Seattle Children's Building Hope: Cancer, Critical and Emergency Care Expansion

BUILDING HOPE CANCER AND CRITICAL CARE EXPANSION SEATTLE CHILDREN’S HOSPITAL

Emergency Department lobby.

SEATTLE CHILDREN’S BUILDING HOPE: CANCER, CRITICAL AND EMERGENCY CARE EXPANSION OWNER

Seattle Children’s LOCATION

Seattle, Washington DATE COMPLETE

April 2013

ARCHITECT

CONSULTANTS

ZGF Architects LLP

STRUCTURAL | CIVIL ENGINEER

Coughlin Porter Lundeen

ELECTRICAL ENGINEER | TECHNOLOGY | SECURITY | ACOUSTIC & VIBRATION

CONTRACTOR Sellen Construction CONSTRUCTION MANAGER Seneca Group LEAN DESIGN Joan Wellman & Associates, Inc.

Affiliated Engineers MEDICAL EQUIPMENT Design Works, Inc LIGHTING Pivotal Lighting ELECTRICAL CONTRACTOR Veca MECHANICAL CONTRACTOR McKinstry GEOTECHNICAL Hart Crowser SIGNAGE & WAYFINDING Studio SC ARTWORK Amy Ruppel, Lab Partners LANDSCAPE Site Workshop CODE CONSULTANT Rolf Jensen & Associates TRAFFIC The Transpo Group HELISTOP DESIGN Airside FURNITURE Garrison Design VERTICAL TRANSPORTATION Lerch Bates MATERIAL MANAGEMENT St. Onge Company SUSTAINABILITY Solarc WIND STUDY RDWI MECHANICAL ENGINEER

PHOTOGRAPHER Benjamin Benschneider, except where noted

Sparling

SIZE 330,000 SF / 8 Stories COST BEDS

$136.32 million 80 with capacity to expand to accommodate up to 192 beds

OVERVIEW The new 330,000 SF, eight-story Building Hope: Cancer, Critical and Emergency Care Expansion at Seattle Children’s expands pediatric in-patient and emergency care in the region while preparing the Seattle, Washington hospital campus for its next generation of care on the site. Building Hope also introduces Children’s updated and modern wayfinding strategy and brand identity in its first new building on the campus. The expansion provides spaces that are physically and functionally flexible, promote a safe and healing environment, and improve flow and efficiency.

TRANSFORMING HEALTHCARE THROUGH LEAN

Building Hope houses a ground floor emergency department, an intensive care level and two cancer care units. There are 80 beds, with the capacity to expand to accommodate up to 192 beds.

Level 8 is home to the country’s first dedicated inpatient cancer care unit for teens and young adults. Landscaping and outdoor enhancements contribute to a sense of well-being and healing.

As an innovative healthcare leader, Children’s wanted an environment that would push beyond a traditional model to radically improve care delivery and patient outcomes. The design response for Building Hope combines Lean and Evidence-Based Design principles to deliver a highly efficient facility that supports caregivers, patients and families.

Seattle Children’s was one of the first medical centers in the country to apply Lean methodologies to healthcare delivery.

Children’s early adaptation of this method—which they call “Continuous Process Improvement” (CPI)—is an ongoing organization-wide philosophy and improvement approach to removing waste from systems and processes, thereby improving quality and safety to deliver the best healthcare to patients and families.

WHERE HOPE LIVES Seattle Children’s serves the largest area of any pediatric hospital in the nation. Their main Seattle campus is home to all of Children’s inpatient care. Building Hope will serve the growing need of the region, including patients from Washington, Alaska, Idaho and Montana.

Phase 4

Phase 2 Phase 4/5

Phase 1 Building Hope

Phase 3

SITE & PLANNING

As part of the Lean approach to campus planning, ZGF partnered with hospital leadership and the adjacent community to provide programming, set site development standards, and form the foundation for Seattle Children’s new 2030 Major Institution Master Plan (MIMP) and long-term Capital Projects Funding strategy. Using Lean tools for campus planning, placement of future phases was evaluated and optimized for greatest efficiency and family-centered care. The planning and organization readies the campus for Seattle Children’s long-term plan to add more than 1 million square feet to the site.

Given the sensitivity of the hospital expansion in the close-knit residential neighborhood, Children’s encouraged early community input which included an extensive public outreach program and a 24-month review and approval process required by the City of Seattle. This led to the hospital’s decision to purchase land adjacent to the Southwest quadrant of campus to meet its bed growth objectives. The expansion provides the necessary space for the continued development of inpatient and highly specialized outpatient services.

The siting of Building Hope is located on the lowest grade of the campus so that none of the new construction exceeds existing height limits, and preserves view corridors for neighbors. A large buffer of up to 75 feet of landscape, trails and even a pocket park, ensures the streetscape bordering the hospital is green and appealing. Mature plants and trees from the original site were preserved and replanted as part of the effort.

