Archive for the ‘Healthcare’ category

A Hospital Pharmacy Renovation – Milestone On Times, Issue #7, October 2010

August 19th, 2013

Here at Milestone, we have so much good information that is sent out over a variety of media, that we thought it would be a good idea if we brought up some past articles from our quarterly newsletter, Milestone On Times.  This article on one of our Pharmacy Renovations, was in the October 2010 issue of MoT.

We hope you enjoy it:

St. Luke’s Hospitals Complete Two USP 797-Compliant Pharmacy Renovations

SLEH Pharmacy
Photography by Geoff Lyon

St. Luke’s Episcopal Hospital and St. Luke’s The Woodlands Hospital recently completed renovations to bring their pharmacies into compliance with USP 797 guidelines.

At St. Luke’s Episcopal Hospital, it was determined by the Pharmacy Department that a new negative pressure chemotherapy prep room was needed in order to comply with USP 797. Because the existing clean room and pharmacy work rooms were required to remain operational during the entirety of the construction, much time was spent planning the construction and occupation sequence.  Careful coordination of the equipment relocation ensured that the pharmacy suffered no downtime; the staff always had ability to prepare IVs and chemotherapy products.

At St. Luke’s The Woodlands, the renovation included the expansion of the existing pharmacy and lab by nearly 1,300 SF. To meet the requirements of USP 797, a new chemotherapy prep room, IV prep room and an anteroom were added.  In order to maintain pharmacy operations, the project was design to be completed in three separate phases, which would require a minimum of three separate TDSHS inspections. To renovate the existing clean room, a temporary clean room was setup outside of the project area so that operations could continue. And with a little creativity, the project team was able to sequence the construction (rather than complete the work in phases) so that only an 80% and 100% inspection were required.

Milestone Project Management was engaged by St. Luke’s Episcopal Health System to manage the design and construction process for both projects.

PhiloWilke Partnership (Architecture) and Telios (MEP) comprised the design team for the St. Luke’s Episcopal Hospital renovation.  WS Bellows’ Medical Center Renovation Team served as the Construction Manager.

For the Woodlands’ hospital, HGA provided both architecture and MEP engineering services. Forney Construction was the Construction Manager.


July 12th, 2012

Well, the suspense is over, the last shoe has dropped with the Supreme Court upholding the majority of the Affordable Care Act. Now it is time to begin implementing the various aspects of the new law.

Throughout the last half of the 20th century the U.S. healthcare industry has been impacted, directed and increasingly regulated by the federal government.  Regulation, from the Hill-Burton Act of 1946, Medicare in 1965, Community Planning and it’s reliance on the Certificate of Need to regulate the supply of healthcare of the 1970s, to DRG’s in 1983 and the Balanced Budget Act of the mid 90s  - all have driven capital facility responses.  Every act has had it consequences.

The Affordable Care Act may be another and perhaps the first real serious step to controlling healthcare cost. Or it may be just another set of rules to be gamed by very smart healthcare, medical and insurance administrators.  Regardless, there are drivers that will have significant impact on the programming, planning, design and construction of healthcare facilities.  Two factors will drive the development of facilities:

1)   Tens of millions of Americans will have access to healthcare insurance.

2)   Reimbursement rates will go down.

These two factors more than anything else will become the challenge for facility design and construction – to support the institution in its efforts to maintain their economic viability and healthcare mission.

In my opinion, the most likely facility responses will include the demand for greater staff efficiency, the optimization of productive care and higher utilization rates.

Staff Efficiency

We’re going to hear a lot more about staff efficiency, which is having the right expertise, in the right place, at the right time and with the necessary tools at hand to support the care.  Every moment will count; it may not be life-supporting but it could make the difference in having a profitable operation and therefore having healthcare available.  Look for highly specialized medical treatment centers to develop around a specific medical need or procedure.  Efficiency will drive the further specialization (assuming the volume is there) to reduce the cost of the treatment.

Productive Medicine

Productive care will require that patients receive the least amount of care at the point that it does the greatest good.  Preventive and early intervention care will drive the need for more outpatient and physician support care centers. (Better to get a pneumonia vaccination before you get sick than a shot of penicillin when you get sick or spend a week in an intensive care unit fighting pneumonia).  Look for the development of more immediate care or walk-in care centers; the development of community, neighborhood and school-based clinics will lead the way to keep people out of the hospital.  Long term, the need for hospital beds should begin to decline as productive use of medicine drives down the demand for beds.  Hospitals should evolve into critical care centers and will only serve the sickest of the sick.


Closely associated with Productive Medicine is the utilization of equipment and facilities.  Utilization rates must continue to increase.  Facility programming and design must allow for patient flow and staff efficiency that keeps the equipment and facility working.  An extra 80 to 100 square feet for an additional dressing room may be a great investment if it allows for another MRI test every 8 hours.  Planning will have to stop basing space programs on “average” patient utilization rates and start basing it on desired optimization rates and return on investment.

There will undoubtedly be other drivers and responses that will, from time to time, come to the surface and create opportunities for new facilities – this is after all the United States, home of entrepreneurs.  The basic intent of the Affordable Care Act is to make healthcare accessible to the millions of citizens without healthcare insurance and to reduce the total cost of healthcare.  However, it may be the unintended consequences that provide the greatest facility challenges and opportunities for the future.  Stay tuned to this blog as we explore the healthcare landscape for the first signs of the unintended consequences of more federal regulation.

