Construction of the Siemens Institute for Advanced Medicine (SIAM) in Winnipeg will begin in early December with completion expected in June 2008. Researchers and clinicians working at the 100,000-sf Institute will use state-of-the-art tools and technology to drive the development of tomorrow’s medical miracles.

The SIAM will be built on the 32-acre campus of the Health Sciences Center (HSC), one of Canada’s largest hospitals with a special focus on teaching and research. It will be located adjacent to the Critical Services Redevelopment Project (CSRP), a new trauma center that will begin treating patients in the spring of 2007. The CSRP, which features 20 operating rooms and a state-of-the-art emergency room, is a 286,000-sf addition to the HSC.

The strategic location of the Institute next to the CSRP will facilitate multidisciplinary collaboration, shared resources, and increased opportunities to create advanced medical treatments, assess new technologies, conduct biomedical research, and evaluate the potential of innovative surgical procedures.

“This project is about improving patient care, not just completing a research building,” says Harry Schulz, chief innovation officer for the WRHA. “We will actually be able to see individuals benefiting from the work taking place at the Institute and the trauma center, and know that we are touching their lives.”

The synergies between the CSRP and the Institute will expand Winnipeg’s reputation for having a growing medical and life sciences cluster. Integrating the resources and expertise of the two facilities will help the WRHA reach its targeted goals of developing tomorrow’s medical advancements, recruiting top-notch scientists and physicians, and using creative revenue measures to sustain the facilities well into the future.

Program Targets

The SIAM will focus on the four core areas of neurosciences, advanced medical imaging, surgery of the future, and medical simulation. It is intended to spur the hospital-lead strategic development of academic medicine. Researchers at the SIAM will explore advances in the areas of infectious diseases, neurological sciences, and neurosurgery.

“Our number one objective in the neurosciences area is enhancing our ability to recruit. The way we do that is by putting together the necessary resources, including equipment, infrastructure, and financing,” says Schulz. “The HSC competes with the other leading hospitals to recruit top talent and create new capacity. A reputation for excellence drives the quality of people you attract. It’s not about bricks and mortar. It’s about attitude.”

Attracting qualified researchers and clinicians to work at the SIAM will build the reputation for academic excellence of the HSC on a national and international level.

The objectives regarding advanced medical imaging are to acquire new technology, support the neurosurgery programs, and once again—enhance recruitment. Advances in medical imaging and neuroscience will work hand in hand with the development of new surgical procedures.

The WRHA plans to create a collaborative scientific environment between the Institute and the trauma center to support the development and eventual implementation of cutting-edge surgical techniques. The SIAM will feature four large surgical research theaters, which will serve as beta sites for testing new technologies, devices, and procedures on animals and humans. The theaters will be linked via a skywalk to the sterile environment of the operating rooms in the CSRP, thereby integrating the research with the actual surgical procedures.

“For example, an injured person could be wheeled from the trauma center to the research operating rooms at the Institute where surgeons could try an innovative procedure or use research-based equipment, such as robotic devices,” explains Schulz.

The primary intention surrounding the medical simulation program is to create a sophisticated team-based environment that can support training of current and future surgical staff members, the preparation and rehearsal for difficult medical cases, and skills assessment validation. The notion is to be able to perform virtual surgery where difficult procedures can be tested before they are put into practice.

The medical simulation unit will include a 14-bed ward where clinical trials can be performed and mock emergencies, such as a SARS outbreak, can be conducted to determine proper protocol for dealing with real-life situations.

Using Advanced Technologies

The WRHA is well aware that creating scientific breakthroughs is not possible without the necessary high-tech equipment. The successful operation of the SIAM as a test hospital to profile new technologies requires the most advanced equipment and diagnostic tools to identify and treat illnesses.

For instance, one of the operating rooms will feature an intraoperative MRI scanner to enable surgeons to take images during surgery. This machine provides surgeons with real-time images to help them determine how well the procedure is going and whether they need to perform additional work. There are only a handful of these scanners currently being used throughout the world. Structural considerations must be made to accommodate the MRI, which can weigh as much as 30 tons. The scanner is suspended from the ceiling, runs on a track, and sits in a special enclosed compartment when not in use.

The Institute also will include a high-resolution PET scanner complete with a shielded cyclotron, representing a combined total of approximately $10 million* worth of equipment. The installation will require at least another $2 million, but creative financing eased the burden of the expense.

“By putting the research institute in convergence with the trauma center, we are able to wear a research hat to get funding for the equipment,” notes Schulz. “We will also have the capacity to put 2,000 patients per year through the PET scanner.”

The creation of a flight simulator for surgery is also being considered for inclusion at the SIAM. The concept is to provide an immersive surgical environment with tactile sensation and visualization for patient-specific perception. The $30-million simulator would be linked to the Institute’s 200-seat lecture theater to create a multidisciplinary team environment. The simulator would be helpful in addressing problems caused by individual and team failures, as well as system inadequacies.

