National Wear Red Day

E4H participated in Wear Red Day on Friday February 1, 2019. This initiative resonates with E4H as it helps further the mission of their clients to raise awareness and education to the topic of Heart Health.

Dallas, TX

Forth Worth, TX

Washington, DC

 

Boston, MA

NYC, NY

 

Nashville, TN

 

Burlington, VT

 

Wentworth-Douglass Hospital Site Visit

E4H aims to expose staff of all phases of architecture including the working construction sites. Every so often, we’ll gather a team to head out to a current project site for a visit. While on site, we’ll review lessons learned, common construction practices, as well as any interesting or unique items specific to that project.

Recently a group from the Boston office visited the Wentworth Douglass Pease MOB sites, in Portsmouth, NH. The group toured two MOB buildings in various stages of construction. Building A is a 2-Storied 25,000 SF building that is roughly 80% complete. Building B is a 3-Storied 60,000 SF building that is roughly 30% complete. Below are the lessons learned from the site visit.

“This site visit enhanced my understanding of the reality of design when implemented during construction. It reminded me of the importance of communication for successful integration of the different building elements and building systems. Having the opportunity to see two buildings in very different phases of construction was eye opening for me. It was like seeing an X-ray of an evolving building because we got to see the “veins” and “guts” that come together to create the exterior walls, the interior walls, and the floors in one building and then we got to see it further along in the other building.

We had the chance to speak to the project superintendent about the coordination it took to construct the space for a linear accelerator. On the design front, we learned that a Physicist was consulted to aid in calculating the thickness and construction of the envelope needed for this space and that there are special lasers that are used with this machine that require an extremely carefully laid out and constructed room for them to work properly. To implement the construction and design required for this space, coordination between the design and construction teams was essential to its success. To me this was not only fascinating but a perfect example of the importance of communication in the healthcare design and construction industry.”

– Kimberly Leonard, LEED GA, project coordinator

“This was a great opportunity to share the day to day activities on a construction site with our younger staff, who would not normally be introduced to a project at this phase until later in their careers.  Observing projects during construction gives a greater appreciation for the effort needed to design, draw, and coordinate thoroughly.  Everything included (or not included) within the drawings and specifications makes its way to the construction site.  It is a good reminder that a project is not finished once the construction documents have been completed.”

– Ray Boudreau, project manager

“It was great to visit the two sites and seeing the projects in their respective stages. I’ve never been to a project site so early in the construction phase as Building A, so it was definitely eye-opening to see how much coordination our projects require from the start, even before the interior walls are even laid out. It was also interesting to learn about the how the future growth of the building was accounted for in the design, as well as how the exterior building finishes were an impact.

Since Building B was much further along, the most beneficial part of this visit was to see the details that we draw in 2D back at the office installed in real life. Other lessons included materials transitions (and how to clarify trouble points on our drawings) and a review of what to check for during punch lists.”

– Marissa Walczak, interior designer

“After the transition from the familiar theoretical realm of learning in school to now seeing firsthand the Wentworth-Douglass Hospital Pease project under construction is certainly an exciting new way to understand the development of design and construction. While walking through the site and hearing from fellow co-workers on how they addressed and reviewed certain challenges was remarkable. It seems that every site will offer a few lessons and to enhance our skills.”

– Shannon McManus, project coordinator

 

2019 Healthcare Facility Design Trend Predictions

Healthcare Design is an ever-evolving topic as systems must continuously adapt to meet complex regulations, reduce operating expenses, integrate emerging technologies, keep up with the quickly changing, consumer-driven landscape, and deliver world-class care to their communities. E4H Environments for Health Architecture, partners closely with health systems to develop an approach to these diverse challenges. The partners at E4H Environments for Health Architecture developed the following list of national design trends that will impact the healthcare design industry in 2019.

