a public-private success laura stillman · dr. steven r. smith md, scientific director 15 years of...

Academic Medical & Health Science Centers Tradeline | October 21 - 22, 2013

One integrated facility speeds translation of research discovery to patient cures

Forum C Laura Stillman MPH

Flad Architects

Robert Deininger MBA Translational Research Institute

for Metabolism and Diabetes

Jeffrey Raasch AIA Flad Architects

“ …” A Public-Private Success

Academic Medical & Health Science Centers Tradeline 2013 І page 2

Introduction

Laura Stillman MPH Principal-in-Charge & Team Leader Flad Architects

Jeffrey Raasch AIA Architect & Design Principal Flad Architects

Presentation Team

Robert Deininger MBA Vice President for Research Florida Hospital Administrative Director Translational Research Institute for Metabolism and Diabetes Florida Hospital • Sanford | Burnham Medical Research Institute

Steven Smith MD SVP, Chief Scientific Officer Florida Hospital Scientific Director Translational Research Institute for Metabolism and Diabetes Florida Hospital • Sanford | Burnham Medical Research Institute


Introduction Our Agenda

Explain the vision, novel approach and research organization – how did the project enable the mission and how did this organization succeed

Summarize the Florida Hospital Business Plan, partnerships, and specific research and partnership results, including metrics achieved

Provide images and floor plans of the completed TRI building


Learn how the organization collaborated to create their business and financial objectives and generated support from the multiple stakeholders.

Understand how to create successful partnerships and foster long-term affiliations.

Develop the right team that incorporates all building users to foster holistic thinking about the future environment.

Understand the specific work flows within the building, how to separate distinct functions while still allowing ease of access between them, and support future adaptability.

Introduction Learning Objectives for Today


Science with an aspiration and passion for faster translation from bench to bedside

New personalized approaches to therapy development; studying multiple factors as causes for disease

Focused, streamlined R&D for global epidemics like diabetes and obesity

Reduced time from discovery to therapy available at the community level

Introduction INNOVATE DISCOVER CURE

The TRI Mission…


Introduction

The TRI believes that this shift in approach needs to occur in

both fundamental research and drug development;

moving from the one-size-fits-all model to using science to find

tailored solutions to treat disease subsets.

Addressing this gap will chart a course with powerful outcomes for public health.

Powerful Outcomes for Public Health

Academic Medical & Health Science Centers Tradeline 2013 І page 7 ” “

Introduction

Lars Houmann President and CEO

Florida Hospital

Terry Owen Senior Vice President

Florida Hospital

Steven R. Smith, MD SVP, Chief Scientific Officer

Florida Hospital Scientific Director

Translational Research Institute for Metabolism and Diabetes

Florida Hospital • Sanford | Burnham Medical Research Institute

The challenge was to unite scientists, clinicians, research volunteers, and

equipment in one building, and meet the size, program, and budget mandate for the project while still supporting effective translational research.

It Started with Leadership and Commitment


Formed in 2009 as an affiliation of Florida Hospital (FH) and the Sanford-Burnham Medical Research Institute.

Funded, owned and operated by Florida Hospital.

Serves as the bridge between basic discovery research at Lake Nona and patient-oriented research at Florida Hospital.

The affiliation agreement governs the development, leadership, operation, intellectual property, and other academic aspects of the TRI.

Multiple ongoing collaborative activities between basic scientists, physicians, pre-clinical investigators, and patient-oriented clinical researchers.

Introduction The Translational Research Institute


The 54,000 SF facility houses:

− Research labs − Nursing units − Overnight stay rooms − Procedure rooms − A research pharmacy − Food testing kitchen − Exercise testing suites − Patient respite areas − A bio-imaging core with DEXA and 3T MRI/MRS for nuclear scanning − An energy and metabolism core

Calorimeter suites (very few existing in the world at this time) measure metabolic rates in pharma-codynamic rooms

Introduction Project Summary


High-tech aesthetic and welcoming image

Support best practice concepts, fuel creativity and scientific mission

Operational plan key

Mix of building uses – must work for all over time

Flexibility and new science / technologies (video, telemedicine, community education, conference and connectivity)

Introduction Project Goals


Founded in 1908 in Orlando, Florida

The largest hospital in the Adventist Health System

One of the largest hospitals in the U.S.

