The Architect's Sustainable Approach (Text Version)

Slide presentation from the AHRQ 2009 conference.

On September 16, 2009, Jonathan Hoffschneider made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (9.6 MB) (Plugin Software Help).

Slide 1

Slide 1. The Architect's Sustainable Approach

The Architect's Sustainable Approach

Jonathan Hoffschneider, AIA, LEED® AP
Perkins + Will
www.perkinswill.com

Slide 2

Slide 2. Agenda

Agenda

  1. Introducing Perkins+Will.
  2. Economic Context.
  3. Meeting Today's Challenge: Reform.
  4. Creating a Healing Environment.
  5. Case Study: The Patient Room.
  6. The Integrated Design Team.
  7. Questions?

Slide 3

Slide 3. 1. Introducing Perkins+Will

1. Introducing Perkins+Will

Founded in 1935
18 Offices
Projects in 49 states + 43 countries
1600+ Staff (700 in Healthcare)
Healthcare Facilities from Clinics to Academic Medical Centers.
Recipient: 2008 Practice Greenhealth Champion for Change Award.

Slide 4

Slide 4. 2. Economic Context

2. Economic Context

Outlook One Year Ago:

  • Construction spending $36.8 billion by 2011 1
  • 72% of CFOs expected hospital capital spending to increase in the next 4 years 2
  • 58% of hospitals plan to add beds in next several years 3

Source:
1 Centers for Medicare and Medicaid Service.
2 2007 Survey of Healthcare Executives.
3 Nurse Executive Center CNO Survey.

Slide 5

Slide 5. 2. Economic Context

2. Economic Context

No end in sight...
…what a difference a year makes.
Modern healthcare.

Slide 6

Slide 6. 2. Economic Context

2. Economic Context

Outlook in 2008:

  • 31% experienced a decrease in elective procedures in the past 3 months.
  • 38% reported a decrease in admissions during the same period.
  • Uncompensated care up 8% from July to September vs. same period last year.

Source: AHA 2008 Hospital CEO Survey Including 736 Hospitals (November 2008)

Slide 7

Slide 7. 2. Economic Context

2. Economic Context

What Clients are Saying:

  • Investment balances hammered "Just lost next year's capital budget".
  • Growing pockets of softening/declining utilization "Elective surgery volume is down".
  • Capital projects put on hold "We've canceled all projects through 2010".
  • Capital budgets reduced to bare necessities "I hope that chiller lasts 2 more years".

What Clients are Doing:

  • Cutbacks made or considered:
    • Administrative costs (60%).
    • Reducing staff (53%).
    • Reducing services (27%).
    • Facility investments reconsidered or postponed (56%).

Source: AHA 2008 Hospital CEO Survey Including 736 Hospitals (November 2008).

…What are the Architects Doing?

Slide 8

Slide 8. 3. Meeting Today's Challenge: Reform

3. Meeting Today's Challenge: Reform

POLICY

  • Healthcare Policy.
  • Healthcare Delivery Methods.
  • Comparative Effectiveness Research.

Four Interrelated Pillars for Reform:

  • Improve value through better information and tools to be more effective.
  • Reward improvements in quality and reductions in cost growth; provide support for health care delivery reforms that save money while emphasizing disease prevention and better coordination of care.
  • Reform health insurance markets and restructure government subsidies to create competition and improve incentives around value improvement rather than risk selection.
  • Give greater support to individual patients for improving their health and lowering overall health care costs, including incentives for achieving measurable health goals.

Slide 9

Slide 9. 3. Meeting Today's Challenge: Reform

3. Meeting Today's Challenge: Reform

POLICY

  • Healthcare Policy.
  • Healthcare Delivery Methods.
  • Comparative Effectiveness Research.

Four Interrelated Pillars for Reform:

  • Improve value through better information and tools to be more effective.
  • Reward improvements in quality and reductions in cost growth; provide support for health care delivery reforms that save money while emphasizing disease prevention and better coordination of care.
  • Reform health insurance markets and restructure government subsidies to create competition and improve incentives around value improvement rather than risk selection.
  • Give greater support to individual patients for improving their health and lowering overall health care costs, including incentives for achieving measurable health goals.

FACILITY

  • Facilities Modernization.
  • Advances in Technology.
  • Application of Sustainability and Evidence-Based Design.

Facility Design Impact on Capital Strategies

  • Disciplined operation / strategic plan.
  • Leading evidence-based capital design.
  • Tangible improvements in quality and patient safety.
  • Improved information connectivity and operational efficiency.
  • "Hospitals that actively distinguish themselves in clinical quality and patient safety will benefit from increasing volumes and improved financial position."
  • "Quality and efficiency outcomes may offset any additional debt incurred to finance projects."

Source: Fitch Ratings Special Healthcare report, May 22, 2007.

