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Feature Story - February 2007

Efficiency in Medical Care Spills over into Design and Construction

More efficient medical treatments mean design changes for health-care facilities, and that’s only the start for companies that work on hospital-related projects.

by Lucy Bodilly

Doctors advise their patients to stay lean.  Now hospital administrators are advising their contractors to do the same thing. As health-care facilities seek to cut costs through more efficient patient care, architects who design and contractors who build their facilities are being asked to do the same.

The practice is being used most stringently by Sutter Health Care in California.  Its latest hospital being planned in the Bay Area is being designed by NBBJ, Seattle and built by Skanska USA Building, Oakland.

“The team is being asked to use set base design,” says Greg Howell, a consultant on the project and executive director of the Lean Construction Institute in Denver, an international organization that promotes and studies the use of lean construction methods. The NBBJ-Skanska team is being asked to come up with a basic plan, and then as carry many elements forward as possible, dropping them out as they no longer become necessary.

For example, at the NBBJ-designed orthopedic building now under construction for Swedish Hospital in Seattle all the rooms are designed identically, instead of being mirror images of each other.  In set base design, elements of the traditional mirror image layout would be carried through the design process until the team was sure no elements could be useful. In traditional design, the architect would decide the rooms would be identical, and not carry other possibilities throughout the process.  “What ends up happening is you then have to loop back around and adjust things,” Howell said. Sellen Construction is the general contractor on the project.

The building will be seven stories above ground with four stories of below-grade parking.  The two floors set aside for medical offices will be leased to Orthopedic Physician Associates, a division of Proliance Surgeons Inc., P.S. OPA is a group of 20 private-practice orthopedic specialists whose clinical offices are currently housed in various medical-office buildings on Swedish’s First Hill and Cherry Hill campuses.

 The facility will also include the addition of 84 new inpatient beds (56 initially and 28 to be added in the future), 10 dedicated orthopedic operating rooms, a dedicated sterile-processing area, 15 flexible preoperative/recovery beds, 13 post anesthesia care beds, outpatient pharmacy, preadmission area, conference rooms and café.

 NBBJ is teamed up with Sellen and the subcontractors to use Building Image Modeling on the project, in the early phases, another boost to construction efficiency. 

As far as the design goes, efficiency starts at the front door of the facility, says Heidi Aylsworth, project director for Swedish.


Instead of being categorized by  attending physician, patients are immediately split into three groups.  The first floor handles those coming for pre-admit physicals and testing, All those coming for operations go directly to the second floor.  And anybody needing follow-up care goes to doctor’s offices in the upper levels.

“This keeps the staff at their area of expertise and means they don’t have to cross back and forth between functions,” says Alysworth. “It’s also easier to make sure all the necessary information is complied before surgery.”

On the surgical floor, patients flow through the space in one direction only, from peri-operative, to surgery, to recovery, to home or upstairs to the patient rooms,  says Kristina Ryhn, principal-in-charge for NBBJ. “This way the patients don’t see each other and it makes it easier for families to meet their loved ones. And physicians never have to leave the space.”

Another proponent of lean medical practices is Group Health Cooperative, which is now building a multi-specialty medical center in Bellevue, to provide acute and urgent care, outpatient surgery, specialty services, diagnostic imaging and primary care services.

The building is designed for outpatient services only because Group Health is moving away from overnight stays at all its facilities. In Bellevue, patients needing care for more than a day will be transferred to Overlake Hospital next door, says William Biggs, executive director of administrative services for the Seattle based HMO.

Lots of things at Group Health will be getting leaner, including the way it provides medical care, Biggs adds. “We are just starting and haven’t gotten to the point of designing a lean building from the ground up, but we are changing the way space is designed in some ways,” he says. “If the ideas work, great. If they don’t we redo it. We can no longer design things and expect that arrangement to last 20 years.” 

On the Bellevue building, one area that came under scrutiny was the doctor’s offices. “We used to allow the docs to have individually designed spaces,” Biggs says. “But this building has a flexible chassis so we can change things around to another specialty on a daily basis.”  Originally programmed to be a 200,000-sq-ft the building, the leaner design is considerably smaller.

Architect is Ellerbe Becket, in association with Northwest Architectural Company General contractor is www.mortenson.com Mortenson, Bellevue. The building will open in spring 2008. Also under construction is a new corporate headquarters in Seattle. Another outpatient clinic is being planned for Redmond, Wash.

Children’s Regional Medical Center in Seattle is also looking into using lean construction methods in its projects, says Karl Sonneberg, a partner with ZGF, a Portland architectural firm.

“We are talking with them about how it can be applied, and we all agree it can make the design and construction of a project run more smoothly,” says Sonneberg.

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