Making the Path of Egress the Path of Least Resistance in Healthcare Facilities
A consultant shares the lessons they learned after informing an architect that their newly designed hospital would require an ...
We began working on our first big healthcare project in 2005: the $900-million Palomar Pomerado Hospital Expansion in San Diego. The hospital leadership held a visioning session with expert speakers from technology manufacturers about what “the hospital of the future” would be like. Experts described robots roaming the corridors, voice-controlled technology replacing keyboards, and video screens delivering an immersive environment.
Of course, this vision of the future excited the project stakeholders, but as the person who had the responsibility of designing the technology infrastructure to support this fantastic future, I was left with a lot of questions about how to design for technology we hadn’t seen yet.
About a year later, our firm started working on the Lucile Packard Children’s Hospital (LPCH) Stanford Expansion, another billion-dollar project, and we saw the same scenario playing out. The project team decided to go on a tour of different manufacturer sites and see what they were working on. Very few technology companies stood out with a strong vision and a plan to deliver on it; most only looked three to six months ahead.
Hospital projects in California can take up to 10 years from the start of planning to when the facility sees its first patient. Technology changes drastically during that time, and we realized we needed a better handle on technology trends. It was then that we decided to start a Research and Development group of our own to study the trends and help advise our staff and clients on how to best address the future.
The first iPhone was released in 2007. Within a year, we saw smartphones changing the expectations of building users and opening up new possibilities for how people worked inside buildings. This led us to create a presentation around trends in technology, which focused on the importance of connectivity, the Internet of Things, and people’s experience with technology inside buildings.
In healthcare, clients started talking about smart devices like internet-connected pill bottles that could detect when you hadn’t taken your medicine and send an alert to your phone. We believed that smartphones, coupled with apps, could replace virtually any other electronic device ever made. We wondered, did we need all of this futuristic infrastructure around the patient room?
In 2008, TEECOM started work on the UCSF Mission Bay Medical Center, a $1.6-billion facility. We were better equipped by this time to talk about the future of technology in healthcare and how that was going to change everyday activities. We had seen that as the Palomar project progressed, the futuristic ideas like RFID bracelets for check-in, a multi-million-dollar video wall, and video footwalls were getting removed from the construction budget, as they were just too expensive without a guaranteed return. Instead of proposing any wild ideas, we discussed supporting and improving existing workflows with technology.
When we pursued the New Parkland Hospital, a $1.25-billion project in Dallas, the Parkland CIO was under pressure to deliver the hospital of the future. But as an experienced and pragmatic individual, he wasn’t taken in by futurism hype. Our message resonated with him, and he invited us to speak at an executive leadership panel of several hundred. It was a big moment for me, and I hardly got any sleep the night before the presentation.
Both of the presenters before me spoke about futuristic healthcare technology, much like we had heard before, which was much more exciting than what I planned to talk about. I delivered my presentation. Then, perhaps because sleep deprivation had lowered my inhibitions, I looked at the banner on the wall that said “Parkland, the hospital of the future,” and I said, “I think your banner is wrong. I think it should be the hospital for the future.”
If you try to build the hospital of the future and guess what that future is going to look like, it’s going to become the hospital of the past the moment it opens. Technology is changing constantly. You should build the hospital for the future, one with foundational flexibility that allows you to adopt new technologies without major changes to your technology infrastructure. This was the philosophy we carried forward on Parkland, UCSF Mission Bay, LPCH, and many other projects we’ve been fortunate to contribute to.
Parkland talked about “the air conditioning mistake” their first hospital made in the 1950s. They saved one or two million dollars by not putting air conditioning in their facility. After going through a summer in Dallas, they spent five or six million dollars retrofitting the building for AC and ended up with low-hanging ducts everywhere.
With Parkland, we designed the technology infrastructure to accommodate two particular advancements we saw on the horizon. One: to enable indoor location, we placed the WiFi antennas so mobile devices could triangulate off of them.
The second: with the increasing demand for cellular connectivity, and low-e glass reflecting cellular signals, we saw the need for a distributed antenna system (DAS) to repeat cellular signals deep into these massive facilities. This wasn’t common at all in 2009-2010, but we pushed for it, tying it back to the air conditioning mistake. By the time the hospital opened in 2015, DAS was commonplace.
We call one of our practices “designing for the last responsible moment.” Often in healthcare projects, equipment is selected as much as five years before it’s installed. When Laguna Honda Hospital was ready to install its security system in 2009, it required floppy disks, which couldn’t be purchased anymore, to upload program changes. Designing for the last responsible moment means estimating for budget purposes but not doing a final equipment selection and design confirmation until it’s time to procure and install.
To this day, every big healthcare project is likely to begin with futuristic visions that get everyone excited. You can adopt these in your design and likely value-engineer them out later. You can build around them and then conduct costly renovations when a new technology comes along a year or two later. Or you can build the hospital for the future, one with the foundational flexibility to evolve with technology and without costly renovations.