8 hospital campuses in Metropolitan Orlando area

2,200 beds

110,000+ admissions/year

350,000 emergency department visits/year

17,000+ employees

2,400 physicians

Organization, Plan, and Results Who We Are: Florida Hospital Organization


Florida Hospital East Orlando

Winter Park Memorial Hospital

The Walt Disney Pavilion at Florida Hospital for Children

Florida Hospital Kissimmee Florida Hospital Altamonte

Florida Hospital Celebration Health

Florida Hospital Apopka

Florida Hospital Orlando

Hospital visits 900,000+

Urgent care visits 400,000+

Inpatient beds 2,000+

Employees 17,000+

Net revenue $2.2 billion

Organization, Plan, and Results Florida Hospital (8-campus) Seminole, Orange, Osceola


Organization, Plan, and Results

Healthcare is changing… and we must too

The Healthcare Environment

Accountable Care Act

Medicare and Medicaid changes

CMS pay for performance

All distills down to… − Reduce demand − Improve value − Maintain quality



Looking forward………

The Healthcare Environment

Cannot survive and succeed as just a large community hospital

Committed to growing academics, research, education

− Statutory teaching hospital since 2010 − ~70 residency slots added in the past 3 years − +$80 million invested in research and innovation since 2009



Translational Research

Part of the Solution to Healthcare Reform

Clinical and Research Focus


Sanford Burnham Florida Hospital Translational Research Institute

Discovery Research

Step 1 Translational

Research

Step 2 Translational

Research

Clinical Practice

Basic knowledge pre-clinical

testing

Proof-of-concept target validation

Is the treatment safe and effective?

Implementation of best

practices

Organization, Plan, and Results Translational Research


Fasted growing diseases in the country

Community health crisis

We are the third largest employer in Central Florida

Aligned with our mission and vision, and core values of wellness

Opportunity for impact on the science

Translational Research Why Diabetes, Obesity, and Metabolic CV?



Dr. Steven R. Smith MD, Scientific Director

15 years of funded, peer reviewed science

Renowned obesity scientist

Over 150 peer-reviewed research papers

President-elect of the Obesity Society

Research focused on metabolism and a personalized medicine approach to obesity and diabetes treatment

Recruited in 2008 to vision and lead the development of translational research at Florida Hospital

Organization, Plan, and Results Scientific Vision, Leadership, and Business Plan


Organization, Plan, and Results Facility Drivers

Core Based Model − Insures efficiency of operation − Allows for core expertise that has

collaborative structure

Space designed to be functional, open, and collaborative

Unique technologies housed not available elsewhere

Is the face of human focused research for Florida Hospital

Personalized medicine based research


Clinical Operations − Research clinic − Research administration

Clinical Research Unit − Research pharmacy − Metabolic kitchen

Imaging

Laboratory − Biorepository and Clinical Chemistry − Biomarker Discovery and Development Unit

Energy Metabolism

Research Database and Bioinformatics

Organization, Plan, and Results Personalized Medicine and the Facility Model


Organization, Plan, and Results Personalized Medicine and the Facility Model

Approaches:

Disease pathobiology

Clinical Trials

Experimental medicine/ − Target relevance − Disease sub-phenotypes

Biopsy based PD / biomarker development and validation

PoC / PoM studies − Industry sponsored − Co-developed protocols − IIT

Deep Phenotyping:

Energy expenditure

Glucose and fat metabolism

Body composition

In-situ biochemistry (MRS) − Lipid 1H − Mitochondrial bioenergetics 31P

Food (energy and macronutrient) intake

Endocrine testing / PK BIOMARKERS


Development/Infrastructure − Key to core development − Leveraging opportunities to serve

as co-development and alpha partners

− Connects our scientists with company scientists, building a bridge that is not vendor based

Pharmaceutical/Industry − Model create truly collaborative science − Positions the TRI at the table during the study

design process − Focused on long term relationships with

multiple projects over piece-meal work − Fiscally responsible for both parties

Organization, Plan, and Results Partnerships

http://www.cerner.com/

http://www.usa.philips.com/index.page


DEXA (body composition)

Proton MRS − Muscle and hepatic lipid − Cardiac

3T research dedicated MRI / MRS − Multi-nuclear: 1H, 31P, 13C

Optical spectroscopy (muscle O2)

