International case study on massachusetts general hospital
- 1. ADAMA SCIENCE AND TECHNOLOGY UNIVERSITY DEPARTMENT OF ARCHITECTURE & URBAN PLANNING CASE STUDY ON MASSACHUSETTES GENERAL HOSPITAL BY; TILAHUN GETACHEW ID; A/UR 4997/09 SUBMITTED TO; Ins. SOLOMON
- 2. CONTENTS 1/ INTRODUCTION 1.1/ BACKGROUND 1.2/ LOCATION 1.3/ SERVICES 2/ DESIGN 2.1/ PROJECT DESCRIPTION 2.2/ ZONING 2.3/ URBAN RESPONSE 2.4/ CONNECTIONS 2.5/ PROGRAM CONCEPT 2.6/ COMPLEXITY 2.7/ DESIGN TOOLS 3/ CONSTRAINTS 4/ SAFETY AND SATISFACTION 4.1/ ROOM SAFETY 4.2/ NOISE 4.3/ LIGHT 5/ FLEXIBILITY 6/ ACCORDANCE OF DESIGN 6.1/ WAITING TIMES 6.2/ STAFF BENEFITING 7/ DESIGN DOWN TO DETAILS 8/ ENVIRONMENTAL POSITIVITY 8.1/ POSITIVE VIEW 9/ DEFECTS IN DESIGN 10/ ACRONYMS & REFERENCE 11/ CONCLUSION M A S S A C H U S E T T S G E N E R A L H O S P I T A L M G H
- 3. INTRODUCTION For 200 years, Massachusetts General Hospital has been at the fore- front of patient care, medical innovation and education. In July 2011, Mass General opened the doors to the new Lunder Building. The Lunder Building, a 530,000-square-foot, 14-floor medical facil- ity located at the heart of MGH’s main campus in Boston, reflects this progressive tradition with its state-of-the-art facilities and leading-edge technology. BACKGROUND Founded in 1811, Massachusetts General Hospital (MGH or the Proponent) is the third oldest general hospital in the United States, and the oldest and largest in New England. The 999-bed, world-renowned medical center offers sophisticat- ed diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. MGH repeatedly is named one of the country’s top hospitals by U.S. News and World Report, ranking in the top three nation- wide for several years. The hospital’s main campus is in down- town Boston. The MGH main campus has an Institutional Master Plan that was approved in 2006 and amended in 2010 (IMP) to include the Paul S. Russell, M.D. Museum of Medical History and Innova- tion. The IMP is expected to be renewed in 2016. CASE STUDY ON MGH Massachusetts General Hospital (MGH) is a large academic medical center in Boston. MGH operates five commu- nity-based health care cen- ters in and around Boston 1
- 4. INTRODUCTION Massachusetts General Hospital (MGH) is a large, academic medical center in Boston, MA. Through clinical practices, outreach, research, recruitment, and train- ing/education at its main campus and five community-based health centers, MGH is pursuing consumer/patient-centered care (PCC) for underserved populations in a variety of ways. Below are some “best practice” strategies undertaken at MGH that help achieve the core components of PCC, and that should be considered for replication or adaptation at other health care organizations: Create a Welcoming Environment: *All signs are in multiple languages; staff wear name tags with welcoming message. *Routine home visits from MGH’s community health centers are made to new refugee families to: welcome them; better understand family’s culture, environment, attitudes about health care, and needs; and jointly de- velop a family “plan” for their health. Educate, Empower, and “Activate” Patients: *A highly visible, accessible, and well-staffed learning center offers educational materials in multiple lan- guages; e.g., booklet defining common health/hospital terms in 18 languages, videos that can be piped into patient rooms. *Health literacy workshops are geared to sixth to eighth grade level in languages most spoken. *Group patient visits and seminars for community residents focus on specific issues most relevant to vulnerable populations such as asthma, breast cancer, nutrition (e.g., refugees taught about food and how to use food stamps), and financial literacy. CASE STUDY ON MGH 2
- 5. CASE STUDY ON MGH 3 INTRODUCTION Promote Socio-Cultural Competence: *Initial request is made for patient’s preferred language, with inter- preters arranged for scheduled visits and 24/7 access to interpreters for walk-ins and emergencies; a language card available in 19 languag- es explains how to access an interpreter. *Staff for community health centers are recruited from local neigh- borhoods. *Staff selected in part based on diversity and sensitivity regarding patients’ background, culture, individual preferences. Provide Physical and Emotional Support: *Social workers are integral part of patient care team, to support patients and families both in emotional and physical needs; e.g., adjusting to illness, coping with death and dying. *Assistance is provided to low-income out-of-town families in finding affordable shelter if family member has extended stay at hospital. Promote Access to Care: *A pilot program informs low-in- come and minority cancer patients about potential enrollment in clini- cal trials. *Under another pilot program, a Medicaid managed care plan reim- burses outreach workers for “naviga- tion” services.
