Master Plan

Record-breaking research growth. More than 5,800 employees. Multi-million dollar investments in state-of-the-art radiation oncology equipment. One new research building under construction. Hospital admissions and emergency department visits growing more than 20 percent. A cancer center experiencing record-breaking growth in the final stages of a $10 million renovation.

How is the University of Louisville Health Sciences Center going to handle this kind of growth and continue expanding its mission as a world-class academic medical center?

The planning horizon

Larry Cook, M.D., UofL's executive vice president for health affairs, notes that Japanese companies -- particularly those that create new technologies -- are successful because their planning horizons stretch as far as 100 years.

UofL is now taking a similar approach, despite the difficulties inherent in predicting the future.

"In health care, life sciences and academic medicine, we are seeing such rapid change that it is difficult to imagine what the field will look like in 20 years. But that's just what we are trying to do," he says.

Working with UofL Health Care, Cook charged a committee composed of experts in planning, construction, education, research and clinical care to complete a campus master plan designed to take the Health Science Center to the next level over the course of the next two decades.

The plan was approved by the university's Board of Trustees at its regular meeting on Feb. 21, 2007.

"We need to ensure that our physical facilities will not just enable us to operate, but also promote and enhance our mission as an academic health sciences center, creating the knowledge to heal," Cook says.

In his view, this mission is accomplished through a complex interplay of three distinct components.

"First, UofL as an institution has to continue to provide excellent patient care, both through UofL Health Care and with our partner hospitals, including Norton Healthcare and Kosair Children's Hospital, Jewish Hospital and the Veterans' Administration.

"Second, we have to educate the next generation of health-care professionals, which needs to be done in a variety of settings and facilities."

Cook is clearly proud of UofL's ability to educate professionals to care for a diverse population. He points out factors that create demand for continuing education, including the aging population and commensurate aging in the health-care work force, shortages of nurses and other health care professionals, and the fast pace of technological and scientific innovation.

"I can not stress enough how critical our educational mission is for the future of our community, state and nation," he says.

"Third, we have to do the very best science possible and find out how to translate what we discover into new therapies and treatments that help people live better, healthier lives."

Pointing out that the nation's academic medical centers -- a term used to describe institutions that include health care education and teaching hospitals -- conduct more than half of all research sponsored by the National Institutes of Health, Cook emphasizes the importance of making research applicable to and beneficial to the patients and communities that UofL serves.

"It's really the opposite of the ivory tower," he says. "When new research is presented, the next question is always: How long before this new finding gets to patients?"

Close quarters

As with any enterprise, fulfilling the mission of the Health Sciences Center takes resources -- for space, equipment, patient care areas and instructional facilities.

"We are truly space-constrained -- and not just for research labs," Cook says. "We have faculty sharing offices and labs, new hires that we have to find places for and we need to think about all of our instructional space and its functionality as we move forward. The last master plan was completed in 1993 and didn't anticipate the level of growth this campus has experienced."

Space is also an issue from the patient-care perspective. University Hospital and the James Graham Brown Cancer Center continue to see consistent growth in both inpatient and outpatient volumes.

"In order to meet the needs of the UofL School of Medicine and the community, it is clear that we will need to build additional patient-care capacity at University Hospital and the Brown Cancer Center," says Jim Taylor, President and CEO of UofL Health Care, which is comprised of the hospital, cancer center and University Physicians Associates.

For the Brown Cancer Center, chemotherapy visits increased 42 percent in 2006 from 2005. On average, more than 2,220 new patients are treated annually at the Brown.

For the hospital, both the average daily census and patient cases increased nearly 6 percent from 2005 to 2006.

Educational programs are also limited by space and facilities that must be adapted to meet the challenges of technological innovation.

Classroom space is a key limiting factor. Last year, the Association of American Medical Colleges (AAMC) recommended a 30 percent increase in medical school enrollment to meet projected needs in the American health-care system.

An AAMC survey released earlier this year cited a lack of classroom space as the second most common barrier to expansion, just behind scholarship availability and equal in importance to the shortage of clinical teaching faculty.

"If we increase the medical school's class size without increasing the pool of financial aid, we will increase average student indebtedness beyond the current $110,000 per graduate," says School of Medicine dean Edward Halperin, M.D., M.A.

"But we must also think about how we can accommodate more students without diluting the quality of medical education."

He cites technology as a driver of changes in medical education, using anatomical education as an example.

"Students' cadaveric dissection will remain the central core of anatomical instruction, but the modern student of anatomy must also learn their anatomy while studying correlative CT scans, MRI scans, plain X-rays and ultrasounds. They should also benefit from heightened computer technology that allows three-dimensional imaging of the human body. Computer-aided anatomical dissection is part of the future of anatomical education. The University of Louisville must provide such training as well as study the best way to do it," he asserts.

Technology also is driving changes at University Hospital, which has "made multi-million dollar investments in leading-edge technology so our doctors and staff are able to better diagnose and treat our patients," Taylor says. "It only makes sense that we have the clinical space to accommodate our growing patient base."

Cook says UofL is very fortunate that the Kentucky General Assembly and UofL's representatives in Washington understand and support the school's vision.

Of the $27.8 million cost to build the new Cardiovascular Innovation Institute, $5.5 million was invested by the Kentucky Cabinet for Economic Development and the Department of Commercialization and Innovation, and $6.2 million in federal earmarks were secured by U.S. Sen. Mitch McConnell.

