Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
for Health
Presenters:
John
John Grounds,
Grounds, AIA,
AIA, LEED
LEED AP
AP
Carlos
Carlos Amato,
Amato, AIA,
AIA, ACHA,
ACHA, EDAC,
EDAC, LEED
LEED AP
AP
RBB
RBB Architects
Architects In.
In.
November
November 18,
18, 2009
2009
What is HCD09?
• The most comprehensive
HEALTHCARE DESIGN Conference
• Over 1000 attendees (4000 last year)
• Over 60 educational sessions
• 59 interactive roundtable discussion groups
• 11 state-of-the-art facility tours 9 pre-conference
workshops
• Keynote Speakers: Michael Graves, FAIA, Blair L.
Sadler, JD President Emeritus of the Rady
Children's Hospital & Health Center and Christine
Malcolm
• Exhibit Hall with 300 vendors
Learning Objectives
• It is becoming integral to
“the process”
Clients
Clients expect
expect design
design professionals
professionals to to be
be aware
aware of
of latest
latest
information
information and
and active
active participants
participants in
in developing
developing new
new data
data
Research
Research isis becoming
becoming pro-active.
pro-active.
Patient-based
Patient-based evidence
evidence is
is emerging.
emerging.
Post
Post occupancy
occupancy evaluation
evaluation is
is key.
key.
Growth of Evidence
•• Ten Key Steps to Implement Evidence-Based
Evidence-Based Design:
Design:
1.
1. Create
Create aa multidisciplinary
multidisciplinary team & develop a clear vision that
includes
includes measurable
measurable quality
quality improvement
improvement goalsgoals
2.
2. Select
Select an
an architect
architect with
with experience
experience in in evidence-based
evidence-based design
design &
&
aa proven
proven track
track record
record of of at
at least
least one
one successful
successful healthcare
healthcare
project
project
3.
3. Identify
Identify &
& select
select evidence-based
evidence-based design design interventions
interventions
4.
4. Evaluate
Evaluate current
current practice
practice and
and develop
develop aa baseline
baseline for
for each,
each, e.g.
e.g.
infections,
infections, transfers,
transfers, employee
employee turnover
turnover (develop
(develop baseline
baseline costs)
costs)
5.
5. Set
Set measurable
measurable postpost occupancy
occupancy improvement
improvement targets
targets && get
get buy
buy
in
in from
from all
all key
key stakeholders
stakeholders –– culture
culture change
change
6.
6. Incorporate
Incorporate design
design improvements
improvements into into capital
capital &
& operating
operating
budgets
budgets approved
approved by by the
the board
board
7.
7. Widely
Widely communicate
communicate improvement
improvement targetstargets internally
internally &
& externally
externally
8.
8. Track and report progress including including Financial
Financial
9.
9. Continually
Continually incorporate
incorporate newnew evidence
evidence based
based design
design strategies
strategies
10.
10. Publish your results!
Stimulus Funds
• 9 months after the signing of the American
Recovery & Reinvestment Act, the federal
government continues to make progress on
several health care provisions included in the
federal stimulus package.
Health IT
Medicaid/FMAP
Work Force Training and Development
Broadband
Community Health Centers
Rural Health
Prevention and Wellness & Comparative
Effectiveness Research
10 New Rules
10.
10. Better Buildings Cost less over time
-- Life
Life cycle
cycle vs.
vs. initial
initial costs
costs
-- 5%
5% initial
initial cost
cost investment
investment typically
typically repaid
repaid within
within 33 years.
years.
9.
9. Become
Become Bi Bi Multi-Lingual
Multi-Lingual
-- Design
Design Professionals
Professionals are
are learning
learning to
to speak
speak the
the same
same language
language
as
as Clinicians/Care
Clinicians/Care Givers.
Givers.
-- Clinicians/Design
Clinicians/Design Professionals
Professionals need
need toto speak
speak the
the same
same
language
language as as Administrators/Finance
Administrators/Finance Officers.
Officers.
-- Administrators/Finance
Administrators/Finance Officers
Officers need
need toto speak
speak the
the same
same
language
language as as Staff/Care
Staff/Care Givers.
Givers.
-- Everyone
Everyone needs
needs to
to learn
learn to
to hear
hear the
the patient.
patient.
8.
8. Move
Move from
from Silos
Silos to
to Synergy
Synergy
-- Seek
Seek outout holistic
holistic solutions.
solutions.
-- Facilitate
Facilitate multi-disciplinary
multi-disciplinary care.
-- Remove
Remove walls
walls between
between “departments”.
“departments”.
