Articles Tagged with: Louis Meilink, Jr.
Planning Facilities for Telehealth

Ballinger Senior Principal Louis A. Meilink, Jr., FAIA, FACHA, ACHE contributed to the cover story of Health Facilities Management’s October issue. The article, “Planning Facilities for Telehealth,” describes considerations for designing healthcare environments that accommodate rapidly evolving technology. 

Excerpted from Health Facilities Management, a monthly publication of the American Hospital Association:

Remote provision of health care services — often referred to as telehealth or telemedicine — has grown in importance, especially with COVID-19-related restrictions on in-person interactions. 

“We know consumers want telemedicine,” says Louis A. Meilink Jr., FAIA, FACHA, ACHE, senior principal at Ballinger, a health care design firm in Philadelphia. “And from a space perspective, telemedicine can be anywhere, from primary and ambulatory care centers, cancer centers, emergency departments, patient rooms, and many other clinical and nonclinical spaces. Implementing telemedicine is a matter of having technology in the space where it’s needed and providing the supporting clinical care model, access and reimbursement structure.”

As Meilink notes, the range of telemedicine applications is broad. Remote clinical care encounters can include a physician with a patient in a hospital; a caregiver with a patient at home; a specialist with a patient and caregiver; caregivers meeting with each other; and remote monitoring of patients in a hospital or home care setting.

Consequently, the creation of effective telehealth spaces is today more important than ever, and telehealth should be considered early in the design phase of a new or renovated health care facility. That hasn’t always been the case, experts say.

“Telehealth is one of those things that has often been an afterthought,” says Bryan Arkwright, co-founder and chief research officer of Cromford Health, a digital health research and advisory firm. “But the facility issues are important. Those details can stop or slow a project.”

As a sign of this growing recognition, the Facility Guidelines Institute (FGI) Health Guidelines Revision Committee (HGRC) established minimum requirements for telemedicine spaces and offered additional recommendations supported by research and best practices in its 2018 Guidelines for Design and Construction documents for hospitals and outpatient facilities. 

Additionally, the brief telemedicine guidance provided in FGI’s 2018 Residential Guidelines has been expanded significantly for the 2022 edition.

Dedicated, integrated or mobile?

According to the American Academy of Family Physicians (AAFP) website, telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote nonclinical services and electronic information sharing, AAFP states. In practice, however, the terms often are used interchangeably.

Perhaps the first design decision that has to be made is whether the system will include dedicated spaces for telehealth; mobile carts that can be rolled from space to space; or telemedicine tools integrated into patient rooms, exam spaces, conference rooms or doctors’ offices. 

“Telehealth can be deployed in any room anywhere in a facility,” says Rebecca Lewis, FAIA, FACHA, CID, director of health care design for DSGW Architects in Duluth, Minn. “You can talk to someone on an iPad, a screen within an exam room or in an office space. You just need to know what’s the best spot to deliver the right kind of care.”

The decision about which form the telehealth facilities will take comes down to a number of variables, ranging from finances to the deployment strategy, with planning strategies including:

Teleheath carts. A hospital or outpatient facility with limited money available to invest in telehealth may choose to make it available on carts that can be wheeled from room to room as needed. Outfitting a cart may cost more than integrating telehealth equipment into a patient room, but using carts can save money because a relatively small number of carts can serve multiple patient rooms and other spaces. Carts can be cumbersome, and care needs to be taken with their cords, but cart-based telehealth is a viable solution for many facilities.

Integrated setups. Many hospitals have opted to build telehealth tools directly into patient rooms. Similarly, ambulatory health facilities that include telehealth sometimes integrate the tools into exam rooms or conference rooms. An integrated setup can be the most convenient, and the equipment — such as the TV monitor — can be used for other purposes when not needed for telehealth.

Kaiser Permanente has integrated telehealth equipment into some of its patient rooms and uses telehealth carts to serve others.

“Our newest hospital, Kaiser Permanente San Diego Medical Center, is equipped with monitors and two-way videos in each of our patient rooms,” says Angelene Baldi, AIA, EDAC, executive director of facilities strategy, planning and design for Kaiser Permanente and a member of the HGRC. “This can be used for telehealth appointments and is also used for entertainment, educational programs, food orders and more. In our older facilities, we use mobile video carts that can be wheeled into patient rooms for video appointments. These serve a dual purpose and can also be used as charting stations for nurses and clinicians.”

Kaiser Permanente’s telehealth program — which is currently handling 55% of the system’s ambulatory care visits — puts a premium on flexibility, says Zack Ryan, executive director of information technology capital project delivery. He says the facilities are designed to allow physician and patient interactions in a wide variety of situations.

“These tools need to be available to both our members and our providers in as many different situations and modalities as possible in order to deliver the optimal digital experience that can truly augment our in-person interactions,” Ryan says. “Our telehealth platform is built so that a provider can take their appointments and ad-hoc visits from their office, clinical spaces, home or other remote locations on a variety of devices. We also created this flexibility for our members and patients.” 

Dedicated spaces. Dedicated telehealth spaces take several forms. Some are designed exclusively for caregivers treating patients remotely, while others are set up so patients and caregivers can be in the dedicated room together and access another caregiver — a specialist, for example — via the telehealth equipment. The advantage of a dedicated space is that everything in the space can be optimized for telehealth.

At least one facility, Mercy Virtual Care Center in Chesterfield, Mo., is entirely composed of dedicated spaces. According to Mercy’s website, caregivers at four-story, 125,000-square-foot Mercy Virtual facility provide around-the-clock supplemental assistance and monitoring to caregivers in the 43 hospitals that make up the Mercy system and other facilities outside Mercy.

