Planning

Planning

ARRAY-ARCHITECTS.COM

Table of Contents

Firm Profile.............................................................................4

Planning Expertise..........................................................8

Laser Spine Institute...........................................16

Montefiore Medical Center...........................24

New York Presbyterian.....................................28

Master Planning Expertise..................................26

University Hospitals...........................................38

Capital Health...........................................................44

St. John Medical Center..................................50

Firm ProfileWe are a team of architects and designers with unique backgrounds, but we all have one thing in common – we share a strong desire to use our expertise and knowledge to design solutions that will help people in moments that matter most.

The complex, changing world of healthcare requires a team of effective communicators and true collaborators. Our 30 year history of being dedicated to healthcare holds countless stories of discovering optimal solutions with our clients.

Our core mission is the same as that of our clients, improve the quality of our work, increase our efficiency, and motivate our staff to reach for success.

I go into every project with the primary goal of building less, and if we can avoid it, building anything at all. It is my responsibility to help our clients think critically about each move.

Noah M. Tolson, AIA, LEED AP BD+C, Lean Green BeltPrincipal and Practice Leader, Planning

Planning Expertise Building on a 30-year heritage of designing for healthcare,

Array has, in the recent years, been refining an integrated

project planning process in every project we engage. Founded

on an awareness that healthcare is changing, and so therefore

must the design to support healthcare operations change,

we delved deeply into Lean design philosophies to guide us.

It is our belief that every facet of the hospital organization

should be driven by study around the optimal functionality,

efficiency, and effectiveness of that space. A hospital will not

function appropriately without standardized, safe, operational

sequences. A hospital cannot be efficient without recognizing

that there is always room for improvement, and only a focus

on continuous improvement can a hospital hope to keep

up with evolving trends and standards. The effectiveness is

determined by positive outcomes in the health status of all

members of the hospital’s community and their perception of

the care provided.

At Array, we are establishing a culture of continuous improvement at all levels of our organization. We have re-designed our design process using Lean as a foundation for a unique Process-Led approach that better meets the needs of today’s healthcare organizations.

Throughout the history of medicine, healthcare facilities

have been designed by providers. This is no longer the case.

Patients and their families are now empowered and informed

to make choices based on readily available data on outcomes,

costs and HCAHPS score. Quality, value, convenience,

environment and amenities are now top of the list. The patient

is designing today’s healthcare facilities.

With this fundamental change, traditional planning processes

and many of the lessons learned from past experience have

lost their relevance. A new approach is required.

PAgE 7 | Planning

Using Lean principles as a foundation, our process begins by understanding your current operations and clearly defining your project goals before we generate options. Working together with you we map an optimal future workflow and patient experience. We employ a variety of integrated methods, such as process mapping, operational planning, virtual mock-ups, and simulation modeling as we work to develop a comprehensive project that supports your mission of caring for your community.

CHECKPOINT

DiscoveryCreation

Solution

CHECKPOINT CHECKPOINT

• Mapping Current State

• Collecting Data and Observing

• Understanding the Future

• Mapping the Future

• Rapid Testing

• Developing Change Roadmaps

• Understanding the Systems

• Targeting Outcomes

Analysis

• Applying the Results

• Developing the Experience

• Testing the Details

• Confirming the Vision

• Confirming the Cost

• Listening

• Visioning

• Defining Metrics

• Target Outcomes

• Executing the Design

• Coordinating multi-Disciplines

• Confirming Quality

• Prefabricating where possible

• Confirming the Vision

• Evaluating the Outcome

OUR APPROACHPROCESS LED DESIGN

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VISIONING Metrics of Success

When we lead our clients through visioning sessions to explore the desired look, feel and functionality of their environments, we use empathy and amenity mapping and top dot exercises to engage clinicians, patients, family members and project leaders in a dynamic conversation around key experience drivers.

EMPATHY MAPPING Engaging the Community

Empathy-driven design is particularly relevant in healthcare. Bringing a variety of project stakeholders to-gether to share thoughts can set the tone for a holistic experience, one where our planners and designers gain insight from providers and patients and then the providers and patients understand more wholly the intent behind our proposed design solutions.

OBSERVATION

Data Collection

Deeply understanding the current state as we work together to define your ideal future state is our next step. Through direct observation and process-flow mapping of your existing services, we work with users to accurately capture the current operational process. This allows us to identify any target areas for process change before design assumptions are made.

Our ToolkitOur Toolkit outlined below is infused with Lean principles. Our process begins by understanding your current operations and clearly de-fining your project goals. On our way to recommending solutions that will support your mission of caring for your community, we map an optimal future workflow and patient experience.

PAgE 9 | Planning

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VALUE STREAM MAPPING

Workflow

We map out the current state for each department that will be in the facility. Work queues and notification dashboards remove the traditional geographic con-straints of key steps in the patient flow, allowing care teams to decentralize, reduce their travel time and increase collaboration at a micro level.

VISUAL PROGRAMMING Identifying Space

With an idealized process defined and confirmed by simula-tion, the types and sizes of rooms identified -a space program is nearly complete. Array has been contributing to the devel-opment of software that allows this information to be cap-tured and displayed in real-time so users are able to visualize all necessary spaces within their department.

