Kaiser Final Submission 4 20 11 Small

BIG SMALL
IDEA HOSPITAL

KP Small Hospital 46983

INTENSIVE OUTPATIENT HOSPITAL

MEDICAL CARE
IS WHAT HAPPENS WHEN HEALTH CARE FAILS


WHERE DO WE START? THE NEXT GENERATION HOSPITAL WILL LEAP
FORWARD ON 2 PARALLEL MISSIONS:

The next generation of hospital will be designed to reduce TABLE OF CONTENTS

the need for itself. It will be the first to aggressively produce
the conditions for health, not just mitigate disease. It will 1 INTERVENTION
focus on the origins of cost in an effort to drastically reduce 1.0 Introduction, the intensive outpatient model: “Sites”
1.1 The efficient and connected hospital: Program
inpatient activity. Like all complex social phenomena, there
1.2 The Boundless Emergency Department
is no single technology or technique that can reduce the 1.3 Connecting the neighborhoods: Site
burden. Its about doing many “small” things, coordinated 1.4 An Architecture of Connection: Building form
at many scales, which culminate to dramatic effect. 1.5 Silo free departments: Plan and Massing

2 PREVENTION
2.0 Design as healing agent: Planning for health
2.1 The first Living Building Challenge© hospital


1 INTERVENTION
BLAH BLAH BLAH TITLE

1
INTERVENTION THE IDEA
is a prototype that removes barriers to migrating care to outpatient
How do you create an affordable, sustainable, and locally settings. Pushing care closer to the most intensive users and reduc-
viable healthcare solution that can become a building block ing inpatient activity, not by rationing access, but by shifting its focus.
for healthy community growth?

1. Dispersing the “site” into many embedded neighboorhood clinics, in the most intense use areas.

2. Using hospital facilites to mitigate healthy community planning

3. Blurring the distinction between swing departments, especially emergency, outpatient and
Pre/Post-Op/PACU of surgery.

4. Breaking down support areas to better facilitate collaboration, leverage visibility, and teaming.


1 INTERVENTION

BOUNDARIES MUST BE BROKEN.

THE NEXT HOSPITAL PAST PRESENT FUTURE
will breach several entrenched divisions that block our ability to connect cause and effect.

Electronic records, will become sources for data mining. Clinical departments will be combined, blurred and leveraged. Monologue Dialogue
The real cost of decisions will be measured. This transparency reveals a closer relationship to health and design: Blog: Team to Team
Doctor to Patient Doctor to Patient
The real cost of convenience-
On average, super-sizing a fast food meal saves 60 cents, then costs $6.00 in health issues.
Expert Authority: Partner Authority:
The real cost of ENERGY- Consensus Authority: Data
$1 dollar of energy equals $23 dollars of revenue. Profession Person

The real costs of OBESITY-
$116 Billion annually for diabetes alone.

If you knew the route to avoid illness, if you could connect the dots that extend wellbeing, Vanquish Nature Learn from Nature Mimic Nature
would you look to a hospital for these answers? Can a hospital inspire you to want something more?

THE NEXT HOSPITAL Study & Sort Comfort & House Select and Empower
will come from a different archetype, one that is retail in philosophy.
It will take a marketers understanding of our motivations to induce the behaviors
that draw us together, and empower positive change.

The secret to retail experiences, the reason shopping is recreational, is the pleasure of finding your fit. A public solution to personal needs. Brick Box: Warehouse Glass Box: Hotel Open Grid: Market
Often sharing the event with friends and family. Hospitals must learn to say “yes” to its customers.


1.1 Program

PROPORTIONAL DIAGRAM

This submission assumes 100 Beds @ 2,500 BGSF/Bed = 250,000 BGSF

1.1
This is aggressive; the normal metric is 2,870 BGSF/bed for a community hospital system.

PROGRAM ASSUMPTIONS It also implies a 75% efficiency factor.
1.33 BGSF/DGSF ratio=
1
1.33
= .75 or 75% efficiency x250,000 BGSF = 188,000 DGSF

