Sutter Health, Eden Medical Center
Budget

Some health insurance executives claim, and some news media have recently reported, that large provider systems like Sutter Health make health care more expensive by demanding higher-than-average reimbursement from insurers.  To clarify Sutter Health’s position and shed more light on Sutter’s priorities, we’re posting this recent Q&A with Sutter Health’s leadership.

What is Sutter Health’s perspective on claims that hospitals’ demands for higher reimbursement from insurers drive up the cost of health care?

Sutter Health believes its reimbursements from insurers are fair, and reflect the high-quality and readily available health care that our doctors and hospitals provide to patients. Insurers contract with us for services of their own free will. There’s plenty of competition in Northern California — from Kaiser, Catholic Healthcare West, Adventist Health, John Muir and the UC hospitals, and from many independent hospitals and physicians. Sutter Health has held annual overall average price increases for commercial health plans to single digits in the past several years. Of course we have no control over whether health plans reflect our single-digit rate increases in what they charge consumers. Recently some health plans announced premium increases in excess of 20 percent, more than double the increase in reimbursement to our providers.

The reimbursement we receive from health insurance companies help fund Sutter Health’s commitments to ensuring our communities have adequate access to physicians, as well as fund our commitments to quality, safety, convenience and free care for the poor. While we continue to focus on meeting our community commitments over the long term, the for-profit health insurance companies focus on short-term profitability goals for their stockholders. For them, that means spending less for patient care, which represents the largest part of their budgets. The U.S. Congress found that the large for-profit insurers paid on average only 74 cents per dollar of premium from individual policies to doctors, hospitals and other providers, keeping the other 26 cents for their costs of administration and profits.

Certain health insurance plans maintain web-based pricing tools for members. Some of these tools post prices that the plans pay doctors and hospitals. Why hasn’t Sutter Health participated in these tools?

We want to provide consumers with fair and reliable information that is easily understood. Although several insurance companies have begun providing what they believe to be comparable data on prices between providers, Attorneys General of multiple states have disagreed with the approaches taken. Until they work the bugs out, we prefer not to add our data to the postings. We strongly believe a patient is best served by talking with a professional who can walk them through their personal health care needs, treatment options/choices and the estimated treatment costs of those options. Staff members at our hospitals and clinics regularly work with patients to answer questions about their estimated costs, and we plan to make estimates of our costs for common procedures available on our web site as soon as we can reliably do so.

Why are health care costs increasing at such a high rate?

The government pays less than the cost of care, so any inflation in health care costs must be borne by those who actually pay a market price. Since government-sponsored patients consume about 50 percent of the care in a typical health system, the cost-shifted to everyone else is double what it would otherwise be. For example, if inflation is 4 percent, a health system’s prices have to go up 8 percent to cover the increased costs of caring for government-sponsored patients when the government keeps its payments to doctors and hospitals arbitrarily low. Improvements in technology, drugs, and seismically-safe facilities all tend to drive the cost up faster than in other industries.

Health care providers, especially those like Sutter Health that invest in their communities (rather than giving that money to shareholders), have significant financial commitments. For example, we are replacing paper records with electronic systems and replacing hospitals at a time when per-bed construction costs have more than doubled, from $1 million about a decade ago to more than $2.5 million today. The other big cost driver is the success modern medicine has had in saving lives. Health problems that were once untreatable can now be treated, so we’re seeing more and more people living with chronic conditions. We’re absolutely committed to saving and extending patients’ lives, and we all need to be mindful that the costs of chronic care continue to be part of the nation’s overall health care bill.

How will health insurance reform impact your costs and affordability goals?

Our affordability imperative becomes even more important given cuts in reimbursement under health care reform. For Sutter-affiliated physicians and hospitals, Medicare cuts will likely total an estimated $124 million each year for the next 10 years – adding up to more than $1 billion in reduced Medicare reimbursement.

The United American Nurses Union/California Nurses Association has questioned Sutter Health’s commitment to “communities of working class people” and diverse populations. What’s Sutter’s response?

