Today, many healthcare leaders are reshaping their vision, strategy, and model for healthcare care delivery. There are three critical success factors that enable an institution to meet its strategic goals in this challenging healthcare environment: leadership, focus, and expertise. University Hospitals (UH), located in Northeast Ohio, is a model system that exemplifies the application of these critical success factors in the development and implementation of its Vision 2010 strategic plan.

University Hospitals’ 1,032-bed, tertiary care academic medical center, University Hospitals Case Medical Center, is the primary affiliate of Case Western Reserve University. Included in UH Case Medical Center are UH Rainbow Babies & Children’s Hospital, among the nation’s best children’s hospitals; UH Seidman Cancer Center (formerly Ireland Cancer Center), part of the Case Comprehensive Cancer Center, a National Cancer Institute-designated Comprehensive Cancer Center; and UH MacDonald Women’s Hospital, Ohio’s only hospital for women. More than 21,000 physicians and employees constitute University Hospitals and its partnership hospitals, ranking it Northeast Ohio’s second-largest private sector employer. UH performs more than 4.5 million outpatient procedures and nearly 63,000 inpatient discharges annually.

 

A new vision, strategy, and model

In 1993, UH developed a new vision, a new strategy, and a new model for healthcare delivery. This new vision called for UH to better meet the healthcare needs of a significant portion of Northeast Ohio through geographic expansion and an increase in the types of services offered. In the process, UH was transformed from a traditional, single-site academic medical center into a broad-based healthcare system.

To complement its nationally prominent services in tertiary medicine, UH added prevention, primary care, and early screening. To strengthen its clinical capabilities, the health system expanded established areas of excellence and developed new service areas. To improve access, UH forged new hospital partnerships, developed the region’s largest primary care physician network, and increased the number and size of outpatient health centers. To enhance care in the communities served by its new partners, the health system opened satellites of key centers of excellence—initially for cancer care, cardiac care, pediatrics, and women’s health. Finally, to make quality care more affordable, UH redesigned its healthcare delivery model, reducing inefficiencies and redundancies.

 

Broad strokes

In 2005, UH developed a strategic facilities master plan—Vision 2010—to identify facility requirements in support of its new operational vision, strategy, and healthcare delivery model. Key drivers included: increasing market share in a competitive healthcare market; developing a hub-and-spoke magnet system that collocates its various centers of excellence while capturing additional demographic areas; promoting a more recognizable brand within the region and parity among its various facilities; and enhancing physician recruitment.

Ultimately, the $1.2 billion Vision 2010 strategic plan included a system-wide information technology investment along with four significant facilities projects: a new cancer hospital (named UH Seidman Cancer Center) and a new center for emergency medicine on the UH Case Medical Center campus; a state-of-the-art neonatal intensive care unit (NICU) at University Hospitals Rainbow Babies & Children’s Hospital; and UH Ahuja Medical Center, a new greenfield site hospital located in a nearby suburb of Cleveland.

While there were components of the vision that were not directly facility oriented, the UH Case Medical Center campus projects and new medical center became the physical manifestation of the Vision 2010 initiative. Array, originally selected after a nationwide search to support the Vision 2010 initiative through an integrated strategic master plan, eventually was named corporate architect. In this role, Array led a team of consultants who worked closely with UH leadership to develop the  strategic and supporting business plans, with the goal of aligning facility development to projected volumes, model of care, and operational goals.

 

Leadership on both sides

UH CEO Thomas F. Zenty III had a vision for improving clinical outcomes, patient satisfaction, and brand identity, and began implementing that at the top levels across the organization. He reached out to leaders at each of the community and specialty hospitals, including the nationally ranked UH Rainbow Babies & Children’s and Seidman Cancer Center to develop consensus about the priorities and direction of a master plan.   

Zenty tapped Steven Standley, chief administrative officer and a veteran healthcare executive, as the point person for University Hospitals. His leadership and consensus building skills contributed to an accelerated completion of the multi-campus master planning effort in just nine months. In addition, Standley was the executive management representative for each of the four design projects, providing guidance and input regarding UH’s strategic and financial objectives for each project.

Array’s principals provided insight and leadership in their areas of expertise, including the facility requirements in support of clinical care for pediatrics, oncology and emergency services, interior design standards that can work across a range of facility types, and project management that maintains equal focus on the big picture and the details. Moreover, these same experts eagerly rolled up their own sleeves to do the day-to-day implementation required to make Vision 2010 a reality.

