Healthcare Case Study: Streamlined Health
By Anne Vazquez
Published in the November 2007 issue of Today’s Facility Manager
Creatingefficiencies is a central part of facility management, and on a grandscale, master planning is an area where this comes into play. In thelate 1990s, management at St. Joseph’s Hospital and Medical Center inPhoenix, AZ began creating a master plan for its 1.6 million squarefeet of space.
Founded in 1895, St. Joseph’s opened as asix-room cottage where the focus was to treat tuberculosis patients.Having undergone changes and growth over the past century, including amove from the original site in the 1940s, the hospital has evolved intoa full service medical and surgical center serving the Greater Phoenixarea.
In its “America’s Best Hospitals 2007” list, U.S. News & World Report ranked St. Joseph’s at 10 in the survey for neurology and neurosurgery.The hospital has been included on this list for the specialty since2002. The Barrow Neurological Institute (Barrow), which opened in 1962as part of St. Joseph’s, is recognized as a world-class medical centerfor patient care, medical education, and research.
When thehospital began considering how to modify its physical facilities forincreased operational efficiencies, the management team turned to itsmaster plan. Barrow quickly rose to the top of the list of priorities.
Nicholas Dalba, director of facilities development for St.Joseph’s, explains, “In deciding what facilities to address first, themanagement team assessed the entire campus and offerings. We took alook at each of our service lines and created a matrix. On the ‘X’ axiswe placed our business position for a particular service, and the ‘Y’axis represented the attractiveness of that service line. We plottedeach service line using these two factors, and if a particular serviceline was in a high business position and high market attractiveness,that was good. If a service line rated low in both areas, that was anarea we needed to reconfigure for improvement.
“Based onthis system,” Dalba continues, “we decided to focus initially onneurosciences, cardiovascular services, and the women’s and children’sservices. This led us to develop the neuroscience building for Barrow.”
Bringing Resources Together
Sinceit opened in 1962, Barrow occupied a building dedicated to itsoperations on the St. Joseph’s campus. As is the case for manyhospitals, as more services were offered and population needsincreased, some functions of Barrow had to be located in otherbuildings on the campus to meet the demand. The operating rooms usedfor neurosurgery, for instance, were situated in another building, andsome patient beds were “scattered throughout other portions of thehouse,” as Dalba explains.
Some of the diagnostic services that support neurological care, including MRI equipment, were spread around the campus as well.
“Thisrequired patients and staff to travel a lot around the hospital,” saysDalba. “From an operational standpoint, this was important. Staffing isa critical issue, so we want to be as efficient as possible.”
In deciding upon the best course of action, St. Joseph’sworked with the Los Angeles, CA office of Perkins+Will, which had beenengaged to provide architectural design services for campus masterplanning and programming efforts.
Russell Triplett, AIA,LEED®AP, project manager for Perkins+Will, says, “The overall goal ofthe master plan was to increase operational efficiency throughconsolidation of services with improved adjacencies to reduce traveldistances and enhance staff productivity. We wanted to respond to coreprograms. Neurology is the first one we addressed, with other projectsplanned for the future.”
In planning the BarrowNeuroscience Tower, the primary goal was to bring all neurologyfacilities at St. Joseph’s back together while also improving services.“We wanted to consolidate all the neuroscience beds in one location,”says Dalba. “Another priority was to provide adequate and state of theart surgical facilities in this particular.”
Operating rooms dedicated to neurosurgery were important tothe program, since this specialty had been sharing operating space withother types of surgery. With about 5,000 surgeries annually at Barrow,the goal was to double capacity.
In order to maximize thehospital’s resources, however, the architects placedthe newneurosurgery rooms near the operating rooms in the existing building,so the recovery space could be shared.
In all, the neurologycare facilities in the new Barrow Neuroscience Tower include 144patient beds, 11 operating rooms, three MRIs, a 26 bed pre-op area, anda 44 bed post anesthesia care unit (PACU). Barrow’s rehabilitation andresearch centers were located in other buildings on the hospital campus.
Providingpatients with attractive and comfortable surroundings was anotherimportant goal. With an eye on “family centered care,” all the patientrooms—relatively spacious at 230 square feet—are private and include acouch for overnight guests.
Perkins+Will also designedspecialized spaces for visiting family and friends. Beyond typicalfamily waiting rooms, amenities include a child’s play room completewith themed flooring and walls. Additional areas are a business center,a library, a waiting room for adults, and a meditation room. A healinggarden for quiet reflection was created on the grounds just outside thebuilding as well.
Hospital staff members also gainedaesthetically pleasing lounge areas, which, with wide expanses ofwindows, provide views of the Phoenix skyline. “Those lounges are fullof light,” notes Triplett. “It enables the nursing staff to get awayfor a period of time.
