Trend Report: Academic Medical Centers
Many design firms across the country say that some of their most innovative work comes when working with academic medical center clients. “Often they’re pioneers in specialty services and research,” says Omri Kenneth Webb, associate principal and senior vice president at HKS (Washington, D.C.). “This manifests itself into the design of new facilities and specialty rooms.”
Mike Pukszta, principal and healthcare practice leader at CannonDesign (St. Louis), says while non-academic clients usually want to see examples of designs in other facilities before they’ll give the green light, academic clients are more willing to be early adopters and consider new approaches. “They love to engage in that dialogue,” he says. “They’re usually thinking very forward.”
That mindset has helped guide these organizations for decades as they’ve built reputations on a tripartite mission to deliver research, teaching, and care on large, established campuses where patients seek treatment for some of the most complex cases, including tertiary and quaternary care.
So when the Affordable Care Act began shifting healthcare’s focus to improving population health, driving down costs, and restructuring payment systems, these academic facilities had to apply their forward-thinking nature to reassessing what they do and the services they provide, Pukszta says. “They’ve always been evolving, but that probably was the single moment that said academic medical centers are going to have to change,” he says.
Part of that relates to the inherent inefficiencies associated with such complex organizations. “Having learners with you slows down the process, there’s no question about it,” Pukszta says. There’s also the fact that many on staff are specialists in their fields, drawing complicated cases involving lots of diagnostics and consultations with subspecialists.
Additionally, clinicians may be involved in research as well as academics, meaning they’re spending their days traveling across campus to multiple buildings. “All of those things start to collide within a system that isn’t necessarily built for speed or lowest cost,” he says.
To address these realities and remain competitive for the future, academic medical centers are turning to healthcare architects and designers to help them update their physical environments, address operational efficiencies, and expand into new markets beyond acute care. “They’re trying to become known as the provider of choice no matter what the disease or need,” Pukszta says.
This evolution is driving a variety of projects, including new bed towers rising on existing academic medical center campuses to meet growing patient volumes, as well as new ambulatory care facilities—both on and off campus—to bring care closer to patients and fuel growth. Some facilities, such as Cleveland Clinic and Milwaukee-based Froedtert & MCW Froedtert Hospital, are forming alliances to create referral networks and share best practices in patient care and clinical research.
The University of Texas (UT) Southwestern Medical Center opened the William P. Clements Jr. University Hospital in 2014 and today is developing an ambulatory center north of the Dallas metroplex to serve patients closer to home and refer them back to the main campus for more complex needs. “Academic medical centers used to be isolated to their main campus and now they’re branching out,” says Mike Hoffmeyer, senior associate vice president at CallisonRTKL (Dallas), which worked with UT on the hospital project.
At the same time, academic medical centers are also updating and maintaining their existing facilities, making sure they reflect today’s standards for patient care, family involvement, multidisciplinary care teams, and new teaching methods. When the University of Connecticut’s Dempsey Hospital opened in the early 1970s, it was considered innovative with its elliptical floor design and combination of private and semiprivate patient rooms.
“By today’s standards, all of those things are undersized and inadequate in terms of being able to deliver patient care and support our missions in education and research,” says Thomas P. Trutter, associate vice president of campus planning, design, and construction at UConn Health (Farmington, Conn.).
Working with SBA/HKS Joint Venture, the organization started construction in 2012 on a 169-bed patient tower on campus that would feature all private patient rooms with accommodations for family members; conference rooms with technology and space for clinicians, residents, and students to discuss cases; and decentralized nurses’ stations with glass-walled work rooms that provide privacy while still allowing visual observations of the patient rooms.
The organization isn’t stopping there, either. As part of the state’s Bioscience Connecticut Project, introduced by Governor Dannel P. Malloy, UConn added a 380,000-square-foot outpatient building and is in the process of renovating its research and academic facilities on campus. “We’re focusing not only on inpatient services here on campus but all of the other missions associated with being an academic medical center,” Trutter says.
Incorporating new design elements
One of the biggest influences on the design of academic medical centers is the evolution of medical and health sciences education, says Tom Chessum, principal at CO Architects (Los Angeles). “Education is becoming interprofessional: They’re training the physician, the nurse, the pharmacist, and the public health students together for portions of their education,” he says.
