Healthcare Case Study: All-Inclusive
By Anne Vazquez
Published in the November 2009 issue of Today’s Facility Manager
With a campus that occupies 166 acres and operates in 50 buildings comprised of 12.5 million square feet, Cleveland Clinic in Ohio serves thousands of patients from all over the world each year. (In 2008, there were 3.6 million outpatient visits and 48,300 hospital admissions.) This non-profit academic healthcare facility provides care in a wide variety of medical specialties, and to maintain its high level of service, the administrative arm of the organization keeps a close eye on the evolving needs of the Clinic.
To that end, relevant stakeholders at the organization focus on ensuring the campus master plan is an active document that administrators use to determine the best course of action for how the Clinic proceeds in modifying its facilities to achieve optimal patient outcomes.
As part of his responsibilities at the Clinic, John D’Angelo, director of facility management there since 2007, works with the Physician Leadership to maintain existing facilities and bring new ones online. His most recent major challenge was the activation of two new buildings in the central part of the campus—the Sydell and Arnold Miller Family Pavilion and Glickman Tower. These adjoining buildings, which comprise 1.3 million square feet, now house the Sydell and Arnold Miller Family Heart & Vascular Institute and the Glickman Urological & Kidney Institute.
Says D’Angelo, “These departments had outgrown their existing spaces. And some of their functions were spread out over the campus. A primary purpose of our master plan is to facilitate controlled growth in areas where it is needed (as well as realignment in others). So these buildings were constructed as part of the continuing look at our operations through that planning process.”
In order to make Miller Pavilion and Glickman Tower a reality, the Clinic’s Board of Trustees provided executive planning and decision making and launched a fundraising campaign. “We have an incredibly active Board of Trustees,” explains D’Angelo. “They took a look at the master plan and put together an idea of how much this project was going to cost. They then did fundraising in order to offset those costs. As a not for profit organization, our ability to grow and improve our infrastructure would be much more limited without a proactive board. We really benefit from the leadership of our Trustees.”
“The buildings were really done right,” he says. “The Clinic didn’t do this with a ‘bare bones,’ cheapest solution. We kept our patients in mind, and that of course benefits patient outcomes. In addition, there are a lot of wonderful things used in the buildings that only the facilities staff would know as they are working behind the scenes.”
When D’Angelo began working at the facility in 2007 the project was already underway, but once on board at the Clinic, he was heavily involved in activating the buildings. “As is typical with construction projects,” he says, “this went through various stages, where getting the buildings up is a significant challenge, and then toward the end, punching out items for completion is another significant challenge. I was not here for that first part, but I was there as part of the punching out process at the end. And even before that stage, I had every opportunity to voice any concerns and opinions and to get them addressed.”
A Chat With John D’Angelo, director of facilities management, Cleveland Clinic
What are your responsibilities at Cleveland Clinic? I am director of facilities management for the health system, which is comprised of approximately 200 buildings, totalling about 23 million square feet. The bulk of our facilities are in Ohio, with 12 hospitals and 16 family health centers in eight counties. We also have a hospital in Westin, FL, with medical office buildings in Westin and West Palm Beach. And there is a new hub in Las Vegas, with some medical office buildings in surrounding cities. Additionally, we have a facility in Toronto. These are all under the Cleveland Clinic umbrella.
How long have you worked at Cleveland Clinic? How long have you been in the facility management (FM) profession? I have been with the Clinic for two years. I have worked in FM for my entire career. I worked for 20 years as a naval officer doing FM, construction, and contingency construction for the U.S. Navy.
What notable changes have occurred in FM during your tenure in the profession? In the early years of my career as a construction project manager, projects were handled by invitation for bid. It was low bid, and there was no sense of partnering with contractors. That has changed, and I’ve actually seen a change in every aspect of FM to mutually supportive partnering. Related to that, I think people have begun to realize that best value is generally better than cheapest initial cost. Still, there are organizations with business models based on initial cost; they don’t realize initial cost decisions are going to impact them for the next 30, 40, or 50 years that the facility is in existence. Also, BIM [building information modeling] is a tool to move toward a best value approach. We have access to BIM files for the new buildings.
