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International Union of Architects/Public Health Group Forum. September 26, 2013. Humber River Hospital. North West Toronto, Ontario Central LHIN Catchment Area of 850,000 Diverse high needs community Providing service on 3 sites 3 outdated facilities within 10 mile radius

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International union of architects public health group forum

International Union of Architects/Public Health Group Forum

September 26, 2013


Humber river hospital

Humber River Hospital

  • North West Toronto, Ontario

  • Central LHIN

  • Catchment Area of 850,000

  • Diverse high needs community

  • Providing service on 3 sites

  • 3 outdated facilities within 10 mile radius

  • 600 physicians, 2800 staff , 300 volunteers

  • Affiliate - University of Toronto


Humber river hospital today

Humber River Hospital – Today


Redevelopment vision

Redevelopment Vision

  • One full service acute care facility on a Greenfield site bringing together all acute care services to create the volumes for centers of clinical excellence and efficiency

  • An ambulatory site for urgent care services in the highest need area of our community


Planned growth

Planned Growth


Alternate funding procurement afp in ontario

Alternate Funding Procurement (AFP) in Ontario

  • Released in July 2004, the Building a Better Tomorrow Framework sets out the Province’s approach to infrastructure planning, financing and procurement, including when the Province will consider using AFP strategies.

  • Five key principles under the Framework:

    – Public interest is paramount

    – Value for money must be demonstrated

    – Appropriate public control/ownership must be preserved

    – Accountability must be maintained

    – All processes must be fair, transparent and efficient


Alternate finance project afp design build finance maintain dbfm

Alternate Finance Project (AFP)Design Build Finance Maintain (DBFM)

  • Use of private expertise and financing to rebuild public infrastructure

  • The public sector is responsible for establishing the scope and purpose of the project and paying for it with a long-term stream of payments.

  • The private sector is responsible for design, construction, financing and maintenance/lifecycle of the facility over the term of the contract (usually 30 years).


What is an afp or dbfm project

What is an afp OR dbfm Project?

  • A.K.A. - Public Private Partnerships, or Performance Guaranteed Facility

  • Private partner - Design, Build, Finance and Maintain infrastructure (greenfield or renovations and expansions)

  • Facilities management over a long term concession period (in this case 30 years + construction) with pre-defined hand back conditions

  • Single entity (“Project Company”) contracts with a Public Sector Sponsor entity and in turn contracts with consortium partners

  • Performance based contracting arrangements

    • On-going payments are subject to deduction for failures in service delivery

  • Firm price for term of the concession


40 year facility cost of operations 1

40 Year Facility Cost of Operations1

Note 1: From July 2010 Healthcare BIM Consortium ,An Organization consisting of Department of Defense Military Health System (DoD MHS), Department of Veterans Affairs (DVA), Kaiser Permanente (KP), and Sutter Health, representing $26B of Healthcare construction


Value for money dbfm project

“Value for Money” – DBFM Project

  • Long term “Whole of Life” costs instead of first cost construction

  • Good decisions during design process consider Value for Money and best investment approach

  • Results in lower whole-of-life facility cost (the “box” is smaller)

  • Facilities management over a long term concession period (in this case 30 years + construction) with pre-defined hand back conditions

  • Provides outcomes that are guaranteed as a result of performance requirements

  • Financing returns are vehicle for Sponsor to enforce the guarantees


Our future

Our Future

14


Developing our vision

Developing our Vision

Considerations

  • An opportunity to design efficiently

  • Patient Centered

  • Capital is one time – operating is forever

  • Designed to make a big hospital feel small

  • Designed to be more accessible

  • Separation of inpatient and outpatient services

  • Respect for interventional procedures

  • Piazza type gathering areas


Developing our vision1

Developing our Vision

Considerations

  • An opportunity to design efficiently

  • Patient Centered

  • Capital is one time – operating is forever

  • Designed to make a big hospital feel small

  • Designed to be more accessible

  • Separation of inpatient and outpatient services

  • Respect for interventional procedures

  • Piazza type gathering areas


Current evolution of hospitals

Current Evolution of Hospitals

  • Deliver high quality, patient centered care cost effectively

    • Maximize efficiency of limited human resources

    • Allow clinical staff to focus on providing care – reduce administrative tasks!

