Development of the New Children s Hospital, Critical Care Tower and Iowa River Landing Clinic *****

1 Development of the New Children s Hospital, Critical Care Tower and Iowa River Landing Clinic ***** Presented to President s Forum By Jean E. Robillard, M.D. Vice-President for Medical Affairs November 4, 2008

2 Background Need for New, Modernized Facilities Patient service volumes are growing in all areas and UIHC is serving an increasingly complex patient population Emerging technological advances require more floor space, greater height and more sophisticated electrical, mechanical and information technology systems Consumer expectations are continuing to rise as are requirements for safety, infection control and patient privacy private patient rooms Intermingled with adult services, facilities for children are currently located in Carver, Colloton, Pappajohn and Pomerantz Family Pavilions and need to be consolidated into a Children s Hospital that is designed to meet the specific needs of pediatric patients Corollary requirements for teaching and clinical research space are continuing to expand Buildings built in the 1970s and early 1980s have reached or will soon reach 30 years of age and need to be modernized and brought into conformance with contemporary codes and expectations Roadways to UIHC are currently crowded with large numbers of patients, visitors and staff coming to the Hospital and need to be decongested by development of an off-site clinic facility

3 Overview of Inpatient Care Project Engaged Kurt Salmon Associates (KSA) and TRG Healthcare LLC, national consulting firms to assist with planning Consultants worked with UIHC planning staff, clinical department heads and faculty, other medical leaders, UIHC, CCOM and UI Facilities and Operations administrators and many other staff to complete assessments in three areas: Strategic assessment translated the future vision into work load projections and facility requirements Operational assessment - evaluated the functionality of clinical space in comparison to contemporary standards Physical assessment - evaluated the physical condition of current facilities and the capacity and constraints related to future development Information from the assessments and other factors led to the conclusions that UIHC s future facility needs could best be met by developing a children s hospital, critical care tower and renovation of existing patient care units.

4 Key Findings: Functionality of Clinical and Other Space Existing at UIHC Contemporary Standards for large tertiary AMCs Majority of patient rooms are semi-private Large, all-private patient rooms Private rooms average 184 NSF Benchmark of 280 NSF to meet AIA standard* Operating rooms are not uniformly sized; many are small; fragmented flow. Current range < 400 NSF to 527 NSF Large, efficiently configured surgical suite; operating rooms minimum 600 NSF; clear & coherent flow Dispersed surgery, angiography, catheterization lab, endoscopy; multiple anesthesia sites No coherent ambulatory vision ; ambulatory services still in multiple locations Access from parking not always direct; difficult way finding Interventional platform with co-located procedural and related support Ambulatory services, integrated, accessible, often in single center Proximate parking, easy way finding No consistent strategy for faculty officing Dedicated physician office locations, not co-mingled in clinical areas On-stage, (public) and off-stage (service) functions intermingled On-stage, off-stage functions separate Few amenities, especially in inpatient areas Strong patient & family amenities Privacy lacking in waiting, reception, prep/recovery areas HIPAA sensitive privacy in the patient areas * Also applies to community hospitals

5 Key Findings: Facility Conditions PFP

6 Key Findings: Our location provides unique challenges Existing at UIHC State of the Art (for large tertiary AMC) 100 acres for UI Health Sciences, not all developable; ~37 acres UIHC Potential (but not immediate) opportunity to acquire adjacent parcels Hospital expansion constrained by multiple factors: building, ramps, roads, utilities, IT 120+ acres campus size for comprehensive AMC, including research labs Clear, unhindered zones for development Poor street alignment & traffic separation Congested external access routes Limited visibility of front door Easy vehicular access, clear circulation & separation of traffic types (patient, service, ambulance) Limited visibility from primary south and east roadways (Melrose, Grand) Parking adequate, but not convenient for ambulatory care (esp. Pomerantz) and stacking space is tight Strong spine in pavilions; extends to Pomerantz; less clarity in General and Boyd High visibility Adequate parking proximate to key entrances (main, amb., ED) Development along a clear circulation axis; may be 1 bldg, interconnected bldg or freestanding

