PEACE ARCH HOSPITAL MASTER CONCEPT PLAN Project ...

PEACE ARCH HOSPITAL MASTER CONCEPT PLAN

MASTER CONCEPT PLAN – DRAFT APRIL 12, 2012 Page 1

Project Number: PAH-10-1010

Site Address: 15521 Russell Avenue White Rock, B.C. V4B 2R4 Prepared By:

• Consolidated Lower Mainland Facilities Management (LMFM)

Funded in Partnership with: • Peace Arch Hospital and Community

Health Foundation

• Kasian Architecture Interior Design And Planning Ltd.

• Resources Management Consultants (Alberta) Ltd.

• Jim Bush and Associates



• TABLE OF CONTENTS

INTRODUCTION .............................................................................................................................. 3

WHAT IS A MASTER CONCEPT PLAN ............................................................................................................................ 3 PURPOSE AND VALUE OF A MASTER CONCEPT PLAN ................................................................................................... 3 WHAT IS A MASTER PROGRAM .................................................................................................................................... 5 VISION, MISSION & PRINCIPLES ................................................................................................................................... 5

Vision ...................................................................................................................................................................... 5 Mission ................................................................................................................................................................... 5 Commitment ........................................................................................................................................................... 5 Core Principles ........................................................................................................................................................ 5 Guiding Principles .................................................................................................................................................... 6

EXECUTIVE SUMMARY .................................................................................................................... 7

PEACE ARCH HOSPITAL MASTER CONCEPT PLAN ........................................................................... 8 Overview of the Chapter .......................................................................................................................................... 8 Demographic Profile of the Service Area. ................................................................................................................. 8

PAH FACILITY PROFILE INFORMATION (ROLE OF PAH) .................................................................................................10 MASTER PROGRAM PRIORITIES & PLANNING PARAMETERS ........................................................................................13

Master Program Priorities .......................................................................................................................................13 MASTER PROGRAM PARAMETERS ..........................................................................................................................14

ADJACENCY MATRIX ...................................................................................................................................................15 FUNCTIONAL EVALUATION SUMMARY .......................................................................................................................16 PURPOSE OF SITE/BUILDING ASSESMENT ...................................................................................................................17 URBAN CONTEXT........................................................................................................................................................17

Topography of Sites ................................................................................................................................................17 ZONING AND LAND USE .............................................................................................................................................18 BUILDING HEIGHTS.....................................................................................................................................................19 SITE STATISTICS ..........................................................................................................................................................21

Setbacks .................................................................................................................................................................21 Maximum Site Coverage .........................................................................................................................................21 Allowable Density (FSR) ..........................................................................................................................................21

BREAKDOWN OF BUILDING / PARKING STATISTICS .....................................................................................................22 Building Floor Area * ..............................................................................................................................................22 Site Assessment......................................................................................................................................................22 Parking Stalls * .......................................................................................................................................................22 Building Age ...........................................................................................................................................................23

EXISTING FLOOR PLANS BY DEPARTMENT / USE .........................................................................................................24 BUILDING / SITE SECTIONS.........................................................................................................................................31 SITE PHOTOS ..............................................................................................................................................................32 URBAN PLANNING ANALYSIS ......................................................................................................................................39 EXISTING GREENSCAPE ...............................................................................................................................................41 SITE / COMMUNITY CHARACTER.................................................................................................................................42 SPACE SUMMARY (CURRENT & PROJECTED) ...............................................................................................................43 PLANNING PRINCIPLES ...............................................................................................................................................46

SITE OPPORTUNITIES .................................................................................................................... 47

SITE DEVELOPMENT STRATEGIES .................................................................................................. 50

PROPOSED SITE DEVELOPMENT SOLUTIONS ................................................................................ 53 Phase 1A - New Residential Care Building, Lot C South - By 2014 (Open) ..................................................................... 53 Phase 3: Second Residential Building on Lot C (North) - Design (2016 - 2018)............................................................. 56 Phase 4: New Tower (2018 - 2030) ............................................................................................................................ 57

0 - 3 Year Cost Estimate – ............................................................................................................. 58

PHASE 1 DESIGN AND CONSTRUCTION SCHEDULE ....................................................................... 59



Site Opportunities Plan (Capacity)

Site Development Plan (Density / Massing / Infrastructure)

Site Master Concept Plan (Projects / Capital)

Project Business Case

Project Capital / Operational Approval

Increased Planning Effort

Project Implementation

Priority Needs

Priority Projects

Project Concept Brief (Service & Value)

INTRODUCTION

WHAT IS A MASTER CONCEPT PLAN A Master Concept Plan (MCP) is an integration of clinical service planning, space programming, asset management, urban planning and site planning undertaken at a higher level to recognize the dynamic nature of the healthcare environment and planning information. It involves a process of assessment and analysis of current and future service needs and facility readiness (both actual and potential) to enable current and future service delivery through the development of short, medium and long term infrastructure projects. The MCP is an innovative variant of traditional Master Plans that are more appropriate for other sectors such as university sectors that have more stability in their facility and capital funding requirements. As a consequence traditional Master Plans commit more planning effort and resources to develop detailed functional plans down to the room level, project phasing plans for the campus with comprehensive capital and operating financial plans and procurement strategies for the phases. Like a Master Plan, the MCP does take a short, medium and long term perspective. But in such a dynamic environment as healthcare, the MCP takes a different approach that provides value over a traditional Master Plan process in two ways. First the MCP process matches the level of service and facility information, processes, resources and deliverables to what is needed to make transparent and defensible facility decisions. Conversely a Master Plan assesses clinical needs at a room detail level which is time consuming and expensive. The MCP process engages greater planning detail at the Business Case stage when there is greater probability of a priority project obtaining capital funding approval. Secondly the MCP focuses on achieving the approval and financing of short term priority projects that mitigate high consequence facility deficiencies impacting care access, quality, efficiency and continuity. Large capital projects are pursued where they represent an appropriate response to facility needs and where there is a reasonable probability of the project being approved. Taken together the MCP provides enhanced stewardship of the Health Authority’s planning funds while providing a context to advance project approval and implementation.

The MCP is one of a suite of three plan typologies that the LMFM Group undertakes for its sites. The two other plan typologies that are commonly undertaken are the Site Opportunity Plan and the Site Development Plan. Both of these plan typologies are really subsets of the Master Concept Plan. The Site Opportunity Plan’s focus is primarily on the capacity of the site and siting opportunities to accommodate additional building area. The emphasis is on the site and urban planning elements found in the MCP. The Site Development Plan extends the focus to consider what the density, massing and built form of development on the site would look like based on high level space projections of selected clinical and operational elements such as inpatient beds that inform the overall size of the future facility. It does not take a more extensive view of considering the service role of the site within a regional system or look at opportunities for service realignment and partnerships or look for opportunities to improve the utilization of space by programs. Nor does a Site Opportunity Plan or Site Development Plan set out to identify short term priority projects to advance them to the Project Brief or Business Case stage for funding approval.

PURPOSE AND VALUE OF A MASTER CONCEPT PLAN The MCP creates a long term vision for a facility to inform optimal short term & long term site infrastructure decisions and focuses on generating value for site users and health service providers in four key areas

• Service alignment, quality and operational productivity

• Asset lifecycle value

• Asset highest and best utilization & synergy with surrounding community

• Identification and configuration of phasing of priority projects to address facility issues having high consequence for care access, quality, efficiency and sustainability. in a way that maximizes financing approval and project initiation

Service Alignment, Quality and Operational Efficiency:

The MCP process provides an opportunity to understand the site’s current and future service plan alignment within a regional context, service requirements on the site and assumptions that drive the current and future capacity and functional requirements of the facility infrastructure. This review provides the basis for understanding where the facility infrastructure is misaligned with current and future patient and service needs or creates obstacles to operational efficiency and care quality.



Asset Lifecycle Value:

Hospital facilities have an economic life that reflects both the physical lifecycle of the facility and its building components and the functional usefulness of facility systems and spaces to accommodate current and future patient and operational needs. The physical lifecycle starts with the construction of a new facility at which time it is at its physical and functional prime. Subsequent investments in preventative maintenance, replacement or upgrades of building components, renovations or even re-purposing of the facility combat the obsolescence caused by age, weather, wear and tear and the pervasive changes in healthcare service demand, clinical practices and technology. A replacement facility is sometimes required when the costs to renew the economic life of the facility approach the costs of building a new facility. The decision to renew, de-commission or replace a facility can be a complex one and requires periodic assessment and planning within a site and even regional context to develop a coherent and optimal facility investment strategy. Without a Master Concept Plan that identifies the economic lifecycle and role of facilities within a broader and longer term context, facility users and the health organization can fail to realize the full benefits of facility investments.

Asset Highest and Best Use:

The projects that are required for the timely renewal or replacement of hospital facilities have a significant lead time for planning, approvals, financing, design and construction. Advanced planning is critical to accommodating this lead time so that the right facility environments are available at the right time, place and cost. Hospital sites often have multiple buildings each with a different economic lifespan and with functional interdependencies that adds to the complexity of making decisions that optimally position the site and its facilities to support the short, medium and long term requirements of patients, clinicians and operations. Site and facility decisions must also take into account that a hospital site has development opportunities and constraints created by the existing site area, shape, infrastructure, zoning and regulatory policies, surrounding land uses and neighbours. In this context, the site itself is a valuable asset from a utility and market perspective. But it has practical limits on its ability to accommodate the current and future space requirements of health services and do so in a way that achieves the siting of services necessary for effective and efficient access to care and delivery of care services. Planning of facility projects in the absence of a Master Concept Plan can diminish the long term utility and value of the site by misusing site area suitable for higher and better uses.

