So today we have Tina Nolan here She's the associate principal of health planning and professional associate at HDR based in Dallas.

Tina has over 16 years of expereince And she has contributed significantly to projects spanning from rural health care facilities to cutting edge healthcare centers, both nationally and internationally.

She's currently serving on the American College of Healthcare Architects, as part of the communication community.

And she has also served, for the FBI 2022 guidelines Revision.

So please help me welcome Tina Nolan.

Okay.

Thank you all so much for having me.

It's such a privilege to be here.

Thank you for the warm introduction.

All of you.

Roxana and I were talking just before this, and I was telling you kind of how I got into healthcare and the industry.

And when I graduated college, undergrad, I was talking to a friend of mine.

This was before the recession, and I was talking to a friend of mine, and I just was asking her about it, and she said, you should come work over here.

And I was like, health care.

I do not want to do health care.

That sounds like the least sexy thing to do with my new with my new degree.

And she's like, just come get experience and then you can do whatever you want with that.

And so I did, and I sat in some meetings and I realized very quickly that these, these people needed good guides, not just people, to say yes to what they were doing, but to understand their operations and their systems.

And they were working towards such a greater good.

And what better work could I find myself doing than something that could provide health and care for people?

All over the place.

So 16 years later, I'm still there.

I'm not going anywhere.

And it's my passion for what I like to do with my degrees.

As I'm here to talk about the processes and trends for safe health facilities as part of the lecture series for, innovative approaches on how to, enhance safety within the health care environment.

When we look at the definition of safety, it's the condition of being protected from or unlikely I get to do up here.

Here we go.

The condition of being protected from or unlikely to cause danger, risk or energy.

And I don't know about you, but when I look at this, I think of the danger, risk and injury and what we can do to kind of prevent that.

My mind goes to the things that I see on the news.

But safety is so much more than that.

At the root of it.

It's really about protection.

And this is a key aspect of what we do and what the people do that we serve through our, design services.

I think what I recognize is it is a gift and a privilege to live in a place where we're not under constant threat.

There are a lot of people that that's not true for.

And despite what we see on the news, we live pretty, safe day to day lives.

The places we go to seek care, employment or seek community.

Those are, the spaces that we need to look to feel protection from as well, especially for the health care facilities that we go to when we when protection or lack thereof, affects us.

It has an impact on physical, emotional, relational and even financial psychological ways.

And there are many categories to safety within the health care systems.

When I was thinking about what to bring to you all today, my mind just went.

There are just so many avenues that we can go down.

There's everything in terms of how it affects patient staff and the public.

There's workplace safety.

This is a big topic right now.

It's been out there for a really long time, but it's come to the forefront right now.

There's the sensitivity and protection of our information and making sure that folks are not getting our information that should not have that.

There's the basics of how are we doing handwashing, keeping our facilities clean to prevent infection.

How are we doing the security around the facility and providing, the door hardware needed in order to do that?

It's also the mental and psychological impacts of the design that we have down to transportation.

I mean, we have to think about the safety of when the ambulances are coming in, when helicopters are arriving to these facilities, how do we segregate those flows so that the public who are urgent for an Ed need are not running into the ambulances, who are also coming in, who are also not interfering with the general public, who's not there for an emergent need.

So it is just really integral in everything that we do for our health care, practices.

And as when we when we're learning this, we're learning this through school, through practice and understanding the codes and delving into research on the subjects to provide solutions for folks.

So when I think about innovation, technology is the first thing that comes to mind.

You can't think about innovation without thinking about technology.

And I was just talking to my mom about this lecture last night, and her and I were talking about when I was born.

There was no internet, and we could not have imagined all of the ways the internet was going to change and affect our everyday lives.

Now we're in this newer era where AI generative, machine learning, those things are now affecting us in ways, and we have no idea how they're going to affect us either.

But they're a part, and they're here of what we can put into place, for these facilities.

So I just want to talk about a number of these solutions today, and then I'm going to give you some, case studies of some facilities that we're doing this in.

Just as an example.

All right.

I'm going to start with something familiar.

Robotics and oers.

These are not new.

They've been around for a very long time.

But still new to many facilities.

They're promising for minimizing errors and their precision capabilities.

The use of robotics is growing both for inpatient and for ambulatory, cases.

