The Right Path: Penn Medicine

March 2, 2022
9:41 am

Justice News Flash Report

The Right Path: Penn Medicine

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From the beginning, Penn Medicine’s new Pavilion was going to be a big deal. The $1.6 billion inpatient building on the Hospital of the University of Pennsylvania’s (HUP) campus in Philadelphia marks the largest capital project in the University of Pennsylvania’s history. Furthermore, it expands the academic medical center’s research, clinical care, and education offerings, including cardiology, oncology, neurology, emergency, and transplant, and is the latest piece of an overall vision that started nearly two decades ago to transform HUP into a connected medical campus.

That vision would call for a sizable building—specifically, a 1.5 million-square-foot, 17-story facility that houses 504 patient rooms, 47 ORs, and a two-story emergency department with 61 exam rooms. Due to the massive size of the project, leaders at Penn Medicine saw an opportunity to utilize an integrated project delivery (IPD) process for the first time. In 2015, a multidisciplinary IPD team, called PennFirst, was formed. Comprising Penn Medicine, architecture firms HDR and Foster + Partners, engineering firm BR+A, and construction managers L.F. Driscoll and Balfour Beatty, the team had more than 100 team members housed together in a collocation office (called “the collo”) on Penn’s campus throughout most of the seven-year project. “It was really kind of a learning lab that was designed to promote the collaboration and innovation that we were looking for,” says Sara Gally, interior design principal at HDR (Philadelphia), which was the architect of record on the project and designer of the clinical areas. Foster + Partners, which collaborated with HDR on the overall architecture, provided the design of the exterior and public space interiors.

One of the first tasks of the IPD team was outlining a set of guiding principles focused on patient experience, investing in the community, innovation, enhanced patient care, and designing for flexibility. Daryl Bodewin, director of strategic projects at HDR (Princeton, N.J.), says a “patient first” mentality permeated the decision-making process from the start, with the team focused on providing private patient rooms equipped with the latest technology to help patients engage in their care. Another goal was to create a “future-ready” building with acuity-adaptable patient rooms capable of flexing from medical/surgical to intensive care as well as hybrid operating rooms (ORs) with intraoperative MRIs and infrastructure to support evolving technologies. “[Penn] wanted to make sure the building had the ability to adapt and grow as healthcare changes, so they wouldn’t lose that patient experience, and that they can always maintain that level of care over the life of the building,” Bodewin says.

Campus landmark

While the size of the building was embraced, the design team wanted to make sure it complemented the existing medical center buildings and neighboring University of Pennsylvania Museum of Archaeology and Anthropology (known as the Penn Museum), a historic facility that incorporates a variety of architectural styles, including a rotunda. “As we studied the building more and more, we felt like we shouldn’t try to pretend that it’s not big and break it down into lots of different pieces,” says Chris West, partner and architect at Foster + Partners (New York). “Instead, we decided to treat this building as a large sculptural element and not try to conceal that.”

Balancing the desire to be a good neighbor while creating a new campus landmark, the project team decided to forgo a more traditional rectangular building shape and round the ends of the Pavilion—a nod to the museum’s architecture that also helped to “soften the building’s presence,” says Derek Tasch, health system architect at Penn Medicine (Philadelphia). “It also makes it a little more welcoming and fitting in the space.”

Inside, however, the facility was shaping up to resemble a lot of other hospitals, with patient floors utilizing a racetrack layout with two patient units divided by a single public core in the middle and patient rooms wrapped around the perimeter, including the curved ends of the building. Because of the IPD approach, clinicians and staff had been involved throughout the design process; the team had utilized table-top models, room mock-ups, and visualization tools such as virtual reality glasses to review layout and room concepts with the staff. “Everyone was seemingly happy with the direction we were going in,” Tasch says. Taking it one step further, the team decided to build a 30,000-square-foot Styrofoam mock-up of part of an inpatient floor and bring in nearly 500 hospital staff, including clinical surgeons, nurses, environmental services staff, mock patients, and food service, to tour and participate in simulations and day-in-the-life scenarios to help find any friction points that might need to be addressed. “It was the most important moment in the project,” Tasch says.

However, instead of reassuring the team that it was on the right path, the process resulted in some unexpected feedback, specifically on walking distances, the size of the floor plate, and access to daylight. For example, West says, while the goal was to make all the acuity-adaptable patient rooms identical in size and layout, the ones that wrapped around the curved ends of the building were more irregularly shaped, which impacted clinical care. Furthermore, the configuration of the public elevators in the middle of the building meant some visitors would have to walk nearly 300 feet to their destination, West says.

Rather than move forward on that plan, the team decided to spend another few months rethinking and redesigning the layout. Among the changes that ultimately came out of the process were elongating the building to 650 feet to get all the patient rooms to the same square layout and size, adding family lounges at the rounded ends of the floors to help bring daylight into the corridors, designing two separate sets of public elevators to reduce walking distances, and utilizing a flexible planning system that enables the 72-bed inpatient floors to be broken down into smaller units to respond to changing needs and patient demands. Once again, the team built a 30,000-square-foot mock-up of the patient floor—a process that went much better the second time around and led to getting the right hospital built, Tasch says. “It was the best thing that ever could have happened to us,” he says.

