Better Facilities for Better Translational Health Science
Simply put, translational health science refers to the process of moving scientific discovery into clinical application. The goal is to create better patient outcomes by accelerating the translation of basic science discoveries into effective therapies, and, ultimately, to extend these novel approaches or therapies into the community for improved health.
The process of translation begins by assessing or improving current knowledge about the mechanisms of disease. It progresses to transforming discovery into new approaches and developing new therapies. Then, these therapies must be validated for safety and efficacy, and finally be delivered to the community and accepted for wider use.
To accelerate the process, collaboration among the many disciplines focused on solving the problem through the various stages of the process is essential. The shift to broadly transdisciplinary research and development—at the heart of translational health science—has led to changes in science methodologies and technologies. These changes, combined with new, more complex team dynamics, require corresponding changes in the facilities that support them.
The tagline “bench to bedside” often applied to translational medicine has led to simplistic literal approaches to facilities and organizations. In reality, the issue is significantly more complex. “Bedside” can refer to a wide range of approaches or therapies, including behavioral, drug, surgical, cell and blood, bio-engineered, targeted, radiation, genetic, and physical therapies.
Therapies may also include vaccines, medical devices, regenerative medicine, and new approaches, such as prevention, education, advanced molecular, and predictive diagnostics. Other approaches to eradicating disease include implementing wellness programs, developing new models of disease, improving treatment pathways, and reducing medical errors.
The “bench” in the tagline can include anything from basic research to clinical, population, development, and translational research, as well as clinical trials, diagnostic development, technique development, technology development, and comparative evaluation, to name a few. When connecting “bench to bedside,” the question becomes much more complicated: which “bench” to which “bed”? Many “translational” research facilities today are simply basic science laboratories with an obligatory interaction area.
HDR’s translational health science initiative
At HDR, we have found that facilities for translational research require closely examining how people actually need to interact and what brings them together in the first place. We know that productive interactions can take place at various scales: in a cafeteria, in a core facility, or on a campus green. Collaboration also can happen through virtual networks.
HDR has been working with top medical, research, and academic institutions to capture a new vision of translational health science. Our translational health science initiative gathers together internationally renowned thought leaders from the fields of healthcare, basic and clinical research, medical education, and commercialization through a series of HDR-sponsored colloquia.
These thought-provoking and interactive symposia are designed to further our understanding of how organizational, governance, and environmental changes can enhance the process of translation—to develop new paradigms for facility design that enable collaboration, integration, and convergence.
We began our initiative to gather information on how the physical environment impacts an institution’s ability to successfully translate discoveries to clinical application. Through discussion at the colloquia, it soon became apparent that organizational structure and the physical environment in which it operates are inextricably linked. We then began the task of concurrently examining organizational structure and the physical environment, and how they enable or impede translation. We have uncovered various models for integration.
Examples of integration
Some organizations provide strategic connections between relevant clinical and research functions; others create a shared destination between functions; and others develop fully integrated solutions at a larger scale. Throughout the world, a number of institutions are taking integration to the highest levels.
One example, a new health sciences campus which has been ongoing for several years, is the McGill University Health Centre. The goal of the center is to provide Quebec with a modern university teaching hospital at the leading edge of healthcare, teaching, and research. The redevelopment project proposed by the McGill University Health Centre aims to draw on people’s different traditional strengths and group researchers in fundamental, clinical, and evaluative research in a new building that emphasizes the increased importance of translational research.
The project centers on the creation of the Centre for Innovative Medicine (CIM), located at the heart of the facility, both horizontally and vertically, to integrate the children’s hospital, adult hospital, cancer center, and the Centre for Translational Biology. The goal of the CIM is to promote a synergy between providing care at the patient’s bedside, and fundamental science and clinical research.
Our most recent Translational Health Science Colloquium, Translation in a Time of Change, was hosted by MD Anderson Cancer Center in Houston. MD Anderson ranks as one of the world’s most respected centers focused on cancer patient care, research, education, and prevention. For eight of the past 10 years, including 2011, MD Anderson has ranked No. 1 in cancer care in “America’s Best Hospitals,” a survey published annually in U.S. News & World Report. Not coincidently, translation and integration is essential to MD Anderson.
The Center for Targeted Therapies facility is integrated with MD Anderson’s Center for Advanced Biomedical Imaging Research to encourage interaction among clinical and basic research professionals. Researchers work alongside clinicians to develop novel therapies to effectively halt the progression of disease. Informal and formal meeting areas designed as destinations, encourage multidisciplinary collaboration.
HDR has also designed the Sheikh Zayed Bin Sultan Al Nahyan Building for Personalized Cancer Medicine, which is now under construction. The facility is based on a new translational model designed to accommodate and facilitate MD Anderson’s reorganization strategy, moving from a departmental to an interdisciplinary structure of programs, centers, and institutes. The facility is on a fast-track schedule, slated for completion in August 2014.