But this idea, when I, when I was first doing my orders, the first year that I was doing it was which was going to be our robotic or right or which couple of hours, maybe our robotics oers.

The latest discussions that I'm involved in are how can we ensure that every O.R.

that we're designing is capable of robotics because they know they can use them for many use cases, and that need is just going to grow.

The design implications of things like, oh, are so technology.

You may not think about the design, aspects that come with that, but for the robotics, there's a much larger operating room that we need to provide to be able to house this equipment within there.

We're looking at 750ft², 800ft², in many cases for these owners to be able to house that and the teams, it's also working with the users to understand how the equipment is going to be positioned when they need to work on multiple sides of the patient, how the patient is going to be brought into the room, where the staff is going to be moving, where materials are, and all of those flows within the O.R.

to be able to influence the way that we lay out the Oers.

In the future, there are predictions of remote surgery, leveraging, remote surgery, leveraging augmented reality.

So could you imagine being in a rural facility and having somebody in another location conducting that surgery for you?

It's being able to bring that care to places that maybe they they cannot reach today.

What a cool opportunity.

So the next one is something I have not done in facilities yet, but in investigating this it's just too cool.

Not to mention anyway, it's the use of AI and cameras.

So there are new technologies coming out when we're talking about safety that monitor behavioral aspects of people moving through the facilities.

But then people trained in security can also track and determine if somebody is a risk to the facility so they can intervene in a very, low impact way for the occupants of the facility.

There's also technologies for virus detection and even the heat map from people walking in to detect if they have a fever, so that the care teams can intervene, whether it's because that person needs care or they're trying to protect the other occupants in the facility and AI for weapons detection.

So with the workplace safety being at the forefront, having that weapons detection as a first line of defense is could be a game changer for many of these facilities.

All of these technologies, require some level of physical design as part of that.

They need line of sight.

If we if we're not providing good line of sight within the facilities, there's nothing for them to see.

And we can use more cameras, but we want to be mindful.

But there's also the design aspect of how we, facilitate the space in a way that minimizes the blind spots and then directs traffic where we want them to go protect, providing layers of protection in both the systems that are available and through design.

Okay.

Meds automation is another one.

Have you all seen this?

How many people have seen the meds automation systems?

Okay, it is cool.

Okay.

Roxanna has, We went to Ohio State.

They had a relatively new cancer center that was built, and we were preparing for a large project that we were doing.

It's being constructed right now for Wexner, inpatient tower and that, the project that they had done had this room that had glass walls and in it were many, many shelves full of medications.

And right in the center was a mechanical arm that is just nonstop grabbing and pulling the meds that need to be grabbed.

There's just so many opportunities with robotics, they can do some of the most mundane tasks or tasks that require so much precision and just endurance.

But these robotics and the opportunity of health care, they can do that.

They can grab the meds that are needed, and then the staff can do what they need to with that in terms of preparation.

But they could also give them to a machine that can pack them into pill packs.

And then from that machine can go into a robot that can take it up to the patient unit and distribute it to the med rooms, where it's put in another robot that they can pull it from when it's needed for the patient care.

So the level of automation within, even just the pharmacy sphere is, is strong.

This is a project that we did it's think whole person healthcare.

This is in Omaha, Nebraska.

This one is also cool because it takes that idea of innovation and how we can use robotics to streamline our services and put it on display, so it also becomes part of the patient experience.

So these these deaths, somebody can walk up to it, place their med order in their as that mentors place goes to the pharmacy.

And they can literally watch and be part of that process as their meds are developing and then coming down to be delivered to them.

So pretty cool.

Pretty cool.

Features go to the next one.

Okay.

Another topic is an incredible amount of data in healthcare, and it has traditionally been relatively siloed.

And so by having this AI generative machine learning, all of these tools, they are able to bring this data together in ways that they haven't been brought together before.

Command centers are one feature that can be used from a department level all the way up to a facility or enterprise level.

These are, DSI allowing that data.

We we use them for hospital wide management in key areas impacting patient experience, safety, patient retention and revenue, which is very important for making sure that they can stay in business and provide that care in their community.

Some of the cases that they're used for would be like, excessive length of stay monitoring, remote patients, O.R.

utilization, and optimizing bed utilization.

So imagine having folks within one room physicians, nurses, schedulers, somebody from EBS.

