TUESDAY, MARCH 27
7 – 8 a.m. | AIA/AAH Sunrise Forums
Codes and Standards Forum: Programming + Planning
Rebecca Lewis, Principal, DSGW Architects; Scott Miller, NCARB, FACHA, Architect, Wold Architects & Engineers; Jennifer Aliber, FACHA, AIA, Principal, Shepley Bulfinch; Peter L. Bardwell, FAIA, FACHA, Principal-in-Charge, BARDWELL+associates
Programming and planning provide the foundation for the development of every hospital and health care facility. They are often the initial point of conversation with clients for a business plan. Crafting a code compliant program with the knowledge of the concomitant implications that address health care delivery requirements is a prerequisite for success. This forum will review recurring code issues, explore case studies, and discuss improvements to the codes that regulate the programming and planning of hospitals and health care facilities.
- Explore the code and design implementation strategies for different regions of the country.
- Confirm code/licensing requirements.
- Examine relevant case studies to determine common code characteristics for programming and planning hospitals and health care facilities.
- Illustrate the tools needed to create code compliant hospitals and health care facilities that meet the business strategy/model for the client.
- Review strategies for developing “universal” code compliant programs and the overview of common challenges.
Professionals in Healthcare Organizations
Vincent Della Donna, AIA, ACHA, Principal & Healthcare Architect, AIA Academy of Architecture for Health; Patrick Fugeman, AIA, MBA, VP Design & Construction, Christiana Care Health System
The Professionals in Healthcare Organizations Forum is a platform for interaction and open discussion between professionals working in healthcare facilities (architects, engineers, biomedical engineers, contractors, facility managers, risk managers, etc.) and consultant design professionals. This forum will review with audience participation some of the administrative and practical issues associated with the delivery and operations of healthcare projects.
- Network with colleagues sharing common goals
- Share strategies and solutions for common issues with peers
- Discuss through a broad overview the concepts and operations of project delivery methodologies
- Discuss other critical issues affecting the industry
8 – 8:15 a.m. | Networking Break
8:15 – 9:15 a.m. | Concurrent Sessions III
Improving Patient Short Stay Environments
Sheila Cahnman, FAIA, FACHA, LEED AP, President, JumpGarden Consulting LLC; Alice Gittler, EDAC, LEED Green Associate, Lean/Six Sigma for Healthcare, Healthcare Research, EwingCole; Larry Weems, Vice President of Hospitalist Services, System Lead Physician for Hospital Medicine, Palliative Care and Hospice Organization, Novant Health
Clinical practice and improved operations are substantially reducing inpatient lengths of stay while increasing services provided in an outpatient setting. What is the appropriate setting for these short stay patients that promotes the best clinical outcomes and patient and family experience, but doesn’t use the space and resources of an inpatient unit? This presentation will review the clinical, operational, and facility requirements of short stay units both inside and outside of the hospital.
- Assess why short stay units are the result of ongoing changes in health care reimbursement and clinical practice
- Review code requirements for short stay units and how they may be inadequate for optimum patient experience
- Evaluate the types of short stay settings both inside and outside of the traditional hospital and the key design elements that research says supports best practices and patient experience
- Review a case study of an innovative short stay approach designed to provide care in a welcoming outpatient environment
Putting Competition Aside: Architects Collaborate to Eliminate HAIs
Cathleen Lange; Alberto Salvatore, AIA, NCARB, EDAC, Principal, Salvatore Associates; Anne Garrity, LEED AP, Shepley Bulfinch; Paula Wright, RN, BSN, CIC, Project Manager, Infection Control Unit, Massachusetts General Hospital; Steffian Architects AIA, LEED AP, Executive Principal and Managing Director, Boston Office, Steffian Bradley Architects
Every year an estimated $20 billion is spent and approximately 75,000 people die as a result of health care-associated infections in the United States. The solutions that will eliminate HAIs must include a collaborative effort in design thinking by all constituents. In 2015, seven multidisciplinary firms entered a design competition to prevent HAIs and then joined forces to form The HAIO Patient Room Challenge Group. We are eager to share our story, process, and solutions with architects and health leaders.