Strategies for successful translation
Discussion at this colloquium included the idea of “disruptive change” as a positive force. Three fundamental strategies emerged:
Integrating expertise. Institutions are looking for an increased level of integration across the board: integration among clinical disciplines for multidisciplinary care; between clinical and
research disciplines for a better understanding of the problem; among research disciplines for innovative approaches to solving the problem; and between science and engineering disciplines for creative development of applications. This integration—along with integration between phases—has proven critical to the translational process.
A plenary speaker at the Translational Health Sciences Colloquium, Dr. Michael Johns, chancellor of Emory University and executive vice president for health affairs, emeritus, and formerly dean of the Johns Hopkins School of Medicine, reflected on his experience integrating medical schools, research institutions, and hospitals. He explained that “changing traditional scientific culture entails at least three major factors, which are challenging in any sector but particularly in academia.
These factors are aligned incentives, participatory decision-making and transparency. The academic culture will need to change its reward structure to align with the vision,” he says. To accomplish this may require an academic institution to create new administrative structures that are “discipline neutral and territory blind.”
Connecting to the community. Many institutions are taking academic research and educational links from their main campuses out into the community to reach a broader segment of the population. Another plenary speaker at the colloquium, Sir Cyril Chantler of the University College London (UCL) Partners, spoke about health in the community, and the importance of involving patients and their families in research and in the healthcare delivery system, with the ultimate goal of embedding health in the greater population.
He spoke of translational research as a circular process involving far more than just scientists. He explained that successful translation must involve patients and their families, professionals from diverse disciplines, and the community being served.
Chantler envisions the development of the “integrated care center,” which would offer many care pathways to treat illness as well as services that promote health. He says that these integrated care centers would contain “primary care doctors, social workers, physical therapists, etc. The center would also include a fitness center and other programs that promote health.” Specialties would coalesce in specialty hospitals, to provide better patient outcomes at a lower cost.
Transferring technology and commercialization. Many institutions are increasing their capability to develop therapies both through internal pipelines and through processes that include corporate partnerships. Institutions are also looking for ways to improve their technology development and technology transfer processes through increased levels of partnerships with commercial organizations, including providing facilities and expertise to private-sector companies.
Technologies such as wireless data transmission and capture; smart devices; integrated clinical and research records; and diagnostic and therapeutic technologies are being pursued aggressively.
Keynote speaker Dr. Eric J. Topol, of The Scripps Translational Institute and author of The Creative Destruction of Medicine: The Wireless Future of Medicine, spoke about the enormous transformation that has taken place over the past decade through the advent of smart devices. Smart phones, iPods, tablets, etc., have transformed the way we communicate, make friends, listen to music, and even how we think. He believes that medicine has not yet even begun to realize the benefits of these technologies.
He notes that in combination with the huge advances is genetic sequencing, medicine is set for a radical change. Topol envisions a future in which healthcare delivery will be entirely transformed.
Did you know that you can already use an app on your cell phone to take your own vital statistics? You can even send them to your doctor, updating your health record yourself. Topol envisions being able to trace a patient anywhere in the world in real time. With so much personal health data available, he also imagines the emergence of a new breed of “cyber-chondriacs!”
“More has been learned about the underpinning of disease in the last two and a half years than in the history of man. Putting this together with an app for your iPhone, as well as with your genotype, will be a hugely significant improvement to guide drug therapy … Through the great advances in technology and its effects on thinking and behavior, we will go from ‘homo-distractus’ to ‘homo-digitus,” Topol says.
He believes that radical change in healthcare in the United States will require massive consumer activism to move away from the current fee-for-services structure. As long as healthcare delivery is driven by fee-for-services, there is no incentive for transformational change.
Looking through the crystal ball, thought leaders in translational health science seem to agree that the future of healthcare will include a new “health” model in which there are fewer acute-care hospitals and more disease-prevention and primary care health centers that include far more than doctors’ offices. With the advent of personalized and predictive medicine, people will be treated before the onset of disease, avoiding hospitalization altogether.
Specialized hospitals will bring together the best doctors and equipment to combat specific diseases. In the future, people will require less hospitalization, and will be able to be treated where they want to be: at home. In cases where hospitalization is required, patients will be hospitalized in specialized hospitals with far better outcomes.
While most major institutions are approaching change to some degree, we have found a wide discrepancy between institutions that are moving slowly, and the handful of institutions worldwide that are aggressively pursuing transformational change. For more information about these premier institutions and how they are effecting change through facility design to enhance translation, please visit www.translationalhealthscience.com. HCD
Jon Crane, FAIA, EDAC, LEED AP, is Global Director of Translational Health Science Initiative and Principal, Healthcare Consulting for HDR Architecture. He can be reached at email@example.com.