Category: Resources
Ballinger presents “The Big Five” Healthcare Planning + Design Strategies

Ballinger Senior Principal Louis A. Meilink, Jr., FAIA, ACHA, ACHE, and Associate Principal Erin Nunes Cooper, AIA, LEED AP were invited to speak at the spring 2019 Architecture-For-Health Lecture Series at Texas A&M University. The televised series, “Health Systems and Networks: The New Clients,” is hosted by the College of Architecture and the Health Science Center School of Public Health.

The presentation examined the “Big Five” key design decisions that enable adaptability in an ever-changing healthcare landscape. Described through case studies of recent projects, the presentation covered trends in health systems, patient-centered care and technology.

Link to video of presentation

Designing Space for Nomadic Workers

Many of today’s workers are nomads – moving from one place to another within a building or campus, or working remotely with periodic visits to the office. How can workplace design enable flexibility, and how do the solutions compare in corporate, academic and healthcare environments?

Writer Patricia Washburn covered the topic in her Tradeline Report “Designing Space for Nomadic Workers,” based on presentations by members of Ballinger’s Research + Strategy team.

“More and more, workers aren’t going to an office and sitting at the same desk Monday through Friday….These nomadic workers are often mobile by choice, taking advantage of the flexibility that technology has enabled for academic staff, knowledge workers, and even healthcare employees,” Washburn writes.

Principal Keith C.H. Mock, AIA, associate principal Christina Grimes, AIA, LEED AP BD+C, EDAC, and senior associate Katherine Ahrens, LEED AP contributed to the research. They looked across a range of work environments to illustrate the continuity of workplace strategies.

The Research + Strategy team at Ballinger builds on experience gained through diverse project types to design evidence-based, high-performing environments.  The team’s unique methodology combines a series of well-honed tools, critical thinking, and cross-market knowledge to better inform project design and outcomes.  This takes the form of detailed pre- and post-occupancy analysis and evaluations, branding and change management communications.

Link to article

The Big 5: Healthcare Planning and Design Strategies for an Adaptable Future

Ballinger Principal Louis A. Meilink, Jr., AIA, ACHA, ACHE and Associate Principal Erin Nunes Cooper, AIA, LEED AP presented “The Big 5: Healthcare Planning and Design Strategies for an Adaptable Future” at the 2018 Healthcare Design Conference in Phoenix. The presentation examined the key design decisions that enable adaptability in an ever-changing healthcare landscape. Utilizing digital audience polling, the presenters facilitated real-time information exchange among attendees about key planning decisions and perceptions. Produced by Healthcare Design magazine in association with the AIA Academy of Architecture for Health, the conference showcases research, trends and strategies in the healthcare design industry.

Link to presentation

Feel the Biophilia: Humanizing Healthcare Design

Ballinger principals Eric Swanson, AIA and Louis Meilink, AIA, ACHA, ACHE, along with landscape architect Jonathan Alderson, presented “Feel the Biophilia: Humanizing Healthcare Design” at the annual Healthcare Design Conference. Their talk explored how nature in healthcare design promotes physical, social and mental well-being, as well as tactical considerations for implementing biophilic design concepts. The presentation included case studies of Penn Medicine: Lancaster General Health, Ann B. Barshinger Cancer Institute and Tower Health’s Reading HealthPlex for Advanced Surgical and Patient Care. The conference, held this year in Phoenix, showcases research, trends and strategies in the healthcare design industry.

Link to slides

The State of Population Health in the U.S.

On display at this year’s European Healthcare Design Congress & Exhibition, Ballinger presented an infographic poster analyzing the current state of population health in the United States and a case study of the Ballinger-designed 88,000 SF green roof at Tower Health System as a solution to space limitations and strategy to improve the patient experience.

Population Health Poster

Beyond Green Poster

 

Telemedicine and the Future of Disruption

Well-trained and effective clinical staff are in high demand around the world. In the United States, primary care physicians are out-numbered 3:1 by specialists, leaving the neediest populations in remote areas without physicians to address chronic and primary care.  Staff at large institutions are increasingly asked to see patients in multiple locations across a number of campuses, stretching their time and resources.

Telemedicine presents an unprecedented opportunity to extend the reach of existing staff into rural and remote locations and prolong the careers of experienced nurses and physicians by reducing the physical demands of providing care. In their presentation to the European Healthcare Design Congress & Exhibition on June 11, “Telemedicine and the Future of Disruption”, Ballinger Principal Louis A. Meilink Jr., AIA, ACHA, ACHE and Senior Project Healthcare Planner, Christina Grimes, AIA, LEED AP BD+C, EDAC explored the increasing implementation of telehealth technologies and ways in which space planning can evolve to support these changes.

The topic was in keeping with the theme of the 4th annual conference, “Utopia or dystopia? Visioning the future for health” focused on the effects of environmental changes and technological advancement on modern healthcare systems and how institutions and designers can adjust to take advantage of advances such as AI, remote and algorithmic diagnosis, nanotechnology, and virtual reality. Held in London, this year’s event was organized by Architects for Health and SALUS Global Knowledge Exchange and hosted by the Royal College of Physicians.

Link to presentation

Ballinger presents “How Do We As The Design Community Contribute To Population Health?”

Ballinger principal Louis A. Meilink, Jr., AIA, ACHA, ACHE was invited to speak at the spring 2018 Architecture-For-Health Lecture Series at Texas A&M University. The televised series “Innovative Healthy Communities’,” invites experts to discuss the built environment’s effect on the health of communities. Louis presented ‘How Do We As The Design Community Contribute To Population Health?’ to an audience comprised of undergraduate and graduate students, as well as faculty members. His talk identified key factors that link design and population health, and illustrated them through case studies. Featured projects included Puentes de Salud in Philadelphia, and buildings at Penn Medicine Lancaster General Health, Tower Health System and Rutgers University.

