Hybrid Operating Rooms: The Next Generation of Medical Design

Hybrid Operating Rooms: The Next Generation of Medical Design
By David Magner and Angela Holcomb

The medical design world is fast-paced, with new trends evolving and technologies rapidly advancing. Still yet, one innovation has stood out from the crowd lately, generating buzz from architects, hospital CEOs and caregivers alike: hybrid operating rooms. 

Hybrid OR suites serve a two-in-one function, housing both diagnostic/imaging equipment and surgical equipment in one centralized location. The highly advanced suite offers the support of cardiac, vascular, oncology, neurology and other cases by allowing caregivers to verify procedures live during an operation, without ever having to move the patient or leave the room. Fewer patient transfers result in decreased procedure times, less chance of medical errors and improved patient safety and surgery outcomes. 

As an example, one of the hybrid ORs at Nashville, Tenn.’s Saint Thomas Hospital is a 1,130-square-foot cardiac procedure room that supports the cutting-edge transcatheter aortic valve replacement cardiac procedure with the Edwards Lifesciences valve. The TAVR procedure allows patients not candidates for traditional open heart surgery to receive the life-saving heart valve replacement. Because of the precision required of the valve placement, the procedure can only be performed in a hybrid OR setting.

Studies have predicted that nearly 75 percent of cardiovascular surgeons will be working in a hybrid operating suite in the next three to five years. In fact, there’s an estimated 100 hybrid ORs already operational in the United States, according to the ECRI Institute. But designing a new hybrid OR for a hospital or medical facility is a complex task; one that involves plenty of advanced planning, strategic discussions and careful preparations.

Before an architect can put pen to paper and begin design drafts, there must be plenty of planning conversations with hospital leadership. First, the team must identify the suite’s intended function — the type of procedures it will support. The suite’s function guides all further planning, preparation and design. The next step is to identify the type of space needed to accommodate the suite and all its equipment and to determine its location within the medical facility. Is there an existing OR that could be renovated? Or will the suite require new construction? From there, the team identifies the staff that will use the suite and the medical equipment it will house. The designers also assess structural requirements, square-footage estimates and other factors, so each unique need is addressed before moving into the design and construction phases.

But the work doesn’t end there; because of the complexities of each hybrid OR and the technologies tied to the imaging component, the team tasked with construction needs to be constantly coordinating with the equipment vendor, facility and architectural/engineering team. This last push in effort makes the room achieve the initial planning goals.

The following timeline provides a rough idea of the duration of the different phases of creating a hybrid OR suite:

• 2 – 4 weeks: identify room function
• 4 – 6 weeks: equipment selection, site visits and vendor presentations
• 3 – 4 weeks: preliminary planning and site testing
• 4 – 6 weeks: schematic design (and preliminary vendor layouts)
• 4 – 6 weeks: design development
• 4 – 6 weeks: construction documents
• 4 – 6 weeks: authority’s review, contractor selection and permitting
• 4 – 8 months: construction
• 3 – 4 weeks: equipment commissioning and trials

A new hybrid OR could be up and running in about a year to a year-and-a-half. Suite sizes commonly range from 1,000-square-feet to 3,500-square-feet, with procedural rooms ranging from 650-square-feet to more than 1,100-square-feet. 

Each facility will pose unique constraints and will support unique functions and procedures, but all hybrid ORs are the same. These spaces aim to improve patient safety and satisfaction by supporting the concerted use of cutting-edge surgical and imaging equipment in one centralized location. In helping medical facilities to streamline operations and improve care, they mark the next generation of advanced operating rooms and the popularity will likely continue to rise for many years to come.

David Magner, AIA, NCARB, EDAC, LEED AP, is a project architect in Gresham, Smith and Partners’ Nashville Design Studio. Magner can be reached at david_magner@greshamsmith.com. Angela Holcomb, AIA, NCARB, is a project architect in Gresham, Smith and Partners’ Tampa office. Holcomb can be reached at angela_holcomb@greshamsmith.com. To date, GS&P has designed 11 hybrid operating rooms nationwide, with seven others in progress.


