ballinger -- tradeline boston -- retooling healthcare facilities -- 2014

PATIENTS, PROCEDURES, + PEDAGOGY

JEFFREY FRENCH, FAIA

LOUIS MEILINK, JR, AIA, ACHA

TODD DRAKE, AIA

RETOOLING FACILITIES FOR A VERY DIFFERENT HEALTHCARE FUTURE

RESEARCHMEDICAL

EDUCATIONHEALTH CARE

WHAT IS DRIVING CHANGE?

DECLINE IN NIH FUNDING

DECLINE IN NIH FUNDING

INCREASE IN

BIO�ENGINEERING $

INCREASE IN

CORPORATE PARTNERSHIPS

(SEND MONEY PLEASE)

AFFORDABLE CARE ACT

PAY FOR SERVICE � PAY FOR PERFORMANCE

FOCUS ON HEALTH

+ PREVENTATIVE CARE

INCREASE IN

OUTPATIENT SERVICES

IN LESS THAN 10 YEARS…

FACEBOOK LAUNCHED IN 2005FACEBOOK LAUNCHED IN 2005FACEBOOK LAUNCHED IN 2005FACEBOOK LAUNCHED IN 2005

(that’s less than TEN years ago) (that’s less than TEN years ago) (that’s less than TEN years ago) (that’s less than TEN years ago)

CROWDFUNDING CROWDFUNDING CROWDFUNDING CROWDFUNDING

RESEARCHRESEARCHRESEARCHRESEARCH

CROWDFUNDINGCROWDFUNDINGCROWDFUNDINGCROWDFUNDING

SOCIAL NETWORKINGSOCIAL NETWORKINGSOCIAL NETWORKINGSOCIAL NETWORKING

DATA + INFORMATION SHARING

SEEKING OUT INFORMATIONSEEKING OUT INFORMATIONSEEKING OUT INFORMATIONSEEKING OUT INFORMATION

CROWDSOURCINGCROWDSOURCINGCROWDSOURCINGCROWDSOURCING

BIG DATABIG DATABIG DATABIG DATAACCESS TO SHARED DATAACCESS TO SHARED DATAACCESS TO SHARED DATAACCESS TO SHARED DATA

“As data access becomes

universal, organizations will

set themselves apart by

what they do with that data”HEALTH CARE ADVISORY BOARD

ONLINE EDUCATIONONLINE EDUCATIONONLINE EDUCATIONONLINE EDUCATION

EVERYTHING ON�DEMAND

BIOBIOBIOBIO����FABRICATIONFABRICATIONFABRICATIONFABRICATION

WEARABLE TECHNOLOGYWEARABLE TECHNOLOGYWEARABLE TECHNOLOGYWEARABLE TECHNOLOGY

HEALTH TRACKINGHEALTH TRACKINGHEALTH TRACKINGHEALTH TRACKING

THE PATH

From BENCH

to TRAINING

to BEDSIDE

RE

SE

AR

CH

ME

D E

D

HE

ALT

H C

AR

E

SILOS

TEAMS

INTERDISCIPLINARYEVERYBODY IN

SURVEY RESPONDENTS

WERE A SAMPLING

FROM

HEALTHCARE,

RESEARCH +

MEDICAL

EDUCATION FIELDS

RESEARCH

DRIVERS FOR CHANGE

DECLINING NIH FUNDING

INCREASE INAVAILABLE BIO�MEDRESEARCH SPACE

BIO�ENGINEERING?

DRIVERS FOR CHANGE: SPACE NEEDS

88%PRIORITIZED TEAM TEAM TEAM TEAM COLLABORATION SPACECOLLABORATION SPACECOLLABORATION SPACECOLLABORATION SPACE

9OUT OF10IDENTIFIED IMAGINGIMAGINGIMAGINGIMAGINGAS HAVING A MAJOR IMPACT

30%RANKED SHARED SHARED SHARED SHARED CORE SPACECORE SPACECORE SPACECORE SPACEAS THE #1 BIGGEST CHANGE #1 BIGGEST CHANGE #1 BIGGEST CHANGE #1 BIGGEST CHANGE

