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  Corporate Realty, Design & Management Institute

Health Care Institute of IFMA

 
     

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SM Wilson & Co.  

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Specified Technologies, Inc  

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Zak Companies  
     
Media Partners
     
 

 
     
Education Partners
     
     
 

 
     
     
     
 

 
     
     

Attendee Comments

     
  "How informative the summit itself was"

"Understanding the trends and drivers in the market place, as well as specific needs of health systems"

"Quality of the panels"

"All sessions were relatively pertinent to everyday planning efforts / current trends"

"Program was on time and no lost time during presentations"

"Matt Hirsch"

"Upcoming changes to the FGI requirements"

"Excellent venue and duration and pace of the presentations was very good"

"Round table discussions"

"Fast pace, excellent content"

"Content was interesting, and I especially enjoyed the tour at the end of the day"

"Great location, good price, good number of attendees"
"The owners and their perspective on the architects they work with"

"Chance to connect with St Louis colleagues, panel formats were good to break up Power Points"

"Variety of information"

"Quick pace"

"Program on What's Driving St Louis HCRE; Great future/business insights"

"Diverse topics; Science, technology & data with real world application"

"Diverse representation of healthcare owners & consultants; Strong topics"

"Blend of panels & short presentations"

"Location good; Networking; Where is Healthcare Going presentation"

"Speakers & topics"

"Variety of topics and Alan Whitson is an excellent moderator"

"Variety of topics addressed"

"FGI update"

"Access to the thought process of systems owners"

"The variety of topics and speakers"

"Hearing from owners on what they are looking for in a design process; Direction of market"

"Panels were great viewpoints"

"Liked the Tips Tricks & Traps; Enjoyed all the panels; Best part is the deep healthcare focus"

"Good mix of owners, consultants & supplier knowledge experts"

"Networking; New insights from hospital leaders"

"Cayton, Coleman, Bengston Trost, Mangers"

"Wide-ranging topics"

"Excellent and unique venue"

"It was very interesting hearing from such a wide range of speakers"

"Healthcare design, how others do it; Lighting advancement"

"Variety of topics, great presentations & discussions"
"Quickly covered numerous topics, experiences"

"As opposed to most day-long seminars/summits, I very much appreciated the shorter duration of each topic. I feel it made for a smoother, more engaging day"

"Fast-paced, short presentations panels in a single day, wide variety of presentation topics, knowledgeable speakers, well-connected local panelists; Venue was great!"

"Change nothing, it’s perfect"

"Very good set of speakers; Networking"
 
 
    St. Louis 2017 - Post Summit Recap
 
 

 

 

 

Key Takeaway Messages

 
  Recap of St. Louis Hospital, Outpatient Facilities and MOB Summit, July 2017, St. Louis
 
  Where is Healthcare Going?
  Alan Whitson, President of Corporate Realty, Design & Management Institute
 

TAKEAWAY MESSAGES

  • Healthcare spending is going up. It is 18% of the gross domestic product in the U.S., and U.S. healthcare spending accounts for 5% of the world’s domestic product. Outpatient visits are up 80%. “That tells you how fast we are moving toward ambulatory care.”

  • More people are living longer. According to the Social Security Administration, the typical 65-year-old today will live to age 85, more than 1 in 3 65-year-olds will live to age 90, and more than 1 in 7 65-year-olds will live to age 95.

  • With private health insurance, the annual healthcare cost for a family of four is $25,000, roughly the cost of a new Mazda. Employee out-of-pocket costs make up 16% of that total, with employer contributions at 58% and employee contributions of 26%, or roughly $534 a month.

  • In every business, you must follow the money. Most hospitals are nonprofit investment portfolios. The Median CapEX is declining, with more and more going to Epic.

 
  An Insider’s View of Facilities Guidelines Institute (FGI) Changes for Hospitals and Outpatient Care Facilities
  Doug Erickson, CEO of Facility Guidelines Institute
 
 

TAKEAWAY MESSAGES

  • “We are not just standards and fundamentals. For 2018, we are really trying to bring research and evidence in to go beyond the fundamentals.” The new guidelines will be split into two parts: Fundamental Requirements, including the minimum/baseline standards that can be adopted as code; and Beyond Fundamentals, focused on emerging practices that exceed basic requirements.

