Design Challenges and Solutions

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Kathryn Dean
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1 Architecture & Design Track Design Challenges and Solutions Presenters: Ryan Felton Project Director, McCarthy Building Companies Travis Cowie Associate Principal, HKS Architects, Inc. Sheri Mitchell Associate, HKS Architects, Inc.

2 Presentation Format Capital Budget Strategies for Budget Management Target Value Design Preparedness Financial Implications Financial Disaster Relief Contract Negotiations Disaster and Emergency Preparedness Definition Considerations + Strategies Case Studies INTRODUCTION

3 Learning Objectives Identify budget strategies and best practices that may be addressed in the design process. Learn strategies for drafting capital budgets that adequately address and allocate money for disaster and emergency preparedness. Explore lessons learned and best practices in designing a crisis ready facility. Review case studies recently-designed crisisready facilities Design a zombie-free facility INTRODUCTION

4 Section 1 Disaster and Emergency Capital Preparedness Budget SECTION 1 / Capital Budget Best Practices

5 Health System Capital Planning Separate structural/infrastructure project budgets from cosmetic refreshes Strategy/Growth Expansion Define annual budgets and project ranking process to vet and decide upon the array of projects, equipment Create a multidisciplinary team(s) to review projects in flight, projects about to start, and future efforts. Coordinate future planning strategies with facilities upgrades SECTION 1 / Capital Budget Best Practices

6 Defining Budget Balancing internal and external drivers Define understanding of objectives and goals Close collaboration Right sizing SECTION 1 / Capital Budget Best Practices

7 Maximizing your Budget s Impact Target Value Design/Collocation Prefabrication BIM Mock-Ups SECTION 1 / Capital Budget Best Practices

8 What is Target Value Design? Source: rg/media/docs/3-target-value- Design-LPC.pdf TVD offers designers an opportunity to engage in the design conversation concurrently with those people who will procure services and execute the design. SECTION 1 / Capital Budget Best Practices

9 DEFINITION: Target Value Design Source: onstruction.org/ media/docs/3- Target-Value- Design-LPC.pdf Rather than estimate based on a detailed design, design based on a detailed estimate. Rather than evaluate the constructibility of a design, design for what is constructible. Rather than design alone and then come together for group reviews and decisions, work together to define the issues and produce decisions then design to those decisions. Rather than narrow choices to proceed with design, carry solution sets far into the design process. Rather than work alone in separate rooms, work in pairs or a larger group face-to-face. SECTION 1 / Capital Budget Best Practices

10 Budget Adherence SECTION 1 / Capital Budget Best Practices

11 Collaborative Design Architect Transparent communication Big room meetings Weekly project leadership coordination Weekly design/user meetings No silos Architect s Consultants Users PROJECT Owner Contractor Design Assist / Sub- Contractors SECTION 1 / Capital Budget Best Practices

space in which all team members are based, as their sole place of

12 Collocation Use technology, including WedEx, to create a virtual environment for project team members to share Create a physical space in which all team members are based, as their sole place of work for the project s duration SECTION 1 / Capital Budget Best Practices

13 Smart Design Start Smart. Design Smart. Build Smart. Aligned interests Improved collaboration Improved problem solving Increased client value No silos Everyone has input SECTION 1 / Capital Budget Best Practices

14 Section 2 Disaster and Emergency Preparedness Preparedness Financial Implications SECTION 2 / Preparedness Financial Implications

15 Bridging the Gap between Budget and Preparedness Strategies to manage the cost implications of designing for preparedness Hazard value analysis Vendor contracts for disaster response Understanding cost implications SECTION 2 / Preparedness Financial Implications

16 Where does the capital or patient reimbursements come from during various types of disasters? SECTION 2 / Preparedness Financial Implications

17 Human Hazards Disaster Capital Dollar Impacts Ventilation Systems Construction processes that disrupt existing issues Water systems Waste holding Cleaning equipment/vendor contracts Security system Disaster Infectious Disease Terrorism Reimbursements [who pays?] Hospital Federal / State Civil Disturbance Hospital Mass Casualty Federal / State Active Shooter Hospital / Insurance SECTION 2 / Preparedness Financial Implications