However, in some cases, dedicated spaces are not used enough to be worthwhile, says Patricia Shpilberg, M.Arch, vice president of planning and development for MedCraft, a health care real estate development firm headquartered in Minneapolis. She adds that access and ease of use are as essential for providers as they are for patient adoption of the technology.

“We had a client who had dedicated telehealth spaces away from their clinics and offices for providers to use during their virtual care sessions,” Shpilberg says. “The result was a limited adoption rate due to the disruption to their workday. Once the hospital integrated telehealth systems into the office work environment, the provider adoption rate started to rise.”

“There are a lot of times the patient is not present in an initial complex case discussion between providers in different specialties, so that’s why that larger telehealth suite was developed: to allow for ease of use and connection with multiple caregivers,” says Jennifer Ruschman, senior director of the center for telehealth at Cincinnati Children’s Hospital. 

Cincinnati Children’s Hospital has a mix of telehealth systems, but their mix includes several dedicated spaces, including a telehealth conference room that seats 18 to 20 people.

Sometimes a facility simply can’t afford to set aside space solely for telehealth, says Lewis, who regularly works with small rural facilities where budget is limited. In those facilities, a conference room or exam room might be optimized for telehealth but made available for other uses when it’s not being used for telehealth.

Regardless of whether a facility opts for dedicated, integrated or cart-based telehealth, experts say flexibility is essential.

“You need to build in flexibility because technology changes constantly,” Meilink says. “Especially on larger projects, the technologies you’re designing for in year one or two may not be what you’re going to install in year five when the building opens. You need to consider infrastructure — such as wireless technology and systems pathways — that enables future changes, including accommodating technology that doesn’t yet exist.”

Ryan says that is exactly how Kaiser Permanente thinks about its telehealth installations.

“It’s challenging to build for the future, with rapid development and changes in technology,” Ryan says. “The building timeline for hospitals is around five years, from design to opening, and telehealth solutions, use cases and infrastructure are very fast moving. The key to success is to plan and design hospitals for what you want the future patient experience to look like, and to create room for flexibility in the design and technology capabilities. 

“Kaiser Permanente strives to enable all of our new facilities to support telehealth, rather than only building these requirements into specific projects,” Ryan says.

Design practices

Many design elements of a telehealth program are similar regardless of whether the equipment is on a cart, integrated into a patient room or doctor’s office, or set up in a dedicated telehealth space. Every telehealth endpoint — that is, where the system connects to a caregiver or a patient — should meet some basic best practices to ensure an ideal experience for all involved parties.

Arkwright says that the standards used by the film industry — such as good lighting, proper acoustics and effective camera angles — should apply to telemedicine as well. 

“Imagine the professionalism CNN or ESPN takes in its productions,” Arkwright says. “Sometimes just the opposite goes on in telehealth. You can beam into a health system and the lighting is terrible, the background is dark, the doctor’s face is washed out and they’re hard to hear. Compare that to when everything is optimal or professional grade. That’s probably the difference between a patient perceiving, ‘This is high-quality care or not.’ These little things are important.”

The following guidelines apply regardless of the endpoint — a patient or exam room, a physician’s office, a conference room or a dedicated telehealth space:

Room size. With the right technology, telehealth can be deployed in any size room. Thus, a facility that is renovating an existing space to accommodate telehealth can create a program regardless of how small the room is. However, in a newly designed space or a renovated space that can be expanded, a larger size is desirable. The FGI Guidelines suggest that “the room should be large enough for the patient and the patient presenter, if one is present, to move about comfortably. The patient should be able to sit in a chair as well as use the examination table … Where the examination includes gait evaluation, the room should provide sufficient space for this activity to be captured by the screen.”

Surface colors. The space should be painted in a nonglossy, neutral color. Light blue or light gray work particularly well, Arkwright says. “White can be a little sterile or too bright, and yellow doesn’t do well on camera,” he says. “If the patient room is painted yellow, the patient might look like they have jaundice.”

Ruschman says they considered paint color carefully when designing the dedicated telehealth spaces at Cincinnati Children’s Hospital and came up with a combination of colors that looks good on video and blends well with the hospital’s brand color palette. 

Lighting sources. Ideally, the light source should be bright and positioned in front of the subject — the patient or the caregiver — so that it illuminates the face clearly. Natural light is good for accurately rendering color, but it’s difficult to control, so if the space has windows, make sure they can be covered when the natural light is not flattering. 

At the Liberty Campus of Cincinnati Children’s Hospital, which features telehealth equipment in each of its 40 patient rooms, natural light is controlled by blinds. “We don’t want to limit the natural light in patient rooms, but it can cause shadows, so we address that as part of our training,” Ruschman says. “We teach users how to do a self-view check — if it’s not good, they pull the blinds.”

Regardless of the light source, it should be balanced and distributed, says Ellen Taylor, Ph.D., AIA, EDAC, vice president for research at The Center for Health Design in Concord, Calif. “You need frontal lighting so there are no shadows,” says Taylor, who is a member of the HGRC. “But you also don’t want someone to look washed out, so depending on the task and type of treatment, the color and brightness of the light matter, too.” 

A technical measure of how well a light bulb renders color is the color rendering index (CRI), which ranges from 0 to 100. Natural sunlight is 100, and a dim streetlight is about 0. Sometimes CRI is not indicated on a lightbulb package, but if the bulb has a CRI of 90 or more (which is preferable), it usually will say so on the package. The FGI Guidelines call for lights in telehealth spaces to be warm, white light — 3,200 to 4,000 Kelvin. 