IN SPACE NEED

INTERDISCIPLINARY

ACROSS SCIENCESCOLLABORATION

BEYOND SCIENCES +

ENGINEERING

NIH – DEPENDENT

WITH PARTNERINGFINANCIAL SUPPORT CROWD�FUNDING

INTEGRATED TEACHING + RESEARCH INDISTINGUISHABLE

WET, ANIMAL�INTENSIVE,

OPENLABORATORY TOOLS

CO�LOCATED w/ TREATMENT,

COMPUTATIONAL, SIMULATED

SEQUENTIAL RESEARCH + FABRICATIONINTEGRATED, CO�LOCATED,

NON�LINEAR

THERAPIES

TARGETING CELLSBREAKTHROUGHS IMMUNOTHERAPY

RISK�AVERSE FDA GLOBAL ACCESS PATIENT COLLABORATION

EVOLUTION OF THE RESEARCH ENVIRONMENTTRADITIONAL STATE OF THE ART STATE OF THE FUTURE

Moving beyond what we currently think of as interdisciplinary

NUTRITIONAL RESEARCH

PRESCHOOLRESEARCH

CORE LABHEALTHY EATING

VENUE

HUMAN

PERFORMANCE LABINTERDISCIPLINARY

WORK ENVIRONMENT

NUTRITIONISTS

SOCIOLOGISTS

GENETICISTS

PUBLIC POLICY EXPERTS

URBAN PLANNERS

EXERCISE PHYSIOLOGISTSWET

RESEARCH LAB

WETWETWETWET

WETWETWETWET

DRYDRYDRYDRY

FLEXIBLE FLEXIBLE FLEXIBLE FLEXIBLE TEACHINGTEACHINGTEACHINGTEACHING

ZONES OF PRE�INVESTMENT

MAXIMUM FLEXIBILITYCasework, Tables + Chairs Casework, Tables + Chairs Casework, Tables + Chairs Casework, Tables + Chairs ALL Moveable / Height AdjustableALL Moveable / Height AdjustableALL Moveable / Height AdjustableALL Moveable / Height Adjustable

Utility DistributionUtility DistributionUtility DistributionUtility Distribution CIP / Floor BoxesCIP / Floor BoxesCIP / Floor BoxesCIP / Floor Boxes

TechnologyTechnologyTechnologyTechnology Multiple Screens / Wired & WirelessMultiple Screens / Wired & WirelessMultiple Screens / Wired & WirelessMultiple Screens / Wired & Wireless

MAXIMUM FLEXIBILITYCasework, Tables + Chairs Casework, Tables + Chairs Casework, Tables + Chairs Casework, Tables + Chairs ALL Moveable / Height AdjustableALL Moveable / Height AdjustableALL Moveable / Height AdjustableALL Moveable / Height Adjustable

Utility DistributionUtility DistributionUtility DistributionUtility Distribution CIP / Floor BoxesCIP / Floor BoxesCIP / Floor BoxesCIP / Floor Boxes

TechnologyTechnologyTechnologyTechnology Multiple Screens / Wired & WirelessMultiple Screens / Wired & WirelessMultiple Screens / Wired & WirelessMultiple Screens / Wired & Wireless

COMPUTATIONALSCIENCE ENGINEERING

DISCUSSION

WETWETWETWET

SUPPORTSUPPORTSUPPORTSUPPORT

DRYDRYDRYDRY DRYDRYDRYDRY

TEAM ROOMSTEAM ROOMSTEAM ROOMSTEAM ROOMS SUPPORTSUPPORTSUPPORTSUPPORTLABLABLABLAB LABLABLABLAB LABLABLABLAB

MEDICALEDUCATION

DRIVERS FOR CHANGE: SPACE NEEDS

95%ADDITIONAL ACTIVE LEARNING +ADDITIONAL ACTIVE LEARNING +ADDITIONAL ACTIVE LEARNING +ADDITIONAL ACTIVE LEARNING +TEAM BASED CLASSROOMS TEAM BASED CLASSROOMS TEAM BASED CLASSROOMS TEAM BASED CLASSROOMS SPACES HAVE LESS IMPACTSPACES HAVE LESS IMPACTSPACES HAVE LESS IMPACTSPACES HAVE LESS IMPACT

95%SAW AN INCREASE IN INCREASE IN INCREASE IN INCREASE IN HEALTHCARE STAFF TRAININGHEALTHCARE STAFF TRAININGHEALTHCARE STAFF TRAININGHEALTHCARE STAFF TRAININGAND RECERTIFICATION AND RECERTIFICATION AND RECERTIFICATION AND RECERTIFICATION NEEDS

