BRIDGE TO THE FUTUREBRIDGE TO THE FUTURETHE INFRASTRUCTURE THAT ENABLED DESIGN

OCTOBER 9 2009OCTOBER 9, 2009Presented by

ANGELA MAZZI AIA, WESTLAKE REED LESKOSKYV. MITCHELL LYLES PE, LEED AP, WESTLAKE REED LESKOSKY

Moderated byTBD Practice GreenhealthTBD, Practice Greenhealth

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"Creating products that make buildings better "Creating products that make buildings better.

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Today’s PresentersAngelaMazzi, AIA

Director of Healthcare

V. Mitchell Lyles, PE

Director of Engineering

C bi i ll l d t h i l tiI t ti d ith j t l

Programming and PlanningAssociate PrincipalWestlake Reed Leskosky

Director of EngineeringPrincipalWestlake Reed Leskosky

Combining unparalleled technical expertise with practicality: Principal Mitch Lyles, the firm’s Director of Engineering, has extensive experience in the design and management of engineered systems for healthcare and 

Integrating user needs with project goals, Angela Mazzi specializes in programming and planning, structuring design methods to foster innovative design in healthcare and lab facilities nationwide. An internationally 

research facilities. 

Mr. Lyles leads the firm’s integrated engineering effort and staff, as well as quality 

published author and researcher, She focuses on impacts of design environments on users; incorporating the demands of healthcare spaces with socio‐cultural issues such as site impacts user needs and control for mechanical engineering.  Under his 

leadership, Westlake Reed Leskosky received the prestigious ASHRAE Region V Technology Award for state‐of‐the‐art mechanical systems in a historic facility.

such as site impacts, user needs and community interaction.  

As Director of Programming and Planning, Ms. Mazzi leads the effort to research and systems in a historic facility.  Ms. Mazzi leads the effort to research and structure projects around current issues facing healthcare today. 

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© Practice Greenhealth 2009

Learning Objectives

Understand how sustainable systems and design affect i l d i f i l bj ioperational costs and infection control objectives.

Identify key MEP system design strategies for sustainability.sustainability.

Understand how the integrated project management approach and client interaction model can be applied.

Learn how to assess campus issues at a macro scale and apply design solutions that work at a microscale.

Understanding InfrastructureInfrastructure:Infrastructure: the most basic level of organizational structure in a complex body or system that serves as a foundation Organizational

Management of design process for serves as a foundation 

for the rest.

Physical

Organizational structure of the hospital

A/E team

Physical systems within the hospital

Infrastructure Informs Design

Programming and planning is not just constrained to architecture

Sustainable Goals

T t d

Proposed Systems Report

Effi i /lif l

Campus Assessment

Q lit f tilitTargeted energy reduction

Reduce carbon footprint

Efficiency/lifecycle analysis

Expandability/capacity

Quality of utility infrastructure

Existing capacityReduce carbon footprint

Stormwater management

Expandability/capacity

Reliability

Existing capacity

Ability to expand

Sustainable Strategies defined inSustainable Strategies defined in terms of operational goals

Energy•Measurement and Verification

RESOURCE

Water •Reduce reliance on potable water for uses that do not require it

MANAGEMENT

Link to Nature•Provide natural light to as many spaces as possible• Incorporate natural and local materials

IMPROVED SATISFACTION Incorporate natural and local materials

Air Quality•Use of outside air• Prevention of toxins and dust pollution

SATISFACTION AND OUTCOMES

•Prevention of toxins and dust pollution

Every Decision is ImportantSalem CommunitySalem Community Hospital Salem, OH

PHASE1LEED Silver

PHASE 2Green Guide for Healthcare

Investing in infrastructure has long‐term impacts on operation

Pilot Project

on operation

Quality materials, access to natural light and nature adds to the quality of life experience ofnature adds to the quality of life experience of staff and users.

Balancing PrioritiesInnovationsInnovations

• Reliability• Redundancy• Safety• Safety• Infection Control• Patient Satisfaction

Concerns

• Energy CostsEnergy Costs• Maintenance Costs• Direct Personnel Costs• Construction (First)CostsConstruction (First)Costs

Linking Priorities to Sustainability

•Solar powered heating•Steam bundling•Equipment Selection •Non‐potable water for 

i t li

Water Supply•Solar Panels•LED lighting•Master Controls •Natural ventilation

Clean Air

q p•Variable Pumping•Reliability/Redundancy

Energy Conservation

equipment cooling•Well‐water as a primary or secondary water source

Lighting

•Proper filtering•Heat capture

Linking Priorities to Sustainability

•Reduce fumes•Reduce allergens •Natural Light

Patient Satisfaction •Areas of respite

•Access to natural li ht

• Right‐sized 

Value

•Reduce chemicals•Reduce waste

Improved Outcomes

•Healing Garden•Natural Materials

light

Staff Retention

building• Efficient layouts

I t t d A h I t t d P j tOur approach to this project

Integrated Approach=Integrated Project

was to work as a MULTI-DISCIPLINED COLLABORATIVE:

Architect

Engineer

•Planners

•Building design

•Infrastructure design Interior ITY

Infrastructure design

•Code analysis

•Lighting design

A di i l/i f ti

Designer

Specifi‐INA

BIL

•Audio-visual/information

•Transport technology

•Security/life safety

Specifications

Specialty Cons.

