Kaiser Final Submission 4 20 11 Small

BIG IDEA

SMALL HOSPITAL

KP Small Hospital 46983


MEDICAL CARE

INTENSIVE OUTPATIENT HOSPITAL

WHEN HEALTH CAREIS WHAT HAPPENS FAILS


WHERE DO WE START?

The next generation of hospital will be designed to reduce the need for itself. It will be the first to aggressively produce the conditions for health, not just mitigate disease. It will focus on the origins of cost in an effort to drastically reduce inpatient activity. Like all complex social phenomena, there is no single technology or technique that can reduce the burden. Its about doing many “small” things, coordinated at many scales, which culminate to dramatic effect.

THE NEXT GENERATION HOSPITAL WILL LEAP FORWARD ON 2 PARALLEL MISSIONS:

TABLE OF CONTENTS

1 INTERVENTION1.0 Introduction, the intensive outpatient model: “Sites”

1.1 The efficient and connected hospital: Program

1.2 The Boundless Emergency Department

1.3 Connecting the neighborhoods: Site

1.4 An Architecture of Connection: Building form

1.5 Silo free departments: Plan and Massing

2 PREVENTION2.0 Design as healing agent: Planning for health

2.1 The first Living Building Challenge© hospital


INTERVENTIONHow do you create an affordable, sustainable, and locally viable healthcare solution that can become a building block for healthy community growth?

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1. Dispersing the “site” into many embedded neighboorhood clinics, in the most intense use areas.

2. Using hospital facilites to mitigate healthy community planning

3. Blurring the distinction between swing departments, especially emergency, outpatient and Pre/Post-Op/PACU of surgery.

4. Breaking down support areas to better facilitate collaboration, leverage visibility, and teaming.

THE IDEA

is a prototype that removes barriers to migrating care to outpatient settings. Pushing care closer to the most intensive users and reduc-ing inpatient activity, not by rationing access, but by shifting its focus.

BLAH BLAH BLAH TITLE1 INTERVENTION


Expert Authority:Profession

MonologueDoctor to Patient

PAST PRESENT FUTURE

DialogueDoctor to Patient

Blog: Team to Team

BOUNDARIES MUST BE BROKEN.

THE NEXT HOSPITAL will breach several entrenched divisions that block our ability to connect cause and effect.

Electronic records, will become sources for data mining. Clinical departments will be combined, blurred and leveraged. The real cost of decisions will be measured. This transparency reveals a closer relationship to health and design:

The real cost of convenience-On average, super-sizing a fast food meal saves 60 cents, then costs $6.00 in health issues.

The real cost of ENERGY-$1 dollar of energy equals $23 dollars of revenue.

The real costs of OBESITY-$116 Billion annually for diabetes alone.

If you knew the route to avoid illness, if you could connect the dots that extend wellbeing,

would you look to a hospital for these answers? Can a hospital inspire you to want something more?

THE NEXT HOSPITALwill come from a different archetype, one that is retail in philosophy. It will take a marketers understanding of our motivations to induce the behaviors that draw us together, and empower positive change.

The secret to retail experiences, the reason shopping is recreational, is the pleasure of finding your fit. A public solution to personal needs. Often sharing the event with friends and family. Hospitals must learn to say “yes” to its customers.

Consensus Authority: DataPartner Authority:Person

Mimic NatureVanquish Nature Learn from Nature

Select and EmpowerStudy & Sort Comfort & House

Brick Box: Warehouse Glass Box: Hotel Open Grid: Market

1 INTERVENTION


20%

10%

27%

43%

PROPORTIONAL DIAGRAM

This submission assumes 100 Beds @ 2,500 BGSF/Bed = 250,000 BGSFThis is aggressive; the normal metric is 2,870 BGSF/bed for a community hospital system.

It also implies a 75% efficiency factor.1.33 BGSF/DGSF ratio=

TOTAL BUILDING AREA

250,000 BGSF

TOTAL DEPARTMENT

188,OOO DGSF

PATIENT BEDS

SUPPORT

SUPPORT

20% (188,000 DGSF) = 38,000 DGSF

Includes M.E.P. as well as I.T.