  • “We have really pushed the Safety Risk Assessment Toolkit.” The toolkit was developed to help integrate patient and staff safety into the design process and help project teams reduce risk in the critical areas of falls, medication errors, behavioral health, hospital-acquired infections, security, patient handling and movement, and patient immobility.

 
  •  Hot Topics for 2018 include: Design/clearances to accommodate patients of size (“Not just bariatric, but also height and distribution of weight”); pre and post-procedure patient care and the flexibility to combine those areas and correct rations when doing so; procedure and operating room sizes focused on a minimum clear floor area; defining “invasive procedures” to determine what the cost of a room will be; guidelines for when exam/treatment, procedural and operating rooms are needed; and a classification system for imaging rooms.

  • A new section has been added on design of telemedicine spaces including a lot of physical environment issues such as privacy, acoustics, lighting and site identification.

  • Outpatient Guidelines will now be a separate book outlining outpatient facility types, common elements for outpatient facilities and approaches to applying requirements to facility projects.

  • Another separate document for Residential Guidelines will address updated acoustic and lighting requirements, grab bar configurations, facilities for individuals with intellectual or developmental disabilities and long-term residential substance abuse treatment facilities.

 
  Connecting the Dots Between Real Estate, Design, and Construction in Next-Generation Medical Buildings
  Terry Banister, Team Leader/Plant Operations, SSM Health Care-DePaul Hospital
Tom Vanlandingham, Principal, Christner
Bill Wagner, Vice President, SM Wilson & Co.
Mike Schriever, Associate, Mechanical, Heideman Associates, Inc., a Zak Company
 

TAKEAWAY MESSAGES

  • “As clients become more sophisticated and have best practices they can rely on or standards that they are using, they can streamline the process and have fewer people involved to be able to speed up the discussion and decision making,” noted Vanlandingham.

  • “Rather than just bringing the general contractor on board earlier, we need to bring other folks on board earlier, like the HVAC contractors and electrical contractors,” Wagner said. “It allows us to prefabricate things a lot sooner, which saves money and time and is safer and, in the long run, you’ll get better quality.”

  • Regarding BIM, Schriever said, “It does take more time on the front end to design buildings, but my observation is that it has really accelerated the construction process. It’s turned into a really quick process for fabricating and I think the quality is better.”

  • Coordination helps with maintenance down the road. It allows the team to predetermine solutions for that designated space for preventative maintenance. It’s a safer environment for the workers as they are spending less time above the ceiling and more time building the racks on the floor.

  • Vanlandingham noted that the way projects are set up can often be an impediment to collaboration. “If those arrangements put everyone in a silo, it’s very hard to function and work across the lines.”

  • Said Schriever, “Once the budget is established, if something isn’t in it, it’s not going to get in it. Having an OPR (Owner Project Requirements) or a PEP (Preliminary Engineering Plan) allows everyone on the team to have a better grasp on what the components of that building are supposed to be and streamlines the process so you aren’t always going through budget issues.”

 
  What’s Driving the Greater St. Louis Healthcare Real Estate Market
  Mike Noto, SVP Real Estate Services, Welltower
Matt Hirsch, SVP Development, MD Real Estate Advisors
Chuck Bryant, VP /Facilities & Properties, SSM Healthcare
 

TAKEAWAY MESSAGES

  • Healthcare systems are one of the biggest real estate owners. Outpatient is a very stable market with 33,387 properties in the continental U.S., largely user owned. 2017 will be a big year for outpatient/MOB completions in St. Louis.

  • Most hospital construction projects are expansions. Of 737 properties in the U.S. hospital inpatient real estate construction pipeline as of January 2017, 560 of them are expansions, accounting for $48.1 billion in total value.

  • Regarding the St. Louis market, Hirsch said, “We don’t see a lot of hospital systems moving into third-party real estate today. The trend over the past 3 to 5 years has been our existing hospital tenants are doing short-term rentals and stopgap measures until some larger facility controlled by the system becomes available and those practices are being consolidated under those roofs.”

  • On the hospital side, Bryant noted, “We really don’t know how we’ll be compensated tomorrow or even today, so the challenge is that there’s so much risk in our business that it’s hard to make any long-term commitments.”