- 6. CASE STUDY ON MGH 4 INTRODUCTION Committees and Departments devoted to PCC-related issues: *Multicultural Affairs Office – dedicated to recruit, develop, and re- tain minority physicians. *Patient Care Service Diversity Steering Committee- supports pro- grams and events that promote diversity of nursing workforce, profes- sional development of minority employees, student outreach, culturally competent care, and patient education materials tailored to a diverse population. *Committee on Racial and Ethnic Disparities - charged with identi- fying racial disparities incare at MGH, developing solutions, coordi- nating with mayor’s citywide initiative. Includes president of hospital. Subcommittees collect and analyze data, hold forums, publish articles, raise awareness, etc. *Disparities Solution Center – devoted to studying why disparities exist and how to address them, training medical professionals and building leadership, identifying and promoting best practices in reduc- ing disparities in health care. *Multicultural Community Advisory Committee - informs MGH about minority patients’ experiences with and perceptions of their care, and recommends ways to address issues identified.
- 7. CASE STUDY ON MGH 5 LOCATION The hospital’s main campus is in downtown Boston. The building located at 125 Nashua Street MGH is located in USA with many other branches in America.
- 8. CASE STUDY ON MGH 6 SERVICES Not only was the function of the unit important, but the staff also expressed that they were looking for a product that would fit in with their eco-friendly construction. There was a need to install a product that would help to reduce the stay of the patient and create an environment where the staff and clinicians would be able to do their best work. Specifically, the Neuro Intensive Care Unit(ICU) would feature intra-operative imaging, the latest technology in brain tumor removal surgery. Therefore, for safety as well as convenience, the patients needed to remain in one bed on the same floor. After comparing ceiling booms to determine which unit best fit their need, MGH found Modular’s Stratus Boom to be the an- swer. “One of the challenges we face in the current unit is a lack of space, but that won’t be a problem in the Lunder Building. The staff is excited to move into the building, as this will provide our patients and families with a healing and therapeutic environ- ment in which to recover,” said Suzanne Algeri, RN and Nurse Director. Through a series of meetings, site visits, and mockups, it was deter- mined that MGH would need a unique design applied to the service modules of their Stratus booms. The nursing side would need to incorporate an extensive amount of services to best care for their high acuity patients, while the respiratory side of the patient bed needed to house the ventilator. Therefore, it was essential for one of the service modules to be designed as a shorter column so that the ventilator could be rolled and kept un- derneath the service unit.
- 9. CASE STUDY ON MGH 7
- 10. CASE STUDY ON MGH 8 DESIGN Project Description The Project includes the interior renovation of the building located at 125 Nashua Street for use by MGH for a variety of administrative uses serving its medical and clinical operations. The Project site includes approximately 90,372 square feet (sf). The renovation will result in a small decrease in the building’s gross floor area from approximately 199,628 sf to approximately 198,080 sf. These uses may include medical record storage facilities, physician and staff offices, accounting and financial offices, other administrative and support space and related accessory uses including but not limited to conference spaces, kitchens and eating areas, parking for up to approx- imately 98 vehicles (that currently exist at the site) and loading. When occupied, the building will be open during normal busines hours. The Project includes facilities for the staff such as bike racks and a shower to encourage biking to work. The Project site also includes certain existing passive recreational space open to the public and a publicly accessible dock that will remain unchanged after completion of the Project.