7 Campus Opportunity Zones Northwest Option West Option East Option Overlap zones 1, 3 & 7 1 Center For Disabilities & Development 6 acres 2 Field House 5 acres 3 4 General Hospital/ Boyd Tower 5 acres Hospital Parking Ramp 2 3 acres 7 6 5 College of Pharmacy 3 acres 6 Dormitories 8 acres 7 Speech & Hearing and Hospital Parking Ramp 1 4.7 acres

8 UI Children s Hospital has Unique Challenges Children need different health care that focuses on their unique needs, involves their parents from start to finish and is provided in places designed to be kid-sized and child friendly We must create the sizing, shape, color, organization and feel that lessen the anxiety and stress for children and their families during hospitalization Children s services are currently spread over multiple pavilions and multiple floors Inpatient and specialty services for children must be provided in patient-centered areas We must meet the expected standard for academic medical center children s hospitals to aid in the recruitment of first class pediatric trained clinicians, house staff researchers and nurses

9 Rationale for Critical Care Tower Volume of cases going to ICU increased 16% in 2006 and another 11% in 2007 First quarter FY2008, 6 out of 8 ICU units were >80% occupancy # of admissions through ETC has increased 31% since 2005 (from 4811 to 6308 in 2007) % of those that need ICU bed has increased by 57% (627 patients coming through ETC required ICU bed in 2005; 984 required bed in 2007) Trauma cases requiring ICU increased 26% between 2006 and 2007 Increased need for ICU with growing transplant and burn programs Because we are the emergent hospital, stand-by capacity is needed

Ambulatory Care Strategies Short Term Strategy Decompress Existing Campus Long Term Strategy Patient-centeredness Build one or more facilities close to main campus for the following purposes: Reduce congestion on the main campus Create new space on the main campus Create additional or improved access points throughout the community for UIHC health care services, to include primary care Will tie to long term facilities growth plan for main campus Will include relocation of business functions currently located within Hospital Create multi-building ambulatory care campus Provide multi-specialty care with focus on preventative as well as chronic diseases May include services such as wellness, pharmacy, day care, restaurants, banking May include administrative functions such as Information Systems, Call Center, Business Office 10