Endpoint background. Designers should consider the background of a TV newscast — if it’s not an image related to the newscast or the network logo, there’s usually not much there. That’s because the network wants the viewers to pay attention to the anchor, not the background. Designers should have the same goal for the background of the caregiver endpoint; it should be neutral enough that the patient pays attention to the doctor, not a cluttered bookshelf in the background. 

“You want to make sure that whatever the patients are seeing behind the provider is a good image for your system,” Shpilberg says. “Sometimes that space is used for branding or education.”

Acoustic issues. There are two issues to consider in telehealth regarding acoustics: privacy and clarity. Privacy can be addressed by making sure the door to the space, whether it’s a patient endpoint or caregiver endpoint, can be securely closed and that it blocks sound. 

“It’s about making the patient feel like they can share information privately,” says Lewis, who also is a member of the HGRC. “Doors can be the weak point with acoustics, so perhaps you shouldn’t locate the door on a busy corridor — perhaps around a corner is better. Simple things like that can add to the feeling of privacy and make the patient more comfortable.”

Acoustic clarity results from a combination of the design and construction of the room and the technology used by the telehealth system. The designers of the dedicated telehealth spaces at Cincinnati Children’s Hospital included acoustic paneling on the walls to optimize the acoustics, Ruschman says. 

Getting technology right

The heart of a telehealth system is the technology that connects the two or more remote participants. Getting that technology right can make the difference between success and failure.

Every telehealth system incorporates a monitor — or multiple monitors — of some type, and monitor technology is constantly advancing. However, putting the monitor in the right place and at the right angle is essential regardless of how advanced the monitor is. The screen should be installed so the patient can comfortably look straight on to the care provider, as if they were in the room. “You want the monitor at eye level, as if the provider were sitting right in front of you,” Shpilberg says. “You want to make it feel as real as possible.”

The position of the camera that is capturing the image — on both sides of the interaction — is equally essential, whether the camera is separate from the monitor or integrated. 

“There was a fascinating study done in 2007 by Tam and colleagues that looked at gaze angle, and at 7 degrees there was a perception that the person was happier, warmer, more approachable, more interested,” Taylor says. “At 15 degrees, it’s starting to look down, and the perception was somebody was sad, depressed, or timid or hiding something. So, imagine a behavioral health visit where just the angle of the camera gives you a different perception of what’s happening with that person.”

Another technological aspect of the camera that is important is whether the caregiver can control the camera at the patient endpoint, which allows them to zoom in on a particular part of the patient. 

“The remote camera control is one of the bigger challenges,” Ruschman says. “The far-end camera controls are really important to our clinicians, because they want to pan and tilt and zoom in and out. This lets them see the nonverbal cues.”

As with the camera, getting the microphone and speaker set up correctly is essential. The microphone built into monitors may be good enough for normal Zoom meetings, but Arkwright recommends a separate external microphone for better quality audio. Similarly, he recommends separate speakers — or even noise-canceling headphones — to maximize sound quality.

At the Liberty Campus of Cincinnati Children’s Hospital, separate speakers and microphones are mounted above the patient beds for maximum audio clarity, Ruschman says. But they’re working on a new health care facility, and they may integrate the audio equipment into the monitor because that technology has improved, she adds.

All telehealth systems rely on a strong internet connection. In some cases, Wi-Fi is good enough, users say, but a wired connection is always more reliable.

“We prefer to use hardwired where we can,” Ruschman says. “But most of our telehealth carts run on Wi-Fi. So, we train folks on how to get a hardwired connection, but we’ve found that usually the carts run pretty well on Wi-Fi.”

Ready for change

The facilities issues surrounding telehealth are complex. The key, those involved say, is building spaces that can accommodate today’s technology while being prepared for it to change.

Design’s Ability to Transform + Deliver Population Health

Design’s Ability to Transform + Deliver Population Health

Ballinger Senior Principal Louis A. Meilink, Jr., FAIA, FACHA, ACHE and Director of Healthcare Planning Christina Grimes, AIA, LEED AP, ACHA, EDAC, presented Design’s Ability to Transform + Deliver Population Health at this year’s European Healthcare Design Congress. The theme of the virtual event was “At the Tipping Point: Designing for Population and Planetary Health.” Ballinger’s poster and presentation explored how innovative technologies and thoughtful design can increase access to healthcare and promote healthier aging.

View the poster

AIA AAH Webinar: The Big 5 Healthcare Design Strategies for an Adaptable Future

How can we design healthcare buildings to be flexible in the face of uncertainty? In a webinar hosted by the AIA’s Academy of Architecture for Health (AAH), Ballinger Senior Principal Louis A. Meilink, Jr, FAIA, FACHA, ACHE and Principal Erin Nunes Cooper, AIA, ACHA, LEED AP will address trends in patient-centered care and technology that drive the need for flexibility.

Their presentation, “The Big 5: Healthcare Design Strategies for an Adaptable Future,” will focus on the impact of floor to floor heights, column spacing, fixed vertical elements, targeted zones of flexibility, and resiliency on a healthcare facility’s future adaptability.

Link to registration

NewYork-Presbyterian David H. Koch Center Wins Award of Merit

New York Presbyterian Hospital, David Koch Center, Location: New York NY, Architect: Pei Cobb Freed & PartnersThe NewYork-Presbyterian David H. Koch Center was officially honored today with the Healthcare Design (HCD) 2019 Award of Merit. This award, part of the 2019 Healthcare Design Showcase, is the highest honor that a project can receive in the program.