1/2RANKED

HUMAN HUMAN HUMAN HUMAN ANATOMYANATOMYANATOMYANATOMYLABS LABS LABS LABS AS THE

#1 BIGGEST

CHANGE

IN SPACE

NEEDS

DISCIPLINE SILOS TRAININGHYBRID

INTERPROFESSIONAL TEAMS

LARGE LECTURE ENGAGEMENT ACTIVE LEARNING

ILLNESS TO TREATMENT LEARNING FOCUS WELLNESS EDUCATION

HUMAN TISSUE MODELS CASE MODELS VIRTUAL ANATOMY

EXAMINATION EVALUATIONCOMPETENCE BASED

CREDENTIALS

4TH YEAR PATIENT

OBSERVATIONFIELD WORK

1ST YEAR PATIENT

ENGAGEMENT

COMMUNITY HEALTH HEALTH DISPARITIES GLOBAL HEALTH

HOSPITAL PATIENT FILES PERSONALIZED DATAPERSONAL ON DEMAND

RECORDS

CONFERENCES SEMINARS LIFE LONG LEARNINGSIMULATION

RE�CERTIFICATION CENTERS

EVOLUTION OF MEDICAL EDUCATION

STATE OF THE ART STATE OF THE FUTURETRADITIONAL

HEALTH [R+D] EDUCATION

POPULATION HEALTH

PROMOTE INQUIRY

PROVIDE PATIENT CENTERED CARE

COLLABORATIVELEARNING

HEALTH PROFESSIONS EDUCATION

EMPHASIZE CRITICALTHINKING SKILLS

COLLABORATION + TEAM WORK INTEGRATION

EARLY PATIENT EXPOSURE:LEARNING CONTEXT

CURRICULAR FACILITY RESPONSE

CONVERGENCEOF USES

SMALL + LARGE GROUP LEARNING

IMMERSIVE LEARNING

FLEXIBILITY

PERIMETER FIXED FORWARD FACING OMNI DIRECTIONAL

TEAM BASED LEARNING

DIVERSITY IN USE

ZONES OF PRE�INVESTMENT

• RAISED FLOOR

• ELECTRICAL ACCESS

• MECHANICAL ACCESS

• EQUIPMENT UMBILICAL

• MOBILE EQUIPMENT

• SKYFOLD WALLS

• THEATRE SETS

• HIGH DENSITY STORAGE

• TECHNICAL GRID

• BOOMS W/ EQUIPMENT

• QUICK CONNECTS

• MOTION CAPTURE

SYSTEMS INTEGRATION

FLOOR BOXES – POWER / AIRAV+LCD SCREENS SKYFOLD WALLS

MOBILE HEADWALLS TECHNICAL GRID CAMERAS, LIGHTS / MICS

SURGICAL LIGHTS, MEDGAS GEN LIGHTING ABOVE GRID MEP ABOVE GRID

SYSTEMS INTEGRATION

MOBILE STAGE SETS

SPACE DIVISION

SIZE OPTIMIZATION

HEALTHCARE

DRIVERS FOR CHANGE: SPACE NEEDS

90%PRIORITIZED

PUBLIC AMENITIESPUBLIC AMENITIESPUBLIC AMENITIESPUBLIC AMENITIES

60%RANKED THE EMERGENCY DEPARTMENTEMERGENCY DEPARTMENTEMERGENCY DEPARTMENTEMERGENCY DEPARTMENTAS STABLE OR DECREASING IN NEED

80%SAW AN INCREASE IN INCREASE IN INCREASE IN INCREASE IN OUTPATIENT SPACE OUTPATIENT SPACE OUTPATIENT SPACE OUTPATIENT SPACE NEEDS

