Constructing the Road to Wellness

By Rachel Duran

When hospitals plan expansions or site for new facilities they are thinking about meeting heath care needs100 years down the road — that means building flexibility into the facilities to support technologies that haven't been created yet. In addition, hospital officials say community support is a necessary ingredient for successfully siting medical facilities today.

What is one of the top tips for siting a new hospital facility? Bringing the community onto the bandwagon. Which is exactly what PeaceHealth in Eugene, Ore., did when it announced it would build a new hospital for Sacred Heart Medical Center at RiverBend, at the bend of the McKenzie River in nearby Springfield.

“What we recognize now is that the community was initially very surprised by the idea that we were going to move from where we are now to a new location,” says Brian Terrett, director of public affairs and communications, PeaceHealth. “It is paramount for any company to get the community on board.”

“Once we made the case that we needed to grow, the community found the idea of moving was more acceptable,” Terrett continues.

PeaceHealth assembled a Patient Family Council consisting of 90 community members to be the voice of the community for the design of the new hospital. In fact, the council was so successful that a number of managers in the hospital have invited some members of the council to participate on management teams.

Saint Mary's Health Network offers up an equally valuable tip when expanding a medical facility: garner physician support for the project. “You want to be in a location the physicians will be comfortable serving in,” says Dan Gonda, project coordinator, Saint Mary's Reno, Nev., campus. The health group will conduct a $160 million expansion of its hospital in downtown Reno.

“The physicians don't belong to the hospital and they can pick and choose where they want to be when there are multiple health facilities in the area,” Gonda says. “Your location needs to draw them to the campus and create a pleasant place for them to work.”

Chuck Siconolfi, director of health care architecture, Hellmuth, Obata + Kassabaum, notes that medical organizations need to be clear about their strategy for 10 years or more after the hospital opens. He says that medical organizations should also recognize that programs change faster than buildings go up, so incorporating flexibility is the key to every aspect in the design.

Flexibility Prevents Intervention

“Work with the architect to establish ways to build in flexibility that come at no additional up front capital costs,” Siconolfi says.

Siconolfi also notes that flexibility is a must in the design of today's medical facilities. For instance, he was the architectural project director for the L.A. County and USC Medical Center replacement facility in Los Angeles, which is currently under construction. He says the clinics, beds and diagnostics in the building are based on modules so that the practices can change during the course of the life of the building with little or no architectural intervention.

The L.A. County and USC Medical Center replacement facility is a 1.5–million-square-foot facility that will accommodate 600 inpatient beds; as well as diagnostic and treatment facilities for those patients and 375,000 annual outpatient visits a year.

Siconolfi says that because technology allows more and more outpatient procedures to be accomplished safely and successfully, those patients who remain in the hospital are those more acutely ill. This drives the need for more single bed rooms and also drives the need for short stay accommodations for the procedures-based outpatients.

Siconolfi says that because many procedures are handled in an outpatient setting, or with stays of less than 24 hours, hospitals are gathering these interventional activities horizontally. “They have the prep and recovery for those patients organized in a centralized manner.”

This set-up allows tremendous flexibility not only in how the nurses take care of the patients, pre- and post-procedure, but also in gathering procedures around the patients because technologies may change during the life of the building. “One technology may grow and one may shrink so you have to have the ability to accommodate this,” Siconolfi says.

The new Sacred Heart Medical Center at RiverBend, which will break ground in the summer of 2004, will be almost 800,000 square feet, 200,000 more square feet than the current facility. Terrett says one of the most important things for the new project is to build on a site with a minimum of 50 acres. “We felt like in order for us to grow for the next 100 years we needed this much space,” he says. “We didn't want to build on a site that was surrounded by residential buildings.”

The Saint Mary's expansion will double the Reno campus with the addition of 450,000 square feet. The emergency room will double to 50 beds. Gonda says the hospital has adjacent property that will accommodate the expansion and create a campus environment. “We are creating a professional building to bring the physicians on campus to give them a comfortable place to conduct business and be readily available to serve their patients in the hospital,” Gonda says.