  • According to Noto, “Nationally, we’re seeing a trend toward hospitals moving services out of the hospital and into our buildings that are more tuned to outpatient services. In 2009, about 43% of our portfolio was occupied by hospitals; today that number is 65%. That is due to acquisition of physician groups and technological advances in medicine.”

  • The healthcare marketplace is moving on a continuum from providing care for sick people to “population health.” Bryant said, “As healthcare organizations become more integrated with the financing side, it behooves us to reduce the cost of healthcare and not bring them to the hospital. Our intent is to be out in the community, helping people with the lifestyle choices to reduce overall our cost of healthcare and improve access.”

 
  Shifting from Hospital to Healthcare System
  Jen Hendrich Cayton, Manager of Design, Planning, Design & Construction, Ascension Health
Nancy Coleman, Director of Design, BJC HealthCare
Charis Bengston Trost, Manager of Facility Design Planning, Design and Construction, Mercy
Doug Mangers, VP Operations and Healthcare Business Unit Leader, McCarthy Building Companies
 
  TAKEAWAY MESSAGES
  • With regards to standards, Coleman said, “One of the things that we do as we grow is really build consensus and support that standards are operating the same and communicating that to our end-users and getting them to understand best practices in the built environment and how it can help them deliver care with a better ease of access, and hopefully build it less expensively.”

  • One of the biggest lessons Cayton has learned is that, “In order to bring us all together, it’s not just us, the owners, but everyone that works for us from the maintenance team to the care providers to the volunteers … Our big challenge has been building that trust across the organization.”

  • For Trost, “Less is more is our biggest lesson learned – having less users at the table. We’re getting away from letting users determine what they want and instead educating them on what they’re going to have and how they will use it.”

  • According to Coleman, “We created standards in order to make everyone’s life easier, but in essence we’ve made it harder. We need to find out how to strike that balance moving forward so we can figure out how to build better and cheaper. The question for end-users now is ‘What can you do without?’ rather than ‘What can you add?’ We need to think differently and try to be more deductive.”

  • One thing Trost said she would change about the process is having “everybody who is a part of the project just laying their egos at the door. We struggle with designers, engineers and contractors who want to do it their way or leave their mark and we have to reiterate to them that Mercy has chosen them for a reason and they are now a part of Mercy as one team together, so they need to learn how to get along and communicate with one another.”

  • “The one thing all really successful projects have is a key individual who works for the owner, who is empowered to make decisions, has a clear vision about what you’re trying to accomplish and takes that leadership through the entire design and construction process,” Mangers said. “The jobs that have a really good core team are the jobs that go really well.”

 
  Hospitals Bringing Technology to Patients – A Peek Inside The Mercy Virtual Care Center
 

Vance Moore, President of Business Integration at Mercy

Tyler Meyr, Designer of Mercy Virtual Care Center Forum Studio

 
TAKEAWAY MESSAGES
  • Goals of the project included preserving the site and as many of the full-grown trees as possible, creating a connection between the building and nature, using a textured base (part of the materials standards), and creating a horizontal focus.

  • The result is a flexible, collaborative space similar to what you’d find in the technology sector. “Virtual is the hybrid of technology and delivery of care.”

  • The first of its kind, the spaces within the virtual care center are designed to morph and grow with the future of the organization, establishing a new standard for an innovative workplace.

 
  • To marry nature with the built environment, the design creates spaces that flow from inside to out. The transparent skin allows mature trees to be visible from every space inside the building. Terraces on every level allow staff to easily access nature, positively impacting their productivity. A palette of natural materials saturates both the interior and exterior.

 
  Repair and Renovation Construction: A Better Way … Job Order Contracting
  Mike Coberley, FMP, GA/C, Brown & Root
 

TAKEAWAY MESSAGES

  • Job Order Contracting uses a pre-established price book and allows for multiple projects to be delivered through individual on-call work orders.

  • The benefits of using JOC include: Complete pricing transparency (no “gotchas”), reductions to overall project cost and schedule, quick response capability, reduction or elimination of change orders, integrated project delivery and incentives for quality performance.

