Case Study: NewYork-Presbyterian Milstein Bed Tower Improvements

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Patient Tower Renovation at NewYorkPresbyterian Hospital A Deeper Look An ideal patient room must be right-sized, appropriately zoned and safe. We apply the tenets of evidence-based design and patient and family-centered care to every aspect of our room configurations. We lead in-depth focus groups and mock-up sessions with caregivers, patients and their families to ensure the ultimate solution reflects the mission, values and vision of all constituents. The hallmarks of success are improved outcomes, reduced injuries and infections, and stellar patient satisfaction scores, which influence HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) and engender patient loyalty.


NewYork-Presbyterian Hospital Milstein Patient Tower CHALLENGE

PROJECT UNDERSTANDING New York Presbyterian (NYP) is at the mid-point of an 8-year Capital Plan for institutional

With a tight urban campus spread across three blocks, NYP commissioned Array to modernize and upgrade their 10-story Milstein Inpatient Tower to support clinical efficiency and improve wayfinding to ensure a patient experience and environment in sync with their worldclass reputation.

SOLUTION

renewal and growth. A key objective is to further their “Patients First� mission. A fundamental component of this initiative is the revitalization of the Milstein Bed Units. The desired project scope included high impact upgrades, including decentralized nursing, improved staff support, patient bedroom and bathroom improvements, MEP/IT upgrades, safety and regulatory upgrades as well as associated A/E reconfiguration and construction. Recognizing the need to work within their budget and maintain system-wide parity, we conducted benchmarking tours with key hospital personnel at both the Columbia and Cornell campuses. Immediately following the benchmarking tours, we scheduled Workshop Sessions with key personnel to develop consensus regarding clinical scope, patient and family amenities, infrastructure investment and phasing strategies.

This transformative $154M renovation will positively impact clinical care, nursing efficiencies, staff collaboration and patient comfort & satisfaction.

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Vision DESIGN PHILOSOPHY

Image

Quality/convey competence

Performance

Longevity/permanence

Maintainability/Life-Cycle Analysis

Value

Safety

Sustainability

HOW SHOULD THE MILSTEIN TOWER BE PERCEIVED BY PATIENTS AND FAMILIES? When the clinical leaders were asked this specific question, survey results indicated that 58% of respondents chose place of science as first choice. 33% of respondents chose temporary home as their first choice and only 9% chose spa/upscale hotel as their first choice.

Modern with clean lines, classic & natural elements Perceived as a place of science while having the warmth of a home.

IMAGE SURVEY RESULTS : WOOD, STONE TEXTURES/TONES

IMAGE SURVEY RESULTS : SIMPLICITY / CLEAN LINES

When the staff was shown images representing wood and stone textures/ tones, 77% of the respondents chose this vision as their first and second choice.

When the staff was shown images representing simplicity and clean lines, 42% of respondents chose this vision as their first and second choice, where 32% chose it as their last choice.

IMAGE SURVEY RESULTS : AESTHETICS Modern with clean lines, classic & natural elements Perceived as a place of science while having the warmth of a home.

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case study: NewYork-Presbyterian Hospital | PAGE 3


Renovation Considerations PATIENT EXPERIENCE

TOUCH POINTS

Although you are not likely starting with a “clean slate” as

One of the early goals of the Modernization Planning Study was

when designing a new patient tower, it is important to remain

to improve wayfinding and arrival sequence within floors five

open-minded when planning a patient floor renovation. Yes,

through nine of the Milstein Tower. Array developed a simplified

there may be budget constraints, but you need not allow the

wayfinding system featuring revitalized elevator lobbies on

existing room layout to limit opportunities to increase patient

each inpatient floor featuring dramatic and vibrant art to help

safety and satisfaction.

visitors and staff navigate each distinct patient unit. Using

Evidence indicates that patients recover more quickly when they are encouraged to restore their independence. Many older patient rooms were designed when a longer length of

amenity and touchpoint mapping to elevate the patient/family experience is an opportunity to inspire confidence and create generative spaces.

stay was the reality and there was little or no consideration to support patient mobility. Patient rooms today are designed to promote empowerment, healing and well-being. Families are encouraged to participate in patient care plans. Patient room configuration must support these goals as acuity levels rise for all specialties.

One of the most common complaints in any hospital is noise. When renovating a patient floor, consider noise reducing design elements such as heavy gauge resilient floors and other high-performance materials. A critical review of paging protocols and alarm systems will reduce alarm fatigue and auditory and sensory overload.

WELCOME • ARRIVAL

DISCOVER • NURSE STATION

PHASING Array worked closely with senior leadership to align business goals and service line priorities with a strategic approach to phasing. We utilized fluid, visual mapping tools to step NYP through a series of what-if scenarios including real-time sched-

$141.1M TOTAL BED UNIT PROJECT FUNDING EXCLUDING INFRASTRUCTURE AND IT

ule and cost data impact of phasing 16 patient units.

$154.2M TOTAL BED UNIT PROJECT FUNDING INCLUDING INFRASTRUCTURE AND IT

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Bed Unit Enhancements WELCOME LOBBY Families arriving on each floor prior to renovation were challenged to find their way without clear wayfinding cues. The new lobbies create a strong visual impact and evoke cleanliness, clarity and above all, competence.

