The original objective was to relocate Coler-Goldwater Specialty Hospital and Nursing Facility (later renamed to Henry J. Carter Specialty Hospital and Nursing Facility) from Manhattan’s Roosevelt Island to the Harlem neighborhood of New York City. The $285 million project would be divided into two projects: renovating 270,000 square feet of the former North General Hospital in Harlem and building 185,000 square feet of space next door to accommodate a new, 164-bed nursing facility.

Had the original timeline been maintained, the hospital and separate nursing facility would still be under construction with a completion date set for March 2015. These plans were overhauled, however, when New York City’s mayor made a special announcement.

“We started schematic design and realized quickly that Mayor Bloomberg had announced that Cornell University and its partner, the Techion-Israel Institute of Technology, were going to be awarded an applied sciences technology school,” said Marsha Whitt, principal at Array Architects, based in King of Prussia, Pa., and project manager for the Henry J. Carter facility.

The technology school was set to build on the same Roosevelt Island site where the Coler-Goldwater hospital was located. The only problem was that the hospital needed to be demolished — quickly. The expedited demolition date moved the completion and patient-move date for Henry J. Carter up to November 2013 and shrank the schedule by 16 months.

“That’s when we had to back up and relook at the project and look at how we were going to approach it. How long was design going take? How long was construction going to take? How were the design team and the construction managers going to work together to meet these accelerated deadlines?” Whitt said.

A new time frame wiped out the design-development process. The solution was to regroup and implement integrated project delivery (IPD) strategies and a collocation system. Array went straight from schematic design to construction documents. This forced the project’s construction manager, Gilbane McKissack (a joint venture between Providence, R.I.-based Gilbane and Nashville, Tenn.-based McKissack & McKissack) to start looking at how they could quickly get resources on-site.

All stakeholders involved in the development process came together in full-team meetings. The strategy united the design team, construction manager and hospital owner in one location, and the collaboration accelerated the decision-making. Additionally, performance incentives that included shared cost and schedule metrics for both the contractor and design team helped to maintain the team effort.

“You’re joined at the hip by money, but since we were collocated, we put that piece aside and started to work as a cohesive team; we were all working toward the same goal,” Whitt said.

One critical component of adjusting to the tighter schedule involved dividing the two projects into multiple bid packages, which helped speed up information delivery, contract award and start of construction.

“Traditionally you may have a site package, an exterior package and a fit-out package. On this, we ended up with 20 packages because we broke it out by what could be purchased and when to get it on-site and get it installed,” Whitt said.

The client, contractor and design team worked side-by-side to review and approve packages. That process helped with getting parts of construction completed earlier — things such as elevators, major medical equipment and the mechanical, electrical and plumbing (MEP).

Just when the process was starting to go smoothly, the development process for the hospital and new nursing facility hit a new obstacle — Hurricane Sandy. Luckily, the Harlem site was not flooded, but it prompted a review of storm and flood elevations for the facilities. The project team included additional equipment protection and elevated electrical equipment on higher pads.

The Henry J. Carter Specialty Hospital and Nursing Facility opened on time, and Array is now involved in “Day 2” revisions, assessing what else is needed — or needs to be adjusted — after occupant move-in.

The post A Case Study in Construction Cost and Schedule Challenges appeared first on HCO News.

Tom Hudak, AIA has been with Array Architects since 2006. He can be reached at thudak@array-architects.com

The post Collocation: A Benefit For Design and Construction Offices appeared first on HCO News.

Atrium spaces create a sense of connection to the outdoor environment by allowing natural daylight into the building, while at the same time provide shelter from rain, wind and temperature fluctuations. In recent years, many studies have been performed on the affect of natural daylight in the healing environment. In 2002, Edwards and Torcellini published “A Literature Review of the Effects of Natural Light on Building Occupant”, and drew clear conclusions that natural light is a benefit to the health, productivity and safety of building occupants. The benefits in a health care setting have shown to reduce patient stress, which has a direct relationship to recovery. Increased full spectrum light is shown to improve visibility which is turn reduces staff error, increases productivity and contributes to their overall wellbeing.

