Hospital Case Study: Comfort Level
By Anne Cosgrove
Published in the May 2012 issue of Facility Executive
There is a CT scanner designed to look like a pirate ship, an MRI machine room outfitted like a treehouse, and activity rooms geared for younger children, teens, and family time. Video games, movies, and the Internet are available in each of the 204 private rooms, and a clown or furry pets can come to visit. If the Joe DiMaggio Children’s Hospital (JDCH) in Hollywood, FL didn’t have such a serious mission, it would appear to be a place dedicated to providing multiple opportunities to play.
But JDCH does have the serious mission of providing medical care around the area to several thousand pediatric patients. Over the years, JDCH has evolved from a community hospital to a regional specialty healthcare provider. In 2010, the facility handled more than 8,000 patient admissions and observation cases, up from 2,000 in 1992. In 2008, hospital administrators began planning for an expansion of the facilities in response to this demand.
The origins of JDCH date back to 1973, when a pediatric department opened within Memorial Regional Hospital (the flagship facility of the Memorial Healthcare System). In 1992, this children’s facility was named after Joe DiMaggio in recognition of the personal time and financial support the baseball legend had given to the facility during his time in the area. An expansion was realized, and JDCH began operating in its own freestanding building in July 2011.
The new 160,000 square foot facility was built on a site adjacent to Memorial Regional Hospital. It is connected by an elevated, enclosed skywalk to pediatric services that remained in the original location.
David Schlemmer, administrative director of construction for Memorial Healthcare System, says, “A leading factor in planning this new facility was to provide an identity for the Joe DiMaggio Children’s Hospital in our community. For many years we were ‘the hospital inside a hospital.’ An important benefit of this new building is having the ability to redefine the hospital’s space and expand upon the patient care.”
A Chat With David Schlemmer
Administrative Director of Construction
Memorial Healthcare System
What are your responsibilities for Memorial Healthcare System? As administrative director of construction, I am responsible for all construction projects that take place in the six hospitals and numerous satellite facilities we operate throughout south Florida. This includes budgeting, working with all contractors and other hired firms, and coordinating with internal stakeholders.
How long have you worked at Memorial Healthcare System? I have worked for the system since 1988.
During your tenure working in healthcare facilities, what are some of the notable changes in the industry that have impacted your work? Occupant health and safety has always been a primary focus in hospitals, but the increasing attention on sustainable practices has raised the bar even further in recent years. Also, the regulations we comply to have changed, but we stay abreast of those so we can meet the requirements as quickly as possible.
Making A Play For Healing
An environment that includes colorful materials and friendly images is standard fare in most children’s hospitals, but at JDCH this approach was taken to another level. Keeping the hospital’s namesake in mind and embracing the concept that physical surroundings impact the healing process, hospital administrators collaborated with the architectural design firm Stanley Beaman & Sears, Inc., of Atlanta, GA, to create a “Power of Play” theme for the facility.
This dynamic theme resulted in the inclusion of a variety of spaces geared to relax and entertain children and their families during their time at the facility. Each of the four levels of the hospital centers around a different aspect of play. The first floor is represented by Sports; the second floor is Arts; the third floor is Games; and the top level is Dreams. And each floor also features a dominant color scheme: Sports is red; Arts is green; Games is orange; and Dreams is blue.
In designing the hospital, the architects also drew on input from staff members in multiple departments and from the JDCH Family Advisory Council. The aim was to advance the patient and family centered approach to healthcare that the hospital practices. This construction project provided the opportunity for JDCH to equip its medical professionals with more tools to deliver quality care, while also making a space where the facility’s young patients and families would feel as comfortable and relaxed as possible.
Schlemmer, explains, “Many of the colors, designs, and even some of the features integrated into the building resulted from consult with a Family Advisory Council, our employees, and our physicians. Many of those people went out into the community and traveled to other healthcare organizations to look at similar types of facilities and discover what works best and what is most practical.”
Each of the patient rooms is private, and the hospital offers video games, movies, and the Internet for patients. The design of these rooms also considers the needs of family and friends. “We were able to redefine these spaces to make the rooms even more family centered,” said Schlemmer. “The rooms are designed to accommodate family members who may want to stay there 24 hours a day.” [For more on patient and family centered design, see the sidebar below.]
The theme of play extends to some of the medical equipment as well. The pirate ship decor of the CAT scan room is an example of how the surroundings were viewed as an integral part of care provided at JDCH.
Speaking about the pirate ship decor, Schlemmer says, “It relieves some of the pressure on a child as he or she is going in for an exam. There are objects they can relate to, and they can relax. There is a mini machine there that a child can insert a doll into as play. These elements are also aimed at reducing the need to sedate the child during the procedure.”