Link to video of presentation

Population Health and the Quadruple Aim

Ballinger participated in this year’s PDC Summit, an international conference and exhibition on health facility planning, design and construction. Ballinger principal Louis A. Meilink, Jr., AIA, ACHA, ACHE, and senior project healthcare planners Christina Grimes, AIA, LEED AP BD+C, EDAC and Debbie Phillips, AIA, ACHA, EDAC presented “Population Health and the Quadruple Aim,” in which they explored how we as the design community contribute to population health. They illustrated the key factors that link design and population health through case studies of Puentes de Salud, Penn Medicine: Lancaster General Health Urgent Care, Reading HealthPlex for Advanced Surgical and Patient Care, and the New Jersey Institute for Food, Nutrition and Health.

A digital poll of the audience, conducted during the presentation, revealed that 69% of respondents view individuals (rather than healthcare providers or policy makers) as having the most impact on population health. The presenters issued a call to action for the design community to employ humanistic design and “the right place” to contribute to population health.

Link to presentation

Ballinger Presents at 2017 International Institute for Sustainable Labs Conference

Ballinger Principals Craig S. Spangler, AIA and Jonathan Friedan, PE, LEED AP presented at this year’s International Institute for Sustainable Labs Conference in Boston, MA. The I2SL annual conference is a technical forum focused on strategies to meet the challenges of energy efficiency and environmental sustainability in laboratories and related facilities.

Their presentation, “Share the Air: Cascading Air Strategies Using Neutral Temperature Dedicated Outdoor Air Systems” explores how cascading air strategies can be applied to the design of complex buildings to optimize energy savings from first costs to continued maintenance.

Illustrated with examples from Ballinger’s portfolio, the presentation highlighted successful design and engineering strategies to minimize energy use and reduce costs through the use of neutral temperature dedicated outdoor air systems.

 

Link to slides

HUP: Q&A with Russ Neithammer

Ballinger’s electrical engineers are celebrating the completion of a long-term project to replace the 15 kV medium-voltage power switchgear in Penn Medicine’s Hospital of the University of Pennsylvania (HUP).

The University of Pennsylvania’s School of Medicine was the nation’s first medical school and remains a renowned center of research and clinical excellence. HUP is the oldest university-owned teaching hospital in the country and sees over 72,000 patients per year. Ballinger has worked with them over the last ten years on the planning and implementation of several major electrical power projects, with the end goal of replacing the 15 kV medium voltage main service entrance switchgear for this prestigious institution.  Chief Electrical Engineer, Russ Neithammer explained Ballinger’s approach to this monumental project.

What was this project all about?

RUSS NEITHAMMER: The overall goal was to upgrade the over 70-year-old 15 kV medium voltage utility service entrance switchgear, leading to an improvement in overall reliability, simplified maintenance, and a reduction in exposure to catastrophic failure. We started with a feasibility study in which we identified a number of approaches to replacing the switchgear and to upgrading lighting, HVAC, fire sprinkler protection, and egress provisions in the hospital’s main electrical equipment vault to meet current code requirements and to be consistent with other University electrical service facilities.

What sort of options did you consider?

RN: Each approach had its pros, cons, and risks.   For switchgear replacement, we considered many options. For example, we looked at a vacuum circuit breaker retrofit into existing switchgear cubicles, installing the new switchgear in the existing location, and installing it in an adjacent transformer vault location.

How did you decide which approach to take?

RN: It was essential that there be no disruptions to hospital operations in the process of replacing the service entrance switchgear.  This meant that we had to have a design that minimized the time required for any single outage as we changed over from the old switchgear to the new, while also allowing for the option of temporarily backing out to existing conditions if we encountered problems during any of the outage work.  Continuity of operations and constructability were the key drivers that informed all major design decisions.

That sounds complex. What methods did you use to make that possible?

RN: We designed the switchgear installation with constructability in mind right from the start.  The design option that resulted in the least amount of risk to hospital operations was the one that allowed for installation and energization of the new switchgear in the adjacent transformer vault before removal of the old.  This allowed us to move loads from the existing to the new switchgear via separate, sequential outages for each of the feeders.

The initial challenge was that before we could address replacement of the main switchgear, the active 2400V transformers in the transformer vault had to be removed from service.   This meant that the entire existing 2400V distribution system (a holdover from the early 1900’s) had to be eliminated.  We accomplished that by executing two predecessor enabling projects.  First, we replaced the 2400V switchgear and transformation (to 480V) in the Dulles building portion of the HUP complex.  Our second enabling project involved the construction of a new building that houses transformation (to 480V) and distribution to the three oldest buildings of the HUP complex.  As with the replacement of the main substation, each of the enabling projects had its own constructability issues, which were addressed in a similar manner to the main substation project, i.e., install and energize the new equipment before removing the existing equipment.  Completing the enabling projects eliminated all loads on the existing 2400V transformers, thus allowing them to be removed from the transformer vault and freeing up the space we needed to completely install and energize the new switchgear and move the feeders.

With an empty transformer vault, construction work leading to installation and energization could go forward, requiring only two short utility outages to tie in and energize the new switchgear and make it ready to accept load as the feeder moves were executed.

What takeaways do you have after 10 years on this project?

RN: Overall, communication throughout the process was the key to executing the project with minimal disruption to hospital operations. The design and construction staff, operations staff, clinical staff, construction manager, design assist electrical contractor, design engineer, and PECO (the electrical utility serving HUP) were all involved throughout the entire process. Likewise, although this project had a heavy electrical focus, architecture and all of Ballinger’s engineering disciplines played significant roles.

