June 15, 2015
Matthew Kennedy

Summer is here and all the hallmarks of the traditional summer are with us once again, including major league baseball. So it may be an appropriate time to quote one of baseball’s best known legends for today’s healthcare blog:

“The future ain’t what it used to be” - Yogi Berra 

And he is right, the future ain’t what it used to be - change is the only constant. This is especially so in medicine and in the design of the facilities where medicine is practiced.

Standing right next to the physicians experiencing the multitude of changes in healthcare - from the way it is financed, to the technologies in use - are the healthcare planners designing the facilities to support physician needs. Healthcare planners have a unique role in this era of change within healthcare, to balance what is possible today with what will BE possible in the future. They need to develop a design approach that doesn’t limit the limitless future, but can embrace changes in medical practices and technologies as they occur. Changes such as those predicted for the future of healthcare at the recent AIA Healthcare Facilities Conference held in Grand Rapids, Michigan and attended by several HKS planners from the Detroit office.

This Midwest conference is typically known for dutiful reporting of changes to building codes and construction practices and less on potential changes in medical practices and the future scenarios they may create. But this year, several conference speakers including Dr. Richard Satava from the University of Washington, presented on new developments in medicine that will change the future of how it will be practiced and as a consequence, change the design of the facilities in which physicians like Dr. Satava will practice. Dr. Satava’s presented on several new surgical technologies in particular that will revolutionize the way surgery occurs in the very near future. Changes of particular interest to the Detroit HKS planners in his audience who are in the process of designing tomorrow’s surgery suite today at the future campus of Botsford Hospital located in Farmington Hills, MI.

Future Scenario #1: When Organs Are Replaced Instead of Repaired

As a surgeon himself, Dr. Satava stated during the conference:

“I am a gastroenterologist and I do 27 distinct types of surgical procedures involving the repair of the organs in the lower abdomen – in the near future I will perform only one type of surgery – replacing the diseased organ and not repairing it”

The technology exists today to regrow human cells, and in the near future that will include growing replacement organs made directly from the cells of the surgical patient. For HKS Planners, the facility accommodations required to support changes of this type are difficult to manage in the traditional design process of a surgical suite where specialized rooms are constructed for specialized procedures. To create flexibility in the surgical suite designed to accommodate changes, even radical changes such as those predicted by Dr. Savata, HKS Planners have initiated the following design actions:

  • Creating Universal Operating Rooms where a variety of surgical procedures - each with their own unique needs for room size, equipment, layout and instrumentation can be accommodated in a “one-size fits all” concept. This requires planners to avoid specialized and/or built-in equipment locations and storage cabinetry, while replacing such items with mobile equipment carts and surgical equipment booms that are easily “swapped-out” between procedures or relocated/adjusted to create a variety of room set-ups to meet not only the procedure needs as they change, but also can accommodate the changing preferences of individual surgeons.

To support swapping-out equipment, increased storage capabilities are provided in easily accessed clean equipment cores within the surgical suite so that different equipment carts can be brought in before or even during a surgical case. Equipment booms themselves are highly adaptable and can be modified as medical technology and practices change by adding or deleting necessary medical gas and power hook-ups, or even adding additional screens for physiological monitors or imaging without the need to demolish existing walls where these support items are typically mounted.

  • Providing each operating room with individualized HVAC equipment and controls. This allows each OR to have customized air flows that (again) can be adjusted to meet the isolation precautions of the procedures as requirements change, or vary the temperature of the rooms as needs for the patient change (i.e., colder rooms for pediatric patients). When these types of changes occur, the facilities can still remain supportive with no impact to adjacent operating rooms or without any downtime due to remodeling efforts that would otherwise be required in a more traditionally designed and engineered surgical suite.

Future Scenario #2: When the Surgeon and the Patient Stay at Home

Dr. Satava also discussed how the increased use of present day robotic surgery will soon be coupled with growing advances in real-time tele-communications and medical imaging, This confluence will lead to an “entirely new kind of operating room: one without a surgeon”. This idea is not so far-fetched from the reality of today where robotic surgical techniques with equipment like the da Vinci Minimally Invasive Operating System are in use at Botsford Hospital, but Dr. Satava see’s such technologies advancing even further to the point where the surgeon, like today’s present day radiologists, can practice from their homes utilizing a simple internet connection and computer control device to operate table-side robotic equipment to perform procedures on patients located thousands of miles away at remote healthcare facilities or even (ultimately) when patients remain at home too, with procedures performed on them while resting in bed.

The idea that surgery rooms may no longer be required is not that far-fetched. HKS Planners have seen how labor rooms in obstetrics, induction rooms in surgery and dark rooms in imaging suites have disappeared in the practice of medicine along with entire hospital-types such as free-standing birthing centers and TB Hospitals.

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On the project at Botsford, HKS planners are working with Team consultants to “Future-Proof” the facility and combat any potential obsolescence with the following design actions:

  • To support technologies of today such as the da Vinci Minimally Invasive Operating System, a series of strategically placed IT server closets and electronic equipment rooms were located by HKS planners throughout the surgical suite. To support this surgical system and other potential data-intensive systems of tomorrow, these IT locations are then “backed-up” with redundant equipment locations located several floors below surgery. These back-up locations are designed to replace the function of the hospital’s main data room if it succumbs to a natural disaster or other misfortune, and to prevent services from being disrupted in surgery or any other data intensive service accommodated on the future campus for Botsford.
  • For that time in the future when surgery can occur at home instead of the hospital, HKS Planners are designing the physical structure of the Botsford surgery suite with the same flexibility designed into it’s digital structure, to accommodate a variety of other healthcare functions through the implementation of a Universal Grid System.

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Like the Universal Room concept, the Universal Grid System supports radical “re-purposing” of hospital spaces without the need to change the basic structural system to preserve the “usefulness” of an area when repurposed for other space needs. By utilizing a 30’ x 30’ structural bay size inherent in this system, research and common experience has shown that less remodeling will be required in the future when repurposing space for other healthcare functions. This is due to common program elements such services share. The Universal Grid System allows for the greatest range of space use without the troublesome need of adjusting room shapes and sizes to fit a non-conforming structural grid when spaces are modified and walls relocating during remodeling efforts when the space is repurposed.

So with ideas like these put into action by the HKS Planners working at Botsford Hospital, and eventually becoming a reality through construction, Botsford will stand ready to swing at any curve balls the future may throw at it. Even if that future starts today.

Other medical technologies of the future:

Additional Images and Plans for the Master Facility Plan Implementation Project at Botsford Hospital, Farmington Hills, MI:

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