Designing for Resiliency
Healthcare facilities function 24/7 which requires them to be sustainably designed in order to maximize resources and reduce energy use/costs. With global warming’s effects quickly shifting the dynamics of our geography, the need for resiliency has made its way to the forefront of design discussions. How will the physical facility perform in the face of a natural or man-made disaster? What is the role of a hospital building to provide shelter and care to a community ravaged by a hurricane, flooding or wildfires? Can our buildings continue to function when all the municipal systems (water, power, sanitary services) around them are compromised?  What protects the safety of patients and staff when there’s an active shooter on the premises? These questions help us think beyond the standard disaster-preparedness drills to ensure the designs we develop thoughtfully address the needs of patients, staff, and their community in a time of unprecedented stress. New operational protocols require new plans, different physical barriers, and an innovative approach to the use of materials. Many E4H projects have been impacted by natural disasters such as Hurricane Sandy, this year’s Hurricane Michael in Florida, and the 7.0 Magnitude Earthquake in Alaska.

The Expanding Role of Genomics in Healthcare
Genomic research is impacting many fields of medical research and is emerging as a key disruptor in healthcare delivery and patient treatment. With rapid technological advances and decreasing costs associated with DNA sequencing, a more accessible diagnostic tool, genomic research has provided a new lens into difficult-to-diagnose and rare diseases. Additionally, Polymerase Chain Reaction (PCR), a mature molecular technology, is being refined through improved techniques, new assays, and much higher throughput capabilities than ever before. We are seeing more molecular testing being done in the clinical lab, with many hospitals creating entirely new Molecular Pathology departments. This genomic data is opening the doors to greater predictability of drug efficacy, an increase in personalized medicine and targeted therapies, resulting in improved patient outcomes. E4H Clients such as the Dana Farber Cancer Institute are at the frontier of translational medicine in healthcare.

AI and Virtual Healthcare
Healthcare delivery has spent the last decades working to transform a process that is heavily dependent on data, and make it work smarter. Hospitals and health systems have been working hard to convert and optimize their databases to improve patient care and streamline processes. Artificial Intelligence is now poised to become the next evolution of healthcare data management, analysis and prediction.

The ability of AI to analyze data and predict outcomes and trends will have impacts not only in the clinical fields, but also operational and the physical environments. AI has already begun to demonstrate its ability to assist clinicians with diagnosis and prevention of medical errors. As this technology matures, it will have a profound impact both on care delivered at healthcare sites and in the virtual realm allowing for more informed diagnosis, smarter monitoring and alerts, and outcome predictions based on patient specific data. As facilities incorporate AI into their operations, it will allow them to look at the effect of the environment on patient, staff, and materials movements. Which will provide them with the opportunity to refine their operations through scheduling to enhance throughput and eliminate waste. This insight will help better inform changes to the physical environment to better suit their needs based on the data that they are able to extract about the flow of material and people within their walls.

AI will provide facilities with the ability to better predict their needs for supplies and deliveries such as medical supplies, food, linens, pharmaceuticals and energy based on patient scheduling.  This will help facilities further reduce the costly footprint of onsite storage through better managed just-in-time deliveries.

Due to the growing need for patient data and medical records to be shared across a network of healthcare entities, blockchain integrations systems have seen a push in digital health as well. Blockchain has the potential to revolutionize healthcare by allowing the sharing and analysis of critical patient data in real time to improve quality of care. Blockchain also increases the ease of information sharing between healthcare providers and patient, thus making data much more secure which allows facilities to better manage their inter administration and IT workflows. It is vital for healthcare systems to become aware of the increased efficiency new technologies can quickly implement, for not only healthcare providers but for all end users alike.

Post-Surgery Accommodations
Health systems are constantly looking for ways to decrease operating expenses. One popular method is to alleviate the real estate footprint. This can be accomplished by moving administrative staff and outpatient services to off campus locations. A newer, growing trend is to move recovering patients off site to a nearby location where transportation is provided to and from the hospital if need be. This model is a convenient option for the patient, caregiver and provider. This allows for the patient and their family to have a sense of privacy, improving the patient experience as well as the rate of recovery.

Memorial Sloan Kettering’s 75th Street Patient Residence accommodates patients with blood cancers and disorders as well as patients receiving a bone marrow transplant. The residence offers fully furnished apartments with on-site concierge services to assist with care coordination. Transportation to and from Memorial Sloan Kettering’s Hospital is available.

Wellness Integration
With the healthcare industry shifting its focus to preventative, population health, wellness has gained significant momentum over the last several years. Wellness incorporates the entire body and all systems as why functional medicine is the science of health, focused on the person and restoring the body’s natural metabolic processes; where traditional medicine is focused on disease.  Wellness is an integral part of delivering holistic healthcare.

