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Home > Issue by Date > November 2007

Streamlined Health

A new building dedicated to neuroscience at St. Joseph’s in Phoenix, AZ elevates the level of care for patients.

By Anne Vazquez

Creating efficiencies is a central part of facility management, and on a grand scale, master planning is an area where this comes into play. In the late 1990s, management at St. Joseph’s Hospital and Medical Center in Phoenix, AZ began creating a master plan for its 1.6 million square feet of space.

Founded in 1895, St. Joseph’s opened as a six-room cottage where the focus was to treat tuberculosis patients. Having undergone changes and growth over the past century, including a move from the original site in the 1940s, the hospital has evolved into a full service medical and surgical center serving the Greater Phoenix area.

In its “America’s Best Hospitals 2007” list, U.S. News & World Report ranked St. Joseph’s at 10 in the survey for neurology and neurosurgery. The hospital has been included on this list for the specialty since 2002. The Barrow Neurological Institute (Barrow), which opened in 1962 as part of St. Joseph’s, is recognized as a world-class medical center for patient care, medical education, and research.

When the hospital began considering how to modify its physical facilities for increased operational efficiencies, the management team turned to its master plan. Barrow quickly rose to the top of the list of priorities.

Nicholas Dalba, director of facilities development for St. Joseph’s, explains, “In deciding what facilities to address first, the management team assessed the entire campus and offerings. We took a look at each of our service lines and created a matrix. On the ‘X’ axis we placed our business position for a particular service, and the ‘Y’ axis represented the attractiveness of that service line. We plotted each service line using these two factors, and if a particular service line was in a high business position and high market attractiveness, that was good. If a service line rated low in both areas, that was an area we needed to reconfigure for improvement.

“Based on this system,” Dalba continues, “we decided to focus initially on neurosciences, cardiovascular services, and the women’s and children’s services. This led us to develop the neuroscience building for Barrow.”

Bringing Resources Together

Since it opened in 1962, Barrow occupied a building dedicated to its operations on the St. Joseph’s campus. As is the case for many hospitals, as more services were offered and population needs increased, some functions of Barrow had to be located in other buildings on the campus to meet the demand. The operating rooms used for neurosurgery, for instance, were situated in another building, and some patient beds were “scattered throughout other portions of the house,” as Dalba explains.

Some of the diagnostic services that support neurological care, including MRI equipment, were spread around the campus as well.

“This required patients and staff to travel a lot around the hospital,” says Dalba. “From an operational standpoint, this was important. Staffing is a critical issue, so we want to be as efficient as possible.”

In deciding upon the best course of action, St. Joseph’s worked with the Los Angeles, CA office of Perkins+Will, which had been engaged to provide architectural design services for campus master planning and programming efforts.

Russell Triplett, AIA, LEED®AP, project manager for Perkins+Will, says, “The overall goal of the master plan was to increase operational efficiency through consolidation of services with improved adjacencies to reduce travel distances and enhance staff productivity. We wanted to respond to core programs. Neurology is the first one we addressed, with other projects planned for the future.”

In planning the Barrow Neuroscience Tower, the primary goal was to bring all neurology facilities at St. Joseph’s back together while also improving services. “We wanted to consolidate all the neuroscience beds in one location,” says Dalba. “Another priority was to provide adequate and state of the art surgical facilities in this particular.”

Operating rooms dedicated to neurosurgery were important to the program, since this specialty had been sharing operating space with other types of surgery. With about 5,000 surgeries annually at Barrow, the goal was to double capacity.

In order to maximize the hospital’s resources, however, the architects placed the new neurosurgery rooms near the operating rooms in the existing building, so the recovery space could be shared.

In all, the neurology care facilities in the new Barrow Neuroscience Tower include 144 patient beds, 11 operating rooms, three MRIs, a 26 bed pre-op area, and a 44 bed post anesthesia care unit (PACU). Barrow’s rehabilitation and research centers were located in other buildings on the hospital campus.

Providing patients with attractive and comfortable surroundings was another important goal. With an eye on “family centered care,” all the patient rooms—relatively spacious at 230 square feet—are private and include a couch for overnight guests.

Perkins+Will also designed specialized spaces for visiting family and friends. Beyond typical family waiting rooms, amenities include a child’s play room complete with themed flooring and walls. Additional areas are a business center, a library, a waiting room for adults, and a meditation room. A healing garden for quiet reflection was created on the grounds just outside the building as well.

Hospital staff members also gained aesthetically pleasing lounge areas, which, with wide expanses of windows, provide views of the Phoenix skyline. “Those lounges are full of light,” notes Triplett. “It enables the nursing staff to get away for a period of time.

The Barrow Neuroscience Tower contains more than neurology services, however. The project also presented the opportunity to expand general emergency and trauma capabilities at St. Joseph’s. The emergency department was relocated to the new building and contains 44 beds and a six-bay trauma center.

Fitting In

To some degree, the site chosen for the Barrow Neuroscience Tower influenced the design of the building. The space, which had been previously occupied by a nursing school facility, is located between two driveways. With two long sides meeting at an outer point, the land lent itself to an elongated shape.

Triplett explains, “The site dictated how the addition would relate to the existing buildings as well as how the nursing floors of the new building extended. Those were drivers for the form of the building.”

As part of the larger hospital campus, the physical considerations of connecting the new building with two adjacent existing facilities was another factor. The hospital wanted to maintain the same floor to ceiling heights in the Barrow Neuroscience Tower as compared to the adjacent buildings. This set some parameters on what could be done.

