Facility projects at Michigan State University (MSU) and the University of Utah prove that, with proper planning and the involvement of key partners, universities can create such buildings.

Integration has long been a desirable goal within the medical education field, explains Dr. Aron Sousa, senior associate dean of Academic Affairs for the College of Human Medicine at Michigan State University.

“The whole movement is about trying to improve quality of patient care. People tend to work better in teams.”

Traditionally, medical education was fragmented, with everyone working on his own project. Institutions weren’t worried about this until a shift in philosophy came from the outside. Accrediting bodies, like the Joint Commission and the American Council on Graduate Medical Education, now require medical schools to integrate disciplines. Residents must teach and the agencies are stricter about integrating research into residency, for example. Grant agencies like the National Institutes of Health have taken a similar tack.

“The question is, how does that actually work? There are still forces that fight against integration. It gets down to how you organize,” says Sousa.

Universities and medical centers still organize mainly based on discipline, but that is changing as new facilities are built.

Secchia Center Expansion Seen as Economic Key

At MSU, the new Secchia Center is the College of Human Medicine facility in Grand Rapids, Mich. It is an expansion project that integrates the medical school’s educational, clinical, and research components. MSU and community leaders believe the facility is key to the region’s economic future.

The 185,000-gsf, eight-story existing building will cost $48 million (construction cost only, excluding “soft” costs). When completed in 2010, Secchia Center will be MSU’s most integrated facility, Sousa says. It will house all four years of undergraduate education, administration, and faculty. Clinical skills, anatomy, and simulation areas are interconnected. Case-based rooms are designed to facilitate discussion. Clinical skills and simulation rooms provide a research platform, and anatomy simulation suites will offer a graduated training opportunity.

Location, Location, Location

Planning for the Secchia Center took years of work involving five different biomedical institutions and an economic development group. Location was a major consideration. MSU wanted the new facility to be part of a community. The desire was to create a concentrated network where facilities can work together, like the Research Triangle in Raleigh, N.C.

“If you can get all those groups working together, there’s an economic advantage,” Sousa explains.

Luckily for MSU an existing building in the heart of Grand Rapids fit the bill.  The building is large enough for the University’s needs and is connected by walkways to nearby institutions, including a children’s hospital, heart center, and cancer pavilion.

“It needed to be a signature building in a prominent place. It had to have room for residents and residency teaching, and a place where the community could learn and interact with all these partners. This site fulfilled our needs,” he says.

Challenges to Designing an Integrated Building

Finding a large enough location is one of the biggest hurdles to integrating medical school facilities, but designing the building poses its own challenges, notes architect Michael Lauber, president of Ellenzweig, the Cambridge-Mass., architectural firm leading the design of the Secchia Center.

Medical schools differ from other higher education facilities because they have large faculties—none of whom reside in the medical facility, all of whom are doing clinical work. People are going back and forth all day.

“Easy connectivity is extremely important because everyone has busy schedules,” he says.

The goal at MSU is to make the space as flexible as possible, since it needs to serve many functions.

The Secchia Center’s first floor serves both as a public function floor and a core facility for the medical students. There’s a main entrance, a multipurpose room, presentation spaces, a large case-based room, a large lecture hall, and an atrium.

A vertical atrium, featuring an interconnected stairway, runs from the first through fourth floors. The second and third floors house more classrooms, student spaces, and medical school offices. The third floor is also where the Secchia Center connects by a bridge to the building next door. Academic administration is situated by this entryway.

“This building really has two public floors. It was important that the bridge connection open up right into the atrium, so you had a sense of a ‘front door’ there,” says Lauber. “Bridges to other spaces were essential to making this work.”

The fourth floor holds dean’s offices, and the fifth and sixth floors have more private educational spaces.

Floor five houses a large clinical skills training suite with spaces that serve medical students, nursing students, and other healthcare professionals. Exam rooms are organized into two segments—one has 16 rooms, the other, nine rooms—so they can be used by two different groups simultaneously.

The setup includes standardized patients, both for high stakes testing and for training, with training and simulation rooms close together. Stairs connect the floor to the anatomy lab.