UNIVERSITY OF IOWA HOSPITALS AND CLINICS FY 2006-2035 STRATEGIC FACILITIES MASTER PLAN IMPLEMENTATION ORGANIZATIONAL STRUCTURE FOR PLANNING AND CONSTRUCTING REPLACEMENT HOSPITAL ADDITIONS, IOWA RIVER LANDING CLINIC AND RENOVATING CURRENT FACILITIES FACILITIES PLANNING & CONSTRUCTION COMMITTEE Gordon D. Williams, Chair M. Artman, M.D., K. Chamberlin, R.N., E. Dickson, M.D., B. Echternacht, J. Fernandez, K. Fisher, T. Gaillard, K. Kates, J. Kurtt, R.N., R. Lehnertz, C. Miller, G. Mowery, T. Mueller, R.N., H. Nobiling, D. Ricketts, J. Robillard, M.D., J. Staley, C. Syrop, M.D., E. Tsalikian, M.D., Consultant Members M. Anderson, M.D., T. Brennan, M.D., J. Buatti, M.D., L. Carmen, J. Cayner, M. Cohen, M.D., T. Craft, L. Fajardo, M.D., J. Hata, M.D., L. Herwaldt, M.D., J. Hoballah, M.D., M. Iannettoni, M.D., C. Kupka, B. Latenser M.D., B. Luxon, M.D., S. Maharry, J. Niebyl, M.D., G. Schmidt, M.D., S. Singh, D. Thoman, M. Todd, M.D., R. Weigel, M.D., G. Weiner, M.D., A. Williamson, Ph.D., R.N., R. Williams, M.D., J. Yankowitz, M.D. VICE PRESIDENT FOR MEDICAL AFFAIRS Jean Robillard, M.D. CHIEF EXECUTIVE OFFICER, UIHC Kenneth P. Kates FINANCIAL PLANNING K. Fisher PROJECT DIRECTOR Gordon D. Williams PROJECT ADVISOR J. Staley PROJECT FACILITATOR B. Echternacht STRATEGIC PROGRAMMING C. Miller Designation of Clinical Services & Support Functions for Inclusion in Children s Hospital and Critical Care Tower; Overall Bed Capacity, Operative, Imaging & Interventional Platform Capacity; & Other Strategic Programming Matters Related to Facility Renovation Comprehensive Program Planning Consultants for Inpatient and Ambulatory Services UI CHILDREN S HOSPITAL USER GROUP M. Artman, M.D. Inpatient Nursing Services Critical Care Services Specialty Clinic Services Interventional Services CRITICAL CARE, INTERVENTIONAL & PROFESSIONAL SERVICES USER GROUP E. Dickson, M.D. Critical Care Units Burn Unit Cardiovascular ICU IPCU Medical Cardiology Unit Medical ICU Surgical ICU Interventional Radiology UIHC OPERATIONS E. Dickson, M.D. PERIOPERATIVE SERVICES USER GROUP T. Mueller, R.N. Operative Suite Prep & Recovery SUPPORT SERVICES USER GROUP T. Gaillard Engineering Services Environmental & Guest Services Food & Nutrition Services Material Services DIRECTOR OF PLANNING & CONSTRUCTION J. Fernandez Architectural & Construction Manager Selection Functional Programming Space Programming Owner Furnished Equipment UIHC Campus Signage UI CAMPUS PLANNING R. Lehnertz Overall Campus Planning & Land Use Campus Signs & Wayfinding Regents Capital Register Processes Displacements of Non-UIHC Functions City Coordination UTILITY PLANNING G. Mowery Utility Demand Utility Capacity Plan Utility Distribution Plan Emergency & Backup Energy Needs UI PARKING & TRANSPORTATION D. Ricketts Planning & Construction of Additional Parking Facilities Temporary Parking Arrangements Patient & Staff Parking Needs Roadways & Facility Access Children s Perioperative Services Women s Services Cardiovascular Laboratories Digestive Diseases Procedures Neurosciences Supplies & Equipment Procurement Services Patient Representatives Architect of Record Architectural Consultants Medical Programming Master Site Planning Teaching Hospital Design Children s Hospital Design Interior Design Engineering Consultants Construction Manager Campus Planning Consultant J. Hibbard Other Professional Services Clinical Laboratories Pharmacy Respiratory Care Rehabilitation Therapies 11

Updated Timeline Children s Hospital and Critical Care Tower 2008 2009* 2010 2013 March, 2008 Permission to proceed with project planning approved by Board of Regents Established Architectural Selection Committee May, 2008 Established Facilities Planning & Construction Committee May-July, 2008 Approved selection of architectural & CM firms May, July, Aug., Sept., Oct., Dec., 2008 Present status reports to Board of Regents Aug. - Sept., 2008 Presentations to UI Capital Projects Review & Campus Planning Committees Feb., March, May, 2009 Present status reports to Board of Regents June, 2009 Present Program Statement to Board of Regents & proceed with final design Sept., 2009 Present Project Description, Budget & Schematic Design to Board of Regents March, 2010 Receive bids for project Spring 2010 Sell Revenue Bonds May, 2010 Begin Construction Present status report to Board of Regents May, 2013 Complete Construction Sept., 2013 Occupancy Parking, Utilities and other UI Responsibilities 2008 March, 2008 Commence preliminary planning with UI staff Sept., 2008 Appoint Subcomm. on Parking, Access & Roadways *UIHC will seek determination of CON reviewability and submit CON application if indicated 2009 Feb., 2009 Subcomm. presents recommendations to Facilities Planning & Construction Committee 2010 April, 2010 Relocate Parking as needed alternate site(s) 2013 May, 2013 Complete all work on Parking, Utilities & other UI responsibilities Replacement of Facilities or Relocation of Programs Center for Disabilities and Development and possibly Wendell Johnson Speech and Hearing 2008 June, 2008 Appointed Subcomm. for planning replacement of Center for Disabilities and Development Sept., 2008 Subcomm. presents plan for relocation of Center for Disabilities and Development services 2009 2010 May, 2010 Relocation of functions to new or interim sites 2013 Off-site Ambulatory Care 2008 March, 2008 Commence site identification July, 2008 Appointed Subcomm. to develop off-site Ambulatory Care plans Aug. - Oct., 2008 Consider Coralville proposal on developing clinic at Iowa River Landing Oct., 2008 Subcomm. presents recommendations on patient experience Oct., 2008 Present proposal to Board of Regents for turnkey contract with selected development firm & partners 2009 2010 2013 Jan., 2009 Present progress report to Board of Regents March, 2009 Commence construction of initial buildings July, 2010 Developer completes construction of initial buildings Sept., 2010 UIHC moves clinical operations into new facilities TL 0003 August 2008 12