Reasons:

Assumes system purchasing

& J.I.T. Supply

DIAGNOSTICS & TREATMENT

70%-43%= 28.45%

Total = 50,700 DGSF

Reasons:

1. Leverage D&T with Mobile Modalities

2. MOB attached with basic D&T primary care

PATIENT BEDS

100 BEDS @ 800 DGSF / bed

Reasons:

1. High acuity general medical surgical

2. Acuity adaptable private rooms with ADA toilet & assistable shower

3. Assume single room maternity C-section leveraged with surgery.

80,000 DGSF

188,000 DGSF= 43%

DIAGNOSTICS & TREATMENT

= .75 or 75% efficiency x 1

1.33250,000 BGSF = 188,000 DGSF

PUBLIC & ADMINISTRATION

Assume 10% 188,000 DGSF x .10 = 18,880 DGSF

Reasons:

1. Leadership H.R. in MOB

2. Electronic Medical Records & Digital Imaging (No archives)

3. Public elevators & circulation shared with MOB

PROGRAM ASSUMPTIONS

We have reduced the mean program by 12.6% by creating a design with surge capacity between the Outpatient Department, Emergency and Surgical Pre-Op/PACU.

Kaiser 2010 Master Planning Initiative Survey:Mean = 2,870 sf/bed

1.1

1.1 Program


FROM HOTEL FOR THE SICK TO MARKET OF HEALTH. There are limits to the power of pampering. Our proposal envisions a new archetype for the hospital expere-ince. When looking for health coaches to manage the cases of the most intensive patients, one turns to retail clerks and managers. They understood the default answer was “yes”. They are trained to connect needs and resources under a different philosophy than traditional clinitions. The “retail” hospital will take its architectural hertiage from marketplaces. Where ideas are exchanged with goods. Where optimism and empowerment are tools of the “trade”.

1.1 Program


THE BOUNDLESS EMERGENCY DEPARTMENTAt the fulcrum between inpatient and outpatient care, our proposal re-thinks the emergency department.

Flexible boundaries between E.D., Outpatient and the prep / recovery of the surgical department allow staff to flow. The purpose is to allow the surge of patients between these services as need and capacity is available throughout the 24-hr day. This also allows the staff to be leveraged between these services as patient to staff ratios allow.

The operational implication of these flexible boundaries is an integrated management and staffing of these service lines. This should yield more efficiency, safety, and greater through-put of patients.

Our experience has shown that staff who have cross trained and range across these departments find the experience fulfilling. Many clinicians have a culture of “helping out” their colleagues, which reinforces their desire for team-work and patient focused care.

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Reduced co-pay from scheduled E.D. visit• 60%

• 85% Utilization of 20 E.D. P.T.

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Outpatient Department Use of E.D. Capacity

Schedule in OPD end of the continuum

Use of cell phone registration

Access to EMR

Internet posted wait time

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Emergency Department Utilization

1.2

1.2 The Boundless ED


DISTRIBUTED TEAM STATION

The team station is the coordination hub of the E.D. Designed to allow maximum visualization of the treatment areas, it works in conjunction with the staff coordination room which features smart glazing providing privacy by darkening on command. At the entry of the exam bays, this arrangement encourages detection and coordination of chronic visitors, and creates a venue for briefings.

REMOVING THE TRIAGE BOTTLENECK

The triage flow takes on new meaning in the boundless E.D. As is also serves as exam and intake for the outpatient dept. This forms a permeable membrane which bridges the scheduled and unscheduled visit mix.

1.2 The Boundless ED


HYPOTHETICAL SITELANCASTER, CA

For the purposes of this competition we have selected a site in Lancaster, California, a community already served by Kaiser. Adjacent to an existing facility, this site seemed positioned to be a bridge between residential andcommercial while dealing with many of the common barriers aften found in communities Kaiser builds in such as the boundaries often created by freeways.