SU

ST

A

•Low voltage system design Cons.

The Messy Truth of Old HospitalsUnavailable adjacentUnavailable adjacent property blocked expansion to the west

Central plant blocked expansion to the east

Older buildings that did notOlder buildings that did not meet code requirements for patient care blocked 

i h hexpansion to the northwest

Zero lot line to the south

The Messy Truth of Old HospitalsMultiple expansions overMultiple expansions over time prevents ideal adjacencies and relationships 

d t tamong departments

Circulation conflicts

Difficult for departments toDifficult  for departments to expand in place

Fire wall and smoke compartment issues

The Messy Truth of Old HospitalsMultiple pieces of equipmentMultiple pieces of equipment serving incremental parts of the building.

Inefficient pieces of equipment with no additional capacity led to the inability to tap into a y pcentral system for new projects.

N i i hi h lNo capacity within the central plants for expansion

Reassessing the SituationStepping back to look at theStepping back to look at the big picture from a “whole building” point of view

Master planning infrastructure not just buildings‐ systems g yexpandability

Making bold moves for big lresults

Incorporating redundancy and reliability into theand reliability into the sustainable plan

Th B id t th F tThe Bridge to the Future

Building a new central plant allowed state of the art equipment to be installed that accommodates future expansion

Relocating non‐clinical functions across street eliminated road blocks to expansion of patient spaceroad blocks to expansion of patient space.

R M tResource ManagementHospitals are among Reduce EnergyHospitals are among the largest energy consumers

Reduce Energy generated

• Decommission laundry with its high steam loads

• 24/7 high volume needs

Sustainable operationsSustainable operations and maintenance strategies are 

Re‐use steam capacity

•Use a portion of the resultant steam capacity 

for sterilization

Recycle waste steam

• Remaining low pressure steam

partnered with  equipment and design solutions

for sterilization•Use steam absorption chiller for first 400 tons of cooling generated

pressure steam used to heat 

domestic water

solutions 

Energy- Reducing Cost and Usage

Smart controls that allow real‐time monitoring of gas, water and electricity use

Ability to calculate month‐to‐date totals

Ability to broker prices with utilities

Fuel oil and generator backup avoids overruns for anomaly monthsanomaly months.

Energy- Providing a Cleaner Solution

Switch from boiler steam to clean electric steam generator for humidification to improve IAQ

Filtration of domestic water allows it to be used for atomization type humidification

Increased filtration efficiency with MERV‐8 and MERV‐14 filters

Fuel oil filtration that reduces maintenance and extends life of fuel oilextends life of fuel oil

Energy- Ensuring Reliability

Flywheel technology allows entire facility to be on UPS

Mission critical design for uninterrupted power and energy needs that go above and beyond standard healthcare requirements

No single point of failure in any MEP system

Entire Hospital backed up on emergency power

Water- Reducing Cost and Usage

Water conserving plumbing fixtures and fittings

Non‐potable well water used for cooling plant and boilers‐reducing demand on water supply/treatment facility.

Sub‐metering of process water to reduce overall costs

Reduced hard surface stormwater run‐off

Water- Providing a Cleaner Solution

RO/DI filtration for humidification; reducing maintenance costs

Use of atomization type humidification (purified water)

Condensate from cooling coils is used for water‐cooled medical equipment

Use of water cooled equipment avoids adding heat loads to buildingloads to building

Water- Ensuring Reliability

Well provides backup water in case of emergency

Two means for heating domestic water: natural gas and steam

Tri‐plex domestic water booster pumps for redundancy

Domestic water back‐up for remote radiators serving emergency generatorsemergency generators

Reaching Beyond SustainabilitySUSTAINABLE EBD SUSTAINABLE EBD

Increase planting on site

Provide views of nature

R d i d

Building and Resource Re‐

use

Acuity Adaptable Rooms

STRATEGY STRATEGY STRATEGY STRATEGY

Reduce Quantity of Stormwater

Improve Quality of Stormwater

Reduce pain and depression

Reduce stress

Reduce length of stay

Design for flexibility and adaptive re‐use

Minimize materials

Reduce Medical Errors

Reduce Falls

Reduce Length of St

Protect or restore open space Increase satisfaction

Waste reduction

Stay

Decrease staff injury

Increase staff effectiveness

Reaching Beyond SustainabilitySUSTAINABLE EBD SUSTAINABLE EBD

Provide Daylight into Occupied Spaces Access to Daylight

Improved Indoor

Improve air quality/Reduce 

STRATEGY STRATEGY STRATEGY STRATEGY

Occupied Spaces

Reduce lighting loadsReduce Pain and 

depression

Environment

Provide an environment free of disruptive levels of sound

q y/Noise

Reduce Medical Errors

Reduce pain

Speed healing

Improve Quality of Sleep

Reduce Stress

Reduce exposure to toxins

Reduce exposure to

Reduce pain

Reduce Stress

Improve Sleep

Improve performance

Reduce heat gain (when windows are properly 

oriented/sized)

