Virtua Health's $325-million replacement hospital in Voorhees, New Jersey, is planned to be a state-of-the-art, 368-bed, 669,000-square-foot inpatient facility. Future inpatient growth is expected to accommodate 600 beds and a total of 1 million square feet. The expansion will be constructed in multiple phases. The goal of providing a sensitive healing environment will be met through the use of natural elements, intuitive wayfinding, and technology. Internal circulation takes advantage of exterior views through expansive windows, visually connecting the buildings to create a campus feel. Exterior gardens offer dining areas, walking paths, and meditation areas. Each entry drive is highly landscaped to provide patients with a moment of decompression before entering.
Virtua Health used a process-driven approach from the earliest stages of its hospital design to achieve the organization's goals for the project. This involved a strong focus on determining the care delivery processes that it wanted to provide and then designing the physical facility to support those processes. One of the primary goals for the design of the Virtua Voorhees facility was to increase clinician time at the bedside. This was based on research literature that suggests adverse events in healthcare could be significantly reduced by increasing clinician time at the bedside. The care delivery processes and the facility design then evolved from this and other project guiding principles.
The design process involved significant due diligence and the use of tools such as Lean to understand what was wanted in the facility. The Virtua Voorhees hospital will admit its first patients at the end of May 2011. Thereafter, the hospital intends to evaluate the impact of its redesigned processes and facility design on a range of patient and staff outcomes.
Meanwhile, even before opening, Virtua is beginning to reap some of the benefits of its rigorous process-based design approach. For instance, Virtua has been able to significantly reduce its number of clinical flow change orders. While a typical healthcare construction project of this size incurs clinical flow change order costs in the range of 3-5% of project costs (usually built into the total project costs), the change order cost for Virtua was only 0.35% of total project costs and 0.5% of total construction costs. Clinical flow change orders typically occur when the hospital owner decides to make changes that impact the design significantly. Often, the change orders occur when the clinical flow processes are determined retroactively, after the design work has been completed. In order to fit the processes into the new facility, design changes are then required, resulting in clinical flow change orders. These changes then require the design to be reworked as well as any construction that had already taken place. The construction management team usually anticipates this cost and builds it into the total project costs.
Given the pressure on hospital construction and operation budgets, healthcare organizations are focused on reducing waste and improving efficiency with existing resources. Virtua's experience indicates that minimizing clinical flow change orders is one way to reduce waste in the hospital construction process.
How was the hospital able to achieve this?
Getting the right people on board
The Virtua team involved staff members across the organization, experts, and consultants early in the process to obtain the necessary input into its new facility design. Virtua also became a member of The Center for Health Design's Pebble Project so it could learn from peers nationally and internationally.
The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at mgoodman@healthdesign.org.
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