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Midwest Healthcare Engineering Conference
Resilience Design for Healthcare Facilities
October 26, 2016
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Shayda Bradley,
Executive Director,
Design &
Construction, IUH
Mara Baum,
Healthcare
Sustainable Design
Leader, HOK
Fred Betz, Building
Performance
Consultant, AEI
Speakers
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What do these places have in common?
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“The Joplin Tornado: The Hospital Story and Lessons Learned”, Marcia Reynolds, RN, BSN,
MSN, CPHRM, Mercy Health,
http://c.ymcdn.com/sites/www.leadingagemissouri.org/resource/resmgr/annual_conference/
wednesday_joplin_tornado_les.pdf
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Definition of Resilience
Resilience is “the ability to prepare and plan for, absorb,
recover from, or more successfully adapt to actual or
potential adverse effects”
- National Research Council
Plan for adverse
event
Absorb stress
Optimal Recovery
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Definition of Resilience
Resilience is “the ability to prepare and plan for, absorb,
recover from, or more successfully adapt to actual or
potential adverse effects”
- National Research Council
Plan for adverse
event
Absorb stress
Optimal Recovery
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Centre of British ColumbiaCentre of British Columbia,
Vancouver, BC
ZGF AEI
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Redwood City Hospital,
Redwood City, CA
HOK, AEI
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Ng Teng Fong General Hospital
Air intake
design to
prevent
bioterrorism
Ng Teng Fong General
Hospital, Singapore
HOK, CPG
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Resilience: More than Just Redundancy
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Weather Pattern Unpredictability
Primary concerns: Extreme heat, tornado & high winds
Secondary concerns: Drought, flood, earthquake, wildfire
equipment & utility failures, fire, ice storms, lightning
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Key Design Principles
Exceed codes & standards as needed1
2
3
4
Energy & water efficiency will make goals
easier/cheaper to achieve
Categorize building program for criticality
Consider potential long-term weather
patterns
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Architect
Engineer
LogisticsSecurity
Landscape
Architect
Owner
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HOK
AEI
LogisticsSecurity
HOK
IU Health Design& Constr.
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IU Health Hazard Assessment
• Natural Hazards
• Pandemic influenza
• Tornado
• Severe winter storm
• Human Hazards
• Active shooter
• Mass casualty incident
• Bomb threat
• Critical Infrastructure
• Information system failure
• Communications failure
• Cyber attack
• Hazardous Materials
• In-hospital spill
• Incident requiring
decontamination of staff or
patients
• Nuclear detonation
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HOK
AEI
LogisticsSecurity
HOK
IU Health Design& Constr.
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Indiana University Health
Statewide Presence
• 15 hospitals plus health centers,
partners, affiliates & joint venture
operations
• 3,098 staffed beds
• More than 29,000 full-time team
members
• More than 2.7 million admissions
and outpatient visits
• More than 1,400 research studies
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IU Health Highlights
Ten clinical programs ranked among
the top 50 national programs in
U.S. News & World Report’s 2015-16
edition of America’s Best Hospitals
In partnership
teach medical students
and/or medical residents
IU HEALTH PHYSICIANS
IU Health Transplant
is one of the nation’s largest
transplant programs
IU School of Medicine
the nation’s largest medical
school and a national leader in
medical education and research
+Seven IU Health hospitals have
achieved Magnet status—the gold
standard for nursing excellence
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IU Health Mission
To improve the health of our patients and community
through innovation, and excellence in care, education,
research and service.
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IU Health Facilities
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IU Health Sustainability
• Educate patients and staff on Sustainability
• Reduce carbon footprint
• Align with Indiana University to achieve
LEED Gold
• Apply lean design methodology
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IU Health Sustainability Direction
Campus Environments – facilities design,
construction and maintenance
Administration & Oversight – corporate
goals, policy and measurement
Team Engagement– IU Health team
education, personal involvement and
celebrations around achievement and
results
1
2
3
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Existing site area
• 5.7 million sq. ft.