1.3

1.3 Site


CONNECTING THE NODES: REGIONAL SITE

Starting with the notion of a single site. The next community hospital must operate as a bridge on many “sites”.

The knot of medical data, and trend spotting must be solved so that the most intensive and costly pateints can transition from emergent to home based care. Our proposal includes specific features to foster “medical home” and intensive outpatient concept. We believe the physical design of the facility can greatly engender these encounters by removing specific barriers that are common today.

These interventions occur at every scale and “site” of the proposal.

A VIRTUAL NODES - web-based resources for health information, chat with nurses and doctorsB MOBILE NODES - on the go screenings, testing, seasonal shotsC YOUNG FAMILY NODES – pre-natal, birthing and pediatric focusD FAITH-BASED NODES – food banks, family counseling, stress managementE ASSISTED LIVING NODES – physical therapy, yoga, water aerobicsF BUSINESS PARK NODES – screenings, executive health counseling, stress management, occupational therapyG FITNESS CENTER NODES – Nutrition counseling, sports physicals, sports injuries, screeningsH SAFETY NET NODES – social worker support, case managers, mental health services, food assistance, housing assistanceI SCHOOL NODES – promoting healthy food choices, physical activity, screenings, physicalsJ GARDEN CENTER NODES – promoting home food growth, cooking classes, healthy food choices K SMALL HOSPITAL NODE - promoting wellness, healthy food, recreation, community gatherings, connecting all other nodes of wellness

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1.3 Site


CONNECTING THE NEIGHBORHOOD: LOCAL SITE

The next community hospital must operate as a central node within the larger wellness network.

The small hospital site becomes the convergence of wellness in the neighborhood, bridging disconnections, promoting well being in all aspects of life. It is the center of restorative wellness, promoting recreation, healthy food, physical activity, cultural events and our spiritual connections to each other.

These activities occur throughout the larger community and converge at the small hospital site where all the aspects of a health community merge.

Site elements

1 bike, running and walking paths

2 pv solar covered parking areas

3 aroma therapy and medicinal herb gardens

4 organic orchards

5 farmers market

6 Outdoor gathering amphitheatre

7 Outdoor dining, cooking, picnic areas

8 Playground

9 Sports fields

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1.3 Site


1.4 Building Form

THE SPACES IN BETWEENThe form of the project is derived not only from the programatic efficiencies of adjacent departments but form the desire to extend the projects reach much like that of an ancient city. Through streets, plazas and gre-enways the project literally reaches out to the community as well as connecting all areas of the hospital. The project creates a dynamic central”square” in which sits the community, meeting and education spaces forthe hospital. wrapping around this greencrescent courtyard are the public circulation “streets” for the project off of which all major public program elements can be accessed.Our memory of great places is largely defined not by the architecture but by these spcaes in between the architecture- the places people occupy, the spaces filed with dappledlight and human interaction. These walls of our project not only define the limits within the building but seek to extend the invitiation the build-ing sends to the community to make it a living part of the place it is is built in .

1.4


SITE PLAN

The small hospital is a “bridge building”. It connects parts of communities which were previously uncon-nected while reducing the typical impervious footprint of a traditional hospital.

1.4 Building Form


LANDSCAPE ASBUILDING,BUILDING AS LANDSCAPEIntensive green roofs control water runoff, reduce the heat island affect as well as offering physical links from one part of the community to another.There is a tangible and unmistakable valuing of Kaiser’s connection to both community and environment through the buildings form.

1.5 Floorplans and Massing

1.5


LANDSCAPE AS BUILDING,BUILDING AS LANDSCAPETopography in nature has always had the potential to act as a landmark- a symbol for a place, a way to orient yourself to ones surroundings. Architecture has the potential to do the same. Blurring the bound-aries between architecture and topography gives this project a unique potential to represent a new kind of building for Kaiser, one that orients the user to both clinical and local community environments.




LANDSCAPE AS BUILDING,BUILDING AS LANDSCAPEThe building’s seamless integration into the landscape softens the project’s form on the horizon and creates an iconic landmark for the community.