That’s influencing the built environment, as more academic medical centers add off-stage areas to support education and collaboration. “Instead of traditionally rounding right outside the patient room, they’re creating small areas on the inpatient floor tucked away out of corridors,” says Holly Ragan, managing principal at FKP’s Dallas office. “These spaces are equipped with technology giving teams the ability to quickly access diagnostic images or consult other physicians remotely.”
Technology is also playing a starring role in the ORs to record and broadcast surgeries to classrooms or conference rooms, where students and instructors can watch and learn in real time. That same equipment also helps connect staff from different departments on campus, including research and labs.
Stan Parnell, a medical planner at CallisonRTKL, says it’s important when designing for technology to account for future needs. “If you miss the capacity on the building air conditioning, power, and plumbing, it’s a tough thing to accommodate in the future,” he says.
Academic centers are also seeking new approaches to private office space. “The thought is, if you’re in clinical environments more than 75 percent of the time, that those ‘owned’ academic offices are an inefficient use of valuable real estate,” says FKP’s Ragan.
Instead, academic facilities are turning toward hoteling-inspired workspaces that are centered on interaction, collaboration, and flexibility, including lounges with a mix of furniture and desks for checking email or charting. The new outpatient pavilion at the University of California San Diego, designed by CO Architects, features sky-lit work nodes to encourage informal clinical interaction, cross-disciplinary collaboration,
and teaching opportunities.
Seeking a different approach
Another topic of conversation between firms and their academic clients today is process design and how to manage patients in a different way. “That’s probably where we have the most challenges because they’re not typically the most efficient, streamlined places,” says CannonDesign’s Pukszta.
When the firm started working with the University of Minnesota Health (M Health) to design a new ambulatory care facility on its Minneapolis campus, it mapped out the patient’s journey using M Health’s existing processes. Among the findings were 20 routes that patients could take to schedule an appointment and 10 activities they went through before they actually saw a provider.
Instead of bringing these inefficiencies to its new facility, CannonDesign suggested a total process redesign focused on efficiency, saving steps, and reducing redundant services, which would also save $26 million on the project. “When they started projecting what kind of revenue they were going to get in the future and projecting decreased per-patient revenue, they were in a situation where financially they had to think differently,” he says.
The five-story, 342,000-square-foot University of Minnesota Health Clinics and Surgery Center, which opened in May, features no check-in or check-out areas, waiting areas, or private staff offices. Pukszta points out two strategies in particular that helped the new ambulatory center realize cost savings and a smaller building footprint despite a similar staff size and patient loads: zero customization of department suites and exam rooms (which provides flexibility for future needs) and technology.
For example, wearable electronic devices are given to the staff and patients upon arrival to keep track of their movements throughout the building and help drive operational improvements. Staff members receive a notice when a patient checks in and can look on a monitor to see where that person is seated so they can approach them in the waiting lounge and greet them by name before taking them back to an exam or procedure room. “There’s no more calling out names or anything like that,” Pukszta says.
The staff is also alerted when a patient has been sitting in an exam room for longer than 10 minutes without seeing a provider. “With the data they’re getting out of the system, they can make adjustments on a daily basis,” he says. “It’s invaluable as a tool for them to refine their processes.”
Like other healthcare sectors, academic medical centers will need to continue refining their processes and adapting their built environments, especially as patient acuity levels rise. “It’s the place where the sickest of the sickest go,” HKS’ Webb says, which can impact a range of design and planning considerations, from lengths of stay and staffing needs to layout, bed counts, and facility sizes.
Addressing those clinical issues while balancing their research and education missions will be another challenge. One key, says FKP’s Ragan, is to create a physical connectivity among departments or buildings to promote collaboration and ease sharing of ideas, such as bridges or tunnels connecting buildings, back-of-house elevators for staff, and open work spaces.
“Academic medical centers are complex organizations,” she says. “Having some sort of connectivity between buildings facilitates an environment for discovery and socialization.”
Anne DiNardo is senior editor of Healthcare Design. She can be reached at firstname.lastname@example.org.
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