Approaching the project with this level of communication meant that the design constructability was understood by all parties.   This understanding led to detailed outage planning for the best possible coordination with hospital operations. The result was a process with minimal design changes or surprises and a project executed on-time and well within budget.

Healthcare Facilities Management Covers Engagement Process at Tower Health System

Ballinger Senior Project Architect Robert P. Goss, Jr., AIA was interviewed for two pieces in the August issue of Healthcare Facilities Management. The article “Six steps for planning low-voltage systems” outlines a process for planning the advanced technology integration now required in hospital design.  Drawing on his experience working on the Reading Healthplex for Advanced Surgical and Patient Care, Rob describes Ballinger’s user engagement process.

The sidebar article “User input and planning informs high-tech facility” dives deeper into the Reading HealthPlex process, highlighting the 60 user group meetings Ballinger conducted as part of the planning phase. 

Read the articles here and here.

Post-Occupancy Evaluation Published for Penn Medicine Lancaster General Health’s Ann B. Barshinger Cancer Institute

Ballinger recently published a Post-Occupancy Evaluation (POE) of the Ann B. Barshinger Cancer Institute at Penn Medicine’s Lancaster General Health. Ballinger conducts POE’s to assess and monitor how buildings are being used. This data informs how future designs can best foster healing and optimize the healthcare experience for patients, families, and caregivers. The research team was led by Ballinger Principal, Louis A. Meilink, Jr., AIA, ACHA, ACHE; Senior Associate, Amy Floresta, AIA, LEED AP; and Healthcare Planner, Christina Grimes, AIA, LEED AP BD+C, EDAC.

The objective of the POE was to understand which planning and design intentions have been most successfully realized, where user adaptations have been made, and the reasons for change. The team began by gathering both qualitative and quantitative data through an on-line survey to patients and staff, on-site interviews with staff, and on-site observation. These varied collection points allowed the evaluation team to triangulate issues that permeate all groups. The data was then evaluated using three categories: the overall building design and the perception of its spaces, how shifts in operations and procedure have affected staff culture, and patient experience.

The results suggest that the design was successful in fulfilling Lancaster General Health’s vision of providing an extraordinary experience every time. The iconic and integrated nature of the building has increased the hospital’s ability to attract and retain talented physicians and caregivers. Patients reported spending a significant amount of time utilizing the building amenities, which can be attributed, in part, to the presence of nature throughout these areas. The clinical layout was designed to provide a quiet and calming atmosphere. By separating the “on-stage” clinical environment from “off-stage” staff circulation, noise, traffic, and disruption were reduced. Decentralization supply stations reduced walking distances for staff and increased their time with patients. Overall, respondents found these planning strategies effective in improving the healthcare experience.

View the post-occupancy evaluation

Ballinger Engineering for Johns Hopkins University Undergraduate Teaching Laboratories Featured in ASHRAE Journal

The July 2017 edition of the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Journal, features an article written by Ballinger Associate Principal, Brad Crowley, PE, LEED AP about the Undergraduate Teaching Laboratories at Johns Hopkins University (JHU). The article, entitled “University Lab Model for Energy Efficiency”, highlights Ballinger’s design for this interdisciplinary research building which recently won first place from the 35th annual ASHRAE Technology Awards in the category of New Educational Facility.

The article explains that Ballinger engineers faced an enormous challenge in designing a sustainable laboratory environment, and especially one that can quickly convert from a wet to dry lab, such as was required for this 105,000 SF teaching and research building addition. The resulting Undergraduate Teaching Labs met the University’s sustainability goals, achieved a 50% reduction in energy consumption over LEED baseline, and earned LEED Platinum certification. The engineering team designed the building to maximize laboratory safety, indoor environmental quality, and energy efficiency, all while complementing and enhancing the architectural design of the renovation. Energy-efficient measures such as enthalpy and sensible energy recovery wheels, chilled-beams, roof insulation, high performance fume hoods, and a neutral air displacement system harmonize with Ballinger’s design and facilitate active learning for students of biology, chemistry, neuroscience and biophysics at the University.

Read the article

Post-Occupancy Research Exhibited at European Healthcare Design Congress and SALUS Global Knowledge Exchange

As part of Ballinger’s commitment to designing facilities that optimize the healthcare experience for patients, families, and staff, our teams conduct post-occupancy evaluations (POE) on completed projects to assess and monitor how they are used. Particularly illuminating was a recent POE conducted on the new Lasko Tower at Penn Medicine Chester County Hospital (PMCCH).

The research team, led by Ballinger Principal Louis Meilink, Jr., AIA, ACHA, ACHE and Senior Project Healthcare Planner Christina Grimes, AIA, LEED AP BD+C, EDAC, assessed how effective the inclusion of decentralized caregiver stations are toward improving staff and patient experience in the medical/surgical inpatient environment. By comparing four new floors of the tower, each with a unique layout featuring decentralized caregiver stations, to the hospital’s existing units which previously accommodated the same patient populations and were built with a single caregiver station, they were able to control for patient populations and consistent staff. The result was a study focused solely ¬on the physical environment.

The POE findings were strongly indicative of the benefits of decentralized caregiver stations. Patient and staff overall satisfaction scores increased by 113% in the new Lasko Tower units as compared to the pre-existing hospital units featuring central nursing cores. Sixty-six percent of staff felt that decentralized stations improved their ability to deliver quality patient care, and ninety-one percent of patients said that the stations improved the way they felt cared for in the new building. The decentralized stations resulted in reduced walking distances and increased patient time for staff, as well as improved fall rates and noise levels for patients. These results suggest an improved patient care environment.

The study was displayed at the 2017 European Healthcare Design Congress held at the Royal College of Physicians in London, UK, and published by SALUS Global Knowledge Exchange, a global media, publishing and research organization whose mission is improving human and planetary health.