These spaces are typically public in function. They can be used as the central collection point for vertical circulation in the building or access to multiple departmental entry points. They can also be used as the iconic place of entry or ‘front door’ to a building and have waiting and reception functions. An example of the Concourse atrium is Array’s project at Capital Health Medical Center Hopewell, where a linear circulation zone was developed to connect multiple departments, office suites and waiting areas all the while looking out over a soaring atrium filled with natural light. The Concourse atrium provides the most access to natural light and visibility, however also exposes the greatest surface area to direct solar gain. The geometric benefits of the Concourse atrium are that the public space can be shallow and linear connecting to multiple departments and waiting areas along a single circulation route.

One of the many considerations when designing atrium spaces is to take advantage of bringing desired natural light into the building while at the same time mitigating direct solar gain associated with the large expanses of glazing. Solar gain translates into cooling loads, which further equates into energy costs. The opposite, however is true in the winter or heating months, where solar gain is desirable and reduces the mechanical energy required to heat the space. The siting of the building and its configuration are some factors to consider early in the design process to balance the complexities of this space type. Analytical tools can help us during the design process to rapidly reconfigure and test different site, programmatic and geometric relationships of the building and fenestration systems. These indicators help to establish mechanical strategies for the space early in the process, helping to provide a more holistic approach to building performance.

The courtyard atrium is surrounded on all sides, which is useful on large building floor plates by bringing light deep into the floor. The sense of connection to the outdoors or visibility of this space as an architectural feature of the building is limited. Additionally, the wall that faces due south receives the highest intensity of solar radiation, however, the east and west walls are partially shaded by themselves over the course of the day. Since several of the walls will cast shadow into the space, this too has an effect on thermal comfort.

The three-side atrium exposes a façade of the building to the outdoors. Sometimes these configurations have a solid roof and a glazed facade, which helps to further provide shade to the interior space. While the exposure is similar to the courtyard type, the east and west walls receive less coverage because of the exposure the south wall provides.

Once heat from the sun penetrates the exterior wall of the building, the only way to mitigate its effect is through ventilation — either natural or mechanical. The primary method of mitigation should be positive shading, in other words, stop the heat before it comes in. One of the ways to do this is through building orientation relative to the solar path specific to the site. This can be accomplished by considering the relationship of the building to the site in plan, as well as thinking about the three-dimensional geometry of the building. Another is to employ high performance glazing in the exterior wall, which can have coatings that reject or reflect the heat of the sun, while permitting the visible spectrum of light into the space. Exterior shading devices can also be used to help provide additional shade. Ultimately a combination of multiple techniques leads to the most robust cost effective solution.

Thermal comfort is another consideration when designing atrium spaces. Since the atrium’s main intent is often circulation, the space can sometimes be used as a thermal buffer for the adjacent spaces and can have a slightly higher design temperature to help create a zone between the exterior and programmatic spaces that require more strictly controlled design loads. Mechanical fans can be placed at the top of the atrium to help reinforce stack effect, draw heat out of the top of the space and enable passive ventilation. Displacement ventilation is another technique to condition these spaces and takes into consideration ventilating the areas of circulation and occupied areas only to allow for higher volumes of air to be provided low in the space, which displaces air up to the top the atrium where it can be exhausted.

An atrium has unique challenges in regards to the life safety of the building occupants. Smoke generated during a fire is one of the greatest risks to occupant safety and needs to be carefully controlled. In some health care spaces, the maximum permitted contiguous area is 22,500 square feet. These compartments must be separated by smoke partitions. Additionally, the NFPA life safety code states that if more than three stories are connected or “open” to one another, a smoke control system must be employed. These systems consist of dedicated mechanical equipment and can have a significant added cost impact to a project. The code provides a provision to perform Computational Fluid Dynamic modeling to size and design exhaust locations, which affect the plume of smoke in a space. The nature of modeling the smoke within a space usually results in ‘right-sized’ equipment capacities and may provide cost savings over traditional methods of calculating the cubic feet per minute requirements of the exhaust fans.

The design of atrium spaces must consider many factors. They are program driven, mechanically purposefully and architecturally inspiring, while challenging to develop. Several tools can be employed early in the design process to leverage intelligent decisions to maximize desired results and in combination with various types of configurations make the atrium a space of opportunity within a project.

Atrium spaces remain a central part of many projects and provide space for many functions in a health care setting. How we program and plan these spaces provides rich opportunities to explore with our clients.

