Planning for the 100-Year Hospital
It all started with the University of Kentucky, which wanted to construct a healthcare facility that would be a local icon and address the region's healthcare needs for 100 years—or at least longer than the 30 to 50 years most facilities hope to achieve. Identifying this as an achievable and philosophically appropriate goal, Ellerbe Becket (in association with GBBN Architects) took on the challenge of leading the team and focusing on the aesthetics, durability, and program functionality of the new facility. Meanwhile, our company, Affiliated Engineers, Inc. (AEI), took on the MEP challenge of determining the engineering implications of the “100-year hospital.”
To address this challenge, AEI built under several assumptions for that time frame:
The facility would remain as an academic acute care facility, but move from a medical/surgical treatment focus to more basic science-based therapies (e.g., DNA applications).
It would undergo three major renovations and at least a dozen minor ones—generally expanding, but all the while maintaining ongoing operations.
It would be more self-generating and reliable in its energy utilization.
How would an MEP system designed and constructed in the early 21st century survive all of this for 100 years? In all truth, we didn't fool ourselves. We knew that there would be several significant changes in the system, based on primary equipment coming to the end of its useful life, and a need to adapt to new standards of care. But the University felt so passionate about the concept of “thinking long-term” that they made this a guiding principle for all the design and planning for the new facility. We found that, if we pushed ourselves and our concepts, we could, in fact, do a great deal to accommodate change beyond a half-century.
This approach is multidisciplined and is based on developing and adhering to criteria that impacts the physical built environment. The following are five representative criteria:
Criteria 1: Design permanent building elements for long-range adaptability. Increasing floor-to-floor height is a key aspect. For example: allowing enough ceiling plenum space to accommodate foreseeable changes in mechanical elements and their installation or maintenance needs. More basic is the approach to the column grid—coordinating a column spacing that allows for program modularity. The final column grid settled in at 36' on center by 30' on center in lieu of a more conventional 30' × 30' grid, addressing such issues as an optimum Operating Room (OR) Suite layout and aligning columns with the physical wall configurations. This created consistency in OR sizing to support standard and specialty ORs (figure 1, red outline).
UK floorplan with OR module identification
Much of this thinking was expressed in designing the mechanical floors (Levels 3 and 4), with space and a service aisle provided for convenient access to install, service, remove, and replace mechanicals (figure 2). This approach also assisted in budget management, allowing the University to hold off purchase and installation of shell space mechanical equipment into the future. The service aisle required coordination within the column grid and integration with exterior façade elements so as not to affect the aesthetics of the facility. Engineering system adjustments could then be made without significant capital investment. It also helped that the University prioritized ease of maintenance from the start.
UK floorplan of the 3rd/4th floor mechanical room
Criteria 2: Plan for dynamic “soft space.” Development of a static “Vertical Utility Core”—ducting, mechanical, elevators, stairwells—kept outside of the primary floor space ensured internal flexibility (figure 3). Locating this core between and linking the two patient wings kept this space outside of the prime clinical space. The last thing you want to do is design a structure for flexibility and then intersect that space with program-limiting vertical elements. Achieving this goal and staying within the core took dedication and strong leadership from the hospital. There had to be general acceptance that, while this approach might not always be the easiest or the least expensive alternative, it is worth the added flexibility.
UK nursing floor with vertical utility core
Criteria 3: Acuity adaptability. Again, in this case the MEP criteria referred to the entire wing, not to the individual patient room. Air handlers were set up to accommodate increased filtration, if needed, with space provided for HEPA filters, UV lights, and carbon filtration when needed. Working with multiple manufacturers on this enabled us to minimize the additional space required.
