MuirLab

New Paradigms in Clinical Laboratory DesignNew Paradigms in Clinical Laboratory DesignBuilding an off-site Core Lab to increase throughput

recruit staff, and adapt to future requirements

Pat Morgan, MA, MT ASCP, CLSAdministrative Director, Muir Clinical Laboratory

Amy L. Delson, AIA Principal - Strategic Facilities PlanningPrincipal - Strategic Facilities Planning

Gary Crosman, AIAHawley Peterson & Snyder Architects

Kevin Ng gProject Manager, XL Construction

MuirLab | SFP | HPS | XL1

August 20, 2009

Presentation OutlinePresentation Outline

I. Project Vision Pat Morgan, MuirLabg ,

II. New Core Lab Planning Paradigms Amy Delson Strategic Facilities PlanningAmy Delson, Strategic Facilities Planning

III. Design Approach G C H l P t & S d A hit tGary Crosman, Hawley Peterson & Snyder Architects

IV. Building the Project g jKevin Ng, XL Construction

V Q&A


V. Q&A

Learning ObjectivesLearning Objectives• Given a tight hospital site and a growing laboratory workload, participants will be able

to understand the user’s perspective in developing the key components of the business plan for an offsite laboratory.

• An interactive approach was required to program and plan a laboratory that can• An interactive approach was required to program and plan a laboratory that can respond to changes in technology and reduced staff availability. Participants will learn about the new paradigms in clinical laboratory design, and how workflow efficiency can be balanced with staff safety and retention.

• To rapidly translate JMH’s vision into construction documents, HPS used 3-D modeling tools to enhance collaboration between stakeholders, consultants, and contractors. By carefully crafting the tilt-up exterior, HPS was able to bring light into the offices and laboratories and create an exciting experience for staff and future g pclients. Participants will see the 3-D models evolving into the built environment, and the opportunities possible with a tilt-up building system.

• While the health system did not want to go through the LEED process, the design-assist team, led by XL Construction, was able to accommodate many sustainable features into the building and site. The participants will learn through seeing construction photos how flexibility, safety, sustainability, and ease of maintenance were incorporated into the project.


I. EnvisionEnvision

B k d• Background

• Project Vision / Goals

• Operations & Technology• Operations & Technology

• Lessons Learned


MuirLab Clinical LaboratoryMuirLab Clinical Laboratory• About John Muir Health • What is a Core Clinical Laboratory?

Consolidated Testingg Automation New Diagnostic Methodologies


Background: Business Case for Offsite LabBusiness Case for Offsite Lab

• Operational Inefficiencies S & A ibilit Space & Accessibility

• Options on Walnut Creek Campus Parking Garageg g Heather Farms

• Benefits of an off-site location Concord Site

Brentwood

Concord Site

San RamonPleasanton

San Ramon


Fact SheetFact Sheet

• Project Team Organization: Muir Champions, HPS, SFP, XL, MHS, Jtec

• Construction Cost $22M

• 56,000 GSF Commercial Circle, Concord, CA. Potential to add 20 000 GSF20,000 GSF

• Opened April 13, 2008

• Largest Custom Beckman Automation Lines in US

• 400 Employees in Lab Services at MuirLab

• 130 Fleet Cars


VisionVision

• Manifest a state-of-the-art, efficient clinical laboratory through automation systems and architectural design

• Sustain excellence through incorporating flexibility for expansion or contraction, and enabling the adoption of new technology.

• Expand breadth of services by providing esoteric tests currently sent to reference labs.

R fl t th l d i ti f JMH P idi lit• Reflect the values and aspirations of JMH – Providing quality healthcare services, employee development, advanced medical technology, and stewardship of resources.

• Provide difficult to recruit clinical laboratory scientists with an outstanding place to work.


C lid t O tiGoalsGoals

• Consolidate Operations: Outreach JMH laboratory and ancillary operations Hospital (Walnut Creek, Concord) services including Microbiology and special testing

• Improve Work Process & Operationsp p Improve accuracy / patient safety using Lean and Six Sigma principles Eliminate waste - steps, time, materials and money Reduce TAT (Turn Around Time) or cycle time Incorporate systems to reduce paper handling / inefficiencies - WebMD, Barcoding at PoC, Document Imaging; consolidated System-wide, HIS/LIS

• Encourage Continued Outreach Growth Design lab to showcase lab automation and work flow Provide attractive and efficient environment

• Foster Staff Satisfaction Provide an appealing environment with natural light and sound abatement where possible Plan a safe environment by mitigating lab hazards, installing adjustable work surfaces, and considering personal safety for PM shifts.

• Incorporate Flexibility and Adaptability Standardize instrumentation across campuses Select flexible casework system Plan for future expansion while optimizing move-in efficiency


Operations and TechnologyOperations and Technology

• Transferred 135 employees from Clinical Lab at Walnut Creek to MuirLab

• Used detailed project plan to complete move without interrupting testing or service to customers

• Incorporated new technology standardized with hospital labs

• Expanded test menu in Molecular Diagnostics and Microbiologyp g gy


Lessons LearnedLessons Learned

• Plan for food available on site especially in an industrial park- everyone loves to eat!p y

• Include a patio as part of break room whenever possible p

• Allow more bench top counter space than you ever think you’ll need- paperless is not yet a reality

• Find a good facilities management company

• Keep the bigger perspective!• Keep the bigger perspective!


II. Core Lab II. Core Lab New Planning New Planning ggParadigmsParadigms

• LEAN Manufacturingg

• Ballroom Concept

• Bench-to-Bench

• Flexibility

• Adaptability (Casework)p y ( )

• Staff Safety & Satisfaction


New Paradigm: LEAN ManufacturingLEAN Manufacturing ModelModel

Improve quality (Six Sigma) while eliminating waste and costseliminating waste and costs.

