Healthcare Case Study: Preserving The Past, Caring For The Future

At Pennsylvania Hospital, the nation’s first, facility upgrades help to steer 21st century operations.

By Anne Cosgrove
From the June 2018 Issue

In Philadelphia, PA, the nation’s first hospital was founded in 1751. With its beginnings in a three-story building on Pine Street, Pennsylvania Hospital is today a 1.3 million square foot facility offering a breadth of services in the city. Located in an urban setting, across a little more than nine acres, the hospital consists of multiple buildings. The Pine building, the original structure, faces the city’s Pine Street , and the three-story structure houses administrative and other offices, in addition to a historic medical library and surgical ampitheatre used for patient care until 1868.

Pennsylvania Hospital
The Pine building at Pennsylvania Hospital in Philadelphia has been in continuous use since 1755. (Photo: Pennsylvania Hospital)

Pennsylvania Hospital is part of the Penn Medicine, University of Pennsylvania Health System. The other buildings comprising this hospital are: Cathcart, Widener, Schiedt, Preston, and Spruce. All but the Spruce building are connected to the Pine building, and the complex is girded by four city streets, Pine, Spruce, Eighth, and Ninth. With vintages dating from 1753 to 2013, the buildings of Pennsylvania Hospital continue to undergo facility improvements to serve patients with modern healthcare.

The hospital provides services in a broad range of medical and surgical specialties, with inpatient and outpatient services. Approximately 800,000 square feet of space is dedicated to inpatient services, concentrated in the Cathcart, Schiedt, and Preston buildings. The Spruce building, undergoing current and future programmatic changes, is primarily outpatient services. Additional spaces include emergency services in the Schiedt and Widener buildings, which are adjacent to each other.

Jeff O’Neill, senior director of facilities for Pennsylvania Hospital since 2013, oversees these projects, in addition to other facility management responsibilities that are broad in scope. Commenting on recently completed and ongoing initiatives, he says, “Two areas we have been working on for the utilities side are air handling and power. On the power side, when I came into this position the hospital was getting underway with an arc flash study. Because construction projects are happening regularly, our staff and the contractors are in the electrical panels often. The safety of our staff and the contractors are of the utmost importance, so the arc flash study has been a priority.”

Still ongoing, this effort focuses on reducing the Hazard Risk Category level for arc flash; on a scale of 1 to 4, a 1 is safest and 4 is harboring most risk. Working with an electrical engineer and their recommendation, O’Neill has overseen electrical system changes that have included replacing breakers, adding gauges outside the breakers, and installing remote switches. These moves help to minimize the frequency with which workers need to open the electrical panels to perform service.

Prior to his current position, O’Neill was a senior project manager for Penn Medicine, University of Pennsylvania Health System, and when he become senior director of facilities, he had familiarity with the Pennsylvania Hospital facility and some of the building improvements that were in progress and planned. This included the replacement of air handling units at the hospital’s Preston building.

“My predecessor in the director of engineering role had initiated that project,” explains O’Neill. “And we finished it up. The impacted space was about 180,000 square feet, and the new equipment brought down our utility costs.”

O’Neill notes the utility savings were relatively modest, because the air handlers cannot be set back at night due to the function of the hospital (“We have a tremendous cooling load,” he notes), but the new system incorporated recovery wheels and filtration that enables the system to recirculate and clean air, which reduces the amount of fresh air from outside that needs to be treated.

“The air handlers that we replaced in the Preston building were 1960s vintage, so by modernizing the equipment, we gained energy efficiency from the start,” he notes.

In the future, this approach to replacing air handlers will be implemented in two other buildings on the campus.

A Chat With Jeff O’Neill

Jeff O’Neill
Senior Director, Facilities
Pennsylvania Hospital

As senior director of facilities at Pennsylvania Hospital, what is the scope of your responsibilities?

My department is responsible for the maintenance of the physical plant, security, and cleanliness, while developing and implementing capital construction projects. I also. have safety, emergency management, and parking as part of my purview. Parking makes me the most popular guy on campus!

What’s next for Pennsylvania Hospital from the facilities standpoint?

We’ll continue to move toward single patient rooms for all inpatient spaces. We will also be upgrading the building systems, while keeping in line with historic requirements.