- Unearth the truths and myths of infection prevention
- Explore other industries for HAI solutions
- Identify the importance of collaborative design
- Discuss known and found HAI-prevention barriers in the implementation phase of a project
Designing and Specifying Fire and Smoke Doors
James Peterkin, PE, LEED AP, Senior Life Safety Consultant, Fire Protection, TLC Engineering for Architecture
The defend-in-place strategy used in health care occupancies is a critical function of patient safety. Because of limited mobility, and in some cases immobility, of patients, it is in the best interest of the patient to remain in place during fire emergencies. In rare cases patients may need to be horizontally relocated away from the fire but not evacuated from the building. For these reasons, fire safety features required for health care occupancies must be properly designed to applicable codes.
- Describe the concept of defend in place
- Identify the correct type of wall separation
- Identify the correct fire or smoke door for the type of wall
- Assess when a fire stop assembly is required
Rethinking Rural Health Care Facilities as Community Engagement Portals
Arthur Brito, EDAC, LEED AP BD+C, DGNB Auditor, Associate Principal and Senior Vice President, HKS, Inc.; Monish Sarkar, Vice President, HKS, Inc.; Vicki Lewis, RN, MS, FACHE, CEO, Coffee Regional Medical Center
Falling reimbursements and the shift away from inpatient care create a challenge for hospitals to balance business, resources, and services provided. As population migrates toward cities, rural health care faces a larger problem in financial sustainability, and an increase in mergers and acquisitions has added pressure on rural hospitals to look at innovative and nontraditional ways to remain viable. Learn how a more community-oriented and sustainable rural health care facility is being created with a facility master plan and non-traditional solutions.
- Recognize current population health issues at play in rural hospitals and potential realignment of services
- Identify the key variables used to forecast bed need and determine feasible facility strategies
- Explore consumer-oriented design as a means for community engagement and a resource for population health management
- Identify effective solutions to repurpose rural health facilities in the era of declining inpatient services and increased specialization
The Single-Bed Patient Room: A 10-Year Review
Ellen Taylor, PhD, AIA, MBA, EDAC, Vice President, Research at The Center for Health Design; Melissa Piatkowski, MS, EDAC, Research Associate, The Center for Health Design; Alan Card, PhD, MPH, Research Associate, The Center for Health Design
In 2006 the Facility Guidelines Institute introduced the requirement that all hospital patient rooms be designed for single-patient use. Ten years later, the requirement is standard practice and other countries have adopted versions of the requirement. With a recent focus on the high cost of construction and limited capital resources in the United States, should FGI revisit this mandate? Researchers will present what they learned from a study of the implementation of the single-patient room as a minimum requirement.
- Discuss how FGI is striving to use research to inform their Guidelines
- Describe variations in patient outcomes from the use of single-patient rooms across health care settings and countries
- Recognize what gaps exist across the studies of single-patient rooms
- Evaluate the advantages and disadvantages of single-patient rooms for patients, staff, and family and visitors
Ultimate Adaptability: Planning and Design amid Federal Uncertainty
John Andrews, AIA, NCARB, Vice President, Senior Project Manager, LEO A DALY; Arthur Smith III, NCARB, Senior Associate, LEO A DALY; Patrick Connell, RN, MBA, FACHE, CBHE, CHC, Vice President, Boys Town National Research Hospital
As a federal health care debate raged in 2015, Boys Town National Research Hospital and LEO A DALY were in the midst of designing a new residential treatment center for at-risk youth. Faced with the uncertainty of funding to sustain the care model, the partnership engineered the space to serve alternative purposes as a back-up plan. This session will detail the planning and design strategies used to adapt while meeting the needs of the highly regarded behavioral health care model.