The 734,000 SF world-class ambulatory facility, completed in 2018, was designed through a collaboration between Ballinger, HOK, and Pei Cobb Freed & Partners. The state-of-the-art facility pushes the boundaries of innovation to provide exceptional care and a seamless patient experience for all.

Ballinger Senior Principal Louis A. Meilink, Jr., FAIA, FACHA, ACHE, and Principal Erin Nunes Cooper, AIA, ACHA, LEED AP, along with Scott Rawlings, AIA, FACHA, LEED AP, Director of Healthcare at HOK, accepted the award on behalf of all the team members who contributed to the project.

Link to NYP’s Award Profile on Healthcare Design Magazine’s Website

Ballinger Architects to Address Chinese Delegation

Ballinger Senior Principal Louis A. Meilink, Jr., FAIA, FACHA, ACHE and Principal Erin Nunes Cooper, AIA, ACHA, LEED AP will present a lecture tomorrow to a delegation from China representing the healthcare and design industries.

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Their talk, “The Spectrum of Technologies: Current + Future State of Healthcare,” will explore the ways technology is changing the healthcare environment. The event was organized by The Center for Healthcare Design, in conjunction with the Healthcare Design (HCD) Conference in New Orleans. This is the third year Ballinger has served as faculty for this annual education program, which seeks to promote exchange and education about healthcare design.

Ballinger to present on Healthcare Planning and Design’s “Big Five”

Healthcare buildings of today must be flexible in order to remain relevant tomorrow. How can we design buildings that remain malleable in the face of uncertainty? Ballinger Senior Principal Louis A. Meilink, Jr, FAIA, ACHA, ACHE and Principal Erin Nunes Cooper, AIA, LEED AP will address these concerns at the New York Health Design Insights Networking Event on September 26. The talk, “The Big Five: Healthcare Planning and Design Strategies for an Adaptable Future,” will focus on the impact of floor to floor heights, column spacing, fixed vertical elements, targeted zones of flexibility, and resiliency on a healthcare facility’s future adaptability.

Link to Presentation

NewYork-Presbyterian David H. Koch Center wins European Healthcare Design Awards

The NewYork-Presbyterian David H. Koch Center was recognized at the European Healthcare Design Awards in London June 18. The project received the prestigious Healthcare Design over 25,000 SM award as well as the Design Innovation for Quality Improvement award. The program, organized by Architects for Health and SALUS Global Knowledge Exchange, celebrate professional excellence in the design of healthcare environments around the world. The awards were presented at a ceremony during the European Healthcare Design 2019 Congress in London.

Link to announcement 

NewYork-Presbyterian David H. Koch Center Receives Top Award

Healthcare Design (HCD) magazine selected the NewYork-Presbyterian David H. Koch Center to receive an Award of Merit, the highest level of recognition, in the 2019 Healthcare Design Showcase.

The 734,000 SF David H. Koch Center is designed to house innovative clinical approaches and cutting-edge technology, resulting in exceptional care and a seamless patient experience. Characterized by warmth and transparency, the design features clear circulation, light-filled spaces, and standardized procedure rooms and patient areas that enable adaptability as requirements and technologies evolve.

The annual Healthcare Design awards program, now in its 19th year, honors the best design and architecture in the healthcare industry. Seventeen jurors, appointed by HCD’s partner organizations (The Center for Health Design, IIDA, and ASID), evaluated the submissions. Awards will be presented during the 2019 HCD Conference and published in the August 2019 issue of Healthcare Design.

The project was a design collaboration between Ballinger, HOK and Pei Cobb Freed & Partners.

Link to announcement

European Healthcare Design Awards recognize NewYork-Presbyterian David H. Koch Center

The NewYork-Presbyterian David H. Koch Center was shortlisted for two European Healthcare Design Awards. The project is a finalist in the Healthcare Design over 25,000 SM and Design Innovation for Quality Improvement categories. The awards, organized by Architects for Health and SALUS Global Knowledge Exchange, celebrate professional excellence in the design of healthcare environments around the world. The awards will be presented at a ceremony during the European Healthcare Design 2019 Congress in London on June 18.

Link to announcement 

NewYork-Presbyterian’s imaging and surgical suite provides first-of-its-kind clinical care

Recently celebrating one year in operation, the NewYork-Presbyterian David H. Koch Center is a world-class ambulatory care facility that combines cutting-edge technology with innovative clinical approaches to ensure a seamless patient experience from diagnosis to treatment.  The MRI/PET/Angiography Suite, which includes a first-of-its-kind procedure room integrating scanning and surgical procedures, is a prime example of the ideas and innovations that are central to the building’s design.

The suite combines key imaging technologies used for minimally-invasive procedures, including MRI/PET, fluoroscopy, ultrasound and rotational CT, with a fixed Angio C-arm in an operating room setting.  A flexible central table design provides access to all of these technologies in a single room. In addition, procedure verification occurs through real-time advanced imaging registration technology, streamlining treatment and reducing the need for multiple patient visits.

“We are proud to have collaborated with NewYork-Presbyterian to create this unique space,” says Ballinger Project Architect Shawn Billiard, RA.  “This co-location and arrangement of equipment allows clinicians to diagnose, plan, and precisely guide procedures all in one place, at one time.”