               

Keen focus

UH leaders initiated the master planning process with an unusually keen focus on their vision. Moreover, their vision was grounded in market research and data that supported a strategy to achieve targeted returns on investment. For example, Vision 2010 not only included funding for four major facilities projects, it also included funding for physician recruitment and corporate branding, because UH understands that facilities alone cannot embody a hospital’s vision.

Array supported not only on the overarching Vision 2010 with campus master planning but also focused on the details for each project, including preliminary programming, test-fit
planning, detailed project budgeting, and identification of enabling projects that were required to lay the foundation for the four major facility projects.

UH invested in development of facilities standards very early in the master planning process, well before selecting architects of record, because it recognized the importance of streamlining the decision-making process and strengthening its brand in the healthcare market. At the same time, its corporate rebranding effort was capped by a new logo. As a result, the look and feel of each building reflects the UH corporate brand. Additionally, UH undertook strategic upgrades to community hospitals, which also reflect Vision 2010, the corporate brand, and interior design standards.

 

Laying the groundwork

Array conducted a comprehensive infrastructure study, which was instrumental in laying a foundation for the master plan. The study involved architectural, engineering, and code assessments of every built space on the UH campuses. This resulted in a ranking of each building based on its value for future use—ranging from “obsolete” to “highest and best use.” This enabled UH to understand where its facility investment would have the greatest impact and yield the greatest return on investment. It also helped identify circumstances where the site was more valuable than the structure on it.

There are several examples of the ways in which Array applied the results of the infrastructure study in the master planning process to discover new locations for programs, such as identifying: 

• The optimum site for the cancer hospital to provide ideal connections to existing hospital services, such as the existing inpatient operating rooms, select practice sites, and GI diagnostic facilities;
• An ideal location for the new emergency department, providing accessibility and parking, and facilitating visibility of the Rainbow pediatric ED, all the while maintaining connectivity with the UH Case Medical Center campus for both adult and pediatric admissions;
• Space in three existing adjacent buildings to create a continuous floor plate for the new Level III NICU contiguous with the existing Level II NICU, which enabled the transition to all private rooms; and
• Space for a new conference center on the 11th floor of the UH campus’s signature building, Lerner Tower, for a stunning new conference center—developing computer graphics and a simple on-site prototype—fulfilling the expectations of a major philanthropist.

 

The process also resulted in identification of 900 corporate and administrative staff members to be relocated to other UH facilities. Staff moves were evaluated based on their need to interact with clinicians on the main campus; sites were identified on-campus, both within walking distance and remote. Array assisted in the selection and renovation of a vacated OfficeMax headquarters (now called the UH Management Services Center) in a nearby suburb to house 600 UH personnel.                 

The process also resulted in identification of more than 1,600 staff members in 74 separate departments to be relocated within and to other UH facilities. Array planned and managed their moves. The planning started with categorizing the departments into three types: direct patient care departments that needed to stay in the hospital, support departments that needed to be close to the campus, and administrative departments that could be located off campus.

Array, as the architect, assembled a team that included engineers, a construction manager, a relocation planner, a moving company, and a furniture dealer. This team worked with the hospital management and the relocating departments to determine space needs, number of current and future staff, furniture and equipment requirements, and available times for relocation.

Over the course of 1.5 years, the planning, remodeling, and moving were completed. All during this process, communication was kept to a high level to assure that leadership and key stakeholders were informed of the reasons for relocations, the functionality of their new locations and layouts, and the schedules and budgets for the moves.

 

Focus on a patient- and family-centered experience

Through the master planning process, Array identified a central site for the new UH patient parking garage. And because of Array’s grasp of the UH vision and mission, UH selected the firm to design it. The new six-story, 800-space parking garage is designed as a tangible expression of the UH mission: “To Heal. To Teach. To Discover.”

The UH focus on a patient- and family-centered experience drove the garage’s fundamental design concept, providing a unique arrival experience. The Array design team translated the emotional concepts of “welcoming,” “embracing,” and “caring” into design through the symbolism of the architecture—the structure’s “arms” reach out to embrace and welcome patients, signifying the caring and compassion UH caregivers express to patients and their families. The signature perforated metal ribbons reach out in two directions—extending a healing message to the community and conveying the collaboration and significance of the teaching component of UH Case Medical Center. Where these two powerful statements converge represents the confluence of collaboration and discovery. At night, the radiance of the human spirit is represented by a colored backlight that accentuates this corner, cycling through a preselected range of hues and timing sequences.