This support was combined with $15 million from Jewish Hospital, $4.2 million from UofL, a portion of a $5 million grant from Kosair Charities and a portion of a $1.5 million gift from the Gheens Foundation, which was used to equip a biosensor research laboratory.

The Biomedical III and IV facility, currently under construction east of University Hospital, will cost approximately $140 million. Of its total cost, $10.1 million came from a federal earmark secured by McConnell. The rest is coming from university funds and bonds authorized by the Kentucky legislature in 2005.

In Cook's view, this public-private partnership model is ideal, because the support helps UofL attract and retain the best physicians and scientists, who bring economic development opportunities to Louisville.

"There is a great deal of competition for top faculty, and facilities can be an important part of the package for someone who wants to build a practice or relocate an entire laboratory to Louisville," he says.

Consulting the experts

All of these factors led Cook to partner with Taylor, pulling together a small group of experts that included facilities, traffic and planning specialists, as well as officials responsible for managing clinical and research activities at UofL and University Hospital. The group created a Request for Proposal, reviewed bids and selected a consultant team made up of representatives from the Campus Studio, JRA Architects, Shepley, Bullfinch, Richardson & Abbot, ClaSickle Engineers and Daggs & Fisher Engineers.

"It was very important to select a group of consultants not only for their expertise in areas like locating buildings in areas of common use, open space, vehicle circulation and parking, pedestrian circulation, and utilities, but who also have an understanding of the big picture -- the constituencies we serve, our mission, future goals and priorities," says Mark Pfeifer, M.D., the V.V. Cooke Chair of Medicine, who brought the benefit of his long tenure at the School of Medicine to the planning group while he was serving as interim dean.

Previous master plans, completed in 1993 and 1972, did not integrate the needs of UofL and the UofL Health Care Medical Campus.

Both Taylor and Cook say it's clear that the new approach is going to yield a much more robust plan for the future.

"We are affected by each other's operations and decisions; it only makes sense that we collaborate on such a plan that will define the landscape for all of our organizations," Taylor says.

Setting priorities

The master plan approved by the Board of Trustees puts forward a set of principles that will guide future development at the Health Sciences Center and establish physical patterns critical for achieving and sustaining a world-class patient-care, teaching and research facility.

The team was in agreement that decisions around future campus development and expansion consider how the physical surroundings communicate the priorities and goals of the entire Health Sciences Center. Their goal was to develop a campus that promotes and stimulates interaction between students, physicians and researchers.

"One of the great things about an academic environment is the interprofessional and interdisciplinary collaboration that can take place," Pfeifer says. "Not just in peer-to-peer relationships but in mentoring and teacher-student relationships as well. These relationships can be a reservoir of creativity that gets expressed in new ways of teaching, new research breakthroughs and in forming best practices for patient care. Clearly, we want the physical surroundings to contribute to creativity."

"Another major consideration is how patients experience the campus," Cook says. "Throughout the process we have been placing a high priority on measures that can facilitate a positive patient experience in terms of finding the boundaries of the campus, navigating by car and on foot, having convenient parking and being able to see the doctors they need to see in a state-of-the-art facility. The plan also calls for more resources for patients, families and visitors, including retail outlets, more accessible entrances, patient pick-up and drop-off areas, and a more attractive urban environment."

The plan also addresses how to accommodate future growth while ensuring that changes to the campus integrate buildings, open space, pedestrian circulation, utilities and parking. Some of the questions the plan tries to answer:

• Is the current use of this real estate the best use of the space?
• Should we use space in the center of campus or at the edges for new development?
• How can we build up instead of out, when necessary?
• How do we create and maintain the best campus atmosphere, particularly for students who spend so much time here?

The master plan envisions a central quadrangle with grass and trees instead of concrete and steel, more places where students can gather and study in groups and more comfortable spaces, according to Dick Rigterink of the Campus Studio.

"When we observed how the students were utilizing the current spaces, we hardly every found anybody in the courtyard. The vision for more comfortable outdoor spaces for students includes more and larger trees, less concrete, places to eat outside or study and to make the most of the open space available," he says.

Other parts of the planning process address basic issues of traffic and pedestrian circulation. Key objectives include designing campus gateways and distinct zones, buildings and signage to help people get where they are going without confusion, ensuring that adequate parking facilities are planned to accommodate anticipated growth and locating service and loading docks in places where they don't obstruct vehicle or pedestrian traffic.

"Boundaries tend to be organic at academic medical centers because that's how they grow," says Rigterink.

"At the same time, we can visually convey physical boundaries to help people get where they are going. It's a functional need to help patients and visitors find their way to their destination."

The plan also takes into account UofL and UofL Health Care's relationships with other members at the Louisville Medical Center and as a neighbor to others in the city. Louisville Metro planning and transportation officials and Louisville Medical Center Development Corp. representatives have had opportunities to offer input and expertise that was integrated into the plan approved by the Board of Trustees.

"We want to be a good neighbor by both acknowledging and working with surrounding development patterns," says Clarke Johnson, assistant vice president for health affairs/planning at UofL.

"This is an ambitious plan," Cook adds. "It is my belief that, by aiming high, we challenge ourselves to take all the parts of our mission to the next level. I am excited to see the changes that we have mapped out become a reality on campus."