After identifying the ideal site area for expansion, the team used a Lean approach to planning and design for the Phase I expansion by engaging a diverse group of stakeholders to collectively participate in the design and programming of Building Hope.

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Building Hope is located on an existing 28.5 acre site within a residential community in Seattle’s Laurelhurst neighborhood.

Utilizing Lean 3-P principles which suggest that design efforts should focus first on process, then on how the work gets done, in order to inform layout and placement of key production elements, the design team engaged a diverse group of care teams to evaluate their current processes, identify areas of waste and improvement, work through process refinement options, and develop a procedure for successfully delivering quality care with improved outcomes and minimal waste.

Lean Planning during Phase 1 informed a design which organizes and optimizes service lines horizontally, rather than in the more traditional vertical model. Building Hope locates core services on the same level as beds to allow caregivers to flow between inpatient and outpatient environments horizontally to improve throughput, quality of care and to minimize patient and staff movement throughout the hospital while adding 80 beds, reducing support spaces by 40%, and travel distances by 20%. The process also helped the team confirm the flexibility of a universal patient room and unit design, proving that the same patient room footprint worked during code simulations for both ICU and Acute Care teams.

The design allowed the hospital to retain its existing bed tower previously slated for demolition as part of Phase 1, and other core services in their existing locations to service both current beds and those added by the Building Hope expansion, avoiding unnecessary and costly duplication and reducing initial costs by 60%.

With general placement of key elements identified, the team continued to work with an integrated team of caregivers, patients, families, and stakeholders to conceive a high performance, operationally efficient, patient-and family-centered care environment.

BEDS BEDS BEDS BEDS SURGERY, RADIOLOGY, CARDIAC, CLINIC, TESTING, LAB Traditional building stack of hospital bed unit.

BEDS

SCCA CLINIC

BEDS/ICU

SURGERY/RADIOLOGY

BEDS

TESTING, LAB

BEDS/ICU

CARDIAC

Phase I building stacking following Lean process.

TOP LEFT Master plan showing future 1 million SF build out.

LOWER LEFT PHOTOGRAHPER Andrew Buchanan

LEFT Public Emergency Department entry to Building Hope.

ABOVE The exterior colorful sunshades can be seen from public

lobby spaces and add an element of whimsy.

LEVEL 1 EMERGENCY DEPARTMENT

Building Support Caregiver Support Caregiver Work Circulation Diagnostic Imaging Family Patient Care Shell N 0' 8' 16'

32'

LEVEL 6

Building Support Caregiver Support Caregiver Work Circulation Family Patient Care

N

Levels 2-5 are shelled out for future expansion.

0' 8' 16'

32'

LEVEL 7

Building Support Caregiver Support Caregiver Work Circulation Family Patient Care

N 0' 8' 16'

32'

LEVEL 8

Building Support Caregiver Support Caregiver Work Circulation Family Patient Care Therapy Garden

N 0' 8' 16'

32'

GUIDING PRINCIPLES Patient-Centered Care Family-Centered Care Staff Comfort Flexible Space Neighborly Safety Universal Design Principles Efficiency of Care Affordability Sustainability

LEAN DESIGN Once campus organization, building siting and programming was established, attention shifted inside with a Lean-driven focus on optimizing the care environment.

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Lean design improves patient safety, quality and cost while preventing delays, improving employee satisfaction and optimizing the 7 flows of healthcare.

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Process Tactics

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More than twenty Lean design workshops were held with participants representing a broad crosssection of stakeholders, including top level hospital leadership, department heads and staff, patients and families to collectively plan and design the optimal care environment. The Lean process focused on evaluating existing processes, identifying areas of waste and improvement and working through process improvements to assure high quality care with improved outcomes. This approach is in stark contrast to a traditional programming effort where program elements including square footage, staffing needs, and adjacency requirements drive floor layout. Using Lean, individual floor, department and room layout exercises began.

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LEAN DESIGN EVENTS

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SEVEN TIMES & SEVEN WAYS = BREAKING BOUNDARIES By looking at seven ways to solve a problem, be it room configuration or unit layout, user groups were pushed to move outside of their comfort zones.

WHY DESIGN WITH LEAN? Initial nursing unit shapes were tested outdoors on top of a parking garage with plastic and wood frame walls. Once the shape was selected; full-size, 35,000 SF floor mock-ups were created in a warehouse and used to test care delivery scenarios, validate design assumptions and refine proposed solutions. Cardboard panels allowed rapid prototyping and modifications.

Prototypes of key rooms were also developed to refine configurations of case work, placement of medical equipment, support and supply locations.

