UCHC Facility Review Project Preliminary Planning Review June 6, 2005

1. UCHC Facility Review ProjectPreliminary Planning ReviewJune 6, 2005

2. Today Next Session Confirm Ten Year Demand for Additional Beds at John Dempsey Hospital, Review Guiding Principles and Planning Trends Review Alternative Planning Models and Determine Optimal Configuration of Additional Beds, Renovations, and Capital Costs Develop Financial Forecast, Conduct Debt Capacity Analysis, and Identify Sources of Capital Determine Strategy for Securing Approvals and Financing CSC & Ballinger’s Engagement

3. Agenda Topics 1. Revisit/ Confirm Bed Planning Analysis 2. Review Planning Trends in AMCs 3. Discuss Guiding Principles for current planning

4. Planning Trends in AMCs

5. Planning Trends in Academic Medical Centers 1. Flexibility • Larger Footprints, Greater Floor to Floor heights • Horizontal/ Vertical Adjacencies for Service Lines and Similar Functions • Expansion Zones 2. Increasing Acuity • Patient Rooms • Infrastructure 3. Clinical Research Growth • Translational Research • Integration into Outpatient and Inpatient Realms 4. Family Centered Care/Self Directed Care • Ancillary Services • Wayfinding • Patient Rooms 5. Increasing Attention to Physical Environment • Daylight, Views, Nature • LEED Certification

6. International Medicine Prototype Incorporation of all trends, especially the use of Nature and views as part of public realm and wayfinding

7. International Medicine Prototype Flexible diagnostic and interventional platform-expandable in two dimensions Bed towers in separate footprints-vertically expandable Ambulatory and Allied services adjacent on separate parcels

8. International Medicine Prototype Vertical and Horizontal circulation across inpatient, outpatient and research realms (Bench to Bedside) Separation of public and physician/clinical traffic

9. International Medicine Prototype Flexible Diagnostic/ Interventional “loft-style” platform Clear separation of public wayfinding and staff circulation/interaction areas Horizontal or vertical identity for functions and Centers Multidisciplinary use of expensive diagnostic and interventional equipment Nursing cohorts for like functions

10. Patient Room Prototypes Generally all private beds Accommodate flexible acuity;visibility into room Accommodate family space within room All toilet rooms accessible for patient assists 14’ wide / 28’ structural bay minimum dimension

11. The Reading Hospital and Medical Center Patient Care Tower 368,000 BGSF, 230 beds $135 M project costs June 2005

12. The Reading Hospital and Medical Center- Emergency Room 110,000 visits/year 60,000 DGSF 24 hour access-physically isolated from other entries Dedicated imaging Separate fast-track

13. The Reading Hospital and Medical Center Cancer Center 75,000 DGSF; 105,000-150,000 visits Integrated multidisciplinary care- radiation, hematology and gynecologic oncology Prevention screenings Image Recovery Suite Clinical Research protocols Dedicated parking and drop-off ‘Healing Gardens’/courtyards

14. The Reading Hospital and Medical Center Cardiology Center 50,000 DGSF, 60-86,000 non-invasive visits, 80% out/20% inpatient; 5-7,000 invasive procedures; 40% out/ 60% inpatient Non-Invasive diagnostics and Invasive procedures for both inpatients and outpatients, each with separate access Dedicated Parking/drop-off CT/IR adjacent with shared recovery Shell space for future equipment

15. Weill Cornell Medical College York Avenue Ambulatory Care Building 325,000 DGSF Radiology, Cardiology, ENT, IVF, Clinical Research, Teaching and Patient Resource Center Center for Health Design Pebble Project Redesign of the Patient Experience/Interaction with the Institution New management concepts and technologies, systems flexibility Wayfinding Consistency of Image/Environment