Counties including Del Norte (the north state’s poorest county), Lake, Merced, Sutter, Yolo and Yuba have some of the highest poverty levels in Northern California – and Sutter Health facilities serve each of them. In many small and rural communities such as Los Banos, Tracy, Novato, Jackson, Davis, Crescent City and Lakeport, Sutter Health is the sole provider of emergency medical services. Also, Sutter Health hospitals together serve more MediCal patients in our Northern California service area than any other health care provider. Sutter Health is building or has a continuing presence in diverse urban areas as well, such as downtown Oakland, San Francisco’s Mission District, midtown Sacramento and Stockton. Ironically and unfortunately, the nurses union formally opposed Sutter Health’s plans to construct new, seismically safe hospital facilities in urban Oakland, downtown San Francisco,Santa Rosa and right here in Castro Valley.

Digby Christian

The Sutter Medical Center Castro Valley project has been recognized throughout the construction industry as a unique project in design and approach, catching the interest of architects and builders throughout the world. We sat down with Digby Christian, Sutter Health Project Manager, for a closer look at what makes this project unique.

Q. Why is this project different than other projects you and the team members have been involved in?

One of the unique features of the project team is that we have an 11-party contract, with the non-owner members putting all of their profit at risk. I’m very confident that’s a unique set-up in the United States.

Another unique feature is that the trade contractors involved in the design and construction of the new hospital have a goal of achieving a fully coordinated, constructable, affordable design, complete with fabrication drawings, before the facility is even built. We do not want to resolve issues in the field during construction. We want to resolve them all as part of completing the design rather than in the field during construction when change orders are costly and time-consuming.

Q. There is a lot of emphasis on the team approach to this project. Who participates in the regular project team meetings?  How do they work together?

The Project Team is managed by a six-member team called the Core Group. I’m on it representing Sutter Health, as is Bryan Daylor, Eden’s Vice President of Ancillary & Support Services, representing Eden Medical Center. The other four members are from DPR Construction (general contractor), Capital Engineering (mechanical and plumbing design), Devenney Group (architectural design), and J.W. McClenahan (plumbing). We meet every two weeks to ensure the project is managing all the risks as optimally as possible. All decisions are required to be unanimous, and for the two years that we’ve been meeting, we have met that requirement.

A much larger group comprising all the designers, builders and specialty consultants meets at least every two weeks to resolve any strategic issues affecting the whole project. There are also subgroups that meet almost daily to keep information flowing fast and efficiently through the project team.

What are the benefits of this team approach?

You get a fully informed designed. You get an efficient plan for construction. But the main thing you gain is certainty about scope, cost and completion date.  These large projects traditionally go a long way over budget and finish very late and with compromises to the goals that the owner had. We worked hand in glove with each other for close to 18 months to get the cost of the project down without altering any of the goals for the building, and now for at least a year I have been completely confident of our ability to get the triple victory of on budget, on time, and with all the goals intact. That’s a tremendous difference from traditional delivery of these complex, expensive, long duration projects.

What have you learned by this approach?

That it works. To make it work requires that a very large team of people works very hard all day, every day for years. But if the owner’s goals are clear, and the team is working under a contract that puts their interests completely in alignment with the owner’s interests, that that monumental level of effort is exactly what you can get out of a team.  Hospital construction in California is some of the most complex, most strictly regulated, construction in the world and it is extraordinarily unforgiving of oversights and errors. To deliver a hospital on time, on budget with no compromises to what the owner and community want is about as ambitious as it gets in construction at this stage in our industry’s evolution.

How has this changed construction projects for the system? For the industry?

It’s been a tremendous proof of concept for how Sutter Health would like to deliver its projects.  And because the project has been written about in various trade publications and has now won two awards for its delivery model, it does have the potential to be a game-changing project in the industry. I would like it to be just that. Our modern society deserves a rock-solid reliable delivery method for these critical facilities, and until now, in my opinion it has not had that.

If you have any questions for Digby or any member of the team, please feel free to let us know or send us your comments.

georgeby George Bischalaney
President & CEO, Eden Medical Center

National health care reform is now apparently right around the corner. After years of discussion, and more recently, weeks of debate in the House of Representatives, legislative action is now in the hands of the Senate. If enacted, it will be the most significant health care legislation in decades.

As a provider, it is both welcomed and feared. Welcomed in that it will help bring insurance to millions of people for whom it is now out of reach. In making this possible, it creates the possibility of opening doors for routine health care services that should help prevent late diagnosis of disease, which becomes problematic and costly to treat. From our perspective as a hospital provider, better access should redirect many people who use our emergency departments as their primary care providers.

