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					                   Pediatric Healthcare




Children’s Medical Center
Ambulatory Care Pavilion

   Post Occupancy Assessment




                                          Children’s Medical Center Dallas
                                          Chris Dougherty, Vice President


                                          Ronald W. Dennis AIA, ACHA
Agenda

  Introduction/Background/Challenge
  Project Description
  Project Outcomes
  Key Lessons Learned
  Future of the Project
               Pediatric Healthcare




Introduction
Introduction

   Children’s Medical Center Dallas
   Founded in 1913
   Academic Partnership with UT Southwestern
   411 beds
   23,000 admissions
   321,000 outpatient visits
   10 Ambulatory Sites
   2nd Hospital Campus
     Existing Campus

                                    Parkland
                                     Parkland
                                    Medical Center
                                     Medical Center


                                             Children’s
                                             Bed Tower



                                                                     Children’s
                                                                     Garages
     UT
     Southwestern      Existing
     Medical           Children’s
     School            Ambulatory          Walkway
                       Care                to Campus

                                                      Former
                                                       Former
                                                      ApparelMart
                                                       ApparelMart
Existing Site
Introduction

   HKS
      Over 200 projects for children’s hospital clients

      Recent Pediatric Facilities 2006-2008
         Completed Construction - 3 million square feet
               Children’s Hospital and Regional Medical Center, Seattle, Washington
               Children’s Healthcare System at Egleston, Atlanta, Georgia
               Children’s Healthcare System at Scottish Rite, Atlanta, Georgia
               Children’s Specialized Hospital, Brunswick, New Jersey
               Children’s Medical Center Ambulatory Care Pavilion, Dallas, Texas
               Children’s Medical Center Ambulatory Care Pavilion, Plano Texas

         Under Construction – 2.5 million square feet
               C.S. Mott Children’s and Women’s Hospital, Ann Arbor, Michigan
               Royal Children’s Hospital, Melbourne, Australia

         In Design – 2.5 million square feet
               Phoenix Children’s Hospital, Phoenix, Arizona
               Children’s Health System, Birmingham, Alabama
               Children’s Healthcare Hospital at Hughes Spalding, Atlanta, Georgia
               Richmond Children’s Hospital, Richmond, Virginia
The Challenges We Faced

  Space Not sufficient
  Not efficiently designed
  Does not facilitate one-stop shopping
  Inefficient utilization
  Patient privacy compromised
  Ambulatory space is not allocated equitably
  Poor wayfinding
  Did not promote a warm welcome
Construction Challenges

  Demolition of portions of the existing building
  Working within a functioning, occupied building
  Minimize disturbances to patients and staff
  Unknown existing conditions – columns and floor openings not included
  in existing drawings
  Unknown site conditions – subsurface water (stream)
  Limited floor-to-floor heights of the existing structure that challenged
  providing state-of-the-art MEP services
Approach


  The Ambulatory Care Pavilion, was planned and
  designed in such a way, that would create an Ideal
  Center for patients, families, providers and staff.
Approach:
Guiding Principles

1. The patient and family experience is first, always!
        Center will reflect and promote a patient/family centered approach to delivery
        As much as possible, services will be provided in a single site

2. Center design must provide for patient and family privacy and safety.
3. Wayfinding cues, displays and public areas should be designed to appeal to
   the age and cultural differences within our pediatric population.
4. Space should reflect unified theme that is representative of Children’s
   Medical Center as a system.
5. Education will be an important aspect of the services in the Ambulatory Care
   Pavilion (Medical, Patient, Staff)
6. Facility design will encourage effective use of resources
        Limit duplication of expensive technology
        Consolidate staffing points/resources where possible
        Unused space and times may be shared/allocated with other programs/services as
        appropriate
        Provider schedules will be “leveled” across the week
        Common spaces, lounges, conference rooms, etc. will be shared
        Information technology will be utilized to its fullest potential
Approach:
Guiding Principles

7. On-stage and off-stage activities will be separated
        Space will be provided for private interactions
        Non-essential tasks and equipment should be accommodated in non-public zones
        Offices and/or work areas for physicians and other providers should be distinct
        from patient zones

8. Program for practice suites will be based on a standardized template
        Customized where needed
        Provide high level of flexibility to accommodate use by different practice types and
        modifications over time

9. Office standards (size and allocation) will be committed to and applied for all
   offices.
10. Furniture standards will be committed to and adhered to
11. Every floor will have at least one family restroom with diaper changing area
    and mother’s lactation room
12. Space standards will reflect reasonable benchmarks and will be maintained
13. Space will be allocated based upon the Ambulatory Services room utilization
    methodology
Approach:
Building Blocks

1. Patient Encounter Space
       Basic building block of patient care area
       Exam room


2. Module
       Practice area, 19 patient encounter spaces plus all needed immediate support and
         staffing spaces/rooms
       Specialty specific clinical support (e.g. audiology booths)


3. Practice
       Service physically occupying a portion of, or some number of, modules


4. Clinical Neighborhood
       Grouping of Modules based on affinity among patients, physicians, equipment
       and/or schedule compatibility


5. Floor
       Horizontal relationship of Neighborhoods along with shared support and public
       functions
Expected Outcomes:
Desired State

  Single Entrance Point
  Horizontal Expandability
  Services Grouped Around Patient Needs
  Improved Parking Access for Patients and Families
  Enhanced Cheerfulness of Decor
  More Family Amenities
  Staffing Efficiencies
  Stream lined Patient Process
Expected Outcomes:
Goals

  Provide Family-Centered Care,
  commitment will be evident throughout the
  facility.