    • Minimize equipment redundancy and maximize equipment utility

    • Optimize inventory turnover


Current evolution of hospitals1

Current Evolution of Hospitals

  • Health, health care and the environment are inextricably linked. The design and construction of a new hospital should be a model of sustainability, efficiency and achieve LEED® rating

  • Impact operating budget to save energy costs


Current evolution of hospitals2

Current Evolution of Hospitals

  • Utilize the most current technologies possible to enhance all aspects of quality care and efficiency.

  • Leverage technology and push technology wherever possible to improve efficiency,accuracy, reliability and safety.


International union of architects public health group forum

Healthcare Reinvented

Green

Patient Centered Care

Work Place of Distinction

Lean

Digital


International union of architects public health group forum

vision : LEANGREEN DIGITAL

  • Philosophy of form follows function

    • Maximize Clinical Efficiency - deliver cost effective care in one of the largest hospitals in Ontario through design, staff mix and appropriate technology mix.

  • Allow for smooth movement of patients, staff and visitors while reducing waiting times.

  • Computer modeling and lean workflow analysis to test design possibilities to ensure efficient flow and reduced travel time


Efficiency by design

Efficiency by Design

Bigger, Nicer, Newer but actually

LESS EFFICIENT in delivering care


Why worry

Why Worry?

  • Current size on 3 sites = 980,000 sq feet

  • New facility = 1.8 million sq feet


Hrh travel distance problem

HRH Travel Distance Problem

GE HoF study demonstrated

Total Distance Traveled in Current HRH Facilities:

Medical Inpatient Nurse walks 5.4 km per 12 hour shift

Use current technology, same model of care

in modern space and design standards

Medical Inpatient Nurse walks 11.6 km per 12 hour shift


Evaluating the vision elements

Evaluating the Vision Elements


Lean green and digital

LEAN, GREEN and DIGITAL


International union of architects public health group forum

Delivering the vision

GREEN

SUSTAINABLE, ENERGY EFFICIENCY

100% FRESH AIR THROUGHOUT

ASHRAE 90.1-2007

40% ENERGY SAVINGS

SUN/SHADE MANAGEMENT STRATEGY

40 % DECREASED ENERGY CONSUMPTION

MAXIMIZE CAMPUS GREEN INTIATIVES


Dbfm energy and npv

If we take a hospital with a first year utility bill of $5,500,000….

The Energy NPV is $223,124,436

If we reduce the annual utility rate by 40% than our Energy NPV is…

$133,874,661 (30 years)

That’s a difference of $89,249,775 (30 years)

DBFM: ENERGY AND NPV


Energy model in dbfm

Energy Model in DBFM

  • Energy Consumption is the responsibility of the operator

  • Cost of Energy is paid by the hospital

  • DBFM model rewards energy efficiency with a pain share/gain share model


Evaluating the vision elements1

Evaluating the Vision Elements


Lean green and digital1

LEAN, GREEN and DIGITAL


International union of architects public health group forum

  • PHYSICAL PLANT

  • Site and Gross adjacencies

  • Departmental Layouts

  • OPERATIONAL STRATEGY

  • Staffing Levels

  • Task Assignment

  • Shared Resources

  • CARE DELIVERY

  • Clinical Pathways

  • Technology Adoption

  • Local Practices


Increase efficiency

Increase Efficiency

  • Maximize efficiency of limited human resources

  • Allow clinical staff to focus on providing care – reduce administrative tasks!

  • Minimize equipment redundancy and maximize equipment utility

  • Optimize inventory turnover


International union of architects public health group forum

Interoperability


Elements of the digital vision

Elements of the Digital Vision?

  • Digital components

    • IP Network

    • IP based equipment

    • Unified communications

    • Digital content management

  • Automation components

    • Automated Guided Vehicles

    • Pneumatic Tube System

    • Pharmacy automation

    • Laboratory automation

    • Surgery automation

  • Interoperability

    • Workflow orchestrations

    • Interoperability engine – Enterprise Service Bus

  • Service Oriented Architecture

  • Abstraction

  • Governance


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