The Barrow Neuroscience Tower containsmore than neurology services, however. The project also presented theopportunity to expand general emergency and trauma capabilities at St.Joseph’s. The emergency department was relocated to the new buildingand contains 44 beds and a six-bay trauma center.
Tosome degree, the site chosen for the Barrow Neuroscience Towerinfluenced the design of the building. The space, which had beenpreviously occupied by a nursing school facility, is located betweentwo driveways. With two long sides meeting at an outer point, the landlent itself to an elongated shape.
Triplett explains, “The site dictated how the additionwould relate to the existing buildings as well as how the nursingfloors of the new building extended. Those were drivers for the form ofthe building.”
As part of the larger hospital campus, thephysical considerations of connecting the new building with twoadjacent existing facilities was another factor. The hospital wanted tomaintain the same floor to ceiling heights in the Barrow NeuroscienceTower as compared to the adjacent buildings. This set some parameterson what could be done.
“We could not make the floor toceiling height in the new building as high as we would have liked to ifit was freestanding,” says Dalba. “We didn’t want any ramps between thebuildings, so we wanted all floors to be at the same level. Thiscreated a problem in that we could not fit as much as we would haveliked to in each floor.”
This scenario also affected the mechanical systems in thebuilding in that it limited how high the space from floor to floorwould be. “The more space between deck to deck, the more room for HVACductwork and piping,” says Dalba.
But, rather than sufferthe limitations, the team took the opportunity to find alternative andbeneficial solutions. I. Bayron of the Los Angeles, CA office of SyskaHennessy Group was the project manager for the engineering (mechanical,electrical, and plumbing) portion of the project, and he notes some ofthe creative approaches taken.
“One of the changes we made tothe original plan,” says Bayron, “was to increase the floor to floorheight below the third level where the pre-op and PACU units [on thesecond level] are located. This was done so we could fit the mechanicaldistribution systems in the ceiling of the second floor.”
Inanother instance, the team altered floor to floor heights in order toaccommodate both core operations and mechanical systems. The operatingrooms, also located on the second floor, required 10′ floor to ceilingspace. As a result, space for mechanical equipment above was lost tothis operating room space. Here, the third level above was not occupiedby medical spaces; instead, the space above the operating rooms wasused to house mechanical distribution, plumbing, and electrical systems.
Acatwalk was located there to facilitate servicing for valves, terminalair units, and other equipment. This arrangement permits maintenanceaccess to the systems without having to enter the operating rooms orsupports.
“Basically, the third floor interstitial areaextends over the pre-op and PACU areas,” explains Dalba. “So, theoperating rooms are actually in a two-story volume, from the second tofourth floor. We have the catwalk at the third level over the operatingrooms that the maintenance staff uses to access all the various systemsin that space that serve the operating rooms and other functionalspaces below.”
Beyondthe space limitations, the team also needed to plan for linking thesystems to the St. Joseph’s central plant. “The new building is locatedacross a driveway from the central plant,” Bayron explains. “All theutilities run under the driveway. We spent a lot of time figuring outhow to get from point A to point B.”
Technology played a partin determining what alterations could be achieved in these endeavors.Triplett explains, “The general contractor, Kitchell, and itssubcontractors had its draftspeople convert our design documents into3-D drawings—in essence to study clearances of systems, because of thevery limited available space. That was one of the big challenges.”
Installingand linking the new systems into the hospital’s central plant also hadto be planned carefully to prevent disruption throughout the rest ofthe campus. “A big switch was with the chilled water system,” saysBayron. “We began at 6:00 a.m. on a Friday and finished by 6:00 a.m.the next day. There was a lot of planning and effort by the contractorand design team to make it happen without shutting down the hospital.It was well coordinated.”
Adds Dalba, “It was a big effort,but we are used to doing those types of things—if we have a valve toreplace, for instance. In this type of situation, we issue ‘disruptionnotices’ housewide to inform everyone of what we are doing.”
Withoperational efficiency as a central goal in the Barrow NeuroscienceTower project, the flow of patients, staff, and visitors influenced thedesign of some areas. An existing building, which would connect to thenew building, contained four elevators, which were used by all thegroups. “We wanted to segregate the patient flow from the visitorflow,” Dalba explains. “So, we included another set of four elevatorsin the new building geared for patients and staff members.”
Triplett adds, “And this didn’t affect just the newtower. In essence, this redefined the circulation in the existingbuilding. The old four elevators became public elevators, and theelevators in the new building are used by staff in both buildings.”
Theaim of increasing staff efficiency was also addressed with a newpneumatic tube system linking the Barrow Neuroscience Tower to relevantspaces, such as laboratory and pharmacy departments. With 6″ diameters,the new pathways improved on the existing 4″ wide system.
“Thebenefit of the wider pneumatic tube system is we can now transportlarger and heavier items throughout the house,” explains Dalba. “Thissaves us manpower from having to transport those items manually.”
