The Royal Jubilee Hospital: Rudi van den Broek, CPO/GM of Special Projects

by HCE Exchange on November 16, 2011

While the diagnostic and treatment portion of Royal Jubilee Hospital on Vancouver Island was upgraded in 2002, until this year, inpatients were staying in facilities built as early as the 1920s.

The $300-million Patient Care Centre project was initiated to address this issue.  It began in July 2008 and was completed in December 2010. Patients were moved into the upgraded facilities in March 2011.

“We had an aging series of buildings,” Rudi van den Broek, chief project officer and general manager of special projects for the Vancouver Island Health Authority, said. “We live in a high seismic zone, and the height and condition of our inpatient units was a concern. Functionally, it was obsolete. We had a high rate of falls, injuries, and hospital-acquired infections, so we knew we had issues.”

The LEED Gold facility has 425,000 square feet and houses 500 patients. Of the approximately 106 known evidence-based design features, more than one hundred have been utilized in this new facility.

An Elder-Friendly, Sustainable Hospital

One-third of admissions and one-half of overnight stays at Royal Jubilee are from patients ages 75 and older. This is one of the facts that came to light when the hospital began developing a strategic approach for upgrading the new patient units.

“We did research around what the needs of the elderly were,” van den Broek said. “All sorts of physical changes happen to adults as they age, and we realized that most hospitals are not designed for older adults. They are designed for younger adults.

“To make it worse,” he continued, “most hospital environments—this is well-established in the literature—are essentially toxic for older adults. Shiny floors, white walls and floors, lack of handrails, clutter and lots of obstacles, overhead paging, high noise levels, rigid hours around food delivery and meds—all of those things serve to disorient older adults, and the older they are, the more frail they are, and the worse the hospital is for them.”

This actually increases the length of the hospital stay for patients “who are otherwise not so bad,” van den Broek said. “They get sicker as you are trying to care for them.”

The residential-style design plan included windows that open wide, garden spaces, and green roofs.

“What we found is that what is good for the elderly was also consistent with sustainability,” van den Broek said.

The décor is earth-toned with subdued and indirect lighting. They used plenty of sound-absorbing materials and lots of wood, from wood-grained flooring and handrails to cabinetry.

“We also included features for families,” he said. “We revised our policy so there are no restrictions to visiting hours. We included a sleeper couch in the rooms. We provide a kitchenette central to the units and try to incorporate family involvement throughout the whole process.”

A Universal Design for Future Flexibility

Every unit in the Patient Care Centre is identical. None are customized for any particular program. The floors may be currently divided into rehabilitation services, heart health, and oncology, but any floor can be converted into another service line in a short period of time because the underlying infrastructure is the same. Gases, mechanical, and information technology are built into every wall. The fixtures merely change to fit the need.

“If we wanted to convert the whole building to mental health, we’d simply valve off the gases and maybe re-drywall those rooms. In a matter of a week or two, we’d be able to convert the whole facility,” Broek said. “That’s big flexibility because over the next 50 years, we don’t know exactly what our program mix is going to be. When we look back at our buildings that are 50 years old today, we are using them for different programs and services than we once imagined.”

Both vertical and horizontal shafts for extra capacity were installed throughout the building. Everything from ventilation systems to circuit boards and cable is ready for expansion.

Royal Jubilee has also been focused on seamlessly integrating all aspects of the electronic medical record. The new smart beds in the facility have the capability of weighing the patients and uploading that information into the medical record. All vital signs can be electronically placed into the patient record. The capacity to drive the clinical display from the footwall monitor has been built in so that a patient can see their records and have a telehealth conversation with providers.

Passing on the Keys to Success

“From my perspective, it’s a large project,” van den Broek said. “20,000 pieces of equipment, 2,000 doors. 1,400 rooms. A lot of details to make sure we get them right.

“We chose the principles of evidence-based design, elder-friendly and sustainability, before any pen went to paper, before there were any specifications, any drawings,” he added. “It was a founding principle. You’ve got to make that call very early. I would encourage folks to use evidence-based design. There are a lot of features out there that not all the architectural firms know about. From a fiduciary and a stewardship obligation, you need to put it into the design. You need to incorporate all the clever information you can.”

-by T.M. Simmons

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