But change comes with a cost.
The mind-numbing price tag of reform is expected to be offset by future savings. In the short term, it will require shifting payments currently dedicated to the Medicare program.

Most hospital providers do not make a profit in caring for Medicare patients overall. There is no doubt that we need to drive inefficiencies out of the health care system in order to help address this issue. But that alone may not do it. When costs are rising at a rate of 4-8 percent per year and reimbursement is 3 percent or less, we are constantly falling behind. There are many reasons for escalating costs. Consider the constant introduction of new drugs, high tech and high-cost diagnostic and therapeutic equipment, and of course labor. Health care is a service business and 60% of hospital costs can be tied to salaries and benefits. The cost escalation of these items alone will keep us chasing the elusive break-even point. And once there, if achieved, there is still ongoing capital investment that is necessary to maintain the capabilities expected of community hospitals.

The final package is likely still months away. Even then, it will take time to analyze and truly understand the effects, positive and negative, of this landmark movement. We hope that the final outcome will have the proper balance, consider as much as possible all the consequences, and result in a healthier and more stable provider system.

I welcome your feedback.

George Bischalaney, President and CEO, Eden Medical Center

By George Bischalaney, President & CEO, Eden Medical Center

Health care reform is on the agenda, again. The stakes are high, but our President is determined to make some significant changes. As the discussion moves from general to specifics, special interests are staking out their positions. None of the stakeholders—hospitals included—wants to feel the impact or be at a disadvantage.

Amidst the demand for cost reduction and health care coverage for all, there is and must be continued investment in care. Physicians demand it. They expect to be able to practice with state-of-the-art equipment and facilities to produce outcomes that meet national, state and local quality standards. Patients demand it. They want to know that their local hospital has the right number of well-trained staff as well as the latest diagnostic and treatment equipment, and contemporary facilities.

With this backdrop of conflicting needs, Eden Medical Center is about to begin a three-year project that will result in the replacement of the Castro Valley hospital. The project cost is estimated to be $320 million. The current 55-year-old building is anything but contemporary. With few private rooms, small operating rooms and inadequate support space for clinical services, a new hospital is very much needed.

Eden Medical Center has served the community well, but it was not designed for patient comfort and needs, more for staff needs and functionality. While our project may seem ill timed given the uncertainty of hospital reimbursement, we are required to meet California legislated standards for seismic safety in hospitals. And it truly is needed.

We’ll celebrate our long sought goal with a ground-breaking ceremony on July 1st. Then we’ll spend the next three years continuing the investment in the new buildings and equipment, while observing and hoping that decision makers do not enact legislation that essentially penalizes us for the commitment we are making. When we celebrate the grand opening and our new beginning early in 2013, it should be with the same hope and dreams as those who celebrated the first ceremony in 1954.

By Cassandra Clark, Project Communications Director

To follow up on the May 12, 2009 Alameda County Board of Supervisors meeting, the decision to certify the final Environmental Impact Report (EIR) has been delayed to June 9th to address concerns raised about San Leandro Hospital, which is leased and operated as part of Eden Medical Center, but owned by the Eden Township Healthcare District (the District).  For more information, please see our previous blog post.

In the days prior to the May 12th meeting, after many rounds of public commentary, and after the EIR and related land use entitlements were approved by the Castro Valley MAC (Municipal Advisory Council) and the Alameda County Planning Commission, several community members and labor representatives raised last minute concerns about parts of the EIR. Those opposed to the EIR certification claim that there was not an adequate assessment of the impact of any possible closure or change of services at San Leandro Hospital, despite the fact that the EIR consultant and County planning staff have stated that the EIR is complete and the issues around San Leandro Hospital, while not related to the project, have no impact on the project. Supervisor Nate Miley made a motion for the Board to meet again to make the decision on June 9, 2009, which would provide attorneys for Alameda County an opportunity to examine these claims in more detail.

Supervisors Miley and Haggerty voiced their concerns about speakers making false or misleading allegations as a political tactic, in order to delay the EIR approval process, thereby “holding the Sutter Medical Center Castro Valley project for ransom,” which he and the other Supervisors warned could endanger the future of both Eden and San Leandro Hospitals. While there has been no decision by Sutter Health or the District on the future of San Leandro Hospital, the issue remains a topic of community discussion.