Terrett says that it was important for Sacred Heart Medical Center at RiverBend's new site to be located with easy access to Interstate 5, because the regional medical facility will serve seven counties. The same holds true for Saint Mary's, which is located in downtown Reno and at the center of the population.

Gonda says it was important to keep ready access to freeways and major thoroughfares available to employees and emergency vehicles. What's more, “We already have medical supply centers and other related organizations to support the hospital in the area,” he says. “We decided to expand here to support that business structure.”

Sacred Heart Medical Center at RiverBend was looking for a location that would promote healing. “Sacred Heart wants to create a healing environment for its patients because hospital officials found a great deal of science and research that demonstrated the connection between shorter and longer healing times was due to the patient's environment.

“The new hospital's location will provide beautiful views as it will be adjacent to the McKenzie River,” Terrett continues. “We are close enough to the river to take advantage of the view, but far enough away that we don't interfere with the it.”

Facility Makeup

The Saint Mary's expansion will feature a new six-story medical plaza with on-site laboratory, diagnostic imaging, radiation/oncology and a 60,000-square-foot wellness center. Gonda says the radiology department is completely digital and that the hospital anticipates one day moving toward a paperless records system.

The wellness center will include fitness and rehabilitation rooms, aerobic training, weight machines, therapy and lap pools, and massage services, among others.

The campus will also feature a West Tower, which will include a public plaza, a parking structure with 1,150 new spaces and a new resource center.

The Sacred Heart Medical Center at RiverBend will be an all-digital facility. There will be docking stations and data ports in patient rooms, as well as flat screen monitors that will serve as a data station for the nurses and as a TV, entertainment and Internet station for patients. The hospital will eventually feature Wi-Fi technology.

Siconolfi says the new L.A. County and USC Medical Center replacement facility's operating rooms are configured to have intraoperative imaging. “The equipment will not be installed, but the accommodations for it have been built into the design and that allows something like magnetic resonance imaging to be introduced into the OR suite or other modalities as well,” he says.

The new Los Angeles facility will also feature elevators dedicated to quickly moving patients and materials throughout the hospital without having to use public hallways and public elevators.

Sacred Heart Medical Center at RiverBend's first three floors will be built on a pedestal, with nursing floors above them. The flexibility in this design will include the surgical suites as part of the pedestal so that when the hospital needs to expand, it can expand the emergency room, the mechanical space, and suites at the same time.

Terrett says this design will accommodate the future growth of the community, which will expand by 170,000 people in 50 years. “We spent a lot of time researching our future growth,” Terrett says. “We talked about a 100-year project and our feeling is that we didn't sell ourselves short.”

The design of the L.A. County and USC Medical Center replacement facility features an 180,000-square-foot footprint, whereas typical office buildings that are 1.5 million square feet would have a 60,000-square-foot footprint, thus the building would be run up tall, which is not desirable for hospitals, Siconolfi says.

Because of the size of the footprint, the structure features three components: an inpatient tower and an outpatient facility, both of which are linked to the diagnostics and treatment facility. Siconolfi says the hospital is designed like this for both medical-planning reasons and for optimal seismic response.

In terms of medical planning, even though units vary, such as nursing units, they tend to look like one another so the floor plan is a module of vertical utilities that create an efficient and flexible building. The seismic response feature of the diagnostic and treatment facility is base isolated: the inpatient and outpatient buildings meet the latest building codes in terms of earthquake design. The diagnostic and treatment facility features columns that do not touch the foundation but rather come down on rubber bearings. These rubber cylinders have the ability to isolate the building structure from the movement of the foundation, which is tied to the movement of the earth.

So as medical groups begin to undertake growth plans a few things are clear. Community and physician support for the new hospital are a must. However, just as important in the process is designing a flexible structure to meet long-term needs, such as looking 100 years into the future.

