Spaces That Bring Medical Research Into Clinical Practice
Transcending the traditional silos of medical research and healthcare delivery, translational medicine is continuing to emerge as a “best of both worlds” model, capitalizing on collaborative intellectual capital and translating it into better healthcare outcomes.
“Clinical research of new therapies can include everything from the study of long-term histories of health or disease development to the clinical trials of specific new treatment studies on volunteer populations in controlled settings,” explains Michael P. Vascellaro, vice president and health and science practice lead at the A/E firm RS&H (Jacksonville, Fla.).
Because both the research and clinical care aspects of translational medicine are highly interactive, there’s a growing trend to bring these functions together inside one, highly collaborative space.
On the funding side, a greater focus on deficit reduction is diminishing federal and state grants and programs for basic university research, while many pharmaceutical companies are starting to see recent years’ blockbuster drugs coming off patents and generic versions being produced, explains Vascellaro. For example, several Pfizer patents expired last year and the pharmaceutical giant took a 6 percent hit in annual revenue.
In order to deal with this new financial reality, research institutions are seeking private sector funding via public-private partnerships, to support their medical research initiatives. At the same time, healthcare organizations are looking to create a specialty niche to gain an edge on the competition as research and development are a key way to advance their healthcare profiles. Emerging from this conundrum has been a mutually beneficial marrying of research and healthcare delivery.
“We’re already seeing many health systems merging with medical centers or building medical schools in order to control their own development of physicians or allied health professionals,” observes Jens Mammen, principal at SmithGroupJJR (Chicago). “Translational research is the clear corollary of that organizational integration; research is simply becoming part of the continuum of care.”
Together but separate
Of course, medical research laboratories and healthcare facilities are two very different building types, each with its own set of demanding programs and space requirements. Consequently, enabling them to coexist inside one environment is no small undertaking. For example, research facilities often require specialized spaces like clean rooms with high pressurization requirements.
The good news is that the infrastructure needs of both building types tend to be fairly similar. For instance, “in research spaces, pressurization is critical to protect samples from cross contamination, and in healthcare, the same HVAC systems are used to prevent disease transfer,” explains Larry DiGennaro, science client leader at BHDP Architecture (Cincinnati). That said, there are differing requirements for items like ventilation and daylighting levels, so designers need to determine the facility’s primary user group—researchers versus doctors, staff, patients, and families—and better customize the overall design to that group.
One strategy is to separate the organization’s research and medical functions. “’Under one roof’ is a misnomer,” Vascellaro says. “While proximity is important for staff heading research and clinical rounds in a single day, facilities can be physically isolated on common grounds.”
However, some would argue that this limits opportunities for the doctors and researchers to interface and collaborate. When answering that need with a single building, Mammen says it’s important to understand that fully optimizing the facility for both research and healthcare functions is not physically possible, so one use will have to be prioritized over the other.
Case in point: At St. Jude Children’s Research Hospital’s Chili’s Care Center, a vertically integrated patient care and research building in Memphis, the building’s healthcare function was prioritized, resulting in a wide floor plan to answer the need for larger patient rooms with adjacent family space. “The facility’s systems are standardized and modularized to allow ultimate long-term flexibility and adaptability, including interchangeable lab and clinical spaces, but the plan grid was ultimately dictated by the model of care and not the lab needs,” Mammen says. “This meant the lab module was a foot wider than is typical,” which is not the most efficient use of expensive lab space.
On the other end of the spectrum, the University of California, San Francisco’s (UCSF) Smith Cardiovascular Research Building (CVRB) primarily houses research labs, so it was the lab function that ultimately dictated the grid. In order to make sure that the building’s infrastructure was still set up to properly support the building’s healthcare component, designer SmithGroupJJR placed its integrated 8,000-square-foot outpatient clinic as a separate element, outside of the primary structural grid.
Inside the walls
A planning grid of 11 feet by 11 feet is generally sufficient to support evolving laboratory models with various orientations. “Maintaining this planning grid can establish a structural planning grid so no columns of the facility interrupt the placement of laboratory casework,” Vascellaro suggests. In other words, designers are afforded maximum flexibility for casework placement with no support beams running through the module.
With such heavy infrastructure requirements, engineers often consider modular mechanical and electrical systems. These can be easily adjusted to accommodate changing space requirements and capture better efficiencies, but it’s dependent upon the nature of medical research and how the labs are set up relative to the clinical spaces, explains Andy Snyder, principal and science/education project leader at NBBJ (San Francisco). “If the research functions are in the same building as the clinical ones, it’s possible to take advantage of shared MEP equipment,” he says. “But research environments sometimes need additional infrastructure to deal with pressurized compartments such as clean rooms.”