Eden Medical Center President & CEO George Bischalaney and other Sutter and Eden project team members emphasized the urgency of not going beyond June 9th to approve the EIR, as the delay of even a month could significantly hold up construction and may cause Sutter Health to withdraw its support from both hospitals. Sutter Health has already promised the $320 million to pay for the completion of the new Sutter Medical Center Castro Valley.

At the conclusion of the May 12th meeting, the four Supervisors present, with Supervisor Keith Carson absent, voiced their support for the new hospital project and the need to rebuild Eden Medical Center. They also are concerned about the future of San Leandro Hospital, and that concerns over San Leandro should perhaps be discussed in another forum, unrelated to the land use entitlements for Eden.

As our project team discussed in previous articles and blog posts and at the hearing, any delays in approvals and construction have serious repercussions, in terms of meeting state deadlines to rebuild, in creating a safe environment for patients and staff, and in funding this major project. The new hospital must be rebuilt, or it will close as an acute care facility effective January 1, 2013. We now have before us a fully funded hospital project—without public funding or taxes—that will secure the future of Eden Medical Center, preserve jobs and bring nearly 1,000 construction jobs to the region at a time when the economy is depressed and construction is drying up.

As I stated before, the issues around San Leandro Hospital are complex and important.  The community has a right to know what is happening. But the information being discussed now is no different that it has been for the past several years: the hospital is struggling and must be reinvented to bring value to the community and ensure that it can sustain itself over time.  It is clear to me that the residents of San Leandro desire a full service community hospital, yet the majority of them will never use it. The community and local elected officials have known that this is a concern, and yet this last minute effort to stop the EIR based on what some claim to be “new information” is not justified. San Leandro Hospital, its employees, physicians and patients need to be part of the solution for the hospital, to be discussed in its own forum with regional providers who can bring truth and substance to the discussion.  It should not be used as a political maneuver to stop Sutter Health from rebuilding Eden.

Please speak up, let our Board of Supervisors know they must not delay any further.  These delays put both hospitals in jeopardy. I encourage you to stand up and let your voice be heard on this issue.  Don’t just wait for the next hearing, but instead pick up the phone or send a letter to the Board and let them know you support the new hospital project, and encourage them to certify the EIR so the project can move forward before it’s too late.

Call today!

Supervisor Nate Miley — 510-272-6694

Supervisor Alice Lai-Bitker — 510-272-6693

Supervisor Gail Steele — 510-272-6692

Supervisor Keith Carson — 510-272-6695

Supervisor Scott Haggerty — 510-272-6691

By Cassandra Clark, Project Communications Director

YOUR HELP IS NEEDED!

We are only a week away from the Alameda County Board of Supervisors hearing in which the Board will consider the Final Environmental Impact Report, zoning changes, and Castro Valley general plan changes. We are asking for your support at this critical step.

Local groups and some residents of San Leandro are applying fierce political pressure on the Board members to deny approval. Their reason? The future of San Leandro Hospital is unknown, and therefore they are pressuring the Board of Supervisors to require Sutter Health to keep San Leandro Hospital open as a condition of approving the land use for the new hospital in Castro Valley.

What wrong with this?  First of all, the Board of Supervisors are not voting on the future of San Leandro Hospital—they are having a public hearing on the land use entitlements and certifying the EIR. To delay or deny approval based on pressure about San Leandro is wrong.

The future of San Leandro Hospital is not and should not be tied to the new hospital. Indeed, San Leandro Hospital is a critical issue that must be addressed—and it requires a regional solution, more careful planning, and a separate focus than this project.  It’s an important issue that cannot be overlooked, for the sake of the staff, physicians and patients. But the complex issues at one hospital should not be tied to the land use entitlements for the new hospital project.

Simply stated, by delaying plans for the new hospital, the Board will jeopardize the future of Eden AND San Leandro hospitals.

I am asking you to attend the Board of Supervisors meeting on May 12 and SPEAK UP in favor of our new hospital. Speakers are limited to 3 minutes, but a simple 30-second statement is powerful. The Board needs to know that residents of Castro Valley and surrounding communities want and need this new hospital, without delays.

Meeting details:

Tuesday, May 12
1:00 p.m.

