The Annual HEALTHCARE DESIGN.10 conference received more than 390 speaker proposal submissions. These proposals were reviewed by a multidisciplinary conference design team with representatives from The Center for Health Design, the Vendome Group, the AIA, ASID, and IFMA. Of those proposals, 11 Pebble Partner organizations were selected to present. The conference has a total of 145 educational sessions and roundtable discussions. To read more about these exciting Pebble presentations and more, please visit and look for the “P” (Pebble) icon next to each session description. We hope that you will join us in Las Vegas in November and learn more about how the Pebble Partners are creating a ripple effect in the industry. This month's Pebble Report is a preview of what our Pebble Partners will be discussing at HEALTHCARE DESIGN.10

Parkland Health and Hospital System, Dallas, TXParkland Emergency-Radical Operational Change Leads to New Emergency Design

Speakers:Jennifer Sharpe, RN, Director of Nursing, Emergency Services Department, Parkland Health & Hospital System; Melanie Viquez, MBA, FACHE, Director, Planning & Activation, Parkland Health & Hospital System.

The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at

We hope that you will join us in Las Vegas in November and learn more about how the Pebble Partners are creating a ripple effect in the industry.

To decrease patient care time, the Parkland Emergency Room adopted an aggressive operational planning initiative to improve the process. This session will tell the story for how those radical changes were tested and implemented in the current facility. Moderators will share how issues and consequences were evaluated, solutions where brainstormed and researched, and how commitment and goals were developed. Participants will specifically learn about two tested operational models: nonproductive waiting, and round-robin patient distribution, and partake in a discussion about evaluation and implementation of the new design process.

The New Parkland Hospital Master Plan-Creating Connections Through Dynamic Planning & Design

Speakers:Hank Adams, AIA, ACHA, Vice-President/Healthcare Principal, HDR Architecture; Walter B. Jones Jr., AIA, LEED AP, Senior Vice-President - Facilities, Parkland Health & Hospital System; Jeffrey A. Fahs, RLA, CLARB, LEED AP, VP, Land Planning, Landscape Architecture, HDR Architecture; Chuck Armstrong, AIA, Principal, Corgan Associates.

This session explores how this multidisciplinary design team simultaneously executed both the master planning and schematic design process for a new 64-acre, 1.9 million-square-foot, full-service acute care replacement hospital to achieve a completely integrated and connected design solution. Their process created connections to the surrounding urban context, to the Parkland community, a new light rail transit system, neighboring institutions, and patients/families. Hear about the critical drivers to achieve success in planning, strategies for connecting the planning process to stakeholders, and how the master plan and schematic design are a rational expression of the programmatic requirements and best practices in healthcare design.

Froedtert & the Medical College of Wisconsin, Milwaukee, WI. Findings from the Clinical Cancer Center at Froedtert-Informing Design for Cancer Patients

Speakers:John Balzer, Vice President, Facility Planning and Development, Froedtert and the Medical College of Wisconsin; Jocelyn Stroupe, IIDA, AAHID, ASID, EDAC, Principal, Director of Healthcare Interiors, Cannon Design.

This case study features a new philosophy of cancer care that integrates all facets of a patient's care-from the first phone call to the last follow-up appointment-in a setting that fosters collaboration among physicians while simplifying the treatment process for patients. Moderators will outline research conducted in three program areas including treatment cycles and settings, how the Quality of Life Center services are accessed, and efficiency of the treatment plan (along with patient and companion satisfaction). Attendees will discuss implications for these findings and their impact on future cancer center planning and design.

Palomar Pomerado Health, Escondido, CAExecutive Management of Healthcare Construction-Operationalizing Lean Principles Effectively

Speakers:David A Tam, MD, MBA, FACHE, Chief Administrative Officer, Palomar Pomerado Health.

This case study will demonstrate best practices as well as innovative approaches to the implementation of Lean construction in a design-build format for a large medical center. Using specific examples, the moderator will demonstrate how to best translate construction issues for critical stakeholders and how innovative technologies are integrated into hospital design and construction while implementing Lean principles. Participants will investigate innovative techniques, such as BIM and the use of a joint governance model to enhance Lean implementation. Strategies for communication with the hospital board and other senior governance bodies throughout the construction decision-making process will also be considered.

ER One at Washington Hospital, Washington, DCPositive Distractions for ER Waiting-Next Steps for ER One

Speakers: Barbara Huelat, AAHID, FASID, EDAC, IIDA, Interior Design Principal, Huelat Parimucha Ltd; Ell Franklin, RN, CRC, Special Projects Director, ER One Institute, Washington Hospital Center.