• More customer value / less work • Standardization• Breakdown Silos

Total Lab Automation• Limit specimen handling• Continuous FlowContinuous Flow• Reduce TAT (Speed)

Informatics • Sample identification and

management• Results reporting• AI


Planning ProcessPlanning Process


ELF ProgramELF Program


Lean Manufacturing: Process RedesignProcess Redesign


Process Redesign: ImplementedImplemented

1 Courier delivers

4. “Sneakerman” putting specimens 1. Courier delivers

specimens from Hospitals, SNF, PSC, MD Offices, and delivery is signed-off

p g pon Autoline

y g

32. Specimen Processing reviews each specimen for proper labeling,

complete patient information, specimen type and volume.

3. “Sneakerman” picks up reviewed specimens for distribution


p yp

New Paradigm: Ballroom ConceptBallroom Concept


MuirLab 1st Floor Lab Plan

New Paradigm: BenchBench--toto--BenchBenchMolecular Dx, Molecular Pathology, Cytogenetics, Pharmacokinetics

Automated DNA extraction

A t t d DNA t ti

Old Paradigm ( ti ) R di

Automated DNA extraction equipment is located in a “clean room” which is sealed off from the routine testing areas.

(continues): Reading Plates Molecular Diagnostics uses

cutting-edge technology to study DNA in order to identify actual pathogens in the body.


Molecular detection and identification of infectious pathogensMicrobiology

Bench to Bench: Flexibility for Paradigm Shift Flexibility for Paradigm Shift Dumbwaiter

Freight/Staff Elevator

“As technology advances, the requirements

MICROBIOLOGYInc

Alco e

requirements for testing in the lab need to change accordingly.

MICROBIOLOGY

IMMUNOIFA

AlcoveWe cannot predict today what has not yet been

MOLECULAR DX

AFBClean Room

O&P Alcove

Virology Alcove

yet beeinvented but will be needed in the future.

So the LabSo the Lab space needs to be dynamic.”


MuirLab 2nd Floor Lab Plan

New Paradigm: Adaptable CaseworkAdaptable Casework


Casework: Prototyping / CollaborationPrototyping / Collaboration


Staff Satisfaction: Safety & ErgonomicsSafety & Ergonomics


III. DesignIII. Design

• Attractive environment toAttractive environment to recruit and retain employees

• Assist in Marketing

• Economic Structure


Staff Satisfaction: Light, View, & Sound MitigationLight, View, & Sound Mitigation


Staff Satisfaction: Light, View, & Sound MitigationLight, View, & Sound Mitigation


Attract Employees: Light and ViewsLight and Views







Attract Employees: Outdoor Staff PatioOutdoor Staff Patio


Site OrganizationSite Organization


Functional Marketing Tool: Marketing SequenceMarketing Sequence




















IV. Construction and Design / Build Approach

• Construction Highlights

• Design Build Approach: Building For Ease of Building Maintenance

• System Redundancy

• Coordination WithCoordination With Automated Testing Equipment

S f• System Performance Tailored to User Needs


Construction HighlightsConstruction Highlights

• Accelerated Schedule – Ground-breaking to operational in 11 months

• Coordination Schedule Integrated with Fabrication and Installation Schedule of Automated Line Equipment Manufacturer

• Total Construction Cost: ota Co st uct o Cost$22,000,000 ($385/square foot)


Construction HighlightsConstruction Highlights

• MEP Design Build• MEP Design Build

• Phased Permit Approval

• Collaborative Design & Coordination to Facilitate Accelerated Construction Schedule


Design-Build Approach: Building for Ease of Building Maintenance Building for Ease of Building Maintenance Air

Handler/Exhaust/BMS/Electrical “Service Corridor”

Roof Service PathTie Off Points for Maintenance Outside Roof Screen (typical)


Roof Screen (typical)

Design-Build Approach: Building for Ease of Building Maintenance Building for Ease of Building Maintenance

• Service Points Located Strategically For Maintenance During Lab OperationIsolation Strategically Integrated With Lab Operation Planning


• Isolation Strategically Integrated With Lab Operation Planning

Design-Build Approach: System RedundancySystem Redundancy

• Redundant Exhaust Systems:• Dual Exhaust HEPA Air Filtrationua aust t at o

• Each Fan Capable of Full Exhaust Load

• Filters Can Be Changed and Fans S i d With t Aff ti L bServiced Without Affecting Lab Operation



• Redundant Power System:• 1500kW Standby Generator

• 100% Building Coverage

• Enables Lab to Function at 100% Capacity During Power Outage



• Redundant/Oversized RO Water Supply

• Redundant Cooling to Operationally Critical Areas

R d d t B il S t (3• Redundant Boilers System (3-Boiler Lead/Lag – Only 2 Required)

• Dual Air CompressorsDual Air Compressors


Design-Build Approach: Coordination with Automated EquipmentCoordination with Automated Equipment










Design-Build Approach: System Performance Tailored to User NeedsSystem Performance Tailored to User Needs

• HVAC Zones Tailored to Equipment Layout and Personnel Areas


• Zones Individually Monitored/Adjusted from Remote PC

Design-Build Approach: System Performance Tailored to User NeedsSystem Performance Tailored to User Needs


Q&AQ&AQ&AQ&A

MuirLabwww.johnmuirhealth.com/index.php/laboratory.html

Strategic Facilities PlanningStrategic Facilities Planningwww.sfp-ald.com

H l P t & S d A hit tHawley Peterson & Snyder Architectswww.hpsarch.com

XL Constructionwww.xlconstruction.com


Documents

MuirLab