Board of Supervisors Meeting Chambers
1221 Oak Street, Oakland

If you cannot attend the meeting, we need to you to contact the Alameda County Board of Supervisors and have you voice your opinion. It is so important that the Board hears from everyone, especially since the majority of people in our community support this project (an astounding 80% of community members are in favor according to recent polls!).

Call your Supervisors today!

Supervisor Nate Miley — 510-272-6694

Supervisor Alice Lai-Bitker — 510-272-6693

Supervisor Gail Steele — 510-272-6692

Supervisor Keith Carson — 510-272-6695

Supervisor Scott Haggerty — 510-272-6691

Thank you for your continued support!

As always, we also appreciate your comments and questions on this blog, and we’ll respond as quickly as possible.

Main Entrance at Twilight

The new Sutter Medical Center Castro Valley, which will replace Eden Hospital.

By Digby Christian, Project Team Leader

We are proud to tell you that on April 7, 2009, the Sutter Medical Center Castro Valley (SMCCV) project team received the 2008 FIATECH CETI Award at the award gala held in Las Vegas.

FIATECH is an industry consortium within the building industry. Its primary mission is to get all the “players” involved in capital projects to adopt new ways of thinking and new technologies to deliver higher value for the funders and end-users of construction projects.

Here is why our team won the award…

As most of our readers know, California’s deadline for retrofitting or building earthquake-proof hospitals from scratch is 2013, less than four years from now. The hospital project in its current form was validated as viable in August 2007, and design work was authorized to start in October of that year, leaving us just over five years to have the building be ready and open for business. Typically, in California, it takes at least seven years for a project of this magnitude.

So the team had to throw out all historical concepts of how design is done and come together as a wide-ranging, multi-company team involving the owner, the designers and the builders, and transform the design and construction process to drive two years out of the schedule. The team is now on track to achieve just that and did it primarily by redesigning the design process in a rigorous and unrelenting fashion, so that it no longer bears any real resemblance to tradition!

If you are familiar with the classic design process, you’ll know that it’s typically abbreviated as “SD-DD-CD”: Schematic Design (broad concepts typically discussed and agreed to by the owner and the architect exclusively); Design Development (often a General Contractor might have some involvement in this); and Construction Drawings (some trades might be brought on board to inform how these are put together). Then, the work goes out to the building community and those companies develop what are known as Shop Drawings. These drawings show in detail how every little and large item in the building will be fabricated, i.e., the structural elements, including steel, metal, glass, concrete, etc.

On the SMCCV project, all of the people who typically are brought in at the end are already on board, and most of them have been on board since August 2007. By the time this project completes its approval process through the County and State we will already be at the Shop Drawing stage. The building is being designed for fabrication now, while the design approval process is underway.

While this concept has been discussed for the last few years within the industry, and parts of the above have been implemented on other projects, no project has implemented this concept as broadly and as deeply as the SMCCV project; certainly not on a project this large and this complex. It is one of the reasons our project won the FIATECH award!

The other primary reason we won the award is because of how thoroughly the building has been designed in three dimensions (as opposed to the typical two dimensional paper drawings we are used to seeing). There are many very attractive shots of 3D design that you can find on websites, and in trade magazines but you can’t tell if the designs are any good—all you know is they look “cool.” But on the SMCCV project, we bring the entire team together at least every two weeks to work through the coordination effort. It’s painstaking and difficult, but utterly critical to a successful outcome in a shorter timeframe.

What is not often understood outside the industry, and to some extent even within the industry, is that different design disciplines use different software, and they can’t see each other’s work in real time while they are designing. Each company has to either import a converted file of each other’s work or send both files to a third package, such as Autodesk Navisworks, to see both designs at the same time. So it’s all too easy to have a poorly coordinated, unbuildable, three dimensional design—no different in fact than having a poorly coordinated, unbuildable, two dimensional design.

In addition, we have focused the team on the larger goal of designing for fabrication rather than the industry convention of designing to produce the construction documentation, which is then coordinated by the construction team. The team’s goal to design for fabrication means we are swimming against the tide. We are allowing our companies to each use their own best-in-class software and then developing a process that allows a high level of coordination and constructability to ensure that what is being designed is actually what we will build.