Ballinger, responsible for clinical planning and design within the NewYork-Presbyterian David H. Koch Center, utilized 3D-printed models of people, equipment and furniture to explore and rapidly assess possible room configurations in order to efficiently advance the suite’s design process with various NewYork-Presbyterian stakeholder groups. This highly-effective workshop style, used for clinical spaces throughout the hospital, helped clinicians quickly understand spatial and design issues and was critical to the room’s success.

room-animation

The NewYork-Presbyterian David H. Koch Center was designed in a collaboration between Ballinger, HOK, and Pei Cobb Freed & Partners.

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

NewYork-Presbyterian ambulatory care center cover story in Healthcare Design

Healthcare Design magazine published a cover story about the 740,000 SF NewYork-Presbyterian David H. Koch Center. The article, titled “Vision Realized,” was written by Anne DiNardo about the unique collaboration that resulted in NewYork-Presbyterian’s award-winning ambulatory care center.

Ballinger Associate Principal Erin Nunes Cooper, AIA, LEED AP is quoted in the article, describing the role-playing workshops Ballinger organized to engage stakeholders. With 3D-printed models, users were able to explore room layouts and equipment arrangements. “Using the models was a simple but effective way to bring the rooms to life, building excitement for the project with stakeholders and involving them early on in key design decisions.”

The project was a collaboration among Ballinger, HOK and Pei Cobb Freed & Partners.

Link to article

 

Louis Meilink Elevated to AIA College of Fellows

Ballinger principal Louis A. Meilink, Jr. was elevated to the prestigious College of Fellows of the American Institute of Architects (AIA), an honor awarded to members who have made significant contributions to the profession of architecture.

Since joining the firm in 1987, Lou’s design solutions have helped shape the future of healthcare. He led the design of significant buildings for NewYork-Presbyterian, Weill Cornell Medical College, Tower Health System, the University of Maryland Medical Center, the University of Rochester Medical Center, Children’s Hospital of Philadelphia, NYU Langone Health, Penn Medicine Lancaster General Health and Penn Medicine Chester County Hospital, among others. Lou is an author, speaker and active member of the AIA Academy of Architecture for Health.

Lou was nominated by Ballinger’s Terry D. Steelman, FAIA who described Lou as “a talented architect with a unique ability to balance the programmatic, budget and schedule demands of the healthcare client while aspiring to create noteworthy buildings with innovative healing environments. Consequently, he has become a trusted advisor to some of the nation’s top academic medical center leaders.”

Ballinger colleague William R. Gustafson, FAIA served as Lou’s sponsor. “I have been working with Lou for his entire 31-year career at Ballinger, and have watched him balance firm leadership, project responsibilities, and knowledge-sharing, all with humility and grace,” Gustafson said.

The Fellowship program recognizes architects who have achieved a standard of excellence in the profession and made a significant contribution to architecture and society on a national level. Fellows are selected by a seven-member jury of peers. Stringent requirements result in only three percent of the AIA’s more than 91,000 members being recognized as fellows, among them current Ballinger principals William R. Gustafson, FAIA and Terry D. Steelman, FAIA.

Fellows will be honored at a ceremony on June 7, 2019 at the AIA Conference on Architecture in Las Vegas.

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

Ballinger participates in Texas A&M’s Health Industry Advisory Council Annual Meeting

Ballinger principal Louis A. Meilink, Jr., AIA, ACHA, ACHE will participate in the 16th Health Industry Advisory Council (HIAC) Annual Meeting this week at Texas A&M University. Lou will present “Lessons from a Post-Occupancy Evaluation” about Ballinger’s work at Penn Medicine Chester County Hospital.

HIAC was founded in 2002 to support the activities of the Center for Health Systems & Design. The Center brings together the Colleges of Architecture and Medicine at Texas A&M to promote innovation with a focus on evidence-based health facility planning and design. Lou has been a member of the council since 2016.

Reading HealthPlex October cover story in Healthcare Design

Healthcare Design magazine published a cover story about the Reading HealthPlex for Advanced Surgical + Patient Care. The article, titled “Shaped by Nature,” was written by Ballinger principal Louis Meilink, AIA, ACHA, ACHE and associate principal Christina Grimes, AIA, LEED AP BD+C, EDAC. It describes how a new surgical platform for Tower Health resulted in an 88,000 SF roof garden, one of the largest in the US.

Ballinger provided architecture, engineering and interior design services for the 476,000 SF hospital, which opened in 2017. The project is one of several Ballinger has designed for the hospital system, now called Tower Health, over the past 35 years.

Healthcare Design magazine is a monthly publication covering architecture, interior design, facility planning, healthcare engineering and construction, relevant research, and the most recent projects opening their doors.

Link to article

Open-Door Planning for Penn Medicine Chester County Hospital’s Expansion

Penn Medicine’s internal newsletter, System News, published an update on the evolution of Chester County Hospital since it became a member of Penn Medicine, highlighting the major expansion project currently under construction.

Ballinger designed the expansion, due to open in 2020, with input from physicians and staff who will inhabit the new space. Ballinger principal Louis A. Meilink, Jr., AIA, ACHA, ACHE is quoted, “Chester County Hospital adopted an open-door policy for planning… the hospital engaged multiple stakeholders with innovative design techniques throughout the process.” Ballinger led planning workshops with 3D-printed models for rapid prototyping and consensus-building.

Ballinger pioneered the use of role-playing workshops with miniature models and now maintains over 250 pieces of equipment and furniture. Employing this technique allows for rapid exploration of layout variations to achieve the optimal solutions for clinicians and staff.

