While the benefits of caring for inpatients within a private room have now been time tested, there are thousands who still receive care outside of this clinically preferred environment on a daily basis.   As is often the case, the benefits may be clear, but the perceived cost of providing more private patient rooms has prevented the wholesale adoption of this basic principle throughout the United States. Building new bed towers has been an option for systems that could afford to build new facilities.  However, many systems do not have that luxury or are landlocked, at capacity and cannot expand or afford to give up beds from their license.  This session will provide a roadmap for the successful renovation of patient units to accommodate all private rooms, or enhanced 2-Bed rooms that incorporate best clinical practices in a cost effective manner.  By breaking down the success factors into ten key considerations, this session will allow designers, managers, and contractors to plan and execute such projects more effectively.   Case studies will be presented to demonstrate how this straightforward approach can increase the success of renovations that convert (primarily) double bedded units into single patient room units.

1. Session E09
Your Aging Patient Bed Tower- Top Ten Considerations When Renovating

2. Presenters
Adrian Hagerty, AIA, LEED AP
Principal, Regional Vice President, National Capital Region
p , g , p g
Array Architects
Patricia Malick, AAHID, EDAC, Lean Green Belt
Principal, Practice Area Leader-Interior Design
Array Architects

3. Session E09
Your Aging Patient Bed Tower- Top Ten Considerations When Renovating
While the benefits of caring for inpatients within a private room have now been time tested, there are thousands who still
receive care outside of this clinically preferred environment on a daily basis. As is often the case, the benefits may be
clear, but the perceived cost of providing more private patient rooms has prevented the wholesale adoption of this basic
principle throughout the United States. Building new bed towers has been an option for systems that could afford to build
new facilities. However, many systems do not have that luxury or are landlocked, at capacity and cannot expand or afford
to give up beds from their license. This session will provide a roadmap for the successful renovation of patient units to
accommodate all private rooms, or enhanced 2-Bed rooms that incorporate best clinical practices in a cost effective
manner. By breaking down the success factors into ten key considerations, this session will allow designers, managers,
and contractors to plan and execute such projects more effectively. Case studies will be presented to demonstrate how
this straightforward approach can increase the success of renovations that convert (primarily) double bedded units into
single patient room units.
Learning Objectives:
1.Explore elements that create a renovated environment that is consistent with patient centered & family centered care.
2.Learn how inpatient renovation projects can improve operational efficiency.
3.Discuss how inpatient unit renovation projects present opportunities to implement sustainable design strategies.
4.Demonstrate the value of integrating infrastructure improvements with inpatient unit renovation projects.

4. Session E09
Your Aging Patient Bed Tower- Top Ten Considerations When Renovating
George Costanzamight disagree:
https://www.youtube.com/watch?v=VfvKc_9YbCs

5. 01 operational
IT
efficiency 07 infrastructure
02 logistical 08 accessibility
03 life safety 09 sustainability
04 control
infection
y
10 i l d
patient/family
05 patient
involved care
safety Array’s 06 i i
Lean
Process Approach
lean
process
engineering • University Hospitals
• New York Presbyterian
case
studies

6. Recognizing “necessity is the mother of invention”

7. finding the
BALANCE
between
LEAN & MEAN

8. 01
operational efficiency considerations
• Using Lean Design principles, test the work flow within a
ensuremaximum unit to ensure maximum efficiency
• Define Current State & Map Future State
• Observe, , Envision, Model, Build Consensus
Value Stream Mapping Spaghetti Mapping Diagrams

9. 01
operational efficiency considerations
• Engagement with Caregivers and Patients
• Rapid Testing of Future State Solutions
• Data-driven Decisions
Rapid Testing Empathy Mapping

12. 02
logistical considerations: feasibility study
• Determine appropriate level of renovation required
• Develop a plan to effectively execute renovation that
minimizes day-to-day disruptions to hospital
operations
• Proper Phasing is essential to success
(vertical vs. horizontal stacked phasing, cost of
escalation)
• BIM can be used to assist Stacked Phasing decisions
Vertical Stacked Phasing Horizontal Stacked Phasing

13. 03
life safety considerations
• Providing a safe environment is utmost
priority
• Using ILSM (interim life safety measures) will
result in ZERO disruption to operations
• 3 main steps in planning and implementation
of ILSMs:
(1) Pre-Construction Assessment
(2) Development and Daily Monitoring of an
ILSM Compliance Checklist
(1) Close-out of the ILSM to transition back
to standard operating procedures.