ER One Institute is well into the next stage of defining evidence for ER waiting. This presentation highlights the innovative and newly designed ER One with an emphasis on stress reduction in relationship to wait times. Participants will gain an understanding of the influence that intentionally and strategically placed positive distractions (including kinetic lighting, interactive videos, and electronic messaging) can have on the patient/visitor and explore how positive distractions influence patient perception of waiting time and anxiety. Finally, presenters will discuss how healthcare provider interaction with patients has improved following the move to this new facility as well as next steps for this ER waiting project research.

Jersey Shore University Medical Center, Neptune, NJ

The Effect of Nursing Neighborhood Design on Communication Patterns, Care Quality, and Patient Safety

Speakers:Tushar Gupta, AIA, NCARB, Principal, WHR Architects; Franklin Becker, PhD, Professor, Cornell University; Teri Wurmser, PhD, MPH, RN, Director, Ann May Center for Nursing, Meridian Health.

At a time when there is both an acute nursing shortage and great concern about the quality of care delivered to patients, it is critically important to explore ways that the physical environment can impact critical-to-quality work processes in order to deliver a safe and effective workplace setting. This presentation will reveal the early findings of the Jersey Shore University Medical Center Pebble Project, which explores the hybrid nurse station configuration and the relationship to interdisciplinary communication patterns and collaboration, length of time spent in direct patient care, care quality, patient safety, and patients' perception of quality care.

University of Kentucky Healthcare System, Lexington, KYApplying Balanced Scorecard Thinking to Patient Care Unit Design and Operations

Speakers:Daniel Miesle, MHA, CHE, Director Facility Planning & Development, UK Healthcare - University of Kentucky; Jeffrey Norton, BSME, MSME, Associate Director, Safety & Quality, UK Healthcare

The “Balanced Scorecard” approach challenges organizations to think beyond single elements of design by employing a decision matrix framework. This presentation will illustrate and show how new patient care units have been designed around a Balanced Scorecard approach while providing tangible examples to attendees to apply to their own projects and organizations. Specifically, presenters will use four scorecard elements-quality, provider outcomes, patient outcomes, and finance-and dissect their design and operational planning initiatives through that prism. Finally, participants will discuss how Balanced Scorecards can be applied to any design, type, and size of patient care units.

Alignment of Inpatient Floor & Unit Design with the Institute of Medicine (IOM) Quality Aims

Speakers:Daniel Miesle, MHA, CHE, Director Facility Planning & Development, UK Healthcare - University of Kentucky; Jeffery Norton, BSME, MSME, Associate Director, Safety & Quality, UK Healthcare

Planning and design of inpatient care units need to respond to the IOM 6 Quality & Safety Aims (safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness) to assure an optimal environment for patients and their care providers. This case study will identify the process that was employed in developing a new inpatient facility. The session will identify key elements in each Aim and how the patient care units and rooms have been designed around each Aim. Presenters will share specific details around design and operational planning, the options considered, challenges faced, and metrics to be measured upon occupying the facility.

University Medical Center at Princeton, Princeton, NJInpatient Room Mock-Up Project at the University Medical Center at Princeton

Speakers:Nicholas Watkins, PhD, Director of Research, HOK; Susan Lorenz, DrNP, Chief Nursing Officer, University Medical Center at Princeton; Ismini Naos, Senior Medical Planner, HOK; Barry Rabner, CEO, University Medical Center at Princeton; Phil Toussaint, Vice-President, RMJM Hillier.

This presentation shares results from Phases II and III of an experimental research study of an inpatient room mock-up on a functioning nursing unit. Presenters will share data collected on standard clinical outcomes such as falls, medication errors, and infections as well as patient satisfaction with the room environment and care delivery. Attendees will learn about development of a functional mock-up room for the purpose of testing evidence-based design interventions and how to define the use of a mock-up room in hospital design. Key aspects of an informed design decision-making approach for project-specific solutions will also be discussed.

The Children's Hospital, Denver, Aurora, COThe Children's Hospital, Denver-

Transition Planning and Lessons Learned

Speakers:Sandra Rankin, BS, MS, Director of Client Services, FDI; Mike Maughlin, Senior People Development Consultant, The Children's Hospital; Jerrod Milton, Vice-President, Operations, The Children's Hospital; Carla Taylor, RN, MBA, Director, Occupancy/Transition Planning, FDI.

This session will outline the transition planning process and the lessons learned from the real-world activation planning efforts undertaken by The Children's Hospital during their transition from a downtown, urban campus to a replacement facility eight miles away. Recommendations and lessons learned from the hospital's formal postoccupancy evaluation process will be shared which are applicable to all hospital transition projects regardless of size or scope. Attendees will learn about the critical elements of transition planning, gain insight into the scope and magnitude of project transition planning required, and understand the critical role of change management in the process.

