Ryan OnDesign - Healthcare (2022)

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The healthcare industry is changing at an unprecedented speed. Factors such as technological advancements, changes in reimbursement models, evolving needs of patients and increased emphasis on infection prevention resulting from the COVID-19 pandemic all contribute to monumental shifts in the way we receive medical care. The physical environment in which we experience healthcare is under a lot of pressure to evolve alongside the industry itself. In this edition of Ryan OnDesign, you will find examples of world leading innovation, ways to improve patient experience through environmental graphics and considerations for how to achieve value-based care with your real estate strategy. Enjoy paging through these projects, and as always reach out with any questions!

ALENA JOHNSON

VICE PRESIDENT OF ARCHITECTURE HEALTHCARE ALENA.JOHNSON@RYANCOMPANIES.COM

ISSUE 1 A+E Update

ISSUE 2 Healthcare

ISSUE 3 Industrial

ISSUE 4 Year in Review

ISSUE 5 Senior Living

ISSUE 6 Multifamily

Ryan A+E Healthcare Projects

Service Offerings: Feasibility Studies Planning Programming Architecture Interior Design Site Design Computational Design Florida Medical Children's Minnesota Clinic PICU MOB

Jewel & Jim Designing forPlumb Healthcare Heart Center Equity -at Mercy Take 5 with Design Healthcare MacKenize - Showcase Kusler Healthcare Design

MEDIA & STORIES

3 Ways Building Design Can Improve Why Acoustics Healthcare Worker Matter Well-Being in Medical Facilities BUILDINGS Ryan Latest

COMPLETED A+E PROJECTS A+E PROJECTS IN DESIGN/CONSTRUCTION

Gillette Children's Neuroscience Suite University of St. Thomas Center for Wellbeing

16 Healthcare Architects, Designers and Interior Designers across the US.

ALENA JOHNSON

Vice President of Architecture, Healthcare

LINAEA FLODEN Director of Architecture, Southeast

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ADAM MCLANE

Associate Director of Architecture, Healthcare

AYMAN ARAFA

Director of Architecture, Technical Design Project name

MEGAN MCNALLY

Associate Director of Interior Design

RYAN DYER

Associate Director of Architecture, Design

BRENT BENUSA

TODD O’NEIL

ADAM RUHLAND

NAZ NAFEI

SHANNONHAGMANN CAROLYN WAKEHAM

ZACHARY GRECO

MACKENZIE GRIGORE KUSLER

JILL METZGER

JENNA SHAWVER AHMED TANTAWY

HANNAH PREBLE SHANNON WAKEHAM

Senior Project Architect

Senior Design Project Manager

Senior Technical Designer

Designer Architect

Project Architect

Designer

Project Interior Designer

Designer

Interior Designer Designer

Interior Interior Designer Designer

How to Achieve Value-Based Care With Your Real Estate Strategy Over the past decade, the healthcare industry in the United States has seen a shift from the traditional fee-for-service payment system to value-based care model, which incentivizes healthcare providers to focus on the quality of services rendered and patient outcomes achieved in the process. The level of investment into value-based care is substantial, although varies significantly based on regionality and market preparedness. One of the most effective ways to achieve significant value is through expanding access to ambulatory care.

While the concept of expanding ambulatory network in an attempt to drive value-based care is not new, certain organizations are executing it at an especially impressive scale.

As more healthcare organizations embark on a journey to shift to valuebased care through expanding their ambulatory network, it is important

• Invest in robust supporting infrastructure, including data, care and pharmacy management systems.

to make sure that any investment in real estate takes into consideration an inflection point at which simply more financial investment does not produce better results. Smart, thoughtful solutions based on data and strict alignment with the overall organizational strategy is key for sustainable growth.

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To learn more, contact:

ALENA JOHNSON

VICE PRESIDENT OF ARCHITECTURE - HEALTHCARE ALENA.JOHNSON@RYANCOMPANIES.COM

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While it is important to note that any real estate asset must align with the organization’s financial and operational strategies, there are a few key considerations for successful ambulatory expansion as it relates to brick and mortar:

• Strategically select locations with good visibility, convenient access points and ample parking.

• Employ thoughtful design that considers ongoing maintenance, future flexibility and standardization of spaces.

• Establish a relationship with an operating partner and/or facility management team that can provide regulatory guidance, accreditation oversight, more streamlined operations and the ability to entice physicians with creative equity partnership possibilities.

• Use data to drive telehealth/virtual health needs. Evaluating the true extent of your telehealth/virtual health needs is critical because there are many variables in a patient’s decision to use telehealth.

