Kaiser Permanente’s Template for Success

Faced with having to replace half its California beds by 2015, the nation’s largest nonprofit HMO created a prototypical hospital template that can be built on virtually any site, with few modifications.
August 11, 2010

     
   
  One of the template’s signature elements is the two-story entry rotunda, which connects to both the hospital portion, shown behind and to the right of the entry, and to the MOB component, shown left of the entry. PHOTO: ROBERT CANFIELD FOR SMITHGROUP  
     

































K aiser Permanente’s two new California hospitals, in Antioch and Modesto, were already well into schematic design when John Kouletsis asked designers at the two architectural firms working on them to put down their drawing pens.



































Kouletsis, director of strategy, planning, and design with Kaiser Permanente’s National Facility Services in the healthcare provider’s Oakland, Calif., headquarters, had other ideas for the new hospitals and for the firms working on them—SmithGroup and Chong Partners Architecture (now Stantec Architecture).

He wanted the two firms to forget about designing discreet facilities. Instead, he wanted them to form a 50/50 joint venture in which they would collaborate on the design of a new hospital template—a state-of-the-art, prototypical hospital that could be built on many different sites (ideally 40-50 acres) with only a minimum of changes to the basic concept.

     
   
  Nursing units consist of 24 patient rooms located within a triangular floor plan. Each hospital template has two nursing towers. PHOTO: ROBERT CANFIELD FOR SMITHGROUP  
     
   
  A. Patient room  B. Clerk  C. Waiting room  D. Administration  
     
   
  A. Secondary MOB. B. MOB. C. Hospital. D. Nursing units. E. Signature entry rotunda. F. Future construction (including hospital expansion, additional MOB, clinic, and parking. G. Future helipad. The plan above shows the Antioch, Calif., facility, which is the first one completed using the template.  
 

His plans for the standardized template would transform the way Kaiser—the nation’s largest nonprofit HMO, with 8.7 million members—approached the design and construction of its new and replacement facilities throughout California.



“The idea was to design a whole new way of going about design,” says Kouletsis. “Driving the idea was the ability to have a building template that embodied the best known clinical practices and allow it to be built quickly and efficiently.”

Being quick and efficient has become tantamount to survival for Kaiser Permanente’s California operations. “We’re rebuilding roughly half our California beds to make them seismically compliant,” says Kouletsis. “That’s a level of building we’ve never had to deal with in our entire history.”

The healthcare provider’s new California hospitals have to be fully operational no later than 2015, thus demanding a construction schedule that puts enormous pressure on the HMO. A typical Kaiser Permanente hospital takes seven-and-a-half to eight years to get built, so the template was seen as a means to cut expenses and shave a significant chunk of time off each hospital.

Over the years, Kaiser had developed best-practices templates for emergency departments, patient rooms, and other individual clinical spaces, but this was the first time those one-off, room-by-room templates would be combined into a single configuration for an entire hospital.

The Building Team members—SmithGroup/Chong Partners, along with Taylor & Associates Architects (Newport Beach) for interior finishes and contractors Harbison-Mahoney-Higgins Builders (Sacramento) and the Irvine office of Whiting-Turner Contracting Co.—were eager to dig into the template idea. But another team member was less enthusiastic. Thinking it would be prudent to have key regulators engaged with the project early on, Kouletsis asked the California Office of Statewide Health Planning and Development to participate. OSHPD’s response: We think you’re going to fail…but we will work with you. And they did, which Kouletsis says played a pivotal role in sheparding the plans through the approval process.

The collaboration begat Template 1.0, which consists of common structural and building systems, planning concepts, floor plans, and equipment and furnishings. Exterior skins and colors may vary from site to site. Each template consists of three main building elements:

The diagnostic and treatment block, always a three-story component, is organized around a central spine with windows arranged to take advantage of natural light regardless of the building’s orientation. Within the block there are several pockets of “soft space” that allow the departments to flex over time and accommodate future growth without requiring major reconstruction.

The nursing units are two triangular towers with two 24-bed units per floor and decentralized nursing stations. The nursing towers are flexible in height, depending on the number of beds required at each location.

A separate medical office building, which is basically half of the template, is always coupled with the hospital. The hospital and the MOB share a two-story entry rotunda that’s become part of Kaiser’s design brand.

Because construction costs for the MOB are significantly less than the hospital component, there was a concerted effort to keep the hospital footprint smaller and less expensive to build. Therefore only those functions mandated by Titles 22 and 24 to be within the hospital itself are located there. All other services are located within the MOB.

Five new California hospitals have utilized Template 1.0. The 430,000-sf Antioch facility, which opened last November, took just five years to build from start to finish. “The template shaved 15-18 months off the typical new hospital project,” says Carl Christiansen, VP, principal in charge, and California healthcare studio leader based in SmithGroup’s San Francisco office. Four other facilities, in Modesto, Irvine, Vacaville, and Ontario, are still under construction.

Another three projects in the planning stage will use Template 2.0, a slightly updated version of the original. “We don’t want the template to be static,” says Kouletsis. “The first generation was very good, but we learned from each project that there were things we could do better, so with 2.0 we’re taking it up a notch. We’ll have a 3.0 if there are even more projects.”

         
 

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