- 11. CASE STUDY ON MGH 9 Other than cleaning and repointing the exterior of the building, re- moving health care related signage and replacing it with the building address signage and upgraded mechanical equipment on the roof, no exterior changes to the building are proposed and the site will remain substantially as it exists today.
- 12. CASE STUDY ON MGH 10 ZONING Existing Zoning The Project site is located within the General Area of the North Station Economic Development Area governed by Article 39 of the Boston Zoning Code (the “Code”) and the Restricted Parking Overlay District, governed by Section 3-1A(c) of the Code. Allowed uses within the General Area of the North Station Economic Development Area include business or professional offices; office build- ings; and professional offices accessory to a hospital whether or not on the same lot. A garage or parking space for occupants, employees and visitors not accessory to a residential use is a conditional use both in the General Area and the Restricted Parking Overlay District. The General Area has a maximum allowed building height of up to 155 feet and a maximum floor area ratio (FAR) of up to 10 if a Proposed Project has completed Large Project Review. There are also specific design requirements regarding street walls and sky plane setbacks in the North Station Economic Development Area. Finally, no structure is to be erected, altered or extended within 35 feet of the existing mean high water mark of the Charles River. No off-street parking facilities are required in the North Station Economic Development Area. The provision and design of off-street loading facilities shall be determined through Large Project Review.
- 13. CASE STUDY ON MGH 11 Proposed Zoning The Project has an existing building height of approximately 105 feet, measured in accordance with the Code, plus rooftop mechanicals reaching approximately 125 feet, which is within the Code’s allowed building height. The Project contains approximately 198,080 square feet of gross floor area. If the Project’s gross floor area is divided by the area of the Project site, it would result in a FAR of approximately 2.19, which is well within the allowed FAR of up to 10. However, the IMP calculates FAR on a campus-wide basis and provides an existing campus wide FAR of approximately 5.42. When the gross floor area of the Project is added to the gross floor area of the main campus, as described in the IMP, and the Project site area of approximately 90,372 sf is added to the IMP Area, the campus wide FAR decreases to approximately 5.06. The Project uses include a variety of administrative uses serving MGH’s medical and clinical operations. These uses may include office uses including, but not limited to, medical record storage facilities, physician and staff offices, accounting and financial offices, other administrative and support space and related acces- sory uses including, but not limited to, conference spaces, kitchens and eating areas. The Project site also includes certain existing passive recreational space open to the public and a publicly accessible dock. The Project includes approximately 98 existing accessory parking spaces and bike racks. The Project includes two existing loading dock spaces which are not being altered in connection with the Project. The Project will include new and updated, but reduced, building and exterior signage.
- 14. CASE STUDY ON MGH 12 URBAN RESPONSE The massing of the building is a reflection of the program within, where the five-story bed tower is visually separated from the procedural floors below. The exterior of the building is a formal response to the horizontal and vertical nature of the adjacent Yawkey and White buildings, respectively creating a visual language that fits with the surrounding urban context. Fritted fins along the lower levels provide privacy for patients and staff on the inside and help break down the exterior mass of the building for pedestrians below. At street level, a paved walkway, stairs, and a canopy create a distinct place and pathway for visitors, directing them to the hospital’s main entrance.