PUBLIC & ADMINISTRATION
Assume 10% 188,000 DGSF x .10 = 18,880 DGSF

We have reduced the mean program
TOTAL BUILDING AREA Reasons:
250,000 BGSF 1. Leadership H.R. in MOB
2. Electronic Medical Records & Digital Imaging (No archives)
3. Public elevators & circulation shared with MOB
TOTAL DEPARTMENT

by 12.6% by creating a design with
188,OOO DGSF

SUPPORT

surge capacity between the Outpatient
20% (188,000 DGSF) = 38,000 DGSF 10%
Includes M.E.P as well as I.T.
.
Reasons:
Assumes system purchasing

Department, Emergency and Surgical
& J.I.T. Supply
20%

SUPPORT
43%

Pre-Op/PACU.
PATIENT BEDS

27%

DIAGNOSTICS
& TREATMENT

Kaiser 2010 Master Planning Initiative Survey:
DIAGNOSTICS & TREATMENT
70%-43%= 28.45%
Total = 50,700 DGSF PATIENT BEDS

Mean = 2,870 sf/bed Reasons:
1. Leverage D&T with Mobile Modalities
2. MOB attached with basic D&T primary care
100 BEDS @ 800 DGSF / bed
Reasons:
1. High acuity general medical surgical
2. Acuity adaptable private rooms with ADA toilet & assistable shower
3. Assume single room maternity C-section leveraged with surgery.
80,000 DGSF
= 43%
188,000 DGSF


1.1 Program

FROM HOTEL FOR THE SICK
TO MARKET OF HEALTH.
There are limits to the power of pampering. Our proposal envisions a new archetype for the hospital expere-
ince. When looking for health coaches to manage the cases of the most intensive patients, one turns to retail
clerks and managers. They understood the default answer was “yes”. They are trained to connect needs and
resources under a different philosophy than traditional clinitions.
The “retail” hospital will take its architectural hertiage from marketplaces. Where ideas are exchanged with
goods.
Where optimism and empowerment are tools of the “trade”.


1.2 The Boundless ED

THE BOUNDLESS
EMERGENCY DEPARTMENT 1.2 25

20 20

At the fulcrum between inpatient and outpatient care,
our proposal re-thinks the emergency department. 15
Outpatient Department
Use of E.D. Capacity

Number of rooms occupied
CAPACITY
Flexible boundaries between E.D., Outpatient and the prep / recovery of the surgical department allow staff 10
to flow. 10

The purpose is to allow the surge of patients between these services as need and capacity is available Emergency Department Utilization
throughout the 24-hr day. 5
This also allows the staff to be leveraged between these services as patient to staff ratios allow.

The operational implication of these flexible boundaries is an integrated management and staffing of these 1

service lines.

5 am

6 am

7 am

8 am

10 am

12 pm

1 pm

2 pm

3 pm

4 pm

5 pm

6 pm

7 pm

8 pm

9 pm

11 pm

12 am

1 am

2 am

3 am
4 am

9 am

10 pm
11 am
This should yield more efficiency, safety, and greater through-put of patients.
24 HOURS

Our experience has shown that staff who have cross trained and range across these departments find the
experience fulfilling.
Many clinicians have a culture of “helping out” their colleagues, which reinforces their desire for team- Reduced co-pay from scheduled E.D. visit
1 Use of cell phone registration 4
work and patient focused care. • 60%
2 Access to EMR • 85% Utilization of 20 E.D. P
.T.

3 Internet posted wait time 5 Schedule in OPD end of the continuum


1.2 The Boundless ED

   

  
 
     
  
  
  
  
 
 
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 
   
   
  
     


   
 

  

  
 


  
  

  
  
  
 
  
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  
  
 



   
 
   
 
 
     
 

  
  

 
  
    
  
  


REMOVING THE TRIAGE DISTRIBUTED TEAM STATION
BOTTLENECK The team station is the coordination hub of the E.D. Designed
to allow maximum visualization of the treatment areas, it works
The triage flow takes on new meaning in the boundless in conjunction with the staff coordination room which features
E.D. As is also serves as exam and intake for the outpatient smart glazing providing privacy by darkening on command.
dept. This forms a permeable membrane which bridges the At the entry of the exam bays, this arrangement encourages
scheduled and unscheduled visit mix. detection and coordination of chronic visitors, and creates
a venue for briefings.