LEFT Mockups created a “living laboratory” where many hypotheses to simultaneously improve work and flow were tested, proven, and ultimately improved. ABOVE Diverse groups of participants walked through various scenarios (such as code and supply delivery simulations) to experience integration of work in the unit and establish standards of work within the new building.

A project designed with Lean engages a fully integrated team­from the beginning to work in partnership through the process and make informed decisions based on what they learn from each other and their relentless commitment to continuous improvement. It is a shift in paradigm built around a culture that is collaborative and promotes innovation.

At the core, Lean is an iterative process of developing options to evaluate against desired function, cost, and quality. The team continually evaluates and tests opportunities to reduce waste, maximize value, and fix problems along the way to yield the highest quality product possible. Decisions are made slowly by consensus, considering all the options, but lead to quick implementation providing schedule and cost savings.

LEAN DESIGN OUTCOMES The Lean programming and design approach creates an environment that is physically and functionally flexible, supports a safe and healing environment and improves flow and efficiency to support caregivers, patients and families. Outcomes of the Lean process include: Universal rooms and an 8-bed neighborhood layout to accommodate fluctuations in census, staffing levels and provide flexibility across levels of acuity at a moment’s notice Medication preparation and charting in patient rooms Use of demountable furniture systems to increase flexibility, and allow reconfiguration of patient rooms and care team spaces Abundance of glass to ensure clear visibility throughout the unit Configuration moves RNs at or near bedside Narrow core supports “just-in-time” care delivery model and decreases steps for caregivers

Through simulations and testing, a “care team porch” was developed directly adjacent to patient rooms to house medical supplies, charts, equipment and medication. This concept reduces travel time for bedside nurses and improves visibility. A pass-through cabinet is designed for “just-in-time” delivery, pick-up and storage of medications, linens, isolation gear, supplies and trash while minimizing the impact on patients and families.

PATIENT ROOM NEIGHBORHOODS Each eight-bed neighborhood has access to the same central resources, including open and closed team spaces for collaboration, medications, nourishment, supplies and equipment. This creates a “simple to navigate” environment and minimizes travel distances for patients, families, staff and supplies. Universal room design provides maximum operational efficiency to accommodate a wide range of acuity levels, or a change in services. A variety of spaces also accommodate ‘rounding’ of teaching teams at bedside, in circulation nodes and in care team zones. The concept for an extremely narrow building core supports “just-in-time” delivery of supplies and improved visibility, while allowing daylight to filter across the entire unit.

The multi-function team stations provide three levels of flexibility by offering open; semi-open; and completely closed spaces to support the needs of a variety of team members working in different ways. Twenty to thirty caregivers can easily gather around the end of the unit for rounding and meetings.

Demountable furniture systems are flexible and can easily be reconfigured with little downtime.

RIGHT The design provides clear circulation pathways for patients and staff. The gently curved tile pattern softens the corridor, while the color transition acts as a visual cue at patient room entry for gowning.

EVIDENCE-BASED DESIGN Evidence-Based Design (EBD) research and principles show that integrating families into the delivery of care, providing nurturing spaces with access to daylight and views, and other supportive strategies, increases recovery rates. These principles are called evidencebased design because they are quantifiable and research-based solutions for enhancing well-being while minimizing potential sources of patient stress, medical errors and the spread of infection.

FAMILY-CENTERED CARE Children’s strong commitment to family-centered care is evident in their steadfast approach to involving families as essential members of the care team.

Building Hope provides larger single-occupant patient rooms and a variety of dedicated family spaces both inside and outside the patient room to give families options for rest and support. Parents who need space to work and siblings who need a place to get away will find a touch of home with comfortable furniture, computers and areas to store and prepare food.

LIGHTING Lighting can help create a sense of well-being and control. In Building Hope a multi-layer approach of direct and indirect pre-set dimmable fixtures mimic the body’s natural circadian rhythms. Patient-controlled, color changing LED lighting offers a sense of control, personalization and adds an element of discovery. The thoughtful approach to nighttime lighting ensures a restful sleeping environment. During the day, natural light is filtered through large windows in all patient rooms and family spaces and spills into corridors and care team cores.

NATURAL MOTIFS Connections to nature are enhanced through multiple opportunities to enjoy uninterrupted views to the outdoors and natural light. Naturalistic, regional motifs integrated into the art reference the building’s forest theme, provide positive distraction and help to clarify wayfinding, thereby reducing stress.

RESTORATIVE ENVIRONMENT A multi-layered approach is applied to acoustics and plays a major role in supporting a restorative, healing environment. All flooring in patient units is rubber to reduce noise. Fabric wrapped panels, enhanced acoustic ceiling systems and cork flooring in family spaces also help improve acoustics.

Quiet rooms on each level offer families a place to reflect or take a deep breath. Floor-to-ceiling windows let in natural light and provide restorative views to nature. Quiet rooms are free of intercom system announcements and distractions.