Image of hybrid operating room at Saint Thomas Hospital in Nashville, Tenn. courtesy of David Bailey Photography.

A Shocking Sight In Downtown Detroit: People - Forbes

A Shocking Sight In Downtown Detroit: People - Forbes

A Shocking Sight In Downtown Detroit: People

Merchant's Row, Detroit downtown (Photo credit: Wikipedia)

Editor’s Note: This post kicks off a new special section called “Reinventing America,” which we launched Tuesday. As part of this effort, more than a dozen Forbes contributors and staff writers will focus attention on the challenges facing towns, cities and traditional industries across the nation–and highlight the growing number of success stories we’re seeing, too. Over the coming months we’ll have stories, rankings of who’s doing it right (and wrong), and, we hope, great conversations with readers, so please join in. It kicks off with this dispatch from our Detroit Bureau Chief, Joann Muller:

The city of Detroit is on the brink of insolvency. So why is it that I’ve never been more optimistic about its future?

But all you have to do is visit Woodward Avenue, the spine of Detroit’s central business and cultural district, to see that something quite encouraging is happening. Woodward used to be Detroit’s Fifth Avenue or Broadway, a thriving retail and entertainment district anchored by the old Hudson’s Department store and the famous Fox Theatre. By the time I moved to Detroit in the late 1980s, all that was gone, and Woodward was a Ghost Town, just one more of those scary, abandoned places you didn’t go in the Motor City.A year ago, I wrote a Forbes cover story, Detroit: City of Hope, which included a conversation with many of the city’s movers and shakers about the challenges of trying to reinvent the Motor City. The headlines since then certainly have been discouraging, at least on the government side. Mayor Dave Bing has been a disappointment and he and the do-nothing City Council can’t seem to agree on anything. Meanwhile, the city’s top lawyer is dithering in court to void an agreement with the state of Michigan for a financial oversight board. The political gamesmanship is probably just delaying the inevitable, which is either the governor’s appointment of a slash-and-burn emergency financial manager to run Detroit or a municipal bankruptcy filing, or both.

But not long ago, I found myself driving up Woodward on a Tuesday afternoon, and I was shocked — shocked — to see dozens of pedestrians strolling along the street. They were soaking up the sunshine at outdoor cafes, or taking a break from work at one of the downtown office buildings to stretch their legs or run errands. In any other city, this would be unremarkable. But in Detroit, it was an amazing sight. Seriously.

Friends who work downtown marvel at the number of people they see riding bikes or walking dogs in the neighborhood. They joke that joggers are running for exercise, not out of fear.

People are moving back to the city’s core. Yes, Detroit lost about 25 percent of its population in the past decade, but young professionals are moving in, lured, in part, by cash incentives offered by some of the city’s largest employers, who have added an estimated 10,000 jobs downtown in the past 18 months.

A year ago, five companies — Quicken Loans, Blue Cross/Blue Shield of Michigan, Compuware, DTE Energy and Strategic Staffing Solutions — pledged more than $4 million to help employees offset the cost of buying, renting or renovating a home in the downtown area. The program was modeled after a similar one a couple of miles to the north, in the area known as Midtown, home to big employers like Wayne State University, the Detroit Medical Center and Henry Ford Hospital. Both programs are part of an effort by these so-called “anchor institutions” to attract 15,000 talented young people downtown by 2015. So far, nearly 500 people have taken advantage of the two programs, with many more applications under way.

The problem now is there aren’t enough apartments for all the people who want to live downtown. But that’s attracting more developers who are remodeling old buildings and creating loft apartments as fast as they can.

Restaurants and nightclubs are multiplying, too. I was at a friend’s bar over the weekend and was delighted as he rattled off all the development activity going on in his neighborhood, where the only other business currently is a strip club.

As I listened to him talk about the new steakhouse opening soon on the corner, and the buildings being rehabbed down the block, I was struck by the fact that entrepreneurs and large employers, too, aren’t waiting for Detroit to solve its fiscal crisis. They sense that Detroit’s on the cusp of a rebound and they want to get in on the ground floor, while it’s still cheap. Even Twitter is opening an office downtown.

andy Baruah, president of the Greater Detroit Chamber of Commerce, confirmed it. “The way business is looking at it, the political struggle in Detroit is not new. It’s been an issue for as long as anyone can remember,” he said. So the threat of a fiscal collapse isn’t deterring their investments.