The above might seem dry and technical; however, by a) having a multi-company team involving all the construction trades from day one; b) throwing out the baggage of a poor design process and starting from scratch to build a better one; and c) having a goal of designing for fabrication will allow us to build a new hospital on schedule, within budget, and without any last minute compromises on the finished product.

On the Sutter Medical Center Castro Valley project, we are breaking new ground ahead of any other project in the country in the way such projects are handled. That, in essence is the reason why the team that is building your hospital won the 2008 FIATECH CETI Award.

In addition to the Sutter Health project team, I want to personally thank The Devenney Group, DPR Construction, Capital Engineering, The Engineering Enterprise, TMAD Taylor & Gaines, GHAFARI Associates, J W McClenahan, Morrow Meadows, Superior Air Handling, MPS Project Management, Navigant Consulting, Greenwood & Moore Engineering, Herrick Steel, Otis Elevators, Strategic Project Solutions, Royal Glass, Clark Pacific, Candela, Sparling, and numerous other specialty trade vendors for making it possible to receive this award—and to meet our 2013 deadline!

For all you construction buffs, or for anyone who is interested, check out FIATECH at http://www.fiatech.org/.

I welcome your questions and comments!

revised-rendering-1-1.jpg

George Bischalaney, President and CEO, Eden Medical Center

 

By George Bischalaney, President & CEO, Eden Medical Center

Last week, the Obama Administration kicked off its efforts to address one the President’s stated priorities, health care reform.  What does that mean, and what will be the result? I wish I really knew.

According to the President’s advisers—and Obama himself during the campaign—there is a need to extend health care coverage to millions of uninsured people across the country, while reducing cost and improving quality. Truly admirable goals with which very few could disagree.

Early discussion of President Obama’s plan calls for creating a savings of $634 billion over the next ten years to help fund reform. A recent article referred to this as a “down payment” on the overall expected costs. About half of this amount is targeted to come from reduced payments to Medicare and Medicaid (known as Medi-Cal in California) providers. On the surface, this is a disquieting concept.

Not too long ago, Eden Medical Center was recognized as one of lowest cost hospital providers in California. It should be no surprise that our costs have risen over the past few years. We have invested heavily in new equipment, both in medical technology and information technology, in order to continue to bring state-of-the-art services to our communities, and to provide our physicians and clinical staff the best tools to diagnose and treat our patients.

Last year, our labor settlement with registered nurses resulted in a three-year agreement that will give the nurses a 20% wage increase over the term of the agreement in addition to improved benefits. This kept our wages comparable to other local hospitals.

One of the benefits Eden Medical Center employees enjoy is a fully paid health plan for themselves and their families. Last year, the average cost was approximately $22,000 per year for an employee and family.

Despite these costs, Eden remains one of the lowest cost providers when compared to peer groups throughout the State. But as can be imagined, it is difficult to contain costs in our environment, especially when 60% of our costs are employee-related expenses. We are, after all, a service industry that is people- and technologically-driven.

The early announcements about health care reform create some concern. To expect to realize the savings needed to fund the plan through reduced payments to health care providers is very troubling.

Physicians are increasingly affected by efforts to reduce reimbursement. Many physicians talk of extending their days, working longer hours, much of which is devoted to the increasing amount of paperwork demanded from them. At the same time, we as patients expect them to remain current in the knowledge of new drugs and treatments in order to serve us to the best of their ability. This is resulting in a shrinking primary care base at a time when our population is aging. How does the plan for reform intend to address this?

Government payers of healthcare services for hospitals—the Federal Government for Medicare, and the State for Medi-Cal—are not paying the full cost of care at the present time. For each patient that is covered by Medicare or Medi-Cal, the cost to care for that patient exceeds current reimbursement. Further reductions will increase the gap that is, out of necessity, made up by insured patients—those lucky enough to have coverage through their employers. This is a cycle that needs to be broken if we are to have true health care reform.

The problems with our health care system are very complex. Reducing payments in an attempt to reduce costs will not yield the full reforms that are needed. I can only hope that this is not another piecemeal approach to change. A broader view of the systemic issues is needed. With the President’s staff talking about implementing reforms by the end of this year, it is questionable as to whether or not this will actually occur.

As always, your questions and comments are welcome. We will respond as quickly as possible.