CELEBRATING CHILDREN’S NEW IDENTITY Building Hope is the first architectural expression of Seattle Children’s new brand identity and wayfinding system on their main campus. Four themed zones – Forest, River, Mountain and Ocean – represent Pacific Northwest geography and simplify the overall campus wayfinding strategy. In keeping with Children’s Lean practices, the new system will save countless hours by allowing doctors, nurses, staff and visitors to move more efficiently throughout all of the buildings.

Modern clean lines and pops of color build a branding story that is uniquely Seattle Children’s. The inviting interior environment characterized by layers of “integrated art” is appealing to patients, age 0 to 21.

BUILDING HOPE IS LOCATED EXCLUSIVELY IN THE “FOREST” ZONE OF CAMPUS Evoking the “Forest” concept for the building, playful patterns and art installations bring an element of cheerfulness to the space – relevant to kids, visitors and staff of all ages.

View into a Family Lounge.

EMERGENCY DEPARTMENT OPEN DESIGN The new ED, designed with input from staff and families, includes 38 exam rooms – 17 more than the former ED. Each room is spacious, enabling parents to stay close to their children while allowing medical teams the space they need to provide the best care possible in routine and emergency situations. Each “neighborhood” within the department is equipped with the necessary supplies to deliver care.

The narrow floor plan, with nursing stations located out in the open and placed strategically throughout the unit, ensures direct visual access to patient rooms.

Monuments that obscure sight lines have been kept to an absolute minimum.

WAYFINDING Color is used with purpose and meaning to support a three-tiered wayfinding system for material management; staff and clinicians; and families and patients. Color offers visual cues to make an often busy and stressful environment easier to navigate.

RIGHT Four “early initiation” rooms allow a senior level resident or nurse practitioner and a nurse to see a patient quickly. Upon arrival, a registered nurse – rather than a registration specialist – greets families and conducts a rapid visual assessment of the patient’s condition. Based on a uniform set of clinical standards, the early initiation team will decide whether to begin tests or provide pain interventions before handing off care to the primary care team. Parents involved in the design process said it was more important to initiate care as early as possible rather than wait for the primary care team to become available.

ENERGY

HABITAT

47% energy use reduction below that of similarly sized hospitals.

Green roofs are provided for 37% of the building’s roof area.

Circadian rhythm lighting – supporting EvidenceBased Design – supports well-being of staff and patients, while reducing lighting output by 40%.

More than 4,000 plants, shrubs and trees were salvaged from the construction site and replanted on the hospital’s campus.

During construction, equipment was powered by biofuels to maintain indoor and outdoor air quality.

Over 50 percent of wood content being used in Building Hope was sustainably harvested.

Radiant heating and cooling of the bridge connection.

Green roof provides habitat for urban species and its permeable pavers allow water infiltration to reduce stormwater runoff.

Excess heat from the new building – which would otherwise be wasted – will be channeled to areas in need of heat such as cooler parts of the building, domestic hot water and even potentially back to the large therapy pool in the existing hospital.

FACADE ENHANCEMENT High performance glazing results in higher solar performance. Sunshading configurations were studied and optimized to reduce peak isolation at mid-morning summer hours by 51%.

Building envelope enhanced by increasing roof and exterior wall insulation.

Wood and wood-containing products are free of toxic urea-formaldehyde binders and adhesives.

WATER Plumbing fixtures reduce water use by nearly 30% compared to similar-sized hospitals in the region.

Reduction of potable water usage with the implementation of low flow toilets, shower heads and sinks where appropriate.

Plants in rain gardens clean water from paved surfaces and provide additional habitat for birds.

RECYCLING

Rain gardens collect and treat stormwater runoff throughout the site. Rain gardens provide flood control by reduction of peak runoff rate through storage and infiltration. They also improve water quality through removal of pollutants and nutrients associated with runoff.

Over 90% of construction and demolition debris diverted from landfills through recycling and material reuse.

TRANSPORTATION

SUSTAINABILITY Seattle Children’s fosters a strong commitment to sustainability. Leadership supports the notion that a “green” hospital is the healthiest environment for staff and patients. Seattle Children’s has made a commitment to the 2030 Challenge for greenhouse gas emissions for new construction representing a 60% reduction in energy use intensity from a typical hospital with a similar program. Building Hope is tracking LEED Gold certification.

$4 million in transportation improvements around the hospital enhances safety and opportunities for biking and walking.

Emergency Department lobby.

CONTACT Leslie Morison 925 Fourth Avenue, Suite 2400 Seattle, Washington 98104 206 521 3481 leslie.morison@zgf.com WEBSITE www.zgf.com TELEPHONE EMAIL

Printed on recycled paper.

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