- Identify key design and engineering elements that allow a behavioral health facility to also serve as an inpatient facility
- Frame the current federal health care debate within the context of past historical occurrences and from a bipartisan perspective
- List specific features for inpatient centers recommended by the Facility Guidelines Institute that can also be used within the behavioral health context, and why they are of benefit
- Identify specific ways an at-risk youth behavioral health facility can increase safety for its patients, staff, and visitors
Going It Alone: The 2018 Outpatient Guidelines
Kirsten Waltz, AIA, ACHA, EDAC, LEED AP, President, U.S. Operations, Steffian Bradley Architects;
Rebecca Lewis, AIA, FACHA, CID, Principal, DSGW Architects
The 2018 edition of the Facility Guidelines Institute’s (FGI) Guidelines for Design and Construction has published the requirements for outpatient facilities separately with the goal of making the requirements flexible to address a variety of projects types, from small clinics or doctor’s offices to tenant improvements in larger buildings to large medical office buildings with multiple clinical services. This session will address the substantively revised text and new language, including applying the guidelines to facility types not included in the document.
- Discuss core differences in the approach to designing hospitals, outpatient facilities, and residential long-term care facilities
- Apply common element requirements to support the delivery of care in outpatient facilities, such as provision of imaging facilities and operating and procedure rooms in a doctor’s office as well as in surgery and endoscopy centers.
- Explain how to find and apply design requirements for outpatient facility types that do not have specific requirements in the Outpatient Guidelines document.
- Take advantage of the flexibility provided in the outpatient guidelines when designing very small or tenant improvement projects
9:15 – 9:30 a.m. | Networking Break
9:30 – 10:45 a.m. | General Session
Innovations in Health Care: Flexibility
Joe Powell, Executive Director, Healthcare Infrastructure Research
This session presented case studies of innovations advancing health care design, construction, and operations and creating facilities that are flexible for the future. The Healthcare Infrastructure Research Institute and ASHE have been working together to identify innovations in the health care field. A jury reviewed more than 70 innovations and selected 16 ideas as best practice. This session will discuss four of the top innovations and will spur attendees to think about innovations for flexibility in their own organizations.
- Describe four innovation projects and their benefits
- Discuss whether the innovations can spur additional flexibility in your organization
- Explain the need for sharing best practices with colleagues and the potential benefits of innovation sharing on health care delivery
- Describe broad themes in innovation that span multiple projects
10:45 a.m. – 1:45 p.m. | Exhibit Hall, Lunch, Architecture for Health Gallery
1:45 – 2:45 p.m. | General Session
The Surveyors’ Perspective: Understanding How Joint Commission Surveyors Conduct Hospital Surveys
James Kendig, MS, CHSP, CHCM, CHEM, LHRM, Field Director, The Joint Commission; Timothy Markijohn, MBA/MHA, CHFM, CHE, Field Director, Surveyor Management and Development Division of Accreditation & Certification Operations, The Joint Commission
This session will discuss how Joint Commission surveyors prepare for surveys and explain the new agenda process, including details on the agenda if a Life Safety Code surveyor arrives on day one or day two of the survey. Presenters will explain how scoring is completed, the SAFER matrix, and new Project REFRESH pilots, as well as review the new fire drill matrix. Attendees can get answers directly from those overseeing Joint Commission Life Safety Code surveyors.
- Describe how Life Safety Code surveyors prepare for surveys
- Explain step by step how surveyors conduct surveys
- Discuss new Joint Commission survey process initiatives
- Implement tips for a successful Life Safety Code survey
2:45 – 3 p.m. | Networking Break
3 – 4 | Concurrent Session IV
Achieving Creativity in Health Care Design
Frank Zilm, D. Arch., FAIA, FACHA, Chester Dean Director Institute for Health and Wellness Design,
The University of Kansas
Are we achieving creative solutions to our health care needs or rearranging deck chairs on the Titanic? This session looks at the question of creativity through research on the personality characteristics of health care architects. The profile of the sample architects is compared to other design team members and to a major study of creative architects conducted in the mid-twentieth century. Suggestions regarding the design process and team culture will also be presented.