- 15. CASE STUDY ON MGH 13 The Lunder building is enclosed by other existing buildings of the hospital (Massachusetts general hospital / MGH). The existing structures were; * Yawkey building * White building * Wang building
- 16. CASE STUDY ON MGH 14 CONNECTIONS Up to 25,000 people a day travel through the second floor corridor connection. As one of America’s largest medical centers, MGH exhibits many characteristics that typify these institutions a tight, urban campus comprised of many buildings from different eras, complex program- matic demands, and the need for high-level coordination and communication between facilities and campus operations. Located at the heart of the MGH campus, it was critical that the Lunder Building facilitate the integration of teaching, research, and patient care by enabling connections between existing buildings. NBBJ used circulation modeling to develop the ideal connections for ease of facility access, patient transport to services elsewhere on campus, and materials flow. Due to constrictive floor-to-floor ceiling heights within existing buildings, the decision was made to limit connections to five floors, where pedestrian traffic and logistical connections to existing buildings were most critical. MATERIALS MANAGEMENT CONNECTION The loading dock and sterile processing department are located on levels LL1 and LL2 respectively, and service the entire campus. Connecting to the White and Ellison buildings below grade, these connections are critical for campus-wide materials distribution.
- 17. CASE STUDY ON MGH 15 EMERGENCY DEPARTMENT CONNECTION In addition to a new lobby connection to the White building entrance, the ground floor provides a seamless ED addition to the existing ED in the White building, enabling the phased renovation of the entire emergency department. SECOND FLOOR CORRIDOR CONNECTION On any given day, 25,000 people arrive at the Charles/ MGH T Stop and travel through the Yawkey Building and through Lunder’s second floor corridor to access other areas of the MGH campus.
- 18. CASE STUDY ON MGH 16 PROCEDURAL CONNECTIONS The third floor connections provide direct access to the White, Ellison, and Wang buildings. All surgical patients check-in and are prepped in the Wang building, then are transported to Lunder or White for their procedures. Post-surgery, outpatients leave through the Wang building, and inpatients are taken to recovery rooms in the Lunder building or elsewhere on campus.
- 19. CASE STUDY ON MGH 17 PROGRAM CONCEPT
- 20. CASE STUDY ON MGH 18 COMPLEXITY The Lunder Building is an incredibly complex building that not only makes external connections to existing infrastructure on campus, but also internally links a number of different programmatic elements. The 14-story building houses a five-story patient tower, high-tech procedural floors, an emergency department, receiving dock, a sterile processing department, a processing department, a five-story patient tower, and new emergency and radiation oncology units. The challenge was to stack this varied program onto an extremely compact site in a way that would maximize future flexibility and minimize disruption to the hospital’s services elsewhere on campus.
- 21. CASE STUDY ON MGH 19 Design Tool: Building Information Modeling The design team employed Building Information Modeling (BIM) technologies to navigate the complexity of the site and explore program alternatives during the design and documentation phases. A working 3D model was created enabling each design team member to layer in trade-specific details as the design pro- gressed, to ensure that all of the building’s components and connections fit and worked within the site. Built-in “collision detection” systems allowed for the early identification of problems and their solutions prior to the start of construction. The 3D model was used to develop core elements of the building, including architecture; interiors; planning intent; and structural, mechanical, and electrical systems. BIM was also used as a communication tool for sharing ideas with the building’s users, obtaining city approvals, and demonstrating how construction was being phased to avoid on-site complications. Fifth floor mechanical and structural coordination BIM models BIM models used to demonstrate construction phasing
- 22. CASE STUDY ON MGH 20 CONSTRAINTS The project brief specified a need for more beds to meet increases in patient volume and a shift from double to single patient rooms for the benefit of infection prevention, privacy, and greater patient/family centered care. However, adding more single rooms typically increases the size of the floor plate, which increases travel distances for nurses, and further separates clinical collaborators who work in close proximity to one another. Site constraints and the square floor plate of the patient tower also made it challenging to provide everyone access to daylight, which was a major design goal for the new building. NBBJ developed numerous options for maximizing daylight and the number of patient beds per floor while minimizing travel distances for staff. The big “a-ha” was in fracturing and shifting the floor plate to break apart the nursing pods and create a central circulation spine that traverses the floor plate diagonally. The spine creates a direct link between an interior atrium and exteri- or garden, improves way finding, and allows daylight deep into the core of the building. Rather than creating a square loop of patient rooms along the perimeter and a central nursing core, the resulting plan yields two interlocking c-shaped groups of beds which allows for more rooms per floor; increases clinical connection; and minimizes staff travel times to patient rooms, central supply, and support areas. FINAL PATIENT TOWER FLOOR PLATE DESIGN
- 23. CASE STUDY ON MGH 21 FLOOR PLATE DESIGN STUDIES Different types of arrangement of floor plans studied before final design was amended.