Jeff Moore

By Jeff Moore, Co-Owner, Greenwood & Moore, Inc., Civil Engineering

Many of you may be wondering why we chose the existing site of Eden Medical Center to build the replacement hospital. In Chapter V of the Environmental Impact Report, the project architect and environmental impact report consultant (ESA) prepared and analyzed alternative sites and concluded that 20103 Lake Chabot Road was still the best choice for building Sutter Medical Center Castro Valley, an affiliate of Sutter Health.

However, building a new hospital next to an existing one presents some interesting challenges. The construction and design teams had to come up with a multi-phased approach to building the medical campus while keeping the existing Eden Medical Center in full operation. The construction of the hospital is to occur in seven main phases. So, it is necessary to provide seven sets of civil construction drawings where one set is normally provided!

For example, phase one begins with the demolition of the Pine Cone Apartments at 20004 Stanton Street, and four existing medical office buildings located next door to Eden. Right now, we have no access to portions of the site because certain structures are in the way. Demolition of existing buildings is a logical and intuitive start to the construction process.

Phase two consists of what is referred to as “make ready” work. This is work that must be completed before construction on the main hospital can even begin. A good example of “make ready” work is the relocation of the existing helistop (helicopter landing pad, used for the emergency transport of trauma patients). The existing helistop is located next to the new hospital. Helicopters cannot land safely at the existing helistop location during construction of the new hospital. Therefore, the helistop must be moved just 150 feet before work can start on the new hospital. In order to move the new helistop, we need to level a hill, provide drainage, provide flight path clearance, ensure adequate lighting, etc. And remember, full access to the new or existing helistop must be maintained at all times during the construction process!

Other types of “make ready” work include:

- Construction of a large retaining wall to surround a portion of the site. The wall supports a critical roadway around the new hospital site.
- Construction of a temporary path from the new helistop to the existing Eden Trauma Center so that patients can have access to the existing Trauma Center
- Build a new bridge from the new road to the existing parking garage (where handicap parking will be relocated during construction)
- Finally, demolition of the current helistop.

These are just a few examples of “make ready” work that will need to be performed. As you can see, it can get pretty complicated. The need for significant construction phasing is what creates a lot of the site design complexity.

We estimate that phases one and two will take six to eight months to complete! Hospital construction can begin in earnest upon completion of the “make ready” work.

Where are all the pipes & wires?!

Even more complex than all the preparation to erect the new hospital is figuring out where all the underground utilities are. We’re talking about 50-plus years of modifications of pipes, wires and sewers, some of which have been abandoned and no one knows exactly where they are. The contractor needs to know where all critical utilities are located so they can abandon or re-route them to fit the needs of the new construction. In order to locate them, the contractor needs to “pothole” (dig them up) to make sure that they are located where we think they are. This is an expensive and time-consuming process. We’ll also have to build a temporary storm drain system to capture rainwater during construction. The final storm drain system will not be completed until 2012, with the completion of the new hospital.

Taking Down Eden—It’s Not a Quick Good-Bye!

Demolishing the existing hospital—a process we call deconstruction because of the selective, targeted work involved and the recycling process—won’t take place until the new hospital is up and running and all patients have been safely transferred. Since the main entrance road to the new hospital is just ten feet away from the existing hospital building we can’t exactly get in there with a wrecking ball or explosives! So special safety precautions will be provided by the contractor to ensure that the hospital is removed safely and efficiently. We are all concerned about getting things done safely, so deconstruction will be slow and methodical over a six month period.

Being in compliance with environmental safety laws also presents challenges during deconstruction. Eden’s ripe old age means that there will be a certain amount of hazardous material that needs to be removed and properly disposed of before demolition and recycling of the old materials can begin.

North View When the deconstruction is finally completed, the bottom basement floor will most likely be left in place (to save money) and stay intact since it will be located underground. So you could say, a little bit of Eden will remain forever!

If you have any questions, concerns or comments, please feel free to leave them in the comment box below this post. (Click on the title of the post, and the comment box will appear below it.) We will respond as quickly as possible. We want to hear from you.

Bryan Daylor

Bryan Daylor

By Bryan Daylor, Vice President of Ancillary and Support Services at Eden Medical Center

Technology is critical to convenience & efficiency…

As I mentioned in my previous post, our collaborative team has been very focused on how we would use technology, innovation and design to improve work flow and increase efficiency. You may also want to read the previous post by Andrew Flanigan, Senior Planner/Designer with Devenney Group, the architecture firm for Sutter Medical Center Castro Valley.

