“The NIH has a wonderful building where the beds are right next to the research facility,” says Alex Wing, principal of Burt Hill, the architectural firm that evaluated several potential sites. “That represents the ultimate in translational medicine. We looked at that idea and brought it forward.  Michigan’s pathology department doesn’t have beds, but it was important to bring clinical and research functions together in one space.

“We told the University that if they could find a model to collocate these functions, they would be unique among peer institutions,” says Wing. “I don’t know of another institution that has done this on the same level as the University of Michigan.”

Location, Location, Location

The University of Michigan has a large, densely developed health sciences complex, with a sprawling university hospital on one side and a medical school on the other. The research and clinical labs are scattered, occupying valuable real estate in the overcrowded hospital. The goal is to consolidate them in the most beneficial location.

A unique relationship exists between university hospitals, which are revenue generating, and medical schools, which are managed as academic institutions. University hospitals serve a dual function to treat patients and provide a training ground for medical students.

“This leads to a parsing of real estate,” explains Wing. “Research is done under the auspices of the medical school, but the research and the clinical labs are ultimately tied to the hospital. Does it make sense to split research from clinical or combine them?

“The University is working hard to establish synergy between them,” says Wing.

“The cornerstone of this synergy would be to centralize all of our clinical faculty and much of our research faculty into a pathology institute, which would be highly interactive internally and with other departments,” says Dr. Jay Hess, chairman of the pathology department, who joined the University in 2005.  “I wanted us to work hard to design a facility to promote that kind of clinical and research interaction. I didn’t want to move to Michigan without having this in place.”

The first task for Burt Hill was to evaluate one over-arching question—should the pathology department be located off site or within the medical school/hospital campus—from the perspective of construction and building project cost, and the impact on productivity and less easily quantified department goals. The one off-site location the University considered was across a railroad track and a river.

The evaluation began with a program analysis involving visiting existing facilities to understand what their needs and limitations were, and comparing those to industry and peer benchmarks. They determined that an entirely new facility would require 190,000 gsf of space, taking into account increased pathology testing and a greater number of primary investigators.

One consideration was the 15,000 sf of animal facilities. Animals follow research, so if pathology moved off site, at least some of the animals would go with it.

Then there are the patient samples that the pathology department works with. Analysts at Burt Hill considered two options for transporting samples between the hospital and the pathology lab—couriers and pneumatic tubes—in terms of reliability, cost, and speed.

Pneumatic tubes are reliable and fast, but expensive, and are limited in what they can transport. The tubes are about 6 inches in diameter, which would not accommodate larger samples, and some samples might be damaged by acceleration and deceleration. Many hospitals use them to transport small samples within a single building, which in this case would cost $1.5 million to install. Laying a tube system across a river and a railroad track would be cost-prohibitive, and would require so many approvals that it would delay the entire project.

Couriers, on the other hand, can transport samples of any size, but less quickly than a tube system. Some samples need to be analyzed while a patient is still in surgery, so the hospital cannot afford a 10- or 20-minute delay. Therefore, a courier system serving an off-site department would necessitate a duplication of some pathology lab services on site. For an on-campus location, a combination of courier and pneumatic tubes works best.

Any time delay, even if it is not harmful to a patient, wastes the time of the physician awaiting the results, and therefore adds to the operational cost of the facility. In addition, physicians and pathologists frequently need to speak face-to-face, so they will spend time walking between the two facilities. Using current salary data, and calculating a loss of 10 minutes a day walking off site, analysts estimated that it could cost the University tens of millions of dollars a year in lost productivity if they operated remote sites.

“These are linear models,” explains Wing. “The interactions are much more complex and random than that. Yet, if you accept that there is some impact, and you even start cutting these numbers in half, you’re still looking at big numbers.  You can’t just move people to a remote location even if you can get the samples to them quickly.”

In addition, there are the more tangible costs associated with running two facilities instead of one: constructing and operating as much as 5,200 sf of duplicated administrative space and service areas.

Another consideration was the efficiency of the facility itself. At the same time that the pathology department was looking for a home, it was studying the potential impact of lean management strategies.

“One of the key findings was that they need a very large open-warehouse space for the testing labs, and they needed to be on the ground floor, right next to where the couriers come in,” says Wing. “The space also needs to be designed so that it can be easily rearranged.”

Patient care also could suffer, says Wing, because people work better as a team if they work in close proximity.

The Final Decision

In the end, the University selected the Kresge site, located on campus between the hospital and the medical school. The clinical pathology laboratories will cost about $100 million, with four floors financed by the hospital. The three additional research floors will be financed  by the pathology department and the medical school. The University is currently in the process of selecting an architectural firm for the project.

“Ultimately we were able to convince the hospital leadership and the medical school to move ahead with the combined clinical and research building, and to site the building on campus,” says Hess.

One convincing argument against locating off campus concerned the lack of a physical connection between the hospital and clinical labs, and the inherent inefficiencies of transporting specimens. In addition, the hospital CEO balked at the additional $10 million that the off-site building would cost, while the medical school dean, who has more than 100,000 sf of research space commitments to honor, liked the idea of building additional research space.

The financial arguments to co-locate research and clinical space appear clear-cut, but it required a significant cultural shift, says Hess. Traditional thinking holds medical school facilities sacred and off limits to outside clinical uses.

“Our current dean takes a broader institutional view of things, which gave us the opportunity to talk about how to meet the needs of both the hospital and the research for the medical school,” he says.

Hess foresees that the new facility will help the University attract the best researchers while remaining flexible for future expansion of the clinical labs.

“At some point, you have to stop and ask ‘Who is really paying for this project?’” says Hess.  “Many people have opinions, but are you actually going to pay any of the cost of this or are you just going to all the meetings?”

“I’m not aware of any examples of mixed-use buildings that haven’t been a tremendous success,” he says. “There are ways to facilitate the process. Identify the stakeholders and understand their interest.”

At the University of Michigan, that led to the understanding that the medical school needed 100,000 sf of research space, and the hospital needed to relieve its overcrowding, and the best way for them both to get what they wanted was to work together.

By Lisa Wesel

We welcome your Questions and Comments

Copyright 2008 Tradeline Inc.
All Rights Reserved
ISSN: 1096-4894