Slide 10

Slide 10. 3. Meeting Today's Challenge: Reform

3. Meeting Today's Challenge: Reform

POLICY

  • Healthcare Policy.
  • Healthcare Delivery Methods.
  • Comparative Effectiveness Research.

Four Interrelated Pillars for Reform:

  • Improve value through better information and tools to be more effective.
  • Reward improvements in quality and reductions in cost growth; provide support for health care delivery reforms that save money while emphasizing disease prevention and better coordination of care.
  • Reform health insurance markets and restructure government subsidies to create competition and improve incentives around value improvement rather than risk selection.
  • Give greater support to individual patients for improving their health and lowering overall health care costs, including incentives for achieving measurable health goals.

FACILITY

  • Facilities Modernization.
  • Advances in Technology.
  • Application of Sustainability and Evidence-Based Design.

Facility Design Impact on Capital Strategies

  • Disciplined operation / strategic plan.
  • Leading evidence-based capital design.
  • Tangible improvements in quality and patient safety.
  • Improved information connectivity and operational efficiency.
  • "Hospitals that actively distinguish themselves in clinical quality and patient safety will benefit from increasing volumes and improved financial position."
  • "Quality and efficiency outcomes may offset any additional debt incurred to finance projects."

Source: Fitch Ratings Special Healthcare report, May 22, 2007.

A Healing Environment.

Slide 11

Slide 11. 4. Creating a Healing Environment

4. Creating a Healing Environment

"...the built environment has a profound impact on health, productivity and our natural environment..."

References LEED & GGHC

  • Top Reasons for Green Hospitals:
  • 58% Enhanced Staff and Patient Health and Well-being.
  • 46% Operational Cost Savings.
  • 41% Increased Building Function Efficiency.
  • 18% Being Part of the Healthcare Sector that Values the Environment.
  • 9% Public Relations Benefits of Being a Green Leader.

Slide 12

Slide 12. 4. Creating a Healing Environment  

4. Creating a Healing Environment

Framework for Evaluating Sustainable Design Options

 Direct ImpactImpact On Patient and Staff HealthNo/Minimal Direct Impact
High-Cost, with Potential Downstream Savings"Worth Strong Consideration"
  • High proportion of outdoor air ventilation2
  • Operating rooms with direct line of sight to vision glazing3
  • Daylit prep/recovery units
  • Vegetated rooftops
 "Lower on the Priority List"
  • Biomass-fueled cogeneration plant
  • Rainwater storage cisterns
  • Photovoltaic arrays
  • Charging stations for hybrid vehicles
Financial Impact
No/Minimal Cost Premium"Low-Hanging Fruit"
  • Low-VOC paint
  • Non-vinyl backed carpeting
  • Low-emitting adhesives and sealants
  • Bicycle storage and changing facilities
 "Assess Relative Environmental Impact"
  • Waterless/low-flow urinals1
  • High ratio of open space
  • Native, drought-tolerant plants
  • Locally manufactured construction materials

Slide 13

Slide 13. 5. Case Study: The Patient Room

5. Case Study: The Patient Room

Patient Environment:

  • Reduce Patient Falls.
  • Provide Access to Daylight & Views.
  • Improve Indoor Air Quality.
  • Consider Ergonomics/ Accessibility.
  • Reduce Infection Risk.
  • Reduce Noise.

Staff Environment:

  • Reduce Staff Lifting Injuries.
  • Facilitate Hand Cleaning.
  • Increase Patient Visibility.
  • Reduce Travel Distances.
  • Provide Appropriate Lighting.
  • Provide Easy Access to Information.
  • Create Restorative Spaces.

Slide 14

Slide 14. 5. Case Study: The Patient Room

5. Case Study: The Patient Room

  • Patient Room Design.
  • Decentralized Nurse Work Area.
  • Improved Patient Visibility.
  • Bacteria-Resistant Surfaces.
  • Easy Access to Handwashing.
  • Non-Slip Floor Finish.
  • Improved Indoor Air Quality.
  • Patient Bathroom on Headwall.
  • Room to Room Sound Isolation.
  • Handrails from Bed to Toilet.
  • Two-Way, Hands-Free Communication.
  • Bedside Controls.
  • Single-Bed Patient Rooms.
  • Positive Distractions (Art, Views).
  • Family Participation.
  • Patient/Family Access to Health Information.
  • Increase Direct Daylighting.

Source: Multiple References, Summarized in RING Paper: Hospital Safety by Mardelle McCuskey Shepley/ Texas A&M/ ART+Science August, 2008.

Slide 15

Slide 15. 5. Case Study: The Patient Room

5. Case Study: The Patient Room

  • Staff Restorative Space.
  • Separation of Clean and Soiled.
  • Auto-Dispensing of Medications.
  • Unit Layout to Reduce Staff Travel.
  • Ergonometric Work Areas.
  • Decentralized Patient Supplies.
  • Standard Room Design.
  • Oversized Patient and Toilet Room Doors.
  • Improved Wayfinding.