Bill Eide has been developing, planning and building healthcare facilities ALMOST since the Hill-Burton Act was enacted.

Adventures in Imaging

November 10th, 2010

Ready for my close-up!

In the past year, Milestone Project Management has been responsible for several imaging projects, including the replacement of a nuclear medicine gamma camera, the replacement of two traditional MRIs, and the installation of a new high-field open MRI. A new 3T magnet was installed for one of the replacement MRI projects, and I was thrilled to have the opportunity to volunteer for a scan last week.

Prior to having a scan, most of my experience with MRIs had been (1) removing them from buildings and (2) installing them. I didn’t have an experience to compare this to – other than the descriptions I’d heard from other people and the videos I watched on YouTube. I heard about feelings of claustrophobia, and the noise that the machine makes likened to a jackhammer.

What was it like? Well, everything started out just fine – after changing into a gown I sat down for a few minutes with a warm blanket while the scan room was prepped. Once in the room, the technician gave me a pair of earplugs and also a headset for listening to music. And then I was “inserted” into the bore of the MRI – head first. This is where I got a little uncomfortable. All I could see was the white interior of the machine; there was nothing to focus on. I had the technician move me out of the machine and I asked him for something to put over my eyes – to keep me from looking around. He moved me back in and explained that I was far enough towards the rear of the machine that I could actually see out – I just needed to tilt my head a little. That made me feel loads better, and we started the scan.

So I listened to some tunes from the 80’s and heard some intermittent beeps and buzzes. I was trying my best to relax when the noise from the scanning started. Frankly, it sounded like the warning noises you hear before something (like a spaceship in the movies) blows-up. VERY disconcerting. But I just lay there imagining what the pictures would look like, and I tried to think about other things, including my holiday shopping list, while the series of beeping and knocking sounds progressed.

After about 20 minutes, I heard the technician say that the scan would only take a few more minutes and then he would come in and get me out. At this point, I started to relax – until the jack hammering started!

I was very happy to exit the machine a few minutes later, and excited to review my scan with one of the MRI physicists that I had been working with. I am thankful to have had this opportunity – so if I need to have a scan done in the future, I will know what to expect.

What are the issues in the US Healthcare Policy?

November 4th, 2009

The issues associated with the current healthcare legislation are long and complex. However, there are a few simple topics that are at the heart of the matter.

I would like to present a few of them here, and open up this post for your thoughts and perspectives.

To begin, I would like to recap the three basic goals that President Obama made in his September 9th address:

1) To provide more security and stability to those who have health insurance.
What this means: a) it will be against the law for your insurance company to drop you because of a pre-existing condition, b) insurers cannot place an arbitrary cap on the amount of coverage in a year or a lifetime, c) a limit will be placed on out of pocket expenses, and d) insurers will be required to cover, at no extra charge, routine and preventative care.

2) Provide insurance for those who do not have access.
What this means: a) if you loose or change your job – you’ll be able to get coverage, b) small businesses will get tax credits to offset the costs of providing insurance, c) a new insurance exchange will be created to assist individuals and small businesses have access to affordable insurance and d) individuals will be required to carry basic health insurance (similar to auto insurance) – provided by themselves or through their employers.

3) Slow the costs of healthcare for our families, businesses and government.
What this means: a) the President will not sign a bill that increases the deficit to fund these programs, b) most of the costs of these plans can be paid for by savings within the healthcare system itself, c) reducing the waste and inefficiency in Medicare and Medicade and d) revenues from drug and insurance companies that will benefit from millions of new customers.

Now what does all this really mean? Can we do it?

A big part of the problem may be if Congress can act in a bi-partisan fashion and implement a roll out of this plan in the current economy. This is no small act.

Additionally, how do you pragmatically change the system without healthcare professionals becoming nervous?

How does this really effect the small business owner and, as stated above, the individual who will be required to obtain basic health insurance. And just what is “basic health insurance”?

I do not think anyone believes that the system can continue to operate like it has done over the past 20 years, and that reform is much needed.

I’d like to open this forum up and have our community provide perspective and constructive feedback on the goals of the White House.

Thank you in advance for your time and comments!

Hospices de Beaune

October 24th, 2009

In 1443, a duke of Burgandy, Nicolas Rolin, founded one of the first hospitals for the poor and needy in what is today, Beaune, France.  The Hotel-Dieu had provided continuous healthcare for the Burgundy region until a new hospital was built for the city  in 1962.  The shining example of medievil Burgundy architecture served the public for a period of over 500 years.

Today, the historic Hospice building is the center piece of Beaune, and is the site each year of the “Vente aux enchères des vins des Hospices de Beaune” wine auction.  This Burgandy wine festival features the auctioning off of that year’s grape harvest right after its first fermentation. These wines are from only from the lands and vineyards that have been donated to the Hospice over the last 5 centuries.

This year will be the 149th edition of the fabled wine auction.  This wine auction’s proceeds support most of the financial needs of the hospital each year.

For more information, please use the link to the official site, and to see more photographs of one of Europe’s original hospitals.

Barrell Tasting

Barrell Tasting