Hospital Case Study: The Hospital Of The Future

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By Heidi Schwartz
Published in the June 2005 issue of Today’s Facility Manager

Futuristic images conjure up clichéd concepts like flying automobiles, freeze dried feasts, and family vacations on distant planets. In more practical terms, facility managers in all industries have been hearing tales about the paperless office and intelligent buildings. But in the world of health care, the hospital of the future is all about growth; and at Banner Estrella in Phoenix, AZ, the future is right here, right now.

Opened in January 2005, this acute care hospital was the brainchild of Connie Harmsen, the CEO of the facility. Javier Quesada, project manager for Banner Estrella explains, “Harmsen was given the responsibility of providing care for the West Valley, an area that’s experiencing tremendous expansion. Harmsen had to conceptualize a facility that could handle the demands of the growing population while serving as the footprint for all future Banner facilities. The task was complex before it was even initiated.”

Harmsen’s response to the assignment was equally complex. First, she came up with the concept of “the hospital of the future” in order to accommodate the demands of the community. To accomplish this, she promoted the idea of “transforming the health care experience” as a method to satisfy patients and inspire members of the project management team.

“This is a concept we all took to heart,” says Quesada. “We asked ourselves, ‘How can we transform the health care experience to make it positive and unique-the way we all dream it should be? When we started with a bar that high, everything else fell into place.”

Open Farmland Yields A Bounty Of Ideas

In early 2002, the site of the new Banner Estrella facility (and its surrounding environs) was nothing more than undeveloped agricultural land; the site was “literally a green field” with views of the scenic Estrella mountains, explains architectural firm NBBJ’s John Pangrazio, partner in charge of the project. “But there was easy access from important roadways (the I-10 and Route 101), which is very important for any health care institution,” he continues.

The ideal location and the vision provided by Harmsen inspired project management team members to work with an unconventional sense of cooperation, trust, and respect. “Before we even developed a space and a functional program, we were thinking about the future and exploring this vision. There were numerous focus group sessions very early on that included hospital futurists, planners, members from the Banner System organization, and the design teams,” Pangrazio recalls.

Quesada notes the uncharacteristically collaborative nature of these meetings, where participants were able to focus entirely on how the project should unfold. “Everyone had an idea about how things should be done, but they were able to put that aside if it wouldn’t work in our situation. They could say, ‘this may be the way I’ve done it for the last 20 years, but if you tell me it’s not going to work now, I’m going to have to leave that outside.’ That was the beauty of this project. It evolved into something that took on a life of its own.”

Those involved in the project saw it as an opportunity to do something unusual-to create a facility that benefited from the vast amount of experience and knowledge of each person on the team. “We wanted to marry the ideas, thoughts, and conceptual philosophy behind all of our experiences in health care and create a success. And we knew these ideas would work, because we saw them work in other facilities,” Quesada continues.

Fortunately, people didn’t get territorial, because everything was handled in a sensitive way. Jackie Bolin, VP of health care for the Los Angeles office of Syska Hennessy Group and project manager for the mechanical, electrical, and plumbing building systems for Banner notes, “If someone was a specialist on a subject, the feeling was, ‘this is your subject; you educate us.’ People were heard, and they showed the same consideration when others spoke up and shared their thoughts. There was respect for the specialist in the same way you respect what doctors and nurses know. Our attitude was, ‘Bring it to the table and we’ll try to incorporate it.’”

Plan Today For Tomorrow’s Needs

Despite the ambitious vision and collaborative nature of the project, members of the team didn’t have the luxury of time in terms of completion dates. In fact, it only took two years and seven months for Banner Estrella to go “from clean paper to opening the doors,” Quesada adds.

Bolin recalls it was necessary to stagger the project to meet the target date. “The schedule was very challenging, but it made us get creative.

One of the unusual things we did was break it down into two separate packages. Part one was shell and core (SC), and part two was tenant improvements (TI). The shell and core package-complete with shafts, elevators, stairs, and major equipment-was designed and approved before we ever saw what the departments were really going to look like,” says Bolin. “We were able to start construction long before we had finished our TI documentation,” she continues.

Still, the demands of the schedule were no excuse for poor communication or shortcuts. “We had teaming sessions where all of the big players were brought together to discuss our problems, challenges, and attempts to help each other prioritize the work to keep the schedule moving. In fact, this was one of our top vision comments from the very beginning; we would not use schedule as an excuse,” Bolin notes.

For the members of this team, it was more important to take the time to discuss a problem early on, even when things were moving at their fastest pace. Bolin concedes, “It’s very easy to say, ‘I don’t have time for a meeting’ when deadlines are approaching quickly. But talking things through face to face, even when the clock was ticking, was what helped us most to focus on what needed to be done. Priority one was to keep the project moving along.”

In the end, this attitude helped the team members focus on the bigger picture. “Sometimes, we came up with creative things that we probably wouldn’t have if we hadn’t been in the room bouncing ideas off of other people,” she concludes.