We're talking a whole gamut.

Somebody from transportation.

You can have a whole bunch of people in there, depending on what your goals are and bringing that data together.

You have a patient who needs to go to O.R.

two from Prep.

They so they move them in there.

They do their procedure.

Then they're monitoring to see which pacu Bay is going to receive them.

They notify the team, bring the patient back to the pacu Bay immediately.

While somebody is doing that, they get the room started for turnover.

So there's no idle time.

And they can measure that and evaluate to see where there's room for improvement.

So pretty cool opportunities with some of these.

And this is a facility in, Portugal, the Champlain Pancreatic Cancer Center.

In this facility, they're using it for supply chain as well.

So not just meds.

Not just in the O.R..

This is for, how they manage their supplies as well.

This helps them to, manage their inventory and retrieve the supplies.

And even though that seems fairly mundane, they're a central part of, making the hospital function the way that it needs to.

So now I just would like to share kind of like a more in-depth case study of where some of this technology is having a great impact on our project.

So there's two I've done recently.

HDR likes to refer these affectionately as Excel projects.

These are like the 1 million plus square foot projects.

So they require a completely different set of tools and evaluation because there's a lot of repetition in this, and a lot of repeated tasks as well.

So we want to make sure that even with spaces operations that we're using technology, and facilitating the design in a way that's going to help these, care providers out in as well as the patients and public.

So Henry Ford is one point 2,000,000ft², 432 new beds.

You see all of the stats.

It's very, very big.

This is such a cool project for Detroit.

It's a commitment by Henry Ford to the community.

You know, Detroit has gone through some ups and downs.

And so it is a it is a commitment to be able to serve them and help grow the Detroit community, as part of this project.

One of the things that they chose to implement was the use of robotics.

So I just want to go over briefly, kind of two main robotics that we're using in that project.

One is an AGV cart.

And this one shows kind of a panel.

It's a flatbed.

And then the, the, the systems that it picks up go on top of that.

So the robot itself is more of this lower piece.

And these are typically back of house functions, things that you want to be able to move that are heavy, or that you don't want staff to move.

And some of the things that we're listing here are areas that Henry Ford has opted to use these robotics.

The Amr mobile cabinet has a lot more flexibility in terms of how it maneuvers within the hospital.

So those can be impatient units in the corridors with patients and staff.

They can stop, move out of the way, let folks pass, and they can be used for, various, delivery, such as the ones listed here.

Pyxis food can be part of that as well.

I want to share a little bit more about some of the requirements here.

So some of the system spaces that go with robots, we can't just plug the robot into any facility.

There are a lot of requirements in terms of making sure that they're successful, travel paths and corridors.

So identifying where they're going to flow is important.

And what type of robot we're going to use is important so that we can determine if a can flow in a standard corridor with or if we need something greater.

And I'll get into that in just a moment.

We have dedicated elevators for these.

We don't want these, systems slowing down patient and staff operations.

We have departments that we need to plan or depots or warehouses where the stuff that these robots are moving can then, dock.

There's also vehicle parking and charging positions.

They need to charge 15 to 20% of their use through every day.

So having those is very important.

And then having them in, consistent locations is also going to be pivotal in whether or not it will be successful.

Their robots.

So they also require maintenance based control rooms for somebody to tell them what to do and workspace.

So a lot of space needs.

Henry Ford is actually, has a little bit lower space need than another project that I recently did, which is Ohio State.

And I'll talk about that in just a moment as well.

But I want to share they can't just move as nimbly as people can.

So when we plan for them, this is showing some elevators within a depot, the parking space.

We have to mean almost 18in clear here, almost 20in clear here for them to be able to maneuver and park there also for the docking for them to charge.

It's a lot of area, just even a couple of them.

It's a lot of area to have to plan within a facility.

And then also the maneuvering capability of them getting from the elevators to and from, between those parking spaces.

Within the corridors.

This is what I was talking about for the AGV specifically, when we have two ATVs moving past each other.

Plus, we need to make room for people movement within that corridor.

What we're looking at is a 14ft corridor to be able to move.

That's a huge implication for when we're doing design.

If they decide to do robotics and we're already through design development, it's a challenge to figure out where we can take that much space from.

I want to show a couple of examples.

This is an inpatient floor plan.