1.3 Site

HYPOTHETICAL SITE
LANCASTER, CA 1.3
For the purposes of this competition we have selected a site in Lancaster, California, a community already
served by Kaiser. Adjacent to an existing facility, this site seemed positioned to be a bridge between
residential andcommercial while dealing with many of the common barriers aften found in communities
Kaiser builds in such as the boundaries often created by freeways.


1.3 Site

A
G
B B

CONNECTING THE NODES: E

REGIONAL SITE C
D
B

I
J
I
D
Starting with the notion of a single site. The next community hospital must operate as a bridge on K F
many “sites”.

The knot of medical data, and trend spotting must be solved so that the most intensive and costly I G
pateints can transition from emergent to home based care. Our proposal includes specific features to F
foster “medical home” and intensive outpatient concept. We believe the physical design
of the facility can greatly engender these encounters by removing specific barriers that are common
H
today.
B
B
These interventions occur at every scale and “site” of the proposal. C

B

A VIRTUAL NODES - web-based resources for health information, chat with nurses and doctors
B MOBILE NODES - on the go screenings, testing, seasonal shots
C YOUNG FAMILY NODES – pre-natal, birthing and pediatric focus
D FAITH-BASED NODES – food banks, family counseling, stress management
E ASSISTED LIVING NODES – physical therapy, yoga, water aerobics
F BUSINESS PARK NODES – screenings, executive health counseling, stress management, occupational therapy
G FITNESS CENTER NODES – Nutrition counseling, sports physicals, sports injuries, screenings
H SAFETY NET NODES – social worker support, case managers, mental health services, food assistance, housing assistance
I SCHOOL NODES – promoting healthy food choices, physical activity, screenings, physicals
J GARDEN CENTER NODES – promoting home food growth, cooking classes, healthy food choices
K SMALL HOSPITAL NODE - promoting wellness, healthy food, recreation, community gatherings, connecting all other nodes of wellness

1.3 Site

CONNECTING THE NEIGHBORHOOD:
LOCAL SITE 4

Site elements

1 bike, running and walking paths 4

The next community hospital must operate as a central node within the 2 pv solar covered parking areas 7
larger wellness network. 3 aroma therapy and 7
5
1
medicinal herb gardens
3 2
The small hospital site becomes the convergence of wellness in the 4 organic orchards
2
6
8
neighborhood, bridging disconnections, promoting well being in all aspects 5 farmers market
9

of life. It is the center of restorative wellness, promoting recreation, healthy
6 Outdoor gathering amphitheatre
food, physical activity, cultural events and our spiritual connections to each 9

7 Outdoor dining, cooking, picnic areas
other.
8 Playground

These activities occur throughout the larger community and converge at the 9 Sports fields

small hospital site where all the aspects of a health community merge.
4


1.4 Building Form

1.4
THE SPACES IN BETWEEN
The form of the project is derived not only from the programatic efficiencies of adjacent departments but
form the desire to extend the projects reach much like that of an ancient city. Through streets, plazas and gre-
enways the project literally reaches out to the community as well as connecting all areas of the hospital. The
project creates a dynamic central”square” in which sits the community, meeting and education spaces forthe
hospital. wrapping around this greencrescent courtyard are the public circulation “streets” for the project off
of which all major public program elements can be accessed.
Our memory of great places is largely defined not by the architecture but by these spcaes in between the
architecture- the places people occupy, the spaces filed with dappledlight and human interaction. These
walls of our project not only define the limits within the building but seek to extend the invitiation the build-
ing sends to the community to make it a living part of the place it is is built in .


1.4 Building Form

SITE PLAN
The small hospital is a “bridge building”. It connects parts of communities which were previously uncon-
nected while reducing the typical impervious footprint of a traditional hospital.


1.5 Floorplans and Massing

LANDSCAPE AS
BUILDING, 1.5
BUILDING AS
LANDSCAPE
Intensive green roofs control water runoff, reduce the
heat island affect as well as offering physical links from
one part of the community to another.
There is a tangible and unmistakable valuing of Kaiser’s
connection to both community and environment through
the buildings form.



LANDSCAPE AS BUILDING,
BUILDING AS LANDSCAPE
Topography in nature has always had the potential to act as a landmark- a symbol for a place, a way to
orient yourself to ones surroundings. Architecture has the potential to do the same. Blurring the bound-
aries between architecture and topography gives this project a unique potential to represent a new kind
of building for Kaiser, one that orients the user to both clinical and local community environments.