SIMULATION

Optimizing Efficiency & Flow

Discrete Event Simulation provides a virtual environ-ment to track and visualize patients, equipment and providers as they move through the steps of care. It is an important tool in supporting Lean Design in the healthcare environment.

BIM

Real Time Coordination

BIM has helped to integrate design teams in their detailed de-sign, engineering, documentation, project management and cost estimation. This progress is having a real impact on our ability to create meaningful connections between each phase of the design - from early conception of the design, to con-struction, through the building’s life cycle - and into renovation or demolition.

EXPERIENCE MAPPING

Creating a Healing Environment

Experience Mapping is meant to be a catalyst, not a conclusion. The takeaways drive the next phase of the design or strategy by illuminating the journey and helping to identify the opportunities and touch points throughout the facility, creating a healing environment.

PROTOTYPING & MOCK UPS Strategies Through Technology

As we work with you to develop these key spaces early in the design process, we use several tools to explore and validate the design as it evolves. These quick studies are part of our basic documentation and allow users to get a clearer under-standing of the decisions we are making.

COLLABORATION SCHEDULING Cloud Based Work Plan

Using a cloud based platform all team members work from one integrated, live work plan that supports the last planner pull schedule. Available on any smart phone, tablet, or touch screen, real time collaboration is constant and transparent.

CONTINUOUS ESTIMATING

Direct Cost Generating

Eliminating the non-value added step of milestone esti-mates, cost information is generated in direct response to design evaluation while working with the CM to test, challenge and inform decisions as they are being made.

WELCOME DISCOVER RESPITE RECOVER

Wayfinding Clarity...I know where I am going.

Patient Centered...Family Focused.

Gathering Zones...I need a breather.

First Impressions...I made the right choice.

Planning | PAgE 10

Programming / Integrated Project Planning

Array’s goal is to see to it that our clients receive buildings that are constructed as they were designed, within the allotted budget, at the expected date and operate efficiently and effectively for years after completion.

In order to do so, Array must communicate a truly integrated and coordinated representation of the design to ensure maximum legi-bility, containment of information and minimal need for changes.

Beyond its impact on design efficiency, Building Information Modeling (BIM) has helped to extend the usefulness of the archi-tectural drawings throughout building construction, fabrication as well as building management after it is turned over to the client.

BIM has helped to integrate design teams in their detailed design, engineering, documentation, project management and cost estimation. This progress is having a real impact on our ability to create meaningful connections between each phase of the design – from early conception of the design, to construction, through the building’s life-cycle – and into renovation or demolition.

The profession though, has been lacking in its ability to connect the Program – perhaps the most important aspect of the design – to the BIM model (and therefore to the final product). The program is the seed of the project – the initial conception of the ideas that every move is built upon. If done well, the Program has the ability to capture the project’s vision, impetus, its original direction, and yet this valuable information sometimes gets lost in the convolution of design, adjustment, value engineering and construction. At Array, we are working to expand Programming beyond the spreadsheet to capture all of this upfront information – and more importantly – connect that information to the rest of the project.

Follows are facets of our design approach that demonstrate some of how our integrative project planning approach has provided value to our clients:

Visioning Array believes that all projects should begin with process analysis before design solutions are explored. Working with senior lead-ership, we will facilitate a visioning workshop including a broad a range of stakeholders. This session will focus on defining aspira-tions, key goals for the project, target outcomes and measures of success. We employ a variety of activities for this session, all centered on developing the appropriate empathetic perspective

for the patients, family and staff who will use the facility. Our design process is more effective because we take the time early in our engagement to understand your goals and priorities.

Process Mapping To best develop a program, it is first important to understand the type of work to be done in the space. Operational models are evolving out of necessity – as regulations and reimbursement continue to change.

Step 1: Observe go to where the staff is currently working and develop a better understanding of the culture, patient volume, demographic and needs, the staff’s workflow, operational protocols, and space utilization.

Step 2: Current State map the current state of operations with a cross-section of users. Observing first, will make the conversation better informed and prepare the designer to ask better questions and challenge when necessary. The outcome of these work sessions is an agreed-upon diagram of the current workflow with areas for improvement/ process breakdowns highlighted.

Step 3: Future State Mapping A workshop with the same cross-section of users to develop an idealized work flow – mapping a process that systematically resolves the breakdowns/challenges of their current state. A natural extension of the process map is the type of spaces that will support this revised workflow – calling out all the critical relation-ships and adjacencies that are required and preferred.

Rapid Testing Simulation. A strategic plan/ business plan (provided by the client) defines the projected/expected volume of patients. Simulation modeling can map how the idealized process will support those goals. The simulation generates the number of rooms required to accommodate the revised process/workflow. Simulation modeling is also used to identify a preferred mode of operations by com-paring throughput and efficiency of various processes and spatial arrangements.

The thorough and systematic evaluation of the interrelated values, goals, facts and needs of a client’s organization, facility users and the surrounding community. A well-conceived program leads to high-quality design.

Programming

Planning | PAgE 12

Early Mock-ups Once the overall idealized process has been established, the environ-ment to support that process can be considered. One key ingredient to developing that understanding of work is to concentrate on the rooms that will have the greatest impact on care delivery: most typically the rooms that are replicated many times in the facility where patients and staff inhabit (e.g. exam rooms, operating rooms, patient bed-rooms, etc). While sometimes perceived as a pause to the design process, mock-ups are a critical first step. (Fight the urge to say: “just make the exam room 100 SF and move on – we’ll figure out what goes in it later). There are many different types of mock-ups – varying in their complexity, useful-ness and timeliness.

