From Bench to Bedside: Design Accelerates Research
Many healthcare systems across the globe are working to accelerate the translation of laboratory discoveries into treatments for patients to improve outcomes. According to the National Institutes of Health, translational research typically begins “at the bench,” with basic research in which scientists study disease at a molecular or cellular level then process to the clinical level, or the patient’s “bedside.” Johns Hopkins University Medical Center has noted from their research that one barrier to translational research is not having the proper resources—including space, equipment, and technology—to make research more translational (Weston, et.al, 2010). Healthcare providers are now looking to the design community to help create infrastructure that supports the implementation of clinical and translational studies. For architects and designers, understanding the interrelated components of translational research can afford a better design response. The design of the physical environment plays a critical role in this acceleration by integrating spaces for collaboration, maximizing flexibility and adaptability, and improving patient experience and recognition.
Collaboration among scientists, physicians, and patients is leading to new innovations and scientific advances that did not occur previously when research groups worked in isolation. It has become clear that partnership among multiple disciplines is essential in tackling today’s most pressing health issues. The new Center for Science and Medicine building at Mt. Sinai’s campus in New York City (opening in 2013) will redefine translational healthcare. By creating a space where patients and scientists coexist in a common facility, and by seamlessly integrating clinical and basic science research with an ambulatory care center, clinicians, scientists, and educators will be united in a truly cooperative way. To accomplish this, the new building is intended to facilitate interactions through the integration of educational spaces, lounges, informatics/bio-statistic computer facilities, basic science research spaces, and other dedicated research centers.
The consideration of the circulation system, interaction nodes, and organization in relation to clinical areas is a key design principle in promoting the level of collaboration necessary between academic and clinical research teams. At Mt. Sinai, the translational model is embedded in the overall section of the building. The atrium space that begins in the main lobby and encloses the waiting areas for the clinical suites feeds up into an interactive stair connecting the lab spaces. This stair serves gathering spaces on each floor that are offset to provide a visual link connecting multifloor research neighborhoods. The clinical spaces comprise a cancer center directly related to the oncology research being performed on the two floors directly above. The proximity of the clinical floors to the research space above engenders a connection between researchers and clinicians by reinforcing the value of the research in treating patients. The architectural resolution of this connection is embodied in the continuity of the atrium space.
Collaboration often occurs through “chance” meetings, whether the conversations are around coffee bars or copy stations, or when passing a colleague in the hallway. When opening in 2012, the new Neurosciences Laboratory and Clinical Research building on the University of California, San Francisco (UCSF) Mission Bay campus will have bridges on the upper levels that connect office areas to laboratory areas. The bridges were intentionally designed to support encounters with seating areas located along the path with power and data sources.
With research constantly evolving, facilities that support research should be flexible and adaptable enough for unanticipated future needs. It has been said that private research companies make physical changes to an average of 25% of their labs each year while academic medical institutions annually change the layout of 5 to 10% of their research spaces (Watch, 2008; Tolat, 2010). Kevin Kirby, vice president for administration at Rice University in Houston, Texas, who oversaw the development of the university’s new BioScience Research Collaborative building, stated that the most expensive part of a research facility is down time during renovations.
To support the translational research units at UCSF, an outpatient clinic dedicated to supporting clinical trials is located on the first floor of the building. The first floor location provides easy access for patients who may have mobility and/or wayfinding challenges and is directly adjacent to the five-story atrium. Adjacent to the clinic is the administrative unit supporting the clinical trials and directly above are the laboratories conducting the “bench-side” portion of the translational research. Directly across the atrium from the laboratory spaces are the faculty offices. The co-location of clinic, trials administration, labs, and offices reduces the travel time spent by researchers, clinicians, and faculty members holding joint clinical and research appointments.
The labs at UCSF are conceived of as a “loft”—open, flexible, unencumbered space that can be arranged and adapted to suit the needs of the users and their science. The laboratory wings have been laid out to maximize the unencumbered space and optimize flexibility. The core and shell were conceived as a highly adaptable building system and structure, which supports different working models. On the fourth floor of the building, three different departments are successfully collocated on one floor each with very different needs for open bench and support room configuration.
At the Research Building at Memorial Sloan Kettering (MSK) in New York, movable desk stations and laboratory benches provide the ability to adapt to shifts in the number of researchers who use the space, and accommodate new research requirements and specialized equipment. The biggest challenge at MSK was to create a contiguous lab floor plan in a compressed urban site. To meet the translational program, the floor plan needed to contain open bench space, enclosed procedure rooms, linear equipment rooms, office space, and an interaction zone to pull these diverse elements together. The minimum required dimension exceeded the available site area wedged between an existing church and the existing Kettering Lab, the obsolete building that the Zuckerman Research Center replaced. To meet this challenge, the two-phased design began with a typical floor-plate that cantilevered offices over the Kettering building. An interaction stair at the heart of the building links open gathering spaces and conferencing facilities on each floor. This stair and the fire stairs are embedded in a very efficient mechanical zone, which forms a spine that organizes the plan into “wet” and “dry” spaces. Given the limited interaction space available, the fire stairs were included in the interaction strategy through the provision of a high level of interior finish and views to the exterior. The second phase, comprising additional vivarium space and dry labs, slips under the cantile
ver in the space created by the demolition of Kettering. This two-phase strategy permitted the implementation of a world-class facility that would have otherwise been unfeasible based on the urban conditions.
