Academic Medical & Health Science Centers Tradeline | October 21 - 22, 2013
One integrated facility speeds translation of research discovery to patient cures
Forum C Laura Stillman MPH
Flad Architects
Robert Deininger MBA Translational Research Institute
for Metabolism and Diabetes
Jeffrey Raasch AIA Flad Architects
“ …” A Public-Private Success
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Introduction
Laura Stillman MPH Principal-in-Charge & Team Leader Flad Architects
Jeffrey Raasch AIA Architect & Design Principal Flad Architects
Presentation Team
Robert Deininger MBA Vice President for Research Florida Hospital Administrative Director Translational Research Institute for Metabolism and Diabetes Florida Hospital • Sanford | Burnham Medical Research Institute
Steven Smith MD SVP, Chief Scientific Officer Florida Hospital Scientific Director Translational Research Institute for Metabolism and Diabetes Florida Hospital • Sanford | Burnham Medical Research Institute
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Introduction Our Agenda
Explain the vision, novel approach and research organization – how did the project enable the mission and how did this organization succeed
Summarize the Florida Hospital Business Plan, partnerships, and specific research and partnership results, including metrics achieved
Provide images and floor plans of the completed TRI building
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Learn how the organization collaborated to create their business and financial objectives and generated support from the multiple stakeholders.
Understand how to create successful partnerships and foster long-term affiliations.
Develop the right team that incorporates all building users to foster holistic thinking about the future environment.
Understand the specific work flows within the building, how to separate distinct functions while still allowing ease of access between them, and support future adaptability.
Introduction Learning Objectives for Today
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Science with an aspiration and passion for faster translation from bench to bedside
New personalized approaches to therapy development; studying multiple factors as causes for disease
Focused, streamlined R&D for global epidemics like diabetes and obesity
Reduced time from discovery to therapy available at the community level
Introduction INNOVATE DISCOVER CURE
The TRI Mission…
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Introduction
The TRI believes that this shift in approach needs to occur in
both fundamental research and drug development;
moving from the one-size-fits-all model to using science to find
tailored solutions to treat disease subsets.
Addressing this gap will chart a course with powerful outcomes for public health.
Powerful Outcomes for Public Health
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Introduction
Lars Houmann President and CEO
Florida Hospital
Terry Owen Senior Vice President
Florida Hospital
Steven R. Smith, MD SVP, Chief Scientific Officer
Florida Hospital Scientific Director
Translational Research Institute for Metabolism and Diabetes
Florida Hospital • Sanford | Burnham Medical Research Institute
The challenge was to unite scientists, clinicians, research volunteers, and
equipment in one building, and meet the size, program, and budget mandate for the project while still supporting effective translational research.
It Started with Leadership and Commitment
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Formed in 2009 as an affiliation of Florida Hospital (FH) and the Sanford-Burnham Medical Research Institute.
Funded, owned and operated by Florida Hospital.
Serves as the bridge between basic discovery research at Lake Nona and patient-oriented research at Florida Hospital.
The affiliation agreement governs the development, leadership, operation, intellectual property, and other academic aspects of the TRI.
Multiple ongoing collaborative activities between basic scientists, physicians, pre-clinical investigators, and patient-oriented clinical researchers.
Introduction The Translational Research Institute
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The 54,000 SF facility houses:
− Research labs − Nursing units − Overnight stay rooms − Procedure rooms − A research pharmacy − Food testing kitchen − Exercise testing suites − Patient respite areas − A bio-imaging core with DEXA and 3T MRI/MRS for nuclear scanning − An energy and metabolism core
Calorimeter suites (very few existing in the world at this time) measure metabolic rates in pharma-codynamic rooms
Introduction Project Summary
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High-tech aesthetic and welcoming image
Support best practice concepts, fuel creativity and scientific mission
Operational plan key
Mix of building uses – must work for all over time
Flexibility and new science / technologies (video, telemedicine, community education, conference and connectivity)
Introduction Project Goals
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Founded in 1908 in Orlando, Florida
The largest hospital in the Adventist Health System
One of the largest hospitals in the U.S.