Identification of Short Term High Priority Project Solutions that Are More Readily Achievable:

The MCP focuses on driving the approval and financing of short term priority projects to mitigate high consequence facility deficiencies impacting care access, quality, efficiency and continuity. However the MCP process looks for opportunities to improve facility and operational conditions that are right sized for financing. Large capital projects are pursued where they represent an appropriate response to facility needs and where there is a reasonable probability of the project being approved for funding. Importantly the MCP provides the longer term vision of the site within which decision makers and potential funders can understand how individual projects fit into the long term development and investment strategy of the site. This reduces the financial risks of a project.

The availability of capital and operational financing for facility projects is linked to the priorities and policies of government, health authorities, regional hospital districts and foundations. One such policy, the Capital Asset Management Framework (CAMF) sets the Provincial Government’s expectations as to the rigour of the service plan,

capital needs, strategic options analysis and solution delivery strategy for capital assets such as facilities as a means of ensuring that capital requests to the provincial treasury have considered non-capital solutions to address capital asset deficiencies and obsolescence and considered non-provincial capital financing solutions for capital projects that are required. The MCP demonstrates that the projects identified for a site have emerged from a process that meets the expectations of the CAMF.

CAMF



WHAT IS A MASTER PROGRAM The Master Program is the key program/service input into the development of the Master Concept Plan. It describes in words and component areas the program requirements for the 31 program components identified for master programming at PAH.

Each Master Program includes a description of the current and projected scope of service for each program, and their corresponding functional, operational, spatial and relationship requirements. It incorporates the projected program space for the next 10-15 years and informs the Master Concept Plan for PAH.

VISION, MISSION & PRINCIPLES The development of the PAH Master Concept Plan was guided by the vision, mission and planning principles for Fraser Health as presented below.

Vision For Fraser Health, the "vision" is the mental concept or image of what the organization is seeking. The general vision is “Better Health, Best in Health Care”.

Mission • To deliver high-quality, culturally-sensitive, health care services;

and

• To improve the health and well-being of the people in our community.

Commitment In carrying out the mission, it is critical that the spirit and intent of the Facility is not lost during the planning, implementation, or operational phases of the Project. To this end, a series of commitments has been made by staff members, physicians, and planners. These commitments are set out below.

Fraser Health is committed to:

• The seamless integration of services into the continuum of care;

• Providing inter-disciplinary primary and chronic care;

• A patient-centered approach to health care delivery;

• Evidence-based best practice and design;

• Exceptional customer service;

• Linking with community care providers and hospitals in order to actively integrate the delivery of care;

• Creating an atmosphere that embraces healthy lifestyles, facilitates healing, and reflects the diverse needs of the community;

• Being on the leading edge of health care delivery through continuous quality improvement, innovation, and a commitment to achieving optimum results;

• Operational efficiency; and

• Creating an environment where care providers and staff are proud and happy to work.

Core Principles Fraser Health has identified six “core principles” that it has concluded will assist to establish effective care delivery models, clinical support and design:

• Patient-Centered. The Facility should facilitate the delivery of patient-centered care that seeks to optimize the overall experience of patients and their families.

• Forward-Thinking (Future-Oriented). The Facility should be designed to accommodate future care delivery trends, technologies, and service needs.

• Efficient Use of Resources. The Facility should be designed to maximize the value of each health care dollar spent to in Design and Construction and after Service Commencement.

• Integrated Care Delivery and Knowledge Transfer. The Facility should facilitate the involvement of all appropriate care providers in the diagnosis and treatment of patients and facilitate access by care providers and patients to complete and timely health information.

• Optimized Health Outcomes (Better Health). The design of the Facility should promote healthy lifestyles and optimize health outcomes for patients.

• Strives for Excellence (Best in Health Care). The Facility should facilitate excellence in clinical and support services and a healthy workplace environment.



Guiding Principles From the core principles set out above, Fraser Health has developed a more detailed set of “guiding principles” that can be used to develop service strategies. These guiding principles essentially create a framework for assessing service strategy decisions against the stated vision, mission, and core principles. These should serve as the common foundation for all planning, design and operation decisions as the development of the Project proceeds.

Patient Centered

• Design with the patient’s perspective in mind.

• Develop and maintain a healing and aesthetically pleasing environment that is inviting, comfortable and sensitive to diversity.

• Improve indoor environmental quality through sustainable design.

• Design care processes that optimize patient, client and family satisfactions.

• Design so that diversity is not a barrier to health care.

• Design parking to provide easy access to the Facility.

Forward Thinking

• Create a flexible and adaptable design to accommodate future structures, processes, care delivery systems and technological needs.

• Minimize impact on the natural and physical environment.

• Strive to be on the leading edge of health care delivery.

• Incorporate state of the art technology.

• Be proactive in thinking and embrace innovation.

• Improve environmental impact through “green” or “sustainable planning” design, construction, operations and maintenance.

Efficient Use of Resources

• Build and promote partnerships that improve effectiveness and efficiency.

• Maximize cost effectiveness and the use of available resources.

• Use technologies as a tool to improve cost effectiveness.

• Maximize space through efficient design and shared usage.

• Utilize an optimal performance approach such as LEAN Healthcare.

Integrated Care Delivery and Knowledge Transfer

• Develop and apply integrated resources to enable:

• Seamless and sustainable care and support for patents and families;

• Effective exchange of information;

• Sharing of technology and services; and

• Ongoing learning and development of new knowledge.

Optimized Health Outcomes (Better Health)

• Use technologies as a tool to improve health outcomes.

• Models of care and design will be evidence-based.

• Promote healthy living.

• Quality and safety will be the paramount features of the clinical and non-clinical work environments.

• Provide staff with the physical facilities necessary to allow them to excel in a safe and multi-functional environment.

Strive for Excellence (Best in Health Care)

• Foster a safe, comfortable and productive healthy workplace environment that promotes recruitment, retention and satisfaction.

• Maintain the individual identities of the Authority while sharing resources and providing seamless services.

• Adopt best practices and aspire to be leaders.

• Open to new ideas and creative solutions.

• Remain patient focused and have the courage to do what is necessary to achieve the Facility’s mission, vision and core principles.



EXECUTIVE SUMMARY

Overall Purpose of Master Concept Planning

• Define the hospital’s role within the network of acute and community services in FH and the Lower Mainland context

• Align capacity planning to the overall capacity planning in Fraser Health and Lower Mainland • Anticipate emerging service requirements • Prioritize service enhancements and required capital investments • Provide support for funding requests and allocation

Goals

• Produce a 10 year plan that includes a 20 year vision • Review current and future scope of clinical services • Indicate opportunities for improved clinical operations & efficiency related to space and design • Identify key operational requirements • Identify expansion areas on the site

Background In 2011 Peace Arch Hospital and Community Health Foundation and Fraser Health jointly funded a Master Concept Plan for Peace Arch Hospital (PAH). The plan is based on high level service demand projections, assumed future service mix and aligned with the hospital typology project. The purpose of the plan is to guide future facility investment decisions as well as provide a framework for ongoing facility planning. Peace Arch Hospital (169 funded beds1) is a community Hospital with a 24/7 Emergency Department that primarily serves the communities of South Surrey and White Rock (SS/WR) with some inflow from other communities (Delta, Tsawwassen, Ladner and Langley). The 2011 population of the Peace Arch catchment area is approximately 87,752 and in the next ten years will grow by 14.7% to 100,670. 2 By 2030, 30% of the SS/WR population will be seniors 65 and older and while enjoying good health and longer life expectancy the high prevalence of seniors in this community is expected to significantly impact health service requirements. The campus includes two Complex Residential Care facilities, Dr. Al Hogg Pavilion and Weatherby Pavilion (234 beds). Past reviews of Peace Arch Hospital programs identified several areas that are struggling to provide a high level of service due to expanding volumes, increasing complexity and lack of space. Overall growth projections indicated that the current site could grow to a range of 348 – 362 beds 3 by 2030. Additionally, the Emergency Department was identified as a priority for grow to 46 treatment spaces from the current 10 treatment spaces based on increasing visit volumes.

1 Includes all acute & 8 palliative beds based on April 2011 information 2 Source BC Stats, People 36 projections & FH Population Health Profile 2010 3 Data to determine this growth was prepared by FH Decision Support Services, using CIHI DAD 2009/10, 2006 ACCI methodology with refined service group mix.

Immediate priorities identified in the next five years are:

1. Expansion of Peace Arch Hospital’s Emergency Department 2. Expansion of Residential Care Capacity 3. Redevelopment of OR & Surgical Inpatient Program

Future Priorities over next six to 20 years include:

1. New ICU 2. New Acute Care tower

Findings To accommodate priority requirements various development scenarios were considered with the most viable option presented below.

1. An opportunity has been identified to develop a complex care residential facility on the PAH Foundation owned property on the North West corner of 156th street and 16th Avenue. Potentially a new facility could be developed within two year to support approximately 200 beds.