1/2RANKED

OUTPATIENT OUTPATIENT OUTPATIENT OUTPATIENT SPACE SPACE SPACE SPACE NEEDS

AS NUMBER

#1 PRIORITY

FRAGMENTED INTEGRATED AUTOMATED

INVASIVE MINIMALLY INVASIVELESS INVASIVE,

PREVENTATIVE

PROVIDER CENTRIC PATIENT CENTRIC OMNI CENTRIC

CENTRALIZED�HOSPITALDECENTRALIZED –

SHIFT TO COMMUNITY

DECENTRALIZED –

WITHIN THE HOME

ONE SIZE FITS ALL LIMITED MENU PERSONALIZED MEDICINE

THERAPEUTICS /

DIAGNOSTICS / DEVICESDIAGNOSE THEN TREAT THERANOSTICS

TREATING SICKNESS UNDERSTANDING WELLNESS PROMOTING WELLNESS

FEE FOR SERVICE PAY FOR QUALITYREWARDING

AFFORDABILITY

AGED AND SEDATE AGING IN MOTION MINIMIZE AGING

EVOLUTION OF HEALTHCARE

TRADITIONAL STATE OF THE ART STATE OF THE FUTURE

5%OF THE POPULATION ACCOUNTS

FOR CLOSE TO HALFOF HEALTH SPENDING

SOURCE: MIT TECHNOLOGY REVIEW

PREVENTATIVE CARE

SOURCE: Centers for Disease Control and Prevention

PRIMARY CARE PHYSICIAN

NURSE CASEMANAGER

COMMUNITY RESOURCE SPECIALISTS

PATIENT SOCIALASSISTANCE

RESOURCE COORDINATOR

HOME SERVICES

PHARMACIST

COMPREHENSIVE CARE MANAGEMENT

SOURCE: PricewaterhouseCoopers

FACETIME APPLICATIONS

DEVICES INCLUDE:STETHOSCOPEOTOSCOPETHERMOMETERDERMASCOPEPULSE OXIMETERSCALEBLOOD PRESSURE CUFF

NYU Langone Medical

Center Campus

Ambulatory Care Center

240 E. 38 Street

EXISTING FACILITIES

MEPMEPMEPMEP

ENDOSCOPY

MOLECULAR PATHOLOGY LAB

MEPMEPMEPMEP

NEUROLOGY

CANCER CENTER

CANCER CENTER

RUSK REHABILITATION

RUSK REHABILITATION

RUSK REHABILITATION

PAIN SERVICES

WOUND CARE

DERMATOLOGY

DERMATOLOGY

AMBULATORY SURGERY

MEPMEPMEPMEP

PRE�ADMISSION TESTING

MEPMEPMEPMEP

COMMON FACILITIES

SPEED OF TECHNOLOGY

SPEED OF PROGRAM – DESIGN � CONSTRUCTION

Ralph Blasier, “The Problem of the Aging Surgeon”

MAXIMUM PLANNING FLEXIBILITY

100’100’100’100’

100’100’100’100’

MAXIMUM PLANNING FLEXIBILITY

100’100’100’100’

100’100’100’100’

FLEXIBLE FOR DISASTER

Embedded Training Space in Clinical Care

SIMULATION + SIMULATION + SIMULATION + SIMULATION + CONFERENCE CENTERCONFERENCE CENTERCONFERENCE CENTERCONFERENCE CENTER

OPERATING PLATFORMOPERATING PLATFORMOPERATING PLATFORMOPERATING PLATFORM

EMERGENCY DEPARTMENTEMERGENCY DEPARTMENTEMERGENCY DEPARTMENTEMERGENCY DEPARTMENT

PATIENT FLOORSPATIENT FLOORSPATIENT FLOORSPATIENT FLOORS

LABLABLABLAB

ARE TODAY’S MEASURES OF SUCCESS ARE TODAY’S MEASURES OF SUCCESS ARE TODAY’S MEASURES OF SUCCESS ARE TODAY’S MEASURES OF SUCCESS

THE SAME ONES THAT WILL INDICATE THE SAME ONES THAT WILL INDICATE THE SAME ONES THAT WILL INDICATE THE SAME ONES THAT WILL INDICATE

STRENGTH IN THE FUTURE?STRENGTH IN THE FUTURE?STRENGTH IN THE FUTURE?STRENGTH IN THE FUTURE?

COORDINATED CARE:COORDINATED CARE:COORDINATED CARE:COORDINATED CARE:

QUALITY CARE AT THE QUALITY CARE AT THE QUALITY CARE AT THE QUALITY CARE AT THE

RIGHT TIME, RIGHT PLACE, RIGHT TIME, RIGHT PLACE, RIGHT TIME, RIGHT PLACE, RIGHT TIME, RIGHT PLACE,

RIGHT PRICERIGHT PRICERIGHT PRICERIGHT PRICE

1.1.1.1. Innovative Innovative Innovative Innovative approaches to addressing approaches to addressing approaches to addressing approaches to addressing

“Forward“Forward“Forward“Forward����Flexible” rapidFlexible” rapidFlexible” rapidFlexible” rapid����change facilities change facilities change facilities change facilities

2.2.2.2. Insight Insight Insight Insight to space based priorities at other to space based priorities at other to space based priorities at other to space based priorities at other

institutions, as this may influence your own institutions, as this may influence your own institutions, as this may influence your own institutions, as this may influence your own

decisionsdecisionsdecisionsdecisions

3.3.3.3. Understanding technology as an accelerant Understanding technology as an accelerant Understanding technology as an accelerant Understanding technology as an accelerant

of change, and anticipating the state of the of change, and anticipating the state of the of change, and anticipating the state of the of change, and anticipating the state of the

facility futurefacility futurefacility futurefacility future