“We could not make the floor to ceiling height in the new building as high as we would have liked to if it was freestanding,” says Dalba. “We didn’t want any ramps between the buildings, so we wanted all floors to be at the same level. This created a problem in that we could not fit as much as we would have liked to in each floor.”

This scenario also affected the mechanical systems in the building in that it limited how high the space from floor to floor would be. “The more space between deck to deck, the more room for HVAC ductwork and piping,” says Dalba.

But, rather than suffer the limitations, the team took the opportunity to find alternative and beneficial solutions. I. Bayron of the Los Angeles, CA office of Syska Hennessy Group was the project manager for the engineering (mechanical, electrical, and plumbing) portion of the project, and he notes some of the creative approaches taken.

“One of the changes we made to the original plan,” says Bayron, “was to increase the floor to floor height below the third level where the pre-op and PACU units [on the second level] are located. This was done so we could fit the mechanical distribution systems in the ceiling of the second floor.”

In another instance, the team altered floor to floor heights in order to accommodate both core operations and mechanical systems. The operating rooms, also located on the second floor, required 10' floor to ceiling space. As a result, space for mechanical equipment above was lost to this operating room space. Here, the third level above was not occupied by medical spaces; instead, the space above the operating rooms was used to house mechanical distribution, plumbing, and electrical systems.

A catwalk was located there to facilitate servicing for valves, terminal air units, and other equipment. This arrangement permits maintenance access to the systems without having to enter the operating rooms or supports.

“Basically, the third floor interstitial area extends over the pre-op and PACU areas,” explains Dalba. “So, the operating rooms are actually in a two-story volume, from the second to fourth floor. We have the catwalk at the third level over the operating rooms that the maintenance staff uses to access all the various systems in that space that serve the operating rooms and other functional spaces below.”

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Beyond the space limitations, the team also needed to plan for linking the systems to the St. Joseph’s central plant. “The new building is located across a driveway from the central plant,” Bayron explains. “All the utilities run under the driveway. We spent a lot of time figuring out how to get from point A to point B.”

Technology played a part in determining what alterations could be achieved in these endeavors. Triplett explains, “The general contractor, Kitchell, and its subcontractors had its draftspeople convert our design documents into 3-D drawings—in essence to study clearances of systems, because of the very limited available space. That was one of the big challenges.”

Installing and linking the new systems into the hospital’s central plant also had to be planned carefully to prevent disruption throughout the rest of the campus. “A big switch was with the chilled water system,” says Bayron. “We began at 6:00 a.m. on a Friday and finished by 6:00 a.m. the next day. There was a lot of planning and effort by the contractor and design team to make it happen without shutting down the hospital. It was well coordinated.”

Adds Dalba, “It was a big effort, but we are used to doing those types of things—if we have a valve to replace, for instance. In this type of situation, we issue ‘disruption notices’ housewide to inform everyone of what we are doing.”

Improvements Made

With operational efficiency as a central goal in the Barrow Neuroscience Tower project, the flow of patients, staff, and visitors influenced the design of some areas. An existing building, which would connect to the new building, contained four elevators, which were used by all the groups. “We wanted to segregate the patient flow from the visitor flow,” Dalba explains. “So, we included another set of four elevators in the new building geared for patients and staff members.”

Triplett adds, “And this didn’t affect just the new tower. In essence, this redefined the circulation in the existing building. The old four elevators became public elevators, and the elevators in the new building are used by staff in both buildings.”

The aim of increasing staff efficiency was also addressed with a new pneumatic tube system linking the Barrow Neuroscience Tower to relevant spaces, such as laboratory and pharmacy departments. With 6" diameters, the new pathways improved on the existing 4" wide system.

“The benefit of the wider pneumatic tube system is we can now transport larger and heavier items throughout the house,” explains Dalba. “This saves us manpower from having to transport those items manually.”

The project also gave Dalba the opportunity to improve on other aspects of St. Joseph’s facilities. He specified a fire alarm system with more capabilities than existed in the rest of the campus. “This was the first step in the evolution of our upgrading the entire fire alarm system,” he explains.

Still Growing

The top floor of the Barrow Neuroscience Tower was built as a shell with the capacity to accommodate 48 more beds at a future, undetermined time. This shelled portion was added to the plans after construction was underway, and the team was able to decide it would be feasible from a cost and operations standpoint.

“I think a lot of credit should be given to Catholic Healthcare West [owner of St. Joseph’s] for its process, which required the team to meet at every major milestone of the project,” says Bayron. “We discussed the value of adding certain elements to the project, and it involved negotiation between the entire team.

“This process kept the project going,” he continues, “and, in the end, we were able to add a floor to the building and put a helipad on the roof. That meeting process was managed very well to finish the job on budget and add the extra floor to the building.”

Going Forward

With its new facility, Barrow continues to serve neurology patients from both near and far. The more than 9,000 admissions each year benefit from the state of the art technology and surroundings created by the project team.

“I really like the ‘two sides of the coin’ with this building,” says Triplett. “There are the highly technical back of house spaces that service the softer, more comfortable spaces for the patients and the public.”

Says Dalba, “It’s not quite the difference between Kansas and Oz in The Wizard of Oz. But when you compare this building to older parts of the hospital, there is a distinct difference between the look and feel of the spaces. People often comment that they like the colors used in the new tower.”

After 45 years of providing neurological health care and education to its community and beyond, Barrow is equipped for the next half century of innovation.

This article was based on interviews with Bayron, Dalba, and Triplett (Russell.Triplett@perkinswill.com).

To share your new construction or renovation story, send an e-mail to avazquez@groupc.com. Past Showcase features can be found on the Web at TodaysFacilityManager.com.

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