Dynamic facilities development
Healthcare in the United States is complex and dynamic. Academic Medical Centers (AMCs) that combine education and research with medical care face unique challenges in responding to change that is constant but at varying cycles. Despite the demands for frequent organizational and facility adjustments in response to changes in the healthcare environment, AMCs need high reliability and minimal disruption for their facilities to effectively support their mission. Physical adjustments that do occur therefore must be tightly planned and managed to send as few “ripple effects” as possible into the healthcare facility. Massachusetts General Hospital (MGH), a premier US academic medical center, has its main campus in a dense aggregation of 25 buildings in Boston, built over the last 196 years on 18 acres (7.28 ha). The main buildings comprise 4.6 million square feet (428,000 m2) and support 1.1 million outpatient visits, 54,000 inpatient visits, and approximately 110,000 emergency department visits per year. To manage its portfolio, MGH has a 35-person facilities planning and engineering department responsible for 200 renovation projects per year, plus a major new building approximately every eight years.
This chapter presents a survey and comparison of basic elements of MGH’s existing facilities by clinical function throughout their lives. The analysis provides insights regarding expectations placed on the initial design of the buildings, whether and how our buildings have adapted to change, and at what point they have limited clinical functionality and require replacement.