- 24. CASE STUDY ON MGH 22 SAFETY AND SATISFACTION A connection to the outdoors and natural light is known to speed up the healing process and increase patient, family, and staff satisfaction. Naturally lit spaces also have operational and sustainable benefits by decreasing reliance on electrical energy. A major design goal was to bring daylight as deep into the space as possible and provide views to gardens and the Boston cityscape. Patient rooms feature full-height windows, and a five-story garden atrium and exterior bamboo garden bring daylight deep into the patient tower, providing rooms along the core of the building access to natural light and views to the outdoors. Several measures were taken in the design of the patient rooms to pro- vide patients, family, and staff with maximum comfort and safety. Personal protection equipment cabinets are located outside each room for convenient point-of-use access to gloves, masks, and gowns; a five- foot-wide entrance with a sliding glass door enables ease of entry and greater visibility; a caregiver work station faces patients so records can be updated while keeping the patient in sight; a semi-opaque toilet room door with a nightlight inside eases way finding in the dark; and a patient lift operates from the bed to the toilet room to help nurses transport patients who are unable to walk.
- 25. CASE STUDY ON MGH 23 PATIENT ROOM SAFETY FEATURES * Saw-tooth corridors (as opposed to straight corridors) minimize sound reflection and transmision. * Acoustical ceiling tiles absorb the sounds of conversation. * Sliding glass doors maintain visibility while keeping the noise out when closed. * Rubber floors dampen the sound of people and equipment moving down the hallways.
- 26. CASE STUDY ON MGH 24 NOISE LIGHT Noise is one of the top complaints of hospitalized patients in the United States and can raise blood pressure, interrupt sleep, increase sensitivity to pain, and raise stress levels. NBBJ employed a combination of strategies to reduce noise throughout the building. Elevators, public waiting areas, and staff meeting rooms are located along the central circulation spine away from the patient rooms. Dispersed “interaction zones” prevent nurses and clinicians from con- gregating at one main nursing station, while support and service areas are tucked away off the main corridor. Rubber flooring and acoustical ceiling tiles buffer the sound of movement and chatter. Large, sliding glass doors to patient rooms provide greater visibility and allow natural light to enter the corridors, while keeping the noise out when closed. Using a standardized Hospital Consumer Assessment survey, MGH has seen increases of six percentage points and higher on the quietness questions for the Lunder patient units. A bamboo garden was planted atop the mechanical floor to provide ICU rooms with calming views and ample daylight for family and staff caring for patients in the most criti- cal of conditions
- 27. CASE STUDY ON MGH 25 FLEXIBILITY The fourth floor houses some of the most progressive medical tech- nologies available, including two intraoperative hybrid ORs using Zeego equipment (image upper left) and an OR suite using an intraoperative magnetic resonance imaging (IMRI) device mount- ed on a ceiling track that can move between two adjacent operating rooms (image upper right). Rather than having to transport patients for imaging post-surgery, surgeons can now perform precise imaging during procedures that will allow unprecedented accuracy, safety, and efficiency. The hybrid rooms feature an imaging system that captures previously difficult vantage points during procedures for both catheter and open cases. A radiolucent operating table can be interchanged with a tradition- al operating table for standard procedures, doubling the functional- ity of each room. The IMRI suite, which was not part of the original plans, came on- line during construction planning as more advanced MRI devices became available. NBBJ redesigned the fourth floor to fit the new three-room suite by incorporating one of the existing ORs with an adjacent MRI bay, and relocating a restroom and some storage space.