8 hospital campuses in Metropolitan Orlando area
2,200 beds
110,000+ admissions/year
350,000 emergency department visits/year
17,000+ employees
2,400 physicians
Organization, Plan, and Results Who We Are: Florida Hospital Organization
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Florida Hospital East Orlando
Winter Park Memorial Hospital
The Walt Disney Pavilion at Florida Hospital for Children
Florida Hospital Kissimmee Florida Hospital Altamonte
Florida Hospital Celebration Health
Florida Hospital Apopka
Florida Hospital Orlando
Hospital visits 900,000+
Urgent care visits 400,000+
Inpatient beds 2,000+
Employees 17,000+
Net revenue $2.2 billion
Organization, Plan, and Results Florida Hospital (8-campus) Seminole, Orange, Osceola
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Organization, Plan, and Results
Healthcare is changing… and we must too
The Healthcare Environment
Accountable Care Act
Medicare and Medicaid changes
CMS pay for performance
All distills down to… − Reduce demand − Improve value − Maintain quality
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Organization, Plan, and Results
Looking forward………
The Healthcare Environment
Cannot survive and succeed as just a large community hospital
Committed to growing academics, research, education
− Statutory teaching hospital since 2010 − ~70 residency slots added in the past 3 years − +$80 million invested in research and innovation since 2009
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Organization, Plan, and Results
Translational Research
Part of the Solution to Healthcare Reform
Clinical and Research Focus
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Sanford Burnham Florida Hospital Translational Research Institute
Discovery Research
Step 1 Translational
Research
Step 2 Translational
Research
Clinical Practice
Basic knowledge pre-clinical
testing
Proof-of-concept target validation
Is the treatment safe and effective?
Implementation of best
practices
Organization, Plan, and Results Translational Research
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Fasted growing diseases in the country
Community health crisis
We are the third largest employer in Central Florida
Aligned with our mission and vision, and core values of wellness
Opportunity for impact on the science
Translational Research Why Diabetes, Obesity, and Metabolic CV?
Organization, Plan, and Results
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Dr. Steven R. Smith MD, Scientific Director
15 years of funded, peer reviewed science
Renowned obesity scientist
Over 150 peer-reviewed research papers
President-elect of the Obesity Society
Research focused on metabolism and a personalized medicine approach to obesity and diabetes treatment
Recruited in 2008 to vision and lead the development of translational research at Florida Hospital
Organization, Plan, and Results Scientific Vision, Leadership, and Business Plan
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Organization, Plan, and Results Facility Drivers
Core Based Model − Insures efficiency of operation − Allows for core expertise that has
collaborative structure
Space designed to be functional, open, and collaborative
Unique technologies housed not available elsewhere
Is the face of human focused research for Florida Hospital
Personalized medicine based research
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Clinical Operations − Research clinic − Research administration
Clinical Research Unit − Research pharmacy − Metabolic kitchen
Imaging
Laboratory − Biorepository and Clinical Chemistry − Biomarker Discovery and Development Unit
Energy Metabolism
Research Database and Bioinformatics
Organization, Plan, and Results Personalized Medicine and the Facility Model
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Organization, Plan, and Results Personalized Medicine and the Facility Model
Approaches:
Disease pathobiology
Clinical Trials
Experimental medicine/ − Target relevance − Disease sub-phenotypes
Biopsy based PD / biomarker development and validation
PoC / PoM studies − Industry sponsored − Co-developed protocols − IIT
Deep Phenotyping:
Energy expenditure
Glucose and fat metabolism
Body composition
In-situ biochemistry (MRS) − Lipid 1H − Mitochondrial bioenergetics 31P
Food (energy and macronutrient) intake
Endocrine testing / PK BIOMARKERS
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Development/Infrastructure − Key to core development − Leveraging opportunities to serve
as co-development and alpha partners
− Connects our scientists with company scientists, building a bridge that is not vendor based
Pharmaceutical/Industry − Model create truly collaborative science − Positions the TRI at the table during the study
design process − Focused on long term relationships with
multiple projects over piece-meal work − Fiscally responsible for both parties
Organization, Plan, and Results Partnerships
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DEXA (body composition)
Proton MRS − Muscle and hepatic lipid − Cardiac
3T research dedicated MRI / MRS − Multi-nuclear: 1H, 31P, 13C
Optical spectroscopy (muscle O2)
31P − Muscle
Echocardiography – planned
Organization, Plan, and Results New Technologies
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Hotel design features