- Evaluate personality strengths of successful health care architects
- Identify differences and common characteristics of design team members
- Assess the implications of personalty strength on the design process
- Explore team culture and establishing trust in the process
Balancing Form and Function in Today’s Psychiatric Facilities
Erica Larson, CID, CHID, EDAC, LEED AP BD+C, Principal, Pope Architects, Inc.; John Ryan, JD, Minnesota Bar Association, Wisconsin Bar Association, American Health Lawyers Association, Physician Owned Hospitals of America, PrairieCare
The shortage of mental health beds for youth is a nationwide problem. One organization overcame legislative hurdles to fill the gap with a new psychiatric hospital. The hospital remains at 100% capacity, and turns away five patients per day. PrairieCare used staff and parent input, product research, and best practices to create a highly secure setting that is aesthetically approachable, tailored to its population, and non-institutional. Patient and staff surveys provide lessons learned for care delivery and design innovations.
- Discuss the significant need for mental health services and facilities, and the hurdles of navigating a specific legislative process
- Explain the shifts in design for today’s non-institutionalized psychiatric settings
- Apply specific architectural solutions that prioritize patient safety while balancing aesthetics and facility maintenance
- Describe examples of specific post-occupancy feedback from patients and staff
Ripple Effect: Creating a Community-Centric Health Hub
Kurt Theune, CHC, DBIA, LEED AP, Construction Executive, Mortenson Construction; Kelly Noel, LEED AP, UPTIME ATS, Senior Vice President Facilities, Aurora Health Care; Scott Lindvall, AIA, NCARB, Principal, HGA Architects
Planning, design, and construction can create a ripple effect that begins with planning and extends well beyond a hospital’s grand opening. This presentation will discuss the catalytic effect a hospital can have on population health and make recommendations for strategies for participants to implement within their own organizations. The session will include improving the patient experience, safety, quality, brand awareness, economic impact, outreach efforts, population health and wellness, and opportunities for partnership.
- Explain the collaborative team mentality necessary for successful project planning and execution
- Assess how to identify guiding principles that affect population health and wellness
- Identify the short- and long-term effects a new facility can have on a community
- List opportunities for your organization to have a ripple effect
Intermountain’s Center for Disaster Readiness: Biosafety and Biocontainment Lessons and Principles
Cyndi McCullough, Senior Communications Specialist, HDR; Selvam Rajavelu, AIA, NCARB, President, NJRA Architects, Inc.; Sharon Sumner, RN, BSN, CIC, Infection Prevention and Control, Infection Preventionist, Intermountain Medical Center
This session identifies the risks in health care settings and how to reduce them by applying fundamental facility design principles related to biocontainment. The presentation will showcase the new Center for Disaster Readiness for Intermountain Healthcare and focus on lessons learned from Emory University and University of Nebraska Medical Center, where Ebola patients have been safely managed. Developing new models for facility design and operations and incorporating fundamental design principles can improve safety for patients, caregivers, maintenance personnel, and the community.
- Identify issues inherent in handling patients with highly pathogenic infectious disease in health care settings
- Describe fundamental design principles for biosafety and biocontainment
- Identify lessons learned from facilities that have handled patients with Ebola and other highly pathogenic infectious diseases
- Explain biocontainment design and protocol guidance specifically for patient care facilities
Mobile Vision: Perspectives of an AHJ and Manufacturer
James R. (Skip) Gregory, NCARB, President, Health Facility Consulting, LLC; Mark Munroe, Vice President of Strategic Projects and Mobile Solutions, STERIS Corporation
Mobile medical units are used throughout the country. The 2018 edition of the Facility Guidelines Institute’s Guidelines for hospitals and outpatient facilities completely revised the chapters on the design of these units; this presentation will explain the revisions, the precepts the revisions were based on, and how the revisions improve patient safety and make it possible for manufacturers to fully comply with the Guidelines. A coach manufacturer representative and an authority having jurisdiction present perspectives on applying the revised requirements.
- Explain the impetus and methodology for the major revisions to the chapter on mobile/transportable medical units in the 2018 Guidelines
- Apply the new tables for imaging and examination/procedure/operating rooms to the classification of mobile/transportable medical units
- Describe how these revisions will affect the design and construction of mobile/transportable medical units and maintain patient safety
- Describe how the new requirements make it possible for unit manufacturers to comply with the Guidelines to support provision of safe, effective patient care in mobile/transportable medical units
Challenging the Status Quo in Surgery Design
Tatiana Guimaraes, Senior Associate, Perkins + Will
Medicine is advancing at breakneck speed. Health care facilities, however, often have a lifespan of 50+ years. The change in the practice of surgical medicine has been vast and fast, and there is an urgent need to challenge existing design practices. Designers accommodate this continuous change through flexibility and vision. This presentation highlights four different case studies that defy the current surgery design model. In addition to an overview of the traditional “clean core” concept, three project designs will be discussed.