Vancouver Island Health Authority, Victoria, BC, Canada Elder-Friendly Design at Vancouver Island Health Authority

Speakers:Robyne Maxwell, RN, BSN, EDAC, Project Director Patient Care Centre, Vancouver Island Health Authority; Rudi van den Broek, BSC, MPA, EDAC, Chief Project Officer and General Manger Special Projects, Vancouver Island Health Authority.

The impact the aging population will have on acute care, in both the near and long term, is profound. This session highlights the elder-friendly design attributes that have been included throughout this replacement inpatient tower-a facility strong with evidence-based design elements, flexible, adaptable, safe, and built to respond to the unique needs of older adults. Attendees will learn firsthand specific elder-friendly design attributes that ought to be shared by both acute care and long-term care environments. Presenters will describe how a set of concrete objectives enhanced the scope of this project and the predicted impact on patient outcomes that these elder-friendly designs will deliver.

A number of recent projects demonstrate that these divergent approaches are not only compatible, but can promote superior outcomes through a rigorous process of using objective research to inform somewhat subjective innovation solutions.

Dublin Methodist Hospital, Dublin, OHThe Elephant in the Room: Innovation and Evidence-Are They Compatible?

Speakers:Peter Bardwell, FAIA, FACHA, Principal, BARDWELL+associates, LLC; Cheryl Herbert, RN, MBA, FACHE, EDAC, President, Dublin Methodist Hospital.

Are innovation and evidence compatible? A number of recent projects demonstrate that these divergent approaches are not only compatible, but can promote superior outcomes through a rigorous process of using objective research to inform somewhat subjective innovation solutions. This roundtable will highlight these examples and offer specific strategies and techniques for time- and cost-effective process improvements predicting long-term successful outcomes. Attendees will delve into elements that are common, and perceived as incompatible, between evidence and innovation and explore approaches to planning and design that accommodate both. Finally, identify outcome measures that predict the long-term success of selected approaches discussed.

It's Not an Accident-How Integrated Stakeholders Make Successful Design Happen

Speakers:Jerry Smith, ASLA, LEED AP, Director of Healthcare & Sustainable Initiatives, MSI Design; Peter Bardwell, FAIA, FACHA, Principal, BARDWELL+associates; Cheryl Herbert, RN, MBA, FACHE, EDAC, President, Dublin Methodist Hospital; Janet Beck, RN, MBA, Partner, Mithoff Consulting; Carol Cosler, MBA, Partner, Mithoff Consulting.

Good healthcare design doesn't “just happen”, but rather is the result of the successful integration of all stakeholders. Through the lens of these various perspectives, this presentation will explore the roles of the arbitrators of the human side of design and their influence on the collective design process. Participants will learn about the connections of the multidisciplinary design team to effectively employ their collective strengths. Elements of the program and planning process that benefit from an integrated team will be explored along with strategies to navigate through multiple user needs to implement an integrated design process that sustains traction through guiding principles to opening day!

MD Anderson Cancer Center, Houston, TXHow to Overcome the Challenges of Specifying Carpet in Healthcare Environments

Speakers:Lucy Nye, Principal Facilities Planner/Designer, MD Anderson Cancer Center; Kieren Corcoran, Market Insight Manager, INVISTA.

One of the major challenges of healthcare design is how to successfully incorporate carpet into the design solution. This roundtable will use MD Anderson as a case study to showcase how carpet can play a vital role in the design solutions. Moderators will discuss how to write a carpet specification that addresses all of the performance challenges and will share recent research studies that outline the value of carpet in healthcare settings. Attendees will explore key criteria for how to select carpet with long term performance to endure the performance demands needed in a healthcare setting.

Vertical Hospital Expansions-Look Out Below!

Speakers:Janet Sisolak, Project Director, The University of Texas, MD Anderson Cancer Center; Susan Lipka, Associate Vice-President for Capital Planning and Management Services, The University of Texas, MD Anderson Cancer Center; Pam Redden, Project Director, Clinical Operations, The University of Texas, MD Anderson Cancer Center; Ben Johanneman, McCarthy Building Companies, Inc.

The 11-story vertical expansion over an existing 12-story, occupied hospital takes continuous planning and communication to ensure successful outcomes. Maximum inpatient bed availability during the hospital's vertical expansion was paramount, requiring that key elements within construction planning and execution, project management, clinical operational planning, and communication be carefully synchronized. This presentation includes the construction, project management, and clinical planning team members who have been managing this expansion project. Learn about “doing the right things” and how to make quick adaptations in the face of challenging situations to achieve project success. HD

What is the Pebble Project?

Launched in 2000, the Pebble Project is a research initiative of The Center for Health Design and selected healthcare providers. The purpose of the work is to create change in the healthcare industry by providing researched and documented examples of healthcare facilities whose design has made a difference in improving patient and staff outcomes, as well as operating efficiency.

Healthcare Design 2010 July;10(7):14-19