31P − Muscle

Echocardiography – planned

Organization, Plan, and Results New Technologies


Hotel design features

Nursing unit

8 rooms (10 beds) for overnight stays

3 procedure rooms

Exercise testing suite

Recreation areas including outside patio

Research pharmacy

Supports energy expenditure and metabolism core

Initially pm, eventually 24-7

Organization, Plan, and Results Clinical Research Unit (CRU)


Resting metabolic rate / pharmacodynamic rooms

Instrument room

Exterior glass wall (east)

Room calorimeters

1

2

1 2

Organization, Plan, and Results Calorimeter Suite


Two 30,000L calorimeters

“Push-pull” air flow

5oC - 38oC temperature control

Full digital datastream

Best-in-class accuracy

Designed in partnership with MEI, Inc. - the world leader in calorimetry technology

Organization, Plan, and Results Calorimeter Suite


Blend of NIH, pharmaceutical, and foundation funding sources

Creation of core based research creates efficiencies and allows better expertise in areas

Leverages Florida Hospital and Sanford-Burnham infrastructure when possible

Organization, Plan, and Results Operating Model

NIH Industry Innovation

Science KoLs

Experience Wisdom

Structure Regulatory Quality Efficiency


Health Village Fast Facts

− 2,200+ hospital beds

− 1.6 million SF medical office

− 500,000 SF research

− 230,000 SF general office

− 380,000 SF education

− 140,000 SF retail

− 463 hotel rooms

− 375 multifamily residential units

− Dedicated Sunrail stop

Organization, Plan, and Results Other Research Investments

* 10 acres of parks and green space

* LEED design expectations

www.floridahospital.com/health-village


Celebration Health Nicholson Center

− 54,000 SF advanced medical learning facility

− Training on 50 surgical and clinical skills stations (DaVinci, Lap, Open, and Ortho) and a multi-specialty, state-of-the-art equipment inventory.

− Two team-training operating rooms are designed as a mock OR setup to closely emulate real world experiences.

− A 500-seat conference center auditorium is the optimal environment for classroom study, lectures and medical symposia. It’s built upon a high-definition multi-media platform with a 16-TV customizable video wall and international broadcasting capabilities. The medical conference center can be easily configured and scaled to your group to optimize learning and guest comfort.

Organization, Plan, and Results Other Research Investments


Bench to Bedside in Action:

Since its opening in March of last year, this facility through its collaborations will perform first human trials of a basic science discovery in less than 18 months since discovery, shortening the time gap by over 8 years. The key to this is the bi-directional, rapid flow of information that is made possible by the assembling of all resources under one roof, and the collaboration and expertise that results from that.

Organization, Plan, and Results Metrics and Results


Published 5 October, 2011

Organization, Plan, and Results Metrics and Results


TRANSLATE – Complete Bench to Bedside

Gardell Pratley

Sikder Smith

Orexin-A Activates BAT differentiation in vitro Activates thermogenesis in vivo in mice Weight loss in mice

TRI has complete bench-to-bedside project underway

− GMP synthesis Completed 4/2012 − IND enabling studies including toxicology

Complete 8/2013 − Investigator initiated IND Filed 4/2013 − Clinical FIH experiments (energy expenditure in

calorimeters) In clinic 2014


How is this possible? − Strong communication between

basic and clinical scientists − Organizations committed financially

and scientifically to making a difference

Where to now? − Already in discussions with a large

pharma to fund the clinic project and acquire IP based on initial data and toxicology results

Less Than 3 Years from Publish to Clinic!


The Building and Its Functional Plan

The physical environment designed to be the platform for the TRI, not only focuses on supporting the research and clinical staff,

but also the volunteers that are part of the clinical trials. By

designing a facility that meets the three needs of connectivity, convertibility, and comfort, the project has been a

success in the implementation of its mission .

A Workplace that Supports the Vision


Connectivity − Collocation / collaboration space − Transparency / science in sight − Technology / shared resources

Convertibility − Flexible planning grid − Systems infrastructure − Easily repurposed

Comfort − Volunteer –focused space

Connectivity

Comfort

The Building and Its Functional Plan Design Drivers

Convertibility


Interdisciplinary relationships can be a challenge to the design process.

It’s expensive to build a building that is all things to all people. It is important to prioritize needs verses wants.