Tape mock-ups: Used very early on to develop a micro-understanding of the work to be completed within the room. Bring the equipment and fur-niture into a large room and arrange to support the tasks performed on a daily basis – only then start to define walls with tape on the floor. Push the users to be efficiency-minded, reminding them that more steps – even across the room for supplies – is wasted time/effort. It’s also important to remember that all space comes with a price – if the exam room can be 10’-3” instead of 10’-6”, those 3” per exam room can add up to a staff respite room later on down the road. No project has unlimited funds to support it.

Cardboard Mock-ups: To more fully comprehend the space, sometimes it is necessary to build walls vertically. It’s always interesting to note the difference in one’s perspective after vertical walls start to define the space. Whenever possible, it is important to have the actual equipment that will be in the room. Anything that can’t be the actual item, should be constructed out of cardboard to its actual size and shape.

Panoramic mock-ups: At an early stage in the design, Array builds virtual models of the major spaces and renders them in a way that allows for 360° panoramic visualization. When some users can’t be present at the physical mock-up, a virtual mock-up allows for remote visualization and feedback. Panoramic mock-ups are designed in BIM, and can therefore be used later as the base building blocks of the BIM model.

Mock-ups continue to be useful beyond Programming, as they solidify consensus and reduce costly changes. Rendered Digital Mock-ups can help the users visualize details such as finish, furniture and lighting options to ensure functionality and aesthetic design intent. Many clients will also choose to fully build a sample of the room that is to be replicated many times in the facility to iron out any last details and build full consensus around the design concepts by constructing Full Built-out Mock-ups. These rooms can be built to include func-tioning lighting, booms, casework, outlets, etc. so users can perform mock-testing of the room and all its details. (They are also great for fun-raising.)

Visual Programming With an idealized process defined and confirmed by simulation, the types and sizes of rooms identified- along with their requisite adja-cencies and relationships, a space program is nearly complete. Array has been contributing to the development of software that allows this information to be captured and displayed in real-time with the users to be able to visualize all necessary spaces within their depart-ment. At our programming meetings, instead of reviewing long (boring) spreadsheets to illustrate space need, the users see all spaces in the department as bubbles or blocks arranged by their critical relationships.

Laser Spine InstituteNationwide

DIAGNOSTIC IMAGING

MATERIALSMANAGEMENT

FOOD & NUTRITION

CENTRALIZEDSCHEDULING

CLINIC DEPARTMENT

LOBBY

SURGERY DEPARTMENT(OR, PRE-OP & RECOVERY)

ADMITTING/REGISTRATION

CONSULTDEPARTMENT

2,059 sqft

4,515 sqft

689 sqft

4,947 sqft

805 sqft

748 sqft725 sqft

11,898 sqft

4,395 sqft

Top: Nurse Stations

Left: Visual Programming Diagram

Right: Call Center Map

Photography: Scott Pease

Laser Spine Institute has experienced exponential growth in their existing locations that has necessitated excessive premature renovation and cost. As the demand for laser spine surgery increases, LSI intends to build several more ambulatory surgery centers in different cities across the country as soon as possible. They recognized that refinement to their approach was necessary though – they realize they need to build an environment that supports their needs for an extended period of time.

The new driving goal is to conceive a flexible care model, define the ideal process to deliver the best care to their patients in an efficient manner, and to develop the most appropriate environment to support these operations. In addition, LSI decided to take their patient-centered approach one step further, and has resolved to be the first Planetree designated for-profit healthcare organization in the country. The Laser Spine Institute has entrusted Array to lead them through the design process in support of these goals.

Array led the users through a series of exercises that defined a workflow and a specific environment that matches the company’s longterm vision. From surgeons to patients, from administrators to medical assistants, from nurses to the IT representatives – everyone who interacts with the various spaces of the building provided the critical feedback necessary to define the ideal environment. Data was collected and assessed, driving a well-conceived environment that serves the needs of all those involved – with particular emphasis placed on the satisfaction of the patient and their family. Visual programming, several iterations of physical mock-ups, panoramic renderings, and relationship mapping were all tools that contributed to an idealized prototypical environment that LSI can now take and replicate across the country and feel confident that their longterm needs will be met.

“I’ve designed, developed, built and managed multiple ASCs from the dirt ground up through licensing and accreditation, and this is by far the best process I’ve ever been through. If I would have had mock-up built to spec to work on before, I can’t tell you how many design flaws, over sites, mis-steps would have been avoided. I think this is genius and I love this approach.”