The top and the bottom are cut off a little bit here.

We were working on with Saint Onge on actually both Henry Ford and OSU in terms of their robotics needs.

This in this inpatient unit, these green elevators represent our robot movement.

The blue elevators represent patient and staff.

And you can see right here that's where we have our parking spot.

So on every single floor for inpatient there are at least that many parking spots that they can plug into because they're bringing so many goods to and from on our surgical floor.

Okay.

On our surgical floor, we have those same elevators that I just highlighted, the ones in yellow where out of you and the other one, those are public elevators.

And in this view, you can see when we're talking about that 14ft corridor that's on that far right side of the plan, they need that width to be able to do their work and bring it all the way up to the elevators and to bring it across that bridge to the legacy facility.

What you can't see on this plan is there is a bridge that goes to the south, and that's where we have our shared service building and that has all the lab, pharmacy, Ccpd, all of those support services functions.

All this tech has impacts on infrastructure as well.

Just as an example, when we were doing this for Ohio State, this was several years before this one, the TDR rooms, the tech rooms have grown by almost 100ft² each.

By the time we got to Henry Ford.

So it is a big implication on mechanical electrical as well.

One thing I don't I don't have a graphic for this right now, but one thing I just want to talk about for the surgery floor, we had, for this one, I do have this graphic that shows the clean flow and the dirty flow we are keeping separate.

So this corridor we're keeping is clean and staff movement.

So for the robots to park are highlighted in green down there.

All of the case cards come out of here and around to that one that's in the upper right hand corner.

That's where they park to be picked up for 29 hours.

On this floor, it's two case cards in queue for every clean that are waiting for their next case.

Inside the clean core, at least two.

And then we have two that are leaving when every case is finished.

So it is a high volume.

That's what is that almost 90.

Every time the rooms turn just for that volume.

Now they turn at different times and everything like that.

But it's a good number and these carts are heavy.

I don't know if you have seen them, but they are heavy and difficult for staff to move.

So if we can prevent the staff from having to do that, that's great, or at least minimizing it.

Throwing tech solutions at health facilities isn't a guarantee remedy for all the things that ailed them.

It's important to identify what their key problems are, what their goals are, where they're willing to make an investment and establish the priorities so they can make a smart investment with the resources that they have available.

I love this quote.

So we were doing these in-home interviews, and one of the folks, it's a patient and their care provider, their family care provider.

And one of the things that they said was, I mean, if it ever got to the point where it was robots instead of people, I might have to draw a line.

So what this is just pointing to is that technology is transformative, but we can't forget that we're designing for people.

Right?

So one, robots are a way to protect, by taking that mundane and protecting the staff by not having to move some of those heavy things, and doing automated tasks.

But we want to talk about the process as designers of how we might approach safety in the work that we do.

So the other ones were more like solutions that we may implement, and this is more about the process of how we would get there.

So Ohio State, I've mentioned it a few times.

This one also used robotics.

It was a tech forward facility.

It is it's still in construction.

It's not occupied yet.

But it also embrace the impact of the human touch.

For example, their, their case cart movement that they're doing with their robots, their Ccpd is off site.

So in order for them to do it, the space that we had to allocate was large within the our platform.

We had to do a clean doc and a soiled case cart doc, have those flows that then got to the dedicated elevators for those, materials that were being moved.

And then up on the surgical floor have huge depots for a massive amount of case carts that were clean and then dirty because they're coming in truckloads.

They're not coming one, two, three at a time like they were in the Henry Ford example.

Evidence based design is a process about using credible evidence and analyzing that evidence to make decisions.

And at HDR, we have the benefit of having a large portfolio of projects to draw on and, get that evidence.

Sometimes it is hard in health care to find true evidence that has the research that's needed.

And so being able to generate the evidence for this and have a more human approach looked a little bit different.

We had experienced design teams that met with 48 people.

These are patient advisory committees and in-home.

We call them in-home dyads of care provider and patient.

And they talked about their experiences.

These aren't all OSU people.

Some of them went to Cleveland Clinic.

Some of them went to other facilities in Columbus.

But we wanted to know what was transformative in their care and what things were creating problems for them and where they thought would make the most difference in terms of an investment in their experience in a new facility.

So we talked with them.

We learned a lot about what was working and what wasn't.