Defining elements

Opened in October 2021, the Pavilion features a variety of amenity spaces on the first two floors, including a chapel, café, cafeteria, and family caregiver center, while the interventional and patient floors are housed on levels four to 14. Within the clinical areas, the building programming was arranged so that ICU care and inpatient units for specific service lines, such as oncology, are placed on the same floor to allow care teams to respond quickly to changes in care level or treatment needs. Meanwhile, neuroscience research and care are brought closer together through an advanced epilepsy monitoring unit and a human neurophysiology research lab.

For the interiors, PennFirst focused on elements of hospitality to create a welcoming, noninstitutional setting. The overall neutral palette features natural materials in strategic locations to add a sense of warmth as well as serve as visual cues to support wayfinding, such as copper portals to frame the entrances to the elevator lobbies on the first floor. Wood is used throughout the facility, starting with bigger gestures in the public spaces—such as on the ceiling in the main corridor on the first floor or on the walls of the elevator lobbies—to create a sense of welcome within the environment. It’s also used more sparingly on the patient care floors to denote specific focal points, such as at the footwall in the patient room, Gally says.

The clean aesthetic also provided a backdrop for two art installations in public areas of the hospital, including a vibrant mural by Philadelphia artist Odili Donald Odita, which starts on the first floor and stretches up to the second floor and down a corridor. The other work, a handmade glass sculpture titled “Decoding the Tree of Life” by artist Maya Lin, is installed in a quiet respite space near the chapel on the first floor and rises through an opening in the floor to the second level. “It goes from being a very dynamic piece at its top to a very contemplative piece at its base,” Gally says.

Throughout the facility, a priority was made to use materials, indoor finishes, and furniture that would contribute to healthy indoor environments, says Eileen Gohr, senior sustainability consultant at HDR (Atlanta), using guidance from the Health Product Declaration Collaborative and U.S. Green Building Council’s LEED for Healthcare guidelines. (The Pavilion is the largest project in the world to achieve certification in LEED v4 Gold Healthcare.) Along with indoor air quality, the building also was constructed with energy- and water-saving features, such as low-flow sinks and showers and low-flush toilets, which are expected to cut indoor water use by 30 percent. “We really wanted to deliver an environmentally responsible contribution to the campus,” Gohr says.

Additionally, during construction, about 25 percent of materials were prefabricated and manufactured off-site, which helped to minimize on-site waste and reduce site congestion. Ed Hanzel, vice president at L.F. Driscoll (Bala Cynwyd, Pa.) and the project executive representing the construction team on PennFirst, says a multidisciplinary group within the IPD team was organized early in the project to consider how prefabrication could be utilized. The bathroom pods for the facility’s 504 patient rooms were a good place to start, he says, because of the repetition of elements and potential for cost and time savings. But the project team didn’t stop there, also prefabricating the headwalls; nurses’ alcoves on the patient floors; and 570 mechanical, electrical, and plumbing racks.

Turning to the exterior architecture, West says the PennFirst team chose a lightweight extruded aluminum panel system that’s used on louvers that conceal the mechanical systems housed on the rooftop as well as the second and third floors, and the spandrel panels of the building. “It unifies the building and kind of echoes the scale of brickwork but in modern way,” West says. Inspiration for the color scheme came from the historical deep purple/brown-colored brick that’s used throughout the university’s campus and in some of the existing building on the medical campus. “It shines and catches the light in different ways and gives a real visual complexity that’s quite nice to look at,” West says.

Future-ready tools

Reflecting on the project, Tasch says many of the firsts on the project for Penn Medicine, including the IPD and prefabrication processes, are tools that he expects the healthcare organization to take forward to future projects. “We’re still working on our lessons learned, but these are certainly things that we’re going to revisit and continue with and improve upon,” he says.

Alyson Cole, associate executive director, HUP transition and occupancy, at Penn Medicine, says feedback so far has been positive on the new Pavilion, including how some of the building’s inherent features have supported infection control during the pandemic, such as the private patient rooms and the updated HVAC system, which provides outside air to the patient rooms. Additionally, she says staff members have commented on the access to natural light and the fluidity of the patient floors, which helped eliminate barriers between units. Looking ahead, she says Penn Medicine plans to do more in-depth review and study of the building and operational performance, including energy- and water-saving features, patient experience, and investments in flexibility, particularly in the acuity-adaptable patient rooms. “It was designed to be flexible,” she says. “Time is going to tell if, in fact, we are as flexible as we think we have built to be.”

Project details:

Project name: The Pavilion at the Hospital of the University of Pennsylvania

Project open date: October 2021

Owner: Penn Medicine

Total building area: 1.5 million sq. ft.

Total construction cost: $1.6 billion

Cost/sq. ft.: +/- $1,000

Architect, interior designer, general contractor, engineer, builder: PennFirst

Art consultant: Ivy Press

Signage/wayfinding design: Cloud Gehshan

AV equipment/electronics/software: Schneider Electric (low voltage integrator), JBB (A/V design), Yorktel (A/V install)

Carpet/flooring: Mannington, Polyflor, Duraflex, Sika,