Anthony Caputo, LEED AP, is Principal and Northeast Region Practice Area Leader for Design at Array Architects. He can be reached at acaputo@array-architects.com. For more information visit www.array-architects.com

The post Atria – From Courtyard to Front Door and other places In Between appeared first on HCO News.

The 24-hour design charette included five other designers from Philadelphia and I set up shop in the Hotel Monaco in downtown Philadelphia along with a product designer and several other Mannington representatives. Each designer was given a digital camera and three hours to explore their city for inspiration. The team decided to split up into six groups in order to better capture the wide range of neighborhoods represented in Philadelphia.

What was amazing about the process is that you started to look at the city from a different perspective, no longer hindered by having an agenda, a meeting to prep for, a train to catch or an errand to run during lunch. I chose to explore South Philadelphia, so I wandered around the Navy Yard for a while before turning my attention to the Italian market. When we all reconvened, we printed our images and started the process of weeding through each photo to get to the common threads woven throughout our tours to different corners of the city.

Working with the other designers was truly a privilege. We all immediately honed in on the same ideas and became a cohesive design unit, surprisingly since we all came from different design backgrounds ranging from higher education to corporate to health care. This further instilled for me the notion that design has become less about each sector and more about the feeling that a space can evoke.

Once we had refined our imagery, several themes began to take focus. The first was the beauty and texture found in decay. Buildings, ships and stone all had this in common. Philadelphia truly embraces the old and worn and celebrates history. The second theme was layering and the idea of order versus chaos. The third theme, circles, was inspired immediately from the cycling culture of the city. Once our themes were refined, we began to work on broad color themes. The Mannington product designer worked closely with us throughout all stages of this process to make sure we understood the logistics of the process as well as what would make a commercial carpet. It was then in her hands to take our vision and bring it to reality. About a month after the event, the entire group was able to reassemble along with the product designer to review her designs and provide feedback before they start production on physical samples. Seeing your ideas come to life through someone else’s eyes is an incredible experience.

So often we get caught up in the demands of deadlines and everyday pressure and forget how and why we do what we do and how to truly get inspired. One of my fellow designers said it perfectly, “I went into work this morning feeling renewed and inspired. Sometimes in our day-to-day work, we lose track of what got us here in the first place – our creative spirits. This weekend was a wonderful reminder of just how magical the creative experience can be and how grateful I am for the opportunity I have to live in such a special city.” It really was an amazing opportunity to learn and be part of the new product development stages.

This experience has taught all of us a lot. Mannington has been incredible in keeping us all involved in the development of our designs. The designs will be selected to launch as part of a collection at the annual NeoCon Conference to be held June 9-11 in Chicago.

Nicole Wood, RID, NCIDQ, LEED AP, is a senior health care interior designer with Array Architects. She is currently collaborating on interior spaces for hospitals in Pennsylvania, New Jersey, Ohio and Florida.

The post Recapturing Creativity in Interior Design appeared first on HCO News.

As the physical platforms for delivering health care continue to evolve in their complexities and regulated reimbursement costs decline, efficient planning and design become increasingly more important as health care cost control mechanisms. Determining the proper operational and physical relationships of project components can have dramatic and far-reaching impact to the bottom line performance of a facility.

The rigor of Array Architect’s approach to ensure maximized efficiency is illustrated by a recent analysis for a large (approximately 175,000 gross square feet) ambulatory care facility in western Pennsylvania. After the conceptual programming phase of the project, we were asked to evaluate two potential sites for the facility. The first site had a compact size that required the program to be distributed over three floors, while the second allowed a two-story scheme. In order to determine which site would result in the most operationally sustainable facility, we evaluated the micro- and macro-departmental relationships as a function of both distance and time.

In order to assign appropriate importance to departments that were more operationally aligned or more frequently traveled, we developed a functional relationship hierarchy and scaled the number of trips between departments accordingly:

1. A very strong relationship has departments that are adjacent and there is high potential for shared staff and/or patient cross referrals. The trip ratio is eight and trip percent is 53.3 percent.
2. A strong relationship requires departments to be on the same floor. The trip ratio is four and trip percent is 26.6 percent.
3. A moderate relationship includes departments that are convenient, however different floors are acceptable. The trip ratio is two and trip percent is 13.3 percent
4. A weak relationship is one where departments have limited traffic or communication and may be remotely located. The trip ratio is one and trip percent is 6.6 percent.
5. No relationship is one in which there is no communication.

