It’s not every day that an acute inpatient behavioral health hospital opens in a converted four-story office building, but that’s just what Quail Run Behavioral Health Hospital did in November 2014.

The team behind the considerable challenge shared the project story on Sunday of the Healthcare Design Expo & Conference in the session “Quail Run Behavioral Health Hospital: A Story of Conversion.”

Kent Hedges, a regional project manager with owner Universal Health Services Inc. (UHS), said the system was interested in bringing more behavioral care to the Phoenix area and began considering a few different options, including raw land, a single-story retrofit, and a multistory retrofit, the latter of which ended up rising to the top of the heap thanks to the cost benefit and speed to market it provided.

But that’s not to say the process was without obstacles. “It’s definitely not the easiest thing to do,” Hedges said.

As an organization, UHS began an internal Lean journey back in 2006 and was increasingly moving toward adopting both Lean and integrated project delivery (IPD) on its building projects—a fact that colored the Quail Run story.

To convert the office building to accommodate a goal of 90-100 beds, an IPD team was brought on board that included Devenney Group as architect, as well as the general contractor and mechanical; electrical; drywall; and doors, frames, and hardware contractors under a multiparty contract—a method of delivery that was new to most on the project.

UHS had a building prototype at hand to be translated to the space, using 8, 12, 16, and 24 beds per unit and a nurses’ station concept that provides lots of visibility. The trick, however, was fitting that prototype into the existing space, described Carol Lynn, senior planner at Devenney Group. That traditional T- or L-shaped unit plan had to instead be accommodated in a vertical floor plate, and none of the floor plates in the building stacked identically.

Key planning principles included visibility, especially in consideration of the building’s multiple entry points such as a main lobby for adults and incoming patients, an after-school program drop-off zone, and an ambulance entrance. Rather than have every entry staffed, the team was able to instead pull the nurses’ stations out to have visibility deep within the floor plate, Lynn described.

Another major piece was creating separation between the pediatric and adult patient populations, with pediatrics assigned to the fourth floor, where age groups such as adolescents and grade schoolers were further segregated. Quail Run also serves geriatric patients, which not only required another dedicated space but also considerations like 8-foot corridors for transport and roll-in showers.

Once the program was fit into the building, achieving a total of 108 mostly semiprivate rooms in its 69,000 square feet, it was then time to consider the site, said Scott Rasmussen, project architect for Devenney. A major piece of that project phase was providing outdoor play spaces for the pediatric patients. “We had the luxury of a surplus of parking, which allowed us to locate the exterior rec yards,” he said. Some considerations paid to those outdoor spaces included a splash pad for hot summer days, as well as creating canopies to shield the children from the eyes of adult patients inside.

Another exterior consideration was assessing the glazing of windows and adding an impact-resistant film to combat the potential threat of patients breaking a window on an upper floor, creating a dangerous situation. A mock-up test was conducted of the film prior to installation with a team member repeatedly pounding a chair into a protected pane, with only an internal layer of glass finally shattering but the system preventing shards of glass from flying as well as the second layer of glass from breaking.

As for applying Lean, the team used last planner concepts and utilized a "big room" for leaders to meet regularly, setting milestones and breaking down tasks into pull planning using a six-week look-ahead and a weekly work register. However, use of building information modeling was limited to the architects work as well as electrical and mechanical modeling, to reduce costs.

A post-occupancy evaluation was conducted at the hospital, too, with priorities like reducing patient injury achieved through the design. However, the team saw an opportunity to further improve family engagement. “Overall, I think we ended up with a pretty good result,” Rasmussen said.