– Kim Howse, Executive DirectorLaser Spine Institute, Tampa

• Designed/designing ambulatory surgery centers in Arizona, Florida, Missouri, New Hampshire, Ohio, Oklahoma and Pennsylvania

• For each surgery suite within the Center, approximately 3,000 SF is required

• All LSI Outpatient Surgery centers include:

• Operating Suites

• Clinic

• Diagnostic Imaging

• Step-Down Lounges

• High-End Finishes

• Surgery Waiting

• Clinic Exam Rooms & Waiting

• Administrative Areas, Offices and Conference Room

• Public Lobbies/Corridors

• Staff Lounges

• Cafe

Laser Spine Institute

Top Center: Community Area

Top Right: Nurse Substation

Middle Left: Reception

Bottom Left: Exterior

Bottom Right: Nurse Stations

Photography: Scott Pease

Collaborators: Benchmark Construction The Procz Group

The role of Industrial Engineers does not traditionally involve work in the architecture or healthcare industries. Presently, however, given the high rate of healthcare costs in America, the industry is experimenting with a marriage of process engineers and architects to create more cost-effective environments with higher quality care. One recent example of architectural optimization in healthcare was conducted under the auspices of Array Architects for Laser Spine Institute. To accommodate a growing volume of patients, this health system is going to open several satellite facilities across the coun-try, testing a smaller community-focused model that would serve as a template for their growth. These smaller facilities will require a set amount of pre-operative care spaces (PRE-OP), post-anesthesia care spaces (PACU), and other necessary support areas to function. This study centered on the use of discrete event simulation model-ing for layout and process planning purposes.

When architects are designing new healthcare facilities, they typi-cally follow accepted design guidelines and client recommendations regarding the amount of space necessary in a specific facility. Due to the space utilization of the current facility, Array and the client were both interested in challenging these conventional guidelines by designing a space that most efficiently and precisely matched their specific function. In addition to this alternative space plan, the client was also interested in altering the current patient flow to improve the patient experience. In the current system, patients are transferred from Stage I recovery rooms to discharge recliners (Stage II) as they transition through the levels of recovery. The newly proposed model would allow the patient to fully recover in the PACU, with family members present, without moving to another location. The challenge would be to accommodate patients in the PACU for the duration of their recovery without causing backup in the ORs. These requests were translated into two major goals: 1) establish-ing an adequate number of recovery and PRE-OP rooms necessary to support the new patient recovery configuration without adding patient waiting time and 2) determining whether the space was

large enough to support future growth in the form of an additional surgeon and patients. As a simulation model would be the best tool for finding a solution to this problem, Array engaged their healthcare systems engineer to study solutions.

The key aspects of a simulation model are the data it runs on and its ability to accurately represent the parts of the system that relate directly to the project goals. Direct visual observations of the current work flow was arranged to validate the existing process map provided by Array and speak with front-line employees from the headquarters facility. Process time data compiled from a previous time study performed at the headquarters facility was used to generate distributions that powered the simulation. These process times were combined with the process map to create a simulation model using Arena Simulation software. To ensure the accuracy of the model, a paired-t confidence test was administered, in addition to other methods of validation and verification. It turned out that the actual values and the simulated values were almost perfectly correlated, resulting in 99.95% confidence that no statistically sig-nificant difference existed between the simulated and actual data, as can be seen in Figure 1. From this, it could be concluded that the processes in the simulated model were running almost exactly the same as the processes at the actual healthcare facility.

Once the simulation model was accurately representing the actual system, small changes could be made to see how they would impact the system. The simulation model was reconstructed for three different patient recovery scenarios — complete recovery in PACU with no overflow; complete recovery in PACU with overflow directly from surgery to PRE-OP; and complete recovery in PACU with over-flow from PACU to discharge chair for phase two recovery. Each of these PACU overflow scenarios was paired with one of three options which tested the capacity limits of the surgery center, including add-ing a recovery room, adding a surgeon, and adding a recovery room and a surgeon.

DESIGN by THE NumbERS: DISCRETE EvENT SImuLaTION aT LaSER SPINE INSTITuTE By: Laura Silvoy

PAgE 19 | Planning

After modeling each of the scenarios combined with all of the options, output data was analyzed and it was determined that the desired future state Array proposed could indeed be achieved. In the ideal future operating state, patients recover fully in the PACU and a patient would never be required to wait for a recovery room to become vacant. The combination of scenarios and options that best meets these criteria allows complete recovery in the PACU with patients moving from surgery directly into a PRE-OP room when all recovery rooms are occupied.

According to the standard ratio of recovery rooms to operating rooms, there should be six recovery rooms and extra room for discharging patients. The proposed design solution suggests four recovery rooms are adequate. In the current operating state, on average, patients will wait 30 seconds after surgery before being placed in a recovery room. If the altered process was applied to the same layout, on average, every patient would wait 9.9 minutes, with a maximum average of 36 minutes per patient. The final

solution requires that the PRE-OP rooms be used for recovery in case of a full PACU, which led to a 0 minute wait for patients exiting the operating room. The simulation model was used to test these different options and scenarios. Careful output analysis resulted in choosing a model with an efficient patient flow plan that involves zero waiting time after surgery and meets both goals set by the client.

While the results of the simulation prove viability of the proposed solution, we recognize that other factors contribute to a care model’s effectiveness. More rigorous prototyping and simulation modeling might study the areas of maximum patient capacity, ideal scheduling, personnel utilization, and cost analysis, to definitively determine the most efficacious operational scheme for the health institution. Nevertheless, the work conducted by Array for the surgery center is a prime example of the way systems engineering and architecture can come together to help the healthcare industry function more efficiently.

This solution leads to an improved patient experience, a more effective use of surgery center space, and a decrease in patient waiting times.