In 2001, the Institute of Medicine’s “Crossing the Quality Chasm” report named patient-centered care as one of the six fundamental aims of the U.S. healthcare system (IOM, 2001). With growing recognition of patient-centered care, as well as evidence of its effectiveness in contributing to better outcomes, comes awareness that today the goals of the patient, researcher, and clinician need to be better aligned. At Mount Sinai, physician-researchers worked closely with the design team to shape the quality of experience for researchers, caregivers, and patients. In this unique example of a comprehensive translational environment, each party is cognizant of the connection between the research being done in the building and the therapies being implemented therein. Given the growing sophistication of patients in researching and understanding the care they receive, this kind of transparency represents a trend that will continue to grow. The development of the planning and stacking of the building is a direct response to the input of the caregivers and researchers into the process of research and treatment. In addition, by receiving treatment at the locus of research, the patient experience is enhanced and the treatment process becomes more transparent. The addition of a 10-modality imaging suite on the lower levels of the building provides both therapeutic benefit to patients in the building and critical data to support bioinformatics researchers.
The Denver Veterans Affairs Medical Center on the former Fitzsimons Army Medical Center Campus in Aurora, Colorado, will comprise a full replacement hospital, including emergency department, spinal cord injury center, ambulatory medical center, community living center, and research facility when it opens its doors in late 2014. The close connections between clinical care, treatment, rehabilitation, and research are enabled by the linear “spine” that acts as a circulation and service connector between each functional area of the medical center. The spine layout enables each building connecting to it to be specifically built for its purpose, rather than being agglomerated into one massive facility. An important aspect of this feature is that each building can then be narrower in footprint than most typical hospital buildings. This provides better access to daylight and views for patients (as well as for staff), which, according to a large body of research, supports the healing process. In addition, landscaped gardens become closely integrated with the architecture, creating easily accessed outdoor therapy and respite spaces. Through the translational nature of the medical center, resources will be easily shared between doctors and researchers, and across the larger Fitzsimons campus. Clarity of wayfinding and ease of circulation will enhance communication and interaction between researchers, clinicians, and caregivers. The lower, non-public level of the spine will allow services to be shared and for movement of items in support of bench-to-beside research.
Recognition in increased funding
Currently, an increase in funding dedicated to translational research is occurring both nationally and internationally. In the United Kingdom this past March, a 30% increase in government funding has been dedicated for translational research in order to provide the best environment to support cutting-edge translational research within National Health Services facilities (Department of Health, UK, 2011). A thoughtfully designed facility has the potential to attract research funding and recruit key staff. As an example, at the University of California San Diego’s Cancer Center, the research space has more than quadrupled from 9,000 to more than 40,000 square feet, and its research funding since opening in 2005 has increased from $1.7 million per year to more than $15 million per year (Holmes, 2011).
Part of the role of a translational building is to attract and retain top-quality principal investigators. It must also facilitate grant-based research in the most efficient space possible for indirect cost recovery. At 420 feet, the Research Building at Memorial Sloan Kettering (MSK) represents a new paradigm for urban laboratory buildings. The facility is intended to create an inspiring and interactive environment for innovative cancer research, as well as create a distinct civic identity for MSK. As both a goal and result of the tight urban site, the design generated a highly efficient floor plan that optimized the number of researchers on each floor. The floor plan provides co-located resources that principal investigators need to produce the kind of groundbreaking treatments for which MSK is world-renowned.
At Mount Sinai, the institution was blessed with an urban site that could support more than the research center itself. In this case, Mount Sinai leveraged existing real estate assets to fund the construction of the new Center for Science and Medicine. The center takes maximum advantage of its end-block site to create floor plates that work equally well for research and clinical functions. Mount Sinai sold the balance of the site to a developer to create new residential units in an existing historical building and new tower. The mechanical space for the center inhabits the base of the tower, further increasing its efficiency. Exhaust ductwork travels the full height of the tower, while the mechanical base raises the lowest residential floor above the adjacent building to optimize views.
Through these examples and others, several recommended design solutions to help accelerate translational research have emerged. These include:
- Design the facility to incorporate clinical spaces that enhance patient-centered care;
- Provide flexibility for future evolution of patient care and the ability to adapt to changing research needs;
- Support innovation and translational research through well-crafted interaction spaces and an adjacent dry research program;
- Logically array adjacencies for healthcare and research to maximize efficiency for both workflow and patient care;
- Create space that attracts and supports world-class principal investigators;
- Implement structural and formal strategies to increase efficiency; and
- Apply urban planning and real estate strategies to optimize existing institutional resources.
The authors wish to acknowledge Danielle McGuire, AIA, for commenting on initial drafts.
Amy Keller is Research Manager at Skidmore, Owings & Merrill LLP and can be reached at firstname.lastname@example.org. Paul Whitson is Director of Skidmore, Owings & Merrill LLP and can be reached at email@example.com. Carrie Byles is Managing Director at Skidmore, Owings & Merrill LLP and can be reached at firstname.lastname@example.org. Joan Suchomel is Associate Director at Skidmore, Owings & Merrill LLP and can be reached at email@example.com.
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