The Brains Behind The Brawn

To create a new health care concept, additional barriers were removed. “Transforming that health experience meant providing a healing environment where patients would not feel like they were being processed in a cold environment and then sent home,” Quesada explains. “Rather, our patients would feel comforted and healed, thus eliminating the walls we build whenever we see the doctor or go to a hospital. We set out to create a clean environment from which our patients would not want to go home. Instead, they’d want to stay here,” he adds.

To deliver the right kind of patient experience-both compassionate and cutting edge-Bolin incorporated the latest technology. “In terms of patient care, we selected the newest technologies and clinical modalities for the opening. But technology becomes obsolete very quickly. You order one set of radiology equipment, and by the time you open, you’re ordering something different because it has been upgraded.”

A significant focus was put on planning this building and laying things out appropriately, “so they could change and upgrade those technologies and modalities rapidly, efficiently, and with minimal impact to patients. They wanted to be cutting edge from the beginning and stay cutting edge throughout,” Bolin explains.

Part of the hospital of the future concept was designing the building to be “plug and play.” By carefully creating a backbone to handle Banner Estrella’s present and future technology demands, it became possible to deliver numerous services without inconveniencing anyone.

Bolin says, “We created a spine that goes all the way along the building. All the services are there, and they’re all expandable; you can plug in anywhere. The way it was laid out, all departments are expandable or contractable. Best of all, there’s minimal impact to the patient. This is an important point, particularly since we anticipate future growth and construction. It can be traumatic for patients trying to find their way around a strange facility that’s under construction,” she notes.

The spine creates true separation between public, clinical, and patient areas. “A lot of the staff members behind the scenes are not clinical; they’re people who deliver drugs, linen, and all of these things around the hospital,” Bolin explains. “Using this spine concept, distribution for them is exceptionally easy. They don’t have to pass through many patient areas to do it, which means they have more space and they can move around at will without disrupting patient movement.”

For facility management purposes, the spine makes it much easier to maintain, operate, and expand the mechanical aspects of the building. “This 16′ x 16′ tunnel holds all the utilities and can be left open for members of the facilities staff, who can travel the full length of the hospital without ever having to step out into patient areas,” Bolin adds.

“When it comes time for the expansion,” she continues, “we’ve already built in the valves and the breakthrough points. All they have to do is build the basement, knock through the wall, connect the pipes, and bingo! There’s extra hospital!”

By the time Banner Estrella opened its doors, numerous housing developments began to surround the facility. The hospital has clearly served as an attraction in this growing community. And word of mouth about the services provided will only attract more people.

Quesada recalls an anecdote about a departing patient who had recently moved to the area from Texas. “There was only one thing he didn’t like about the facility, and that was the name. In his booming Texan voice, he said, ‘This should not be called Banner Estrella; it should be the Banner Hilton!’ When I heard about that comment, I knew we were well on the road to accomplishing our goal: to make a real difference to those who matter most.”

This article was based on interviews with Bolin, Pangrazio, and Quesada. For more information on this project, contact Carol Walker of Syska Hennessy Group at [email protected]

 

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Project Information:

Project: Banner Estrella Medical Center. Location: Phoenix, AZ. Type of Project: New. Function of Facility: Acute Care Hospital. Owner: Banner Health. Manager: Kim Burke, AVP-Design & Construction, Strategic Development Department. In House Project Management Team: Javier Quesada, Project Manager; Susie Faz-McCann, RN, Clinical Project Manager-Design & Construction. Square Footage: 440,000. Construction Timetable: 31 months. Budget: $90 million; $200.84 per square foot. Architect/Lighting Designer: NBBJ. Associate Architects: The Orcutt/Winslow Partnership. Electrical/Mechanical Engineer: Syska Hennessy Group, Inc. Structural Engineer: Paul Koehler. General Contractor/Construction Manager: DPR Construction. Landscape Architect: Steve Martino Associates.

Product Information:

Furniture: Herman Miller; Nemschoff. Wall Coverings: J.M. Lynne. Movable Walls: Hufcor. Flooring: Mannington Commercial; Sadler Tile. Carpet: Mannington Commercial. Ceilings: Armstrong. Fabrics: Designtex. Window Treatments: Solar Shading Systems. Storage: Herman Miller. Light Fixtures: Columbia; Lumascape; Lithonia. Lighting Controls: Square D; Lutron. Exit Signs: Lithonia. Rest Rooms: American Standard. Security (includes CCTV, door locks, smart cards, safety equipment, alarms, and sensors): Siemens Building Technologies. HVAC: Tower Engineering Cooling Towers; Vapor Power International Boilers; York International Chillers; Cemline Corporation Heat Exchangers; Bell & Gossett Pumps; Energy Labs, Inc. Air Handling Units; Loren Cook Company Fans. Building Management Systems/Services: Siemens Building Technologies. Power Supply Equipment: Square D; Russelectric Automatic Transfer Switches; Caterpillar Generators. Windows/Curtain Walls/Skylights: Walters & Wolfe. Glazing: Viracon/Bendheim. Elevators/Escalators: Kone, Inc.

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