Work from most technically challenged space to most flexible.

Predicting new technologies and being prepared for them is a necessity.

The Building and Its Functional Plan Physical Challenges


L1 - Clinical

L2 - Testing

L3 – Research

Level Three − Laboratories

Level Two − Clinical resources − Metabolic unit − Biorepository lab − Kitchen − Pharmacy

Level One − Administration − Clinics − Imaging − Staff Support

The Building and Its Functional Plan Building Statistics


Vision

Design

Goal: Find Collaboration Spaces Mechanical

− Mechanical units per floor

Research labs − Located for flexibility

Clinical research unit

− Located for collaboration

Outpatient functions − Located for accessibility

The Building and Its Functional Plan Connectivity: Work Flow – Block and Stack

Mechanical

Research

Testing

Clinical


X X X X

Y

1/3

1/3

1/3

1/2

1/2

1/2 x 2

1/2 x 2

1/3

2/3

Modular Subdivisions

X

Vision

Design

Module determination: width, length, height

Planning configurations: Major components and design issues

Utility interface: systems distribution options

Typical modules are 11’ wide by 33’ long

The Building and Its Functional Plan Convertibility: Modular Planning Guidelines


The Building and Its Functional Plan Convertibility: Planning Module

Flexibility / Adaptability

Imaging Laboratory Clinical Officing


Vision

Design

“Readily accessible and correct proportion of support spaces – equipment, tissue culture, supplies, etc.”

“Daylighting is important in both lab and office”

The Building and Its Functional Plan Convertibility: Flexible and Adaptable Planning


Vision

Design

The Building and Its Functional Plan Convertibility: Flexible and Adaptable Planning

“Daylighting is important in both lab and office”


Consistency / Efficiency / Cost Effective

The Building and Its Functional Plan Regulating Lines


The Building and Its Functional Plan Building Flows and Support


The Building and Its Functional Plan Ground Level


1. Arrival Auto-Court and Drop-off

1

2

2. Main Entry

The Building and Its Functional Plan Ground Level – Entry and Arrival


3. Entry lobby from drop-off

4. Entry lobby from Princeton Street

3 4

The Building and Its Functional Plan Ground Level – Public Spaces


5. Waiting

6. Entry lobby from Princeton Street

5 6

The Building and Its Functional Plan Ground Level – Public Spaces


7. Administrative Offices

8. Conference Room

7 8

The Building and Its Functional Plan Ground Level – Administration


9. Typical Exam Room

10. Clinic Reception and Waiting

9 10

The Building and Its Functional Plan Ground Level – Clinical


11. DEXA (body composition)

12. Sub-waiting and Changing

11 12

The Building and Its Functional Plan Ground Level – Imaging


13. Control Room

14. MRS

13 14

The Building and Its Functional Plan Ground Level – Imaging


The Building and Its Functional Plan Second Level


15. Upper Waiting

16. Upper Lobby

15 16

The Building and Its Functional Plan Second Level – Public Spaces


17. Nurse Station

18. Overnight Stay Room

17 18

The Building and Its Functional Plan Second Level – Clinical Resources


19. Exercise Room

20. Procedure Room

19 20

The Building and Its Functional Plan Second Level – Metabolic Unit


21. Pharmacodynamic Room

23. Calorimetry Room

22. Calorimeter Suite

21 22 23

The Building and Its Functional Plan Second Level – Metabolic Unit


24. Clinical Lab

26. Tissue Culture Lab

25. Histology Special Chemistry Lab

24

25 26

The Building and Its Functional Plan Second Level – Biorepository Lab


27. Controlled Dining Area

28. Food Testing Kitchen

27 28

The Building and Its Functional Plan Second Level – Kitchen / Dining


29. Outdoor Terrace

30. Garden

30 29

The Building and Its Functional Plan Second Level – Terrace


The Building and Its Functional Plan Third Level


The Building and Its Functional Plan Image and Identity


Engagement of end user during design is key

Design team that takes the time to adequately learn the business of their client

The Building and Its Functional Plan Lessons Learned


1. Clinical organization in a research setting

2. Flexible, adaptable core and infrastructure

3. Alignment of vision with partnerships

The Tradeline Three Big Ideas

Questions

a public-private success laura stillman · dr. steven r. smith md, scientific director 15 years of...

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