the architect’s sustainable approach johathan hoffschneider, aia, leed ap perkins + will
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The Architect’s Sustainable ApproachJohathan Hoffschneider, AIA, LEED APPerkins + Will
AgendaIntroducing Perkins+Will, Economic Context, Meeting Today’s Challenge: Reform, Creating a Healing Environment, Case Study: The Patient Room, The Integrated Design Team, Questions?
Agenda
Founders Larry Perkins and Phil Will
1. Introducing Perkins + Will
Founded in 193518 OfficesProjects in 49 states + 43 countries1600+ Staff (700 in Healthcare)Healthcare Facilities from Clinics to Academic Medical CentersRecipient: 2008 Practice Greenhealth Champion for Change Award
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
…what a difference a year makes
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):
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?
•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.
Source: Engelberg Center for Health Care Reform“Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth,”
3. Meeting Today’s Challenge: Reform
•Healthcare Policy
•Healthcare Delivery Methods
•Comparative Effectiveness Research
•Facilities Modernization
•Advances in Technology
•Application of Sustainability and Evidence-Based Design
Facility Design Impact on Capital StrategiesDisciplined operation / strategic planLeading evidence-based capital designTangible 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
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.
Source: Engelberg Center for Health Care Reform“Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth,”
3. Meeting Today’s Challenge: Reform
• Healthcare Policy
• Healthcare Delivery Methods
• Comparative Effectiveness Research
• Facilities Modernization
• Advances in Technology
• Application of Sustainability and Evidence-Based Design
Facility Design Impact on Capital StrategiesDisciplined operation / strategic planLeading evidence-based capital designTangible 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”
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.
A Healing Environment
3. Meeting Today’s Challenge: Reform
“…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-being46% Operational Cost Savings41% Increased Building Function Efficiency18% Being Part of the Healthcare Sector that Values the Environment9% Public Relations Benefits of Being a Green Leader
Source: McGraw-Hill Construction Research & Analytics 2007
4. Creating a Healing Environment Sustainable and Evidence-Based Design
Source: Advisory Board/ Innovations Center interviews and analysis.
Framework for Evaluating Sustainable Design Options
Impact On Patient and Staff Health
•Waterless/low-flow urinals1
•High ratio of open space•Native, drought-tolerant plants•Locally manufactured construction
materials
•Low-VOC paint•Non-vinyl backed carpeting•Low-emitting adhesives and
sealants•Bicycle storage and changing
facilities
•High proportion of outdoor air ventilation2
•Operating rooms with direct line of sight to vision glazing3
•Daylit prep/recovery units•Vegetated rooftops
Financial Impact
•Biomass-fueled cogeneration plant•Rainwater storage cisterns•Photovoltaic arrays•Charging stations for hybrid vehicles
“Lower on the Priority List”
“Worth Strong Consideration”
“Assess Relative Environmental Impact”
“Low-Hanging Fruit”
No/Minimal Direct Impact
Direct Impact
No/Minimal Cost Premium
High-Cost, with Potential
Downstream Savings
1 Used in public restrooms.
2 Feasibility of increasing outdoor air dependent on infection control regulations. 3 Vision glazing refers to windows (or portion of windows) connecting to the outdoors.
4. Creating a Healing Environment Sustainable and Evidence-Based Design
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
5. Case Study: The Patient Room Applying Sustainable and Evidence-Based Design
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
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Source: Multiple References, Summarized in RING Paper: Hospital Safety by Mardelle McCuskey
Shepley/ Texas A&M/ ART+Science August, 2008
5. Case Study: The Patient Room
Patient Unit Design
• 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
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Source: Multiple References, Summarized in RING Paper: Hospital Safety by Mardelle McCuskey
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5. Case Study: The Patient Room
Source: Patient Safety Design Integration Study: St. Cloud Hospital East Addition - April 2009
5. Case Study: The Patient Room Analysis of Evidence Based Design Strategies: Cost vs. Effectiveness
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Source: Patient Safety Design Integration Study: St. Cloud Hospital East Addition - April 2009
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5. Case Study: The Patient Room Analysis of Evidence Based Design Strategies: Cost vs. Effectiveness
CLIENT
Facilities
MDs
Admini-
strators
Vendors/
Suppliers
Nursing/
Support
Patients
Families/
Public
Industry
Design
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6. The Integrated Design Team
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