Link to Poster

 

Post-Occupancy Evaluation White Paper Published by the American College of Healthcare Architects

A white paper by Ballinger principal Louis Meilink, Jr., AIA, ACHA, ACHE and Senior Healthcare Planner Debbie Phillips, AIA, ACHA, EDAC was published by the American College of Healthcare Architects and appeared in the Summer 2017 ACHA Quarterly Newsletter.

The Ballinger team conducted a post-occupancy evaluation at Penn Medicine Chester County Hospital (PMCCH) comparing the recently completed Lasko Tower, designed by Ballinger, to a unit in the neighboring West Building.

Since the move from West Building to Lasko Tower, the hospital has seen significant improvements in HCAHPS and staff satisfaction. The results from this study informed Ballinger’s design for PMCCH’s next bed tower, currently under construction.

Link to white paper

Post-Occupancy Evaluation Published for Penn Medicine Chester County Hospital’s Lasko Tower

As part of Ballinger’s commitment to designing facilities that optimize the healthcare experience for patients, families and staff, our teams conduct post-occupancy evaluations (POE) on completed projects to assess and monitor how the buildings are being used. Ballinger recently published a POE on their design for the Lasko Tower at Penn Medicine Chester County Hospital, completed in 2015. The research team, led by Ballinger Principal Louis A. Meilink, Jr., AIA, ACHA, ACHE and healthcare planners Christina Grimes, AIA, LEED AP BD+C, EDAC and Debbie Phillips, AIA, ACHA, EDAC, assessed which planning and design interventions were most successful and what effect the unit design had on staff and patients.

Although the primary goal was to gather insights for an additional bed tower (currently under construction), it also offered an opportunity to compare patient satisfaction and operational performance against an existing 20-bed unit, the West Building (built in 1962 and renovated in 1998). Significant differences between the West unit and the Lasko Tower unit include a larger floor area with a racetrack organization of patient beds rather than a single-corridor layout, the inclusion of decentralized care stations between every two patient rooms, and more locations for staff charting.

The analysis assessed patient satisfaction with rooms and amenities, staff operations relative to charting and patient care, and housekeeping operations relative to material selection and ongoing maintenance. Because both of the units studied have private patient rooms, the evaluation enabled direct comparison between fall rates, HCAHPS scores (noise and cleanliness), and rates of hospital acquired infections (HAI). The study included a proximity index charting the travel distances between staff care stations, patient rooms and supplies, and assigned a cost/benefit metric to key design considerations.

The POE results suggest Lasko Tower is an improved patient care environment, and since moving in, the hospital has noted significant improvements in all categories. The insights gained through this study directly informed planning of the 96-room patient bed tower currently under construction.

View the post-occupancy evaluation

Clean Flow: Fact or Fiction?

At a recent webinar hosted by The Center for Health Design, Ballinger Principal Louis Meilink, Jr., AIA, ACHA, ACHE and Director of Healthcare Planning Dwight Smith, AIA, NCARB, EDAC explored what is fact and what is fiction when it comes to clean flow.

As procedures become less invasive and expand to other modalities, differentiating cleanliness protocols have expanded to other disciplines, but in the process, grayed the understanding of what is best practice. The webinar presentation served as a reminder that maximizing clean flow processes has a direct impact on patient safety and the bottom line, and that its success is only as good as its weakest link.

Ballinger’s recommendation for approaching construction projects is to establish a multidisciplinary team to:

  • Focus on opportunities to control airflow and turbulence
  • Establish instrument movement to always flow from dirty to clean
  • Stock equipment and supplies properly (location and quantity) to reduce staff movement and need for IMU
  • Use proper room zoning to protect the sterile environment
  • Remove unessential staff from the operating room

Link to Presentation

Using VR Visualization to Help Clients Envision a New Space

Over the past year, Ballinger has utilized 360° immersive experiences to provide our clients with a level of engagement and interaction that was not possible with traditional presentation techniques.

During the design of a recent project for Penn Medicine, Ballinger utilized Enscape3D – a plugin for Revit and Sketchup – to create high-quality 360° panoramic views. The technology let the nursing staff experience various waiting area options years before construction was scheduled to begin. These interactive views allowed them to virtually ‘sit’ at the check-in desks – via web browsers and mobile devices – and rest assured that the design enables clear lines of sight between themselves, their patients and the landscape outside.

The Universal Prep/Recovery: A New Paradigm or Smoke and Mirrors?

Ballinger’s Director of Healthcare Planning, Dwight Smith, AIA, NCARB, EDAC, and Senior Healthcare Planner Richard Lawless, AIA, LEED AP, EDAC presented a talk at the 2017 PDC Summit in Orlando, an annual international conference on health facility planning, design and construction.

Their presentation, “The Universal Prep/Recovery: A New Paradigm or Smoke and Mirrors?” explored the benefits and limitations of a universal room design. Building a universal room can impact construction, it can affect the clinical care model – primarily in the areas of patient safety and efficiency of the workplace environment – and it can improve consumer satisfaction.

Illustrated with examples from Ballinger’s portfolio, the presentation highlighted the benefits of multi-functional standardized spaces, such as a universal prep recovery room, to provide adaptability and flexibility for the future.

Link to Presentation

The Whole Box: Beyond Pre-Fabrication

For decades architects, engineers and contractors have speculated about how the healthcare building process can be improved. Pre-fabrication offers dramatic opportunities for construction process improvement and quality control. What are the right applications for pre-fabrication in healthcare and what factors should be considered at the start of design?