Existing beds: 1,428
• Methodist 750
• University 387
Building ages
• 10 to 100 years
Investment plans:
• $900M
New Adult Hospital, Downtown Indianapolis
HOK
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Total site area
• 70 acres
Design phase
• Schematic
Design
Investment plans
• $340M
IU Health Bloomington (Preliminary)
HOK
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IU Health’s Resilience Interests and Concerns
The Joplin Tornado: The Hospital Story and Lessons Learned, Marcia Reynolds, RN, BSN, MSN,
CPHRM, Mercy Health,
http://c.ymcdn.com/sites/www.leadingagemissouri.org/resource/resmgr/annual_conference/wednesday_j
oplin_tornado_les.pdf
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HOK
AEI
LogisticsSecurity
HOK
IU Health
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Expanded Consideration of Risk
Basis of
Design
Resilience Charrette
Vulnerability & Hazard Assess.
IUH Project Requirements
Project
Design
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Expanded Consideration of Risk
Basis of
Design
Resilience Charrette
Vulnerability & Hazard Assess.
IUH Project Requirements
Project
Design
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IU Health Project Requirements
IU Health’s needs, goals and directives
• Design to address high risks as is reasonable
• 96 hours of operations during disruptive events
• Incorporate IU Health’s Hazard Vulnerability
Assessment and AEI’s Resilience All Hazards
Assessment
• Use LEED Resilience Pilot Credits framework
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Expanded Consideration of Risk
Basis of
Design
Resilience Charrette
Vulnerability & Hazard Assess.
IUH Project Requirements
Project
Design
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Hazard Vulnerability Assessment:
Probability - Magnitude - Preparedness
Qualitative Hazard Assessment – undertaken with
limited data, supports priority setting
Natural hazards
• Pandemic influenza
• Severe winter storm
• Tornado
Human hazards
• Active shooter
• Mass casualty incident
• Bomb threat
Critical infrastructure
• Cyber attack
• Information system failure
• Communications failure
Hazardous materials
• In-hospital spill
• Incident requiring decontamination
of staff or patients
• Nuclear detonation
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IU Health’s Project Requirements
• Drought
• Flooding
• Weather
changes
• Earthquake
• Winter
storms
• Tornado/
high wind
• Wildfire
• Equipment
failure
• Fire
• Lightning
• Utility failure
• Hurricanes
• Landslides &
unstable soils
• Sea level rise,
storm surge
• Tsunami
• Sand storm
Additional
consideration
IU Health
focus
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Expanded Consideration of Risk
Basis of
Design
Resilience Charrette
Vulnerability & Hazard Assess.
IUH Project Requirements
Project
Design
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Resilience Charrette Guidelines
• The project will be designed to meet the
resilience requirements of the OPR.
• Buildings will be well-maintained.
• The emergency preparedness strategy is
supported through design.
• Projects are designed to align with
municipal/regional emergency response plans.
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Evidence
Agre
em
en
t
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Categorize Space by Resilience Need
• Address needs in critical spaces
– Thermal comfort
– Power
– Water
– Waste Management
• Can we provide natural ventilation in critical
spaces?
• Can spaces be flexible for changed use needs
during hazard event?
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Resilience Charrette –
Failure Scenario Exercise
<96 Hours: electric utility failure
>96 Hours: electric utility failure
Standard Operation
Catastrophic Event
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Resilience Charrette –
Electrical Utility Outage
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Resilience Charrette – Catastrophic Failure
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Resilience Results
Well-articulated commitment to specific
metrics & details
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Expanded Consideration of Risk
Basis of
Design
Resilience Charrette
Vulnerability & Hazard Assess.
IUH Project Requirements
Project
Design
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Example Quantitative Metrics
• 96 hours of operation during
disruptive events
• Energy Star score of 75
• LEED v2009 Gold
• 50% less potable water than baseline
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Conclusions
• Process, process, process!
• Collaborative, collaborative, collaborative!
• Meet early, discuss often
• Overcome ownership challenges
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Shayda Bradley,
Executive Director,
Design &
Construction, IU
Health
Mara Baum,
Healthcare
Sustainable Design
Leader, HOK
Fred Betz, Building
Performance
Consultant, AEI
Thank You
HOK HOK