 

Matching skill sets to each project           

UH understands that complex facilities challenges require the expertise of planning and design specialists—just as cancer patients, heart patients, and children require specialists who can diagnose and treat their illnesses. Therefore, for each of the four major building projects, UH wanted an architecture firm that specialized in that specific service line. As corporate architect, Array not only was responsible for the master planning, but also for matching skill sets of architects of record to each of the four building projects and managing the selection process.

Array issued four separate RFPs and guided UH through the interview and selection process. The RFPs sought information about the architects’ expertise and experience in the particular service lines, including questions that probed for evidence of successful execution of similar projects, and identified the team members who worked on those projects. This resulted in UH selecting not only the firms that had executed outstanding projects in these service lines, but also ensured that the individuals who had made those projects successful comprised the teams assigned to the UH projects.

As a result, UH hired Cannon Design for the cancer hospital and for the emergency medicine center, Parkin Architects for the NICU, and HKS Inc., for the UH Ahuja Medical Center—as determined by Array to be the best architects in North America for these projects.

Array also served as associate architect to en
sure continuity and fulfillment of Vision 2010. During the master plan stage of the project, Array’s interior design team was tasked with developing a comprehensive interior standards program, which set the bar for all facility improvements and established a strong design vocabulary in sync with the new UH branding initiative.

The standards program also established guiding principles for sustainable initiatives in material selections, as well as a platform for incorporating tenets of evidence-based design. During the master planning process, UH hired Health Strategies and Solutions, which specializes in healthcare research, strategic and facility planning, and physician recruitment. For the larger projects, Gilbane Building Co. served as construction manager, while Adams Program Management and MCM Building Co. provided program management services to enhance consistency in project delivery.  

 

Engaging the community

Leadership, focus, and expertise were perhaps the three highest critical success factors in achieving Vision 2010. But there is another: UH engaged all of its employees, as well as the community and UH patients and families, to gain their support for Vision 2010. This included a public outreach campaign to solicit input and gain approval.         

As the project progressed, UH also reached out to engage with the larger community to pursue two additional objectives: LEED certification for the cancer center and Ahuja Medical Center, and registration of the UH Rainbow Babies & Children’s Hospital NICU as a Pebble Project.          

University Hospitals’ community engagement resulted in extensive philanthropic support. A $42 million donation, the largest gift in University Hospitals’ history, in support of the new cancer hospital to be named the “Jane and Lee Seidman Cancer Center” in the donors’ honor,  launches the public phase of University Hospitals’ $1 billion comprehensive fundraising campaign, “Discover the Difference: the Campaign for University Hospitals.”              

The Discover the Difference campaign has already raised $685 million since its quiet phase began in 2003. Numerous individuals, foundations, and corporations have supported the campaign, which also has received seven transformational gifts of more than $10 million.   

By far the largest fundraising campaign in UH’s nearly 145-year history, Discover the Difference will build upon the success of Vision 2010 and its new capital projects. In addition to UH Seidman Cancer Center, they include: UH Ahuja Medical Center in Beachwood (opened: early 2011), the Center for Emergency Medicine at UH Case Medical Center (opening: summer 2011), the Quentin & Elisabeth Alexander Neonatal Intensive Care Unit at UH Rainbow Babies & Children’s Hospital (opened: spring 2009), and four outpatient health centers throughout Northeast Ohio.               

“As we celebrate the near completion of Vision 2010, which has transformed the healthcare landscape in our region, we turn an eye toward our exciting future,” Zenty says. “Since our health system’s founding in 1866, patient-centered care, clinical research, and teaching have been hallmarks of University Hospitals. The next phase of our efforts will be to focus on what we do best—providing the highest-quality patient experience for every patient, every time.”

 

A remarkable balance

To fulfill the goals of University Hospitals’ multifaceted facilities projects required collaboration of multiple firms with specialized experience and expertise—all drawing on a vision—engaged by a corporate architect with a comprehensive understanding of the entire process.

UH leaders have achieved a remarkable balance between articulating and maintaining its focus on Vision 2010, at the same time that they have empowered staff and consultants alike with authority and responsibility to fulfill the implementation component of that vision. HCD

 

Christopher P. Trotta, AIA, is Vice President/Design Principal, of Array Healthcare Facilities Solutions. He may be reached at 216.292.7950 or ctrotta@arrayhfs.com. Patricia D. Malick, AAHID, IIDA, is Vice President, Interior Design, of Array Healthcare Facilities Solutions. She can be reached at 610.724.3054 or pmalick@arrayhfs.com.