- Identify key strategy for surgery design
- Assess surgical flows in different operational models
- Describe pre/post area ratios
- Identify the need for and impact of future flexibility
Population Health and the Quadruple Aim
Louis Meilink, Jr., AIA, ACHA, ACHE, Principal, Ballinger; Christina Grimes, AIA, LEED AP BD+C, EDAC, Senior Associate, Ballinger; Debbie Phillips, AIA, ACHA, EDAC, Senior Healthcare Planner, Ballinger
Population health can be affected by modifying behaviors, the physical environment, and proximity of care. To increase and improve access, architects can help navigate from the triple aim (the right care, at the right time, at the right cost) to a quadruple aim: care in the right place. To improve the patient care environment, architects can design spaces that emphasize humanistic care, support the healing process, and improve infection control rates. This session explores how design partnerships with health care providers are significant to improving overall wellness for communities.
- Describe the relationship between population health and the importance of place.
- Explain the health determinants of population health and how outcomes are measured and affected by the design process.
- Show how humanistic design contributes to an institution’s image within the community.
- Provide examples of a variety of scaled projects to contribute to a healthier community.
4 – 4:10 p.m. | Networking Break
4:10 – 5:10 p.m. | Concurrent Sessions V
Legionella in Health Care: The Importance of Water Management
Heather Platt, PE, MBA, Senior Mechanical Engineer, Mazzetti+GBA; Enid Eck, RN, BA, MPH, Infection Control Specialist, Mazzetti+GBA Consultant; John Wood, CHC, CHFM, SASHE, Senior Associate, Senior Facility Operations Consultant, Mazzetti+GBA
Hospitals are increasingly in need of water risk management planning to reduce and eliminate the possibility of waterborne illness such as Legionella. ASHRAE published the new standard ASHRAE 188-2015 to establish minimum requirements for building water systems. This session offers a review of the ASHE water management monograph to assist members in complying with the standard and demonstrate why a water management plan ensures patient and facility safety.
- Develop a water management program to protect patients, visitors, and staff from waterborne pathogens
- Meet the water system requirements of CMS Condition of Participation 482.42 Infection Control, Joint Commisssion Enviroment of Care, and the ASHRAE Standard 188
- Reduce waterborne HAIs
- Identify case examples of waterborne pathogens and scenarios
From Old Med/Surge to New Behavioral Health–How Hard is it Really?
Eric Lautzenheiser, Director, Health Facilities Planning, Francis Cauffman; Erin Kelly, AIA, NCARB, Senior Associate, Francis Cauffman; Peter Palmer, Project Manager, Atlantic Health Morristown Medical Center; Thomas Zaubler, MD, MPH, Chairman, Department of Psychiatry, Atlantic Health Morristown Medical Center
The conversion of a dated inpatient unit to behavioral health can seem simple, given the assumption of a “low acuity patient,” but the challenges range from concept to fit out. This session presents a case study of an expanded and altered inpatient behavioral health unit from start through post-occupancy feedback. The challenges of renovation for behavioral health can be underestimated, yet there are compelling opportunities for shaping focused and effective behavioral health environments and responding to increased community needs.
- Shape space that addresses key design priorities, including clear sightlines, social interaction space, and patient and staff safety
- Identify essential design and fit-out elements in shaping a safe and comfortable enviornment for at-risk patients
- Identify key issues with complex patient groups, including acuity range and co-morbidity patients
- Describe key lessons learned based on post-occupancy observations
Impact of Connected Care on the Built Environment
Carrie Condry, Senior Technology Consultant, Mazzetti+GBA; Josh Kelly, RCDD, Senior Technology Consultant, Mazzetti+GBA
More than 8.3 million people receive support from long-term care services. At the same time, the continued focus for hospitals on reducing readmissions is forcing systemic changes. Some health systems are adding aftercare facilities to their own campuses and recognize that communication can improve patient outcomes. Moving communication and monitoring beyond the physical walls of the hospital requires significant changes inside the hospital walls. As health systems push the boundaries of care, the built environment must support this growth.