LauRa SILvOy

As a Healthcare Systems Engineer, Laura collaborates on projects firm-wide, enhancing our team’s ability to deliver enhanced project results through more rigorous data analysis. As an integral part of the Process Improvement Team for Array, Laura works with clients and staff to promote a philosophy towards, and implementa-tion strategies for, continued process improvement. Laura’s energetic ap-proach to investigation and her insight on how data can be deciphered and lead to improved patient environments will have definable results for Array’s healthcare clients and their efforts to affect the health improvement in the communities they serve.

Click here to visit Laura’s Thoughts page.

View Laura’s Slideshare about this study to learn more

“I’m excited by the shift in healthcare towards performance based metrics and patient satisfaction. It’s focusing the value proposition on the patient and family which I believe will result in higher quality buildings that will stand the test of time.”

Seena Hassouna, AIA, EDAC, LEED AP BD+C, Lean Green Belt - HealthcareHealthcare Planner

Planning

Montefiore Medical CenterAmbulatory Care CenterBronx, NY

“A lean design approach collaboration with Montefiore’s industrial engineers was imperative to understand how clinicians and staff work and how information and patients flow to maximize efficiency in this unique space.” – Jason Lee, LEED AP, Lean Green Belt

Principal and Studio Director, Northeast Region

Array was retained to provide planning and design services for the complete fitout of 12 stories at the newly developed Hutch 2 Tower – part of a Class A office complex convenient to the Medical Center.

Ambulatory surgery and support services are split between three floors and as well as waiting, prep/recovery, physician lockers and Central Sterile Processing. The ORs needed to be distributed between several floors with great care taken to properly connect them to achieve maximum efficiency and patient safety. The Ambulatory Center incorporates a full imaging suite with two MRIs, two CTs, four Radiology rooms, mammography and ultrasound rooms on the 2nd floor of the building.

The seven upper clinical floors are based on modules and pods so that space can easily be increased or decreased between groups as needed. Rooms can easily swing from office to consult to exam rooms due to standardized configurations and provided infrastructure. Multiple points of entry were also carefully monitored due to patients who self-park, patients who take mass transit, and patients who are dropped off. With these conditions, came additional requirements for security and emergency preparedness.

Exterior

Photography: Halkin Mason Photography

Top: Waiting

Bottom Left: Nurse Station

Bottom Right: MRI

Photography: Halkin Mason Photography

Collaborators: BR+A Cauldwell Wingate Reuther + Bowen

• 280,000 SF Ambulatory Care Center

• 12 ORs / 4 Procedure Rooms

• 64 Bay Recovery Area

• 20,000 SF imaging suite

• On-site Pathology with elevator that connects directly to ORs

• Plastic Surgery

• Dermatology

• Cardiovascular with Nuclear Medicine

• Pain center with four treatment rooms and eight recovery beds

• Urology with three treatment rooms

• ORL with five audio booths

• Ophthalmology with two laser treatment rooms and 12 exam rooms

• Internal Medicine with dedicated Pediatrics

• 177 exam rooms throughout building

• Ten total elevators, five to serve all 12 floors, three dedicated for OR transport two dedicated for CSS

• Large cantilevered entry canopy to protect multiple cars during drop off

• RFID equipment and personal tracking system throughout

• Electronic bed side registration and charting

• Central sterile with four lines

• Pharmacy with 797 lab

• Article 28 compliant

Project Information

New York PresbyterianChildren’s Hospital of New YorkNew York, NY

PICU / Nurse Stations

Photography: Halkin Mason Photography

New York PresbyterianChildren’s Hospital of New YorkNew York, NY

In addition to experiences, quality and safety, adjacencies and future space requirements need to be considered when Pediatric spaces are being moved and improved. The completeness of planning scenarios and phasing is of the utmost importance when the projects will affect many departments across several floors of more than one bed tower.

Located at New York Presbyterian’s (NYP) Columbia Campus, the Morgan Stanley Children’s Hospital of New York (CHoNY) is comprised of three buildings, ranging in age from 10 to 90 years. The owner chose to embark on a series of feasibility studies to map out the most effective plan to implement modernization projects in four key areas of the two older buildings and one location in the newest tower building.

Critical care bed demand and surgical services growth were key drivers along with maternity capacity and the creation of single family rooms. The projects are donor-funded with defined funding schedules. Each department’s improvement plan is phased to accommodate the domino-effect of planning multiple moves within occupied spaces. Implementation is also dependent on timing of new infrastructure installation.

Feasibility studies were prepared with input from a diverse group of stakeholders and user groups to confirm volumes, census levels and operations. A program of requirements was prepared and test fits developed to ensure that each unit would meet current codes, incorporate evidence-based design tenets and respond to volume projections. The team worked closely with hospital personnel to ensure continuity of identity and wayfinding with the goal of maintaining system-wide parity and compatibility with the Hospital’s design of interior finishes and construction standards.