The project also gave Dalba the opportunity to improve onother aspects of St. Joseph’s facilities. He specified a fire alarmsystem with more capabilities than existed in the rest of the campus.“This was the first step in the evolution of our upgrading the entirefire alarm system,” he explains.
Thetop floor of the Barrow Neuroscience Tower was built as a shell withthe capacity to accommodate 48 more beds at a future, undeterminedtime. This shelled portion was added to the plans after constructionwas underway, and the team was able to decide it would be feasible froma cost and operations standpoint.
“I think a lot of creditshould be given to Catholic Healthcare West [owner of St. Joseph’s] forits process, which required the team to meet at every major milestoneof the project,” says Bayron. “We discussed the value of adding certainelements to the project, and it involved negotiation between the entireteam.
“This process kept the project going,” he continues,“and, in the end, we were able to add a floor to the building and put ahelipad on the roof. That meeting process was managed very well tofinish the job on budget and add the extra floor to the building.”
Withits new facility, Barrow continues to serve neurology patients fromboth near and far. The more than 9,000 admissions each year benefitfrom the state of the art technology and surroundings created by theproject team.
“I really like the ‘two sides of the coin’ with thisbuilding,” says Triplett. “There are the highly technical back of housespaces that service the softer, more comfortable spaces for thepatients and the public.”
Says Dalba, “It’s not quite the difference between Kansas and Oz in The Wizard of Oz.But when you compare this building to older parts of the hospital,there is a distinct difference between the look and feel of the spaces.People often comment that they like the colors used in the new tower.”
After45 years of providing neurological health care and education to itscommunity and beyond, Barrow is equipped for the next half century ofinnovation.
This article was based on interviews with Bayron, Dalba, and Triplett ([email protected]).
Project: Barrow Neuroscience Tower at St. Joseph’s Hospital and Medical Center (part of Catholic Healthcare West).
Location: Phoenix, AZ.
Type of Project: New Construction.
Function of Facility: Hospital.
Owner: Catholic Healthcare West.
In-House Project Management Team: Nicholas Dalba, director of facilities development, St. Joseph’s.
Square Footage: 400,000.
Construction Timetable: 2003 to August 2006.
Cost Per Square Foot: $220.
Architect: Perkins+Will (Jean Mah, AIA, FACHA, LEED® AP, architect of record; Russell Triplett, AIA, LEED® AP, project manager).
General Contractor/Construction Manager: Kitchell Contractors (Russ Korkuska, project manager).
Electrical Engineer: Syska Hennessy Group, Inc. (Nasser Nejati).
Mechanical Engineer: Syska Hennessy Group, Inc. (I. Bayron, project manager; Bob Newfeld, plumbing lead).
Structural Engineer: Paragon Design (Mark Larsen).
Interior Designer: Lynette Tedder, IIDA, CID, AAHID, LEED® AP.
Lighting Designer: Syska Hennessy Group (Mathle Leyes); Perkins + Will (Lynnette Tedder).
Landscape Architect: Greg Flanagan and Associates (Greg Flanagan).
Patient Area Furnishings: Nemschoff; Brayton.
Office Furnishings: Herman Miller.
Seating: Nemschoff; Brayton; Steelcase.
Storage: Herman Miller.
Flooring: Forbo Linoleum; Tarkett Sheet Vinyl; Johnsonite.
Carpet: Bentley Prince Street.
Textiles: Luna; Momentum; Paul Brayton Textiles.
Surfacing: Staron; Avonite; Nevamar.
Building Management System: Andover.
Security System: DSX.
CCTV: First Line (DVD recorders); Pelco (camera controls).
Smart Cards: DSX.
Security Alarms: DSX.
Fire Alarms: Notifier Onyx Series.
Safety Equipment: Notifier (annunciators and strobes); SimplexGrinnell (sprinklers).
Lighting Control Products: PCI.
Lighting Sensors: WattStopper.
Lighting Fixtures: Mark Lighting; Kurt Versen; Translite Sonoma; Alko; Louis Poulsen; Edison Price.
Dimming Ballasts: Lutron.
HVACMechanical Equipment: Energy Labs (air handling units); Twin City(fans); Cleaver Brooks (steam boiler); Armstrong (heat exchangers,pumps); Cemline (hospital grade steam generators); Aerco (domesticwater heaters).
Power Supply Equipment: General Electric.
Back Up Power (UPS): Cummins.
IT Infrastructure: Genre, Burton & Associates (Tony Sanchez).
Roofing System: APP Roflex Series.
Exit Signs: Lithonia LRP; McPhilben.
Windows/CurtainWalls/Skylights: EFCO 5900 Series (window curtain wall system);Northwestern Industries (skylights); Pentaglas by CPI International.
Window Treatments: MechoShade (solar and blackout).
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