Ballinger Principals Louis Meilink, Jr., AIA, ACHA, ACHE and Barry Finkelstein, PE and Healthcare Planner Christina Grimes, AIA, LEED AP BD+C, EDAC, along with Richard Lanzarone, a Project Executive at Turner Construction Co., explored these questions at the 2017 PDC Summit in Orlando, an annual international conference on health facility planning, design and construction. Their presentation “The Whole Box: Beyond Pre-Fabrication,” illustrated the spectrum of pre-fabrication possibilities, from components to structural modules, and outlined a process to help clients determine if a project, or part of a project, is right for pre-fabrication.

Link to Presentation

Quadruple Aim and the Importance of Place

MCDQuadruple Aim and the Importance of Place, an article by Ballinger’s Louis Meilink, Jr., AIA, ACHA, ACHE and Christina Grimes, AIA, LEED AP BD+C, EDAC, was published in the March/April 2017 issue of Medical Construction and Design Magazine. The article suggests that health networks and architects must act together to put forth a diversity of healthcare facility solutions, thereby delivering the right care, at the right time, with the right price, in the right place.

Read the full article.

Reading HealthPlex: Q&A with Senior Electrical Engineer Ben Medich

In January 2017, construction was completed on Tower Health System’s new Reading HealthPlex for Advanced Surgical + Patient Care. At first glance, the Ballinger-designed 465,000 SF facility is notable for its 88,000 SF green roof, which serves to visually minimize the massive 115,000 SF operating platform footprint and provide patients with an environment that promotes healing. Equally important to patient experience, however, are the advanced systems employed by Ballinger’s engineers to ensure that the hospital is able to provide seamless care under any circumstances. We sat down with Ballinger Engineer on the project, Ben Medich, PE to learn about how the engineering team approached the unique challenges of this project:

What factors need to be considered when designing a power system for a hospital as large as the Reading HealthPlex?

BM: It’s crucial for all hospitals to have reliable power supplies in case of power outage. At Reading HealthPlex, everything from the technologically advanced machines in the surgical suites to the lights in the patient rooms are critically important to patient care. We drew from our previous hospital experience and also considered reliability strategies employed in data centers when designing this power platform.

What sort of solutions did you come up with?

BM: Our system employs fully-redundant UPS (Uninterruptable Power Supply) systems. Each UPS has N+1 flywheels for energy storage to back-up all of the lighting and receptacle power in the building and ensure no disruption to the medical equipment or patient care during a power outage. The systems are employed in conjunction with the paralleled backup-generators to provide both short-time ride-through of transients and intermediate-term power backup.

So what would happen if there was a power outage?

BM: Our design allows for 96-hours of on-site fuel storage for the generators. The system will function without interruption to the power of emergency and life-support systems. Even if the UPS units were not online, the power system would still meet The Joint Commission’s requirements for back-up power to critical and life safety systems within 10 seconds of power loss. This allows us to design the system without requiring the UPS units to have a UL 1008 listing, which is not available in large sizes.

In the event of a natural or man-made disaster that could impact the power supply, the hospital can continue to fulfill its commitment to emergency preparedness and patient safety.

The Pennovation Center: Q&A with Chief Structural Engineer Angela Fante

The 62,000 SF Pennovation Center is an incubator space developed by the University of Pennsylvania to foster tech start-ups.  Ballinger engineers worked hand-in-hand with design architect HWKN and architect-of-record KSS Architects to transform a former DuPont paint testing facility into a flexible laboratory and co-working office space.  Building operations and tenant occupancy started in Fall 2016 with positive reviews from the design and engineering community and the building’s occupants.

We caught up with Ballinger’s Chief Structural Engineer, Angela Fante, PE, SECB, LEED AP.

One of the building’s most striking features is the dramatic faceted glass outcrop.  Can you tell us about what went in to engineering that?

ANGELA FANTE:  Through collaboration with the architect and University, we were able to meet an incredibly complex structural challenge with an elegant solution. The addition of the north elevation ‘faceted façade’ had an immensely complex effect on the existing building frame.

It is not structured with cantilevers, a misnomer many are giving the north extension’s structure.

Pennovation exterior photo

If not a cantilever, what is it?

AF:  Because the architectural design required maintaining the same horizontal banding depth across the existing to new addition interface, there wasn’t enough depth to accommodate the structure needed to cantilever the addition.  Instead, we broke the north elevation into seven individual existing column frame elevations. From there, we designed new diagonal ‘column props’ and horizontal floor strut/tie beams, which impose either a horizontal tension or compression on the existing frame, at different levels throughout the geometry of the façade.

The effect on the frame was a series of ‘pushes and pulls’ on the existing building structure, none of which it was originally designed for when it was constructed in 1954.  (In that era, engineers barely considered wind and earthquake loading).

3D view of “pitch bleacher” structure

 How are those “pushes and pulls” supported by the existing building frame?

AF:  Although the appearance of the geometry of the addition looks complex, the interface between the new and existing building boils down to 28 unique connection points (seven existing grid lines x four floor levels), each custom-detailed to develop and complete the load path from the new to the existing frame.  Once the tension or compression at each of the 28 nodes transfers to the existing north column line, the ‘dots’ of the load path are connected back through the structure down to the foundation.  New horizontal bracing in the plane of the floors was inserted within the existing building where required to transfer the horizontal force through the respective floor levels and then into the three vertical braced frame lines.  The vertical braced frames are strategically hidden within the exterior walls or exposed to view in the co-working areas, as part of the raw, industrial aesthetic.

At the base of the braced frames, the accumulated collection of these load terminates  in two-foot thick x 22’-long x full basement story height walls, ballasting the new structure against uplift and preventing the structure from lifting out of the ground.

It was like designing for the weight of 50 elephants pulling on the north face of the building.

Evaluating the Benefits of Decentralized Stations Beyond Patient Visibility

Ballinger recently conducted a post-occupancy evaluation to assess how effective the inclusion of decentralized caregiver stations are toward improving staff and patient experience in the medical/surgical inpatient environment.