2. Phase 1a: Decant 80 beds from the Weatherby Pavilion into the new residential facility (excluding Oceanside – Tertiary Mental Health program).

3. Phase 1b: Decant Berkeley Pavilion, Vine Avenue and Russell Unit as well as some areas from the main floor of the Acute building to the Weatherby Pavilion.

4. Phase 2: Renovate and expand the existing Emergency Department, minor O/R and surgical outpatient areas.

5. Phase 3: Demolish Berkeley Pavilion, Vine and Russell buildings for development as interim parking lot until construction of a new tower.



PEACE ARCH HOSPITAL MASTER CONCEPT PLAN STRATEGIC CONTEXT, SERVICE REVIEW & HOSPITAL PROFILE

Overview of the Chapter This section of the report presents demographic information for the PAH service area, master plan priorities and key planning parameters that directed the development of the plan. The service planning information was used to project workload and staffing which are the key space drivers. The chapter also includes information on bed projections, planning parameters for each master program, and the space summary based on the master programs.

Demographic Profile of the Service Area. Peace Arch Hospital (PAH) is located in the Lower Mainland of BC in the City of White Rock. The following table presents the demographic information for the White Rock / South Surrey area (Source: BC Stats, BC Ministry of Labour & Citizens’ Services, P.E.O.P.L.E. 35 projections). Observations - Demographic Profile Information The population increased by 5% between 2008 and 2010. It is projected to increase by another 8.5.0% by 2015, and another 7% by 2020. • The seniors population (age 65 plus) is a significant population. The SS/WR population is older than Fraser

Health overall with more seniors 65+ than children ≤16 as seen in the inverted pyramid shape in the age‐sex distribution graph. A popular retirement community with our lowest birth rate, SS/WR is home to one of the largest concentrations of seniors in our region.

The following map shows the South Surrey/White Rock Local Health Area (LHA) boundaries (Note: Patients from outside the White Rock / South Surrey area access PAH for health services but the primary service area is White Rock / South Surrey).

The following information is taken from the Population Health Profile 2010 for the South Surrey/White Rock (SS/WR) Local Health Area (LHA) document prepared by Fraser Health: • In SS/WR, 24% of the population are seniors 65‐years and older, giving SS/WR the largest proportion of seniors

among Fraser Health LHAs. The aging population is a significant driver of demand because the need for health services rises dramatically with age. In 2006/07 people over 65 made up 14 per cent of the B.C. population, but used 33 per cent of physician services, 48 per cent of acute care services, 49 per cent of PharmaCare expenditures, 74 per cent of home and community care services and 93 per cent of residential care services. The following graphically illustrates this point, i.e. seniors are significant users of health services.

• By 2030, 30% of the SS/WR population will be seniors 65 and older. • Low‐income is less prevalent in SS/WR than in many of our other LHAs. SS/WR has the highest average family

income in Fraser Health and one of the highest median incomes. • Cancer, depression/anxiety, and dementia in seniors are major causes of illness, with higher rates than Fraser

Health or BC overall. • About 17% of Fraser South residents smoke, a major risk factor for cardiovascular disease and lung cancer, two

of the leading causes of death in SS/WR. • Older adults can be heavy users of our healthcare system and their healthcare needs are generally more diverse

and more complex than those of younger age groups. While a growing seniors’ population could increase demand in our health care resources and other services, this age group also has much to offer society through volunteerism, civic participation, and community involvement. Fraser Health can help to protect this resource and reduce the anticipated demand on healthcare utilization by encouraging seniors to adopt healthy, active lifestyles and by providing supports for optimal aging.

• Health Status: In general, South Surrey/White Rock residents enjoy good health and have long life expectancies. However, South Surrey/White Rock has higher incidence rates for cancer and prevalence rates for dementia among the elderly and depression/anxiety compared to the Fraser Health and BC averages. The prevalence rates for a number of chronic diseases are on the rise and a cause for concern and some health practices can also be further improved. For example, less than 40% of Fraser South residents eat the recommended five daily servings of fruits and vegetables. In addition, 17% of residents smoke, and smoking remains the single most significant preventable risk factor for cardiovascular disease and a number of different types of cancer. Cardiovascular disease remains one of the leading causes of hospitalization among men age 25‐64 and among men and women age 65 and older in South Surrey/White Rock, and is the leading cause of death as well. Cancer is also a significant cause of death. In fact, chronic diseases contribute to 9 out of 10 of the leading causes of death in South Surrey/White Rock.

Area 2008 2010 2015 2020

White Rock / South Surrey 82,287 86,013 93,177 99,460 % é - 5% é 8.5% é 7% é





PAH FACILITY PROFILE INFORMATION (ROLE OF PAH) A primary role of the PAH is to provide secondary acute services and fulfill the role of a community hospital.

In order to provide sustainable, high quality health care (from prevention to end-of-life care) throughout the region, Fraser Health continues work to integrate services and care processes across the continuum. From a patient safety and quality of care perspective, continuity of care between hospitals and between hospital and community services is paramount. Transitioning patients from specialized care at one of Fraser Health regional centres to care at a community hospital will be medically appropriate, efficient and effectively utilize Fraser Health resources to better serve patients, families and communities.

To pursue Fraser Health’s future vision of a seamless, integrated, high quality network of services, Fraser Health – in collaboration with academic and community partners – has undertaken a number of extensive planning exercises. One such exercise, the Acute Care Capacity Initiative (ACCI), included a systematic literature review in regards to hospital roles and functions within an integrated system. The hospital roles contained in this section are grounded in the literature and provide the foundation for future planning and resource allocation.

Hospitals Defined: A Classification of Regional and Community Roles

Fraser Health’s integrated care network contains “regional” and “community” hospitals. Within regional and community hospitals a range of services are provided based on proximity to other sites, their specific clinical function, historical referral patterns, integrated service delivery models and the health needs of the population served. The following table articulates the general functional characteristics of regional and community hospitals. As outlined, all Fraser Health hospitals have variable components of non-referral services, referred services and academic teaching and research elements.

Table 1 – Fraser Health Hospital Classifications

Regional Hospitals Community Hospitals

Non–referral services

Primary

- 24/7 Emergency - Some GP services

Primary

- 24/7 emergency - Some GP services

Referral Services

Secondary

- Primary care/community practitioner refers patient and specialists may provide care

Secondary

- Primary care / community practitioners manage majority of care, refer patients to specialists when required. At some sites specialists may be primary care giver.

- May include “area of specialty focus.” Tertiary

- Highly specialized acute care services that require multiple medical specialties, specialized technology and multi-disciplinary care team

- Designated referral centre for selected specialized services, serving the entire region.

Tertiary

- Tertiary services are not provided at Fraser Health’s community hospitals.

Academic health care network

Active participation in medical education / residency programs and clinical teaching. University designated “Clinical Academic Campus.”

May participate in medical residency programs & clinical teachings

Potential clinical teaching sites

C O M P L E X IT Y O F C A R E

R E G IO N A L H O S P IT A L

C O M M U N IT Y H O S P IT A L

R o ya l C o lu m b ia n H o sp ita l

A b b o ts fo rd R e g io n a l H o sp ita l a n d C a n c e r C e n tre

S u rre y M e m o r ia l H o s p ita l

B u rn a b y H o sp ita l

R id g e M e a d o w s H o sp ita lL a n g le y M e m o ria l H o sp ita l

C h illiw a ck G e n e ra l H o s p ita lP e a c e A rch H o s p ita l

E a g le R id g e H o sp ita l

D e lta H o s p ita l

M iss io n M e m o r ia l H o sp ita l

F ra s e r C a n y o n H o sp ita l

h ig h lo w



The next series of table present service utilization information for PAH. This information further substantiated the \key program pressure areas and in particular acute care capacity requirements for the Emergency Department and acute beds at the site.

The following table presents the number of PAH Cases by Service & Patient Residence LHA for 2009/10.

LHA Cardiac Medicine Surgery Neurosc. Paeds. Maternity Psych. Other TOTAL

Abbotsford 1 5 10 1 0 4 1 0 22

Agassiz 0 0 1 0 0 0 0 0 1

Burnaby 4 2 11 1 0 3 4 0 25

Chilliwack 0 4 6 2 0 2 2 0 16

Coquitlam 3 7 11 1 0 6 5 0 33

Delta 9 34 72 3 2 117 15 4 ****256

Hope 0 0 0 0 0 0 1 0 1

Langley 25 65 101 5 1 117 17 5 ***336

Maple R 3 3 5 2 0 0 0 0 13

Mission 0 3 2 0 0 0 2 0 7

New West 3 2 6 1 0 2 0 0 14

WR/SS 875 1603 1492 297 23 699 316 158 *5463

Surrey 132 318 487 34 7 559 70 17 **1624

VCHA 8 19 23 6 0 5 5 1 67

Other 21 45 55 8 0 9 11 1 150

TOTAL 1084 2110 2282 361 33 1523 449 186 8028

Notes: WR/SS = White Rock / South Surrey

As shown above, the largest number of cases were from White Rock / South Surrey (highlighted in red font), the second largest number of cases were from Surrey (green font), the third largest number from Langley (blue font), and then Delta (orange font). This information confirms that the primary clients of PAH are residents of the White Rock / South Surrey area.

The following table presents the PAH Percentage Occupancy of Inpatient Services.