  Create a superb and delightful work
  environment for physicians, other
  clinicians and all staff.

  Create a dazzling “front-door” to Children’s
  Medical Center.
              Pediatric Healthcare




Project Description
Project Description

   Existing commercial building – 60,000 sf floor plates
   New entrance atrium
   Typical clinic module
   Clinical “neighborhoods”
   Ancillary space
   Complete renovation of floors 4 and 5
   Addition of 30-foot pedestrian sky bridge connecting the 5th floor to
   existing parking garage
   Family Resource Center and multi-purpose room
Project Description
Project Description
First Floor:
Ancillary




                                ☺




                                              ☺


                                                  ☺




                                                  ☺




                                      ☺

               EWC3




                                                  ☺




                                              ☺




                                          ☺
                                                      Blood Draw & Lab
                                                  ☺




                              Outpatient
                               Imaging




                      ☺




                          ☺




                                                                         Public

                                                                         Outpatients
   Fourth Floor:
   Neighborhood – 64 Exams

                         OFFICES
Clinics
   Plastic Surgery
   GI
   Urology
                                     GASTRO-     UROLOGY
   Endocrine                       ENTEROLOGY    GENETICS
   Diabetes                                     METABOLISM
                                                                  NUTRITION
   Obesity

                                                                Tlt.
Ancillary
   Orthodontics                                                        REG

   Education
   Nutrition
                                                PLASTIC
                               ENDOCRINOLOGY
                                                SURGERY
                                     OBESITY
Off Stage
   Physician Offices
   Medical Records
   Staff
                         OFFICES                ORTHODONTICS                  PUBLIC
   Break/Lounge                                                EDUCATION
                                                                              PUBLIC


                                                                              OUTPATIENTS
                                                                              OUTPATIENTS


                                                                              STAFF
                                                                              STAFF
    Fifth Floor:
    Neighborhood – 64 Exams

                        OFFICES                                       AUDIOLOGY
Clinics
   ENT
   Pulmonary
   Pulmonary Lab
                                  PULMONOLOGY
   Cystic Fibrosis                CYSTIC FIBROSIS       EAR NOSE
   Allergy                           ALLERGY               AND
                                   IMMUNOLOGY            THROAT
   Immunology                        ASTHMA                                   SPEECH
   Asthma
   Neurology
                                                                       Tlt.
   Rheumatology
   Rehabilitation
                                                                              REG.
   Dermatology
   General Surgery
                                                     REHABILITATION
                                    NEUROLOGY
                                                     DERMATOLOGY
                                  RHEUMATOLOGY
Ancillary                                           GENERAL SURGERY
   Audiology
   Speech
   PT/OT

                           OFFICES                      PT/OT
Off Stage                                                                              PUBLIC
                                                                                       PUBLIC

   Physician Offices
                                                                                       OUTPATIENTS
                                                                                       OUTPATIENTS
   Medical Records
   Staff Break/Lounge                                                                  STAFF
                                                                                       STAFF
Typical Module



                                                   Consult
   Assessment
                                            Assessment

                                                        Exam
    Exam                  Waiting
                                                          1
      1

                                                        Exam
    Exam
           Check-Out Reception        Check-Out           2
      2

    Exam                                                Exam
                Nurse               Nurse
      3         Work                Work                  3

    Exam                                                Treat
                  Physician Touch Down
      4

    Exam          Treat    Clean    Exam                          ZONES
      5                    Meds       4           Tlt    Soiled
                                                                          Waiting
                                                                          16 Exams
                                                                          Treatment
    Exam   Exam     Exam     Exam   Exam Exam       Exam                  Support
      6      7        8        8      7     6         5
                                                                          Reception
            Pediatric Healthcare




Project Outcomes
Previous   New
Single Entrance Point
Warm Welcome
Previous   New
Streamlined Processes
Previous   New Facility
Improved Wayfinding
Improved Wayfinding
Previous   New
Improved Wayfinding
Improved Wayfinding
Physician Practice Module
Physician Practice Model
Physician Practice Model
Cheerful Decor
Project Outcomes

  Awards
     Best of 2007 Awards
     ”Texas Construction Magazine”



  Recognition
     “Children’s to Build a New Tower”
       Dallas Morning News, December 2005


     “The Star Treatment”
       Medical Construction & Design, Jan/Feb 2008


     “Best of 2007: Children’s Medical Center Dallas”
       Texas Construction, December 2007
Project Outcome

  Patient Satisfaction Results
  Family Comments
            Pediatric Healthcare




Key Lessons Learned
Lessons Learned:
Process

   Teamwork and communications
       Owner/children’s facility
       Medical and facility professionals
       Architects and consultants
       Contractor, subcontractors and vendors to maximize coordination and
       address construction challenges


   Weekly Team Meetings

   Sharing is difficult!!
              Pediatric Healthcare




Future of the Project
Future of The Project



   6th Floor
   Adding Additional Levels to Main Campus
   Developing Satellite Ambulatory Care Pavilions
      Legacy Campus
      Potential for 4-5 additional sites
Legacy - Plano




                      New
                 Ambulatory Care
                    Pavilion

				
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posted:11/12/2011
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