LANDSCAPE AS BUILDING,
BUILDING AS LANDSCAPE
The building’s seamless integration into the landscape softens the project’s form on the horizon and
creates an iconic landmark for the community.



LEVEL ONE
KEY ROOM PLAN
The ground floor plancreates a welcoming gesture to
the community- inviting entry to the facility. A grand
public stret sweeps around the crescent shaped green
space offering direct acces to the inpatient and outpatient
functions.



LEVEL ONE
KEY ROOM PLAN



LEVEL ONE PERMEABLE SURFACE PARKING

DEPARTMENT PLAN
The design leverages surge capacity between the Outpatient
Department, Emergency and Surgical Pre-Op/PACU.
surge
zones
OUTPATIENT EMERGENCY
MEDICAL OFFICE BUILDING

IMAGING

surge zones

GARDEN
ENTRY

PERMEABLE SURFACE PARKING

SURGERY

ADMIN
FOOD SERVICE MAT MGMT MECHANICAL



LEVEL TWO
DEPARTMENT PLAN
MEDICAL STAFF
MEDICAL OFFICE MECH
CONF CENTER

NON INV CARDIO
REHAB
OPEN PULMMONARY
RESOURCE CTR LABS
MEETING AREA
O.P INTAKE
.

ROOF

DINING

NURSING UNIT 30-34 BEDS
FITNESS



At the heart of the building is a crescent shaped outdoor garden in which the copper clad resource center
and meeting facility sits. All of the public circulation fronts this garden.



The project’s roofscape is an active green-roofed surfuce connecting hospital to community and reducing
the buildings impervious footprint.


2.0 Planning for Health

HEALTHY SITE
HEALTHY COMMUNITY 2.0
REGION: Connecting many community organizations with focus on promoting
health and well-being of the area, the small hospital becomes a central node in the
larger community health network.

COMMUNITY: Bridging barriers withing the neighborhood site, promoting healthy
food options, outdoor recreation, physical activities and cultural events. The small
hospital becomes a hub of healthy lifestyle activities.

DEPARTMENTS: Departments flow together, remove barriers between emergency
and out-patient care. Communication is improved, staff is more fully utilized and
flexibility of roles is enhanced.

STAFF: Bridging barriers to coordination and visualization of care.



HEALTHY BUILDING = HEALTHY COMMUNITY
ANNUAL ENERGY CONSUMPTION - ELECTRICITY KWH (X000)
ORIENTATION AND DAYLIGHTING: The proposed building uses the optimal orientation and limited
depth of the building to maximize the potential for daylighting on the upper levels, while using skylights
to bring light into the central areas of the 1st and 2nd floor services. These strategies reduce the light-
AREA LIGHTING - 854.1 KWH
ing load substantially, reducing the lighting to 15% of the total for this facility.
15%
ENVELOPE: The proposed building envelope is well insulated and uses high performance glass with
a high R value, a low solar heat gain coefficient and a high visible light transmittance. This helps to
reduce the heat gain load on the roof, walls and glazed elements of the building while, at the same time
SPACE COOLING - 69.8 KWH
using the benefit of day light to its maximum potential.
1%
MECHANICAL SYSTEMS: The proposed mechanical system is a highly efficient chiller plant with
Smart evaporative condensing chillers and heat recovery for pre-heating hot water. Ventilation air is
provided via.... These strategies reduce the mechanical system load substantially, these loads account 15%
AREA LIGHTING
VENTILATION FANS - 593.6 KWH
for 13% of the total load for this facility. AREA
11% LTG.

WATER EFFICIENCY: The proposed building water fixtures will be highly efficient in flow rates and 11%
will help to limit the use of potable water in the facility. The building will also provide all the hot water
VENT. FANS
needs of the hospital with solar hot water panels mounted to the roof of the building for maximum effi-
ciency. This will greatly reduce the need for natural gas used for hot water heating in the facility. PUMPS & AUXILLARY - 93.7 KWH
71%
2%
ENERGY USE AND ON-SITE PRODUCTION: From CBECs data, an average existing hospital build-
MISC.
ing in the western region has an Energy Use Intensity rating of 246.8 Kbtu/sf. The proposed building EQUIPMENT
was modeled and has an EUI estimated at 75.2 Kbtu/sf. To reach the goal of 75% under the average
CBECs 2003 data, the facility would need to produce some of it’s own energy on site. A photo volatic MISC. EQUIPMENT - 3962.1 KWH
array sized to make up the difference is approximately 6000 KW, about 490,000 sf of surface area. This
71%
would allow the facility to operate at 61.7 Kbtu/sf. We propose that portions of the roof, parking areas
and portions of the southern facade would be covered in photo voltaic panels in order to generate power
on-site.