Program/Unit 2006/07 2007/08 2008/09 2009/10 2010/11

ICU 85.1% 82.1% 83.6% 87.8% 90.2%

Medicine 106.6% 105.6% 102.6% 101.1% 113.9%

Rehabilitation 99.1% 99.2% 106.4% 106.9% 227.7%

ACE - - 103.5% 108.0% 104.5%

Maternity 68.6% 72.2% 75.1% 69.4% 67.5%

Surgery 85.6% 87.7% 95.8% 98.8% 97.8%

Psychiatry 94.5% 98.4% 102.1% 104.8% 108.1%

The red font indicates over 100% occupancy. The recommended target bed % occupancy for Fraser Health is 85% occupancy. The only inpatient service that is within the recommended target is the Maternity unit. This information supports the requirement for additional acute beds at PAH. The next table presents the Average Length of Stay (ALOS) at PAH.

2006/07 2007/08 2008/09 2009/10

PAH ALOS 8.3 days 8.3 days 9.1 days 9.2 days

Notes: Year to date for 2010/11: 8.6 days (excl. newborns) The following table presents the Current and Projected Number of Surgical Cases at PAH showing both day patients and inpatient surgical cases at PAH.

Patient Type 2008/09 2009/10 5-7 years 10-15 years

Day Patients 6,296 (73%) 6,265 (73.3%)

6,798 7,274

Inpatients 2,319 (27%) 2,282 (26.7%) 2,516 2,692

TOTAL 8,615 8,547 9,314 9,966

Notes: The projected number of surgical patients by patient type applied the same percentage as current practice, i.e. 73% day patients and 27% inpatients.



The next table presents the historical number of PAH Emergency Department (ED) Visits by CTAS Level (Level 1 is the highest acuity and Level 5 the lowest acuity).

As shown above, the number of ED visits continues to rise, with the largest number of ED patients classified as CTAS Level 3 (highlighted in red font) and the second largest group CTAS 4 (green font).

The Projected Number of Visits for the PAH Emergency Department is presented next.

Notes: Projections prepared by Fraser Health Decision Support Unit

PAH Bed Requirements

The following table provides an overview of the current beds and future bed requirements. It is important to note that projected bed range of 348-362 beds was reviewed and agreed upon by the clinical program directors.

A Summary of Current & Projected Acute Care Beds at PAH

UNIT NAME CURRENT FUNDED

BEDS

AVAILABLE BEDS

MASTER PROGRAM BED

ALLOCATION

COMMENTS

Medical Beds 82 84 136-150 Master program assumes up to 5 30-bed units

Telemetry – Future Allocation

0 0 12 Currently 8 beds included in Medical bed count

Surgical Beds 25 29 75 Master program assumes up to 3 25-bed units

Mental Health Beds 11 12 26

Maternity Beds 7 8 8 Status quo

Critical Care 7 8 16

ACE Beds 17 17 25 Master program assumes 1 25-bed unit

General Rehabilitation Beds

12 30 25 Master program assumes 1 25-bed unit

Geriatric Rehabilitation Beds – Future Allocation

0 0 25 Will be a regional service – new unit

TOTAL 161 188 348-362

Palliative Care Beds 8 10 10 A 10-bed hospice plan included in End of Life master program

Notes:

1. 10-bed hospice included in the End of Life master program is over and above the projected acute care bed numbers of 348-362.

2. Excludes the 3 infant spaces in the nursery on the Maternity Unit.

2006/07 2007/08 2008/09 2009/10

ED Visits 32,640 33,877 37,760 38,407

CTAS %

CTAS #1 0.2% 0.4% 0.2% 0.2%

CTAS #2 3.6% 10.1% 10.9% 11.3%

CTAS #3 43.1% 48.4% 40.8% 36.9%

CTAS #4 36.4% 31.8% 30.5% 34.3%

CTAS #5 5.4% 5.5% 12.0% 13.2%

Unknown 11.3% 3.8% 5.6% 4.1%

2010 Actual 2015 2020 2030

ED Visits 41,592 45,150 50,011 60,760



Residential Care Beds at PAH Residential Care beds at PAH are located in two buildings – the Weatherby Pavilion and the Al Hogg Pavilion. There are a total of 234 beds. The projected number of residential care beds for White Rock/South Surrey is presented in the table below:

The residential care space in both the Weatherby and Al Hogg Pavilions do not meet the complex care space requirements, i.e. the recommended ‘neighbourhood’ size is 24-28 residents not 42-50 residents, 95% of the rooms should be single room accommodation, all rooms should have ceiling lifts, no shared bathrooms, etc. The program leads did indicate that residential care does not need to be located on the PAH campus.

MASTER PROGRAM PRIORITIES & PLANNING PARAMETERS

This section of the chapter presents the master program priorities and planning parameters including highlights from the 31 master programs.

Master Program Priorities The master program priorities that emerged from this planning work are as follows:

• Emergency Department – Require additional treatment space (46 appropriate spaces) to support the projected 60,000+

visits per year. – Require improved ambulance area.

• Surgical Suite

– The current 3 operating theatres (OR’s) and support space built in the 1950’s are not adequate to support the type of caseloads and current and projected workload at PAH.

– The area requires 8 OR’s and support space for the projected volume of surgical cases.

• Critical Care (ICU) – The current unit does not meet best practice clinical and space standards, i.e. enclosed private

room, infection control needs, family & staff support space, etc. – There are 8 ICU beds and the projected need is for 16 beds.

• Interim Bed Expansion

– As shown in the projected bed table on page 2-6, additional beds are required and there is significant pressure on medical beds.

– The suggested strategy is to use vacated space (once the Critical Care Tower that will accommodate the three program listed above is built) to create additional acute care bed capacity.

The rationale used to establish priorities were:

• Mitigate risk —regulatory non-compliance or health safety issues • Enhance operational efficiency • Improve space utilization • Improve patient access/satisfaction • Build future capacity • Renew/retool physical plant (New Program Technology) • Facilitate donor/partner funding

Key Planning Parameters The following high level planning parameters were used to develop and evaluate the site development options. Physical Parameters

• The site will offer an open, friendly, well lit, cheerful and inviting environment. • The space will be designed in a flexible manner to accommodate current and future service requirements. • The Emergency Department (ED), Surgical Services and Critical Care will be developed in new space and

the vacated space will accommodate other outpatient services and interim acute care inpatient beds. • Direct convenient access from parking facilities to the main entrance and high volume ambulatory

programs is essential. • Minimize the number of internal moves and renovations required to accommodate program space needs,

appreciating the operational impacts and disruption to existing services.

Operational Parameters

• Program and service space will be designed to support a family-centred care model. • Needs of special patient populations must be reflected in design, e.g. elderly patients and bariatric

patients. • Where ever possible, reception and waiting space will be a shared resource. • Meeting space will be a shared resource in the facility. • Ambulatory Care services including the ED with strong functional affinities with the Diagnostic and

Treatment services (DI and Lab in particular) should be located nearby to maximize operational efficiencies.

• There will be restricted access in treatment and staff areas. • As much as possible, outpatient programs and services will be located together to maximize operational

efficiencies.

Current Beds

# of Beds by 2015

# of Beds by 2020

# of Beds by 2025

# of Beds by 2030

TOTAL

White Rock/Surrey 814 895 1,125 1,531 2,096 2,096 Additional Beds - (+81) (+230) (+406) (+565) (+1282)



MASTER PROGRAM PARAMETERS Component Highlights

1. Administration & Staff Facilities

ü Level 2 area could be modified to increase work spaces ü Additional meeting and staff amenity space projected

2. Auxiliary & Volunteer Res.

ü Future volunteer lounge and additional retail and storage area included in the master program

3. Biomedical ü Increased staff projected based on expansion of acute care, and therefore additional work area and storage space projected

4. Cardiology ü Ambulatory care clinic space planned ü A potential change in reporting relationship Nuclear Medicine/ Cardiology

program which could impact future service directions 5. Critical Care ü Project the need to increase the number of ICU beds from 8 to 16 beds

ü Projected space based on best practice space guideline 6. Emergency ü Project the need for 46 treatment spaces to support the projected volume

of approximately 60,000 visits/year by 2030; currently have 30 spaces which includes 8 chairs

ü Ambulance bay requirement (including a suggested 2 unit enclosed area that could also double as an disaster response area) included in master program

7. End of Life Program ü Preferred direction to locate the 10-bed hospice and the Hospice Society Supportive Care Unit on the PAH campus

8. EPI - Early Psychosis Intervention

ü Prefer to locate program in community rather than at PAH ü Additional space projected to support program growth

9. Food & Nutrition

ü Opportunity to relocate kitchen to Level 0 ü Additional staff work space included in master program

10. Foundation

ü Current location accessible to public ü Located in recently renovated space that is adequate to support future

requirements 11. Home Health

ü Projected space based on the Gameplan space plan report ü There are patient coordination and staff integration benefits of locating

Home Health on PAH campus 12. Housekeeping, Laundry

& Waste ü Housekeeping and linen services contracted ü Laundry area in Level 0 of the residential care wing does personal items only ü Any new space will incorporate housekeeping closets ü A new loading dock would include waste/soiled holding space

13. IMIT ü The projected space requirement as per the previous Kasian master plan report

14. Infection Control ü Project additional IC staff and therefore additional work space projected

15. In-Hospital Replenishment

ü Additional space to be determined with the projected expansion space ü An improved loading dock required to support future site expansion