Nursing unit
8 rooms (10 beds) for overnight stays
3 procedure rooms
Exercise testing suite
Recreation areas including outside patio
Research pharmacy
Supports energy expenditure and metabolism core
Initially pm, eventually 24-7
Organization, Plan, and Results Clinical Research Unit (CRU)
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Resting metabolic rate / pharmacodynamic rooms
Instrument room
Exterior glass wall (east)
Room calorimeters
1
2
1 2
Organization, Plan, and Results Calorimeter Suite
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Two 30,000L calorimeters
“Push-pull” air flow
5oC - 38oC temperature control
Full digital datastream
Best-in-class accuracy
Designed in partnership with MEI, Inc. - the world leader in calorimetry technology
Organization, Plan, and Results Calorimeter Suite
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Blend of NIH, pharmaceutical, and foundation funding sources
Creation of core based research creates efficiencies and allows better expertise in areas
Leverages Florida Hospital and Sanford-Burnham infrastructure when possible
Organization, Plan, and Results Operating Model
NIH Industry Innovation
Science KoLs
Experience Wisdom
Structure Regulatory Quality Efficiency
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Health Village Fast Facts
− 2,200+ hospital beds
− 1.6 million SF medical office
− 500,000 SF research
− 230,000 SF general office
− 380,000 SF education
− 140,000 SF retail
− 463 hotel rooms
− 375 multifamily residential units
− Dedicated Sunrail stop
Organization, Plan, and Results Other Research Investments
* 10 acres of parks and green space
* LEED design expectations
www.floridahospital.com/health-village
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Celebration Health Nicholson Center
− 54,000 SF advanced medical learning facility
− Training on 50 surgical and clinical skills stations (DaVinci, Lap, Open, and Ortho) and a multi-specialty, state-of-the-art equipment inventory.
− Two team-training operating rooms are designed as a mock OR setup to closely emulate real world experiences.
− A 500-seat conference center auditorium is the optimal environment for classroom study, lectures and medical symposia. It’s built upon a high-definition multi-media platform with a 16-TV customizable video wall and international broadcasting capabilities. The medical conference center can be easily configured and scaled to your group to optimize learning and guest comfort.
Organization, Plan, and Results Other Research Investments
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Bench to Bedside in Action:
Since its opening in March of last year, this facility through its collaborations will perform first human trials of a basic science discovery in less than 18 months since discovery, shortening the time gap by over 8 years. The key to this is the bi-directional, rapid flow of information that is made possible by the assembling of all resources under one roof, and the collaboration and expertise that results from that.
Organization, Plan, and Results Metrics and Results
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Published 5 October, 2011
Organization, Plan, and Results Metrics and Results
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TRANSLATE – Complete Bench to Bedside
Gardell Pratley
Sikder Smith
Orexin-A Activates BAT differentiation in vitro Activates thermogenesis in vivo in mice Weight loss in mice
TRI has complete bench-to-bedside project underway
− GMP synthesis Completed 4/2012 − IND enabling studies including toxicology
Complete 8/2013 − Investigator initiated IND Filed 4/2013 − Clinical FIH experiments (energy expenditure in
calorimeters) In clinic 2014
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How is this possible? − Strong communication between
basic and clinical scientists − Organizations committed financially
and scientifically to making a difference
Where to now? − Already in discussions with a large
pharma to fund the clinic project and acquire IP based on initial data and toxicology results
Less Than 3 Years from Publish to Clinic!
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The Building and Its Functional Plan
The physical environment designed to be the platform for the TRI, not only focuses on supporting the research and clinical staff,
but also the volunteers that are part of the clinical trials. By
designing a facility that meets the three needs of connectivity, convertibility, and comfort, the project has been a
success in the implementation of its mission .
A Workplace that Supports the Vision
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Connectivity − Collocation / collaboration space − Transparency / science in sight − Technology / shared resources
Convertibility − Flexible planning grid − Systems infrastructure − Easily repurposed
Comfort − Volunteer –focused space
Connectivity
Comfort
The Building and Its Functional Plan Design Drivers
Convertibility
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Interdisciplinary relationships can be a challenge to the design process.
It’s expensive to build a building that is all things to all people. It is important to prioritize needs verses wants.
Work from most technically challenged space to most flexible.