The research team focused on the Ballinger-designed Lasko Tower at Penn Medicine Chester County Hospital that was completed in 2015 and utilized data and survey results to compare the new floors, each featuring decentralized caregiver stations to existing units which previously accommodated the same patient populations and were built with a single caregiver station and no decentralized stations.  By controlling for patient populations and consistent staff, the study focused on the physical environment. Its results support a strong case for the use of decentralized stations with benefits extending beyond patient visibility.

This research was published by the AIA AAH Academy Journal in an article written by Ballinger principal Louis A. Meilink, Jr. AIA, ACHA, ACHE and senior associate Christina Grimes, AIA, LEED BD+C, EDAC entitled “The decentralized station: More than just patient visibility”.

Link to Article

The Evolving Quadruple Aim: Improving Public Health and the Importance of Place

In 2007 the Institute for Healthcare Improvement (IHI) developed the Triple Aim framework, an approach to optimizing health system performance. The idea was to simultaneously improve the patient care experience, improve the health of a population, and reduce per capita healthcare costs. Ballinger principal Louis Meilink, Jr., AIA, ACHA, ACHE paraphrases the goals of the framework as “delivering the right care for the right price at the right time.”

Given the impact of the Affordable Care Act and current trends in population health, today’s healthcare institutions and planners must also consider a fourth aim: the right place. The Evolving Quadruple Aim builds on the IHI framework to include the importance of place. By considering the location, scale and services provided within a facility, healthcare planners can optimize operations and improve population health.

Ballinger is studying the spectrum of healthcare from homecare and telehealth to academic medical centers. By understanding and balancing the benefits of on-demand access, tertiary and quaternary care, spaces for community use and other factors, Ballinger is studying and advocating for improved population health through the design of health facilities.

Louis Meilink and Senior Healthcare Planner Debbie Phillips, AIA, ACHA, EDAC, were invited to speak at the Fall 2016 Architecture-For-Health Lecture Series at Texas A&M University. The series, “The Global Impact of the Concept of Population Health on the Design of Health Networks and Health Facilities,” invites experienced public health and design professionals, who have programmed and designed healthcare facilities, to present on relevant themes. Louis and Debbie presented “Research-based Design: Fundamental to Architectural Excellence While Advancing Population Health” and answered questions from students, faculty members, design professionals and an international delegation. The presentation coincided with the annual meeting of the Texas A&M Center for Health Systems and Design’s Health Industry Advisory Council (HIAC).

Link to presentation

The Emerging Open Scientific Environment

Ballinger Principals Jeffrey S. French, FAIA and Craig S. Spangler, AIA participated in Tradeline’s College and University Science and Engineering Facilities 2016 Conference. Their presentation “The Emerging Open Scientific Environment: Challenges, Solutions, and Lessons Learned” examined Ballinger’s recent and ongoing science and engineering projects at Swarthmore College, the University of Wisconsin, the George Washington University, and Rutgers University.

Facility Solutions for the New Medical Education Models and the ‘Renovate, Repurpose or Build’ Decision

Ballinger Principal Todd Drake, AIA, LEED AP presented a talk at Tradeline’s 2016 Facility Strategies for Academic Medicine and the Health Sciences conference. Todd was joined by the University of Michigan Medical School’s Rajesh S. Mangrulkar, MD, Associate Dean for Medical Student Education and Bradley R. Densen, MPH, Director of Office of Medical Student Education, as well as Joseph C Fantone III, MD, Senior Associate Dean for Educational Affairs at the University of Florida College of Medicine.

The presentation, titled “Facility Solutions for the New Medical Education Models and the ‘Renovate, Repurpose or Build’ Decision,” examined different approaches to facility modernization. Ballinger designed the renovation of the Taubman Health Sciences Library at the University of Michigan and the Harrell Medical Education Building at the University of Florida. These case studies illustrate the decision factors and planning implications of choosing to renovate, repurpose or build medical education facilities.

Link to presentation

 

Tradeline: Hospital Expansion Inspires Workplace Redesign and Cultural Change

Tradeline published a report “Hospital Expansion Inspires Workplace Redesign and Cultural Change,” based on a talk by Douglas E. Carney, Senior Vice President of Facilities, Real Estate and Capital Programs for The Children’s Hospital of Philadelphia (CHOP), and Ballinger’s Keith C.H. Mock, AIA and Katherine Ahrens, LEED AP. It describes the rigorous, research-based approach Ballinger employed, in partnership with CHOP, to redesign CHOP’s workspaces. The “Test of Change” informed the design of CHOP’s Schuylkill Avenue Phase 1, currently under construction.

Link to Article

 

Tradeline Report: Retrofit or Renovate?

Tradeline has published a report entitled “Penn Renovation Yields Class A Laboratory Space for Half the Cost of New Construction: Weighing the Cost/Benefit of Retrofit vs. Gut Renovation.”

The article was inspired by a Tradeline conference talk delivered by Ballinger’s Jonathan Friedan, PE, LEED AP, and Eric Swanson, AIA, along with Perelman School of Medicine’s Eric Weckel, AIA, Executive Director for Space Planning and Operations. It presents the strategy, phased approach, and cost-saving steps behind the major renovation of Stemmler Hall, a 1970s research, classroom and administrative building in the heart of the University of Pennsylvania campus.

Ballinger’s Jonathan Friedan is quoted: “When you just do system replacements, you can get good, but not optimal, energy reductions. But you also get people complaining, ‘We spent millions of dollars, and what did we get?’ They’re still in aged compartmentalized labs, and wishing instead that they were in the brand-new lab down the street. We didn’t want to retrofit Stemmler Hall’s systems without doing something transformative to the building.”