Component Highlights

16. Laboratory ü Opportunity to increase core lab area with microbiology area vacated (and adjacent space potentially available for additional expansion area) if lab remains in current location

ü Clinical program leads recommend the laboratory be located proximal to other clinical diagnostic services (e.g. Medical Imaging) and high volume program areas, i.e. Emergency, Surgical Suite and Critical Care

ü Additional outpatient laboratory phlebotomy space included in the master program and increased body holding space in the morgue

17. Maternity Program ü The inpatient service located in newly renovated space ü Adjacent space planned for Maternity Clinic (current location of clinic on

Level 1 is under-sized) 18. Medical Imaging ü Important to main adjacency to the Emergency Department

ü Additional diagnostic and support space identified to support future service volume; vacated Emergency Department space (when ED moves to new space) identified as the logical expansion area for Medical Imaging

19. Medicine Program (includes needs of Ambulatory Care)

ü Require additional medicine beds to meet current and projected needs ü Master program includes 150 medical beds and 12 telemetry beds based on

best practice space planning guidelines ü Additional space for an ambulatory care IV therapy service has been

included (10 treatment spaces) 20. Mental Health &

Substance Use

ü 26 beds planned which is an increase of 15 beds from the current 11 beds in operation

ü Projected space based on best practice space planning guideline ü Additional community mental health space projected

21. Older Adults ü A 25-bed ACE service projected which is an increase of 8 beds from the current 17 beds

ü Projected space based on best practice space planning guideline ü Additional clinic space projected to support projected service needs

22. Paediatrics ü 4-bed observation area included in master program ü The operational model is in development

23. Pharmacy ü Additional work space projected ü Assumes Pharmacy will remain in current location

24. Plant Services

ü Additional space to be determined as part of expansion plan, e.g. a new tower will include appropriate Plant Services space

25. Protection Services & Parking

ü Additional space for security personnel include in the Emergency Department projected space allocation

ü Will require a parking study to determine future parking stall requirements for the site

26. Public Health ü Projected space based on the Gameplan space plan report ü There are patient coordination and staff integration benefits of locating

Public Health on PAH campus 27. Records Management/

Patient Registration

ü Additional archival storage space included in master program ü Additional patient registration stations & support space projected to

support projected service volume



Component Highlights

28. Rehabilitation Services

ü 25-bed general rehab unit and a 25-bed geriatric rehab unit (regional resource) projected based on best practice space planning guidelines

ü Additional storage space on Level 2 projected ü Assumes other functions not part of Rehabilitation Services (e.g. the space

being used by Pre-Surgical Screening, Surgical Outpatients, OR Booking and the Dietitian) will be located elsewhere thereby providing additional required space for Rehabilitation Services

29. Residential Care ü Current facilities do not meet complex care space requirements, i.e. do not have single room accommodation, appropriate family and staff support space, etc.

ü Residential care spaces onsite (234 beds) do not need to be located on acute care site

ü Project additional 565 beds for area by 2030 (from current 814 spaces in White Rock/South Surrey)

30. Respiratory Therapy ü Additional space projected to support acute care service expansion ü Projected space based on previous Kasian master plan report

31. Surgical Services (includes Surgical Suite, OR Booking, Surgical Inpatient, Surgical & Medical Ambulatory Care, and SPD)

ü Currently 3 OR’s designed in the 1950’s; projected workload to support 8 OR’s and support space including PACU

ü OR Booking and PAC includes space needs related to projected staffing; co-location with Surgical Services recommended

ü Project the need for 75 beds (3 25-bed units) based on best practice space planning guidelines

ü Ambulatory Daycare requires additional treatment and support space ü SPD requires adjacency to Surgical Suite and space for assembly, case carts

and improved scope cleaning

ADJACENCY MATRIX The following chart presents the key adjacencies between program components. The red circle indicates a critical adjacency, the green circle a close adjacency requirement, and the grey circle a convenient adjacency.

Project Components Admi

nistra

tion &

Staf

f Fac

ilities

Auxil

iary &

Volu

nteer

Res

Biom

ecial

Card

iolog

y

Critic

al Ca

re

Emer

genc

y

End o

f Life

Pro

gram

EPI -

Ear

ly Ps

ycho

sis In

terve

ntion

Food

& N

utritio

n

Foun

datio

n

Home

Hea

lth

Hous

ekee

ping,

Laun

dry &

Was

te

IMIT

Infec

tion C

ontro

l

In-Ho

spita

l Rep

lenish

ment

Labo

rator

y

Mater

nity P

rogr

am

Medic

al Im

aging

Medic

ine P

rogr

am

Menta

l Hea

lth &

Sub

stanc

e Use

Olde

r Adu

lts

Paed

iatric

s

Phar

macy

Plan

t Ser

vices

Prote

ction

Ser

vices

& P

arkin

g

Publi

c Hea

lth

Reco

rds M

gt/ P

t Reg

istra

tion

Reha

bilita

tion S

ervic

es

Resid

entia

l Car

e

Resp

riator

y The

rapy

Surg

ical S

ervic

es

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 l2 l3 l4 l l5 l l l l6 l l l7

8

9 l l l l l l l l10 l11 l l l12 l13

14 l l l l l l15 l16 l l l l l l l17 l l l l18 l l l19 l l20 l21 l l22 l l l23 l24 l l25 l l26 l27 l28 l l l l l29

30 l l l l l31 l l l

Residential Care

Infection Control

Biomedical

Food & Nutrition

Foundation

Home Health

Emergency

Aux iliary & Volunteer Res.

Cardiology

Administration & Staff Facilities

IMIT

Housekeeping, Laundry & Waste

End of Life Program

EPI - Early Psy chosis Interv ention

Critical Care

Surgical Serv ices

In-Hospital Replenishment

Laboratory

Maternity Program

Medical Imaging

Paediatrics

Mental Health & Substance Use

Medicine Program

Older Adults

Respiratory Therapy

Pharmacy

Plant Serv ices

Protection Serv ices & Parking

Public Health

Records Mgt/ Pt Registration

Rehabilitation Serv ices



FUNCTIONAL EVALUATION SUMMARY Legend: Good p Fair u Poor q

Program Component

Functional Evaluation Summary

Location Overall Layout Room Sizes Meets Space Benchmarks

1. Administration & Staff Facilities

p p p N/A

2. Auxiliary & Volunteer Resources

u u q N/A

3. Biomedical p u u N/A

4. Cardiology N/A N/A N/A N/A

5. Critical Care u q q No

6. Emergency u q q No

7. End of Life Program q u q No

8. EPI - Early Psychosis Intervention

q p p N/A

9. Food & Nutrition u u u N/A

10. Foundation p p p N/A

11. Home Health u u q N/A

12. Housekeeping, Laundry & Waste

u u u N/A

13. IMIT p p u N/A

14. Infection Control p p u N/A

15. In-Hospital Replenishment

p p u N/A

16. Laboratory u q u No

Program Component

Functional Evaluation Summary

Location Overall Layout Room Sizes Meets Space Benchmarks

17. Maternity Program p p p Yes

18. Medical Imaging p u u No

19. Medicine Program (includes needs of Ambulatory Care)

u q q No

20. Mental Health & Substance Use Services

u q q No

21. Older Adults u q q No

22. Paediatrics N/A N/A N/A N/A

23. Pharmacy p p u N/A

24. Plant Services p p u N/A

25. Protection Services & Parking

p p u N/A

26. Public Health u u q N/A

27. Records Management/ Patient Registration

p p u N/A

28. Rehabilitation Services u q q No

29. Residential Care q q q No

30. Respiratory Therapy p p u N/A

31. Surgical Services (includes Surgical Suite, OR Booking, Surgical Inpatient, Surgical Ambulatory Care, and SPD)

u q q No



EXISTING SITE ANALYSIS

PURPOSE OF SITE/BUILDING ASSESMENT A major focus of this work stream is to assess the state of the current site infrastructure and buildings, their state of maintenance and performance, their remaining life and replacement requirements and key areas of risk from unscheduled failure & shortened lifecycle of building components that require mitigation. These risks can manifest themselves in life safety, service continuity, service accreditation, collateral building damage, regulatory enforcement, high operating costs and major capital investments sooner than necessary. Together the physical condition assessment from this work stream and the functional assessment from the Master Program work stream determine the economic life of a building and the extent of its role at the site. The role of the building in response to its remaining economic life will influence the optimal long term use and investment strategy for the building and what the prudent short term maintenance investment strategy should be. This work stream is important to optimizing the asset and investment lifecycle that deliver the greatest value to the facility users and health authorities.

The assessment reports will ensure the MCP is based on accurate existing site/building information. It is important to review all systems reports and historical data, as well as involve all knowledgeable personnel in a complete building assessment.

URBAN CONTEXT White Rock is bounded to the north, east and west by the City of Surrey, with Semiahmoo Bay to the south. White Rock has a total land area of 5.2 km2 representing less than 1% of the Metro Vancouver land area. Similarly, the population of White Rock in 2006, at almost 19,000, is less than 1% of that in Metro Vancouver.

Peace Arch Hospital is located in the North Bluff East area of the City of White Rock. Its Lower Mainland location, in relation to nearby hospitals is illustrated on the right.