Architectural and Construction Manager Selection 13 Architectural Selection Process Completed Heery International (Iowa City office) selected as Architect of Record HKS (Dallas, TX) selected as Design Architect Stanley Beaman & Sears (Atlanta, GA) selected as Children s Hospital Architect Construction Manager Selection Completed Gilbane Building Co. (Chicago, IL) selected as Construction Manager

14 Facilities Planning and Construction Committee Key Decisions Beds 2008 2013 Projected Bed Need Moderate High Adult 534 579 599 Pediatric 171 198 215 Total 705 777 814

15 Facilities Planning and Construction Committee Key Decisions CCOM Site Options 2 1 GH RCP JCP JPP PFP

16 Facilities Planning and Construction Committee Site Selection Criteria 2 1 PFP GH RCP JCP JPP CCOM Key Decisions Patient Experience of the Future Operational Efficiency Adjacencies & Flow Option 1 Option 2 + + + + Image, Identity & Clarity of Orientation Capacity for Future Service Line Growth + + + + Financial Realities Minimize Domino Projects Deterring Priority Initiatives + + Future Flexibility +

17 Option Priorities Strategic Priorities Adjacent Adult & Pediatric Interventional Platform Best Use/Highest Cost; Highest Margin Contribution; Recruit Best Surgeons Children s Hospital Consolidation Image/Identity; Recruitment; Market Expansion; Patient/Family Experience Critical Care Bed Upgrades Best Use/Highest Cost; Safety/Quality; High Margin Contribution Single-Bedded Patient Rooms Patient Experience; Safety/Quality; Operational Efficiency BALANCED PRIORITIES

18 Massing Study 1 New Adult Hospital and Bed Tower New Entry for Adult Hospital New Childrens Hospital and Bed Tower New Entry for Childrens Hospital Existing Hospital Existing Parking 700,000 GSF 80-90k Footprint Replacement For Ramp 2 Bus Lane Hawkins Drive New Parking Ramp Stadium

19 Massing Study 1

20 Ambulatory/Outpatient Facilities Project Subcommittee for Developing Off-Site Ambulatory Care Facility Plans Ms. Kathleen Barbee, Co-Chair John Swenning, R.N., Co-Chair Paul Abramowitz, Pharm.D. Lori Christensen, M.D. Laurie Fajardo, M.D. Ms. Teddie Federici * Dan Fick, M.D. Mr. Randy Fry Mr. Jay Goodin Mr. Mark Hingtgen Ms. Diana Leventry Ms. Chris Miller Keri Semrau, R.N. Mr. John Staley Craig Syrop, M.D. Bonnie Wagner, R.N. Ms. Lauren Waitzman * Representing Patients/Customers

21 Subcommittee Activities/Tasks Completed To date, the Subcommittee for Developing Off-Site Ambulatory Care Facility Plans has completed five meetings. On August 26, two representatives from the Disney Institute met with the Subcommittee and thirty others to discuss Disney s approach to service. The Subcommittee is in the process of defining the Iowa Patient Experience for the facility. The Subcommittee is working on defining the service lines to be relocated to the Off-Site Facility. The Subcommittee has established seven workgroups to address the following: Define ideal patient experience Establish standards for patient experience Functional evaluation of clinics with workload projections Functional space program for off-site facility Staffing model Business planning Training and Research

22 Iowa River Landing I-80 1 st Ave. 9 th St. Marriot UIHC reviewing proposal from City of Coralville to develop clinic at Iowa River Landing. 7 th St.

23 Questions?