Capital Planning - Dipesh Patel

Integrated Transitions in Health Care Capital Planning
Dipesh Patel & Dominic Langley
London Health Sciences Centre
Overview
• Why did we go this way?
• Renal Dialysis Relocation
• Community Mental Health
• What if we did more?
• Community Ambulatory Care
• Alternate to ED
• Special Considerations MATT input
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Framework for Capital Investment
• LHSC developed a framework, one that evolves, to assess
capital investment
• Key considerations:
• Organizational challenge
• Patient experience
• Financial
• Right patient right setting
• We learn from each development
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Milestone Restructuring
• Following the mergers of three hospitals, LHSC was directed
through the 1997 Provincial Health Services Restructuring
Commission to align citywide services differently
• Services transferred between LHSC and SJHC over the next
15 years
• New partnerships developed with Lawson Health Research
Institute and the University of Western Ontario
• New buildings were added and building changes were
implemented
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Milestone Restructuring
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LHSC Sites
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Three Projects
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Renal Dialysis Relocation
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Community Mental Health Facility
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Community Care Centre
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RENAL DIALYSIS RELOCATION
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1
Renal Dialysis Relocation
Why are we doing this?
• Part of LHSC’s redevelopment and needed to be relocated
• Opportunity to look at relocating in a community setting
• Re-examination of the patient care model
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1
Renal Dialysis Relocation
Project Requirements
• 35 renal dialysis chairs with support services
• Equals approximately 30,000 square feet of space
Community Engagement
• Patient focus groups and site selection committee
• Meeting patient criteria
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1
Renal Dialysis Relocation
Westmount Mall features
• Close to Victoria Hospital
• Central public transportation hub
• Free underground heated parking
• Natural light in the clinic (windows & skylights)
• Below market lease rate for 10 years
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1
Renal Dialysis Relocation
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1
Renal Dialysis Relocation
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1
Renal Dialysis Relocation
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1
Renal Dialysis Relocation
Westmount Mall “Medical Hub”
• West London Family Health
• Shoppers Simply Pharmacy
• Body Mechanics
• Westmount Family Physicians
• Custom Mobility
• Kidney Foundation of Canada
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1
Renal Dialysis Relocation
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1
Renal Dialysis Relocation
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1
Renal Dialysis Relocation
Success of the project
• Rejuvenated the mall as a medical hub
• Dialysis clinic became an anchor tenant and catalyst for other
health care providers
• Patient and staff satisfaction is high
• Patient-friendly
• Easy accessibility
• Pleasant, non-institutional environment
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COMMUNITY MENTAL HEALTH
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2
Community Mental Health Facility
Why are we doing this?
• Project was initiated by CMHA Middlesex
• Proposed building was too large for their needs
• Opportunities for LHSC:
• Consolidate specialized outpatient mental health programs
in a community setting
• Develop synergies with CMHA overnight program
• Patient needs are better served in a community setting
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2
Community Mental Health Facility
Project Requirements
• Conducted site visits and building audit
• Deal with potential stigma / NIMBYism (Not In My Backyard)
from the community
• Mental health program assessment
• Identified Adult Eating Disorder, Psychosis Program
(PEPP) as potential programs to relocate
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2
Community Mental Health Facility
Site features
• Quiet, residential community
• Proximity to Victoria & University Hospitals
• Access to public transit close by
• Proximity to recreational trail and Thames River
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2
Community Mental Health Facility
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2
Community Mental Health Facility
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2
Community Mental Health Facility
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2
Community Mental Health Facility
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2
Community Mental Health Facility
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2
Community Mental Health Facility
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2
Community Mental Health Facility
Project Successes
• Freed up almost 15,000 square feet of space at Victoria
Hospital for acute care expansion
• Consolidated some specialized mental health programs in
one location
• Made use of a vacant building and purchased at below
market value
• Develop synergy with CHMA overnight program
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COMMUNITY CARE CENTRE
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3
Community Care Centre
What’s the opportunity?
• LHSC in preliminary
discussion with a private
company to lease
ambulatory space in their
new multi-disciplinary
centre
• Privately built and
managed ambulatory and
long-term care
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3
Community Care Centre
Building Features
• Close proximity to hospitals
• 100,000 square feet of facilities
• 50% ambulatory care
• 150 apartments with supportive long-term care
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3
Community Care Centre
New care centre
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3
Community Care Centre – Ground Floor
Audiology
Day Surgery
Dentistry
Diagnostic
Imaging
Exercise Centre
Lab
Optometry
Pharmacy
Walk-in Clinic
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3
Community Care Centre – Second Floor
Dermatology
Psychology
Sleep Center
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3
Community Care Centre – Long-Term Care
Two floors of senior
residents who require
supportive care
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3
Community Care Centre – Long-Term Care
Why engage with the private sector?
• Hospitals are all being squeezed in both dollars and space
• How do we deliver services in more efficient manner?
• We are building less and looking more at opportunities to
divest services in the community
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Future Investment
• There will likely be more opportunities to investigate how
services performed in our acute health care setting could be
better delivered in other settings
• Our framework provides a good stepping off point
• Increasing community interactions
• Population Health Strategist added to Decision Support
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Community Health Collaborative
Vision: Communities where every individual’s well-being is
actively and fully supported
Mission: Partnering to build on community strengths to
systematically and equitably ensure quality of life for all
• Understanding gaps in our local infrastructure will enable not
only the community to better plan capital investments in the
future, but it will enable LHSC to have a broader viewpoint of
the community as a whole when we investigate capital
investment in the community
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Membership of the Collaborative
• Addiction Services of Thames Valley
• Canadian Mental Health Association - Middlesex
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Branch
City of London
Fanshawe College
Goodwill Industries
Human Environments Analysis Laboratory
London Catholic School Board
London Cross Cultural Learner Centre
London Economic Development Corp
London Food Bank
London Health Sciences Centre
London Inter-Community Health Centre
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London Police
Middlesex County
Middlesex-London Health Unit
St Joseph’s Health Care London
South West Community Care Access Centre
South West Local Health Integration Network
Southwest Ontario Aboriginal Health Access Centre
Thames Valley Family Health Team
Thames Valley District School Board
United Way London and Middlesex
YMCA
University of Western
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Long-term Cost Analysis
Project (costs)
Square
Footage
Capital
Cost
Year 1
Year 2
Year 3
Year 4
Year 5
Renal Dialysis Relocation
30,000
$11M
$450K
$450K
$450K
$450K
$450K
25,000
$4M
$250K
$250K
$250K
$250K
$250K
25,000
$0
$500K
$500K
$500K
$500K
$500K
(Renovation, Rental, Operating)
Community Mental Health
(Purchase, Renovation , Operating)
Community Care Centre
(Rental, Utilities)
Year 6
Year 7
Year 8
Year 9
Year 10
Total cost over
10 years
Cost per
square foot
$450K
$450K
$450K
$450K
$450K
$15.5M
$51.67
$250K
$250K
$250K
$250K
$250K
$6.5M
$26.00
$500K
$500K
$500K
$500K
$500K
$5M
$20.00
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Long-term Cost Analysis
$0
$2
$4
$6
$8
$10
$12
$14
$16
$18
Renal Dialysis Relocation
Capital Cost
(in millions)
Community Mental Health
Cost over 10 years
(in millions)
Community Care Centre
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Lessons Learned
• Community engagement with multiple stakeholders is an
integral part of any capital project
• Partnership with other health care providers expands the
services available and reduces the burden on the hospital
• The long-term costs of capital projects are reduced by
minimizing our capital investment
• We are not alone in providing services to the community;
supporting partners can be found in the private sector as well
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