Click on the below image to read a detailed case study on Array’s CHoNY Improvement projects

Top Left: Waiting

Top Right: Nurse Station

Middle Left: Waiting / Reception

Bottom Right: Patient Room

Photography: Halkin Mason Photography

Subspecialties Clinic

• 7,300 SF

• 14 exam rooms, one procedure room

• Open, curved registration/waiting area with decentralized work areas opens clinic to more light and provides welcoming entrance

Neonatal ICU

• 12,500 SF Renovation/ 17 beds with ability to flex-up to 22

• 7 private rooms/5 two-bed pods each with a flex-up position

• Decentralized nursing model

• Integrated ECMO service on unit

Pediatric ICU

• 10, 750 SF Renovation

• 14 private rooms

• Decentralized nursing model

• In-room family amenities including oversized day-bed for two, in-room refrigerator and safe

AntePartum

• 10,500 SF Renovation

• 14 exam rooms, one procedure room

Project Information

Master Planning Expertise Healthcare is a complex and diverse business enterprise that is in incredible flux. Each facility struggles to know the best next step to take, however each facility knows their next step must offer an appropriate ROI. We help clients by implementing a process that drives critical information through rigorous testing. Master Planning is not project planning – it is its own unique discipline – a discipline which provides a specific calculation of the practical steps needed to achieve an institution’s goals over an extended period of time. With a unique take on Master Planning, we help clients see where they need to go.

Healthcare has shifted from a volume-driven practice to a value-driven practice. Array has done the same. Smart front-end thinking goes a long way. Array goes to great lengths to substantiate our solutions with hard data. Our pragmatic process, intensified by our unique planning toolkit, enables more informed decisions to maximize flexibility, efficiency, and return on investment. Once a strategic, programmatic direction is formulated, it serves as a springboard and checkpoint for designing the most appropriate solution.

Facility investment is significant. Proper planning ensures maximum return. Our advisory services ensure that critical investment decisions are framed by the optimal breadth and depth of thinking through strategic planning, market assessment, demand projection, business planning, service line analyses and tracking key market trends and indicators. Our planning exercises explore areas of strategic growth, pinpoint potential problems, and develop alternative solutions to unique challenges.

PAgE 33 | Planning

Clearly defined business strategies lead to intelligent planning decisions. To ensure that we deliver results, our talent includes experts in strategic planning, program planning, performance improvement, technology, finance, market analysis, and medical equipment. Array’s master planning activities focus on solutions that maximize short-term and long-term use of facilities consistent with and supportive of the organization’s chosen strategic direction.

PhilosophyWe define a Facilities Master Plan as “a comprehensive framework for the organized and financially responsible development of facilities over time.” The purpose of a Facilities Master Plan is to ensure that:

• Strategic and financial objectives drive facilities investment decisions

• Facilities “project” plans respect an overall long-term planning framework

• Functionality and operational efficiency are maximized

• Site(s) and facilities remain viable and flexible in the long run

• Risks associated with facilities development investments are minimized

The absence of a Master Plan often leads to poorly located, configured and/or sized facilities projects which will result in:

• Short project life

• Lost capital due to ary service relocations

• Excessive construction costs due to a mismatch of service use and building type

• Negative impact on operations and operating cost

• Capacity issues

Array has extensive planning experience with a proven success record spanning 30+ years. Below are notable clients we have collaborated with:

Planning | PAgE 34

• Capital Health, Trenton, NJ

• Baltimore Washington Medical Center, Glen Burnie, MD

• Barnabas Health, Livingston, NJ

• Delaware Psychiatric Center, Wilmington, DE

• Franklin Square Hospital Center, Baltimore, MD

• Hunterdon Medical Center, Flemington, NJ

• Huntsville Hospital System, Huntsville, AL

• Jupiter Medical Center, Jupiter, FL

• Laser Spine Institute, Tampa, FL

• Miami Children’s Hospital, Miami, FL

• Mercy Medical Center, Toledo, OH

• Montefiore Medical Center, Bronx, NY

• Nazareth Hospital, Philadelphia, PA

• Nemours/ Alfred I. duPont Hospital for Children, Wilmington, DE

• New York Presbyterian, New York, NY

• Rex Hospital, Raleigh, NC

• St. Elizabeth Healthcare, Covington, KY

• Saint Joseph Hospital & Medical Center, Phoenix, AZ

• St. John Medical Center, Westlake, OH

• Somerset Medical Center, Somerville, NJ

• University Hospitals, Cleveland, OH

• Veterans Affairs Medical Center, Nationwide

• Wheaton Franciscan Healthcare System, Milwaukee, WI

Notable Clients:

"Watch and listen, then think and imagine, then test it, kick it, turn it upside down...and repeat. Only after

rigorous study can we sketch something out that might get us close to where we want to go."

-Noah Tolson, AIA, LEED AP BC+C, Lean Green BeltPrincipal and Practice Leader, Planning

Having dedicated my career to the design of hospital facilities, seeing first hand how lives are being saved through today’s technology helps me appreciate how design can impact efficiency and the delivery of healthcare.

Udo H. Maron, AIA, ACHAPrincipal & Healthcare Planner

University HospitalsFacilities Master Plan & ImplementationCleveland, OH

Providing more than 1,500 beds, University Hospitals is one of the largest and most respected health systems in the country. With the goal of increasing quality, market share, efficiency and improving their Centers of Excellence, University Hospitals recognized the need for a System-Wide Facilities Master Plan that would pinpoint areas for strategic growth, identify obsolete facilities and provide a phasing and implementation plan that would align their facilities with their long term growth strategies.