Predicting new technologies and being prepared for them is a necessity.
The Building and Its Functional Plan Physical Challenges
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L1 - Clinical
L2 - Testing
L3 – Research
Level Three − Laboratories
Level Two − Clinical resources − Metabolic unit − Biorepository lab − Kitchen − Pharmacy
Level One − Administration − Clinics − Imaging − Staff Support
The Building and Its Functional Plan Building Statistics
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Vision
Design
Goal: Find Collaboration Spaces Mechanical
− Mechanical units per floor
Research labs − Located for flexibility
Clinical research unit
− Located for collaboration
Outpatient functions − Located for accessibility
The Building and Its Functional Plan Connectivity: Work Flow – Block and Stack
Mechanical
Research
Testing
Clinical
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X X X X
Y
1/3
1/3
1/3
1/2
1/2
1/2 x 2
1/2 x 2
1/3
2/3
Modular Subdivisions
X
Vision
Design
Module determination: width, length, height
Planning configurations: Major components and design issues
Utility interface: systems distribution options
Typical modules are 11’ wide by 33’ long
The Building and Its Functional Plan Convertibility: Modular Planning Guidelines
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The Building and Its Functional Plan Convertibility: Planning Module
Flexibility / Adaptability
Imaging Laboratory Clinical Officing
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Vision
Design
“Readily accessible and correct proportion of support spaces – equipment, tissue culture, supplies, etc.”
“Daylighting is important in both lab and office”
The Building and Its Functional Plan Convertibility: Flexible and Adaptable Planning
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Vision
Design
The Building and Its Functional Plan Convertibility: Flexible and Adaptable Planning
“Daylighting is important in both lab and office”
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Consistency / Efficiency / Cost Effective
The Building and Its Functional Plan Regulating Lines
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The Building and Its Functional Plan Building Flows and Support
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The Building and Its Functional Plan Ground Level
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1. Arrival Auto-Court and Drop-off
1
2
2. Main Entry
The Building and Its Functional Plan Ground Level – Entry and Arrival
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3. Entry lobby from drop-off
4. Entry lobby from Princeton Street
3 4
The Building and Its Functional Plan Ground Level – Public Spaces
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5. Waiting
6. Entry lobby from Princeton Street
5 6
The Building and Its Functional Plan Ground Level – Public Spaces
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7. Administrative Offices
8. Conference Room
7 8
The Building and Its Functional Plan Ground Level – Administration
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9. Typical Exam Room
10. Clinic Reception and Waiting
9 10
The Building and Its Functional Plan Ground Level – Clinical
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11. DEXA (body composition)
12. Sub-waiting and Changing
11 12
The Building and Its Functional Plan Ground Level – Imaging
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13. Control Room
14. MRS
13 14
The Building and Its Functional Plan Ground Level – Imaging
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The Building and Its Functional Plan Second Level
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15. Upper Waiting
16. Upper Lobby
15 16
The Building and Its Functional Plan Second Level – Public Spaces
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17. Nurse Station
18. Overnight Stay Room
17 18
The Building and Its Functional Plan Second Level – Clinical Resources
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19. Exercise Room
20. Procedure Room
19 20
The Building and Its Functional Plan Second Level – Metabolic Unit
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21. Pharmacodynamic Room
23. Calorimetry Room
22. Calorimeter Suite
21 22 23
The Building and Its Functional Plan Second Level – Metabolic Unit
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24. Clinical Lab
26. Tissue Culture Lab
25. Histology Special Chemistry Lab
24
25 26
The Building and Its Functional Plan Second Level – Biorepository Lab
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27. Controlled Dining Area
28. Food Testing Kitchen
27 28
The Building and Its Functional Plan Second Level – Kitchen / Dining
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29. Outdoor Terrace
30. Garden
30 29
The Building and Its Functional Plan Second Level – Terrace
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The Building and Its Functional Plan Third Level
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The Building and Its Functional Plan Image and Identity
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The Building and Its Functional Plan Image and Identity
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Engagement of end user during design is key
Design team that takes the time to adequately learn the business of their client
The Building and Its Functional Plan Lessons Learned
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1. Clinical organization in a research setting
2. Flexible, adaptable core and infrastructure
3. Alignment of vision with partnerships
The Tradeline Three Big Ideas
Questions