Funding Strategies

The cost to build the Institute is estimated at approximately $35 million with the total soaring to $150 million once the equipment installation and leasehold development are added. Although the project began as just a concept for creating the SIAM, it has grown to include developments that will generate revenue to support the research facility.

“Part of my job is to generate external revenue to support the science center and it is important to have a blend of funds,” says Schulz. “It’s not just about raising the necessary capital because there also has to be enough money to keep the facility running once it becomes operational. Fundraising is tough and the tin cup goes slow.”

The federal government provided $9.5 million, while Siemens gave $5 million to secure the naming rights to the SIAM, a $25 million capital campaign is under way, and revenue will also be generated through the daily operation of the facility.

Since the naming rights were sold exclusively to Siemens, there is no need to gather requests for proposals when selecting equipment vendors. The price of equipment is often reduced when the RFP process is eliminated, providing a cost savings.

Despite the early financial commitments and the promise of the SIAM generating revenue through its operations, it became evident to Schulz that an entrepreneurial approach is necessary to sustain a project with such lofty ambitions. Therefore, hotel and retail components were added to the project, bringing the total development cost including the Institute to $200 million.

The hotel construction will cost about $30 million. Attaching a hotel to a major healthcare facility is a novel idea in Canada. The building will include 150 guest rooms, executive rooms, and suites, as well as food and beverage concepts, and spaces for banquets, meetings, and conventions.

The multimillion-dollar development will consist of one building with retail stores and restaurants at street level and then two towers on top. One tower will be used for the SIAM and the other for the hotel, which will also use only Siemens equipment. Having a hotel adjacent to the Institute will create yet another revenue-sharing synergy where successful programs at the SIAM will lead to hotel business and vice versa.

“During peak periods, there are 25,000 people on campus and that translates into a very large commercial base,” says Schulz. “This is all about revenue sharing.”

Developing the hotel, however, means the elimination of the infectious disease clinical trial unit and the level three animal facility, which were part of the initial design, due to budget considerations. The project has faced obstacles from the onset, but each has been met with a solution.

Overcoming Challenges

The relationship between the WRHA and Smith Carter Architects & Engineers Inc. of Winnipeg is bringing the project closer to reality each day. Construction of the SIAM will move forward, despite the lack of a definitive functional program.

“The only constant in this project has been change,” says Gordon Ferguson, a principal at Smith Carter. “How do we accommodate all of the programs, technologies, and equipment into a flexible facility when we do not even know what will ultimately end up in the building.”

Ongoing administrative challenges include the difficulty of raising funds for a project that does not have a functional program in place and dealing with the bureaucracy of the government’s checks and balances on traditional funding. Early construction challenges included the inability to develop underground parking because of the location on a high water table with soft ground. The depressed office leasing market with rates averaging $12 per square foot made it impossible to proceed with the original three-tower design that would have allowed for the animal facility and clinical trial unit.

Escalating construction costs and a shortage of skilled trades people to work in Winnipeg as a result of an oil boom in Alberta is also a primary challenge. Even a slight delay in construction could substantially hike the project price since construction costs are climbing by one or two percent each month.

Architectural Considerations

The WRHA requested that Smith Carter design the SIAM in a manner that would project architectural and scientific significance at the local and international levels. An adaptable design is necessary to accommodate flexibility in the programs, technologies, and infrastructure.

The robust design is predicated upon balancing the three main project components, including the quality, scope, and budget. A primary driver of the SIAM project is to create a facility that can bring together researchers who work in facilities scattered throughout the Winnipeg biomedical science hub.

The design features what Schulz calls the “wow” factor, or creating a building that will draw people, excite them, and make them remember the SIAM. The green concept is maintained with an aesthetically pleasing plaza outside the entrance to the building. An outdoor garden area and an atrium will also add to the architectural attributes of the complex featuring the SIAM, the hotel, the CSRP, and the HSC.

Initial plans called for the construction of three towers, but when the concept was changed to feature a freestanding tower for the SIAM and one for the hotel, Smith Carter had to alter its design relevant to exiting requirements, capacity, occupancy, codes, and structural sizes. Animals are segregated from the human population with a special loading and receiving area on the main floor and a holding area in the basement.

“Our challenge is to keep testing all of the programs that come and go and to make sure we have that wow factor so people remember our facility,” says Ferguson.

One of the biggest lessons learned from the design is realizing that a balance must exist between the academic medicine agenda and the need to generate revenue.

“In our effort to be entrepreneurial, we have yanked the architect’s chain,” says Schulz. “They have kept revisiting and retooling the design for us, but at some point, we will achieve the balance between science and what we must do to make it economically sustainable.”

* All monetary amounts denote Canadian currency.

By Tracy Carbasho

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