“There is an article of faith going on here,” he said. “We know it’s not going to be pretty. But the fundamentals, the basic assets in Detroit, are strong enough that it’s worth it, especially when prices are so low. At the end of the day we know there will be a city. It will find a way.”

Jay Walljasper: Young, Talented-- and Living in Detroit

Jay Walljasper: Young, Talented-- and Living in Detroit

Declining, desperate Detroit is old news.

It's not that the city's economic woes, struggling schools, racial friction and crime have been magically solved. A glance at local headlines will tell you that.

But there are new stories to tell about Detroit today. Which doesn't mean the old stories are all wrong -- just that they're not the whole story anymore.

In recent years, for instance, Detroit has become a magnet for ambitious young people. Some grew up in the area; some move in from the coasts or other parts of the Midwest. Many are motivated by idealism or a sense of adventure, seeking to play a part in reviving a Great American City. Others, however, simply see an opportunity to fast track their careers.

You see them everywhere -- sporting events downtown, galleries in Midtown, pubs in Corktown, restaurants in Southwest, music clubs in Hamtramck, sidewalks on the East Side, soccer fields at Belle Isle park, vegetable stands at Eastern Market. But a lot of people inside Michigan and out still don't know about it.

This new story is exemplified by the Detroit Revitalization Fellows Program (DRFP), a Wayne State University project that connects rising mid-career professionals to organizations at the forefront of efforts to boost economic development in the city. Initiated by Wayne State Associate Vice President Ahmad Ezzeddine in partnership with the Kresge Foundation, the Hudson-Webber Foundation, the Ford Foundation, and the Skillman Foundation, the project drew inspiration from a fellowship program in post-Katrina New Orleans. A wide majority of the 25 New Orleans Fellows stayed in the city after the program concluded, notes DFRP Executive Director, Dr. Robin Boyle -- a nationally known planning professional who chairs Wayne State's Department of Urban Studies and Planning.

"I still marvel over the fact that we had almost 650 applicants from across the country apply for 25 positions -- the opportunity to come to Detroit," says Rachele Downs, the DRFP Program Manager and a veteran commercial real estate broker. "These are people who are graduates of some of the best schools in the country with equally impressive professional experience."

In the end, 29 applicants with backgrounds in fields spanning real estate, finance, urban planning, entrepreneurship, law, accounting, health care, civil engineering, community organizing and tourism development were selected for two-year fellowships. On top of stellar credentials, the fellows offer a unique world of experiences. Brian Connors is still co-owner of a cafe he founded in Beijing. Felicia Andrews managed economic development projects for the African Union. Beau Taylor managed economic reconstruction projects in the midst of the Iraq and Afghanistan wars. Abir Ali designs eco-friendly furniture. Marcus Clarke published a book about spirituality and hip hop music. Sarida Scott Montgomery runs a gourmet popcorn shop in downtown Detroit. Michael Forsyth worked on a GM assembly line.

The fellows -- 16 women and 13 men -- range in age from 25 to 42, with more than one-third being people of color. Seventeen fellows grew up outside the Detroit region and 12 had no previous experience living in the area, while seven of the locals were working outside Michigan when they were chosen for the program.

One of the homecomers, Allyson McLean, 28 -- who worked as a strategic planner for a D.C. consulting firm -- rejoices at no longer being part of the Detroit brain drain. "I'm frustrated with how many people have given up on Michigan," she says. "Most of the kids I went to school with are now gone. They hear gloomy stories about Detroit and don't even try to find a job around here." McLean is now working to bring new businesses and jobs to low-income neighborhoods at the Community Investment Support Fund.

Each fellow has been hired fulltime for at least two years at an organization DRFP has identified as being "actively engaged in building the Detroit of tomorrow." Off the job fellows participate in intensive sessions in leadership development and executive-level education in one of three areas: real estate development, project management or placemaking. Twice yearly they take road trips to examine urban revitalization best practices in other cities.