Link to article

NewYork-Presbyterian Sets the Bar for Contemporary Hospital Design

The David H. Koch Center at NewYork-Presbyterian appeared in the October issue of the Conde Nast publication Architectural Digest. The piece, written by Elizabeth Fazzare, focuses on innovations that improve the patient experience: “Prep rooms double as recovery rooms, providing continuity for patients and their companions. Hallways run along the perimeter, taking in sunshine and city views. And MRI facilities are above-ground, rather than relegated to the basement, as is usually the case,” she writes. Ballinger associate principal Erin Nunes Cooper, AIA, LEED AP, who was interviewed for the article, explains, “A lot of it is focused on reducing anxiety.”

Link to article

NewYork-Presbyterian’s David H. Koch Center Featured in Metropolis

The David H. Koch Center at NewYork-Presbyterian was featured in the September issue of Metropolis magazine. Writer Liz Stinson profiled the 740,000 SF ambulatory care center and its focus on the patient experience. She described the “patient-centered design choices at the finish and product scale: clinical rooms with sofas large enough to seat two, so family members can comfortably accompany patients; dimmable overhead fixtures that double as exam lighting, reducing clutter and the need for additional equipment.” The project, opened in 2018, was designed through a collaboration between Ballinger, HOK, and Pei Cobb Freed & Partners.

Link to article

NYP’s David H. Koch Center named Best Healthcare Project of 2018 by ENR

The New York chapter of Engineering News-Record (ENR) named the David H. Koch Center at NewYork-Presbyterian the Best Healthcare Project of 2018. The 740,000 SF project was a design collaboration between Ballinger, HOK and Pei Cobb Freed & Partners.

ENR’s annual awards program is dedicated to honoring the best construction projects and the companies that designed and built them. NYP’s David H. Koch Center was submitted for the award by construction manager Turner Construction.

Congratulations to the team!

 

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

NewYork-Presbyterian’s Operating Room of the Future featured in The Wall Street Journal

NewYork-Presbyterian’s David H. Koch Center is home to cutting-edge technology and thoughtful design solutions. Healthcare journalist Laura Landro profiled the evolution of operating rooms for The Wall Street Journal and highlighted the state-of-the-art ORs designed by Ballinger.

The 740,000 SF David H. Koch Center, designed in collaboration with HOK, and Pei Cobb Freed & Partners, opened in April 2018.

Link to article

 

 

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

NewYork-Presbyterian Opens a World-Class Center for Ambulatory Care

A Seamless Patient Experience, Designed to Reduce Stress and Anxiety, Keeps the Focus on Healing

On April 24, 2018, NewYork-Presbyterian (NYP) celebrated the opening of the David H. Koch Center, a world-class ambulatory care center that combines innovative clinical approaches and cutting-edge technology to provide exceptional care and a seamless patient experience.

The design is a collaboration among Ballinger as Medical Architect, HOK as Architect, and Pei Cobb Freed & Partners as Consulting Architect for building envelope and lobby.

The approximately 740,000-sq.-ft. facility, located at the NewYork-Presbyterian/Weill Cornell Medical Center campus on York Avenue and 68th Street, is home to a wide range of ambulatory care services, including outpatient surgery, interventional radiology, diagnostic imaging and infusion services, as well as an Integrative Health and Wellbeing program that will open in June.

“Our goal in creating the NewYork-Presbyterian David H. Koch Center was to develop a new vision for what ambulatory care could be by focusing first and foremost on patients’ needs and the delivery of exceptional care,” said Dr. Steven J. Corwin, president and CEO of NewYork-Presbyterian. “Every decision about the design and operation of this building was made with the patient in mind, from the quick and easy check-in to the private prep and recovery rooms, light-filled treatment areas and real-time status updates. This is truly an environment that was designed for healing, and we believe it represents the future of ambulatory care.”

For patients, the NYP David H. Koch Center will serve as a one-stop destination for individualized, coordinated care from diagnosis to treatment. Multidisciplinary teams of physicians from Weill Cornell Medicine, working collaboratively under one roof, will consider each patient holistically, whether they are being treated for digestive diseases, cancer or other conditions, or coming for outpatient surgery, interventional radiology or diagnostic imaging.

Smart technology and smart spaces are central to the design and function of the building to make patient visits as smooth and pleasant as possible. For example, patients can complete their paperwork remotely and securely before their visit, on their mobile phone or online. Upon arrival, they will be offered a personalized “smartband” that provides access to the building and receive information about their visit and step-by-step directions to their room through the NYP app. Each patient’s visit has a clear, planned flow that begins and ends in the same space for patients having a procedure — a private prep and recovery room that serves as “home base” for them and their companions throughout their visit.

Technology is central to delivering exceptional, cutting-edge care. A prime example is the NYP David H. Koch Center’s MRI/PET/Angiography suite, the first of its kind in the world. Combining all of the key imaging technologies used for minimally-invasive procedures, including MRI/PET, fluoroscopy, ultrasound, and rotational CT, it enables clinicians to diagnose, plan, and precisely guide procedures and verify their completeness. The NYP David H. Koch Center features three linear accelerators, including New York’s first MRI-guided linear accelerator for precision radiation treatment of tumors.

Additional clinical features include:

  • 12 operating suites, 6 interventional radiology procedure rooms, and 11 endoscopic procedure rooms, including an operating room dedicated to breast surgery with mammography and ultrasound equipment.
  • Decentralized clinical care with stations directly outside private patient rooms, offering patients easier access to their care team.
  • Radiation oncology services located on the light-filled 4th floor, thanks to the building’s unique engineering. Unlike many institutions, there are no basement treatment areas here.
  • Easy access to discharge instructions, test results and video follow-up appointments with physicians through the NYP app.

