Co-Located Clinical and Research Facilities: Can One Building be All Things to All People?

Co-Located Clinical and Research Facilities:

Can One Building be All Things to All People?

Robert F. Pulito AIA

Principal, The S/L/A/M Collaborative

More and more, healthcare institutions are collaborating with academic research

institutions as well as private pharmaceutical and R&D corporations to form innovative partnerships and establish “co-located” clinical and research facilities. But these

“marriages’ of disparate missions, personnel, and culture can provide significant challenges, not all of them solved by simply placing clinicians and researchers side-by-side in the same facility.

I. Why consider a co-located research lab?

1. Dollars

No one needs to point out to healthcare administrators that clinical healthcare and services research is costly – or that academic research institutions and corporations have greater access to the funds and grants necessary to mount and support leading-edge projects. As long as the Federal Government and the pharmaceutical industry continue to dedicate vast sums of money to health-related research, scientists and clinicians will continue to explore the mutual benefits that accrue to joint projects in co-located facilities.

For their part, healthcare institutions often do not have the funds available to construct and operate a clinical research facility on a permanent, continual basis. Corporations, on the other hand, often do not have the space or staff available to pursue all the research initiatives they require. In addition, companies may sometimes see a benefit in pursuing research in an environment that is not encumbered with the typical corporate bureaucracy and hierarchical structure. For these and other reasons, combining their research pursuits can be attractive to both organizations.

2. Talent

Healthcare and academic institutions compete with research based-industry for the best minds in every discipline, and leading programs can be made (or broken) by their ability to attract the best talent with inducements such as square footage, equipment, building amenities, as well as access to a sufficient clinical base. By joining resources and

increasingly attractive settings to the best and the brightest researchers, who appreciate their convenience as well as their potential for greater cross-disciplinary collaboration.

3. Prestige

Access to detailed information on the status and rankings of healthcare institutions, especially through web-based research, has made today’s patients and their families increasingly sophisticated healthcare consumers, demanding the latest technology and treatments, especially when faced with serious illness or injury. A healthcare institution that can boast the presence of important clinical drug trials and sophisticated research programs may score a competitive advantage in an economically challenging

marketplace.

II. Key issues to keep in mind

Despite these seemingly self-evident benefits of economic and workflow efficiencies, the actual implementation of a co-located research facility is not without significant

challenges, even obstacles. At the heart of many of them is the difference between the mission and culture of academic, healthcare and research institutions: The academic hospital is a people-centered facility whereas the research industry lab is focused on science, results, and accountability to stockholders. Although their ultimate goal (improved patient outcomes) may be shared, their organizational structure, leadership, and physical environments are very different.

For the pharmaceutical industry, bringing a drug product to market is a long and complex process. Creating and sustaining a fruitful relationship with a clinical or academic

institution during this process can be especially challenging when corporate management is suddenly confronted with the more collegial, democratic “culture” of the typical clinical or academic environment.

1. Patient Privacy

Today’s patients may demand the latest clinical trials and experimental protocols, but they (and their families) do not want to be treated in a “typical” laboratory setting. They expect even experimental treatments to be given in a comfortable facility that respects their dignity and privacy. The design of a co-located research facility must therefore combine the best of patient-centered amenities, with the efficiency of the modern research function remaining out of patient view. Building entrances and exits should be clearly separated by function, with the clinical and research sections overlapping only in selected staff areas.

2. Security

Patient security as well as the security of their medical records are paramount issues in today’s health care. Moreover, some co-located labs contain animal facilities as part of a broad research spectrum, a factor that also demands complex security precautions. The design of co-located facilities must balance these concerns, carefully avoiding any appearance of “high security” intimidation, but ensuring the utmost level of protection for patients, staff and data.

3. Management Concerns

In a co-located research and clinical facility there may be inevitable tensions concerning which function is preeminent. This tension can be further amplified by a disparity in one group’s ability to generate revenue/funds and or expenses. Strong leadership that

promotes the synergistic possibilities and benefits of the co-located facility is critical. By seeking formal and informal opportunities to bring together staff from both functions, management of co-located facilities will experience fewer “turf crises.” Moreover, architectural design that fosters some level of mingling of research and clinical personnel may reap unexpected “scientific” benefits, with opportunities for each “side” to provide a different perspective on the same problem.