LEVEL ONEKEY ROOM PLANThe ground floor plancreates a welcoming gesture to the community- inviting entry to the facility. A grand public stret sweeps around the crescent shaped green space offering direct acces to the inpatient and outpatient functions.



LEVEL ONEKEY ROOM PLAN



LEVEL ONEDEPARTMENT PLANThe design leverages surge capacity between the Outpatient Department, Emergency and Surgical Pre-Op/PACU.

MEDICAL OFFICE BUILDINGOUTPATIENT EMERGENCY

IMAGING

SURGERY

FOOD SERVICE MAT MGMT MECHANICALADMIN

ENTRY

GARDEN

PERMEABLE SURFACE PARKING

PERMEABLE SURFACE PARKING

surge zones

surge zones



LEVEL TWODEPARTMENT PLAN

MEDICAL OFFICEMEDICAL STAFF CONF CENTER

MECH

NON INV CARDIOREHABPULMMONARYLABSRESOURCE CTR

MEETING AREA

FITNESSNURSING UNIT 30-34 BEDS

DINING

O.P. INTAKE

ROOF

OPEN


At the heart of the building is a crescent shaped outdoor garden in which the copper clad resource center and meeting facility sits. All of the public circulation fronts this garden.




The project’s roofscape is an active green-roofed surfuce connecting hospital to community and reducing the buildings impervious footprint.


HEALTHY SITE HEALTHY COMMUNITY

REGION: Connecting many community organizations with focus on promoting health and well-being of the area, the small hospital becomes a central node in the larger community health network.

COMMUNITY: Bridging barriers withing the neighborhood site, promoting healthy food options, outdoor recreation, physical activities and cultural events. The small hospital becomes a hub of healthy lifestyle activities.

DEPARTMENTS: Departments flow together, remove barriers between emergency and out-patient care. Communication is improved, staff is more fully utilized and flexibility of roles is enhanced.

STAFF: Bridging barriers to coordination and visualization of care.

2.0 Planning for Health

2.0


HEALTHY BUILDING = HEALTHY COMMUNITYORIENTATION AND DAYLIGHTING: The proposed building uses the optimal orientation and limited depth of the building to maximize the potential for daylighting on the upper levels, while using skylights to bring light into the central areas of the 1st and 2nd floor services. These strategies reduce the light-ing load substantially, reducing the lighting to 15% of the total for this facility.

ENVELOPE: The proposed building envelope is well insulated and uses high performance glass with a high R value, a low solar heat gain coefficient and a high visible light transmittance. This helps to reduce the heat gain load on the roof, walls and glazed elements of the building while, at the same time using the benefit of day light to its maximum potential.

MECHANICAL SYSTEMS: The proposed mechanical system is a highly efficient chiller plant with Smart evaporative condensing chillers and heat recovery for pre-heating hot water. Ventilation air is provided via.... These strategies reduce the mechanical system load substantially, these loads account for 13% of the total load for this facility.

WATER EFFICIENCY: The proposed building water fixtures will be highly efficient in flow rates and will help to limit the use of potable water in the facility. The building will also provide all the hot water needs of the hospital with solar hot water panels mounted to the roof of the building for maximum effi-ciency. This will greatly reduce the need for natural gas used for hot water heating in the facility.

ENERGY USE AND ON-SITE PRODUCTION: From CBECs data, an average existing hospital build-ing in the western region has an Energy Use Intensity rating of 246.8 Kbtu/sf. The proposed building was modeled and has an EUI estimated at 75.2 Kbtu/sf. To reach the goal of 75% under the average CBECs 2003 data, the facility would need to produce some of it’s own energy on site. A photo volatic array sized to make up the difference is approximately 6000 KW, about 490,000 sf of surface area. This would allow the facility to operate at 61.7 Kbtu/sf. We propose that portions of the roof, parking areas and portions of the southern facade would be covered in photo voltaic panels in order to generate power on-site.