18 Technological Hazards Disaster Capital Dollar Impacts Ventilation Systems Construction or building processes Water systems Waste systems (PWS or manual) Equipment Security systems IT Server systems Disaster Plant / Mechanical Flood (not a natural disaster) HVAC/ Sewer/ Gas Medical Vacuum Communications /IT (non-terrorism) Reimbursements [who pays?] Hospital / Insurance Hospital Hospital / Insurance Federal / State Hospital / Insurance SECTION 2 / Preparedness Financial Implications

19 Natural Hazards Disaster Capital Dollar Impacts Structural Systems Building design Equipment location Waste systems (PWS or manual) Contractor/Vendor Contracts Alert systems IT Server systems Disaster Hurricane/ Tornado Flood (a natural disaster) Epidemic (must be declared an epidemic by CDC) Earthquake Ice Storm / Blizzard Wildfire / Tidal Wave (non-terrorism) Reimbursements [who pays?] Federal / State Federal / State Federal / State Federal / State Hospital / Insurance Hospital / Insurance SECTION 2 / Preparedness Financial Implications

Natural Technological Human Hazmat Total for Facility Hazard Risk Analysis SUMMARY OF MEDICAL CENTER HAZARDS ANALYSIS Probability 0.80 0.60 0.

20 Natural Technological Human Hazmat Total for Facility Hazard Risk Analysis SUMMARY OF MEDICAL CENTER HAZARDS ANALYSIS Probability Severity Hazard Specific Relative Risk: SECTION 2 / Preparedness Financial Implications

21 Relative Threat to Facility Hazard Risk Analysis Hazard Specific Relative Risk to Medical Center Natural Technological Human Hazmat SECTION 2 / Preparedness Financial Implications

22 Balancing Budget Considerations Prevention + Preparation Recovery + Response SECTION 2 / Preparedness Financial Implications

23 Section 3 Disaster and Emergency Preparedness SECTION 3 / Disaster and Emergency Preparedness

24 Preparedness External Disaster Hurricane Tornado Flooding Fire Earthquake Zombies Internal Disaster Attack/Shooting Cyber Attack Security Breach Infectious Disease Outbreak Bomb Threats SECTION 3 / Disaster and Emergency Preparedness

25 Design and Planning Considerations Structure and infrastructure design of key systems such as the IT vaults and Central Utility Plants Back up Generators: Equipment, medical gases, and other facility items Downtime procedures for operations when all electronic systems are unavailable; stairwell locations; department stacking; etc. Disaster command rooms with adequate IT, communications and AV systems SECTION 3 / Disaster and Emergency Preparedness

26 Hospital Considerations Emergency Supply Storage [food, water, etc.] Disaster planning protocols, teams, and leadership defined Spaces for the disaster temporary tents/buildings set-up near or on the hospital property Contracts that are negotiated with vendors prior to a disaster, in order to set up expected costs, needs and responses in the event of a disaster. SECTION 3 / Disaster and Emergency Preparedness

27 Construction Considerations Hardening Components Underground Utilities Bunkered CEP Impact Resistant Materials Flood level / storm surge elevations SECTION 3 / Disaster and Emergency Preparedness

28 Disaster Prevention SECTION 3 / Disaster and Emergency Preparedness

29 Case Study: Tornado Mercy Hospital Joplin SECTION 3 / Disaster and Emergency Preparedness

30 Case Study: Earthquake Camp Pendleton SECTION 3 / Disaster and Emergency Preparedness

31 Case Study: Hurricane Southeast Georgia Health System SECTION 3 / Disaster and Emergency Preparedness

32 Case Study: Infectious Disease Staff Flow Patient Flow SECTION 3 / Disaster and Emergency Preparedness

33 Case Study: Hurricane University of Texas Medical Branch SECTION 3 / Disaster and Emergency Preparedness

34 Case Study: Internal Disaster It s hard to design a foolproof system because fools are so ingenious. SECTION 3 / Disaster and Emergency Preparedness

35 Case Study: Zombie Attack! Preparing for the unknown SECTION 3 / Disaster and Emergency Preparedness

Evaluate every potential event in each of the three categories of probability, risk, and preparedness. Add additional events as necessary.

Evaluate every potential event in each of the three categories of probability, risk, and preparedness. Add additional events as necessary. HAZARD VULNERABILITY ANALYSIS The Joint Commission defines hazard vulnerability analysis as the identification of hazards and the direct and indirect effect these hazards may have on the hospital. Hazard