Array provided facilities master planning, corporate

architecture, design and interior design for over 50

projects across the University Hospitals system.

We conducted comprehensive site, facilities and infrastructure analysis of every building at each of University Hospitals’ 15 campuses, and ranked each building based on its value for future use. Building upon a strategic plan prioritizing services, we provided programming, test-fit planning, detailed project budgeting and identification of enabling projects that resulted in the construction of four new projects totaling $500 million.

The System-Wide Facilities Master Plan allowed UH to identify the locations for multiple projects including a new Cancer Hospital, sited to increase efficiency and interface with the hospital services in order to reduce redundancy. A location for an expanded Emergency Department was identified that improved connectivity to the hospital, increased patient through-put and reduced wait times. Overcoming the limitation of available contiguous space, a new Level 3 NICU was planned in an area that spanned three adjacent buildings.

Top Left: Infusion

Top Center: Reception / Waiting

Top Right: Nurse Station

Bottom Right: 3d Plan

Bottom Right: Exterior

Photography: Kevin Reeves

Seidman Cancer Center

• 375,000 SF, 10-story new construction• 120 inpatient beds (Transplant, Medical and

Surgical Oncology) with dedicated Pharmacy (expandable to 150)

• Radiation Oncology with two Linear Accelerators, one Cyber Knife, one Gamma Knife, one Tomo Therapy Suite and four Simulators (two CT)

• 42 Infusion Bays with dedicated Pharmacy• Ambulatory Clinic with 40 Exam Rooms• Cancer Surgery Prep/Recovery (10 bays) and four

new Operating Rooms including intra-operative MRI; attached to existing 22 OR Surgical Service

• Other services including Survivor Center, Phlebotomy and Lab Services, Imaging Services, Breast Care, Clinical Research Center and dedicated Pharmacy

• Amenities include Gift Shop, Café, Meditation Room and Family Welcome Center

• LEED Certified

ahuja medical Center

• First healthcare project in the country certified Silver under the LEED NC 2009 rating system

• 144-bed greenfield site hospital Phase 1; planned for 600 beds in future expansion

• Hospital Facility 375,000 SF• Central Plant 20,290 SF• MOB 56,545 SF• 22-bed Emergency Department (including 6

dedicated pediatric beds)• Collocated Outpatient and Interventional

Medicine Platforms

• Noninvasive and Interventional Platforms

System Includes:

• 1,500 total beds• Full academic medical center (Case Medical Center)• Two critical access hospitals• Four community hospitals• Thirteen ambulatory care sites• Several major building projects resulted from the

master planning effort including:

• A new, greenfield Hospital• A new, freestanding Cancer Hospital• A major renovation/expansion for the NICU

program• An expanded and renovated ED• A new 800-space parking garage• Improved site circulation; Improved Branding

and Patient Experience

Facilities master Plan

"Array has been instrumental in managing our master plan strategies, supporting UH’s fundamental mission, and has been a true partner and resource for leading our major building campaign." - Steven Standley, Senior Vice President University Hospitals

Patricia D. Malick, CHID, EDAC, NCIDQ, Lean Green BeltPrincipal and Practice Leader, Interior Design

Environments have the power to set our expectations, lift our spirits and inspire hope. This is what motivates me to create spaces that mitigate the challenges faced by all who enter a healthcare facility.

As part of a 20-year relationship with Capital Health, Array master planned and renovated their clinical facilities to respond to an increased demand for patient care services at their urban Regional Medical Center while planning for the suburban, Greenfield hospital where may services were being relocated from a second urban facility to be shuttered. Relocation of such services as the Regional Perinatal Center (RPC) and expansion of Pediatric Beds was requested as part of a Certificate of Need. The RPC reactivated 10 LDRP Beds, two Postpartum Beds, a 10 Well Baby Nursery, and two C-Section Rooms. An adjacent area was renovated into a 15 Bassinet NICU and seven Bassinet Intermediate Care

Nursery. The existing six Bed Pediatrics Unit was relocated and expanded to 10 Beds. Several functions were displaced by these services being renovated. This resulted in a challenging, phased renovation of a number of other areas to provide new space for the displaced inpatient rooms. New inpatient units were constructed in existing space, including a 12 bed Intermediate Care Unit and a 36 Bed Med/Surgical Unit. Work was phased, with construction completing on schedule at the end of September 2011 to allow for patient transfer at the planned shuttering of the other urban campus/opening of the new suburban campus.

Capital Health Facilities Master Plan Pennington, NJ

Top: Exterior

Left: Atrium

Right: Infusion

Right: Photography: Blake Marvin

Top Left: Patient Room

Top Center: Healing Garden

Top Right: Waiting / Reception

Bottom Right: Dining

Photography: Blake Marvin

Collaborators:

AKF EngineersAnchor Health Properties

HKS, Inc.O’Donnell & Naccarato

SkanskaTarget Building Construction

The Lighting PracticeWells Appel

• 925,000 SF replacement hospital and MOB on greenfield site

• 223-bed, five-story patient tower featuring single-occupant patient care rooms

• 4 Med/Surgical floors including 24-bed ICU

• 18-bed PICU (17 Bed Pediatric Unit-including 4-Bed Intermediate Care)

• 12-bed NICU (Level II), expanding to 31 beds (all private)

• 14-bed LDR

• Features 36,000 SF Emergency Department with dedicated Pediatric Care Unit

• 20,000 SF Diagnostic Treatment and Patient Support Building

• 80,000 SF Cancer Treatment Center adjacent to new hospital

• HKS, Inc. is the Architect of Record (exterior image credit); Array provided programming, corporate architecture and interior design services on this project.

