1 Myra Gray Fouts Natalie C. Miovski RN, MSN, OCN, CNAA AIA, LEED AP VP, Medical Affairs Principal Aptium Oncology Inc. EwingCole Architecture: Space Planning and The Development Process Sponsored by: Sponsored by: Aptium Aptium Oncology Oncology 2 National Healthcare Expertise 300+ Professionals (Philadelphia, PA, Washington, DC, Irvine, CA, Cleveland, OH Healthcare Strategic/Master Planning, Planning & Programming, LEED Design, Architecture, Interior Design, Cost Estimating, Program Management, Structural, Mechanical/HVAC, Electrical, Plumbing, Fire Protection/Life Safety Engineering, Natalie C. Miovski, AIA, LEED AP Principal EwingCole
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Architecture: Space Planning and The Development Process
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Myra Gray Fouts Natalie C. MiovskiRN, MSN, OCN, CNAA AIA, LEED AP VP, Medical Affairs PrincipalAptium Oncology Inc. EwingCole
Architecture: Space Planning and The Development Process
National Healthcare Expertise 300+ Professionals (Philadelphia, PA, Washington, DC, Irvine, CA, Cleveland, OHHealthcare Strategic/Master Planning, Planning & Programming, LEED Design, Architecture, Interior Design, Cost Estimating, Program Management, Structural, Mechanical/HVAC, Electrical, Plumbing, Fire Protection/Life Safety Engineering,
Natalie C. Miovski, AIA, LEED APPrincipal EwingCole
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Cancer Treatment Centers of AmericaCedars-Sinai Medical CenterChildren’s Hospital of New YorkCity of Hope Medical CenterClara Maass Medical CenterDeborah Heart and Lung CenterFox Chase Cancer Center Geisinger Health SystemLoma Linda Cancer Institute
Memorial Sloan-Kettering Cancer CenterNorth Shore Long Island Jewish Health SystemSaint Jude Children's Research HospitalSanford Children’s HospitalSUNY, Stony BrookUniversity of California, Irvine Medical System
EwingCole HealthcareRepresentative Clients
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Aptium works with hospitals and physicians to design, finance, build and manage comprehensive cancer centersAptium’s comprehensive cancer center model brings all the disciplines and services involved in cancer care under one roof.They are customized to their market; tailored to their situation.
Myra Gray Fouts, RN, MSN, OCN, CNAAVP, Medical Affairs, Aptium Oncology Inc.
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Host Hospitals IncludeCedars-Sinai Medical Center CALIFORNIA
Alta Bates Summit Medical Center CALIFORNIA
St. Vincent’s Hospital Manhattan NEW YORK
Desert Regional Medical Center CALIFORNIA
Mount Sinai Medical Center FLORIDA
Boca Raton Community Hospital FLORIDA
New York University Cancer Institute NEW YORK
Trinitas Hospital NEW JERSEY
The Aptium Network
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Demand for Services How to Measure SuccessTeam, Team, TeamApproach
Planning/developmentDesignConstructionResults: Case Study
Trinitas Comprehensive Cancer Center
Agenda
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A growing demand for servicesAn explosion of treatment optionsUncertain financial climateIncreasing administrative burdens
Future of Cancer Care
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Raise the level of cancer care in the communityIncrease regional presenceRetain and attract leading physiciansFurther enhance research programs and clinical protocols
Increase cancer program profitability and cash flowsDecrease patient out-migrationExplore opportunities to partner with a 3rd party to meet objectives
Proven expertiseAccess to funding
Common Hospital Service Line Goals
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11%
16%
23%
27%
29%
30%
37%
40%72%
0% 20% 40% 60% 80%Capacity
Patient Satisfaction
Government Mandates
Patient Safety
Quality
Personnel Shortages
Care for Uninsured
Physician and Hospital Relations
Financial Challenges
Source: Modern Healthcare, January 1, 2007
Pressures on HospitalsCEO Top Concerns
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Patient satisfaction“I find it very relaxing even though circumstances dictate anxiety.”“Your staff is the most compassionate, caring and courteous medical staff I have ever encountered; each and everyone of themtreats you as a special person.”“You should be extremely proud of your facility and of your magnificent staff!”
How To Measure Success
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9793.7
95.4
90.5
95.3
90.2
95.4
91
50
60
70
80
90
100M
ean
Sco
re
Facility cleanliness Find way aroundfacility with ease
Waiting area comfort Changing roomprivacy
*PG Database = All facilities in Press Ganey's Outpatient Oncology Database
TrinitasPG Database*
Results Overall Consensus - Positive
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Patient satisfactionStaff satisfaction
“Everyone was surprised and delighted with the way it turned out”“What I need to do my work is convenient to me. I turn around and there’s my supplies, my computer, my pharmacy, my patients.”