15. It’s more than just
WASHING
your hands.

16. 04
infection control considerations
• 1 in 20 patients acquire an infection during hospital stay
• Aspergillus- most common microbes associated with construction
• ICRA (infection control risk assessment)-multidisciplinary, documented assessment
process to proactively identify and mitigate risks from infection that could occur
during construction activities
• Process should begin in early stages with stakeholders; CM with strong track record

17. A nurturing environment =
HAPPY Patients =
higher HCAHPS scores

18. 05
patient safety considerations
• Patient Unit Design should promote healing and
collaboration
foster patient and family • Provide adequate support zones to reduce hazards
• Consider proximity of bed to bathroom; lifts
• Install multi-function lighting options & controls
• Provide patient control of shading, education and
entertainment
• Incorporate noise reducing design elements
• Integrate equipment and alarm configuration
• Provide materials which are easily cleaned AND
maintained

19. 06
engineering considerations
• HVAC system can account for more than 50% of the
cost
• Comprehensive facility condition assessment is
necessary- surprises can be expensive
• Ideal opportunity to correct facility deficiencies=
improved operational costs over the life of the facility

20. ARE NOT THE ANSWER

21. 07
IT infrastructure considerations
• CINS (Clinical Integration Networks) allow caregivers to
access the data of patients
• EMR access becomes hub for all activity on floor
• Provide Access to Point of Care (POC) Mobile Technology,
Nurse Call Innovations
• Patient Entertainment, Education, Communication & Surveys

22. ACCESSibility
is more than just clearances

23. 08
accessibility considerations
• “Barrier-Free Health Care Initiative”- goal of ensuring
that persons with disabilities have access to medical
information as well as physical access
• “ADA Path of Travel” requirement- visualize entire path
of travel from the drop off point to patient’s destination
• Verify that constructed solution meets design criteria
and ADAG requirements.

24. Can you make your father’s
OLDSMOBILE
run like a
PRIUS?

25. 09
sustainability considerations
• Environmentally-friendly design & system choices
• Investigate opportunities to recycle construction waste
•• Identify design and engineering options that reduce electricity and
water use
• Focus on selecting sustainable project materials that support high
indoor environment quality (IEQ), and green cleaning

26. ““““We’’’’re all in this
TOGETHER.””

27. 10 patient/family-involved care
id ti
considerations
• Opportunity to reinvent the patient
pp y p
experience
- Wow Factor – Inspire Confidence
- Create Generative Spaces
- Promise, Deliver, Delight!
• Use Amenity & Touchpointmapping to
elevate the patient/family experience

28. OINTS OF IMPACT Mapping the Patient and Visitor Experience
Wayfinding Clarity…
I know amgoing
Patient Centered…
Family Focused
where I am going
WELCOME DISCOVER RESPITE RECOVER
First Impressions…
I made the right choice
Gathering Zones…
I need a breather

29. So How Do We Get There?

30. Conventional Approach

31. Conventional Approach

32. A New Approach
PROCESS LED DESIGN
Solution
Discovery
Creation
Analysis

33. CASE STUDY
University Hospitals
MacDonald Women’s Hospital

34. Project Drivers:
• Aging Infrastructure
• Parity with other University Health System Hospitals
• Create a patient-centered, healing environment for high-risk
maternity patients

35. patient and family centered
1. information sharing
2. foster collaboration / participation / education
3. honor patient and family perspectives
4. accommodate diversity – (cultural; socio-economic)
5. right support/right place/right time
6. proximity to Level III NICU

36. operational ideals
1. quality / safety initiatives
2. support UH model-of-care
3. technology and equipment integration
4. de-centralized caregiver zones
5. improve acoustics / ergonomics
6. exceptional ‘‘guest’ service

37. Current State:

38. Current State:

39. Inspiration:
strength .. joy .. trust .. beauty .. promise .. growth .. calm .. warmth

40. Team
Station:

41. Unit Corridor
& Team Stations:

42. Private
Patient Room:

43. University Hospitals
MacDonald Women’s Hospital
PHASE 1
July 2, 2013 – Page 43
NICU ACCESS

44. CASE STUDY
NewYork-Presbyterian Hospital
Milstein Tower

45. overview
current state
Milstein Enhancement Bed Unit Renovation
Typical Floor Project Challenges:
• Project Scope: 5 Floors, 20 Bed
Units, 680 Beds
• Construction Start:
4Q 2012
• Construction Complete:
1Q 2018
• Project Cost: 160Million

46. Overview
current state
Milstein Enhancement Bed Unit Renovation
existing conditions

47. Overview
current state
Milstein Enhancement Bed Unit Renovation
existing conditions

48. current state best practice influencers vision
current
state
• infrastructure deficiencies
• out of sync with World‐Class reputation
• patient and family perspective
best
• safe, equitable
• patient and family centered
• operational ideals
practice
i fl
• patient experience improvement strategies
• HCAPHS, patient satisfaction scores
influencers • evidence based design
• “patients first” mission
• building vision
towards an experience
• stakeholder survey, amenity mapping, image dialogue

49. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
Modern with clean lines, classic & natural elements
Perceived as a place of science while having the warmth of a home.
image survey results: design vocabulary

50. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
58% 39% 3%
# of respondents # of respondents # of respondents
19 A 13 B 1 C
image survey results: art

51. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
12% 42% 45%
# of respondents # of respondents # of respondents
4 1 14 2 15 3
image survey results: cars

52. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
39% 61%
# of respondents # of respondents
13 1 20 2
image survey results: home

53. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
27% 73%
# of respondents # of respondents
9 1 24 2
image survey results: hotel

54. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
9% 52%
39%
1 2 3
# of respondents # of respondents # of respondents
3
17 13
image survey results: front door

55. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
How should the Milstein Tower be perceived by patients and families?
1st choice
1st choice
1st choice
58%
9%
33%
3rd choice 58%
# of respondents # of p respondents # of respondents
18 place of science 1 1 temporary home 3 spa / resort

56. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
What adjectives describe the aesthetic goals the enhanced bed unit?
a) sleek and modern 4
b) warm and cozy
2
c) quiet and peaceful
9
d) educational and engaging
1
e) ______________________ 17

57. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
Image Survey Total
Responses Preferred #1 Preferred #2 Preferred #3 Preferred #4 Preferred #5
77%
A ‐ Wood
Stone/Textures/Tones 31 14 10 3 1 3
B Simplicity/Clean Lines 31 7 6 3 5 10
‐ 23% 32%
C ‐ Luxe/Amenity Rich 31 3 4 6 7 58%
11
D ‐ Color Saturated 31 4 6 13 8 0
68%
E ‐ Patterns/Shape/Texture 31 2 5 4 12 8
65%
image results survey

58. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
Preferred . Not Preferred
77%
23% 32%
58%
68%
65%
image results survey

59. Overview current state influencers vision
Milstein Enhancement Bed Unit Renovation example
What adjectives describe the aesthetic goals the enhanced bed unit?
a) sleek and modern 4
b) warm and cozy
2
c) quiet and peaceful
9
d) educational and engaging
1
e)
f)
Write in: “All of the above” 6
Write in: “A+C” 6
Write in: “welcoming” or “technology” 4

60. CIRCULATION
VERTICAL CIRCULATION
Milstein Enhancement Bed Unit
Renovation
MER / IT / SHAFTS
PATIENT BEDS (QUAD)
PATIENT BEDS (ISO)
PATIENT BEDS (DOUBLE)
PATIENT BEDS (SINGLE)
CLINICAL SUPPORT
OFFICE / ADMIN SUPPORT
IMAGING

61. ELEVATOR
LOBBY
SCHEMATIC VIEW

62. UNIT
CORRIDOR
SCHEMATIC VIEW

63. PRIVATE
ROOM
SCHEMATIC VIEW

64. Milstein Enhancement Bed Unit Renovation
example

65. enhancements: overview
enhancement level comparison example

66. enhancements: overview
enhancement level comparison example

67. enhancements: overview
enhancement level comparison example

68. enhancements: overview
enhancement level comparison example

69. Milstein Enhancement Bed Unit Renovation
$154.2M
TOTAL BED UNIT PROJECT
$141.1M
TOTAL BED UNIT PROJECT
FUNDING INCLUDING
INFRASTRUCTURE AND IT
FUNDING EXCLUDING
INFRASTRUCTURE AND IT
Bed Unit Enhancements
FACE Program
Contingency Alignment
Infrastructure
IT

70. phasing scenario studies - example
HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH
9
MCKEEN MCKEEN
BEHAVIORAL
INFECTIOUS
HEALTH
DISEASE NEUROSURGERY NEUROLOGY /
8 EPILEPSY REHABILITATION NEURO ICU
SURGERY TRANSPLANT SURGERY /
ORTHOPEDICS HOSPITALIST
MEDICAL
SURGICAL
GENERAL
GENERAL
7
6
ONCOLOGY
ONCOLOGY
MEDICINE
MEDICINE
CARDIAC SURGERY
STEP CARDIAC ICU CARDIOLOGY CARDIAC
5
PHASE 0: CONSTRUCTION COMPLETION: PROJECT COSTS:
EXISTING STACKING
NA NA
STEP-DOWN
DIAGRAM

71. phasing scenario studies - example
HUDSON NORTH HUDSON SOUTH GARDEN NORTH GARDEN SOUTH
BEHAVIORAL
HEALTH 9
ORTHOPEDICS /
TRANSPLANT TRANSPLANT MCKEEN
NEUROLOGY /
8 EPILEPSY NEUROSURGERY REHABILITATION NEURO ICU
MEDICAL
ONCOLOGY
SURGICAL
ONCOLOGY
GENERAL
GENERAL
7
6
INFECTIOUS
SURGERY SWING SPACE
RENOVATE FOR
CARDIAC
HOSPITALIST MEDICINE
MEDICINE 5
DISEASE
CARDIAC SURGERY
STEP CARDIAC ICU CARDIOLOGY CCAARRDDIIAACC
PHASE 16: CONSTRUCTION COMPLETION: PROJECT COSTS:
1Q2019 $154 2M
STEP-DOWN
RENOVATE CARDIAC 154.2M

72. QUESTIONS & ANSWERS