4. Space and Infrastructure Requirements

The challenge of the space and technology infrastructure demanded in a co-located research facility can be met by a creative design and planning team, preferably one with experience in both clinical and research environments. In general, a co-located research facility should embody the best of the hospital and the lab, with separate systems when demanded by infection control, privacy and security - and shared economies of space, equipment, technology, and data when possible.

Co-locating clinical and research facilities can be especially challenging if the different functions are to be stacked upon one another. The modularity of the clinical examination area is different from that of the research laboratory, not to mention that of an animal vivarium. Designing a structured bay system that will accommodate clinical and research modules is important if the building is to be efficient.

Co-locating can be further complicated by different criteria for vibration noise and light control. The mechanical systems for lab and clinical areas will be separate, but they may share mechanical spaces and a distribution shaft to increase the efficiency of the building. Separation of circulation systems for patient, researchers, and animals must be strictly maintained, often requiring separate entries and services areas which may burden the facility with increased square footage.

On the positive side, co-locating clinical and research facilities in the same building may ultimately save some space when it comes to offices and administration. Clinicians and researchers who must work in separate facilities for their clinical and research activities

often require two distinct offices and support space. When these functions are co-located, the institution can often achieve space (and related cost) efficiencies.

III.

Do co-located facilities REALLY work?

• Emory University in Atlanta is undertaking the creation of an innovative co-located pediatric facility. Expected to open in 2004, the new 140,000 GSF facility will be located on the Emory University campus and will house the hospital’s Pediatric Clinic as well as basic pediatric research and support laboratories.

The lower levels of this unique facility (including the entry level) is dedicated to clinic space and is designed to accommodate the needs of pediatric patients and their families. The upper levels house the research labs, with administration in between. Typically, Ph.D. researchers have one office located on their research floor, as well as access to consultation areas on the clinic floor.

The Research Module drives the structural bay configuration for the facility. The Clinical functions drive the location of entrance stairs and elevator. The requirements of each function are carefully woven together to produce the most cost-effective solution.

The lab floors are designed with two separate traffic patterns, one for lab personnel and one for general circulation. The axis of both vertical and horizontal circulation is where meeting rooms, lounges, and community spaces are located, providing opportunity for interaction between Lab and Clinical staffs.

• Pharmaceutical giant Pfizer Inc has embarked upon the development of a new, three-story Phase I Clinical Trials facility in New Haven CT that will combine research and clinical functions in a setting close to Yale-New Haven Hospital clinicians and Yale University researchers.

This new clinical trial facility will allow the company to have complete control over its Clinical Phase I trials. With an on-site pharmacy and analytical labs, it is designed to provide continuous "real time" data retrieval. By enabling Pfizer to schedule and modify trials, and analyze data immediately, the facility is expected to dramatically reduce the time needed to obtain FDA approval and bring new products to market.

The location of the facility will allow for collaboration with Yale Medical School and access to its state-of-the-art imaging equipment for additional drug research on a cellular level.

IV.

Conclusion

The ultimate design and configuration of these facilities may look very different, and each will respond to its specific programming requirements in unique ways, but they share an important similarity: They are tangible examples of the growing recognition by healthcare, academic and corporate organizations that forging partnerships is a trend whose time has come. They are among similar institutions across the country who anticipate that co-located facilities will lead to significant, mutual benefits, including:

• well-designed, state-of-the-art, efficient facilities;

• increased ability to attract and retain the best research minds in a range of disciplines;

• the most efficient use of research dollars and resources;

• a direct connection between researchers and patients whose lives will be affected.

Robert F. Pulito AIA

Principal, The S/L/A/M Collaborative 80 Glastonbury Boulevard Glastonbury, CT 06033-4415

www.slamcoll.com [email protected]