The Humber River Regional Hospital (HRRH) redevelopment project, an undertaking of nearly $1.75 billion scheduled to be completed in 2015, brings together a group of firms and organizations dedicated to designing and building a hospital that will improve patient and bedside care. The 1.7-million-square-foot hospital in Toronto, Ontario, is the result of collaboration between the Ontario Ministry of Health and Long-Term Care, HRRH, and Plenary Health Care Partnerships (PHCP). This will be the first hospital in North America to fully automate its operational procedures. In this interview for HEALTHCARE DESIGN with Shandi Matambanadzo Associate Editor, PHCP talks about some of the features in the hospital.
Can you explain a little bit about PHCP and the firms and organizations involved?
PHCP: Plenary Health Care Partnerships includes consortium members Plenary Group, HCP Social Infrastructure, PCL Constructors Canada, and Johnson Controls, as well as partners HDR (Architect), Halsall (Structural Engineer), Smith + Anderson (Mechanical/Electrical Engineer), A.M. Candaras Associates (Civil Engineer), Quinn Design Associates (Landscape Architect), St. Onge (Supply Chain/Logistics), Enermodal Engineering (Energy Modeling), Plan Group (Electrical/ICAT Subcontractor), Modern Niagara Group (Mechanical Subcontractor), RBC Capital Markets (Financial advisor), and Hewlett Packard (Digital Technology).
The private sector consortium was selected by Infrastructure Ontario through the AFP Process. The hospital felt that it was important to have their private sector partner maintain an active role with an equal vested interest for the long term. As a result, in addition to construction of the new facility, key risks associated with the maintenance responsibility of the hospital over the 30-year service period have been transferred to PHCP.
With this being the first fully digital hospital in North America, there are many features that are of interest, can you talk about some of them and their importance to patient care?
PHCP: In order to maximize operational efficiency, patient autonomy, and self-care, the building has been designed to support a comprehensive digital platform. When patients, visitors, and staff first arrive at the new HRRH, it will immediately become apparent that they have entered a truly remarkable and state-of-the art facility. Access to data and information will enable users to become “connected” anywhere/anytime from points such as kiosks situated throughout the hospital or on mobile devices anywhere in the building, leveraging the widespread wireless network. HRRH is committed to providing the most up-to-date capability of PDAs, Smartphones, and other portable devices at the opening of the hospital in order to provide peak functionality for staff to ensure maximum productivity. Up-to-date room information will be identified on flat panel monitors outside rooms, ensuring that patient confidentiality and privacy is maintained. Within the rooms, patients will use Integrated Bedside Terminals (IBTs) to control room lighting, window shades, and temperature—all at arm’s length from their beds. Further capabilities of the IBTs allow patients to communicate verbally and, when needed, visually with their primary clinicians, optimizing efficiencies and enabling timely communication when it matters most.
Through systems integration and interoperability, HRRH provides a unique opportunity to optimize design and apply technology and change processes allowing staff to spend more time with patients and to deliver more accurate, faster treatment. To improve effectiveness and efficiency of clinical and healthcare services as well as control operational costs, new Information, Communication and Automation Technologies (ICAT) are fundamentally integrated with facility planning and design. Anticipated digital technology innovations include:
- Portable computers and interoperable equipment, including RFID-based “smart bed” technology, automatically records and transmits vital signs such as a patient’s heart rate, temperature and blood pressure to secure electronic health records;
- High-level communication devices instantly deliver laboratory test results allowing caregivers to act upon the results more quickly and accurately;
- Bar coding and RFID labeling of prescription medications ensures the right patient receives the right dose of the right drug at the right time;
- Robotic delivery systems or Automated-Guided Vehicles (AGVs) automate supply distribution;
- Pneumatic systems automate soiled linen and waste collection;
- Equipment labeling reduces staff time wasted tracking misplaced equipment;
- Digital signs direct patients, their families, and visitors within the facility. Kiosks enable patients to check-in and receive information including post-treatment instructions in 50 different languages.
What are some of the sustainable design standards that will be used in this facility?
PHCP: The new hospital was designed to inextricably link healthcare and the environment. Design and construction will adhere to the guidelines and sustainability principles of LEED Canada for New Construction and Major Renovations, with a goal of achieving LEED Silver certification. In addition, the hospital will follow principles from the new LEED-Healthcare rating system, and will meet the requirements for the city of Toronto’s Green Standard for Mid to High-Rise Development, Tier 1.
Sustainable highlights of the new hospital include:
- Design elements that respond to climate conditions, including prevailing winds, site orientation, seasonal sun paths and precipitation, surface water drainage and solar gain;
- Integrated, sustainable landscape elements such as pastoral gardens, patios and a piazza, all featuring native and drought resistant plants;
- Enhanced lighting strategies, improved outdoor views and maximized daylighting capture for interior spaces;
- A traffic demand management strategy, in partnership with Smart Commute Toronto, to promote alternative means of access to the site: bike lockers, enhanced public transportation access, car pooling and ride sharing, etc.;
- Greenroofs (50% of roofs will be green) to help manage storm water, reduce the heat island effect, improve air quality, and beautify the views from inpatient rooms. Non-greenroof areas will be painted white to help reduce building heat gains;
- Highly efficient plumbing fixtures, including low-flow toilets, faucets, and showers. The fixtures will decrease indoor water use by 35%;
- Diverting 75% of construction waste from the landfill;
- Low-emission materials for adhesives and sealants, paints and coatings, and carpets.
What are some of the other "firsts" that will be a part of this facility design?
PHCP: Lean Process Improvement concepts reduce duplication, decrease non-value-added effort and eliminate unnecessary variation to improve outcomes, throughput, and staff satisfaction all while driving operational efficiency. HRRH is the first Infrastructure Ontario AFP Project to use Travel Distance or “sneaker time” as an evaluation tool.
Decentralized “Portals-of-Care” planning streamlines the ambulatory patient experience. The Portals-of-Care concept assigns each clinic its own distinct space and entrance. The clinics act as individual neighborhoods, preventing patients and visitors from walking through endless corridors to reach a destination. Once inside the appropriate clinic, visitors can access all areas of the building via the main concourse, which acts as the boulevard and connective tissue of the greater facility. HRRH is the first hospital in Ontario to use the “Portals-of-Care” model at the Ambulatory Care Units.
For more information on Humber River Regional Hospital, visit http://www.hrrh.ca.