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Virtua’s new healthcare campus will change medical delivery

By M. B. Owens

An innovative program to develop a new medical complex in Southern New Jersey will change how hospitals and ambulatory centers will be planned and constructed for decades to come.

Virtua Health, which consists of four hospitals and an array of other medical facilities, is replacing its 260-bed Virtua West Jersey Hospital in Voorhees, NJ, near Philadelphia. It has pulled out all the stops to plan, design and build an almost completely digital campus on 120 acres a few miles from the current location. The $300 million complex will have 360 beds in 660,000 square feet, plus another 540,000 square feet of outpatient space. The new healthcare campus will be operational in 2010.

For the project, Virtua Health brought in some of the top consultants in their specialties, such as General Electric’s (GE) Health Care Division for operational consulting and Hammes Company for facility planning and development services. Virtua is also working closely with its own clinical staff at every level to understand the day-to-day working details of all patient care services, and will apply the findings to the layout and function of the new complex.

“What we are doing is creating a health care environment that will be able to incorporate the changes in bioscience and technology during the next 50 years,” said Richard P. Miller, president and chief executive of Virtua Health. “It will be a model for the future and a lasting legacy for the community.”

According to Miller, it is difficult for existing hospitals to adapt to changes, particularly in the area of information technology, because much of the new clinical technology ties into the IT system and structural building design. With this in mind, Virtua has started its development program for a new medical complex by looking at present and future technology, along with alternative ways of doing things, which will make future changes and upgrades, both planned and unplanned, easier to implement.

“Virtua is also responding to the needs of patients through improved customer service and quick access into the health care process,” said Miller. “The days of making people wait for service is gone because today’s mindset is for higher service expectations.”

Virtua’s approach is unlike anything tried before with a project of this magnitude in health care construction.

“What Virtua is doing is not the traditional architectural design process used in construction of large scale medical facilities,” said Richard Galling, president of the health care consulting firm, The Hammes Company, headquartered in Brookfield, WI., brought in at the beginning to help manage development of the new healthcare campus from start to finish. “The major difference in this case is that Virtua did not focus on what the users [physicians, staff and patients] felt they needed; instead they looked at having the users try and define how to do the process better in the future. That is the real key.”

This approach created an environment to encourage everyone involved to think “out-of-the-box”, and to really challenge them in terms of how they can deliver health care better in the future, Galling said.

Using this attention to detail, Virtua took 10 months at the outset to focus on processes and not the building design, partnering Virtua healthcare engineers with GE industrial and management engineers and working with other experts to perform detailed analyses of department after department, to formulate the framework for the best hospital design possible.

In this way, management has and is identifying the processes Virtua wants to use in the future, giving the architect a framework to design the complete facility, Galling explained.

And, to enhance the process beyond the scope of their own facilities, Virtua managers performed research of facilities in other regions that were functioning effectively in a particular discipline by making conference calls to selected medical experts and by touring to find improved ways of operating.

Even the selection of the architect was different.

“We included a design problem in the RFP for which the architect had to provide solutions demonstrating their understanding of true work-process engineering,” Galling said. “And one of the reasons Hammel, Green and Abrahamson (HGA) was selected by Virtua was because they got it.”

HGA’s healthcare industrial engineers were involved in the process stage upfront to make sure their expertise was incorporated in all aspects of final design.

“The process [stage] led to uncovering key information that was critical to the design team so they could come up with a design response that is unique,” said Kurt Spiering, vice president of the health care practice group for HGA. “We actually studied [at Virtua facilities] from a very analytical perspective of how movements of patients work within medical facilities… and then, out of that study, we created a series of assumptions about how a facility might best work and flow…including placing entrances at different locations.”

“We took the top 20 patient movements and created a series of design alternatives, eventually ending up with ‘six extreme schemes,’ all working with the objective of providing each primary specialty center its own private entrance,” Spiering said.

These were tested against a statistical model for where and why patients moved within the complex, ranking each scheme for each service area (such as obstetrics, cardiology, general surgery, etc.), he added.

After careful analysis, the final result was a hybrid of the top two ranked schemes, married with some of the best attributes from the other four schemes, which met the goal of operating efficiency for both staff and patients.

The extreme scheme mentality really allowed the designers to have the freedom for new ideas and creativity, Spiering said.

“We brought an open mind to reshape the design process around this management engineering attitude,” he said

To help come up with the potential designs, Virtua used specific and well defined approaches throughout, to examine preexisting situations and to support the management engineering effort.