Miller Family Pavilion, New Main Entrance
With patient care and the Clinic’s place in the Cleveland community central to this expansion, the 10-story Miller Family Pavilion was not only designed to stand out visually with its curved form, but it was also decided that the building would become the main entryway to the entire campus. At the time, there was not one main entrance, and the Clinic took the opportunity to create unity with this decision.
Says D’Angelo, “Prior to this project, a true main entrance had been lacking. The campus was not connected; there wasn’t a central focal point. And it could be fairly confusing for patients—even longtime patients—to find their destination. We are trying to achieve the best clinical outcomes, so relieving some of the stress a patient experiences was a big part of creating the new main entrance in the Miller Family Pavilion.”
Centrally sited in the campus, the new main entrance includes a tree lined drive and water features to welcome visitors. This controlled aesthetic was intended to provide a calming influence for those approaching and leaving the campus. Once inside the multistory lobby, visitors can gain assistance from “red coats”—greeters who are trained to provide directions and offer other facility information.
The consolidation of the Clinic’s Heart & Vascular Institute brought the resources for this clinical specialty under one roof. The designers sought to streamline these resources for the benefit of both patients and staff members. For instance, rooms for diagnostic services (e.g., CT, MRI) were sited in a joint imaging center on the first floor.
In addition, Miller Family Pavilion houses 278 private rooms, 110 intensive care unit (ICU) beds, 16 operating rooms, 79 procedure rooms, 128 exam rooms, and 155 physician offices.
To aid in reducing stress, each patient room features floor to ceiling windows that provide views of either Lake Erie or downtown Cleveland. Other stress reduction strategies included installing slideover panels to conceal the medical equipment positioned behind patient beds. “It has been discovered,” says D’Angelo, “that when patients walk in their room and see that equipment, they get stressed. The panels help eliminate that.”
Retail shops, artwork in the main lobby and other common spaces, and a massage and relaxation suite add to the atmosphere inside. Outside, a rooftop plaza provides a retreat for patients and visitors. Consisting of a glass enclosed patio and outdoor walkway, with seating for up to 150 people, the plaza was not part of the original design.
Explains D’Angelo, “The decision to create that space came from our CEO [Dr. Delos M. Cosgrove] after he was up on the roof for a topping out ceremony. The views of Lake Erie and downtown Cleveland prompted him to assert that it should be part of the patient experience. It really is a great place for patients, visitors, and staff to take time out and relax.”
Home to the Clinic’s Urological & Kidney Institute, the 322,000 square foot Glickman Tower is connected to Miller Family Pavilion by a structure containing a four story high hallway. Set behind the larger building, Glickman Tower brings together the specialty’s resources to include 21 dialysis beds, 74 exam rooms, 20 procedure rooms, and a conference room with telemedicine, satellite video, and digital imaging capabilities.
With 12 floors, Glickman Tower is slightly taller than Miller Family Pavilion; the top two floors of the building house mechanical equipment and shell space.
Behind The Scenes
Efforts to provide a comfortable facility for the thousands of patients visiting the Clinic each year were not limited to the front of house design strategies. The areas that D’Angelo and his staff are most frequently working in support the tasks of caregivers. And the extensive planning that went into those spaces and the building systems contained therein have made his job easier, he explains.
“These buildings have probably the nicest mechanical and electrical spaces I have worked with in my career,” says D’Angelo. “As complex as the buildings are, the systems are laid out in such a way that they are very simplified. I attribute this largely to our internal construction team and our construction contractors working closely on these aspects. Walking through those spaces, you get a feel for the pride of craftsmanship the contractors put into it.”
Discussing the possibility of disaster and emergency events, D’Angelo says the mechanical and electrical systems were placed in a manner that would make it easier to recover from a building wide disaster. He cites the four diesel generators (each two megawatt capacity) that would provide power to the Miller and Glickman facilities in the event of an emergency.
