AAH Summer Leadership Conference 2008 Summary

0by Mary Beth Klatt

The annual Academy of Architecture for Health Summer Leadership conference, July 17-20, 2008, at the Drake Hotel in Chicago drew members from more than 31 states, a record-breaking attendance. The two-and-half day conference started with provocative insights of the keynote speaker, David Dranove, author of "Code Red: An Economist Explains How to Revive the Healthcare System without Destroying It."

0He talked about how to fix a broken healthcare system. He spoke about the history of modern U.S. health care. Presidential candidates John McCain and Barack Obama both have talked about fixing the tax code as one way to reduce escalating health expenditures if they're elected to office, a move which Dranove supports. The current system means the shift in outpatient care will continues, and any inpatient care will need to be flexible. "Cardiac and cancer wards are dying concepts," he says. Building design will be instrumental part of the change, with beds becoming information spokes, and nurses, information hubs.

Dranove was followed by Blair L. Sadler, past president/CEO of Rady Children's Hospital, San Diego, and current Senior Fellow, Institute for Healthcare Improvement, who says there's value in doing research- influenced design. He says hospitals face greater transparency around patient/workforce safety/quality issues. "Progressive architects can achieve measurable improvements and operating savings through evidence- based design," he says. The goal should be an error-free hospital, not a bigger hospital. "Winning architects, designers will add value by showing evidence-based design interventions which will help them succeed in the marketplace through decreased operating costs and increased satisfaction scores," he concludes.

Russell Perry, AIA, who leads Smithgroup's corporate sustainable design efforts, discussed the value in sustainable design during his talk. For starters, consider the local climate for your project. Orient the building so that it's most energy-efficient and makes the most of solar energy available. Construct green roofs to absorb storm waters. Use regional materials including certified wood. Replace Portand Cement, which contributes to greenhouse gas emissions, with fly ash/blast furnace slag. Illuminate hospital rooms, not outside streets to reduce light pollution.

0The Healthcare Design Award Winners for this year are:

• Shenzhen Third Peoples Hospital, Shenzhen, China. Near Beijing, TRO Jung/Brannen designed this suburban hospital. The primary challenge was to incorporate what the Chinese know and "what we in the West can do," the architects says.

• Peter and Paula Fasseas Cancer Clinic at University Medical Center, Tucson, Arizona. Designed by CO Architects, this state-of-the- art clinic was finished in Jan. 2007. The architects were proud of bringing the project under budget at $21.4 million.

• CHA Hospital for Women and Children, Bundang, Korea by KMD Architects. Called the "Prada of Hospitals" by Contract Magazine, this hospital was a challenge because planners wanted to introduce U.S. birthing concepts such as a LDR room, water birthing and an improved NICU which met reimbursement under the Korean health care system.

Col. Thom Kurmel, U.S. Army, Chief of Staff, Office of the Assistant Secretary of Defense for Health Affairs, addressed how members can "help us give better value" in his session on "Learning from Your Medical System." He stressed that his work is "about the building," and treating the urgent health care needs of critically wounded soldiers. His department envisions a world-class health system that supports the military mission by fostering, protecting, sustaining and restoring health. The U.S. government will spend $11 billion in the next five years to build new military hospitals, he says. Toward that end, construction has started on the new Walter Reed Military Medical Center in Bethesda, Maryland.

There was considerable discussion in an Academy Update lead by Ray Pentecost, AIA, the academy's President-elect, about Guidelines for Design and Construction of Health Care Facilities, now that AIA and FGI have parted ways. Neither ASHE nor the AIA logo will appear on the 2010 edition of Guidelines; copyright on the contents will be held by FGI.

The update was followed by a spirited discussion on the value of Integrated Project Delivery focusing on contracts. Attorney Mark Frielander favors one contract signed by all parties. "We can return the architect to master builder," he says. He contends that this can save costs, cut down on change orders, and increase overall project satisfaction. Other panelists, Jim Young, and John Pangrazio, FAIA, were skeptical. "This requires a lot of cultural transformation," says Pangrazio. "Value is whatever the client says it is," Young says. Kurmel, with the U.S. government, noted he can't sign these kinds of contracts because he's governed by congressional appropriations. "I can't afford to watch over you," he says. "It's not fair to the taxpayer." Frielander optimistically predicts integrated project delivery will eventually become popular. "The contract is not as important as the attitude of the parties," he says.

The conference ended with two tours, John H. Stroger Jr. Hospital Emergency Department and Prentice House Women's Hospital.

Open since 2002, John H. Stroger Jr. Hospital Emergency Department is considerably smaller than the 3,000-bed Cook County Hospital it replaces. In fact, the old hospital is being demolished, and only the facade is being saved for an unspecified future use. Tour host David Levine, M.D., talked about the political challenges he and his colleagues faced when the hospital was being designed. If he had to do it again, he would have pushed for a bigger overhang in the emergency vehicle area, more storage space, and wider hallways. The hospital has no major future plans - just improving wayfinding by installing plasma signs similar to those in DMV facilities.

Prentice House Women's Hospital, Chicago, hasn't even been open a year, but the 36-bed hospital has been a hit with patients, according to James Bicak, AIA, Vice President, Campus Development. "There are bigger rooms, more space for families," he says. Unlike other hospitals, Prentice officials promised that they wouldn't open the facility with untested technology. That was a challenge, and the jury's still out about whether this was an effective design approach. Bicak plans to sit down with staff later this year for their input on the new building.