The employers run the gamut from the city's purchasing department to the Tech Town business incubator to Data Driven Detroit, a nonprofit offering the latest information and analysis on conditions in Detroit. Boyle notes, "Almost all these organizations have hired fellows for projects they would not necessarily be able to execute were it not for the talent the program was able to recruit."

Celeste Layne, for example, previously launched bike and pedestrian projects in the South Bronx and Harlem for New York's Department of Transportation. She is now applying her skills on the streets of Detroit with the East Jefferson Corridor Collaborative. "My vision is that we need better links to the Riverwalk, a bike lane protected from motor vehicles and a combination of good traffic flow and lively street life," Layne says.

"Celeste has made a big difference," says her boss Josh Elling, executive director of the Jefferson East Business Association. "She's had a dramatic effect on the scope of our work."

While not even a year old -- fellows first met one another and reported for work last August -- the program is already realizing one of its chief goals: fostering closer cooperation among groups working to improve Detroit's economy and civic culture.

Jean Redfield, vice-president for public programs at Next Energy, a non-profit that works with the city on sustainable energy technologies, says, "The fellows program is having a positive effect on the tendency for organizations to collaborate; their informal network results in getting things done when the traditional methods of interaction -- meetings or calling people up whom you don't really know -- are too slow or don't work at all."

Twitter Opens Detroit Office In Downtown Madison Building

Twitter Opens Detroit Office In Downtown Madison Building

Social media fans get ready: Twitter is coming to Detroit.

The company announced Wednesday it will open its first Michigan office at Dan Gilbert's tech hub "M@dison" building in downtown Detroit.

"Detroit's emerging mix of automotive and digital cultures made it a natural location for Twitter's newest office," Adam Bain, Twitter's president of global revenue, said in a statement. "We're excited to work face-to-face with the city's most established brands and happy to play a role in downtown Detroit's digital renaissance."

A quick look at the enthusiastic #TwittertoDetroit tweets confirms Twitter picked a city that will give the San Francisco company a very warm welcome.

The M@dison Building, located at 1555 Broadway in downtown Detroit, is owned by developer and Quicken Loans founder Dan Gilbert's company Rock Ventures LLC. It's already home to startups and tech companies like Detroit Venture Partners, Skidmore Studios, Detroit Labs and Doodle Home. The M@dison building is one nine Gilbert purchased in downtown Detroit last year and a cornerstone for his development plans.

Twitter is also a great fit for Gilbert's "WEBward" initiative to re-brand the city's central Woodward Ave. artery.

"Twitter coming downtown is exactly the kind of innovative company Detroit needs to advance our vision of becoming one of the most exciting high-tech and web-centered corridors of growth and activity found anywhere," Gilbert said.

Ecker: Future of commercial real estate undergoing a fundamental shift | REJournals.com

Commercial real estate is experiencing a fundamental, disruptive and well-overdue shift.  People entering the workforce today have a completely different concept of work and the space in which they work than when I began my career, more than 40 years ago. They’re younger than they have ever been, more tech savvy and globally aware with social media consciousness baked into their DNA.

Back when I started, I worked hard during the day and spent evenings and weekends socializing.  I believe that today’s workforce goes to work to socialize, as they have the ability to work 24 hours a day, seven days a week from anywhere they are located.  As the habit of the workforce changes, space available for lease must adjust to the work and social needs of this “new worker,” or go unrented.

Companies must develop new ways to allocate space as the traditional office becomes obsolete —new floor plans within old spaces designed for new work habits – to cater to employee needs and eliminate costly reconstruction.  No longer do employees require “the accoutrements of success” (i.e. large offices) to bolster their egos.

Recently, I have witnessed corporations such as BP and United Airlines relocate from the suburbs to the city in order to build the best employee base possible. It is also rumored that Sears and Kraft are considering moving back to the city. If brought to fruition, these moves will help the companies regain the culture imperative to their success. I think that one thread runs throughout successful relocations: Space that reflects the culture, values and ethos of the company itself. Perhaps Sears should consider moving to its former headquarters at Homen and Arthington?  Sara Lee has made a bold and smart move with its recently announced relocation from Downers Grove back to the city, repurposing the 400 South Jefferson building.