For example, says Vascellaro, negative pressure would be required for areas of containment, while positive pressure is the norm for barrier conditions, so the rate of air change is specific to the room’s function
In some cases, separating the HVAC lab support systems from the office HVAC system can also capture energy efficiencies. With this segregation, the majority of office air can be recirculated, reducing office conditioning costs by as much as 66 percent, as compared to laboratory spaces, according to Vascellaro. “Additionally, we design our office spaces to be slightly positive such that the air pressure slows or stops the migration of odors from the laboratory to the office,” he says. “The air transferred due to this positive pressure can then be used to help offset the make-up air requirements of the laboratory.”
Another area where flexibility is essential is with casework systems. Here, Vascellaro has found a combination of fixed and movable casework to be the best solution. This may include installing fixed sink units along the lab’s perimeter with movable, reconfigurable island benches connected to specialty ut
ilities supplied from above. “The hybrid use of both fixed and movable casework further expands the capabilities of a laboratory by easing the higher cost of all flexible furnishing systems,” he says.
Easing the burden
While providing an environment ripe for medical breakthroughs and improved health outcomes, translational facilities are also highly complex, energy-intensive building types. That said, designers are making efforts to scale down energy use.
As a starting point, building orientation, building enclosure and insulation, HVAC systems, and light controls are key. For example, Synder sees engineers employing innovative strategies, such as zoning and individual space controls, to reduce air change rates while still complying with rigorous code requirements. “It’s possible to optimize the air changes for the spaces that are being used at any one time. Also, reheat is an area of opportunity to reduce energy,” he says.
Considering energy efficiency in the design of UCSF’s CVRB, which primarily consists of translational research labs, SmithGroupJJR conducted an energy design charrette and solicited input from the Lawrence Berkeley National Laboratory’s (LBNL) Labs21 program, which supports the design of sustainable lab facilities, and LBNL Energy Group members at the project’s inception. Next, the group performed an extensive “rightsizing” exercise where the electrical loads of 14 comparable laboratory spaces on the UCSF Mission Bay campus were measured with electrical submeters.
Taking this data, engineers were then able to rightsize the mechanical and electrical equipment in the CVRB to support highly efficient building operations. The result was a LEED Gold-certified facility that’s using 20.6 percent less energy than a comparable building designed in compliance with the 2005 California Energy Efficiency Standard’s Title 24.
Mammen reports that energy-efficient features include a high-performance building envelope, low-emissivity glazing, extensive daylighting, daylighting controls, variable-air-volume systems, nighttime setbacks for mechanical and electrical systems, occupancy-based controls, and operable windows in private offices.
In order for translational facilities to be truly effective, they must be designed to support multidisciplinary teamwork and collaboration between the researchers and medical staff in the bench-to-bedside model.
To create these gathering nodes, designers can set up corridors, entry lobbies, and meeting areas to support casual points of interaction between the researchers and medical caregivers to better promote dialogue and the exchange of ideas. For example, seating areas, writable walls, and coffee stations can help enhance these encounters. For more formalized gathering areas, heads-down rooms are important for processing data, in addition to larger meeting spaces where teams can translate that data to healthcare platforms.
In addition, Vascellaro recommends designing these spaces with light and color to encourage creativity. Snyder also prioritizes daylighting: “Not only does daylighting have an effect on energy reduction and occupant comfort and health, but it also drives recruiting. The best and brightest talent wants to work and research in spaces that are great spaces to be in.”
However, due to the large footprint required by these facilities, it can be a challenge to optimize daylighting within a limited perimeter zone. This is where transparent building materials come into play, serving the dual purpose of bringing natural light deeper into the core and promoting a team-based working environment. For example, says Snyder, “By developing lab technician work bays directly adjacent to labs, visually attached and conveniently located yet physically separated, we enhance the interactivity between data gathering and data recording.”
Industry experts anticipate that the translational approach to combining medical research and healthcare will continue to gain traction. “Translational research facilities are playing a big role in helping healthcare organizations and academic medical centers innovate and bring new products to market,” Snyder says.
And because these unique facilities are a combination of two very different building types, the design itself calls for a collaborative environment.
“There can be quite a design specialization gap between those who design hospitals and those who design research facilities,” DiGennaro says. “I’d suggest that both of these highly specialized design experiences are required on a design team to create these new translational research buildings.”
Barbara Horwitz-Bennett is a contributing editor for Healthcare Design. She can be reached at firstname.lastname@example.org.