For example, in our clinical lab today, we have clinical space that is not fully utilized. The lab was originally designed when equipment was much larger and therefore required more space. The current lab was designed as a “decentralized” service, meaning that different sections of the lab, i.e., blood bank, hematology, chemistry, microbiology, pathology were divided into separate areas. We have learned over the years that this concept is outdated, as well as inefficient to operate and impractical to rebuild.

The new “best practice” is to create a centralized service where the work flow is organized and instruments are closely aligned. In this type of design the work flow is much more efficient, and staff has fewer steps between tasks and can be much more expedient in processing specimens. Ultimately this increases turnaround times of critical test results for physicians and patients, and results in a better work environment for the staff. With the advances in technology, one person can do multiple tasks in one area using state-of-the-art instrumentation.

Another mechanism to provide efficiency and convenience for the patient is the new Control Center, located on the first floor close to high activity areas. The Control Center functions similar to an “air traffic control” room. It is staffed with a variety of people representing key functions within the hospital. The area is designed for maximum communication and collaboration among the teams.

There will be multiple computer screens that will provide large visual displays of the various activities and flow of resources—patients, staff and key equipment. Bottlenecks in processing and movement of patients through the care continuum will be readily apparent and the Control Center staff will be able to quickly resolve issues. This will allow us to be much more efficient as we’ll see problems before they occur. The computer monitors will show us bed status: full, vacant, ready for cleaning; patients scheduled and waiting for discharge; expected completion times for surgical procedures; ER patient flow status, etc.

What does this mean for patients? It means less waiting time, more convenience and more time for personal care. For example, the Control Center can monitor patient wait status to ensure no one waits too long for testing. The necessary alerts will be displayed to the staff so they can provide efficient service. If surgical cases are running late, staff will be able to more effectively plan so resources of the OR and other support areas will be efficiently utilized, including communication to other affected physicians, patients and families. We’ll know on a real-time basis if we’re not performing at optimum levels and what the barriers might be. This knowledge will allow us to take the necessary action—e.g., deploy additional resources such as staff or equipment, and return the hospital to optimum performance levels.

Patient-focused clinical flow…

We also looked at clinical flow, from the patient’s perspective. One of our major goals from the beginning has been patient-focused care, creating convenience and comfort for our patients. We have effectively eliminated unnecessary trips within the new hospital for both patients and staff, starting with pre-op registration and diagnostic testing before surgery.

In the new hospital once the patient is registered and accompanied to their suite, clinical staff will come to the room for laboratory and other portable diagnostic testing. The goal is to minimize the amount of travel and disruption for the patient. We are also putting more services at the bedside. Due to the new hospital design of all private inpatient rooms, which are larger than our current rooms, we will be able to deliver more therapies at the bedside. This is an improvement for both patients and staff.

Please email me if you have any questions about the internal layout of the new medical center, or feel free to leave a comment here. We welcome your input!


Subscribe By Email

  • Subscribe to our blog!
    Enter your email address:

     
  • See our live WebCam!

    webcam

    Our construction WebCam is live, 24 hours a day (ok, so you may not see anything at night!). Go to the SMCCV WebCam now.
  • Welcome To Our Blog

    We have launched a Social Media outreach program, using the Web to keep you informed about our progress in building the new Sutter Medical Center Castro Valley, a Sutter Health affiliate, which will eventually replace Eden Medical Center. We want to provide you with a forum to interact with us so we can address your questions and concerns.

    Our blog will serve as your Internet "headquarters," where you can find updated information, plus you'll find links to other popular online social networks (see below), where we have started groups and online communities for further discussion about the new medical center.

    We hope you'll subscribe by email or RSS feed. Please go to the "Subscribe by Email" box or the orange RSS icon above. The blog will be updated frequently.

    We look forward to hearing from you and starting a conversation! Please feel free to comment at the bottom of any of the posts. We will respond.

  • Favor our Blog!

    Add to Technorati Favorites

  • Now in Alltop Health!

    Featured in Alltop

  • Featured Video

  • Watch more videos

  • On Social Networks