And then went through a list of different amenities and had them prioritize them.

So instead of OSU throwing the kitchen table at everything, they were able to, select the ones that were going to have the greatest impact based on these discussions that they were having.

So that's one approach in terms of process.

This is another this is another example of how we may address process in terms of, innovation for enhancing safety and health facilities.

This is Mayo Clinic Health Systems.

We've done a lot of work with Mayo Clinic.

This is in their Mankato, Minnesota location.

The charge for this project was three bed floors on top of a DNA platform that was already there.

They had waited a long time.

This project was going to have a big impact on their community, and they were very excited.

One of the things about the Mayo Clinic projects, all of their inpatient units are either double loaded corridors or all on stage.

And as we with any client where we're going to talk about an inpatient unit, we'll bring different models in, board out, board, mid board, toilets.

We'll look at on stage off stage models and the different permutations about how those may come together.

So when we met with them we reviewed kind of what their existing state was, what their future state could be and were evaluating where would be the impact for them.

That would make the biggest difference.

One of the things that we noted, and this is 2017, because that's when we were doing this project.

It's been a little while.

Health Care Finance reported that noise is at top complaint and affects not only patients, but hospital visitors and staff as well.

And the Cap survey results for 2017 and 2018 says 48 rooms.

Percent of respondents rated quiet at night as usually, sometimes or never quiet.

And when we were looking at the data for, Mankato.

They were well below the national average in terms of the respondents view of quiet at night.

So there was a lot of room for improvement and how we could do it.

And while we didn't have there's not great evidence around on stage, off stage, providing the remedy to this.

There is a lot of anecdotal information and feedback that we have from different facilities that we have worked with.

So this is from Parkland Hospital and they're talking about on stage, off stage design fosters a healing environment, environment and a better patient care.

This was something that we got after we did the large project for them in Dallas.

And just in terms of what data is available, what we have found is that for large safety net hospitals that include on stage, off stage, cause in their new facility where they previously had all on stage, the h cap scores show lower, or show greater improved responses about being quiet at night.

All right, so in their new space, I just want to share this is a response to the podium that was below the connections that we needed to make with the public elevators and the service elevators that they already had in place.

But you can see down the middle is this off stage corridor.

So we evaluated all of this information with them.

We talked about it.

One of Mayo's three shields is in research.

And so they valued this as a new model to test as part of their, growth and development.

And invested in it.

So we even talked about space considerations in that.

And not all the them had the, you know, knowledge about on stage, off stage.

Can you explain?

Yeah.

Yes.

Yeah, absolutely.

Okay.

On stage.

Let me go back a few slides.

Thank you.

I'll go back to here.

This is an example of everything being on stage.

It's also double loaded.

So that means there's patient rooms on both sides.

The other model of all on stage is that you have a core in the middle.

That's where your meds clean soiled nourishment.

Your team spaces live, but they don't have a way to do that where it's outside of the view of the patients.

What we hear a lot is that when patients or when patients are in their room and staff are accessing those rooms, those doors can be right outside of the patient rooms, and it's a out of constant movement of equipment and supplies and the the staff opening the doors.

So let me now go back to that other one.

And you can kind of appreciate what we've done here.

I'll walk through.

So now you see this core.

The patient rooms are in blue.

The support spaces are in brown tan down the middle here and right here we have a corridor that connects all of those.

So if staff are moving through this, they don't need to be within the public zone.

They can be down in this core.

They can use it for communication.

That's where they grab their equipment from.

So when they're here and they're opening the door to be able to grab some equipment, this patient and this patient are not going to hear it, right, because it's behind the doors and it's more off stage.

And that's the value.

And being able to do that is have that collaborative space kind of behind the scenes and keep it a bit more quiet, which affects the, production of staff.

They, they report that the noise affects the production of staff as well as patients ability to rest and recover.

Any questions about that one?

Wait till the end.

All right.

Back to Henry Ford.

This is one that I've been working on for a little while, so it is very much in my head at the moment.

Henry Ford, I think I mentioned they are expanding across from their legacy hospital, that is there today and creating a bridge connectivity to get back so you can see the legacy hospital over there.

This is a replacement hospital.

This is the first phase of the replacement hospital.

So almost everything is coming over except for surgical beds, labor and delivery, and a few had a few other services.