Link to Article

Ballinger’s design approach to interdisciplinary buildings featured in Tradeline Report

Can architecture create a culture of collaboration? Tradeline’s recent article “Transforming Organizational Culture through Building Design” explores the goals and challenges faced by Dr. Peter Gillies, Founding Director of the New Jersey Institute for Food, Nutrition and Health (IFNH) at Rutgers University, as he launched the Institute and imagined an open environment that would foster such a culture.

Ballinger’s approach to interdisciplinary facility design fosters cross-discipline collaborations and emergent outcomes. Our design for the New Jersey Institute for Food, Nutrition and Health, opened in July 2015, reflects the ambitious goal of the barrier-breaking Institute: connect a wide range of disciplines to solve the childhood obesity epidemic. Co-located within the building are a student health clinic, a human performance lab, a nutrition research center, a healthy eating courtyard and a pre-school, as well as wet and dry labs, workspaces and outreach meeting spaces. An open stair integrates the building vertically and features New Jersey’s largest indoor living wall.

The article, based on a conference talk given by Ballinger principals Jeffrey S. French, FAIA and Craig S. Spangler, AIA, along with Dr. Gillies, also examines convergent environments at the University of Wisconsin and George Washington University, whose characteristics of transparency and visual access informed some of the IFNH design strategies.

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Ballinger Presents at PDC Summit 2016

At the PDC Summit 2016 in San Diego, CA, Ballinger’s Principal Louis A. Meilink, Jr., along with healthcare planners’ Christina Grimes & Debbie Phillips, and Chester County Hospital’s Director of Medical Services Cathy Weidman presented a Post Occupancy Evaluation (POE) of Penn Medicine Chester County Hospital’s new 24-bed Lasko Tower.  Although the primary goal was to gather insights for another bed tower in design, it also offered an opportunity to compare patient satisfaction and operational performance against an existing 20 bed unit, the West Building (built in 1962 and renovated in 1998).

The most significant changes between the existing unit and the new unit included a much larger floor area and a racetrack organization of patient beds rather than a single corridor.  In addition, the new Lasko Tower’s design includes decentralized care stations between every 2 patient rooms and more locations for staff charting.  The analysis reviewed multiple items including:

  • Patient satisfaction with the new room and other amenities,
  • Staff operations relative to charting and patient care, and
  • Housekeeping operations relative to material selection and ongoing maintenance.

Because both units had private patient rooms, there was a more direct comparison between fall rates, HCAHPS scores (noise & cleanliness), and rates of hospital acquired infections (HAI).  Since the move, the hospital has seen significant improvements in all categories.

The study assigned a cost/benefit metric to key design considerations including private rooms, decentralized care stations, supply locations, and family amenities.  The study also included a Proximity Index charting the travel distances between staff care stations, patient rooms and supplies.  Insights gained will directly inform plans for the future 96-room patient bed tower design scheduled to be built in 2018.

Data collection method: 117 staff and 50 patient survey responses, onsite observation and onsite interviews with staff (December 2015).

Link to Presentation

The Ballinger presentation at the PDC Summit 2016 utilized live polling software to gauge the audience’s perspectives on several healthcare design topics.  When asked the question “Which intervention had the Highest Impact for the Least Cost?” the audience made up of architects /engineers and healthcare staff responded:  70% Decentralized Station; 18% Noise Reducing Measures; 9% Décor + Material; 3% Size of the Patient Room.

Link to Video of Polling

The Wistar Institute Featured in Modern Steel Construction

Modern Steel Construction, published by the American Institute of Steel Construction, features the Wistar Institute’s Robert and Penny Fox Tower on its cover. Associate Principal Edward J. Zinski wrote an article for the December issue describing Ballinger’s unique solutions for this complex urban project.

The Robert and Penny Fox Tower satisfies the Institute’s need for state-of-the-art interdisciplinary research space and a stronger, more unified visual identity.

The project comprises a seven-story research tower, a new entrance leading to a public Forum, and a central utility plant. In addition to the design and engineering of the research building, Ballinger provided existing facility assessment, master planning, and programming to determine the best solution for Wistar.

Link to Article

Iconic Design and Clinical Excellence: You Can Have Both

At the 2015 Healthcare Design Expo & Conference in Washington, DC, Ballinger’s Louis Meilink, Jr., Christina Grimes and Amy Floresta along with Dr. Randall Oyer, Medical Director, Oncology Program, Penn Medicine Lancaster General Health, presented the results from the post-occupancy evaluation of the Ann B. Barshinger Cancer Institute. In their talk entitled “Iconic Design and Clinical Evidence: You Can Have Both!” the team described how the iconic and biophilic design effectively integrates with the caregiving model to provide a best-in-class experience for every patient visit. Dr. Oyer remarked how the iconic design is a beacon for the community, an important influence in retaining and recruiting staff, and by putting the patient experience first, feels less like a hospital and more like a home environment to many patients and visitors.

Link to Presentation

Ballinger and GW Lead Tradeline Session on Effective Interdisciplinary Facilities

Ballinger Principal Craig S. Spangler, AIA and Associate Principal Rob W. Voss, AIA, LEED BD+C joined George Washington University’s Dr. Can Korman on stage at Tradeline’s 27th annual College and University Science Facilities Conference. Their talk, titled “Mixing Bowls for Science and Engineering: Recipes and Ingredients For Inspiring Interdisciplinary Learning and Discovery Environments,” compared four academic building designs.

By exploring how openness and transparency relate to cost, code, culture and program, Ballinger provided attendees with tools and metrics for planning future interdisciplinary learning environments.

Tradeline is an industry resource that presents high level conferences focused on the latest planning, design, operations and financial thinking for the built environment. This year’s College and University Science Facilities conference was held in Boston, MA.