71%

AREA LIGHTING

MISC. EQUIPMENT

VENT. FANS

11%

15%

PUMPS & AUXILLARY - 93.7 KWH

2%

SPACE COOLING - 69.8 KWH

1%

MISC. EQUIPMENT - 3962.1 KWH

71%

AREA LIGHTING - 854.1 KWH

15%

VENTILATION FANS - 593.6 KWH

11%

ANNUAL ENERGY CONSUMPTION - ELECTRICITY KWH (X000)

AREA LTG.


75%

ON THE WAY TO NET ZERO ENERGY:

70% reduction

30% generation

10%

30%

30%

Well insulated envelopeMaximum R value glassUltra low Solar heat gain coefficient glassMaximum visible tranmittance glassVery low lighting power density in all non-critical spaces 0.8 w/sf

Highly efficient ventilation air handlers and fansEnergy recovery on all exhaust sources

Highly efficient chiller plant with Smart evaporative condensing chillers Heat recovery for pre-heating hot water Solar hot water heating array on roof for hot water needs

Photo voltaic arrays, wind turbines, fuel cell boxes and other on-site energy sources will help to generate enough power to get the facility on the road to net zero energy.


2.1


APPENDIX


Major Healthcare Trends and Implications on Hospital DesignThe following key trends will shape how care is provided in the future, informing new operational paradigms and hospital design requirements. These trends are borne out of macroeconomic and regulatory/political dynamics, such as downward reimbursement pressures, quality incentives/disincentives, push to insure more people, worker supply shortage (particularly physicians), and a greater emphasis on work/life balance to name a few.

– Standard and routine work will follow best practice models, care plan templates– Advancing diagnostic capabilities will surface more complex diseases requiring a team of physician experts to determine the most effective treatment regimen– Advances in genomics will allow for more personalized medicine that will enhance outcomes– Increasing transparency related to key metrics such as clinical quality, cost, and service– Patients are increasingly more informed about diseases and purchasing healthcare

– Providers will more actively manage patients/diseases and anticipate care needs– Patient-centric care processes will evolve due to requirements for better clinical quality, outcomes, cost, service, etc.– Increasing integration of physicians and alignment of incentives and mission will support high quality, patient-centered care

The rate of change in healthcare will accelerate. Planning and design should integrate flexibility and adaptability opportunities. For example, site planning should allow for anticipated parking expansion and hospital expansion to ensure optimal connectivity and functioning of the hospital in the future. Facility design and sizing must consider ways in which aspects of the hospital can adapt to different uses or incorporate new technologies.

Small scale programs rely on sharing resources to achieve efficiency. Particularly with a relatively small hospital initially, small scale functions or services should maximize resource sharing opportunities related to staff, facilities, equipment, etc. For example, are there opportunities to share resources based on differences in time-of-day demand?

Integration of Health System resources will be essential. Fully leveraging the resources of the Health System will be vitally important to the success of the small hospital. Leveraging central laboratory resources, technology systems, purchasing contracts, etc will enable the small hospital to be as efficient as possible.

In the future, care will be delivered in a highly collaborative, team-based environment. Team rooms for multiple cliniciansTechnology to connect various experts in the hospital, health system, etc

In order to achieve quality and throughput goals, care delivery must be organized around the patient. Facilities should not be organized based on ‘departmental’ efficiencies, but ‘patient flow efficiencies.’

The small hospital will be the ‘head quarters’ for health and wellness in the community. Services and resources (e.g., nurses, technology, etc) will be dispatched from the hospital to serve the community, for example, in the areas of preventive care, care management, and follow-up care.

Healthcare delivery will increasingly rely on high-technology solutions. The care environment should correspondingly be ‘high-touch’ from the standpoint of customer service, environmental design, etc.

3.0 Appendix

3.0


PATIENT ROOMSThe patient room is a key elementof a hospital. The optimum design for the patientroom should include consideration of healthcaretrends that will influence the room’s features,including characteristics of future patients, resource

limitations, rising costs and technology.

Three distinct zones are under consideration during design, one each for caregivers, the patient and family members.

3.0 Appendix


3.0 Appendix


3.0 Appendix

Documents

Kaiser Final Submission 4 20 11 Small