In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject.

Jeff Nicholas is director of healthcare at Tocci Building Companies (Woburn, Mass.) and has 30 years of experience in medical construction and management. Here, he shares his thoughts on how the integration and convergence of technology, project delivery teams, and tracking tools are impacting facility design.

1. Integrating medical technology

The integration of disparate medical technologies began accelerating years ago when cancer treatment centers began using 3-D CT imaging to plan radiation therapy. This has now expanded to using MRI imaging for treatment planning. Similarly, MRI, CT, and bi-plane imaging modalities have been introduced onto the interventional surgical platform resulting in hybrid operating rooms. Today, advances in telemedicine/teleradiology/telesurgery technology provide for high-resolution images to be transmitted and viewed from remote locations, allowing radiologists, physicians, and surgeons to treat patients from across the street or 1,000 miles away. This trend is now informing healthcare facility design, and the speed of change raises the stakes in facility adaptability.

2. Improving patient floor operations

Patient floor designs are being influenced through the use of technologies like smartphones as clinical tools. By quickly obtaining advice and information, caregivers can remain closely connected to the patient. Patient rooms are also becoming larger to help deliver better care, which increases travel distances for staff and makes central nurses’ stations and supply areas less practical and less prevalent. Automated re-stocking and point-of-care systems are being used to reduce delays in care and promote improved focus on the patient.

3. Building stronger project teams

Another area of convergence is the increased use of project delivery approaches, such as design/build, integrated project delivery (IPD), and public private partnerships (P3), that integrate involvement across the project team from planning through operations. These delivery models leverage the expertise of team participants early in the planning and preparation of design documents rather than waiting until later in the design and construction phases.

4. Utilizing better project tools

Technological advances are also impacting healthcare planning, design, and construction. For a project with a Boston hospital, the hospital's IPD team is using 15 software systems to track and manage activities on a $300 million multi-phase addition and renovation. These systems are better informing our activity planning and the hospital facility and clinical teams are better prepared and more aware of plans and phases. The transition to fully functioning care delivery space can include useable facility management data obtained directly from the project documentation.

5. Linking design and trade work

The concept of IPD also extends to the linking of MEP design objectives to actual trade work documentation and coordination, work sequencing, pre-fabrication and fabrication, and field work sequencing. The final documentation is delivered through a combination of design engineers and trade worker efforts with minimal rework and improved team efficiency. For the Boston hospital project, the trade partners supported the MEP engineers with trade documentation and are setting up a multi-trade, off-site prefabrication work zone. Trade teams use the 3-D models created in design to plan their work on headwall and other pre-fabricated assemblies. Employees have the advantage of working on a well-lit bench in a conditioned space, which helps improve quality, efficiency, and safety.

Jeff Nicholas

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