The Peace Arch Hospital site is bounded by North Bluff Road/ 16th Avenue to the North, Finlay Street to the East, and Russell Avenue to the South. The Western portion of the Comprehensive Development Zone which the principle hospital resides in is bounded by Vine Avenue and Hospital Street. The site is in general surrounded by higher density residential to the West and North (including Peace Portal Lodge and Whitecliff Retirement Residence), and low density residential to the East and South. An electrical substation is located in the south east quadrant of the North Bluff Rd/Finlay St intersection.

Site circulation is principally accommodated by internal streets such as Weatherby Street, Hospital Street and Vine Avenue. Two adjacent sites shown as A & B on the diagram on the right are separately owned by PAH Foundation and currently used by PAH for parking.

Topography of Sites The Peace Arch Hospital site and the PAH Foundation Site A slopes approximately 8m down from west to east and is generally level north to south.

The PAH Foundation Site B slopes approximately 2m down from west to east and also is generally level north to south.



ZONING AND LAND USE Any future development in the North Bluff east area, as described in the Official Community Plan (OCP), is intended to protect and enhance the quality of the natural and built environment and to promote a ‘West Coast or Sea Side Village’ building vernacular reflective of White Rock’s history and setting. The size and scale of the hospital should relate to adjacent development and provide a transition between the ‘Town Centre’ and ‘Apartment Areas' (both development areas as described in the OCP). The OCP designation for the hospital site is Public/Institutional/Utility. The Peace Arch Hospital falls into the Comprehensive Development Zone – 1 (CD-1) as described in the City of White Rock Bylaw 1591. The intent of this zone is to accommodate development of a full range of comprehensive public and semi-public hospital facilities.

Uses: The following uses and no others are permitted in the CD-1 Comprehensive Development Zone;

a) A hospital and related facilities provided or funded by a federal, provincial, regional, local government, or a non-profit society or organization; b) A health care facility provided by a not-for-profit society or organization c) An accessory off-street parking use; d) An accessory off-street loading use; e) Public and private open space and recreation areas

The PAH Foundation Site A directly North-West of the Hospital site fall within Development Permit Area 2 – identified in the Official Community Plan (OCP) as Hospital Street. That area is flanked by Hospital Street, Vine Avenue, and North Bluff Road. Primarily higher density residential uses are permitted including medical and/or hospital related uses. New development must contribute to improvement of the visual image of the area. The PAH Foundation owned property B north of North bluff Road is within the City of Surrey jurisdiction and is designated RF (single family residential) except for LMP Parcel 15562 which is CD (comprehensive development).

The legal titles of the sites are:

Peach Arch Hospital Lot 1, Plan LMP 15904, Section 11, Township 1, New Westminster Land District, & PLC A (BYLAW PL LMP21578) Plan

PAH Foundation A LMP Parcels 15475, 15476, 15485, 15486 and 15496

PAH Foundation B LMP Parcels 15562, 15563, 1627, 1637, 1647, 1661, 1662, 1673, 1687 an 1697



BUILDING HEIGHTS Peace Arch Hospital has maximum building height elevations ranging from 105m, 124m and 135m above sea level, depending on the parcels identified in the CD-1. The elevation of existing main floor level of the hospital is approximately 103.4m. Refer to diagrams at right (from City of WhiteRock CD-1 Zoning By-laws).





SITE STATISTICS

Setbacks Vary from 1m to 16m, refer to Site Plan at right.

Maximum Site Coverage Refer to zoning diagrams

Allowable Density (FSR) Not specified.



BREAKDOWN OF BUILDING / PARKING STATISTICS

Building Floor Area * Bldg Name Floor Int. Gross

Area (sm) External Gross

Area (sm) Acute Care Building Level 0 5,323.87 5,445.49 Level 1 5,744.96 5,866.58 Level 2 3,473.42 3,799.89 Level 3 2,295.87 2,383.69 Level 4 2,234.93 2,402.56 Level 5 2,553.61 2,673.91 Level 6 2,571.16 2,689.87 Level 7 0.00 2,712.70 Level 8 1,233.90 1,321.06

Sub Total: 25,431.72 29,295.75 Berkley Pavilion Level 0 91.70 99.82 Level 1 1,873.08 1,1969.99

Sub Total: 1,964.78 2,069.81 Dr Al Hogg Pavilion (originally Finlay Pavilion)

Level 0 2,057.23 2,166.85

Level 1 2,232.09 2,352.68 Level 2 2,006.21 2,149.62 Level 3 2,005.02 2,093.62 Level 4 0.00 2,093.62

Sub Total: 8,300.55 10,856.39 Russell Unit Level 1 580.04 593.93 Vine Unit Level 1 127.37 133.30 Weatherby Pavilion Level 0 1,161.31 1,660.94 Level 1 1,552.35 1,624.90 Level 2 1,545.41 1,613.99 Level 3 1,522.75 1,589.12 Level 4 1,522.75 1,589.12

Sub Total: 7,304.57 8,078.70 Total: 43,709.03 51,027.88

Site Assessment The site areas are: • Peace Arch Hospital Site Area: 41,538m2 • PAH Foundation Site A Area 2,958m2 • PAH Foundation Site B Area 14,177m2

Parking Stalls * Lot A (Laneway) 47 Stalls #1-32 Permit Holders Only Lot A (Parking Lot) 71 Stalls #1-51

#1-3 #4-7

Permit Holders Only H/C Parking Patient Pick Up and Drop Off Only

Lot B (Main) 292 Stalls #1-9 H/C Stalls #64/65 H/C Stalls #10-18 Out Patient Stalls #1-94 No Staff Parking 8am - 2pm

Mon-Friday #95-291 General Stalls 2 Stalls Peace Arch Van

Outside of Weatherby Pavilion 5 Stalls 3 Stalls Cross Hatched Bus & 10 Minute Pick Up Drop Off Only

2 Stalls Emergency Physician Call Back Parking

Lot C (Staff Parking) 400 Stalls 400 Stalls Surface / Gravel Lot D (Foundation Lot) 127 Stalls 118 Stalls Emergency Parking

9 Stalls H/C Parking Berkeley Pavilion 21 Stalls #33-53 General Stalls

#38/39 H/C Parking Loading Zone 6 Stalls 4 Stalls Service Vehicles Only

2 Stalls Loading Trucks Total Number of Stalls: 969

*Source: Fraser Health Authority



Building Age The first building on the site was constructed and opened in 1954 as a 47 bed community hospital.

The Berkley building was purchased in 1967 to serve as an extended care unit. The current six storey acute building, completed in 1968 raised the total acute beds to 155. An expansion of the diagnostic and support services was completed in 1993. The Weatherby Pavilion, opened in 1987, added 150 extended care beds and a further 150 extended care beds were provided in the Finlay Pavilion constructed in 1993. The latter building is now known as the Dr. Al. Hogg Pavilion.

Various internal renovations have been undertaken over time and two temporary buildings (Vine Unit and Russell Unit) added. Peace Arch Hospital currently has 178 acute care beds and 343 extended care beds.



EXISTING FLOOR PLANS BY DEPARTMENT / USE















BUILDING / SITE SECTIONS



SITE PHOTOS

1. Peace Arch Hospital - Panoramic View from Finlay Street

2. Peace Arch Hospital - Emergency Entrance Panoramic View



3. North Bluff Rd. / 16 Ave. @ Hospital Street



4. North Bluff Rd. / 16 Ave @ Best Street



5. Peace Arch Hospital – Front Entrance

6. Front Entrance access from Finlay St.

7. Access from Finlay St. / Dr. Al Hogg Pavilion

8. Dr. Al Hogg Pavilion view from Main Parking

9. Main Parking Entrance



10. Russell Ave. looking West

11. View from Finlay St. @ Russell Ave.

12. Russell Ave. @ Weatherby St.

13. Access from Russell Ave.

14. Hospital & Russell Unit viewing from Russell Ave.



15. Parking Lot B Entrance

16. Berkeley Pavilion viewed from Russell Ave.

17. Berkeley Pavilion Entrance

18. Emergency access from Russell Ave.

19. Berkeley Pavilion view 1

20. Berkeley Pavilion view 2 21. Berkeley Pavilion 3

22. Berkeley Pavilion 4

23. White Rock Medical Associates parking

24. White Rock Medical Associates front view

25. Hospital viewed from Vine Ave. @ Best St.



26. Emergency & Berkeley Pavilion

27. Emergency viewed from Hospital St.

28. Vine Youth Clinic

29. Public Pay Parking

30. North Bluff Rd./16 Ave. residential building

31. Dr. Al Hogg Pavilion viewed from N. Bluff Rd./16 Ave.

32. McCracken Courtyard access from N. Bluff Rd./16 Ave.

33. McCracken Courtyard

34. Dr. Al Hogg Pavilion viewed from Off-site Parking

35. North Bluff Rd./16 Ave. @ 156 St. Off-site Parking



URBAN PLANNING ANALYSIS Access, Circulation and Parking Vehicular access to the site is from North Bluff Road, Russell Avenue, Finlay Street, and Vine Avenue. Parking is currently provided by the surface parking located at the South East corner of the site at Finlay Street and Russell Avenue. An objective the OCP is that all off-street parking should be below grade or enclosed within a building, with the exception of some visitor surface parking spaces. Transportation - Vehicular Bus service to Peace Arch Hospital is provided by multiple routes with stops adjacent to the campus. Bus routes include C50, C51, C53, 321, 354 and 375. Many staff and visitors to Peace Arch Hospital use these services.



