The healthcare design and construction picture has been muddied by uncertainty over the new healthcare law. Hospital systems are in a bind, not knowing what levels of reimbursement to expect. Building Teams serving this sector will have to work even harder to meet growing client demands.

March 01, 2012

Princeton Healthcare System: Applying the '70/30 rule'

Princeton HealthCare System’s University Medical Center at Plainsboro, designed by HOK (with RMJM Hillier), with Syska Hennessy as MEP engineer, Turner Construction as GC and Navigant as PM/development adviser. It opens May 22.

The 231-bed replacement hospital that Princeton HealthCare System (PHCS) is about to open in Plainsboro, N.J., is based on an intense reorganization strategy developed through something called the 70/30 rule.

“The 70/30 rule says that 70% of organizational improvement comes from re-engineering your existing operations. The other 30% comes from the physical design,” says the rule’s progenitor, Fred Campobasso, managing director for healthcare at Navigant, PHCS’s development adviser and program manager.

Barry Rabner, PHCS’s CEO for the last decade, and his board brought in the consultant several years ago, when it became clear that the 93-year-old hospital in downtown Princeton needed to rethink its entire organization in order to compete with local rivals Capital Health Regional Medical Center, in Trenton, and Robert Wood Johnson University Hospital, in New Brunswick—not to mention quaternary hospitals less than two hours away in Philadelphia and New York.

With Navigant’s counsel, PHCS officials engaged in a robust strategic planning process that included tours of a dozen other hospitals. From this came a set of guiding principles—notably, to reduce infection, errors, falls, and operating costs, and to improve clinical outcomes and patient satisfaction.

These are fairly common guidelines, but PHCS planners took them very much to heart. “Every time we had a decision to make, we would look at the guiding principles,” says Rabner.

The key question: whether to rebuild in downtown Princeton, or move out altogether. “Our patient population was growing, but 70% of our market was coming from the region, not from downtown,” says Rabner.

Navigant helped the PHCS staff evaluate 10 core processes, from registration to discharge. To test their ideas, PHCS built a model patient room—not the usual rough mockup, but a fully functional patient room, right in the existing hospital—and provided patient care right there. “We made more than 200 changes,” says Rabner. Examples: putting a safe that could hold a laptop in the room, and installing a swivel night light next to the visitor’s couch to allow the patient to sleep.

The plan that eventually flowed from this process called for the main campus to be moved three miles out to a 171-acre site in suburban Plainsboro, where the new hospital would form the core of an elaborate mixed-use complex.

More important, the new PHCS University Medical Center at Plainsboro would step up its clinical capabilities through partnerships with nearby world-class institutions. The first of these is with Children’s Hospital of Philadelphia (CHOP). “My motto was, Don’t dabble,” says Rabner. “We were dabbling in pediatrics, and we determined that we would do better with a partner.” CHOP will build and staff a 100,000-sf clinic on the new campus; children needing more intense care will be transported to Children’s Hospital of Philadelphia.

PHCS had to go all out to sell the plan—which called for PHCS to divest the existing properties, including the old hospital—to the highly sophisticated Princeton community. “We had almost 75 meetings just on the strategic plan, and another 75 on the building design and zoning approval in Plainsboro Township,” says Rabner.

The logic of the plan turned the tide of opinion in PHCS’s favor. The old hospital has been sold to Princeton University, which will convert it into housing for faculty and staff. AvalonBay Communities bought the second site and will build apartments and keep the existing medical office building in operation.

The new 2.1-million-sf campus is being financed with cash from operations and the property sales, along with bonds and donations. The 630,000-sf University Medical Center at Plainsboro will offer nine centers of care, a 24-bed emergency department, eight labor/delivery rooms, 24 postpartum rooms, and 600-sf surgery suites.

In addition to the CHOP clinic, Formation-Shelbourne will build an 85-unit senior living complex, and Trammell Crow is putting in a five-story, 146,000-sf medical office building. Windsor Health has built a 200-bed skilled nursing facility and a subacute nursing facility, and will soon open a dialysis center. In the works: a 47,000-sf fitness/wellness center and a 13,000-sf childcare facility.

Rabner says he made “a big discovery” building the first new hospital of his career: “Before, I viewed a building as a container that holds people and equipment. I didn’t understand that the building has the capacity to help us reach our objectives.”

On May 22, he and his PHCS colleagues will find out how far they have progressed toward that goal. +


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