Develop detailed business case includingClinical program recommendationsStaffingEquipmentSpace requirements
Approach: Program
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Model Cancer CenterProgram
Key Influencers
Processes
Design DevelopmentPost-Occupancy
Patient & StaffSatisfaction
Construction/ Costs
Timeline
Approach
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PatientViews of nature, daylight and sunlightControl of local environmentSocial supportPrivacyNurse visibilityPlaces for family/guestsTranquil, state-of-the-art environment
StaffPatient visibilityMinimal footsteps to key areasSingle point access to pharmacyCollaboration with other nursesSpace for private conversationsAmple supplies near at handPlaces for personal effectsErgonomics
Approach: Model Cancer CenterRecognized Convention
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“It is the unqualified result of all my experiences with the sick, that second only to the need of fresh air is their need of light; that, after a close room, what hurts them most is a dark room.”
– Florence Nightingale
Approach: Model Cancer CenterRecognized Convention
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Equipment & TechnologyLatest, greatest, fastest, smallest, lightestFlexibleComprehensive & user friendly
“The flow for the patients has been well thought out, not only to reduce patient apprehension, but to help the staff coordinate their care.”Chief, Radiation Oncology
Budget Value matrixCost containmentManage expectations
Approach: Construction/Cost
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Northeast Urban Cancer Center – 2007 costs Medical oncologyInterior fit-out only $340/sf
Northeast Suburban Cancer Center – 2005 costsMedical & radiation oncology New building $435/sf
Southwest University Cancer Center – 2007 costsMedical oncologyInterior fit-out only $320/sf
Median range (2007) $210-360/sf fit-out only$250-480/sf new building
Pharmacy fit-out only $850/sfLinear accelerator only $450/sf
Approach: Construction/Cost
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National Median 2Cost per square foot: $240Size: 64,000 square feetTotal cost (excluding land): $16.4 M
~$250 per sq. ft.~$200 minimum per sq. ft.highly variable by location
Approach: Construction/CostThe Advisory Board
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Vaults$275–$350 per sq. ft.$25K+ for door3,500–6,000 sq. ft. per vault
Infusion Center$200–$225 per sq. ft., often 1/4 of facility space500 sq. ft. exam room350–500 sq. ft. per infusion space, 350 sq. ft. additional for open bay layout
Clinical Office Space$180 per sq. ft.
Shell Space$60–$90 per sq. ft.
Approach: Construction/CostThe Advisory Board
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Model Cancer CenterProgram
Key Influencers
Processes
Design DevelopmentPost-
Occupancy
Patient & StaffSatisfaction
Construction/ Costs
Timeline
Approach
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300-bed Community Hospital with religious affiliationsUrban and inner city neighborhoodProminent location on campus and in cityAward winning economic re-development organizationFormer location of parking lot/original hospital chapel
Approach: Post-OccupancyCase Study: Trinitas Comprehensive Cancer Center
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Specific challenges:Changing use and programNew management teamPredetermined design/construction teamFixed exterior designFast track construction with construction weariness and boom in areaPreset budget and schedule
Approach: Post-OccupancyCase Study: Trinitas Comprehensive Cancer Center
What kind of culture did we create?“A culture where patients feel cared for and about”
Is it the ideal place for patients to be treated and for physicians to treat patients?
“Yes, given the space available”
Is it a healing environment?“Yes, but could have more water features, gardens etc., to add to the concept”
Approach: Patient & Staff SatisfactionDid We Accomplish Our Goal?
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All areas would have liked more spaceCommon theme included:
Bigger conference roomsIdeally would be all on 1 floor – patients find multi-levels confusingStaff lounge area too small (not enough seating those who need to eat at the same time – not enough for growth)“We’ve already outgrown the space”
Approach: Patient & Staff SatisfactionAcross The Board
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When asked: “What should have been eliminated to make more space for “x”?”
No one could identify what should have been left out or identifyother priorities for space available
Approach: Patient & Staff SatisfactionAcross The Board
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“A nice warm experience for patients and staff”“Patients are very happy”“Patients feel like they aren’t coming to a hospital or a clinical environment”“Patients love it”“Everyone was surprised and delighted with the way it turned out”
Facility cleanliness Find way aroundfacility with ease
Waiting area comfort Changing roomprivacy
*PG Database = All facilities in Press Ganey's Outpatient Oncology Database
TrinitasPG Database*
Results Overall Consensus - Positive
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“The center is always very clean, it is very easy to go from one place to another it is always labeled, the privacy of the changing rooms is very good.”
“I find it very relaxing even though circumstances dictate anxiety.”
“It feels like someone cared about me - everything from the valet parking to the wireless internet”
“The first time they told me about the Center, they said it was like a hotel and not a hospital. When I saw it, I found out that what they said was true. I felt like I was the only patient there with all the attention I received.”
“Hospitality and attention to details are the hallmarks of the patient-centered care at Trinitas”
“All the natural light makes such a difference, I don’t feel like I’m in a cancer center” From Trinitas Cancer Center Press Ganey