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Planning Horizons

UofL has healthy designs on downtown

planning.jpgRecord-breaking research growth. More than 5,800 employees. Multimillion dollar investments in state-of-the-art equipment and research buildings. Hospital admissions and emergency department visits up more than 20 percent. A cancer center experiencing unprecedented growth, in the final stages of a $10 million renovation.

How is the University of Louisville Health Sciences Center handling this type of escalation while simultaneously expanding its mission as a world-class academic medical center?

Dr. Larry Cook, 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. Despite the inherent difficulties in predicting the future, the university is taking a similar approach.

"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," Cook says, "but that's just what we are trying to do."

Last year Cook, working with UofL HealthCare, charged a committee composed of experts from across the medical center with mapping out a facilities master plan designed to take the medical center to the next level. They emerged with an ambitious, comprehensive 20-year plan that addresses all aspects of the 30-block HSC area-from educating students to research to patient care.

The UofL Board of Trustees approved the plan in February.

The HSC master plan represents yet another way the university is taking a leadership role in the community, says UofL President James Ramsey.

"Kentucky cannot grow and prosper and be successful if Louisville doesn't grow and prosper, and Louisville won't if the University of Louisville doesn't assume a leadership position.

"It reflects our desire to be accountable to our community-to be a good citizen to our community."

The Master Plan

All aspects of health care were in view when HSC started charting its latest planning horizons, Cook says.

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

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

  • Providing excellent patient care, continuing the tradition established by UofL HealthCare (comprised of University Hospital, UofL's James Graham Brown Cancer Center and University Physicians Associates) and the university's partner hospitals, which include Norton Healthcare and Kosair Children's Hospital, Jewish Hospital and the Veterans' Admini-stration Medical Center.
  • Educating the next generation of health-care professionals in a variety of settings and facilities so they can accommodate the needs of a diverse population. Continuing education is an important piece of this, too, especially considering the aging population and commensurate aging of the health-care workforce, the shortage of nurses and other health-care professionals, and the fast pace of technological and scientific innovation.
  • Translating discoveries into new therapies and treatments, by using the best science possible. The nation's academic medical centers conduct more than half of all research sponsored by the National Institutes of Health today, Cook says, so it's imperative that the Ivory Tower reconnect with the practical concerns of everyday life. The objective for any new research finding must be, "How long before this gets to patients?"

Close Quarters

As with any enterprise, fulfilling the HSC's mission 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."

Last year, the Association of American Medical Colleges recommended a 30 percent increase in medical school enrollment to meet projected needs in the nation's health-care system. But in a survey released earlier this year, the association 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.

Accommodating more students- "without diluting the quality of medical education," says Dr. Edward Halperin, dean of UofL's medical school-is a major concern at UofL, and something addressed in the new master plan.

Space is also an issue from the patient-care perspective. University Hospital and the Brown Cancer Center continue to see consistent growth in both inpatient and outpatient volumes. On average, more than 2,200 new patients are treated annually at the cancer center. Chemotherapy visits alone increased 42 percent in 2006 from 2005.

Over the same period University Hospital's average daily census and patient cases increased nearly 6 percent.

"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 HealthCare.

Technology is another major factor in the master plan. Halperin cites technology as a driver of change in medical education today, using the anatomy class as a prime example.

"Students' cadaveric dissection will remain the central core of anatomical instruction,' he says, "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."

University Hospital is feeling the financial effects of keeping up with technology, too, resulting in "multimillion dollar investments in leading-edge technology so our doctors and staff are able to better diagnose and treat our patients," Taylor says.

UofL "is fortunate" that the Kentucky General Assembly and the state's representatives in Washington understand and support the university's vision, Cook notes. For example, of the $27.8 million cost to build UofL's new Cardiovascular Innovation Institute, $5.5 million was invested by the Kentucky Cabinet for Economic Development and the Department of Commercialization and Innovation, while $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 $1.5 million gift from the Gheens Foundation (used to equip a biosensor research lab).

The Biomedical III and IV facility currently under construction east of University Hospital will cost approximately $140 million. Of that amount, $10.1 million came from a federal earmark secured by Sen. McConnell and the rest 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 financial support helps UofL attract and retain the best physicians and scientists, and they in turn attract economic development to Louisville.

"There is a great deal of competition for top faculty," he says, "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."

Consulting the Experts

All of these factors led Cook to partner with Taylor in pulling together a master plan team made up of facilities experts, traffic and planning specialists and managers of clinical and research activities at UofL and University Hospital. The team then brought in consultants from Campus Studio; JRA Architects; Shepley, Bullfinch, Richardson & Abbot; ClaSickle Engineers; and Staggs & Fisher Engineers to assist in developing the plan.

The input of Louisville Metro planning and transportation officials and Louisville Medical Center Develop-ment Corp. representatives was also integrated into the plan, says Clarke Johnson, UofL's assistant vice president for health affairs/planning, explaining, "We want to be a good neighbor by both acknowledging and working with surrounding development patterns."

Though the 1993 master plan and another completed in 1972 did not integrate the needs of UofL and the medical campus community, Taylor and Cook believe the collaborative approach of the new plan will yield a more robust strategy 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

A major consideration in the new master plan is how the HSC's physical setting communicates its priorities and goals, and promotes and stimulates interaction among students, physicians and researchers.

As part of the planning team, Dr. Mark Pfeifer brought the benefit of his long tenure at the School of Medicine, including time spent as interim dean.

"One of the great things about an academic environment is the interprofessional and interdisciplinary collaboration that can take place," he says, "not just in peer-to-peer relationships, but in mentoring and teacher-student relationships. 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."

So the master plan provides for a student-friendly campus featuring a central quadrangle with grass and trees.

"When we observed how the students were utilizing the current spaces, we hardly ever found anybody in the courtyard," notes Dick Rigterink, Campus Studio's representative on the planning team. "The vision for more comfortable outdoor spaces for students includes more and larger trees and less concrete, places to eat outside or study and to make the most of the open space available."

The public face of the project-"how patients experience the campus," Cook says-includes plans for better traffic flow and pedestrian circulation, distinct HSC gateways and "wayfaring" signage to help people easily find where they need to go. Convenient parking and being able to see the doctors they need to see in a state-of-the-art facility are prime considerations.

"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 environment," Cook adds, acknowledging, "This is an ambitious plan. 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."

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