding would happen behind a welding screen, but the goal was to keep everything visible and keep the children as informed as possible, making sure there was never anything that they didn't understand.
The importance of a shared understanding of owner goals
While going to these lengths isn't always standard practice, meeting the needs of the client certainly is. RBC would not compromise its philosophy at any cost. If things got too noisy, the NICU job was shut down. The project team had to adapt its processes from the “typical” job site environment to one of a very sensitive healthcare environment for children.
RBC worked very closely with the construction team to keep the environment open but also safe. The relationship between the owner and Gilbane was successful because they collaborated on everything from the construction schedule to organizing various events and activities for the patients. RBC staff members were active participants in the kids' construction program. They even had small hardhats made for the children at the kickoff event for the construction of the pedestrian bridge.
Involving the children in the construction process made sense for RBC's new NICU. The hospital's relationship-based care approach was not set aside during construction. Instead, team members embraced the philosophy and not only produced an impressive new healthcare space, but also put aside the traditional construction mindset and put the smallest, most fragile end users first. HD
Roger Brown is a senior project executive with Gilbane Building Company.
For more information, visit http://www.gilbaneco.com.
Healthcare Design 2009 March;9(3):16-20