Transportation - Non - Vehicular



EXISTING GREENSPACE



SITE / COMMUNITY CHARACTER

This Site comprises areas near Hospital Street, Vine Avenue, and North Bluff Road. Primarily higher density residential uses are found here including medical and hospital related uses. This area is called North Bluff East. Peace Arch Hospital occupies the CD-1 Zone within the City of White Rock.

The intent of this zone is to accommodate the development of a full range of comprehensive public and semi-public hospital facilities on a site of approximately 41,538 square metres (10.26 acres). (White Rock Zoning Bylaw 1591)

Similarly across North Bluff Road in the City of Surrey, the neighbouring community character remains primarily higher density residential uses, with single family residences adjacent to these.

According to the Official Community Plan (OCP) of White Rock, new developments should endeavour to contribute to the improvement of the visual image of the area. The size and scale of buildings should relate to adjacent development and provide a transition between the Town Centre and Apartment Areas. New developments should be designed to consider the compatibility with surrounding land uses, buildings and the physical environment. Roof lines, height, building mass, form, architectural character and outdoor spaces should complement adjacent buildings and spaces. Building materials should reflect the existing or planned character of the area, and the use of a variety of materials is encouraged in order to provide articulation and visually interesting design. Generally, buildings should be designed to appear to have limited frontage lengths and variations in façade treatment among different buildings. And the ground level treatment of development should enhance pedestrian interest through design, detailing and landscaping while maintaining necessary privacy and security for residents.

These are but a few Development Permit Guidelines Applicable to the development of Peace Arch Hospital, respecting the character of the surrounding community. In conjunction with the OCP and CD-1 Zoning future plans should take into consideration how the City of White Rock views this site.



SPACE SUMMARY (CURRENT & PROJECTED) The following section presents the space summary table (current and projected) for the 31 master programs.

PAH Component/Sub-ComponentCurrent

CGSMAdditional

CGSMProjected

CGSM Comments

1. AdministrationAdministration total projected space = 1,470.0 sqm

Admin Offices - Level 2 340.9 0.0 340.9

Meeting Space 246.3 100.0 346.3 Current space shown on Level 0

On call Space 48.0 0.0 48.0 Require improved location

Library 78.8 0.0 78.8 Require accessible location

Staffing Office 50.0 15.0 65.0 On Level 0

Other Staff Office Space Level 0 73.3 71.5 144.8Future space to support projected expansion at PAH

Staff Lockers/Change Area/Lounge 246.2 200.0 446.2On Level 0; future space to support projected expansion

2. Auxiliary/Volunteer Resources Auxiliary/Volunteer Services total projected space - 325.7 sqm

Auxiliary Space 131.7 80.0 211.7Additional space for retail in Acute & Residential Care plus storage

Volunteer Space 48.0 66.0 114.0Additional space for 1 new office, volunteer lounge & storage

3. Biomedical Engineering 49.2 53.4 102.6Add'l space requirement from Kasian report

4. Cardiology 0.0 80.0 80.0

Clinic space for mobile team; can be located with other ambulatory care space

5. Critical Care Unit 264.4 1,175.6 1,440.0Projected space based on 16 beds @ 90 cgsm per bed

6. Emergency Department 763.7 1,168.3 1,932.0Projected space based on 46 treatment spaces


CGSMAdditional

CGSMProjected

CGSM Comments

7. End of Life ProgramEnd of Life Program total projected space = 1,672.0 sqm

Hospice 468.2 646.8 1,115.0 Based on 10 hospice beds

Supportive Care Centre 180.0 377.0 557.0Projected space from Hospice Society planning report

8. EPI (Early Psychosis Intervention) 133.0 192.0 325.0 Does not need to be located at PAH

9. Food & Nutrition 1,137.7 61.8 1,199.5

Current space includes coffee shop, cafeteria, kitchen and storage; add'l space for offices

10. Foundation 192.0 0.0 192.0Sti ll need to meet with program to confirm space needs

11. Home Health 611.2 600.0 1,211.2Existing and projected space from Gameplan report

12. Housekeeping, Laundry & Waste 290.8 0.0 290.8

Current space includes space on Level 0 of Al Hogg Pavi lion and acute bldg; future space TBD

13. IMIT 340.2 14.5 354.7

Space taken from Kasian report; Still need to meet with program to confirm space needs

14. Infection Control 12.0 12.0 24.01 additional work space for projected staff increase of 1

15. In Hospital Replenishment 960.1 0.0 960.1 Future space to be determined

16. Laboratory Medicine & PathologyLaboratory total projected space = 532.9 sqm

Lab - Level 2 366.0 0.0 366.0

Requires renovation to address space issues (vacated microbiology space and adjacent space avai lable - test fit required)

Outpatient Lab - Level 1 38.8 40.0 78.8

Additional exam room for FNAs, 2 add'l phlebotomy stns and support space

Morgue - Level 0 88.1 0.0 88.1Overal l space adequate; body holding area requires renovation




CGSMAdditional

CGSMProjected

CGSM Comments

17. Maternity ProgramMaternity Program total space = 1,190.0 sqm

Maternity Unit 835.0 0.0 835.0 Recently renovated space

Maternity Clinic 108.7 246.3 355.0

Plan to move to vacated winter surge bed area on 3rd flr (355 sqm); currently in temporary space next to ED on Level 1

18. Medical ImagingMedical Imaging total projected space = 1,767.8

Main MI - Level 1 879.2 202.0 1,081.2

Add'l staff support space, patient waiting, fluoro rm, diag. mammo suite, and 2 ultrasound rooms

Storage - Level 0 132.9 0.0 132.9

MRI 153.2 0.0 153.2Located in newly developed space but not adjacent to MI

Nuclear Medicine/Cardiology 265.8 40.0 305.8 Add'l staff support space

Screening Mammography 94.7 0.0 94.7 Currently located in Berkeley Pavil ion

19. Medicine ProgramMedicine Program total projected space = 11,640.0

Medical Daycare Program 0.0 300.0 300.0 Assumes 10 treatment spaces

Medicine Inpatient Beds 2,655.1 8,684.9 11,340.0

5 units each at 30 beds x 70 cgsm/bed = 10,500 cgsm; Total bed count = 150 plus 12 telemetry beds @ 70 cgsm per bed

20. Mental Health & Substance UseMental Health & Substance Use total projected space = 2,717.6

Inpatient Unit 498.8 1,321.2 1,820.0Projected space based on 26 beds x 70 cgsm/bed

Community MH Program 576.5 70.0 646.5 Add'l 3 clinician offices & med rm

Geriatric Psychiatry 64.2 0.0 64.2 4 offices in the Berkeley bldg

Group Therapy Program 186.9 0.0 186.9Located in renovated space on Level 0 of Weatherby Pavi lion


CGSMAdditional

CGSMProjected

CGSM Comments

21. Older Adults ProgramOlder Adults Program total projected space = 2,259.6 sqm

ACE - 5 South 657.7 1,092.3 1,750.0Projected space based on 25 beds x 70 cgsm/bed

Specialty Seniors Clinic 429.6 80.0 509.6 Additonal clinic space required

22. Paediatrics 0.0 300.0 300.0

Projected space 4 paediatric observation spaces with family & staff support space

23. Pharmacy 520.2 30.0 550.2 Add'l work space

24. Plant Services 1,731.7 0.0 1,731.7 Future space to be determined

25. Protection & Parking Services 8.2 12.0 20.2 Project 1 add'l space in ED

26. Public Health 455.6 144.4 600.0Projected space from Gameplan 2009 report

27. Records Mgt & Patient Regist.Records Mgt & Pt Regis. Program total projected space = 394.5 sqm

Records Mgt 238.3 0.0 238.3

Archival Records Storage 51.6 18.6 70.2 Add'l space as per Kasian report

Patient Registration 51.0 35.0 86.02 add'l registration stations & support space

28. Rehabilitation Services Rehabilitation Services total projected space = 3,812.4 sqm

5 North 1,190.0 200.0 1,390.0Assume unit remains with 25 beds; add'l space for dining, gym

Geriatric Rehabilitation Unit 0.0 1750.0 1,750.0 New 25-bed unit; a regional resource

Rehab Outpatient Department 591.2 30.0 621.2 Add'l equipment storage space

Social Work 51.2 0.0 51.2 Located on Level 2




CGSMAdditional

CGSMProjected

CGSM Comments

29. Residential CareResidential Care total space = 14,374.0 sqm

Weatherby Pavilion 6,150.0 0.0 6,150.0

Al Hogg Pavilion 8,224.0 0.0 8,224.0

30. Respiratory Therapy 84.5 114.0 198.5Located on Level 1 ; space as per Kasian 2004 report

31. Surgical ProgramSurgical Program total projected space = 8,749.3 sqm

Surgical Inpatient Beds 891.6 4,358.40 5,250.0

Assumes 3 units @ 25 beds per unit (70 cgsm per bed); Total bed count = 75

Surgical Program Outpatients and Surgical Daycare 471.0 124.0 595.0 Add'l space as per Kasian report

OR Booking 12.5 7.5 20.0 Add'l workstation space

Pre-Admission Clinic 44.3 40.0 84.3Add'l space includes 4 offices and an exam room