ON THE WAY TO NET ZERO ENERGY:
70% reduction
10%
2.1
Well insulated envelope
Maximum R value glass
Ultra low Solar heat gain coefficient glass
Maximum visible tranmittance glass
Very low lighting power density in all non-critical spaces 0.8 w/sf

30% Highly efficient ventilation air handlers and fans
Energy recovery on all exhaust sources

75%
30% Highly efficient chiller plant with Smart evaporative condensing
chillers
Heat recovery for pre-heating hot water
Solar hot water heating array on roof for hot water needs

Photo voltaic arrays, wind turbines, fuel cell boxes
and other on-site energy sources will help to
30% generation generate enough power to get the facility on the road
to net zero energy.

APPENDIX


3.0 Appendix

Major Healthcare Trends and 3.0 The rate of change in healthcare
will accelerate.
Planning and design should integrate flexibility and adaptability

Implications on Hospital Design In order to achieve quality and
opportunities. For example, site planning should allow for anticipated
parking expansion and hospital expansion to ensure optimal
connectivity and functioning of the hospital in the future. Facility design throughput goals, care delivery must
and sizing must consider ways in which aspects of the hospital can
adapt to different uses or incorporate new technologies. be organized around the patient.
Facilities should not be organized based on ‘departmental’ efficiencies, but
The following key trends will shape how care is provided in the future, informing new operational ‘patient flow efficiencies.’
paradigms and hospital design requirements. These trends are borne out of macroeconomic and Small scale programs rely on
regulatory/political dynamics, such as downward reimbursement pressures, quality incentives/ sharing resources to achieve
disincentives, push to insure more people, worker supply shortage (particularly physicians), and a
greater emphasis on work/life balance to name a few. efficiency. The small hospital will be the ‘head
Particularly with a relatively small hospital initially, small scale functions
– Standard and routine work will follow best practice models, care plan templates or services should maximize resource sharing opportunities related to quarters’ for health and wellness in
staff, facilities, equipment, etc. For example, are there opportunities to
– Advancing diagnostic capabilities will surface more complex diseases requiring a team of physician
experts to determine the most effective treatment regimen
share resources based on differences in time-of-day demand? the community.
Services and resources (e.g., nurses, technology, etc) will be dispatched from
– Advances in genomics will allow for more personalized medicine that will enhance outcomes the hospital to serve the community, for example, in the areas of preventive

– Increasing transparency related to key metrics such as clinical quality, cost, and service Integration of Health System care, care management, and follow-up care.

– Patients are increasingly more informed about diseases and purchasing healthcare resources will be essential.
– Providers will more actively manage patients/diseases and anticipate care needs Fully leveraging the resources of the Health System will be vitally
– Patient-centric care processes will evolve due to requirements for better clinical quality, outcomes,
important to the success of the small hospital. Leveraging central Healthcare delivery will increasingly
laboratory resources, technology systems, purchasing contracts, etc
cost, service, etc. will enable the small hospital to be as efficient as possible. rely on high-technology solutions.
The care environment should correspondingly be ‘high-touch’ from the
– Increasing integration of physicians and alignment of incentives and mission will support high standpoint of customer service, environmental design, etc.
quality, patient-centered care
In the future, care will be delivered
in a highly collaborative, team-based
environment.
Team rooms for multiple clinicians
Technology to connect various experts in the hospital, health system, etc


3.0 Appendix

PATIENT ROOMS
The patient room is a key element
of a hospital. The optimum design for the patient
room should include consideration of healthcare
trends that will influence the room’s features,
including characteristics of future patients, resource
limitations, rising costs and technology.

Three distinct zones are under consideration
during design, one each for caregivers, the
patient and family members.


3.0 Appendix


Kaiser Final Submission 4 20 11 Small

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