As reimbursement continues to shift to a model that encourages preventative healthcare, we are seeing a shift in not only delivery of care but the physical aspects of the hospitals themselves. This growing trend can be seen in healthcare facilities across the country in the form of community gyms, yoga studios, and dietary kitchens fully loaded with cooking classes. This allows the health systems to make use of unused space, keep patients engaged and accountable for their healthcare by providing other interactions besides checkups and/or emergency situations. This shift provides an opportunity for the hospital to build relationships with the community. Many E4H clients offer nutritional services, full gyms, and community programs to promote wellness such as Covenant Health Lifestyle Centre in Lubbock,TX.

Boutique Medical Centers
There are two primary factors driving the rise of boutique specialty care centers, or precision medicine, nation-wide. One, a new and unique generation of informed healthcare consumers who expect quality, convenience and customization for all their needs, the other an advancing platform of technologies permitting providers a greater range of services bundled at a single point of care.

Millennials prioritize the enrichment of their health, lifestyles and experiences. Their decisions are based off quick and convenient platforms such as Google reviews, Yelp, Zocdoc, and several others that allow consumers to select a facility based off reviews vs a physician referral. Millennials are quick to express unmet expectations which has caused the healthcare systems to expand their service offerings. This new generation responds more readily to a successfully branded, boutique environments of clinical care.

Convenience is a pillar of retail success which suggests that healthcare systems will have to pivot in order to thrive in this arena. Healthcare providers are trying to diversify, differentiate and deliver their product distinctly to stay competitive. Fortunately, advances in technology and flexible design, have afforded clinical providers the means to offer broader ranged and more complex services in a single exam or treatment room; services that may have previously necessitated multiple visits to multiple locations. E4H projects such as the Hospital for Special Surgery Orthopedic Center Of Excellence in Palm Beach, FL offer full diagnostics services, ambulatory surgery, rehabilitation, and sports performance programs in one location.

About E4H
Committed exclusively to the design of innovative health facilities, E4H Environments for Health is a national architecture firm focused on improving outcomes through inspired design. Our team of future-focused strategists and visionary health and life science architects create flexible, state-of-the-art facilities designed to enhance the well-being of our clients’ patients, staff and families. With more than four decades of experience, we provide value to our clients through the design of LEAN, economically and environmentally sustainable spaces. E4H’s unique SmartDesign process fosters collaboration and drives next-generation solutions to complex challenges encountered in today’s health landscape. Combining experience with for-profit and non-profit institutions allows us to provide efficient, speed-to-market solutions for our clients.

 

For more information, visit www.e4harchitecture.com.

NeoCon 2018

NeoCon brings together nearly 500 companies and 50,000 design professionals, providing 100 CEUs and showroom tours highlighting new products. We were honored to attend “the commercial design industry’s launch pad for innovation” at the 50th Annual NeoCon.

Similar to a project launch, our trip began with familiarizing ourselves with the site (Chicago) and networking with ten other Boston designers who comprised our team for the week. The icebreaker event at BeSpoke Cuisine divided the group into smaller task forces, each completing one course of the meal. We were excited to work together to make something wonderful, appreciating the unique skills and perspective everyone brought to the table!

The following morning, we headed to the Focal Point factory, which graciously sponsored our trip to Chicago with Boston Light Source. Familiar with the Focal Point, we were excited to delve into their design and development, manufacturing processes, and operational strategies. We were given the opportunity to weigh in on some of their newest product developments like the Skydome Edge Acoustic, an acoustical ceiling solution that compliments their Skydome LED pendant. We are already brainstorming ways we can utilize these innovations in one of our next projects!

Chicago’s architecture has an amazing blend of Neoclassical juxtaposed against the sleek lines of modern design. This contrast of old and new is also apparent in the sculptural art found in the city—for instance Buckingham Fountain with its Rococo-influenced intricacies in comparison to the simplicity of Cloud Gate. And for the record, we Bostonians agree… it’s most certainly a bean, not a cloud.