Additional constants that were used in our calculations included the average adult walking speed (4.1 feet per second) and the typical elevator wait and trip time (20 seconds per floor for the two-story design and 30 seconds per floor for the three-story design).

After measuring the distance between building entrances, departmental entrances and vertical transportation points, we converted all data to time in order arrive at a comparable, apples-to-apples data set (for example, a 100-foot travel distance was converted to time by dividing by the 4.1 feet per second walking speed constant). The final step was to weight the data based upon the departmental priority rankings.

The data clearly proved that the two-story scheme resulted in the most efficient building. However, regardless of the information that this type of raw data can convey, we have found that if data isn’t easily understandable it is easy to ignore. The challenge we set for ourselves is to be able to convert complex data into pictures and graphics that legibly and comprehensively fit onto an 11×17 sheet of paper (or an A3 for those speaking in lean language).

Finally, we try to make a quantifiable comparison statement about the data — for this project, saying that one design performed an aggregate of 221 seconds per interdepartmental trip better than another design would have been meaningless, however converting this data to the corresponding 8.3 full-time equivalent employees ($1.2 million in salary) per year and forecasting the $34 million in salary over the course of the anticipated 20-year lease provided our client’s senior administration with building performance metrics in a format that could be used in their fiscal evaluations and decision making processes.

The final presentation of this data is in the illustration above. I believe that the value of infographics like these is in its offering of clarity. When properly and scientifically composed, they can quickly and compellingly convey salient information and relevant data while enabling the quick decision making that is a base requirement of today’s fast moving project schedules. Taking the time to analyze design option data and to skillfully communicate it creates a tangible link between operational constructs, design strategies and performance metrics.

L. Kent Doss, AIA, LEED AP, is a principal with Array Architects.

The post Building Performance Evaluation as a Function of Distance and Time appeared first on HCO News.

Projects sometimes spend considerable money and time developing mock-ups during the design phase. There are several approaches to mock-ups, but the bigger-is-better approach seems to be leading the charts. Massive macro mock-up trends focusing on full-scale departments requiring a warehouse and truckloads of cardboard are gaining popularity. But do they add value?

In the ever-shifting health care environment, as providers continue to need to spend their precious capital dollars wisely the first time, and as projects move at faster and faster paces, how do we ensure that mock-ups add value and do not lead to a false sense of security in the design? Like all decisions in the design and care delivery process, we should ask ourselves if this will add value? Will this advance our mission and how can we be sure we get the most out of it?

The answer is an approach and not a product. As in lean design, start by asking: why are we doing the mock-up? It could be testing a new work flow, accommodating specific equipment, testing privacy, challenging benchmark rooms sizes, confirming finishes, placing accessories, convincing team members, fundraising, etc. After you can clearly articulate why you are doing the mock-up you can determine what format or level will give you the most bang for you or your client’s buck. You might need to rent a warehouse and call in the cardboard trucks or you might need to plug in a projector and buy some painter’s tape or both.

After defining the goals and objectives, the other essential ingredient is people. Mock-ups, like all valuable tools in the design process, are about engagement and consensus. Let the mock-up be the place to bring all of the users and departments together, engender empathy and educate across the silos. Design teams are the facilitators and the mock-up can be a powerful instrument when you have the right folks in the room. The physical interaction of mock-ups can make them rich experiences that encourage participation across professional levels and personality types.

We recently observed the value of this approach working with a large tertiary facility on the design of a comprehensive, inpatient rehabilitation hospital. The project scope included the renovation of existing 40-year-old patient care units. The target outcomes included, among other things, reducing the number of patient fall incidents while encouraging independence. The users fell into two major subgroups: those who provided nursing care and those who provided therapy. Each design workshop included dedicated work sessions with each group to define and develop their specific work areas, but each work session also included a cross-discipline group meeting around the patient room.

It was during one of these integrated sessions we watched the value people could provide if the mock-up is leveraged. Using only a 3-D view and colored tape on a conference room floor, we were testing different configurations for the patient toilet room. A disagreement arose as to the best orientation of the toilet. After a stalemate based primarily on gut feelings brought our meeting to a halt, we suggested the group role play. I got into a wheelchair, announced I had recently had a stroke and had to pee.

