HCD.10: Creating a regenerative healthcare facility
David Burson, AIA, Senior Project Manager, Partners HealthCare, is an architect with more than 30 years of planning, design, and project management experience in both private and public sector practice. His work has focused primarily in the areas of institutional facilities programming, design, and campus planning.
Acting as Senior Project Manager on the Spaulding Rehabilitation Hospital in Boston, Burson is leading a team in designing and constructing a “regenerative hospital,” a concept he will speak about at the HEALTHCARE DESIGN.10 conference in the session "Regenerative Hospitals." The session will be held at 9:15 a.m. on Tuesday, Nov. 16, in Room 319. Burson shared some of his thoughts on regenerative hospitals during an interview with HEALTHCARE DESIGN.
HCD: Tell me a little bit about Partners HealthCare and what you do there.
Dave Burson, AIA: Partners HealthCare is a network of healthcare providers—it was established around 12 years ago. We have two founding hospitals, Massachusetts General Hospital and Brigham and Women’s Hospital here in the Boston area, and then another half-dozen or so affiliates that have joined over the years.
I work in the corporate real estate facilities group for Partners. Our Vice-President for Real Estate and Facilities Kathryn West, who heads up this group and oversees the work that we do here in the corporate group and also the individual, also oversees planning, design, and construction at the facility and member hospitals. So there is a planning and construction group at Mass General and counterpart real estate, a facilities group at Brigham and Women’s Hospital, and an engineering group that works system-wide. It’s kind of a confederation. There are individual entities at various locations but they all roll up to Kathy West.
In the corporate group, what I’m typically doing is managing capital projects that aren’t being run directly by the individual hospitals. The project of interest for our HEALTHCARE DESIGN.10 conference proposal is the Spaulding Rehabilitation Hospital which we have been working on—on again off again—for the last four years, and I’m the Senior Project Manager for that, essentially responsible for coordinating work with our architects, contractors, and engineers, and interfacing with our decision makers here.
HCD: Can you speak a little bit about the concept of “regenerative hospitals”?
Burson: It’s a term that I believe was coined by Robin Guenther of Perkins+Will who has done a lot of very interesting work in the field of sustainable healthcare design, planning, and construction. We’re using that with her full blessing and participation; she has been a part of the sustainable initiative that we’ve been developing for the Spaulding Hospital. We’re using it in a number of senses here. It’s regenerative in Robin’s terms that at the core it’s a healthcare environment, not just depleting resources but actually replenishing resources on-site in its purchasing policies and operational practices, as well as in the design and construction side. It’s beyond sustainability to a regenerative profile. We use it additionally with Spaulding to communicate the fact that we are a rehabilitation hospital, regenerating the lives and restoring to society the patients that come through our facility.
We’re also engaged in a major brownfield site reclamation and regeneration. In that respect, we are restoring what was a former U.S. Navy shipbuilding repair site that has been a derelict, abandoned lot for some years on the edge of an otherwise vibrant community. So we’re regenerating this site for a useful life in the community. So the term works on a number of levels for us.
HCD: So it’s more of a holistic approach to designing these facilities as it is the actual internal functions of the hospital itself?
Burson: Yes, that’s a good way of saying it.
HCD: The description I’ve read of regenerative design sounds like it deals heavily with evidence-based design concepts. Is evidence-based design a primary focus of this process?
Burson: Yes, absolutely yes. It’s something that we’re looking at and thinking about all the time. It’s very much a part of our program for this facility. We’ve taken measures to ensure, for instance, widespread access to daylight and views to nature for the patient facilities. Yet again, there are evidence-based design principles that state that these traits yield better patient outcomes or staff and visitor satisfaction. So yes, that’s a big part of our program.
HCD: Can hospitals be retrofitted to achieve this “regenerative hospital” profile?
Burson: I think they certainly can to a degree. You’re obviously more constrained when you’re working in an existing healthcare setting. It’s something that we have looked at with the existing Spaulding hospital because, as I mentioned before, the project has been kind of on-again, off-again.
We were getting some significant cost problems in the history of this development. So we went back and looked at what was involved in trying to renovate and expand the existing Spaulding hospital. In the end, we concluded that we would have had a compromised outcome, spending just about the same amount of money because of the problems working around an occupied hospital. In this particular case, we were able to make the case successful to Partners leadership and our finance committee folks to invest in a wholesale reconstruction on the site of the facility. I think we got the most regenerative outcome that we could have because of that. It’s not to say it couldn’t be done with an existing hospital.
HCD: Are there any downfalls to this type of design process? Is the initial capital investment sometimes cost prohibitive?
Burson: Yes, it can be. The number of sustainable and regenerative initiatives that we’ve been pursuing here may not ultimately make the cut; we’re still in the process of buying out the job. Now, one aspect of the project that we spent a lot of time and energy on is trying to develop a greywater recycling system to minimize both our water use and our discharge into the municipal source system. The current water rates, at least here in Boston, that it’s pretty tough to justify this on a return on investment basis, at least in the near-term. Plus, greywater systems have not been widely deployed—to our knowledge—in healthcare settings, at least in this country. All of the infection control concerns that would come up with greywater are certainly in play here. So I don’t know if we’re going to be able to make that particular system work or not. Certainly not everything we’re trying is going to be part of the project in the end.
Robin Guenther did a piece in the Summer 2009 issue of HERD Journal called “Moving to a Regenerative Healthcare Model.” We’re taking that as a touchstone for the approach we’re using for this facility.