For more information about the organizations and companies featured in this article visit:

Hellmuth, Obata + Kassabaum Inc., www.hok.com

Sacred Heart Medical Center at RiverBend, www.peacehealth.org/willamette

Saint Mary's Reno Campus, www.saintmarysreno.com

Creative Contraptions

By Rachel Duran

Medical device manufacturers are searching for locations that have skilled labor, specifically Ph.D.s and technicians, as well as low costs of conducting business. An excellent quality of life doesn't hurt either.

Back in 2000, as San Francisco Bay's rents continued to skyrocket, Aesculap, a manufacturer of surgical instruments, decided to look into relocating. Because B. Braun Biotech, Inc., a biotechnology equipment manufacturer owns Aesculap, it made sense to locate in Bethlehem, Pa., to share services such as finance and IT in order to reduce costs.

Out of 170 employees, Aesculap was only able to attract six workers to Bethlehem and 12 to the St. Louis repair facility it created in the move. “So, we basically hired from scratch,” says Dirk Kuyper, executive vice president and COO, Aesculap.

He offers tips to fellow medical device companies considering relocation: have a plan in terms of training new employees. “We offered a substantial stay bonus to our employees in California to help them train their replacements,” Kuyper says. “That six-month overlap helped us in the transition, but we still lost a tremendous amount of knowledge. You have to be prepared to reinvest in all of your processes.”

Kuyper says Aesculap was able to establish a relationship with Lehigh Valley University to help people his staff of 70 in Bethlehem, which is now up to 90 workers. The company has also worked on a few projects with the university's advanced metals group.

Kuyper adds that the Lehigh Valley area has a fairly large number of skilled employees, “which we found helpful as we were recruiting,” he says. Kuyper also notes that a couple of Bethlehem area companies were downsizing at the time, so Aesculap was able to pick up some of those workers. “The skills were similar in generic terms, not specific to the medical industry, but certainly marketing and finance skills carried over,” he says.

For Arthrotek Inc., a subsidiary of Biomet, setting up its manufacturing in Redding, Calif., was ideal because of the area's skilled manufacturing personnel and their familiarization with the principles in the development company, says Ken Brown, director of manufacturing for the company. Arthrotek, a manufacturer of orthopedic surgical and arthroscopic surgical systems, developed the product in Southern California but decided to manufacture it in Redding. The company found a partner at Shasta Community College.

“Shasta Community College is interested in supporting technical-job-related training,” Brown says. “The area doesn't have a four-year college — there is one 60 miles away — but there are extension classes at the community college as well as several private colleges.”

B. Braun Biotech's vice president of sales, marketing and service, Len Goren, recently told a group of business executives this about the Lehigh Valley workforce: “The Lehigh Valley offers a wealth of skilled labor in terms of tool and die, which has been a real plus for us. That's a labor force that is difficult to find if you don't have them nearby. You also can find skilled technical workers, such as engineers, to design and build your equipment, as well as research and development personnel who help us develop future products.”

“It is important to turn out students who fit within a cluster,” says Ray Suhocki, president and CEO, Lehigh Valley Economic Development Corporation. “These companies are looking for skill levels ranging from community college graduates to Ph.D.s. The connection between the employer and the education community, so that the education community understands the needs, is very important.”

Suhocki notes that when Agere Systems, a provider of advanced integrated circuit solutions, was in need of technicians, Northhampton Community College put a 26-week program in place to meet the company's needs. Lehigh Valley companies are also able to access a nearby cluster's workforce.

Goren says that 80 percent of the nation's total pharmaceutical employment is located within a 50-mile radius of Philadelphia. “That is a lot of experienced people,” he says.

In Florence County, S.C., the experienced workforce makes it an attractive location for medical device companies to consider. Because of two major medical facilities, about 10,000 workers are involved in health care in the area, says Mike Eades, president and CEO, Florence County Economic Development Partnership.

What's more, Roche has an R&D center in the county, which employs 300 workers. The company's investment in the community is close to a $1 billion, Eades says. Another company, IRIX Pharmaceuticals, conducts contract R&D work and manufactures pills. In addition, General Electric manufactures equipment used in MRI machines.

