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