Link to Presentation

Ballinger Presents at 2015 Healthcare Facilities Symposium & Expo

On October 7, 2015, Principal Lou Meilink, Jr., AIA, ACHA, ACHE, and Director of Healthcare Planning Dwight Smith, AIA, EDAC spoke at the Healthcare Facilities Symposium & Expo.

The surgical suite has historically been broken down into zones or levels of cleanliness.  As procedures become less invasive and expand to other modalities, differentiating cleanliness protocols have also expanded to other disciplines and in the process, grayed the understanding of what is best practice.  This presentation explored the history of clean flow in the medical field.  What is the definition of clean flow and is it fact or fiction?  As an architect, what design decisions influence clean flow in either a positive or negative way?  What are the components of clean flow and the risk factors associated with each?  What are the minimum requirements and are they truly best practice?  With the implementation of the Affordable Care Act linking reimbursements to reductions of surgical site infections (SSI), the effectiveness of clean flow will have an impact on every institution’s bottom line.

Link to Presentation

Ballinger Helps Academic Medical Centers Move Beyond State-of-the-Art to Anticipate the Road Ahead

In the Sept-Oct 2015 issue of Medical Construction and Design, Ballinger Principal Louis Meilink Jr., AIA, ACHA, ACHE, discusses the future of Academic Medical Centers (AMC).  AMCs account for 6 percent of care providers, but contribute 20 percent of all hospital care and 40 percent of the uncompensated charity care in the US.  With a disproportionately large market share, AMCs are the first to feel the impact of regulatory and market pressures.  To neutralize pressures without sacrificing mission or quality of care, AMCs must identify strategies to ensure regenerative institutional growth.  Forward-thinking planning and design can contribute directly to the agility of these institutions.

Link to Full Article

Tradeline Report: Convergence Drives New Approaches to Strategic Planning

Tradeline published a report featuring Ballinger’s design for a new engineering teaching and research building at the University of Maryland, College Park. Designed to facilitate the practical integration of bioscience, medicine and engineering, the building will serve as a national center for innovation.

The report is based on presentations at Tradeline’s College and University Science Facilities 2014 conference, given by Ballinger principal Craig S. Spangler; lab planner Jeffrey Schantz; Founding Chair of the Fischell Department of Bioengineering at the University of Maryland, Bill Bentley; and Dean of the A. James Clark School of Engineering at the University of Maryland, Darryll Pines.

Link to Article

Ballinger’s Research on Designing for Multiple Generations Published in Health Facilities Management

Ballinger Principal Louis Meilink Jr., AIA, ACHA, ACHE and Senior Associate Christina Grimes, AIA, LEED AP, EDAC shared their analysis of multigenerational healthcare workers’ preferences in an article in Health Facilities Management.

In an effort to plan and design healthcare workplaces better, Ballinger used post-occupancy evaluation surveys to gather data on generational preferences for different kinds of working environments.

A key finding of their research is the importance of an inclusionary design process. Facilities that are designed to comprehensively address multiple generations result in a more efficient and fulfilled workforce.

Health Facilities Management is a publication of the American Hospital Association, providing comprehensive coverage of health facility design, construction and operations.

Article Link

Ballinger Presents Post-Occupancy Data at Tradeline

Ballinger Principal Jonathan Friedan, PE, LEED AP and Associate Principal Stephen M. Bartlett, AIA, LEED AP presented a talk at Tradeline Research Facilities 2015 in St. Petersburg, Florida. The session, titled “Post-Occupancy: Lab Functionality, Flexibility, Energy,” reviewed post-occupancy findings from three high profile science facilities at Johns Hopkins University, the Wistar Institute, and the University of Pittsburgh.

They presented data on modeled-vs-actual building performance, real-world use of interchangeable features, amenities for collaboration and interaction, and operating details. The presenters explained how end-user feedback can inform decisions on next-generation research facilities to maximize return on investment.

Link to Presentation

Tradeline Features Ballinger’s Laboratory Renovation

Tradeline recently published a report featuring Ballinger’s design for Johns Hopkins University’s new Undergraduate Teaching Labs. In it, they detail how this addition and renovation to the Mudd/Levi Biology complex integrates into the campus and modernizes the University’s research capabilities. The structure of the laboratory, seminar, office, and amenity spaces provides a state-of-the-art academic environment for JHU’s chemistry, biology, biophysics, psychology, and neuroscience students, as well as the flexibility for these academic programs to grow and evolve into the future.

Link to Article

Tradeline Features Ballinger’s Workplace Strategy Team

Ballinger’s Workplace Strategy team was recently featured in a Tradeline report entitled, “Culture Drives Collaboration; Space Design Enhances It.” The article focuses on Ballinger principal, Keith Mock, AIA and Ballinger designer, Katherine Ahrens, LEED AP, and how they combine an understanding of a client’s office culture with a library of industry metrics and research on space utilization to arrive at a tailored workplace strategy and design.

The report presents a number of case studies across a range of industries. In the case of the University of Wisconsin’s Wisconsin Institutes for Discovery, the University’s desire for a strong sense of community inspired a design that combines lab modules, open collaborative areas, and amenities such as shops and restaurants to promote formal and informal learning.

At a Boeing helicopter factory in Pennsylvania, Ballinger’s Workplace Strategy team was tasked with reorganizing the space to integrate engineers into the factory to optimize collaboration while allowing for sufficient space for focused work.

For Merck’s New Jersey headquarters, Ballinger engaged in a year-long research project that included a 27,000 SF pilot workspace to create a custom solution that reflected the Merck culture and work style.

To learn more about Ballinger’s methods for leveraging office culture to create successful workplace designs, read the full article.