“It is this base of workers that shows we can attract the talent needed to operate medical device facilities,” Eades says. “These three companies conduct business on a worldwide market level, and we are successful in recruiting and retaining those Ph.D.s and highly skilled engineers.”

Eades adds that Florence Darlington Technical College can provide companies with technicians to support their products.

Consider the Real Estate Opportunities

Kuyper says that Aesculap found a building in Bethlehem where the owners were able to design the second floor to accommodate the company's needs. “When we first moved in we had only the second floor and since then we have taken space on the first and third floors,” he says. “We will hopefully be able to expand in this facility over time.”

B. Braun Biotech recently decided to build a new 85,000-square-foot facility in Bethlehem to bring four operations under one roof. “We will be roughly doubling in size in terms of square footage with plenty of land available around us to be able to expand further as we need it,” Goren says.

Suhocki adds that the Lehigh Valley is in discussions to look at combining various models, such as incubators and accelerators, in one place to support companies as they emerge from the incubation level to a more commercial company.

Eades notes that medical device companies will find space at three business parks, as well as free-standing facilities, which have been certified as shovel ready. “We have conducted the environmental, geotechnical and wetlands analyses,” he says.

The Quality Factor

Brown says Redding's quality of life attracts many highly skilled and experienced workers. “The local mountains, lakes, rivers and streams are fantastic,” he says.

Brown also notes living, facility and labor costs are much lower than those found in Southern California.

For Aesculap, the cost of labor is not nearly as high as it was in California. The cost of living is also lower. What's more, the area offers direct access to the cultural and social benefits of New York City and Philadelphia.

Eades notes that the cost of living is lower in Florence County compared to the areas that Roche, IRIX Pharmaceuticals and General Electric are recruiting from, particularly from the Northeast and California. “We also offer the amenities of living near the coast,” Eades adds.

While the availability of Ph.D.s and technician level workers are important to medical device manufacturers, the cost of conducting business is just as important. If a community has all these factors, and an excellent quality of life, it is all the better.

For more information about the companies and organizations featured in this article visit:

Aesculap, www.aesculap-usa.com

Arthrotek Inc., a subsidiary of Biomet, www.biomet.com

B. Braun Biotech, www.bbraunbiotech.com

Florence County (SC) Economic Development Partnership, www.fcedp.com

Lehigh Valley Economic Development Corporation, www.lehighvalley.org

Top States for Health

(without medical device manufacturers)

Based on number of establishments

New Branches

1.      California

2.      Texas

3.      Florida

4.      Pennsylvania

5.      New York

6.      Illinois

7.      Michigan

8.      Ohio

9.      North Carolina

10.  Georgia

Start-ups

1.      California

2.      Texas

3.      Florida

4.      New York

5.      Georgia

6.      New Jersey

7.      Illinois

8.      Pennsylvania

9.      Washington

10.  Ohio

This data includes the following SICs: 80xx

Top States for Medical Device Manufacturers

Based on number of establishments

New Branches

1.      California

2.      Texas

3.      Massachusetts

4.      Florida

5.      Georgia

6.      Illinois

7.      North Carolina

8.      New York

9.      Colorado

10.  Ohio

Start-ups

1.      California

2.      Texas

3.      Florida

4.      New York

5.      Ohio

6.      Minnesota

7.      Georgia

8.      Massachusetts

9.      New Jersey

10.  Washington

This data includes the following SICs:

2835-26, 3823-25, 3481-45

Source: Since 1990 BizMiner has built its reputation on quality research in the fields of economic and business development. It develops vitality benchmarks for more than 18,000 lines of business and every U.S. county, MSA and state. Measures include business retention, entrepreneurial activity, new branch attraction, business relocation trends and concentrations of high growth firms and tracking more than 11 million U.S. business establishments annually. Custom analyses also segment any industry or area by firm age, sales, employment scale or growth. Visit www.bizminer.com for online area benchmarks, or industry benchmarks