Sustainability and Resiliency
The NYP David H. Koch Center is designed to be highly sustainable, from its green roof, which can detain up to six inches of storm water, to its high-performance building envelope. The distinctive “skin” consists of triple-paned insulated glazing with a slatted wood screen, which significantly reduces solar glare, building heat gain, and the need for solar and privacy shading.

The building is also resilient in the case of an extreme weather event or disruption to city power, with heating equipment, air handling units, emergency generators and other key operational equipment located on higher floors above potential flood levels.

Enhanced Care for Patients
The design features a soothing palette of materials including wood and stone. A typical procedure floor has a sky lobby, 12 flexible procedure rooms, and 36 private prep and recovery rooms. Procedure preparation and recovery occur in the same dedicated room, which helps minimize patient movements and provides peace of mind for the patient, family, and care team.

Circulation is clear, with a separation of “on-stage” and “off-stage” flows so patients and families can travel along the light-filled perimeter corridors with clear wayfinding, and staff can move efficiently throughout the building, minimizing disruption to guests.

Infusion and radiation oncology areas – typically located on lower levels – are co-located on the 4th floor of the building. This allows patients and staff access to natural light, an example of the extraordinary accommodations made at the NYP David H. Koch Center to prioritize patient-centered care. The infusion area features a variety of treatment environments ranging from private rooms to warm and inviting community spaces.

NewYork-Presbyterian Alexandra Cohen Hospital for Women and Newborns
Beginning in 2020, the top five-and-a-half floors of the building will become home to the NewYork-Presbyterian Alexandra Cohen Hospital for Women and Newborns, the first of its kind in the tri-state area, offering compassionate, personalized care to pregnant women, newborn babies and their families. The 220,000-square-foot hospital within a hospital will feature 75 private rooms, 16 labor and delivery rooms, five cesarean section operative suites, 20 maternal critical assessment and treatment unit rooms and 15 ultrasound rooms, which will offer state-of-the-art visualization. The neonatal intensive care unit features 60 positions in private rooms, and is set to be the first facility in New York City to have MRI capabilities and an operating room in its neonatal intensive care unit.

 Team
NewYork-Presbyterian David H. Koch Center
Medical Architect: Ballinger
Architect: HOK
Consulting Architect (building envelope and lobby): Pei Cobb Freed & Partners
Interior Design: Ballinger and HOK
Structural Engineer: Thornton Tomasetti
MEP: Syska Hennesy Group
Construction Manager: Turner Construction Company
Lobby Art: Paqutá (2018) by Beatriz Milhazes

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 Addresses Chinese Delegation

Ballinger Principal Louis A. Meilink, Jr, AIA, ACHA, ACHE and Associate Principal Erin Cooper, AIA, LEED AP gave a presentation to a Chinese delegation of 30 people from healthcare institutions and the design industry. The event was organized by The Center for Healthcare Design, in conjunction with the Healthcare Design (HCD) Conference in Orlando, Florida. Louis and Erin gave an overview of recent operating/procedure room platform designs, highlighting Ballinger’s projects for Penn Medicine, Tower Health and NewYork-Presbyterian.

“Sharing our work and engaging in dialog with our healthcare design colleagues from China is an opportunity to broaden our knowledge base. This is the second year we’ve presented to the Special Delegation, and we have found that through the exchange of ideas, we gain an elevated appreciation of cultural differences and their influence on design,” said Cooper.

The presentation was interpreted into Mandarin by Dr. Zhipeng Lu of Texas A&M University and presentation slides were translated by Coco Wang.

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 Recognized at the Design + Health 12th World Congress

Ballinger’s work was recognized at the Design + Health International Academy Awards held in Vienna, Austria during the Design + Health World Congress.

Penn Medicine: Lancaster General Health Ann B. Barshinger Cancer Institute won an award for its use of art in public and private spaces and was the overall winner in the Interior Design category. Reading HealthPlex for Advanced Surgical and Patient Care won an award in the category of Sustainable Urban and Built Environment.

The Design + Health International Academy Awards is a leading advocacy program recognizing professional excellence in the research and practice of designing healthy built environments.

Ballinger principals Louis Meilink, Jr., AIA, ACHA, ACHE and Eric Swanson, AIA accepted the awards at a gala dinner at Vienna’s historical City Hall, chaired by Professor Alan Dilani, founder of the International Academy for Design + Health.

Ballinger Presents at the Design + Health 12th World Congress

Ballinger principals Louis Meilink, Jr., AIA, ACHA, ACHE and Eric Swanson, AIA attended the International Academy for Design and Health (IADH) Design + Health World Congress held in Vienna, Austria July 12-16. The program for the conference and exhibition explored public health on a global scale.

Louis and Eric presented the recently completed Reading HealthPlex for Advanced Surgical and Patient Care in a talk titled “A Closer Look at the U.S. Healthcare Built Environment.”

With experts from the UK, Italy, Sweden, Australia, South Africa, Taiwan, Brazil and others, the conference was an opportunity to exchange ideas and review progress to improve patient care.

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

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.

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

Opening Ceremony for Reading Hospital Healthplex

Reading Hospital Medical Center held an opening ceremony for its new state-of-the-art Reading HealthPlex in West Reading, PA.

This Ballinger-designed surgical tower complex consolidates campus-wide surgical services including pre-admission testing, an eight-room procedural suite, and the addition of a surgical center with 24 operating rooms including four hybrid rooms and two daVinci System robotic surgery rooms.

From left to right: Helen Joo, Jacob Shoemaker, Louis Meilink, Dr. Robert Brigham, Rob Goss, Tom Parr, and Dennis Meskill. 