- 28. CASE STUDY ON MGH 26 FLEXIBILITY The IMRI suite, which was not part of the original plans, came online during construction planning as more advanced MRI devices became available. NBBJ redesigned the fourth floor to fit the new three-room suite by incorporating one of the existing ORs with an adjacent MRI bay, and relocating a restroom and some storage space. The design of the suite required meticulous planning. The 18,000 pound imaging device has a magnetic field 60,000 times more powerful than the Earth’s, so the magnet had to be shielded from steel columns, beams, and electrical transformers. To contain the magnet’s forces and keep interferences out, copper and silicon steel make up a continuous barrier behind all wall surfaces, the ceiling, and floors to create this shield. Concentric ovals on the floor mark the levels of the magnet’s pull, en- suring that operating instruments and other metal items are kept at a proper distance when the magnet is brought into the room. Ceiling booms allow mounted lights and equipment to be easily moved out of the way. The three-room IMRI suite includes a magnetic resonance imaging device mounted on a ceiling track that can move between two ORs. In advance of the latest technology, the hallway that was used to transport the MRI in and out of the building was designed with larger beams and more reinforcing steel to withstand the load of the IMRI machine. The exterior wall at one end of the corridor was built in a modular fashion so it could be easily removed to hoist new equipment through the wall during installation and for future replacement. There are two rooms of zee- go hybrid operating rooms.
- 29. CASE STUDY ON MGH 27 ACCORDANCE OF DESIGN Decreased Wait Times The Lunder Emergency Department (ED) addition provides 17,500 square feet of expanded space, which includes new patient registration and triage bays for walk-ins; acuity-adaptable screening and acute areas; trauma rooms; a hazardous materials decontamination area; and an enclosed ambulance garage. As part of a larger plan to increase emergency services at the hospital, transitioning these services to the Lunder Building allowed existing ED spaces in the White and Ellison buildings to undergo phased ren- ovations. The new ED also supports a split-flow process that MGH piloted in their existing ED. The goal is to cut long patient wait times and “leaves without treatment” by separating the flow of the sickest patients from those who are less sick. Walk-in patients arrive at a space filled with light and views and are met by a greeter nurse who does an immediate assessment and sends the sickest patients to a bed and pediatric patients to the pediatric ED. Beyond the greeter nurse are five glass-enclosed triage/registration bays that allow nurses to quickly register and check vital signs for the less-sick patients, who are then sent to a screening room where a physician conducts an extended diagnostic triage. From there, patients can be sent for post-screening follow-up, directly for treatment, or to a hospital bed. Patients arriving by ambulance are assessed in a separate stretcher triage area. The triage staff work area, which has views to the ambulance bay and the walk-in area, is the hub that observes and supports both the stretcher and walk-in patients. The final result is decreased wait times, quicker care for sicker patients, and greater visibility for staff while also providing patient privacy.
- 30. CASE STUDY ON MGH 28 ACCORDANCE OF DESIGN Improving the Patient and Staff Experience Radiation Oncology Located three and four stories below grade, the Clark Center for Radia- tion Oncology incorporates soft lighting, natural finishes, garden-themed graphics, and both open and intimate spaces to create a sense of calm for patients and staff. The new Center houses the latest technology in radiation therapy and is designed for the comfort of both new and returning patients. The Center occupies two levels, and provides separate entries for new and returning patients. New patients, arriving for their first consultation, enter on the upper floor separate from any clinical or treatment activity. Returning patients arrive on the lower level, where their routine path of travel begins with a two-story receiving lounge, then an art-filled corridor that leads to the dressing rooms. Another waiting lounge near the treatment rooms offers clustered seating for social interaction, or lounge chairs and bamboo banquettes for more privacy. Inpatients arriving by stretcher have a private entry into the treatment room without having to pass through the more public areas. Small rooms are available immediately off the waiting lounge so that patients can consult with their caregivers in private. Muted tones, natural finishes, pendant lights, andwall-wash lighting add to the calming atmosphere.