Updated Patient Spaces, Increased Efficiencies

On the inpatient front, programmatic changes that O’Neill has been focusing on include shifting inpatient spaces throughout Pennsylvania Hospital to all single patient rooms. The patient room projects have included updates to lighting, finishes, and furniture. Two of the three buildings involved (Schiedt and Preston) have made the transition, and the Cathcart building is next to be modified. “From the project management perspective, we’re still finalizing this,” says O’Neill,

Pennsylvania Hospital“And when we make that shift, we’ll also make the HVAC improvements using the approach we used for the air handlers in the previous project.”

Meanwhile, the Spruce building, located across the street from the larger facility, will soon house a comprehensive offering for spine care and psychiatric care. Specialties related to spine care (including neurosurgery, orthopedics, pain management, and physical therapy) are currently dispersed in proximity of the hospital.

Pennsylvania Hospital
(Above, top) The surgical ampitheatre in the Pine building.
(Bottom) A hybrid operating room at the hospital.
(Photos: Pennsylvania Hospital)

But as O’Neill points out, bringing these under one roof in the Spruce building will allow for more efficient care, especially outpatient services.

Psychiatric care will also be consolidated into the Spruce building, by moving the crisis response center there. Related facilities already operate in that building, so this will enhance efficiency of care also.

“In a way, our outpatient focus has made us think a lot more efficiently about our inpatient function,” notes O’Neill.

Sprinklering An 18th Century Building

“One of the most recent projects we’ve done here was with our Pine Building,” says O’Neill. Still in use, this building is the oldest structure on the Pennsylvania Hospital campus. It opened in 1755, after the hospital was founded several years earlier by Dr. Thomas Bond and Benjamin Franklin. The men established the hospital to “care for the sick, poor, and insane who were wandering the streets of Philadelphia.”

Acknowledged as one of the finest examples of Colonial and Federal period architecture, the Pine Building was designed by Samuel Rhoads, a member of the first Board of Managers. The building is a three-part structure, completed as funds became available: the East Wing opened in 1755, the West Wing in 1796, and the Center House in 1804.

The brick structure today houses several medical departments as well as administrative offices, the archives and historic library, and the contemporary library.

Adding fire sprinklers throughout the entire building was the latest project for O’Neill and his team pertaining to the Pine building. On the National Register of Historic places, the structure contains three distinct historic spaces, he explains. “The first is the Great Court, which is the center of the building. The second is the historic library, and we’ve done a lot in there to improve temperature and humidity control. The third is the surgical ampitheatre on the top floor. The skin of the building is also on the National Register.”

There were sprinklers in portions of the Pine building, but this most recent building-wide project called for attention to the historic nature of the building. O’Neill says, “We worked with a contractor that has done this in other historic facilities in the area, like Independence Hall and Christ Church. They know how to work around original plaster, and how to handle the sensitive installation of the sprinkler heads, for instance. In some areas, we simply surface mounted a pipe and painted it the same color as the trim. Because rather than take apart the old molding work or build new to try to hide something, the idea was to minimally touch what was there originally there.”

The importance of working with contractors well-versed in the type of project at hand is demonstrated in an anecdote O’Neill shares about installing the sprinklers in the historic surgical ampitheatre. The walls were plaster with the original horsehair, often used in 18th century construction. “Getting into the walls was a controlled process,” explains O’Neill. “They needed to cut a hole to gain access, then cut into some of the wood, to add the equipment. This was a sensitive thing. When we were doing the exploratory, the original contractor told us they didn’t want to touch anything there, because they were afraid of asbestos. We had to explain there was no asbestos in 1753. So we brought in another contractor, more of an artisan, for the job.”

Commenting on project management in general, O’Neill notes that having a stable of reliable contractors that do quality work and meet hospital objectives is key.

A facility manager’s work is never done, and for more than 250 years, the facilities of Pennsylvania Hospital in Philadelphia have been cared for, so that patients can access the care that they need. As the hospital continues to improve its system of delivery to these patients, O’Neill and his facilities team help to steer these improvements.

hospitalCosgrove is Editor-in-Chief of Facility Executive magazine. For more about Pennsylvania Hospital, visit O’Neill will speak at the Facility Executive Live! conference in Philadelphia on September 20, 2018. Visit

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