- Identify new monitoring technologies that will affect workflow and the built environment
- Explore examples where health systems are implementing integrated solutions
- Discuss industry changes and challenges that are creating the need for new solutions
- Assess options facilities should consider in preparation for these technology challenges
The 2018 Guidelines: Demystifying Imaging, Operating, and Procedure Rooms
Bryan Langlands, AIA, ACHA, EDAC, LEED GA, Principal, NBBJ; Kevin Matuszewski, AIA, LEED-AP, Senior Vice President, Cannon Design
This presentation will review revisions to the 2018 FGI Guidelines for Design and Construction of hospitals and outpatient facilities, focusing on the sections that address exam/treatment, procedure, operating, and imaging rooms. The 2018 Guidelines clarify the definition and application of requirements for hospital and outpatient facility room types where procedures take place based on level of invasiveness and the perceived risk to the patient. The presenters will discuss a new imaging room classification system and revised operating room space requirements.
- Predict procedure room needs based on the procedures a health care organization plans to perform
- Explain the new imaging room classification system and how it can be applied to the design of imaging facilities
- Describe how the minimum operating room size can be determined for a project and when minimum requirements may not meet a client’s needs for the procedures to be performed
- Discuss the clearances needed to accommodate provision of anesthesia and other staff in a procedure or operating room
3D Cameras for Hospital Construction and Facility Management
Michael Bown, Associate Professor, Brigham Young University
3D cameras can create images during construction that will make life easier for owners and facility managers. This presentation will demonstrate the use of a high-end 3D camera for a new hospital project. A camera was used to form a detailed composite of the building before the walls were closed. The details and cost of creating high-quality imagery will be discussed and examples given of situations where a 3D camera could have prevented operating issues and made warranty discussions easier.
- Judge the usefulness of 3D imagery for a specific project or building
- Assess the cost of creating high quality 3D imagery using a particular platform
- Discuss the things a facility manager will be concerned about during ongoing operation
- Describe the need to plan ahead during construction to avoid operating issues and warranty complications
The Health Facilitator
Lindsay Todd, EDAC, Vice President, HKS, Inc.; Brian Holmes, Senior Vice President of Real Estate Development & Deployment, Texas Health Resources; Craig Kolstad, AIA, NCARB, LEED BD+C, ULI, Associate Principal and Senior Vice President, HKS, Inc.; Brett McClung, Executive Vice President and North Zone Operations Leader, Texas Health Resources
What if the new paradigm for a hospital was that of a proactive health facilitator rather than the more traditional, reactive role? Inherently, this would imply a foundational shift to the programming, design, and operational assumptions associated with a hospital. The Texas Health Resources campus in Frisco will serve as a case study with the objective to exploit this building project’s potential and evolve the current hospital model to more closely reflect a transition toward health, wellness, and preventative care.
- Explore the community impact potential of a health facilitator by evaluating site selection and design, place-making architecture and campus strategies, and a hospital’s reach outward
- Identify the responsible design impact of the health facilitator
- Assess the user impact opportunity of a health facilitator from the perspectives of the staff, patient, and visitor
- Hypothesize the anticipated long-term impact of a health facilitator in a neighborhood
Gender and Cultural Equity in Health Care PDC – An honest discussion
Krista McDonald Biason, PE, Associate Vice President, HGA Architects and Engineers
Training for technical careers is reflecting more diversity, but we are not seeing the same trend in the design and construction industry. This interactive session is part of a continuing conversation about the current state of leadership. The diverse team of presenters will provide statistics and findings from ASHE surveys that have focused on equity issues. The goal is to share experiences, concerns, and strategies for a diverse work force and how to engage the best and brightest talent.
- Review statistics of women and minorities in the construction field
- Discuss benefits and challenges to attain equity in leadership roles
- Engage attendees in select topics regarding workplace challenges
- Report out to the group a summary of individual tabletop discussions to evaluate alignment