What happened next will likely remain a highlight of my career and had nothing to do with me. Two of the most empathetic and hard working nursing techs I have met began the process of taking me to the bathroom and helping me onto the toilet. The walls were tape and in this case, the toilet was a stacking chair. As they transferred me the way they would do with patients countless times a day, they demonstrated how the toilet location caused them to twist and climb in order to prevent me from falling. Before we could test the alternate arrangement, which I already knew was going to have the same issue, two of the physical therapists jumped up and asked if the techs ever used a gait belt. The techs hadn’t. The gait belt was a therapy tool and the nursing staff didn’t usually have one or think it would help much since they weren’t administering therapy. Then the physical therapist demonstrated how he could transfer me from the toilet to my wheelchair in one move without changing positions by using the gait belt. The techs loved it and are now implementing a gait belt in all patient rooms.

This moment of cross-discipline learning had nothing to do with our project. These great providers all work within 100 feet of each other every day, but do not have regular opportunities for this sort of interaction. The therapists have different training than the techs and didn’t know they possessed a simple tool that would be helpful. If we had reviewed the mock-up with each user group separately we might not have had this opportunity and might have made a physical change to solve one problem that created another.

6 keys to a value-based mock-up:
1. Only mock-up what is important to the project. It might be an exam room or a patient room, a check-in desk or a charting station. Mock-up what is different and untested to the end users. Mock-up what you need to make decisions and engage the customers. Don’t mock-up what is only slightly different from what they have. Don’t mock-up a full room when you only need to work out a head wall. Adding complexity that doesn’t add value increases cost and limits participation and nimbleness.

2. Make your mock-ups progressive and stop when you get what you need. Start with 3-D visualization and tape on the floor. Find a similarly sized room or stand the conference room tables up on their end to test the edges. Not all mock-ups require a contractor. Decide why you are doing the mock-up, what decisions you need and that will inform the least complicated and expensive approach. You can’t test paint colors without the walls and the proposed lighting, but you can test sight lines with a 3-D model and a projector.

3. Use the mock-up. Run actual scenarios. Don’t step though a process academically. Get in a wheelchair or on an exam table and role play. A large group of well meaning professionals can stand in a mock-up and not see anything wrong until they pretend to be a young couple with a sick child and realize there is no place for a diaper bag.

4. Have actual equipment. You can simulate walls, but you can’t beat actual equipment. This helps confirm size and function but also acts as crucial prompts to help the cue the providers and get them into their normal routine. Provide a clear list of the necessary items well in advance and most organizations can find what you need. Don’t use post-it notes to represent a 13-inch deep automatic paper towel dispenser. It might not fit in the corner as nicely as the sticky note does.

5. Mock-up and repeat. As the design evolves, return to the mock-up, test the changes, confirm the vision and give the providers additional opportunity to role play and think of something they missed. Progress the mock-up to hard walls or actual finishes if it continues to aid in decision making and engagement and is feasible.

6. Invite and encourage a cross section of all providers and staff involved with the work flows that impact the space. Have them all come to review the mock-up together. Don’t let existing silos segregate the mock-up review. It is the people who add the most value, not the foam walls.

Jonathan Bykowski, AIA, is a health care architect and senior planner with Array Architects. He is currently planning and designing projects in Florida, New Jersey and Tennessee.

The post When a Chair Becomes a Toilet: Why the People Are More Important Than the Mock-up appeared first on HCO News.

The post Comforts of Home: Furnishing a Health Care Setting appeared first on HCO News.

She opened by saying that several of us suffer from “educated incapacity,” which means we know too much about our field making it difficult for us to be able to see the future. Our education is our greatest asset and our greatest liability. She posed a question to the group: “Do you walk around with all the Louis Vuitton bags you have accumulated over the years or should you leave your bags on the street and run forward into the future with just a backpack?”

We all have a wealth of experience, and many of us have relied on our past experience to guide us as we go forward. But Weiner’s point is that we need to be open minded when learning: The old way may just be that heavy baggage we don’t need to carry with us.

Personally, I have experienced seasoned professionals who have done it their way for so many years that they refuse to learn a new, more-efficient way of doing things. An example is when our industry transitioned from hand drafting to using Computer Aided Design (CAD). Now we are transitioning away from two-dimensional CAD to three-dimensional Building Information Modeling (BIM). There are still firms out there using AutoCAD because they feel they are more efficient at the old way and refuse to accept the way of the future. They do not want to invest the time and resources upfront that will ultimately save time and resources.