Reduce Length of stay

Increase satisfaction

Reduce exposure to contaminants

Increase ventilation effectiveness

Improve Privacy/Confidentiality

Increase satisfaction

Increase staff effectiveness

Li k t N t Li htiLink to Nature- Lighting

Natural light reduces building lighting load

Light orients patients and maintains staff morale

Clerestories and translucent glazing protect patient privacy

Light is calming and aids in the healing process

Link to Nature- Materials

Locally available exterior materials in a palette matching existing campus were used.

Natural materials such as wood help interiors feel less institutional

Rubber sheet goods are an example of low‐VOC recyclable products that were used

Color palette found in nature is calming

Link to Nature- Places of Respite

Healing garden provides a destination and orientation point for patients and families

Native plant materials do not require excess watering or care

Landscaping aids in stormwater management

Landscaping around building perimeter reduces heat gaingain

Air Quality

Enthalpy‐based air monitoring maximizes use of outside air without compromising air quality

Extra enforcement of outside air intake protection during construction to avoid contamination of ducts.

Multiple layers of humidity control

Pre‐ and final filters selected for higher filtration efficiencyefficiency

Thinking Beyond Today’s Project

Designing in the capacity for future needs allows facilities to seamlessly change and grow

PLUG‐N‐PLAY• Services for future expansion were capped at the northern edge of the phase IIedge of the phase II development to allow seamless connections in the future

G tti R ltGetting ResultsThe new facility is 30% percentThe new facility is 30% percent larger than the existing facility, but the s.f. operating and maintenance costs have decreased by incorporating the following design strategies:g• utility metering

• chilled water optimization

f li• free cooling

• economizer cycles

• energy efficient lighting

Getting Results

The new utilities infrastructure positions the hospital for future expansion projects and all currentexpansion projects and all current and critical systems needs.  

It allows purchase and easy load‐in of chillers, boilers, UPS modules, and engine generators to handle current loadsto handle current loads, increasing hospital demands, and potential emergencies.

Getting ResultsTO

Logical circulation separating staff, public, and patient traffic

VISITORAMB.

PATIENTSSTAFF

DISCHARGE

TO

and patient traffic

Maximized adaptability and flexibility 

OR’s

CORE

OR’s

OUTPATIENTPRE/POST OP CARE

TO CSR

Optimized flow for materials receiving, processing and

INPATIENTPRE/POST OP

CARE

TO ORTO ICU/MS

EXPA

NSI

ON

SOILED PROCESSINGINCOMING

TO

TO SURGE

RY

processing, and distribution.

SUPPLIES

STERILIZATIONEQUIPMENT/CA

RT STORAGE STAFF

VISITORS/ DELIVERIES

OUTGOINGHOSP.

Getting ResultsShell spaceShell space accommodates growth

Adjacent inpatient and j pambulatory areas are each other’s overflow spacespace 

Central core OR concept creates uninterrupted link to CSR below

Integrated storage reduces clutterreduces clutter

Getting Results

universal bays handle pre‐and post‐operative patientspatients.  

Integrated OR incorporates booms to accommodate various procedures and preferences.  

Outfitting OR’s with theOutfitting OR s with the same equipment allows any procedure to take place in any room

Getting Results

Natural light for both departments‐ even in the basement even inthe basement, even in staff‐only areas  

Staff areas of respite such as outdoor break area

The Bridge to the Future

The path to facility expansion

The Bridge to the Future

A lifeline to operations and pmanagement

The Bridge to the Future

The link to sustainablesustainable campus design

Questions?

DES IGN ING THE SPACES THAT MAKE PEOPLE BETTERDES IGN ING THE SPACES THAT MAKE PEOPLE BETTER

Angela Mazzi, AIA

DES IGN ING THE SPACES THAT MAKE PEOPLE BETTERDES IGN ING THE SPACES THAT MAKE PEOPLE BETTER

Associate PrincipalDirector of Healthcare Programming and Planning amazz@wrldesign.com

V Mitchell Lyles PE LEED APV. Mitchell Lyles, PE LEED APPrincipalManager of Engineering mlyle@wrldesign.com

Special Thanks to our Sponsor

“Creating products that make buildings better.”

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