Greenfield Hospital master Plan

• 97,000 SF renovation with all private rooms

• Rooms designed with bariatric patient lifts/accessibility

• Women’s Obstetrical Program - 22-bassinet (15 Level III / 7 Level II bassinets) NICU - 10 LDRP beds - two Postpartum Beds - 10 Well Baby Nursery - two C-Section Rooms

• Trauma Intensive Care Unit - 14 ICU beds supporting the Level II Trauma Unit

• Step-Down Unit - 12 beds supporting ICU step-down patients

• Medical/Surgical Units - 96 beds over four nursing units

• Laboratory - Pathology, Histology, Specimen Processing & Blood Bank

Regional medical Center

Lisa N. Lipschutz, AIA, ACHA, EDAC, Lean Green BeltPrincipal and Senior Planner

After having the privilege of working with heroes who cure, treat and receive care in our environments, I will never underestimate the importance of creating uplifting, inspiring spaces.

St. John Medical CenterFacilities Master Plan & ImplementationWestlake, OH

Waiting

Photography: Kevin Reeves

Due to the growing populations of Cuyahoga and Lorain Counties, St. John Medical Center (SJMC) decided to modernize and expand their services to accommodate growth and remain the healthcare provider of choice on the west side of Cleveland and increase University Hospitals’ image and competitive edge in the community. They engaged Array to perform a Facilities Assessment and develop a Modernization and Planning Study that evolved into a Campus-wide Facilities Master Plan. The Master Plan determined that key Medical Center services were in need of expansion and modernization to support the quantitative demand and qualitative vision for the future.

Array worked with a Steering Committee comprised of SJMC and University Hospitals representatives to define capacity requirements and develop planning alternatives in support of the agreed upon drivers and project budget target, including space program of requirements (PoR), development of test-fits, and detailed project budgeting and phased implementation.

St. John Medical CenterFacilities Master Plan & ImplementationWestlake, OH

Click on our Thought Leader below to learn more about project visioning.

St. John Medical Center3389.03June 6, 2014Level 1 and Level 2

Level 1 Floor Plan Level 2 Floor Plan

Top Left: Exterior

Top Right: Reception

Bottom Left: Floor Plans

Center Right: Operating Room

Bottom Right: Nurse Station

Photography: Blake Marvin

Collaborators: Barber & HoffmanDonley’sMCM CompanyOsborn Engineering CompanySandhu & Associates

• New Ambulatory addition with Patient Access function, Diagnostic Services and Same Day Surgery intake and main lobby

• Renovation of Non-Invasive Diagnostic Services including Imaging, Respiratory Therapy Biometrics, Phlebotomy, Pre-admission Testing

• Expansion of Surgical Suite, PACU, Same Day Surgery Prep and Recovery, Endoscopy and the Pathology Lab

• Renovation of Visitor Entrance with new canopy and renovated Lobby, Gift Shop and Café

• Increased inpatient capacity with addition of Pediatric Inpatient Unit and Clinical Decision Unit adjacent to ED

• Renovation to existing Inpatient Nursing Units

• Improved wayfinding and separation of inpatient, service and public flow

• Site and infrastructure improvements including a relocated helicopter landing pad

Facilities master Plan

A well-designed space has a profound impact on residents in healthcare facilities. That’s why I am passionate about creating environments that promote comfort and security through familiar, high-quality design elements.

Jon SellHealthcare Planner

LOCATIONS

Mid-Atlantic Region1 West Elm StreetSuite 400Conshohocken, PA19428

610-270-0599Contact: Kent Doss, AIA, LEED AP BD+C, Lean Six Sigma Black Belt

New England Region745 Atlantic AvenueSuite 236Boston, MA02111

ARRAY-ARCHITECTS.COM

617-982-0982Contact: Jeffrey Drucker, AIA

Northeast Region44 East 30th Street10th FloorNew York, NY10016

617-982-0982Contact: Jeffrey Drucker, AIA

National Capital Region1915 I Street, NWSuite 800Washington, DC20006

202-243-7495Contact: Adrian Hagerty, AIA, LEED AP

Southeast Region6001 Broken Sound Parkway, NWSuite 420Boca Raton, FL 33487

561-995-1700Contact: Mark Taudien, RA #AA26002642

Southwest Region1910 Pacific AvenueSuite 11100Dallas, TX 75201

214-939-7565 Contact: Marsha Whitt, CHID, EDAC, NCIDQ, Lean Six Sigma Healthcare

Midwest Region100 E. Campus View BoulevardSuite 250Columbus, OH 43235

3201 Enterprise ParkwaySuite 495Beachwood, OH 44122

614-758-6850Contact: Andy Vogel, AIA, LEED AP

216-292-7950Contact: Andy Vogel, AIA, LEED AP

Boca Raton / Boston / Cleveland / Columbia / Dallas / New York City / Philadelphia / Washington