Over the past few years, we’ve started seeing a shift in healthcare design to take inspiration from other sectors of design, in particular hospitality and residential, and this year’s product introductions at the Merchandise Mart only reinforced this trend. Comfort and flexibility impact the user experience and we’re starting to see waiting spaces evolve. A combination of soft seating, usable work areas (such as a high-top counter), and areas for privacy versus family space are all considerations when designing these healthcare waiting environments. As designers, we are responsible for considering the needs of a wide range of users to make our designs as inclusive and comforting as possible.

The Merchandise Mart also featured a few finish showrooms such as Tarkett, where we saw new releases in both the resilient (Johnsonite) and carpet (Tandus) industries. Bold shapes and tile formats left us brainstorming fresh ways to look at flooring for future projects.

We kept our eye out for unique alternatives for products as our industry continues to look at other markets for inspiration. Carnegie, Buzzispace, and 3form all had great new concepts for combating acoustics, without sacrificing form for function. Incorporating decorative techniques to address acoustics could impact hospitals, specifically regarding HCAHP scores on the “Quietness of Hospital Environment”.

    

The Barbican showroom featured their NeoCon Gold-winning WEV collection and a new concept for ceiling design—a 3D fiberglass printed mesh grid system which could be accented in a variety of colors while allowing lighting, sprinklers, sound, and security systems to live above the tiles. This product lends itself to a particular type of installation where the ceiling plays a more influential role, but if specified in the right application, it could introduce color and pattern in an unexpected way.

A few more product highlights:

  • KI featured their new desking series Tattoo, which won a NeoCon Gold award. This series embodied flexibility with options from sliding privacy screens, height adjustable worksurfaces, and hybrid storage and seating options.

   

  • Doug Mockett had rows and rows of hardware and accessories. This was interesting to see firsthand as these details sometimes come as an afterthought. We’re always keeping an eye out for innovative design.
  • Sherwin Williams highlighted color trends for the upcoming year. To combat the stereotype of hospitals being white and sterile, it’s important to incorporate fresh and engaging schemes. Paint is an inexpensive way to refresh a space.

Gerflor flooring’s European product designers were the masterminds behind the latest Gerflor launch—a terrazzo inspired sheet product with vibrant color options. This product would be perfect in bright colors for a pediatric environment but could also be used in neutral colors for a lobby space looking for a terrazzo visual for a fraction of the price. We’re seeing a growing interest in resilient flooring (rubber, sheet goods, and luxury vinyl tile) because of cleanability, comfort under foot, and acoustics.

NeoCon offered plenty of inspiration for us. We’re looking forward to applying these innovative products to our projects.

Berkshire Hathaway, Amazon, and JP Morgan’s Bold Initiative

Increasingly as healthcare groups consolidate, the single hospital model of healthcare delivery is vanishing. As architects centered in healthcare, working with both for-profit and not-for-profit systems, we’ve seen the consolidation drive a direction from single facilities to real estate management. Larger healthcare groups are now launching their own insurance groups to drive consumers to their care products.  This focus developed the emergence of a new trend, healthcare being stitched into lifestyle communities: why get 15% of a person’s income while under treatment when entire health/lifestyle maintenance organizations could be created, capturing a larger segment of the economic pie. Each of us, in America, has had to deal with rising insurance costs covering less and less care. In a characteristically visionary statement, Amazon, JP Morgan Chase, and Berkshire Hathaway have announced their intent to create a healthcare system for their own employees, effectively capitalizing and driving this transformation.

As consolidation of hospitals into systems have begun in earnest over the last few years, it seems to be inevitable that there will end up being eight to ten national healthcare delivery systems emerging. Although great strides have been made in the for-profit sector, in regards to breaking down the state borders and managing the different healthcare approval agencies, the question remains – where is the funding coming from? In providing a ready source of payees, these three large corporations are basically providing the means to effectively self-insure and care for their employees.

As treatment modalities become increasingly home-based and as humans become intrinsically more disease resistant due to genetic advances and treatments, the large central hospital seems destined to transform into smaller regionally-based trauma centers. We see this emerging in the trend for micro-hospitals, private urgicenters, and the conversion of retail spaces into ambulatory care centers.

As pharma starts to integrate into these large corporate entities, they will have access to large national distribution centers with ready buyers and prescribers of their products. To be sure, there is a great deal to be developed in this new corporate model, integrating employees with health systems, but we have already seen it taking root in the pharmacy chains such as Walgreens merging with nationally recognized healthcare providers.