Eventually, when the next phases are built out, those will come over to this campus as well.

But some of the things that we were looking at is this is a this is a big facility.

And when we think about let me go to the next one, you can see how big this platform is when we're looking at the procedural platform, that floor plan that I showed earlier, that's more than 400ft from one end to the other.

That's a lot of walking.

One of the key things that we see this is from the American Nurse Association.

Almost two thirds of nurses experience burnout and two of the leading causes of burnout is mental and physical exhaustion and reduced efficacy in the workplace.

So what is our role in being able to manage that better for them?

How do we help them feel like they're spending more times with their patients and able to make a bigger difference?

And how are we protecting their physical expenditure so that they can use that for the care?

So when we started this project, we were leveraging computational design at this point for being able to evaluate, this is their legacy hospital, this is the new hospital that's going up some of the key routes that needed to happen between the hospital, the two hospitals.

And one is they're going to present an emergency.

How do they then get to labor and delivery?

How long is it going to take?

Where do we need to make connections?

And is that amount of travel frequent?

And is it within tolerances that are going to support the staff?

Another, and I don't know if you all have seen this, but one of the tasks that we do early on in design is we take all of the rooms that make up a department, and we cut them out so that they can do gaming, and we work through there.

We've gone through their, past operations, their current operations, and they typically have established a future state that they want to operate within.

And so we use that as a benchmark to lay out the departments with them.

We literally hand them the keys to the car and say, we want you to drive.

How this is going, what would best serve you in this new facility?

And we'll we'll prepare models for them to look at and get some ideas from.

And that but coming out of the gaming exercise, when they had done several models, we then mocked them up in our models and use computation to measure them so that they would know which were performing best.

So together we did the flows, the seven flows of health care, to be able to measure the movements and analyze, patient staff, meds, information, supplies, all of all of those.

But when we bring it back to this, it makes it a little bit more objective.

What is performing well, what isn't.

So this we evaluated the travel distances.

We did it furthest over to furthest over for this prep to furthest prep and PACU.

And then a combination of the two.

And these were three different scenarios that they were looking at.

They thought they knew they wanted to go with one of the other options.

They liked the way that they were coming together.

We were concerned that it might be further travel, but you need to test it to be sure.

And so when we when we ran the models and then brought it back to them, it became very clear.

Yellow and green are good, red is bad.

Which ones were going to serve them best in terms of reducing that travel for them.

So this this really was foundational.

And then being able to make an informed decision on what would protect the time, and demand, impact patients and staff in the surgical environment.

And I just want to, close this out by talking about, so we know technology is very important.

We just want to remember that the human touch is part of this as well.

And these mechanisms that we design and employ in protection of the occupants, we need to be willing to investigate, and change our assumptions if we're coming in with our own kind of held beliefs about how things need to come together, like the measurement of those floor plans, we need to be able to put that aside and evaluate them clearly and explore new solutions so that we can provide a better environment for them.

So I'm going to advocate for you all to be curious.

And to explore in your design with health care design.

Because after all, what greater honor do we have than to be able to, protect and care for the people within our community?

So thank you.

Presentations.

Very informative.

Thank wonderful, exciting.

Oh.

Thank you.

I know I have myself a lot of.

I will wait for the students to see, what questions they have, especially as students work in the studio, focus on, ambulatory surgical centers.

I know that there were a lot of discussions around developing some information, and this is something that is also very precedent.

So feel free to ask questions.

Yes.

She looks excited.

I'm so excited.

Presentation.

Very impressive to me.

So you mentioned that's part last part about the the analysis of the travel distance in minutes.

So I'm curious about what software that you can run these models.

I want to be exactly right.

So Rhino and Grasshopper are primarily the the models being used.

And I will tell you not not everybody does this within the firm.

It is something that is, not necessarily the most intuitive method.

So I had a partner and being able to run those and he set up the, grasshopper models and ran all of that as we were laying this out to be able to test to see what those travel distances were to the grasshopper, we little with.

The script will be through grasshopper.

The plans would be in Rhino and then facilitated through.

Yeah of course there's plugins for a method that you need to purchase a license.

You have a variety of software and you.

But, grasshopper, I know, I know are the ones that could do something like, if you have a license to do the for.

Them.

And, thank you so much doing that.