16. Weill Cornell Medical College

17. Weill Cornell Medical College

18. Robert Wood Johnson University Hospital- Hamilton Bed Expansion

19. Robert Wood Johnson University Hospital- Hamilton Bed Expansion 32 Bed Unit- 25,000 DGSF Private rooms with accessible toilets at exterior wall to allow for flexible acuity 28’ structural module Decentralized Nursing stations (1:8) Patient Education and Family areas Rooms oriented to courtyards and long distance views LEED certification goal

20. Applying Planning Trends at UCHC 1. Flexibility • While primary need is for new beds, plan footprints and building locations that will accommodate conversion to other uses as technology advances and healthcare continues to evolve. • Consider horizontal and vertical integration of services and plan for expansion zones near signature services and diagnostics 2. Increasing Acuity • Provide larger, more flexible patient rooms 3. Clinical Research Growth • provide for the increasing integration of clinical research into outpatient and inpatient realms 4. Family Centered Care/Self Directed Care • Allow patients and family to easily navigate the hospital and provide space for their education, physical needs and emotional respite 5. Increasing Attention to Physical Environment • Take advantage of Views, Nature and allow building to have positive impact on the campus environment and become a visible demonstration of UCHC mission and goals

21. Specific Observations and Planning Considerations 1. Cancer Services- plan for eventual NCI status • Extensive Screening Programs • Interdisciplinary clinics for disease specific sites • Basic diagnostics (imaging, lab) within or proximate to Cancer Center • Specialized chemotherapy infusion and apheresis procedures • Bone marrow transplantation • Programmatically integrate radiation therapy • Clinical research protocols and coordinators within the center • Biological therapies • Complementary Services • Patient Education • Image Recovery

22. Observations and Planning Considerations 2. Cardiology Services- plan for improved and enlarged front end • Extensive Screening and Prevention and Patient Education Programs • Integrate Non-Invasive Programs • Allow for new diagnostic and invasive technologies to be incorporated into program • Cath Recovery and Step-down beds need to remain in close proximity 3. Radiology • Improve patient convenience and facility image/comfort • Consider decentralized services- Women’s Center, Cancer Center, Emergency Room • Allow for new technologies to be incorporated into program • Effective utilization/sharing of expensive equipment • Expand and improve Interventional Services • Streamline patient experience

23. Observations and Planning Considerations 4. Bed Planning- plan for increasing acuity and patient/family centered care • Consider larger nursing units (32 beds) • Plan for larger rooms that have the ability to flex to higher acuity • Family spaces and conveniences on unit and in patient room • Increased support areas for storage, nursing • Take advantage of views and light in wayfinding and patient rooms • Accommodate allied professionals and clinical researchers hotelling workstations on unit • Allow educational/academic functions to happen out of patient/family areas

24. Facilities Solutions – Guiding Principles • Response to Signature Services Priorities • Return on Investment • Enhance Patient Safety and Environment of Care • Economy/ Value • Infrastructural Renewal • Provide Long Term Flexibility • Enhance image and physical environment of campus • Investment must meet Signature Program space and technology requirements as major priority • Investment must yield enough incremental net income to support investment and achieve positive margin • Renovations and new construction must meet current code requirements. IT investments should move to paperless environment to promote safety. • Most of investment should be directed toward new and attractive construction • Infrastructure deficits must be addressed • Any new construction should allow for additions in the future and ability to change the use of facilities • New construction should harmonize with existing facilities and improve the overall environment

25. Guiding Principles- JDH Bed Planning • Consider Status as Acute Care General Hospital • Focus and Choices • Signature Programs • Services in Support of Signature Programs • ? Psychiatry • ? Maternity and NICU • Design for Patient Safety , Privacy and Satisfaction • Single Bedded Rooms • Reduced Noise • Design for Management Effectiveness and Efficiency

26. Guiding Principles- JDH Bed Planning • Design for Staffing Effectiveness and Efficiency • Logical mathematical division of patients for staffing purposes • Consider future workforce Availability • Consider MD FTE Requirements to Support Beds • Consider ED as Major Determinant of Bed Requirements