MuirLab

New Paradigms in Clinical Laboratory Design
Building an off-site Core Lab to increase throughput
recruit staff, and adapt to future requirements

Pat Morgan, MA, MT ASCP, CLS
Administrative Director, Muir Clinical Laboratory

Amy L. Delson, AIA
Principal - Strategic Facilities Planning

Gary Crosman, AIA
Hawley Peterson & Snyder Architects

Kevin Ng
g
Project Manager, XL Construction

August 20, 2009

MuirLab | SFP | HPS | XL
1

Presentation Outline

I. Project Vision
Pat Morgan, MuirLab
g ,

II. New Core Lab Planning Paradigms
Amy Delson Strategic Facilities Planning
Delson,

III. Design Approach
Gary Crosman, H l P t
G C Hawley Peterson & S d A hit t
Snyder Architects

IV. Building the Project
g j
Kevin Ng, XL Construction

V.
V Q&A
2

Learning Objectives
• Given a tight hospital site and a growing laboratory workload, participants will be able
to understand the user’s perspective in developing the key components of the
business plan for an offsite laboratory.
• An interactive approach was required to program and plan a laboratory that can
respond to changes in technology and reduced staff availability. Participants will
learn about the new paradigms in clinical laboratory design, and how workflow
efficiency can be balanced with staff safety and retention.
• To rapidly translate JMH’s vision into construction documents, HPS used 3-D
modeling tools to enhance collaboration between stakeholders, consultants, and
contractors. By carefully crafting the tilt-up exterior, HPS was able to bring light into
the offices and laboratories and create an exciting experience for staff and future
g p
clients. Participants will see the 3-D models evolving into the built environment,
and the opportunities possible with a tilt-up building system.
• While the health system did not want to go through the LEED process, the design-
assist team, led by XL Construction, was able to accommodate many sustainable
features into the building and site. The participants will learn through seeing
construction photos how flexibility, safety, sustainability, and ease of
maintenance were incorporated into the project.

3

I. Envision
• B k
Background
d
• Project Vision / Goals
• Operations & Technology
• Lessons Learned

4

MuirLab Clinical Laboratory
• About John Muir Health
• What is a Core Clinical Laboratory?
 Consolidated Testing
g
 Automation
 New Diagnostic Methodologies

5

Background: Business Case for Offsite Lab

• Operational Inefficiencies
 S
Space & A
Accessibility
ibilit

• Options on Walnut Creek Campus
 Parking Garage
g g
 Heather Farms
Brentwood
• Benefits of an off-site location
 Concord Site

San Ramon
Pleasanton

6

Fact Sheet
• Project Team Organization: Muir Champions, HPS, SFP, XL, MHS,
Jtec

• Construction Cost $22M

• 56,000 GSF Commercial Circle, Concord, CA. Potential to add
20,000
20 000 GSF

• Opened April 13, 2008

• Largest Custom Beckman Automation Lines in US

• 400 Employees in Lab Services at MuirLab

• 130 Fleet Cars

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Vision

• Manifest a state-of-the-art, efficient clinical laboratory through
automation systems and architectural design
• Sustain excellence through incorporating flexibility for
expansion or contraction, and enabling the adoption of new
technology.
• Expand breadth of services by providing esoteric tests currently
sent to reference labs.
• Reflect the l
R fl t th values and aspirations of JMH – P idi quality
d i ti f Providing lit
healthcare services, employee development, advanced
medical technology, and stewardship of resources.
• Provide difficult to recruit clinical laboratory scientists with an
outstanding place to work.

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Goals
• Consolidate O
C lid t Operations:
ti
 Outreach JMH laboratory and ancillary operations
 Hospital (Walnut Creek, Concord) services including Microbiology and special testing

• Improve Work Process & Operations
p p
 Improve accuracy / patient safety using Lean and Six Sigma principles
 Eliminate waste - steps, time, materials and money
 Reduce TAT (Turn Around Time) or cycle time
 Incorporate systems to reduce paper handling / inefficiencies - WebMD, Barcoding at PoC,
 Document Imaging; consolidated System-wide, HIS/LIS

• Encourage Continued Outreach Growth
 Design lab to showcase lab automation and work flow
 Provide attractive and efficient environment

• Foster Staff Satisfaction
 Provide an appealing environment with natural light and sound abatement where possible
 Plan a safe environment by mitigating lab hazards, installing adjustable work surfaces, and
 considering personal safety for PM shifts.

• Incorporate Flexibility and Adaptability
 Standardize instrumentation across campuses
 Select flexible casework system
 Plan for future expansion while optimizing move-in efficiency

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Operations and Technology

• Transferred 135 employees from Clinical Lab at Walnut Creek to MuirLab

• Used detailed project plan to complete move without interrupting testing
or service to customers

• Incorporated new technology standardized with hospital labs

• Expanded test menu in Molecular Diagnostics and Microbiology
p g gy

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Lessons Learned

• Plan for food available on site especially in an
industrial park- everyone loves to eat!
p y
• Include a patio as part of break room whenever
p
possible
• Allow more bench top counter space than you ever
think you’ll need- paperless is not yet a reality
• Find a good facilities management company
• Keep the bigger perspective!