Patient Centered Design
By Phyllis Goetz, EDAC PVDN
Designing environments that enhance interaction of patients, family, friends, and staff tremendously impacts the healing process. Facilitating this involves taking the perspective of patients who have concerns about their visitors’ comfort and accommodations.
Are there places for my friends to sit? Is the nurse feeling like visitors are in the way? In a pediatric unit, does the room accommodate parents’ presence and assist them in helping with their child’s needs? Designing a room with a patient zone, staff zone, and family zone helps to address some of those questions. Zones are delineated with the appropriate furniture and finishes. A patient care zone may not have carpet, for example, but a family zone might. Other approaches include the following tips.
Rooms should be designed with acuity levels in mind. In an ICU room, family will have a smaller zone because the staff-to-patient ratio and interaction levels go up. In a labor, delivery, recovery room, the family zone will be larger. And in an emergency situation, family and friends should not have to be in the path of the caregivers.
Enhancing communication within a patient room can be as simple as installing a white board. These boards are used to note basic information—day, names of staff, schedules. But they also allow family and friends to communicate with staff. There are other benefits to this simple tool. The patient who sees the “I love you Grandpa” message on the board is reminded of his loved ones. Or a message addressed to the patient by name from a nurse connects them.
In most patient rooms, caregivers have their backs turned to patients while at the sink. Positioning the sink so caregiver and patient can talk face to face during hand washing can add to connection.
“Invisible architecture” is a term to define things that one experiences in a space but doesn’t touch. Among them are light levels, sound levels, flow of movement, and work. These things all affect interaction between patient and staff. If a hall is noisy, communication between patient and staff may be difficult. Good lighting levels help staff to see well—essential in avoiding medical errors.
Spaces can be designed to give nurses necessary access without making patients feel stressed about their guests’ presence. Stress is a very real deterrent to healing. In fact, alleviating stress from patients, family, and staff is one of the most significant benefits of patient centered design.
Goetz is director of strategic sales initiatives for Herman Miller Healthcare. With more than 25 years in the healthcare industry, she is chair of the Planetree Visionary Design Network and a founding certificant of EDAC.
The new building has added just over 200 licensed beds and six pediatric operating rooms to JDCH resources. Radiology services and an entire floor dedicated to inpatient and outpatient oncology care are also sited in the new facility.
Services that remained in the existing children’s hospital include critical care areas such as the Wasie Neonatal Intensive Care Unit, the pediatric intensive/cardiac care unit and pediatric emergency department, and Level 1 trauma bay. Other programs that stayed in the older building are the Pediatric Heart Station and its heart transplant program and pediatric cardiac cath lab, pediatric inpatient rehabilitation, and interventional radiology.
Hurricanes are par for the course in south Florida, and the hospital was engineered to withstand the forces of these and other threatening weather conditions. In 2005, Hurricane Wilma swept through the area, and in response, Memorial Healthcare System had already reinforced its other facilities in the region.
With the new facility, Schlemmer explains, “We designed this hospital to withstand hurricane winds up to 140 miles per hour. The structure is concrete block, with number seven rebar for extra strength.” And to protect against flying debris from a tropical storm or hurricane and water infiltration, high performance window systems were specified.
Another emergency preparedness measure was to implement a backup power system to sustain the hospital for up to seven days if the main power supply was lost. Two 1500 kVA generators with the capacity for 40,000 gallons of diesel fuel have been installed on-site. “We set up the backup plant to run on bi-fuel,” says Schlemmer. “The generator can operate on a 50/50 blend; if something goes wrong with the natural gas line we can go to 100% diesel. We can’t go 100% natural gas, but it supplements the diesel so we can extend our run time if needed.”
Keeping people safe during the nearly two year construction was a primary concern. Al Fernandez, president of ANF Group, Inc., the general contractor, says, “We always take into consideration the active campus during a project. In this case, it was a new building, so there were no occupants but we still had to consider the safety of the subcontractors and staff working on the project as well as the road and pedestrian traffic. It was also important to work closely with the facility about road or utility shutdowns—items that feed the existing hospital on the site.”
The ANF Group, located in Cooper City, FL, has been working with the Memorial Healthcare System since 1988, and Fernandez also sits on the Board of the Memorial Foundation, the fundraising arm of the system. “This project was fulfilling on both a professional and a personal level,” he explains.
Meanwhile, another focus was to implement strategies and materials to elevate energy efficiency and sustainability. A system wide “Go Green” initiative was already in place at the existing hospital, and the standards of that initiative were applied to JDCH. However, administrators went further with this project by pursuing LEED certification.
In February 2012, the hospital was certified LEED Gold for New Construction v2.2. The facility is the second children’s hospital in the U.S. to attain this level. Some of the strategies contributing to this achievement were: access to public transportation; availability of bike racks and showers; employee shuttle service for parking; and continued use of recycled content and local materials under the existing Go Green initiative.