Part of flexibility is the ability of the air handling system to be placed into a negative pressure surge mode using 100% outside air and direct exhaust, in place of the more economical recirculation mode, in the event of a pandemic or biohazard emergency (figure 4). Each nursing wing of the top floor of the facility can be isolated in this way for negative pressure. Some facilities elect to break these adaptable zones down within each nursing unit, depending on how aggressively a facility wants to invest in this. The basic analysis is: review existing infrastructure sizing (chilled water pipe sizing, heating hot water pipe sizing, etc.) and determine what, if any, additional capacity is available, and how much space could be supported at 100% outside air without significantly affecting the present design. The intent is to make the best use of the available infrastructure and maximize the opportunity for converting over to negative pressure.
UK nursing floor “surge” diagram
Criteria 4: Build in a “level of reliability.” In other contexts this is sometimes referred to as “redundancy,” but Webster's Dictionary notes that this can have the negative connotation of “superfluous.” That is far from what we mean, and we've trained ourselves at our company to use the term “reliability” instead. In any event, evaluating “reliability” means looking at systems in a holistic manner and deciding just how much backup is really needed. Let's focus on the electrical system, for example:
How reliable has the primary utility system been? What is its outage history? How many substations? What is the electrical switchgear configuration and what level of alternate power paths are provided? What is the configuration of the standby generator system (quantity, paralleled)? What systems are on the generator above code and AIA guidelines (air handlers, data center, diagnostic equipment)? Do any of the systems require Uninterruptible Power Supply (UPS) and what duration of operation? Can the UPS utilize motor generator (flywheel) design versus battery storage (reduces implication of battery system hazardous waste and maintenance). All these systems and their interrelationship in the overall electrical power system need to be considered so as to provide a high level of reliability without overdesigning, given its inherent associated cost. In looking into the future and considering the 100 year life, the generator system designed to provide reliability and stability now could also be an excellent long-term investment in that it might allow the facility future load-shed or cogeneration potentially, providing real cost savings.
What about IT and wireless requirements—one of the biggest needs for UPS in the building? As UPS technology has evolved, IT services such as VoIP are becoming much more accepted as long-range approaches. With this, IT closets have become significant design elements. Although some AIA standards are now in development for sizing and layout of these spaces, there has certainly been a growing trend toward dividing them into zones—one zone dedicated to the primary hospital IT functions, as well as their hardware and software (internal data network, medical records), and the other zone designed to allow vendors for systems such as security, nurse call, and building management convenient access to their equipment without direct access to the healthcare servers. HIPAA privacy drives some of the concerns for isolation but, in reality, I think the trend is due more to healthcare clients valuing this isolation and control of hospital information systems.
Criteria 5: Planning for technology adaptability. This is an area that many healthcare clients are focusing on in regard to space planning for the future. It helps to look at this hierarchically. You have, at the base, the building, with the infrastructure branching into various systems and applications (figure 5). Application software is the most dynamic and adaptive to new clinical applications and modalities. Creating a robust infrastructure in cabling, riser availability, and pathways on the floor extends the life of the building. Thinking of change in this way puts it in perspective and keeps its implementation within the context of overall systems.
Technology hierarchy diagram
One step that was analyzed for the University of Kentucky project, and that is becoming more common in the technology industry, is the ability to quadrant out data servers onto the floor plate—that is, moving the electronics (servers) out of the closet to the main floor and remoting ceiling-mounted technology enclosures with servers of their own for segmented control (figure 6). This allows areas of the floor to adapt to new technology without impacting adjacent spaces and potentially utilizing patch-corded type links for modifications to be implemented by in-house staff, if desired.
Technology distributed server diagram after remoting of servers
Behind an ambitious effort of this type are several factors: a comfort with asking hard questions, openness to exploring new scenarios and alternatives, and a drive to reanalyze everything that might be impacted by long years of service. There has to be a willingness to move beyond short-term cost optimization, realizing that the added costs involved in this approach—and there are added costs—are buying both short-term flexibility and long-term budget predictability. Even though aesthetic and value engineering concerns may militate against this approach, these have to be confronted, which means that the crucial need for all of this is leadership: a champion who will consistently push everyone toward thinking, planning, and investing in the long-term viability of their facilities. HD
Paul Petska is Principal with Affiliated Engineers, Inc., based in Chicago, Illinois.