From left to right: Helen Joo, Jacob Shoemaker, Louis Meilink, Dr. Robert Brigham, Rob Goss, Tom Parr, and Dennis Meskill.

Members of Ballinger’s team attended the event where Tower Health System leadership, including Dr. Robert Brigham, for whom the surgical center is named, gave speeches to the audience. Dr. Brigham has said of the new building, “We are going to offer a whole new experience for the patients, a much more conducive environment to healing and to recovery. We are going to be able to offer much greater technology to expand our minimally invasive surgery techniques in the realms of cardiac surgery, vascular surgery, and neurosurgery. This is really advancing healthcare in our community and will transform the way we deliver health care in our community.”

The design of this 465,000 SF building focuses on the patient/family experience and integration with the existing Hospital campus by taking advantage of opportunities for connectivity, advanced medical care, and enhanced use of green space. Maximized daylighting and views of the 88,000 SF accessible green roof and neighboring public gardens and art museum contribute to the healing nature of the space.

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

Topping Out Ceremony for NewYork-Presbyterian’s Ambulatory Care Center

On February 21, 2016, NewYork-Presbyterian held a beam signing ceremony to mark the installation of the final beam in the NewYork-Presbyterian Hospital Ambulatory Care Center. Expected to open in 2018, the state-of-the-art facility marks the first hospital and inpatient facility to be constructed across York Avenue. Existing residential and medical office spaces were decanted from the site in order to provide a sizable 42,000 SF footprint for a new building. Rising 18 stories, and comprising 724,000 SF, Ballinger was the healthcare planner for the building and Medical Architect for the healthcare floors located on floors 4-18.

ToppingOut-Larsen - 35

Members of Ballinger’s team Louis Meilink, Eric Swanson, Erin Cooper and Don Semler attended the ceremony, including the signing of the final beam.

ToppingOut-Larsen - 9

Ballinger Applies 3D Printing Technology as a Hands-On Tool for Streamlining Healthcare Design

Three-dimensional printing capabilities are becoming a fixture in Ballinger’s healthcare planning and design process. In an effort to provide clients with the most effective means to collaborate and assess options, Ballinger’s NewYork-Presbyterian Ambulatory Care Center team employed 3D printed model pieces to design 28 procedure rooms. The model pieces were used in interdisciplinary role playing workshops with users during schematic design and design development.

Rather than using 3D print technology for massing models or façade explorations, the ACC team took 3D printing to a new level, creating printed pieces of all the equipment in the procedure rooms; from surgical tables and anesthesia carts to fixed imaging equipment and waste bins. Over 250 moveable 3D printed pieces were made to cover 22 procedure case types.

The team made use of Ballinger’s in-house plastic and powder 3D printers, which allowed them to add to the fleet of pieces on-demand as the client investigated additional case types. In the user group workshops, the presence of model pieces generated excitement and cultivated a heightened level of focus and engagement – as well as fun – amongst the participants. A key advantage of this process was the ability to try various layouts quickly and efficiently, eliminating scenarios that did not work, and honing in on the details of the most promising scenarios. As a result of these sessions, room layouts were solidified early in the design process and a template design was developed for Ambulatory Surgery, Interventional Radiology, and Endoscopy procedure rooms. In a bold move, Interventional Radiology and Endoscopy were designed to be OR-like, including applying clean flow, while improving operational and space efficiency.

Building on the success of the planning process for the Ambulatory Care Center, Ballinger has continued to invest in 3D printing technologies and has applied this strategy on several other projects. Recently Ballinger had the opportunity to bring the models back to NewYork-Presbyterian for a new Women’s Hospital project.

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 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

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.

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Ballinger Senior Principals Lead Tradeline Session on Adaptive Reuse

How are leading academic medical and allied health organizations weathering the storm of healthcare reform, performance-based hospital reimbursement, and declining NIH funding? Ballinger principals addressed this question at the 2014 Tradeline Facility Strategies for Academic Medicine and Allied Health Conference.

Senior Principals Jeff French, FAIA, Louis Meilink, Jr., AIA, ACHE, ACHA and Todd Drake, AIA, LEED AP led a session titled “Patients, Procedures, + Pedagogy: Retooling Facilities for a Very Different Healthcare Future.” In it they described how organizations are adapting facilities across the research, training, and care continuum to maximize the value of existing space, particularly in response to changes in patient physical location.

Based on Ballinger’s expansive healthcare and academic portfolio, they provided insight into how institutions can adapt new and existing spaces to a broader functional spectrum, determine candidacy for facility adaptability or renewal, and evaluate facilty needs.

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 Facility Strategies for Academic Medicine and Allied Health Conference was held in Boston.

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Ballinger Healthcare Experts examine Evidence-Based Design in Pediatrics

Ballinger Principal Louis Meilink, Jr., AIA, ACHA and Director of Healthcare Planning Dwight Smith, AIA, EDAC discussed evidence-based design (EBD) at this year’s Healthcare Design Expo and Conference, sponsored by the Center for Health Design.

EBD research to date has predominantly focused on the adult environment, with few examples of its impact on pediatrics. Throughout the design of the Golisano Children’s Hospital at the University of Rochester Medical Center, Ballinger tested and tracked the application of EBD principles and best practice theories as they apply to pediatric spaces.

Lou Meilink and Dwight Smith, along with Golisano Children’s Hospital Chief Operating Officer Elizabeth Lattimore, presented the outcome of their design process, highlighting strategies that are translatable between adult and pediatric populations.