For a period of time in the ‘80s and ‘90s, corporations lost track of the need for the workplace to reflect the values and culture of a company. I cannot tell you how many CFOs and real estate directors only asked one question—“Where is the best deal?” The bottom line today does not only equate to the cheapest cost per square foot but must relate to the market value of the company.

A new formula

My colleagues and I have developed a formula, RV (Real Value) = MV (Market Value) x SV (Symbolic Value). In other words, the cost of office space must take into consideration the dynamics of the real estate market in addition to the Symbolic Value of a space. No longer can we judge the value of space by the old “per square foot” metric. Today, we need to look at the real value of the full spectrum of issues that make up the fiscal and cultural well-being of a business.  Only then can a judgment be made as to the Real Value of any particular space.

The future of office space

Zappos is repurposing the old City Hall building in a blighted area of downtown Las Vegas and Google took over the former New York Port Authority building in the Meat Packing District of New York City. Forward-thinking companies will follow suit and continue to find older buildings to repurpose at favorable prices. In conjunction with organizations such as ArtPlace, which aims to develop creative space use to enliven communities, developers will gain long-term potential for successful real estate development.

It is my opinion that, after the non-traditional spaces start to be absorbed, companies will begin to repurpose iconic buildings, such as the Willis Tower. To succeed, ownership of these buildings will be charged with facilitating alternative uses of their traditional office space. Companies that will boom in the coming years are those that are comprised of the new employee—tech savvy, young, socially conscious—and are choosing homes for their businesses that reflect the needs of these employees and which rise to their cultural demands. 

Howard Ecker is CEO and President of Howard Ecker + Company, a commercial tenant representation company. He can be reached at howard@howardecker.com

Lodging Sales Surge As 'Unprecedented' Hotel Market Run Unfolds - CoStar Group

Lodging Sales Surge As 'Unprecedented' Hotel Market Run Unfolds - CoStar Group

Lodging Sales Surge As 'Unprecedented' Hotel Market Run Unfolds

Improving Credit Conditions Expected to Entice More Buyers Off the Sidelines In 2012

By Randyl Drummer

March 21, 2012

The U.S. lodging industry, benefiting from two years of sporadic recovery, should continue to enjoy gains  in occupancy and pricing power through 2014, with rising profits luring greater levels of investment, according to a series of hospitality reports and outlooks released over the last few days. 

PKF Hospitality Research, LLC predicted this week that revenue per available room (RevPAR) for U.S. hotels will rise 5.8% in 2012, the result of solid annual gains in occupancy and average daily room rates (ADR). 

"Ever since the first quarter of 2010, growth in lodging demand has greatly exceeded the supply increase," reported R. Mark Woodworth, president of PKF-HR. 
"We have seen six straight quarters of [room rate] growth, and are confident forecasting a sustained period of attractive industry profit growth," barring some huge economic disruption such as rising energy costs due to potential military hostilities with Iran, Woodworth wrote. 

"U.S. hoteliers have never enjoyed such an extended period of favorable market conditions. This is truly unprecedented and will likely result in accelerated, and significantly greater, levels of capital investment into the domestic lodging industry," he added. 

The number of sales of flagged select-service assets doubled last year, contributing to a 78% spike in sales of branded select-service, limited-service and economy hotels, Marcus & Millichap said in its first-quarter 2012 hospitality update, analyzing data from CoStar and other industry sources. 

Investors are showing particular interest in select service transactions as capital continues to flow into lodging, according to Jones Lang LaSalle Hotels, which forecasts that 2012 volume of select service hotel portfolio sales will likely double over 2012. 

"The select service sector is the most agile and resilient of the hotel transaction market. Its demand has quadrupled in the last 15 years, giving way to growth in the product offering," notes Al Calhoun, managing director of Jones Lang LaSalle Hotels. "An increase in corporate demand at branded upscale select service hotels is expected to bolster the performance for the overall sector in 2012." 