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II. Core Lab
New Planning
g
Paradigms
• LEAN Manufacturing
g
• Ballroom Concept
• Bench-to-Bench
• Flexibility
• Adaptability (
p y (Casework)
)
• Staff Safety & Satisfaction

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New Paradigm: LEAN Manufacturing Model

Improve quality (Six Sigma) while
eliminating waste and costs
costs.
• More customer value / less work
• Standardization
• Breakdown Silos

Total Lab Automation
• Limit specimen handling
• Continuous Flow
• Reduce TAT (Speed)

Informatics
• Sample identification and
management
• Results reporting
• AI

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Planning Process

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ELF Program

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Lean Manufacturing: Process Redesign

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Process Redesign: Implemented

4. “Sneakerman”
1.
1 Courier delivers putting specimens
p g p
on Autoline
specimens from
Hospitals, SNF, PSC,
MD Offices, and
delivery is signed-off
y g

3.
3 “Sneakerman”
2. Specimen Processing reviews
picks up reviewed
each specimen for proper labeling,
specimens for
complete patient information,
distribution
specimen type and volume.
p yp

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New Paradigm: Ballroom Concept

MuirLab 1st Floor Lab Plan

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New Paradigm: Bench-to-
Bench-to-Bench
Molecular Dx, Molecular Pathology, Cytogenetics, Pharmacokinetics

Automated DNA
extraction

Automated DNA extraction
A t t d t ti
equipment is located in a
“clean room” which is sealed
off from the routine testing
Old Paradigm areas.
(continues): R di
( ti ) Reading
Plates Molecular Diagnostics uses
cutting-edge technology to
study DNA in order to identify
actual pathogens in the body.

Microbiology Molecular detection and identification of infectious pathogens

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Bench to Bench: Flexibility for Paradigm Shift
Dumbwaiter

“As technology Freight/Staff
advances, the Elevator
requirements
for testing in
the lab need to
change
accordingly. Inc
Alco e MICROBIOLOGY
Alcove
We cannot
IFA
predict today IMMUNO
what has not
yet bee
been
invented but MOLECULAR DX
will be needed O&P Virology
in the future. Alcove Clean
Alcove
AFB Room
So the Lab
space needs
to be
dynamic.”

MuirLab 2nd Floor Lab Plan

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New Paradigm: Adaptable Casework

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Casework: Prototyping / Collaboration

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Staff Satisfaction: Safety & Ergonomics

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III. Design

• Attractive environment to
recruit and retain employees
• Assist in Marketing
• Economic Structure

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Staff Satisfaction: Light, View, & Sound Mitigation

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Staff Satisfaction: Light, View, & Sound Mitigation

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Attract Employees: Light and Views

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Attract Employees: Outdoor Staff Patio

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Site Organization

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Functional Marketing Tool: Marketing Sequence

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57

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IV. Construction and Design / Build Approach

• Construction Highlights

• Design Build Approach:
Building For Ease of
Building Maintenance

• System Redundancy

• Coordination With
Automated Testing
Equipment

• S
System Performance
f
Tailored to User Needs

61

Construction Highlights

• Accelerated Schedule – Ground-
breaking to operational in 11
months

• Coordination Schedule Integrated
with Fabrication and Installation
Schedule of Automated Line
Equipment Manufacturer

• Total Co st uct o Cost
ota Construction Cost:
$22,000,000 ($385/square foot)

62

Construction Highlights

• MEP Design Build

• Phased Permit Approval

• Collaborative Design &
Coordination to
Facilitate Accelerated
Construction Schedule

63

Design-Build Approach: Building for Ease of Building Maintenance
Air
Handler/Exhaust/BMS/Electrical
“Service Corridor”

Tie Off Points for Maintenance Outside
Roof Screen (typical)
Roof Service Path

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Design-Build Approach: Building for Ease of Building Maintenance

• Service Points Located Strategically For Maintenance During Lab Operation
• Isolation Strategically Integrated With Lab Operation Planning

65

Design-Build Approach: System Redundancy

• Redundant Exhaust Systems:
• Dual Exhaust HEPA Air Filtration
ua aust t at o
• Each Fan Capable of Full Exhaust Load
• Filters Can Be Changed and Fans
Serviced Without Affecting Lab
S i d With t Aff ti L b
Operation

66


• Redundant Power System:
• 1500kW Standby Generator
• 100% Building Coverage
• Enables Lab to Function at
100% Capacity During
Power Outage

67


• Redundant/Oversized RO Water
Supply

• Redundant Cooling to
Operationally Critical Areas

• R d d t Boilers System (3-
Redundant B il S t (3
Boiler Lead/Lag – Only 2 Required)

• Dual Air Compressors

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Design-Build Approach: Coordination with Automated Equipment

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Design-Build Approach: System Performance Tailored to User Needs

• HVAC Zones Tailored to Equipment Layout and Personnel Areas
• Zones Individually Monitored/Adjusted from Remote PC

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Design-Build Approach: System Performance Tailored to User Needs

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Q&A
MuirLab
www.johnmuirhealth.com/index.php/laboratory.html

Strategic Facilities Planning
www.sfp-ald.com

Hawley Peterson & S d A hit t
H l P t Snyder Architects
www.hpsarch.com

XL Construction
www.xlconstruction.com

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MuirLab

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