The LEED pursuit was part of the larger initiative by the Memorial Healthcare System to increase sustainability. “The LEED program was able to provide us with consistent and credible standards for designing and maintaining the building, not only for the safety and health of our patients but for the families, the visitors, and employees,” says Schlemmer.
Working as LEED consultant on the project, Charles A. Michelson, AIA, LEED AP, principal of Saltz Michelson Architects in Ft. Lauderdale, FL, helped the hospital go after the certification. “Everything was on the table with regard to creating a green building,” he says. “Building materials from demolition and construction were separated and recycled. We purchased as many building materials as possible from within a 500 mile radius, and, when possible, we selected recycled materials. Taking indoor air quality into account, we also took a careful look at the chemicals in products going into the building, understanding that certain products offgas. For example, the cabinetry chosen needed to be formaldehyde free.”
Capturing and reusing rainwater and installing water efficient landscaping practices are two significant strategies for reducing consumption of that resource. This included a new approach for the hospital—watering exterior landscape with reclaimed water. The twist is that this water is not taken from hospital operations; it’s sourced from the city of Hollywood’s reclaimed water supply.
“The city had excess reclaimed water that we had the capacity to access,” explains Schlemmer. “To achieve this, we tapped into the line, which is located about a city block from our site. It reduced water costs significantly. It is good we had a consultant to suggest things we might not have looked at otherwise.”
Achieving LEED Gold required the project team to interface with the USGBC at a time when the requirements of the hospital did not fit neatly with the rating system’s guidance. Michelson offers a few instances. “We weren’t able to use waterless urinals, because there are issues of infection control in a medical environment. That takes precedence over trying to save water. And we worked with the USGBC when analyzing the air conditioning system, because, at the time, LEED didn’t distinguish on specific air pressures and flows needed in operating spaces and sterile corridors. But we demonstrated the efficiency of the system, and it was acknowledged that in a medical environment there are certain needs that take precedence.”
Opening The Doors
The new JDCH facility was completed in 21 months, and Schlemmer says assembling the proper team and adhering to a regular meeting schedule were two strategies that made it work. “The coordination was key to making the project as smooth as it was,” he says. “From the construction team to engineers to architects to our individual departments (IT, purchasing, facilities, grounds, civil engineers), we were able to pull the project together and stay on our target.”
Fernandez of ANF Group says, “The project was completed 60 days ahead of schedule, and the budget decreased by about $15 million. Some of this was due to changes in the market, but it was also due to the value engineering we used, working with architects and engineers to find cost-effective construction methods.”
After nearly a year in operation, the expanded JDCH is a welcome resource to the region. “The new building has relieved a lot of pressure from the other facility,” says Schlemmer. “With our patient load and volumes, it was wonderful for us to get the facility done. To watch it evolve was personally most rewarding for me—seeing what we accomplished for the community.”
This article was based on an interview with Fernandez, Michelson, and Schlemmer (www.jdch.com).
Name of Facility/Organization: Joe DiMaggio Children’s Hospital. Type of Facility: New.Function of Facility: Pediatric Healthcare. Location: Hollywood, FL. Square Footage:160,000. Budget: $73 million (construction). Construction Timetable: 24 months. Cost Per Square Foot: $455. Facility Owner: Memorial Healthcare System. In-House Facility Manager:Memorial Healthcare System. Architect/Interior Designer/Lighting Designer: Stanley Beaman & Sears Architecture and Interiors. General Contractor/Construction Manager: ANF Group, Inc. Electrical/Mechanical Engineer: Smith Seckman Reid, Inc. Structural Engineer: Brill Rodriguez Salas & Assoc. Inc. Landscape Architect: Calvin, Giordano & Assoc. Inc. LEED Consultant: Saltz Michelson Architects.
Flooring: Armstrong (static dissipative tile); Johnsonite (rubber base); Lonseal (vinyl); nora systems, Inc. (rubber flooring); Ozoloc (vinyl); Stonhard (epoxy); TM Supply (terrazzo). Carpet:Interface. Ceilings: Armstrong (acoustical ceiling tile). Paint: Sherwin-Williams.Acoustics/Sound Masking: Modular Arts. Movable Walls: Modernfold. Fire System Components: SimplexGrinnell. Other Safety Equipment: Siemens (fire alarms). Lighting Products: Sesco Lighting (manufacturers’ representative). HVAC Equipment: York. Power Supply Equipment: Caterpillar (generators). Roofing: Siplast. Signage: Custom Signage by Architectural Signing, Inc. Windows/Curtainwalls/Skylights: Crawford Tracey Corp. Elevators/Escalators: Kone Elevators.