Another interesting point made by Weiner is that we are not in a recession but in an economic transformation. This happens when disruptive technology creates efficiencies, which lessen the need for human labor. We saw this when we went from an agricultural-based economy to an industrial-based economy and then on to post industrial. The assembly line and machines took jobs away from people but created new jobs at the same time. It takes time for people to learn and be skilled at jobs that never existed before. Thus for those without jobs, it seems like a recession; but for those with the new skills, they are part of the transformation.

MaryAnne Gilmartin, executive vice president at Forest City Ratner Companies (FCRC), was another panelist who believes that modular construction will be the future. She says that even with all the technology we have, we are still building like our grandfathers. FCRC has setup a modular factory in the Brooklyn Navy Yard where everything will be built in units on the ground floor. Then it will be transported about a mile away and hoisted into place. Utilizing modular construction for a 32-story residential tower in Atlantic yards, they plan on cutting the construction time by one-third and reducing construction waste by 70 percent, compared to traditional construction. Skanska will train the union workers in lean manufacturing methods by using detailed work instructions along with precision tools and templates so that the fabrication process is consistent.

Wiener also commented on studies that indicate a patient heals 10 times faster when doing something they enjoy and brought up the idea of creating future hospital rooms to incorporate virtual reality. “During and following your procedure, what if you were able to experience something you love to do?” she asked the audience.

Weiner, also a leader in change management, shared some of her thoughts on employee productivity. She emphasized that happiness has nothing to do with productivity and implored employers to stop trying to make their employees happy. “Simply treat your employees fairly, with respect and remove obstacles so that they can do their job; don’t focus your search for candidates that are intelligent because intelligence is abundant; and seek out those with good judgment because that is harder to find,” she advised.

Perhaps Weiner’s last discussion resonated with architects the most. She impressed upon the audience that, as designers, we are not only building and designing for those of us currently alive, but for those of us that are not yet born. What we build now will ultimately be used by a future generation. We need to think outside of the box and anticipate what that future generation might need. Whatever we design should be adaptable and long lasting. Innovation is sometimes a risk and we need to encourage that. We need to develop a tolerance for risk and a comfort with imperfection.

Change is here and those of us that want to be part of the transformation are adapting. Technology is changing the way we do things by giving us options. I no longer need to go to a jobsite with a roll of drawings. All the information I need is on a single portable tablet. Our resources are not limitless. I hope that as designers, we can leave behind our baggage, save some trees and develop more of a tolerance for risk — as that is the only way we will be able to design for the future.

Eileen Lee is an architect with Array Architects.
 

The post CUNY Lecture Discusses Adapting for the Future appeared first on HCO News.

One of Array Architects’ recently completed Greenfield replacement hospitals uses an observation unit for these very reasons. The emergency department at Capital Health Medical Center – Hopewell in Pennington, N.J., includes all private exam rooms, with separate adult and pediatric components. However, the design team, along with Capital Health, recognized that throughput efficiencies could be further enhanced with the inclusion of a dedicated observation unit directly adjacent to the emergency department.

Hopewell uses an eight-bed observation unit for those patients who cannot yet be safely discharged, but do not require full admission to the hospital. The unit is thoughtfully located just outside the emergency department, yet easily and quickly accessible by both emergency department and inpatient teams and is conveniently accessible to the discharge waiting area. This also provides the patient with a better level of care and feeling that they are not being left in an exam room unobserved for an extended period of time. In addition, this allows the exam room to be turned over and ready for the next patient, resulting in shorter door-to-exam times and greater patient satisfaction.

While it is anticipated that the Affordable Care Act will increase the overall number of insured patients, many still use the emergency department as the primary entry point to hospital care. By many estimates, this produces more than 50 percent of non-obstetric inpatient admissions. This means that half of the arrivals at a hospital facility have their first experience by way of the emergency department. Without efficient throughput, that patient experience could be devastating to the facilities reputation in an ever-increasing, consumer-driven health care environment. The properly planned and used observation unit can enhance that throughput, reduce inpatient admissions, provide operational savings and improve patient satisfaction.
 

The post Emergency Departments Save by Using Observation Units appeared first on HCO News.