“The generators are located above all the patient floors, so there isn’t a threat from events like a flood, for instance,” he says. “Many building designs place the generator room in the smallest, darkest, deepest room in the building. That’s not the easiest place to prevent an issue from affecting a generator, and it’s certainly not the easiest place to recover from a generator problem.”
When the buildings were opened in October 2008, the new facility represented the largest single expansion in the Clinic’s history. Additionally, an underground service center was constructed as part of this project to upgrade and consolidate functions that had been previously served by several individual sites.
Located underneath a 4,000 space parking garage (built at the same time), the new service center,
D’Angelo explains, “is the hub for incoming and outgoing materials needed to serve the clinical core.” This includes food service items, linens, and medical supplies. In addition to providing ample space for trucks to deliver and pick up materials, along with increased storage, the new service center operates with the help of autonomously guided vehicles programmed to transport materials back and forth between clinical areas.
Miller Family Pavilion and Glickman Tower have been in operation for a year, and D’Angelo reports the buildings are operating as intended. “There is some shell space being converted, but otherwise, there is not much tweaking to be done. We are now working to bring some of the other buildings on campus up to the new standard of care these new buildings have created for us.”
Speaking on the two new buildings, D’Angelo concludes, “My favorite part is how everything acts together to foster patient care and improve outcomes,” says D’Angelo. “These buildings were designed and built with that in mind.”
This article was based on an interview with D’Angelo. Find out more at the Cleveland Clinic Web site (www.meetthebuildings.com).
Project Information (Arnold and Sydell Miller Family Pavilion):
Type Of Facility: New. Function Of Facility: Healthcare, housing the Sydell and Arnold Miller Family Heart & Vascular Institute. Location: Cleveland, OH. Square Footage: 985,000. Budget: $506 million (with $360 million for construction). Construction Timetable: April 2005 to October 2008. Cost Per Square Foot: $365 (construction). Facility Owner: Cleveland Clinic. In-House Facility Manager: John D’Angelo, director of facilities management. Architect: NBBJ; Bostwick Design. General Contractor/Construction Manager: The Whiting-Turner Contracting Co. Electrical/Mechanical Engineer: Bard, Rao & Athanos. Structural Engineer: Korda/Nemeth. Interior Designer: NBBJ; Patricia Able Design. Lighting Designer: NBBJ. Landscape Architect: Peter Walker Partners. Other Consultants: Balfour Concord (owner’s representative); Buric Consultants (scheduling); Façade Forensics (exterior wall); Balfour Resource Group (transition planning); RTKL (equipment planning).
Product Information (Arnold and Sydell Miller Family Pavilion):
Furniture: Brayton; Cumberland; Dauphin; Gunlocke; ICF; Nienkamper; Steelcase. Flooring: Forbo; Johnsonite; Mannington; Tate. Carpet: Collins & Aikman (Tandus). Ceilings: Armstrong; Decoustics; USG. Wallcoverings/Textiles: Maharam; Spinneybeck; Ultrafabrics. Paint: Sherwin-Williams. Office Equipment: Xerox. Building Management System/Services: Johnson Controls. CMMS Software: Facilities Survey, Inc. Security System Components: Matrix Systems. Fire Alarm Components: SimplexGrinnell. Other Safety Equipment: Patterson (fire pump); Tyco (sprinklers). Lighting Products: Advance; American Ballasts; Fulham; Lithonia; OSRAM Sylvania; Philips; Spectrum; Universal. HVAC Equipment: Environmental Air Systems, Inc. (air handlers); Greenheck (fans). Power Supply Equipment: Caterpillar (emergency generators); Cutler-Hammer (switchgear/substations). IT Infrastructure: Corning (fiber optics); Systimax (cabling). Roofing: Soprema. Exit Signs: Hubbell, Inc. Other Signage: Brilliant Electric Sign Co. Ltd.; Signets. Curtainwall: Permasteelisa. Window Treatments: MechoShade (blinds). Elevators/Escalators: Otis.
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