Navigating Complex Projects in Landlocked Spaces In 2020, Children’s Minnesota collaborated with Ryan on a four-part project to consolidate services from two campuses into a single Minneapolis location. One of the four projects included a complex remodel and installation of an iMRI system into a landlocked space on the second floor of an existing hospital, creating a new Hybrid Operating Suite. The unique iMRI system consists of a magnet that travels on a ceiling-mounted rail system between the diagnostic room and adjacent operating room, bringing the iMRI system directly to the patient and surgeon. With a moving magnet, the patient will never need to be moved for a scan allowing the surgical team to stay with the patient. This state-of-the-art technology allows surgeons the ability to evaluate the progress, help identify possible complications for earlier intervention and assist with any in-surgery decision-making needed.

Within this multifaceted project the key challenge was to identify where, within the existing facility, this new iMRI system would be located. After analysis of multiple spaces, the team redesigned two existing shell general operating rooms into a Hybrid Operating Suite. The approach was sophisticated and included collaborations with all partners and over one dozen vendors to make the footprint work. The goal was to ensure a safe environment and operational sense for the client. Within these projects, it is critical for team to:

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IDENTIFY THE RIGHT SPACE WITHIN THE LANDLOCKED FACILITY The Children’s Minnesota campus is surrounded by developed land with no room to add an expansion.

Within the tight site, the teams got creative for construction staging and prep areas as the selected space was sandwiched between an existing parking ramp, active operating rooms, below the NICU and above the Emergency Department.

MINIMIZE OPERATIONAL DISRUPTIONS With the NICU above and an Emergency Department below, the remodel was taking place between some of the most critical patients in the hospital. The team came together early in the design phase to allow everyone to discuss and select the best approach for operating in a live environment and explored any foreseeable issues or concerns that would need to be addressed prior to the start of construction.

ALLEVIATE SOUND DISTURBANCES DURING CONSTRUCTION & OPERATION An acoustical consultant joined the design team to document existing noise levels, analyze the different iMRI noise frequencies and provide recommendations to limit noise transfer to meet or exceed FGI requirements.

Positive Impact of Environmental Graphics on Patient Experience Graphics and large-scale artwork can play a major role in creating highimpact healthcare interior environments. When implementing positive distractions within spaces that aid life's most critical moments, graphics can help support storytelling, and different strategies can reinforce overall navigation and the care of intergenerational patient populations and their specific needs.

Bayfront Health Freestanding Emergency Department I St. Petersburg, Florida

Jewel & Jim Plumb Heart Center I Cedar Rapids, Iowa

Children's Minnesota Pediatric Intensive Care Unit I Minneapolis, Minnesota

At the Bayfront Health Freestanding Emergency Department and MOB, stakeholders and design team members envisioned an interior environment that visually exudes expert quality care, while incorporating local context of the area utilizing imagery of mangroves that are unique to the St. Petersburg landscape.

In this application, the team developed a color palette reminiscent of the crystal blue water and textures seen in the mangroves that protect the coastal shoreline - resulting in a story that honors the region and patients this facility serves.

At the Jewel and Jim Plumb Heart Center, nine patient care corridors within the outpatient clinic are differentiated with bold and distinctive color and letter identification to assist patients and guests to and from exam

Jewel & Jim Plumb Heart Center I Cedar Rapids, Iowa

Children's Minnesota Limited Stay Unit I Minneapolis, Minnesota

St. Peters Ambulatory Surgery Center & Clinic I St. Peters, Missouri

space. Additionally, oversized and contrasting signage in public areas further support wayfinding to important destinations and are easily viewed for those with lower visual acuity levels and catering to populations from pediatrics to those with memory loss. zane -- sites Pediatric Intensive Care Unit, a wrapping In the Children's610 Minnesota

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and their parents, theand client.illustrates a positive distraction that is bright, colorful, hopeful and provides cues to the unit's nurse station for those that may need assistance.

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MEGAN MCNALLY

ASSOCIATE DIRECTOR OF INTERIOR DESIGN MEGAN.MCNALLY@RYANCOMPANIES.COM

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CREATING CONTEXT & COHESION

SUPPORTING WAYFINDING & NAVIGATION

CATERING TO INTERGENERATIONAL CARE

The most impactful environments are ones that tell a cohesive story from exterior to interior and reflect the mission, local context and patient population served by the healthcare system. One way to achieve this is by incorporating large-scale graphics into the architectural design package, resulting in a more integrated design that is determined early, and not an afterthought when budgets are tight.