- 31. CASE STUDY ON MGH 29 Improving the Patient and Staff Experience Translucent glass screens separate the waiting area from the corridor, giving patients and staff greater privacy. The changing area for patients is designed with soothing colors and privacy in mind. A returning patient is guided from the waiting area to the treatment area
- 32. CASE STUDY ON MGH 30 DESIGN DOWN TO DETAILS The environmental graphics program is integral to the overall experi- ence of being inside the Lunder building, reinforcing the MGH brand and unifying the multiple departments and spaces within. Abstracted images of local foliage carry through the garden theme on each floor—from large-scale wall graphics to curtain and furniture details. Consistent, clear signage and the MGH branded blue are used through- out the building to assist visitors and patients with wayfinding and orientation. A Healthy Neighbor The Lunder Building is LEED NC Gold certified, and features sustainability measures that add to the aesthetics, experience, and efficiency of the building. Material Selection More than one-third of the materials used for construction were recycled or locally extracted or manufactured materials. Renewable materials were used for interior finishes. Water Conservation Low-flow plumbing fixtures were installed to reduce water consumption by 1.4 million gallons per year (20%). To eliminate the use of potable water for plant irrigation, systems capture rainwater and air cooling condensate for irrigation. Energy Conservation The exterior glazing system minimizes heat gain and loss while al- lowing daylight to enter. This system improves thermal performance by 39% and reduces baseline solar heat gain by 31%. The design achieves an overall reduction of energy demand by 10%.
- 33. CASE STUDY ON MGH 31 Healthy Indoor Air Interior finishes and furnishings are free of volatile organic compounds. An enhanced ventilation system maintains a constant supply of clean, healthy air. Enhancing the Urban Environment Greenery covers more than half of the building’s footprint area and light fixtures have been carefully selected to reduce light pollution. Delivery trucks and ambulances enter through the Lunder Building core to keep noise and activity off neighborhood streets.
- 34. CASE STUDY ON MGH 32 GREENERY POSITIVITY
- 35. CASE STUDY ON MGH 33 FINAL PLANS
- 36. CASE STUDY ON MGH 34 CONSTITUENTS * Five in-patient floors * 28 operating suites * Central sterile processing and supplies department * Materials management department * Radiation oncology services * 150 inpatient beds * New emergency department
- 37. CASE STUDY ON MGH 35 POSITIVE VIEWS * “They designed the whole building so that it would be flexible for technology that we know now and technol- ogy that we don’t know about that will be here in 10 years when the building is still there,” says Jean Elrick, MD, Mass General’s senior vice president for Adminis- tration. * The initial plans for the Lunder Building’s fourth floor called for installing an MRI 10 times more powerful than the semi-portable device in a room adjacent to one operating room. By having the MRI in a separate room lined with special shielding, operating room monitors and tools would not be impacted by its strong magnet and vice-versa. The Lunder Building is also one of several buildings on the MGH campus that provides an indoor route for pedestrians from the Charles/MGH MBTA station on Cambridge Street through the campus complex to the West End a key hospital route during Boston’s harsh winters. The patient floor plan comprises two interlocking, C-shaped groups of single-patient rooms, traversed by a central circulation spine. This configuration fits more rooms into the constrained site, minimizes staff travel times, and brings natural light to not only the patient rooms but staff support areas as well. The bed tower also incorporates two gardens (a five- story indoor atrium, and an outdoor bamboo garden on the sixth floor), as research has demonstrated a link between views to nature and the quality of the healing process.
- 38. CASE STUDY ON MGH 36 * Designed to reduce falls and injury * Minimize medical error and infection * Improve staff productivity and communication * Enhance patient and family healing, comfort, and satisfaction *
- 39. CASE STUDY ON MGH 37 The Radiation Oncology Department, though below-grade, incorporates soft lighting, bamboo accent walls, large garden-themed graphics, and both open and intimate spaces to create a sense of calm. One great and amazing thing about the design of the lunder building of the massachusettes general hospital is that the whole building is incorpo- rated between existing structures which is effectively design to overcome the problems of light and ventilation. The lunder building is located in between other urban structures and the design still gives it to have a very good access to its emergency depart- ment as well as the entrance Interior design of the lunder building is well designed to fit any medical machines which are available and going to be available for the future 10 years ahead. The greenery concept of the building makes it well ventilated and comfortable design for patients and staffs.