Surgical Suite (includes PACU) 586.3 1493.7 2,080.0

Projected space based on 8 ORs including support space/physician & staff work space/PACU; 260 cgsm per OR

SPD 520.0 200.0 720.0Add'l space for assembly, case carts & improved scope cleaning

Total 36,570.1 25,848.2 62,418.3

Notes: New facilities will include required additional logistical support space - TBD

CGSM = Component Gross Square Meters

In regards to the benchmarks and peer hospital comparisons used to develop the master programs, RMC used the following:

• Bed Planning Guidelines, New Zealand

• Health Facility Planning Guidelines recently published from Australia

• AIA Planning and Design Guidelines for Bariatric Healthcare Facilities and other AIA facility planning publications

• SpaceMed Space Planning Guidelines 2008 publication (Cynthia Hayward - author)

• Future of the Operating Room, Innovation Center, Washington, DC

• RMC functional programming information from other health facility planning projects, e.g. Strathcona Community Hospital (Sherwood Park, AB), Misericordia Community Hospital and Grey Nuns Community Hospital (Edmonton, AB), Foothills Medical Centre (Calgary, AB), Edmonton Tertiary Level Ambulatory Clinic (not to mention the other health centres we have planned in Alberta)

• RMC planning work undertaken in the Lower Mainland, e.g. Surrey Memorial Hospital, Royal Columbian Hospital (New Westminster), Burnaby Hospital and Langley Memorial Hospital



PLANNING PRINCIPLES Development Assumption

• Flexibility • expandability • adaptability • Parking • Retention of Existing

FLEXIBILITY The given site allows for numerous design solutions that will provide a robust variety, accommodating much of the hospitals current and future uses. Depending on the preferred design option, the campus can be arranged to utilize both the underdeveloped areas as well the existing infrastructure and building. EXPANDABILITY The comprehensive development zone allows for a multitude of institutional activities, and hospital functions to be configured on the hospital site. With the adjacent Development Area – 2 (Hospital Street), it can be anticipated that these opportunities can be appropriated after engaging with the City of White Rock. The surface parking at the South-East corner of the campus already within CD-1 also provides opportunity for growth. As well the surface parking North-West of Comprehensive Development Zone 1 provides ideal area for growth. ADAPTABILITY With the already prescribed CD-1 and the DP-Area-2 (Hospital Street) a number of configurations can be realized. The hospital provides for current needs, and the site/zoning will allow the hospital to adapt to future requirements and needs as they arise. PARKING The site has two large surface lots that provide the majority of the sites needs. As development of the site increases, need for additional parking can be assumed. Off-Street parking is a requirement for developments such as the one found on site, any surface parking that is developed into hospital function, will need to be accommodated elsewhere. Below grade parking is certainly an option, as well as intensifying surface parking, into more efficient above grade structured parking. RETENTION OF EXISTING Though there will be significant rework of existing underdeveloped parcels within the CD-1 and adjacent DP-Area-2 in any one of the development options, there will be a concerted effort to leverage buildings and structures already on site. Healthcare facilities such as the Peace Arch Hospital, once opened remain operational 24/7, 365 days a year. Renovation and alteration of existing is a given, though a rigorous effort will be maintained to keep much of the existing for both operational, and fiscal motives.



SITE OPPORTUNITIES This section of the study provides an indication of land availability on both the Hospital and Foundation properties for future growth of hospital facilities. During this process 5 potential expansion zone sites were identified and considered for the most appropriate use related to expansion of hospital programs (departments) identified in the master program. Expansion Opportunity 1 Location: • City of White Rock; west of Weatherby Pavilion and Emergency Department- known as Hospital Street. • Includes existing parking lot on PAH Foundation Property and Hospital Street Development Considerations: • Proximity to Emergency and Diagnostic Imaging Departments • Good Access to 16th Ave • No existing Structures • Existing underground services at the south side of this zone • Oxygen tank at south end of this zone • Facing high density residential on the north Recommended Use: South Side: Emergency Department Expansion North Side: Non Acute Care Use (Foundation)



Expansion Opportunity 2 Location: • City of White Rock • Hospital property; west of main hospital tower and south parkade area • Currently site of Berkeley Pavilion Development Considerations: • Relocation of programs located in Berkeley Pavilion and Russell and Vine Unit • Demolition of Berkeley Pavilion, Russell and Vine Unit • Directly adjacent to Russell Avenue • Direct adjacency to inpatient tower • Facing single family residential zone on south Recommended Use: Development of future inpatient tower Expansion Opportunity 3: Location: • City of White Rock • Existing main parking area east from main entrance between Weatherby Ct. and Finlay St. Development Considerations: • Direct adjacency to main entrance • Direct adjacency to Weatherby and Dr. Al Hogg Pavilions • Sloping site (two building floor levels) • Directly adjacent on east and south side to single residential zones • Largest zone available on hospital site Recommended Use: • Site suitable for future replacement hospital with underground parking • Hospice site



Expansion Opportunity 4 Location: • City of White Rock • Existing parking lot, south of main inpatient tower Development Considerations: • Smallest zone on hospital site • Facing on south side single family residential Recommended Use • Parking / Green Amenity • Decant site Expansion Opportunity 5: Location: • City of Surrey • North West corner of North Bluff Road and 156th Street • Foundation Property Development Considerations: • Direct adjacency to residential zones on north, east and west • Facing North Bluff Road and 156th Street • Currently gravel surface parking for hospital • Quiet zone • Bus stop and pedestrian crossing at North Bluff / 156th Street Corner Recommended Use: • New residential care facilities • Mixed Use



SITE DEVELOPMENT STRATEGIES Following the indicated site opportunities three strategies of site expansion were developed to indicate potential growth paths that are keeping within the design principles outlined above, and are illustrated below • Strategy 1 - Linear long east west concourse defining main pedestrian circulation through the site. Retaining existing hospital as part of the hospital campus and creating a new main entrance at Finlay Street.



• Strategy 2 - Linear along east west concourse defining main pedestrian circulation through the site. Removing the oldest part of facility to create a new main entrance at Russell Avenue.



• Strategy 3 - Main intersection concept defined by east-west and north - south pedestrian paths. Main entrance located in the current parking area at Finlay Street. This strategy minimizes impact of hospital development on the adjacent single family residential zone.



PROPOSED SITE DEVELOPMENT SOLUTIONS The Master concept Plan establishes the scope of future clinical and non-clinical requirements related to the growth and profile of the population using the facility which is set in construction timeframe the outcome of which is defined by phased Site Development Solutions. These Site Development Solutions are based on following design/development assumptions: • Single bed accommodation (80 %) • Senior Clinic to be in community. • Renovating emergency will allow future Medical Imaging Expansion. • Critical that Emergency is a adjacent to MI • Main Hospital is not going to be demolished. • Berkeley and Russell buildings to be demolished. (Alternative solutions for current departments required) • OR & Surgical Suite to be placed in new building. • Review location of public entrance • SPD/Material Management maybe located in new building. • Flexibility, Adaptability and Expandability are critical drivers in development strategy. • Sustainability. • Additional Green Areas an objective • Parking expansion and objective

Phase 1A - New Residential Care Building, Lot C (North) - By 2014 (Open) • 150 New residential care: 80 beds from Weatherby 70 new beds • Parking • New hospice



Phase 1B - Decanting • Decant Vine and Mental Health (Berkeley Pavilion) to Weatherby - 2014 • Relocate Oxygen tank - anytime • Kitchen to new Residential Care - 2014 • Russell Unit Program to be relocated • Medical Records and Library to relocate to Weatherby Pavilion



Phase 2: New Emergency Department (2012 - 2016) • Expanded (2013-2014) • Existing Emergency Department Renovation • Redevelopment of Minor OR & Surgical Outpatient Program (2015-2016) • Demolish Vine and Russell Unit



Phase 3: Second Residential Building on Lot C (South) - Design (2016 - 2018) • 200 - 250 new beds: 100 from Dr Al Hogg

100-150 New • Al Hogg Redevelopment • Berkeley Pavilion Demolition • Berkeley Parking Lot Development • New ICU - Level 2 - May require relocation of:

o Admin to AL Hogg o Lab to Level 1



Phase 4: New Tower (2018 - 2030)



0 - 3 Year Cost Estimate – description area unit cost total cost (m2) ($/m2) ($) 1 Decant Vine and Russel 250.00 $ 2,212.50 $553,100 Relocate U/G Services allowance $250,000 Relocate Medical Records and Library to Weatherby 408.00 $ 1,327.50 $541,600 Emergency expansion (ADDITION) 1168.00 $ 6,386.75 $7,459,700 Emergency renovation 764.00 $ 4,026.75 $3,076,400 TOTAL $11,880,800 2 Surgical Outpatient expansion (ADDITION) 271.00 $ 6,386.75 $1,730,800 Relocation of food services (INCL. $1.5M EQUIP*) 1199.00 $ 5,276.04 $6,326,000 TOTAL $8,056,800 3 Relocation Clinics to Weatherby (RENOV) 355.00 $ 3,023.75 $1,073,400

1+2+3 TOTAL $21,011,000

(INCLUDES $1.5M FS EQUIP*) - Building Shell NIC (assume provided by 150 bed residential)



PHASE 1-3 DESIGN AND CONSTRUCTION SCHEDULE

PEACE ARCH HOSPITAL MASTER CONCEPT PLAN Project ...

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