On a bright Sunday morning in early August, 14 local ambulances, each staffed by three emergency medical technicians, lined up in formation about a block or so from the main entrance to 75-year-old St. Joseph's Community Hospital of West Bend, a 103-bed facility in southeast Wisconsin. Their mission: a safe, orderly relocation of 29 patients, including the potentially tricky transport of one young woman in labor.
Outside the loading dock, meanwhile, several teams of workers were already busy filling three 55-foot tractor-trailers with everything from centrifuges and X-ray film to nursing stations and incubators for a five-mile journey south, where these truckloads of gear-about 700,000 pounds in all-would be carted into the hospital's brand-new, 80-bed replacement facility on Pleasant Valley Road, just off Interstate 45.
For those who think moving from one house to another is a major headache, try coordinating the move from a 410,000-square-foot hospital.
"In terms of the level and detail of planning, it's like the ultimate wedding," says Mike Murphy, St. Joseph's vice president for patient-care services, who coordinated the complicated relocation. "It's like spending a year or so getting prepared for one morning."
St. Joseph's big move is hardly a rare occurrence at a time when many hospitals and health systems are building new facilities and either shuttering older ones or using those aging buildings for other purposes, such as administrative services, outpatient care or storage.
Turning to the experts
Indeed, 121 new or replacement hospitals worth about $5.2 billion were completed in 2004, according to a survey by Modern Healthcare. Almost $23 billion was spent on all healthcare construction projects last year, which means a lot of medical equipment and manpower were moved around the map in the healthcare industry.
"There's lot of business (for relocation services) out there, especially in California because of the seismic issues," says Sandra Rankin, director of occupancy and transitional planning services at Facilities Development, a Phoenix-based consulting company that works with many hospitals and health systems. "But it's happening all over the country. Where there's population growth, there are new hospitals."
These so-called "transitional planning practices" are reaping the rewards of the hospital building boom, with many small firms or single consultants moving in to provide their expertise. A small number of well-established firms perform this kind of consulting work, as do construction-management companies that include transitional planning in their project fees.
"They're popping up all over the place," Rankin says of these firms. Her company has been in the business for about a quarter-century. "For years and years, hospitals didn't even put out a request for proposals. Now, with all the competition, that's pretty standard operating procedure."
At St. Joseph's, the transition planning began some two years before Aug. 7, the day more than 150 employees, evenly divided between the two campuses, gathered for the relocation. In the months leading up to the move, a committee of hospital officials, working with an outside consultant, drew up intricately detailed plans about the precise timing for the transfer of everything from a 6,000-pound MRI machine to a plasma freezer and crash carts.
John Reiling, president and chief executive officer of the hospital and parent SynergyHealth, compared the move to a well-executed military operation. It officially kicked off at 7 a.m., although some equipment, including the MRI machine, had already been moved. The MRI unit, among the most complicated parts of a difficult relocation, was safely situated at the new hospital about a month earlier. One of two large surgery sterilizers also was moved beforehand, ensuring that it would be operational the moment the new hospital opened on the day of the move.
Murphy, a veteran in the relocation arena-this was the fifth hospital move of his career-served as the "incident commander," coordinating the move with local emergency officials, who took the opportunity to use the event as an evacuation drill. His day started at 4: 30 a.m., checking paperwork from doctors who filled out medical forms highlighting special needs of the patients to be moved.
As the emergency room was shut down at the old facility, the new one was opened simultaneously down the road.
Shortly after 7 a.m., the first ambulance rolled up to the front door, and paramedics wheeled out a stable postoperative patient from the third floor to begin the relocation. Her name was checked off and employees at the new hospital were notified of her arrival. As she left, another ambulance pulled up, repeating a process that occurred continuously over the next three hours or so. The only major concerns were for a woman in labor-the second patient moved-but that transport was uneventful.
"We planned for the most difficult situations and we fully staffed every ambulance as if there was a risk of coding," CEO Reiling says.
There were some patients who received a slightly different type of special attention: Three new mothers, their newborns and other family members were driven in style, traveling the short distance in stretch limousines. One mom asked if the entire family could join in the ride. Of course, they did-and Reiling was enlisted to drive the father's car over to the new hospital.
"We just decided we wanted to make this as pleasant an experience as possible-and it was," says Janet Ford, a hospital spokeswoman.
New role for old hospital
In all, Murphy says, about 80% of the hospital's contents were moved to the new facility. Among the items left behind: old beds. Patient supplies also weren't moved because officials will use parts of the old hospital as a warehouse for the medical group that is part of the hospital's integrated system. Reiling says 19 beds will be converted for behavioral patients. Other sections of the old hospital will be used for office space and outpatient radiation oncology services.
Another key facet of the move was all but invisible: Extensive employee training. Each staff member, depending on his or her role, received as much as 40 hours of transitional training, learning how to operate in an entirely different environment with new equipment. The training was especially important in the case of St. Joseph's, which is considered a national innovator in patient-safety design. Officials say the facility has received national attention, with heavyweight organizations such as the Mayo Clinic and Johns Hopkins Hospital and Health System reviewing the design.
"Most new hospitals being built are much more technologically advanced, especially this one," Reiling says. "That creates a lot of complexity, and you need to provide the staff with a certain comfort level."
While many hospitals and health systems use their own employees to help organize the move, an increasing number of facilities, including St. Joseph's, tap the expertise of outside consultants like Rankin.
"Hospitals typically think they can do the job themselves," says Rankin, whose firm is usually involved in four or five projects per year. Administrators "figure they move patients all the time. They don't realize how many things need to be done when you're closing one entire hospital and opening a new one. There are literally thousands of things that need to be done, and they all have to be well-choreographed, and they have to be done in the right order. Any single piece of the move is not difficult. Put it all together, and it's incredibly complicated."
There's also the crucial element of the bureaucratic maze that must be nimbly negotiated as the hospital moves from one location to another. "There's a myriad of licensing and regulatory issues imposed by the state government, the Joint Commission and others," says Nancy Hogan-Baur, member-manager of 5THink, a company that jumped into the transitional planning business about five years ago to help hospitals plan moves. "They focus on things as simple as every employee of the hospital dealing with a new piece of equipment must be oriented and trained-with documentation to prove that the training transpired."
She suggests that the growth in the business, especially among consultants, has been driven by three key factors. A decade or so ago, few total replacement hospitals were being built. And in those relatively rare cases that one hospital closed and another opened, the projects were much smaller. What's more, the larger hospital staffs in past years provided more flexibility by allowing the facility to do much of the work without outside help.
"It was always left to the hospital operations to figure out how you were going to move into a new building," Hogan-Baur says.
Officials at St. Joseph's estimate that the move cost the hospital about $500,000, including the professional movers, consultants and staff time. Compared with the price of the hospital-about $50 million-that might not sound like much, but the cost of an outside consultant is steep enough that many cash-strapped hospital administrators remain reluctant to hire such firms. The majority of hospitals, observers say, still prefer to keep the project in-house, relying on employees and an outside moving company to do the job.
Prices for transitional planning services vary widely depending on the scope and complexity of the job, experts say, with total costs well above St. Joseph's for relocations of hospitals with several hundred beds.
"Most hospital executives think they can save money by doing it themselves," Rankin says. "We can have kind of a hard sell (to convince administrators to hire outside consultants), because it's difficult to quantify what you can save a hospital since no one knows what wrong road they will go down (if they do it themselves).
"We tell them we can help you avoid going down those wrong roads," she says. "In the end, it'll end up saving money."