-- Facilitate
Facilitate adaptable
adaptable care
care environments.
environments.
10 New Rules
7. Embrace Radical Transparency
- Consumers trust peer recommendations.
- Everything is available on-line.
- Accept/Admit/Own mistakes and actively seek
improvement.
IT’S
IT’S OKAY
OKAY TO
TO CHEAT,
CHEAT, IF
IF YOU
YOU REALLY
REALLYDON’T
DON’T LIKE
LIKE TO
TO LOSE
LOSE
Innovations in Healthcare Delivery
•• Nanomedicine:
Nanomedicine: Future Future Applications:
Applications:
•• The
The elimination
elimination ofof bacterial
bacterial infection
infection inin aa patient
patient within
within minutes,
minutes, instead
instead
of
of using
using treatment
treatment withwith antibiotics
antibiotics over
over aa period
period of of weeks.
weeks.
•• The
The ability
ability to
to perform
perform surgery
surgery atat aa cellular
cellular level,
level, removing
removing individual
individual
diseased
diseased cells
cells and
and even
even repairing
repairing defective
defective portions
portions of of individual
individual cells.
cells.
•• Qdots:
Qdots: that
that identify
identify the
the location
location of
of cancer
cancer cells
cells in in the
the body
body
•• Nanoparticles:
Nanoparticles: that
that deliver
deliver chemotherapy
chemotherapy drugs drugs directly
directly toto cancer
cancer cells
cells
to minimize damage to healthy
to minimize damage to healthy cells. cells.
•• Nanoshells:
Nanoshells: that
that concentrate
concentrate the the heat
heat from
from infrared
infrared light
light toto destroy
destroy
cancer
cancer cells
cells with
with minimal
minimal damage
damage to to surrounding
surrounding healthy healthy cells.
cells. For
For aa
good
good visual
visual explanation
explanation of of nanoshells,
nanoshells, see see thethe picture
picture below.
below.
•• Considering
Considering thethe rapid
rapid progress
progress in in this
this field
field itit is
is hoped
hoped thatthat
nanotechnology
nanotechnology will will soon
soon bebe aa huge
huge force
force against
against diseases
diseases in in the
the
coming
coming days and it will help in wiping away the most lethal diseases in
days and it will help in wiping away the most lethal diseases in
the
the current
current era.
era.
Nanomedicine
• Stats:
Only 6 feet above sea level, 30’ from sea
998 bed Tertiary Hospital
6 story addition, 340,000 SF with 64,500
SF ED.
Completed 2008
• Lessons Learned:
Additional
Additional upfront
upfront costs
costs will pay off
Overdesigned
Overdesigned for for day
day to
to day
day use
use
Trauma
Trauma == Controlled
Controlled “Evidence
“Evidence Based
Based Chaos”
Chaos” no
no matter
matter
how
how much
much space
space you
you have
have
Storage,
Storage, Storage,
Storage, There
There is
is never
never enough…
enough…
Hospitality
Hospitality feel
feel
Form
Form follows
follows function
function ?? Absolutely!
Absolutely!
Apply
Apply Evidence
Evidence Based
Based Design
Design concepts
concepts
Florida Hospital - Ginsburg Tower
EBD notes:
Staff lounge, is at the midpoint of the
floor
Round Spire at the end of the tower is
a Conference / Education Rm.
• Stats:
$170 Million, 600,000 SF ($280 / SF)
New 12 Story Facility
Structure designed for vertical expansion
• Additional 8 story tower with 300 beds
135 acre Greenfield site
277 Beds, 82 critical care
Connected 5 story MOB
First Floor
Second Floor
Third Floor
Fourth Floor
Fifth Floor
Patient Floors
Administration
• Lessons Learned:
Iconic design statements have value
Cost savings is not a substitute for smart
design
Advanced technology may be optional
Need to Embrace the Contrarians
Take Away Concepts
Questions?
Selected References
• HCD09 Conference Proceedings
• Blair L. Sadler, JD, Healthcare Estates Welsh Conference &
Exhibition
Exhibition 2004
2004
• Angela Burke, 2030
2030 Nanotechnology
Nanotechnology inin hospitals:
hospitals: Is
Is the
the future
future
smaller?,
smaller?, NBBJ
NBBJ Architects
Architects
• Gary Burke and Terrie
Terrie Kurrasch,
Kurrasch, Ratcliff
Ratcliff Architects
Architects
• David Chambers, Sutter Healthcare
• Nanotechnology, nanomedicine and nanosurgery. International
Journal of Surgery (2005)
RBB ARCHITECTS INC