St. PeterÔÇÖs Health Care Services

The compassion to heal┬áSt. PeterÔÇÖs Health Care embarks on its third major expansion over the past 40 years, with an eye on long-term growth and quality patient care, Linda Seid Frembes reports. St. PeterÔÇÖs Health Care Services of Albany is a well-known regional healthcare center in upstate New York. As part of Catholic Health East (CHE), a multi-institutional Catholic health system based in Newtown Square, Pennsylvania, representing over 20 hospitals from Florida to Maine, St. PeterÔÇÖs consistently ranks as a top performer in the system.   When it began an ambitious $259 million expansion and renovation in 2004, the facility relied on a team of seasoned professionals to ensure that the construction would not interfere with patient care.The three-phase building plan, known as the St. PeterÔÇÖs Master Facilities Plan (MFP), was drawn up in 2003 after a series of interviews with physicians to explore what they thought the facility needed to improve. Charles Gianfagna, vice president for facilities planning and management at St. PeterÔÇÖs, consulted on the plan in 2003 and was later brought on to oversee the implementation.ÔÇ£The hospital had a previous plan called The Big Idea, but costs on the plan were more than $400 million. That plan was resized, reduced in scope and eventually became a $275 million project,ÔÇØ explains Gianfagna. The hospital brought in financial services firm Kaufman Hall to review the finances and provide a feasibility study. ÔÇ£We needed to know that the debt service would not affect hospital operations and delivery of patient care. Based on that analysis, the task became how to reduce the project costs to $245 million without sacrificing project scope.ÔÇØTo achieve this, Gianfagna brought in a ÔÇ£second-opinion teamÔÇØ consisting of a mechanical engineer (ICOR Engineering) from New Jersey and a construction management firm (Central Consulting) from New York City, along with the original architects, Freeman White, Inc., from North Carolina and Envision Architects, a local firm from Albany. ÔÇ£The first turning point was re-evaluating MEP systems through a comprehensive infrastructure survey. This process realized significant costs savings that allowed us to increase the clinical scope,ÔÇØ he says, crediting his second-opinion team for the creative improvements made to the MFP. ÔÇ£Once St. PeterÔÇÖs Hospital approved the budget, the $245 million figure was cast in stone.ÔÇØThe MFP is being financed via $200 million in tax-exempt bond sales, $35 million in philanthropy, and the balance as an equity contribution from St. PeterÔÇÖs reserves. Phase 1 began in 2004 with mostly renovations to the existing buildings. Phase 2 would consist of new construction and the addition of a parking garage, an upgraded high-voltage electrical substation (high yard) and a pavilion. Phase 3 would complete renovations and upgrade the infrastructure for future growth.As Phase 1 progressed, CHE and St. PeterÔÇÖs delayed the Phase 2 Pavilion Project from 2006 until 2007, and this change brought additional costs in escalation as well as additional opportunities. First, an adjustment of approximately $14 million was approved by St. PeterÔÇÖs and CHEÔÇÖs governance bodies to compensate for 12 months of escalation, bringing the MFP costs to $259 million.  During the delay, Gianfagna was able to organize the purchase of a 6.5-acre parcel of land carved from a larger 9-acre parcel from neighboring Temple Israel, and the new purchase created the opportunity to build a free-standing parking garage early on in the MFP construction.┬áAs part of the multi-phase project, back-office functions were moved out of the hospital into a nearby office building. This provided the needed space to build eight state-of-the-art surgical operating rooms that will later be converted to invasive cardiology procedure and electrophysiology procedure laboratories. According to Gianfagna, those services now reside in a vintage 1948 building within a long narrow floor configuration that is not conducive to efficient patient flow.┬á The first cluster of new interim operating rooms opened in October 2007 as part of Phase 1; the second cluster will open in March 2009. This means that the first cluster will be open for two and a half years and the second for one and a half years before conversion. ÔÇ£Instead of remaining vacant space, these operating rooms will have been generating revenue the entire time. According to Hammes Company, a nationally known healthcare developing firm hired by CHE, this is the first time they have ever encountered a building replacement program generating self-funding opportunities,ÔÇØ says Gianfagna.┬á To patients, this multi-phase project provides a less confusing environment that results in greater overall efficiency and a simplified patient experience. Outpatients will have on-grade dedicated parking support of the two freestanding medical office buildings located on the St. PeterÔÇÖs campus. To further enhance a positive patient experience, there will be a bridge to the second-level garage leading to ÔÇ£Main Street,ÔÇØ a two-story atrium that is an all-weather connected entrance. ÔÇ£When Main Street opens in 2010, it will greatly simplify our patient flow. Every patient decision happens here, plus St. PeterÔÇÖs Heart and Vascular programs are consolidated on this level.ÔÇØ St. PeterÔÇÖs Health Care is one of only five hospitals in the nation named for nine years as a Thomson Reuters 100 Top Hospitals: Cardiovascular Benchmarks for Success winner. From the patient health perspective, Main Street also means that patients who have heart conditions donÔÇÖt need to wander all over the facility for their services. All cardiac services will eventually be located on one floor, reducing the time and energy currently spent in the less efficient, multi-floor/multi-building configuration. ÔÇ£Main Street is an organizing wayfinding and access principal for patients, visitors and staff movement,ÔÇØ says Gianfagna.As another outcome of the MFP, the hospitalÔÇÖs 442-bed certification shifts from 7 percent private rooms to 70 percent to increase the value of the patient experience. Clinical studies have shown that a private room speeds healing, lowers infection rates and reduces the chance of medical errors. To keep the staff informed of MFP progress, e-mails or hard-copy announcements are published regularly. ÔÇ£All approaches follow the Quint Studer pillars of people, growth, service, quality and finance. Senior leadership, working through the Corporate Communications department, makes sure that employees see whatÔÇÖs happening under each pillar,ÔÇØ says Gloria Van Dyke-Dean, project data manager for St. PeterÔÇÖs. ÔÇ£There is also an MFP logistics team made up of representatives from IT, security, housekeeping, clinical technology, the project managers and the end users that work together to manage the impact of construction and relocations on staff. We also post progress photos in our surgical waiting area for staff and visitors alike to view our development. The project team, under Mr. GianfagnaÔÇÖs leadership, works very closely to make this time of construction disruption as positive as possible for everyone,ÔÇØ says Van Dyke-Dean. ÔÇ£This project is an example of an enhanced building replacement program. Upon its completion, it will have improved the quality of the patient and public experience in terms of their perception of space and accessibility. Simplified organizational models will eliminate fragmentation and duplication as well as provide for better, safer, state-of-the-art environments, from ergonomics to the streamlined workflow of people, information and materials,ÔÇØ says Gianfagna.ÔÇ£Who would have thought that a building replacement program focusing primarily on a fatigued infrastructure could have such a far-reaching effect on clinical outcomes, patient experience and staff satisfaction?ÔÇØ he muses.┬á