“It’s wonderful to be able to have all these space-intensive functions in close proximity to one another,” says Lauber.

University of Utah Shared Health Science Education Building

In 2004, the University of Utah in Salt Lake City opened the new Eccles Health Sciences Education Building, also designed by Ellenzweig. The 155,000-gsf facility cost about $31 million to construct and is shared by four disciplines: medicine, pharmacy, nursing, and allied health. Few higher institutions have committed the time and money to create such interdisciplinary space, says Lauber.

“This came out of an interest in sharing and saving resources, as well as to say the future of healthcare is bringing all of these people together,” he explains.

The building is a central hub located among research, teaching, and clinical facilities. The primary focus is teaching.

The building is organized along a central spine, promoting easy movement. An outdoor courtyard sits next to the café on the ground level. The café is a public facility on a main pedestrian thoroughfare, so it serves as a gathering space for students, faculty, researchers, and administrative staff, and ties the building to the rest of campus. Opposite the café is a central atrium, which connects four levels and the fifth, also an entry level.

The building contains a lot of student spaces because of intense student use. There are numerous lounges and breakout spaces. The atrium is popular with students and has space for shared social functions.

“Since all the schools use the building, a lot of people move through the building. We had to add space to accommodate those crowds,” says Lauber.

Shared Teaching Spaces

The Health Sciences Education Building contains a variety of teaching spaces, many suited for distance learning and for video conferencing (used in about a third of the rooms). There’s a lounge with pool tables and foosball for downtime, plus a student locker room.

A variety of spaces are shared by all the health science disciplines, such as teaching labs, lecture halls, and 15 problem-based learning areas where core curriculum is taught. The building includes space for hospital training and brings healthcare practitioners into the facility.

The largest component of shared educational space is the clinical skills suite, which has 16 exam rooms with the standardized patient area in the center and the usual high technology accoutrements.

“This suite has probably been the most successful in bringing together the healthcare disciplines,” he says.
 
The building isn’t entirely integrated. Each discipline wanted a little “turf” so separate lounges were created.

“Schools need their own identity. To run a professional curriculum requires that you have a profession, so there’s a piece about them having their own space that is identifiable,” notes Sousa.

Integration Involves More Than Shared Facilities

Getting people to collaborate takes more than specialized facilities. Planning is crucial. At the University of Utah, the process involved a committee with representatives from each building.

“Everything we did was vetted by everyone’s interests to make sure it worked for them,” says Lauber. “That was a key part of the process: to have everyone at the table.”

It’s important to decide who will operate the building, Lauber emphasizes. In Utah, the Health Sciences library staff runs the new building. They ended up unifying the technology in a pilot program that has seeped into the University’s other schools.

“A big issue is making sure the technology works across different disciplines,” says Lauber. “These administrative issues need to be addressed in the integration process.”

Space is another big issue, notes Sousa, and planners must find and improve space so it works for everyone.

Financial Implications and Lessons Learned

Theoretically, shared space should save universities money, Lauber says, since there’s less physical plant and redundant services are eliminated.

“I think lower cost is a major benefit to having a central teaching facility.”

Sousa says MSU considered cost and where the funds would come from, but doesn’t yet have a clear picture of overall cost effectiveness. They will know better once the facility opens.

MSU’s main hurdle is aligning the different missions and understanding what each partner wants and needs. Clinical institutions want benefits of a research program, but can’t be giving money away. Research institutions need the freedom to try things that may not work and some insulation from short-term financial disturbances. Education programs need a stable source of intellectual support. Good leadership and the ability to look at how short- and long-term goals can be reached together are crucial.

“They all have to learn to work together, and each has to decide what to give up,” says Sousa. “At MSU, they have all done a remarkable job of working together and aligning their missions. So far we feel really good about where we are.”

Integration of the different disciplines at Utah’s Health Sciences Education Building hasn’t happened overnight, says Lauber.  Students from the different schools use the rooms, but the creation of programs that bring nursing, pharmacy, and medicine together has occurred slowly.

“It was administratively difficult, but they’re beginning to bring these healthcare groups into joint training instead of just sharing space.”

By Taitia Shelow

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