- 40. CASE STUDY ON MGH 38 DEFECS IN DESIGN There is not much more to talk about the defects or problems in the design of the lunder building of Massachusettes general hospital but with a research done through a questionary some people have a problem in the reflection of the light from windows of the lunder building to the neighbouring buildings like the Yawkey building. The lunder building is an expanding project of the massachusettes general building, due to this the design process faced many chal- lenges of site orientation and existing struc- tures. Building this hospital is costy compared to standard of living conditions of our country Ethiopia. The designing team could have minimized the cost by using alternative systems like more greenery areas rather than using an air conditioner. Facad building materials are aluminium with variety of shapes, this aluminium designes coulld also have been replaced by other materials like wood to make the building interior part and also exterior part reflect the concept of the design. Mostly maximum range of room standards and width of corridors, but as a problem parking space for the building is less in proportion with the design that it have 150 bed.
- 41. ACRONYMS REFRENCE CASE STUDY ON MGH 39 * IMP ................................. institute of master plan * FAR ................................. floor area ratio * MGH .............................. massachusettes general hospital * ICU ................................. intensive care unit * ITU ................................. intensive therapy unit * NBBJ ............................... the architectural firm * LEED .............................. leadership in energy &environmental design * ED ................................... emergency department * PCC ................................ patient centerd care * SF ...................................... square foot * ER .................................. emergency room * OR ................................. operation room * A&E ............................... accident and emergency * MRI ................................ magnetic resonance imaging * IMRI .............................. intraoperative magnetic resonance imaging * BIM ................................ building information modeling NBBJ WEBSITE MGH RECORDS BOSTON HEALTHCARE INSTITUTES (LIST) AWARDS AIA New York Design Awards, Merit Award, 2012 AIA Academy of Architecture for Health (AAH) National Healthcare Design Award, 2012 AIA New York State Design Awards, Citation for Design, 2012 Boston Society of Architects, Healthcare Facilities Design Award, 2012 Healthcare Design, Architectural & Interior Design Showcase, Citation of Merit, 2012 Modern Healthcare Design Awards, Citation, 2012 Associated General Contractors Build New England, Honor Award, 2011 International Academy for Design and Health, High Commendation, 2011 AIA New York, Building Type Merit Award, Health Facilities, 2009 PUBLICATIONS “Massachusetts General Hospital, The Lunder Building,” Architec- tural Record, August 2012 “Nature Nurtures,” Architectural Record, August 2012 “All’s Quiet on the Lunder Floors,” Mass General Magazine, Summer 2012 “Hospital, Heal Thyself,” ArchitectureBoston, Summer 2012 “Designed for Change,” Mass General Magazine, Spring/Summer 2011
- 42. CASE STUDY ON MGH 40 CONCLUSION In general, building designes especially health care designs should effectively comply with standards and safety issues for the users. This case study on massachusettes general hospital enables me to see how to design taking the future circumstances, like technological advancement inorder to make rooms fit for future equipments. Green development of design can give a better living conditions for the users as well as neighbourhood. “I see things on the Lunder patient units that I could only have dreamed of at other places I’ve worked. Private rooms, comforting colors, more light, floor to ceiling glass. It’s fun to see something new that embodies a lot of the concepts we’re looking for.” RICHARD EVANS, SENIOR DIRECTOR, SERVICES IMPROVEMENT DEPARTMENT, MGH MGH is trying to promote patient-centered care for underserved populations through major initiatives aimed at measuring and reducing health disparities, improving cultural competence, recruiting a more diverse workforce, reaching out to underserved local communities, and helping patients navigate the health system. Importantly, its leadership is willing to devote resources and create structures (committees, programs) that support these efforts. T hough decentralized across multiple departments and sites, MGH’s activities in PCC result in numerous “best practices” that should be expanded internally, and replicated in other organizations. M G H