  • JOC significantly reduces pre-construction timelines, particularly if not using A/E. It also decreases upfront costs while maximizing the dollars to in-place construction and local subs.

  • If executed properly, it can mean a faster, better and more cost-effective method of completing work than traditional low bid single project methods.

 
  Breakthroughs in Lighting Technologies That are Transforming the Patient Experience
 

Patricia Rizzo, Senior Lighting Applications Developer, Philips Lighting North America

Kate Wickham, VP Healthcare Sales, Philips Lighting

 

 

TAKEAWAY MESSAGES

  • Tunable White lighting is an enabling technology, or “lighting devoted to improving the human experience.” It helps create human-centric environments that can lead to improved patient and staff satisfaction by supporting the circadian rhythm. Human-centric lighting works on functional, biological and emotional levels.

  • Tunable White works by providing varied light, rather than one color all day long. It uses a board of alternating LED chips (warm, cool, warm, cool), rather than bulbs, that can be easily customized to each situation (i.e. pediatric vs. adult acute care). It’s ideally suited for staff areas, patient rooms and corridors.

  • In patient rooms, Tunable White uses a transition of color throughout the day that mimics the natural progression of daylight, helping patients fall asleep sooner and sleep longer. In rooms without windows, it supports the biological clock by helping indicate the time of day.

  • A co-design pilot program in the Pediatric ICU at the University of Minnesota Masonic Children’s Hospital was well-received by patients, parents and staff. It provided more options for patients to assert control over their environment, gave nurses more options to comfort children and help them rest, and created a more healing and restful ICU environment.

 
  Tips, Tricks & Hidden Traps to Avoid from In-the-Field Experts
 
 

 

Daniel Andersen, DuPont Surfaces:
Tip:
“Internal cladding is a great use for solid surface materials. It allows you to sanitize those areas quickly and effectively.”

Trick:
“With solid surface, when doing a renovation, you can actually mount it over ceramic tile, reducing downtime for your facilities and reducing costs.”

Trap:
“Dark colors in solid surface with high gloss look extremely good for a short amount of time and then they wear really quickly. In high traffic areas, opt for lighter colors in a matte or semi-gloss finish.”

 

Dave Blackwell, Camfil:
Tip:
“Air-filtration for hospitals is low-hanging fruit for energy savings. High performance filtration can drop fan energy by 20-50%.”

Trick:
“Modern air filters last much longer than they used to. Well designed filters can last nine months to a year as a pre-filter, which can cut your labor installation costs.”

Trap:
“Within ASHRAE 52.2-2017 there has been a change in how manufacturers have to report performance of their air filters. Manufacturers must perform the tests and you can demand the results from your manufacturer.”

  Ken Pedley, Specified Technologies:
Tip:
“Design forward. Work with your design professionals to come up with a passive containment standard before you release the documents. Don’t rely on contractors to bring those to bear if they’re not specified in your designs.

Trick:
“Firestopping represents less than 5% of the project bid, but it’s in the top 5 citations when having inspections. Design things that reduce the chance of operator installation error.”

Trap:
“There’s a misunderstanding that all firestop manufacturers are created equal. There are really only about three players in the industry that can play in a healthcare environment. Don’t let the contractor drive your compliance.

Julie Stegeman, nora systems:
Tip:
“Low bid is not always the best bid when you’re looking at flooring installation. One way to qualify bidders is to require a mock-up.”

Trick:
“Test drive your floors just like you test drive your cars. Have manufacturers do a test install and beat it up, then ask them to repair it.”

Trap:
“Avoid wheel markings and indentations. Often that’s coming from patch failures in your subfloor or underlayment. Talk with your patch manufacturer and pay just as much attention to patching as you do to the floor product itself.”

David Wood, Cambridge Sound Management:
Tip:
“When dealing with privacy or distraction issues, use the ABCs of acoustics: absorbing materials, blocking materials, covering materials. It’s usually a combination of these, not one solution.”

Trick:
“When you’re doing the design, work on a team of people up front to make recommendations on how to reduce costs and improve the performance of the space.

Trick:
“Many people think the way to achieve great HCAP scores is to create a really quiet environment. It’s very difficult. A more achievable solution is to make a space that has a constant sound that covers up the noises that startles someone out of sleep to improve your scores.”