And, yeah, actually, I'll always produce them, amazing.

Beautiful.

And also, you know, thank you as well.

And, I'm just wondering, you know, the other health care facility, hospitals are getting bigger and bigger because it has to come with a, you know, the technologies and all the, you know, the new, you know, way, the process when you're designing the, Henry Ford and then when you, you know, I think it's very innovative because you use the, the clean and dirty.

Wow.

Arrange the one way traffic for the robot.

Yes.

And then, you know, you make increase the space.

You, you know, make may or may not.

And then how's how's your clients react to that.

They discuss the budget of the project and then sometimes maybe they, you know.

Yeah, there's I mean we do evaluations upfront.

This one was different and so was OSU, actually, in the sense that our Ccpd was not going to have vertical connectivity to the Oers and the Oers, whether they were all in one big pod or split up.

We had three pods on each floor.

Because it was a two level platform, that, that one elevator was not going to serve directly into core for any of them, even if it was below.

And so part of what we looked at was, how do we extract the services in the case of Henry Ford, actually in OSU, also by doing an offsite.

So they extracted the non acute services to a lower cost facility, whether it was right there across a bridge like in Henry Ford or it was in a remote location like for OSU and kept the dollars for acute care on campus.

So it was an impact like it did impact the outcome of those projects.

But I think I would argue that the on stage, off stage should not add a lot of circulation.

We this one is called a finger model.

So it has this back of house connectivity at the back.

That's where we bring all of the clean supplies and services in.

They can bring the meds in from that route.

Staff can access that route.

And then it really keeps that front edge focused on patient movement and staff having two routes then to get to and from the O.R..

So in terms of productivity, it's it's a really good model.

There's design implications.

I have like another study or another discussion that our planning team was having in terms of if we're going to do this model like we did at Ford in OSU, these are some considerations that we need to have to make sure that they're successful.

Thank it's great to know.

And then, I had a project collaborating department right now and then that, the director saying that.

Do you have some concern from business school?

The business school.

Help me to analyze, you know, how much saving, I can, you know, can lead to.

Yeah.

That further convinced me adopting this kind of approach and not the other.

Yeah.

Yes.

I think your comments, but your your answers.

Okay.

Great.

Thank you.

And Danny.

Thank you for the presentation.

So I have a several part question you mentioned something about my memory is low, so.

No, I'm just kidding.

I was going to say give them to me in bits.

Stands for I think it relates to like, the technology side of things.

It's for low voltage.

It's for the, low voltage systems that are running all of this technology.

Okay.

So is it similar for like, a server room or is it just the actual power front of the building?

Power is going to be provided through the actual electrical rooms.

This is more for that information movement.

Okay.

Okay.

So you mentioned that in one of the cases it happened to grow by like 100ft².

And I was wondering like, would you be able to estimate for like percentage over time that those rooms are growing?

No, I would love that metric.

If we could have that metric, that would be wonderful.

It actually it was a so it's the same engineer for both projects.

So we can't even say it's a difference of their approaches.

I think it's probably lessons learned from OSU that lead also to the larger needs for TDR and future proofing.

They know technology is going to continue to play a role in their facilities.

So we need to design the room so that they have that capacity to be able to add to it.

So it was future capacity as well as lessons learned from there not being enough space for just how fast it's evolving right now.

I hope that it does not continue to develop at such a pace that we have buildings that are mostly MEP.

And no, I'm just I'm kidding.

But it was a surprise on that one.

Thank you.

Hey George, and thank you.

Do karaoke.

All right, let's hear it.

Tina, it was a wonderful presentation.

And, I texted you the Galaxy Quest.

I think you that's what I was, If someone.

I have a couple of parts to my question.

If someone comes to work with you at HPR, let's say from Texas A&M, let's say someone from this room, what are some of the characteristics that signal that you made the right choice?

And what are some of the characteristics that maybe you said this may not be working out?

Well, I can speak to this very specifically right now because we have a health scholar.

We have three health scholars this year, recent grads that came to work with us.

They have a year kind of, with us doing the scholar work.

And then the hope is that they become full time employees and they submit, applications for this program.

So we're very fortunate to have one of them sitting in our office right now.

She is wonderful, but she has curiosity.

She has been paying attention in her academics.

So she asks incredibly good questions.