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REITs accounted for 35% of transactions as measured by dollar volume, up from about 24% the year before. Properties in high demand areas of large markets such as Texas and California are often achieving the best prices for sellers. 

"As property operations climb to former levels, the investment market is surging with renewed vigor as buyers push to acquire assets priced well below recent peaks," Marcus & Millichap said. Financing capacity is returning for deals with strong sponsorship and operating cash flows, whetting the appetite of investors for stable properties, many of which will likely trade in 2012 as buyers seek to take advantage of positive hotel fundamentals. 

U.S. hotels rented out more rooms than ever before in 2011 and demand will only continue to rise in coming years as business and leisure travel continues to recover amid a dearth of new hotel rooms, Val Bauduin, U.S. hospitality leader with Deloitte & Touche LLP, said during a panel last week titled "U.S. Hotels: A Performance Review and Forecast for the Future." 

After most major U.S. markets saw declines in the number of hotel rooms filled in 2009, often by double digits, the national occupancy rate turned positive in 2010 and a robust recovery took hold across the U.S. last year. U.S. occupancy averaged about 63% in 2005-2007, falling to 54.6% at its recessionary low point in 2009. It has grown steadily for two years, reaching 60.1% in 2011, and STR forecasts 60.4% occupancy in 2012 and 60.7% in 2013. 

While occupancy has been rising steadily since the end of 2009, room rates were slower to recover. But that too has changed. Nominal ADR for U.S. hotel rooms peaked in 2008 at $107.39 before falling to around $98 in both 2009 and 2010. However, the ADR shot back up to over $101 last year and should jump to $105.45 this year and $110 in 2013, Bauduin said. 

"What’s fascinating here is we’re predicting that we’ll be back to the peak within two years. I don’t think that any panel of experts last year would have predicted how fast [ADR] would rebound," he said. 

The projected steep climb in revenue per available room completes the recovery picture. RevPAR dropped off a cliff during the recession, falling from $64.23 in 2008 to $53.51 in 2009. As occupancy has firmed up, allowing owners to raise rates, revenue improved in 2010 and 2011 and will rise to a projected $61.06 in 2012 and $66.81 in 2013, according to STR Global. 

Lodging demand hit record levels last year in 30 of the 50 local markets covered in PKF-HR’s forecast reports. While the average annual change in the nation’s lodging supply from 1988 through 2011 was 2.1%, PKF-HR forecasts that new supply growth will remain less than 2% annually through 2016, leading to continued annual occupancy gains over the next 3-4 years. 

Combined with occupancy increases in 2010 and 2011, the industry will experience an unprecedented six-year run of occupancy growth, Woodworth said. 

With occupancy levels expected to exceed the STR long-term average of 61.9% in 2013 and beyond, "we are beginning to see operators capitalize on these favorable market conditions and increase room rates," he said. "We expect to see [ADRs] increase in excess of 4% per year through 2014." 

In addition to the top-line revenue growth, hotel managers have implemented policies and practices that have improved operating productivity, resulting in strong bottom-line gains. With hotel profits already increasing by 30% since 2009, Woodworth said profits will continue to grow at an average 10.3% though 2014, far above the historical average of just fewer than 4%. 

Since 2009, hotels in the luxury, upper upscale and upscale chain-scale segments have logged the greatest gains in room revenue, while hotels in the lower-tier upper-midscale, midscale, and economy categories have grown RevPAR at a slower pace. 

During the recession, hotels competed based largely on price, with the rate compression blurring the distinction between room prices on two- and four-star properties, Bauduin said. With improved job growth and corporate profits, "luxury is now leading the recovery and expanding the chain scale, allowing different operators to again target their customer segments, and the benefits are trickling down from luxury to upscale and upper mid-scale," he added. 

The national occupancy level for hotels in each of the upper-tier chain-scales will exceed 70% through 2016, leading to lack of availability during peak periods and greater pricing power for hotel operators, PKF-HR's Woodworth said. Some travelers will opt for less expensive lodging, to the advantage of moderately priced hotels, he said. 

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Real estate continues to be one of the most profitable avenues to invest

Real estate continues to be one of the most profitable avenues to invest - The Economic Times