Beyond Opening Day: Reinforcing
Good Design at The Royal
Healthcare Infrastructure Summit 2014
April 30 – May 2
Pam Jackson
Director of Patient Care Services, Mood
and Anxiety and SUCD
Royal Ottawa Health Care Group
Paul Boucher
Vice President Infrastructure Development
Carillion Canada Inc.
Beyond Opening Day...
• Design is a “means to an end” – a virtuous circle of
positive health outcomes by:
̶ Increasing patient comfort (mental and physical)
̶ Speeding healing
̶ Engaging family and community
̶ Promoting staff satisfaction and safety
̶ Delivering effective and efficient healthcare
• Good design needs to be reinforced
̶ Preserve and maintain good design characteristics
̶ Adapt and change according to different needs,
therapies, evidence, regulations
̶ Complement good design with good hard and soft
facility management services
• An excellent case study is provided by the Royal
Ottawa Mental Health Centre (The Royal)
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About The Royal Ottawa Health Care Group
• One of Canada’s foremost mental health care and academic health science
centres, delivering specialized mental health care, advocacy and research and
education – to transform the lives of people with complex and treatment-resistant
mental illness.
• Vision: Mental health transformed through partnerships, innovation and discovery
• Values: We are guided by innovation and a passionate commitment to
collaboration, honesty, integrity and respect
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Programs and Facilities at The Royal
• Part of a continuum of care provided by The Royal for communities across Eastern Ontario:
− Ottawa site (400,000 ft2):
− 190-bed state-of-the-art Royal Ottawa Mental Health Centre
− 96-bed Royal Ottawa Place for recovery and long-term care
− Tower housing the Royal’s Institute of Mental Health Research
− Brockville site:
− 161 inpatient beds (61 forensic, 100 STU)
− 183 beds in the community (Homes for Special Care)
• Clinical programs at The Royal focus on:
− Anxiety, mood and sleep disorders
− Forensic, geriatric, youth and general psychiatry in transition
− Schizophrenia; substance use and concurrent disorders
• Serving 62,000 clients and families through in-patient and out-patient programs as well as
outreach and education to the community, LTC facilities, shelters, etc.
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Redevelopment at The Royal
• In 2002, the Province on Ontario
announced that a new mental health facility
would be built to ...
− Replace the century-old structures
− “Bring mental health care out of the
shadows”
− Provide a leading-edge hospital... with
a healing, therapeutic environment
filled with natural light, extensive
patient courtyards and a Winter
Garden
• An innovative Alternate Funding Plan (AFP)
contract was signed in July 2004 and the
new facility reached Substantial Completion
in October 2006
• Canada’s longest running healthcare AFP
project
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Redevelopment at The Royal (cont’d.)
• Under the AFP contract, the FM service provider
delivers the following services to The Royal:
− building, site, landscape maintenance
− patient and retail food services
− housekeeping and linen
− waste management
− security and parking
− centralized Call Centre
− lifecycle for the above
• FM service provider is fully integrated into operations at
The Royal, participating in all short and long-term
planning and change management
• Allows The Royal to maintain, adapt and improve
building features from the original design to the present
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Design Features and Positive Health Outcomes
Summary of General Design-Outcome Relationships
Even though
redevelopment at The
Royal preceded
today’s organized
Evidence Based
Design approach,
there were many
features included in
the design by John
McSween at Parkin
Architects for positive
health outcomes
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Opening Day Design Features at The Royal – Oct. 2006
• Emphasis on natural light for
− all inpatient rooms
− key therapy rooms
− inpatient and Outpatient gathering spaces
− naturally lit, 3-storey public space
• Glass block was used extensively to provide “borrowed light”
yet maintain privacy
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Opening Day Design Features at The Royal – Oct. 2006
• Natural views and landscaping
− secure courtyard access from rooms
− greenhouse spaces
− natural views for changes of season, wayfinding
• Progressive spaces – bedroom, neighborhood,
downtown
− for longer term patients, organized as 4 residential
areas with 16 patients each
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Opening Day Design Features at The Royal – Oct. 2006
• Single Patient Rooms for >83% of mental health beds improve
infection control, patient satisfaction, etc.
• Separation of public and patient flows:
− building core outwards, you move from public to semiprivate, outpatient areas to private inpatient areas
− back-of-house corridors allow access treatment areas
without going through public areas
− secondary corridor surrounding the Winter Garden allows
patients to bypass this public space
− floor plan creates private “wandering loops” for patients
• Flexible space configuration
− “back-to-back” inpatient wards and door locations allow
wards to grow and shrink according to demand
− magnetic lock door locations allows forensic patients to
visit gym without handcuffs, enhancing patient dignity
• The Royal and its FM service provider have further adapted
the facility to reflect operational realities….
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Adapting Design to Increase Clinical Effectiveness
and Efficiency
• Reworking space:
− reconfigured reception and food retailing for better flow
− created secure bicycle compound for staff
− Constructed labyrinth after four years into operations
• “As required” strategy for wall protection
− FM service provider responsible for materials, portering
− minimized wall protection for non-institutional look
− reduced cost, increased visitor satisfaction
• Expanded emergency power service:
− more backed-up receptacles (e.g., CPAP machines)
• Safety film for internal glazing without institutional look
− shatter-resistant film applied for schizophrenic ward
• Responding to regulations:
− Converted to “non-smoking” shortly after opening
− accessibility required additional washroom door openers
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Adapting Design for Innovative Problem Solving
Example #1 – Wheelchair room
• Opening Day – plan was to clean wheelchairs off
site but a separate “staging area” had not been
programmed for soiled wheelchairs leading to
infection control risks
• At the same time, the sliding door to a group
therapy area did not provide adequate privacy and
noise attenuation
• Solution? Re-purpose the sliding door to divide
clean and soiled wheelchairs
Example #2 – Dementia resistant door handle
• Clinicians wanted to discourage dementia patients from
leaving an area without having to restrain them
• Solution? Facility General Manager Pedro Narbaitz
developed a door handle shield that kept dementia patients
in but did not impact functionality for staff and visitors
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Reinforcing Good Design with Good Service
• Supporting normalcy
− food service provides choice for patients
(including youth dietary preferences)
− FM service provider personnel are
frequently seen so distinctive uniforms
avoided
− control over environment (e.g. room
temperature for patients in withdrawal)
− precautions include maintenance work in
pairs and taking tool inventory
• Supporting transition
− FM service provider participates in
“graduation parties”
− employment in food service has been
explored
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Summary and Lessons Learned
• Redevelopment of The Royal introduced many state-of-the-art design features
which have been associated with positive healthcare outcomes
• Today’s healthcare facilities must adapt and evolve to cope with changes in
therapies, patient needs, regulations, etc.
− made possible through a highly collaborative relationship between hospital
administrators and FM service provider
− FM service provider should be fully integrated into hospital planning and
operations with a wide scope of responsibilities
− FM knowledge leveraged and shared with other healthcare facilities
• Good design must be reinforced with “good service” to deliver the healthcare
outcomes
− services must complement design features
− FM service provider personnel must
recognize that they are part of the clinical
environment and act accordingly
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Thank You
Questions?