NURSE STATION

CORRIDOR

PATIENT ROOM

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Material Selection WATCH

PATIENT UNIT FLOORING One of the most important finish choices a healthcare facility must make is the flooring types they will use. We assisted NYP with evaluations through many lenses - durability, sustainability, maintainability and appearance keeping first and life-cycle cost top of mind. Materials must stand the test of time, from both durability and aesthetic viewpoints. Array is responsible for educating our clients around the many options and maintenance needs of the cross-section of flooring available for healthcare.

Flooring Mockups: An Integral Part of Healthcare Design Watch our video to follow Array’s team as we test various flooring materials at NewYork-Presbyterian Hospital in New York City. Testing the Ease of Cleaning Frequently, a patient’s perceptions around quality are tied to cleanliness, and rightfully so. Infection control weighs heavily on our clinicians minds as well as patients’ families, so maintenance is closely tied to appearance. We not only want to camouflage, but we, in fact, want to make sure that the floors are easily cleaned by the environmental service staff.

Click here to read more on the “Story Behind Choosing Patient Unit Flooring.”

STANDARD DETAILS & MATERIAL SELECTIONS Armstrong Striations Mannington, Progressions Toli, Linoesta Nora, Noraplan Setica Johnsonite Mest Configurations Mondo, Harmoni Polyflor, Pearlazzo PUR Centiva, Contour Centiva, Event Ceres, Sequoia Halo, Stones & More Armstrong, Natural Creations ArborArt Armstrong, Natural Creations EarthCuts Mannington, Nature’s Path Teknoflor, Forestscapes

Results Fifteen different materials were tested and rated in the following categories; appearance, surface texture, camouflage level, sheen level, and safety.

Developing a universal selection of flooring type - by room type - and interior standards throughout a given unit allows easier maintenance from department to department. An interior standards package will provide a framework to inform your current spaces, define future endeavors and solve many challenges faced by patients, visitors, staff and facility managers. Implementing a Standards Package simplifies decisions on many fronts and allows for quick implementation on diverse renovation projects. Array was tasked with refreshing Interior Guidelines for NYP based upon the mock-up and testing effort.

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Mock Ups MILSTEIN BED ENHANCEMENT MOCK-UP: RESULTS Facilities, Clinical and Administrative leaders were invited to evaluate a double and single patient room mock-up. Surveys were customized with questions to be rated based on specific topics related to that group. After compiling all the evaluations, we developed a dashboard showing the results which allowed for data-driven decisions.

DOUBLE PATIENT ROOM Existing

Schematic Design

SCORING CRITERIA KEY

Milstein Bed Enhancement Mockup: Results

1

Each group rated a series of questions based on the following topics. Below represents the average score and additional comments when evaluating a single and double patient room during the mockup.

Double Patient Room

Single Patient Room

FACILITIES FEEDBACK

2

unacceptable

CLINICAL FEEDBACK

3

4

acceptable

5 excellent

ADMIN FEEDBACK

Handwashing Sink Materials

Patient Bathroom Materials

Patient Headwall Accessibility & Materials

Handwashing Sink Location & Size

Patient Bathroom Toilet Location

Patient Bathroom Sink/Shower Location

Handwashing Sink Location & Size

Patient Bathroom Toilet Location

4

4

4.25

2

3.5

3.25

3.4

4.3

4.5

Patient Wardrobe Location & Size

Overall Room Finishes & Maintainability

Patient Headwall Outlets & Wall Panels

Patient Wardrobe Location & Size

Patient Footwall Information Panel & TV Location

Patient Headwall Outlets & Wall Panels

Patient Wardrobe Location & Size

Patient Footwall Information Panel & TV Location

3.75

4.25

3.3

2.3

3.3

4.5

3.3

4.25

Handwashing Sink Materials

Patient Bathroom Materials

Patient Headwall Accessibility & Materials

Handwashing Sink Location & Size

Patient Bathroom Toilet Location

Patient Bathroom Sink/Shower Location

Handwashing Sink Location & Size

Patient Bathroom Toilet Location

Patient Bathroom Sink/Shower Location

4

3.5

4.25

2

2.25

2.75

3

3.20

3.65

Patient Wardrobe Location & Size

Overall Room Finishes & Maintainability

Patient Headwall Outlets & Wall Panels

Patient Wardrobe Location & Size

Patient Footwall Information Panel & TV Location

Patient Headwall Outlets & Wall Panels

Patient Wardrobe Location & Size

Patient Footwall Information Panel & TV Location

3.25

2.5

3.65

4

3

4

3.25

3.4

POPULAR COMMENTS

Location of handwashing sink is undesirable located behind door

Wardrobe closet should be full length Height of toilet is low

Mock-Up

Add additional whiteboard space for patient/family communication & education

Outlets are too high on headwall

Need a place for personal toiletries

Patient Bathroom Sink/Shower Location

Toilet too close to door

Finishes are durable and look great

Attractive wall panels

“We started working with Array [several] years ago. They were awarded a very challenging project, the renovation/modernization of 16 inpatient units in a 25+ year old building. What quickly became apparent was their leadership ability to drive our large and complex organization through the decision making process. They have met our aggressive schedules and are always willing to go the extra mile to get things right. Working with so many of the healthcare architectural firms, I can say what sets Array apart is their core of interior designers who understand healthcare from the patient, staff and donor’s perspective and their keen ability to translate that knowledge into timeless interior design.” - Marjorie Sobylak Former Facilities Design & Construction, NewYork-Presbyterian

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