Navigation issues that patients and guests may experience within healthcare environments often diminish overall patient satisfaction, impact the perceived quality of care received and influence patients' attitudes and agitation when interacting with staff. In addition to a clear signage strategy, there are several approaches we can employ to improve wayfinding and navigation and create a sense of place within an interior environment. Incorporating bold graphics can provide memorable landmarks, and varying color to differentiate departments or patient hallways creates clear separation and provides a sense of place and can orient visitors.

Large scale imagery, especially those with biophilic elements found in nature, have a proven effect to improve patient outcomes, wellbeing and outlook.

When developing an integrated graphics package, the design team considers the patient population served.

Oftentimes, the range can be anywhere from pediatric patients to older adults with dementia, and therefore, result in careful selection of graphics that cater to a variety of patient demographics, ability and visual acuity levels, and cultural preferences.

Staying Nimble and Planning for Change Ryan recently conducted a survey of healthcare leaders in partnership with Modern Healthcare. In that survey, 23% of respondents noted “unclear future service needs” as a top barrier for creating and implementing their organization’s real estate strategy.

Medical Offices, Ambulatory Surgery Centers, Imaging, Emergency Care, Urgent Care, Rehabilitation and Inpatient Care are all medical care environments that carry different space requirements and planning ideals to best serve staff and healthcare consumers. When designing a medical space, it is often difficult to know which modality will ultimately end up occupying the space, where tenant agreements can be made in the midst of the design process or even after the ribbon-cutting. So how does our design team plan to accommodate all or most uses without over or under building? As a central question to most developer-led medical facilities, the solution lies in starting with the most accommodative building "bones" to help prevent potential costly

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redesigns or massive scope changes. Working with a team that brings experience in all forms and varying degrees of acuity in healthcare delivery allows for the creation of optionality within the design to simplify the

RYAN DYER

ASSOCIATE DIRECTOR OF DESIGN

upgrades or downgrades needed. In these situations, our team considers the following critical items:

UNIVERSAL COLUMN GRID

FLOOR-TO-FLOOR HEIGHTS

Employ an efficient, universal column grid and appropriate building proportions.

Correct spacing allows for clinic, exam, surgery and patient rooms along with office modules to fit anywhere.

Start with accommodative floor-to-floor heights that meet the needs of the most intensive potential uses.

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RYAN.DYER@RYANCOMPANIES.COM

EXTERIOR FACADE LOGIC Utilize an exterior facade logic with windows and building access points that account for a variety of complex internal layouts and possible egress needs.

Project Highlights Highland Bridge Medical Office Building, St. Paul, MN Highland Bridge Medical Office, a two-story, 60,000-SF, Class A, multi-tenant medical office building is located on the corner of Ford Parkway and Mount Curve Boulevard. M Health Fairview will occupy 26,000 SF, primarily the second floor with a pharmacy located on the first floor of the building. M Health Fairview’s clinic will provide primary care services including family, women’s and general pediatric care. Additionally, the community will have access to urgent care with extended and weekend hours. M Health Fairview Rehabilitation Services, which offers physical therapy and sports medicine, will also be part of the new space.

Gillette Children's Neuroscience Suite, Saint Paul, MN The newly renovated 6,800-SF circular, inpatient unit cares for children and teens with complex conditions and injuries affecting the neurological system. The team refreshed the space in just two months with new finishes, improved nurse stations and a more comfortable family area.

Keeping an existing under-the-sea mural and other artwork, our design team built a cohesive color palette, drawing accent colors from the mural and introducing calming, solid textures throughout the space. A new, central nurse and reception desk includes improved visibility to each of the ten patient rooms, and other updates include six larger nurse charting stations; new flooring, wall finishes and cabinets in the playroom; and a refreshed nutrition alcove for families.

Children's Minnesota Limited Stay Unit, Minneapolis, MN The renovation of the Limited Stay Unit at Children's Minnesota includes 9,000 SF of the first floor of the Children's Hospital in Minneapolis. Originally built as a Pediatric Intensive Care Unit in the 1990's, the existing space was tight and the infrastructure had to be completely remodeled with fully engineered MEP to meet to new needs of the specialty unit. The remodel includes six observation units and eight inpatient rooms for overnight stays, a family lounge and children's play area.

St. Peters Ambulatory Surgery Center, St. Peters, MO With a focus on flow and ease of access, as well as a modern and timeless design, this new facility provides orthopedic care options to patients through four different specialty areas – including an ASC, clinic, imaging center and physical therapy clinic. Centrally located in St. Peters, MO, the Ryan-owned 46,000-SF building achieves a cohesive feel between all the clinics through strategic patient, staff and material flow, connectedness between interior and exterior designs and a welcoming common space. The design features ample daylighting within the lobby, corridors and patient areas.

Harper Apartments | St. Paul, MN

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