Winchester Hospital: Robby Robertson, Vice President of Facilities and Real Estate Services

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When an organization is looking to gain space for its services and specialties, but expansion is out of the question, the hub-and-spoke model can be an effective solution to this dilemma.

Winchester Hospital has developed a hub-and-spoke approach as its growth has prompted it to extend into the community and provide more services for its patient population. A 229 licensed-bed regional hospital in the suburbs of the Boston, Mass., area, Winchester Hospital consists of a main site and 37 satellite locations that house everything from clinical services to physician offices.

In 2005, Winchester acquired property at 620 Washington Street, and since then, they have been involved in the major undertaking of converting the site into a prime satellite location for the hospital.

A strategic approach

As Robby Robertson, vice president of facilities and real-estate services for Winchester, explained, the hub-and-spoke model is employed when hospitals have outgrown their site’s facilities and buildings. The organization will then strategically relocate its services to other portions of the area. One location will serve as the hub, where imaging services, lab, physicians, and necessary modalities may be housed. Then, the hospital will develop spokes that extend farther out into the community with physician offices, lab drawing stations, and many other services.

When considering expansion options, Robertson said he first starts out by examining site logistics. He said a project is multidimensional and comprised of a series of smaller projects that go into achieving the end results.

When examining site logistics, Robertson analyzes how the site lines up with Winchester’s service area, never forgetting that convenience for the patients and providers is a key factor. Some physicians he said will need to travel to the hospital, their office, and a satellite location, such as a surgery center. This must be accounted for.

Once a site is selected, Robertson said the issue of permitting from the city or the town becomes the focus. He advises factoring this process into the project timeline, because obtaining the necessary approval can be lengthy.

For example, the first project at 620 in 2006 needed a special permit for a radiation oncology linear accelerator. The next project, in 2009, needed permits for development of a comprehensive cancer center, which required extensive planning, architectural design, and renovation of the pre-existing building that had services in it that couldn’t be shut down during construction.

“All of this needs to be taken into account as you move forward into project planning,” Robertson said. “I think most importantly, we conducted focus groups to get the patients’ perspective so that early on in the design we had a solid understanding of that.”

Construction managers vs. general contractors

Robertson has come to favor construction managers on projects over the traditional general contractor. The main advantage, he said, is having the construction manager integrated early in the process to work on design with the architect.

“The major difference I feel that’s an advantage is everybody works as one team under the construction-manager methodology,” Robertson explained. “Under construction management, you all work together as a team, you all establish the budget, you all have ownership on the job, you all have rewards and successes on the job. It’s a much friendlier atmosphere and is more efficient. You can get a job done faster and at less cost under construction-management methodology.”

He added, there are still challenges, such as dust control, vibration monitoring, air-quality testing, etc., but overall, this method is a welcome change from the past.

Accounting for advancing technologies

The newer technologies are a little more complex and require more precision between the manufacturer, the engineers for the project, the materials management and procurement experts within the facilities, and the construction manager, Robertson said.

“I also think that the advanced technologies have to be given consideration up front in the design to make sure that you have the appropriate space, clearances, and ceiling heights for the  equipment,” he stated.

Also, building more flexibility into sites, especially to be proactive and visionary, is vital. Everyone knows technology is going to change rapidly, Robertson observed, and you have to plan on changing every five years or so.

“You don’t want to be going backwards when you need to advance,” he said.

Winchester is also a major proponent of Leadership in Energy and Environmental Design (LEED) standards. Early on, Robertson said, the hospital embraced it and felt it was the right thing to do for its employees, community, and patients. When he looks at the numbers, Robertson estimated that 75 percent of what Winchester is doing on projects is LEED.

“The value of a LEED focus is tremendous,” he said. “We believe in it. It’s a little extra work. There’s a lot more paperwork. But it’s worthwhile.”

The 620 site is aiming for LEED Gold certification in two areas–Existing Building Renovations and New Building Addition.

Four keys to success

In short, Robertson boils his approach to hub-and-spoke, and healthcare facilities in general, down to four points. First, be aware that the approval process can sometimes be longer than you’d like and plan accordingly. Second, know that very rarely will an organization purchase a building or property or seek to renovate an existing area without there existing logistical issues. Plan to work around departments that can’t shut down and always need to be operational.

Third, emphasize infection control and know your risks.

“You really have to take all the right steps to ensure that you’re doing the right thing and there are no negative effects,” he said.

Fourth, communication is vital among the construction management team, the subcontractors, and even the vendors.

“People upfront will say it’s a lot of time, but it saves you a lot of headaches and a lot of conflicts,” Robertson said. “I personally find it very, very exciting that there are challenges, but if you are thinking ahead and you have good communication, I think you can overcome them.”

-by Pete Fernbaugh

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