“We had an initiative to do current-state process mapping to show the way that the work is currently done on a unit,” said Stephanie Fendrick, the Virtua project manager for the new Voorhee’s campus.

For instance, a management engineer would follow a staff member, such as an RN, on a unit to observe her work flow, such as what her travel distances were while looking at how many times she had to leave a bedside to find medications, to get linen or supplies, Fendrick said.

Virtua used photo-journals as a way to capture staff and patient perspectives by having
staff members use cameras and literally take pictures of their work environment, along with taking notes about what worked well, she explained.

And staff, with patient permission, followed patients through their experience and received their input about how the facility impacted them during their stay, she added.

Special engineering techniques such as Lean (a system for organizing and managing product development, operations and customer relations) and Six Sigma (a methodology that describes quantitatively how a process is performing) were incorporated by the management engineers for process analysis, Fendrick continued.

The new advances in health care are impacting the new Voorhee’s campus overall design as well.

“The hospital is being built to accommodate future technology whether it is a paperless environment or advanced diagnostic capability and to create a different kind of patient experience,” said Mike Kotzen, vice president and chief operating officer of Voorhees Hospital. “It is to be an all private room facility, with the rooms as universal as possible, with the exception of intensive care units.”

“We have spent a lot of time and effort of separating backstage work, services and patient movement from the public flow of visitors,” Kotzen said.

The hospital plans to use technology, such as RFID, for specific needs like tracking beds and patient discharge, Kotzen added.

Technology also will ease patients’ initial access. When patients come in, they will be escorted to their rooms where they will be registered in comfort using an electronic registration process, he continued.

Virtua management is quick to point out the facility is not just a hospital, but an entire health care campus.

Adrienne Kirby, PhD., vice president and chief operating officer of Virtua’s ambulatory services and programs of excellence, said, “There are two main components to the campus -- the hospital and a comprehensive ambulatory care service center. The hospital is divided into two distinct towers with two distinct usages. One is for the large women’s and children’s program and the other is for the adult and general surgical population.”

Within the ambulatory component there will be an ambulatory surgery center, a cancer center, a diagnostic and treatment center, a pediatric pavilion and a medical office building, Kirby said.

The office building floors are aligned to match the physicians with the patient services they provide for the physician convenience and for efficiency of operations, she continued.

“Everything we are doing on the inpatient side we are doing on the outpatient side with efficient processes, information technology, ease of access and even retail centers,” Kirby added.

Yes. Retail centers.

“Hospitals typically discharge patients with a number of product needs leaving patients and family members to find resources in the community, on the Internet or in specialty stores. At our new hospital, we will provide a full complement of one-stop services, and a major retail presence,” said project manager Fendrick. “We will have a health/wellness store and specific sites having products that anticipate the needs of our patients.”

The retail centers will be located throughout the campus and their products will be tailored for the patients’ needs in that area. For instance, the cancer center retail component will offer wigs and prostheses; the women’s and children’s pavilion will offer products to support breastfeeding, premature infants, and fun gifts for children and new parents.

And, as emphasized in the development process, the incorporation of digital technology throughout the new medical campus will be extremely important, making the information technology department an integral part of the design effort.

“Virtua has a commitment to move towards a completely digital infrastructure,” said John Bloomer, vice president and chief information officer at Virtua. “This involves the three themes of paperless, filmless and wireless along with the goals of ubiquity, efficiency and effectiveness.”

“Most of the challenge in designing a digital medical campus is not technology or even bricks and mortar, it is process and people, and that is the reason we have spent so much time studying, quantifying and getting it right,” Bloomer added.

One of the innovations is a high-fidelity video conference system, which places an Internet-connected flat screen television in every patient room, permitting two-way communication.

“The timeliness of getting a qualified professional in for patient care is huge,” Bloomer said.

For example, by utilizing a teleneuorology system for stroke patients where every second counts, an emergency physician can consult with an outside neurologist who can review the patient’s CT scan, even zoom in with a camera to inspect the patient, help make a diagnosis with the potential for administration of medication to reduce brain damage, he explained.

The projected shortage in some specialties makes the need for improved technology and communications, with resulting hospital design changes, even more important in the future, Bloomer continued.

The end result from all the study, analysis and design encompassing the Virtua project is a very flexible and resourceful campus for patients, physicians and staff.

“It will create a feeling of destination upon arrival through site layout, landscaping, signage, building structure and functionality, with total operating efficiency throughout, but most importantly it will be a place for healing,” said Hammes’ Galling.

And through the fundamental changes in the way this facility was planned and developed, a new model for health care delivery has been created that will influence new medical facilities constructed for years to come.