Source: Multiple References, Summarized in RING Paper: Hospital Safety by Mardelle McCuskey Shepley/ Texas A&M/ ART+Science August, 2008.

Slide 16

Slide 16. 5. Case Study: The Patient Room

5. Case Study: The Patient Room

Image: Analysis of Evidence Based Design Strategies: Cost vs. Effectiveness.

Source: Patient Safety Design Integration Study: St. Cloud Hospital East Addition - April 2009.

Slide 17

Slide 17. 5. Case Study: The Patient Room

5. Case Study: The Patient Room

Image: Analysis of Evidence Based Design Strategies: Cost vs. Effectiveness.

Source: Patient Safety Design Integration Study: St. Cloud Hospital East Addition - April 2009.

Slide 18

Slide 18. 6. The Integrated Design Team

6. The Integrated Design Team

Image: An image of a diagram is displayed. The center image says "CLIENT", which is surrounded by images of "Design Team". Around the "Design Team" are the following items.

  • MDs.
  • Nursing/Support.
  • Patients.
  • Families/Public.
  • Industry.
  • Vendors/Suppliers.
  • Administrators.
  • Facilities.

Slide 19

Slide 19. 6. The Integrated Design Team

6. The Integrated Design Team

Image: An image of a diagram is displayed. The center image says "CLIENT", which is surrounded by images of "Design Team". Around the "Design Team" are the following items.

  • MDs.
  • Nursing/Support.
  • Patients.
  • Families/Public.
  • Industry.
  • Vendors/Suppliers.
  • Administrators.
  • Facilities.

Slide 20

Slide 20. 6. The Integrated Design Team

6. The Integrated Design Team

Image: An image of a diagram is displayed. The center image says "CLIENT", which is surronded by images of "Design Team". Around the "Design Team" are the following items.

  • MDs.
  • Nursing/Support.
  • Patients.
  • Families/Public.
  • Industry.
  • Vendors/Suppliers.
  • Administrators.
  • Facilities.

Slide 21

Slide 21. 6. The Integrated Design Team

6. The Integrated Design Team

Image: An image of a diagram is displayed. The center image says "CLIENT", which is surrounded by images of "Design Team". Around the "Design Team" are the following items.

  • MDs.
  • Nursing/Support.
  • Patients.
  • Families/Public.
  • Industry.
  • Vendors/Suppliers.
  • Administrators.
  • Facilities.

Slide 22

Slide 22. 6. The Integrated Design Team

6. The Integrated Design Team

Image: An image of a diagram is displayed. The center image says "CLIENT", which is surrounded by images of "Design Team". Around the "Design Team" are the following items.

  • MDs.
  • Nursing/Support.
  • Patients.
  • Families/Public.
  • Industry.
  • Vendors/Suppliers.
  • Administrators.
  • Facilities.

Slide 23

Slide 23. 6. The Integrated Design Team

6. The Integrated Design Team

Image: An image of a diagram is displayed. The center image says "CLIENT", which is surrounded by images of "Design Team". Around the "Design Team" are the following items.

  • MDs.
  • Nursing/Support.
  • Patients.
  • Families/Public.
  • Industry.
  • Vendors/Suppliers.
  • Administrators.
  • Facilities.

Slide 24

Slide 24. 6. The Integrated Design Team  

6. The Integrated Design Team

Image: An image of a diagram is displayed. The center image says "CLIENT", which is surrounded by images of "Design Team". Around the "Design Team" are the following items.

  • MDs.
  • Nursing/Support.
  • Patients.
  • Families/Public.
  • Industry.
  • Vendors/Suppliers.
  • Administrators.
  • Facilities.

Slide 25

Slide 25. 6. The Integrated Design Team  

6. The Integrated Design Team

Image: An image of a diagram is displayed. The center image says "CLIENT", which is surrounded by images of "Design Team". Around the "Design Team" are the following items.

  • MDs.
  • Nursing/Support.
  • Patients.
  • Families/Public.
  • Industry.
  • Vendors/Suppliers.
  • Administrators.
  • Facilities.

Slide 26

Slide 26. 6. The Integrated Design Team

6. The Integrated Design Team

Image: An image of a diagram is displayed. The center image says "CLIENT", which is surrounded by images of "Design Team". Around the "Design Team" are the following items.

  • MDs.
  • Nursing/Support.
  • Patients.
  • Families/Public.
  • Industry.
  • Vendors/Suppliers.
  • Administrators.
  • Facilities.

Slide 27

Slide 27. Questions?

QUESTIONS?

Jonathan Hoffschneider, AIA, LEED® AP
Perkins + Will
www.perkinswill.com

Current as of December 2009
Internet Citation: The Architect's Sustainable Approach (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2009/hoffschneider/index.html