And if she doesn't know, she's not afraid to look things up.

I think that was the thing I learned, kind of early, is we have a bunch of people that we can count on as our team.

I don't need to have the answer for everything.

And knowing that is half the battle, you don't need to come in knowing everything.

You will have more information than I had when you enter the workforce.

Just by sheer circumstance of taking health care focus classes.

I didn't have any of those when I graduated.

So I think as long as you have a curiosity and you remember what that foundation is for you that's driving you towards health care, it will help get you through the moments of man, I just had to put in some incredibly long hours this week in order to meet all of the deadlines that I have, so that would be for me.

Okay, let me ask a question of the students.

What does HDR stand for and where is the headquarters of the company?

Did anybody look that up?

Nope.

Stands for Henningsen Durham Richardson and they're out of Omaha.

But yea, this firm is ranked number one in square footage, so if I were a student, I'd get on that side and find out that this college program and do a little research on the firm that's coming to see them, I want to congratulate you.

There was no, like, maybe a little.

Yeah.

Thank you.

Good luck.

And it doesn't happen overnight.

You have YouTube.

You can get up there and make a presentation and then watch yourself on it, because there are all kinds of possibilities for the future that you come prepared for.

The lecturer in Pakistan has done a fantastic job of getting some big fish firms and big fish people.

Excuse me.

I'm okay.

Thank you.

As a code for significant for your partner, who is your daughter there.

Is that your daughter?

No, no, no, I have a I have a son.

He's two and a half.

But that's not him to this.

Like that you are.

You know why I forgot?

About what?

About HDL, what it stands for.

Did you fact check him?

We're in the era of fact checking.

It's good.

Well, thank you so much, George.

Well, I have, one question again, going back to your presentation, one of the highlights of the presentation for me personally, was mentioning robots and their operations and considerations regarding that when it comes to planning the layout of the facility.

Like, for example, where should we actually store these robots?

Where should they get charged?

Like, what about, you know, robot, robot, parking stations and you covered that beautifully.

Thank you.

So, I'm just wondering, we have a considerable level of research when it comes to, let's say, telemedicine robots that are moving throughout the facility and are, remotely operated.

There has been reports regarding, for example, collisions, some incidents, you know, especially in, hectic, chaotic departments like the emergency department.

So, what are some safety aspects when it comes to, you know, the operations?

Of the robots, these units.

Yeah.

Just because a robot like the smaller Amrs can go into any room doesn't mean they should or can go into any space.

Doesn't mean that they should.

So some of the considerations on these projects were where are they going to not impact operations.

So when they're bringing the cleaning for multiple reasons, we don't want them to bring clean case carts into the sterile core.

Those robots travel all over the place.

And we want to keep that sterile core sterile.

And so providing spaces adjacent that then they can bring them in is important.

Same within like the inpatient units being able to have that doc so that they're not moving all over the facility for the larger, RVs especially.

But we did look at being able to bring the meds into the med room.

So that is one of the delivery processes that we're looking at for Ford.

And the robot can roll up to the med room.

The door will detect that they're there.

And just like a card reader can open for the robot so it can go in and wait until somebody comes in the room and then loads the Pyxis or whatever.

Adu is in the room.

Did you were actually work on parking yourself?

Parking?

I did not I was not in Dallas when that was happening, but I did Henry Ford, OSU.

Those were my two most recent projects here.

A view from Dallas.

Parkland is a joint venture with HPR and associates.

Has anybody seen that building?

And, it's worth looking up 800 beds.

So huge hospital.

Yeah, the presence feels very big.

You know, OSU was 900, and it doesn't look as big because it's more vertical.

But, yeah, the big facilities.

And then they call me and say they came all the way down, and then not one student sent them an email.

So it's like, you know, it's great.

Student.

Before Tina gotten her card, she have an email from me.

And look up that scholars but and don't do it tomorrow in an email world because if you come to the faculty at the end of the semester and say, help me find a job, what do you think Roxanna doing all semester, which was one of the hidden agendas here.

And then Andre putting h d r h the alphabet Perkins in will hdr HDTV.

So, show that you're alive unless your father's head of the bank of, America or China or wherever you come from.

And, I don't think you'd be here or things start.

Well, thank you so much.

Thank you, thank you.

It's a fantastic presentation.

Thank you.