Although US healthcare is divided currently into three sectors, regional, for-profit, and not-for profit, these too may merge as the need for research-fed, targeted, precision medicine will be required to be market-ready and competitive. The merging of for-profit versus not-for profit care models will help defray the costs typically associated with research. Nowhere is this more evident than the groundbreaking work in IVF where costs have vastly dropped and success rates drive the patients to providers who yield the best outcomes.

Governmental cutbacks to funding have spurred a need to come up with affordable care alternatives. Although companies such as Prime, Kaiser Permanente, and Adeptus, to name a few, have established much of the groundwork for such large corporate healthcare entities, this bold step by these three corporations represent a modality and reality that was thought to be far in the future. Healthcare Center construction demands great financial resources and long lead times, it is incumbent on those in the healthcare design community to provide for flexibility for an uncertain future. As professionals schooled and dedicated in the planning of healthcare centers, we need to be helping our clients plan for diverse and innovative options as these consolidations speed forward.

FIRST LOOK: University of Vermont Medical Center’s Robert E. and Holly D. Miller Building

Title Render

 

The University of Vermont Medical Center’s Robert E. and Holly D. Building E4H designed was highlighted by Healthcare Design Magazine! Read the full article here.

This project has been part of E4H’s master plan of the UVM campus. We are thrilled to have been part of the planning and implementation of such a world class healthcare facility. The new 162,000SF inpatient bed replacement project will have 128 private rooms with natural light and ample space for supporting family members.

 

 

E4H Project at Memorial Sloan Kettering Highlighted in Vice President Biden’s “Moonshot” Cancer Initiative

From: https://www.mskcc.org/blog/between-moon-and-new-york-city-vice-president-biden-leads-msk-cancer-moonshot-roundtable
From: https://www.mskcc.org/blog/between-moon-and-new-york-city-vice-president-biden-leads-msk-cancer-moonshot-roundtable

E4H designs space for Epigenetics Program at Memorial Sloan Kettering. Over the years, E4H has worked extensively to transform the facilities across the Memorial Sloan Kettering health system, including an improved ICU, upgraded outpatient exam Rooms, a wellness-focused rehabilitation center,  and the freestanding Sidney Kimmel Center for Prostate & Urologic Cancers.

A full renovation of the 4th Floor of Memorial Sloan Kettering Cancer Center created a space for the new Epigenetics Program, where scientists and clinicians can engage in scientific discovery, translational cancer research and drug development. The aim is to facilitate faster discovery of breakthrough therapies by bringing scientific research closer to the point of care.

The renovations of this world-renowned medical center were designed to propel its cutting-edge research. E4H Architecture’s New York office led this multi-year phased project, which incorporated our Smart Facility Design principles to best support current evidence-based clinical practices, for patients, clinicians, and staff alike.

The next phase in development will renovate the building’s walkways and existing laboratories to provide more space to accommodate contemporary models of interdisciplinary care teams. The offices from the 2nd through 10th floors are being redesigned and converted into interactive areas for collaboration, and conference rooms will be upgraded to include state-of-the-art communications technologies.

In May, Vice President Joe Biden visited the Epigenetic Center at Memorial Sloan Kettering Cancer Center in New York City as part of his “moonshot” initiative to cure cancer. Over the last several months the Vice President has met with hundreds of top cancer physicians, researchers, and funders to show the federal government’s commitment to increasing public and private resources in the fight against cancer. The Vice President has also called on the medical research community to share data and information in order to accelerate our understanding of the disease, its causes, and options for a cure.

Forbes report on Healthcare and Technology

http://www.forbes.com/healthcare-2025/#40f986664f30
http://www.forbes.com/healthcare-2025/#40f986664f30

Forbes recently published a report on how technology is revolutionizing the healthcare industry. It looks at three categories: Consumers and technology, Funding and Finance and Active Lifestyles.

The report references a StartUp Health Insights report that stated digital heath companies received a record $1.8 billion dollars in funding in the first quarter of 2016 – That is a 450% increase over the first quarter of 2011.

With increasing availability of new smart tools (fitbits, smart refrigerators, etc.) and new digital platforms to make healthcare more available (Doctor on Demand, GetHeal, etc.), we are excited to see how technology will continue to transform the health landscape.