WRO Medical Support Center proposal on construction project

 

WROMSC_WRO Medical Support Center

 

Table of Contents

 

Executive Summary and Finance Application

 

1.0. Introduction

1.1. Healthcare in Evolution

1.2. Vision and Mission Statement

1.3. Background Information

1.4. The WROMSC Project

2.0. Structure and Approach

2.1. Organization

2.2. Departments

2.3. Scope of the Project

2.4. Human Resources

2.5. The Creation of New Facility

3.0. Site Details and Plans

3.1. WROMSC Site Details

3.2. Project/Facility Design and Construction

3.3. Construction Schedule and Budget

4.0. Planning for Services

4.1. Guiding Principles for Patient Services

4.2. Services to Patients and Research

4.3. Next Steps in the Planning Process

5.0. Project Financials

5.1. Budget Assumptions

5.2. Revenue Assumptions

5.3. Operating Expenses

5.4. Cash Flow and NPV Analysis

 

 

2.0. Structure and Approach

 

2.1. Organization

 

In May 2002 an Interim Board was created, whose composition and mandate were set out in this section. Shortly thereafter, a Joint Planning and Steering Committee was formed, in accordance with the Board meeting, this committee began meeting in May 2002. This Planning Committee includes not only representative of the WROMSC. Concurrent with planning activities, the Board of the Partners undertook the work of fund-raising and negotiating various service agreements. In May 2002, the so-called WROMSC Board was formed to establish a new general hospital, and a steering committee will be created for governing the project. The first mandate of the Committee was to carry out a detailed feasibility analysis, intended to lead ultimately to functional and technical programming for a new facility. This involved a number of tasks, in accordance with the requirements set out by the initial plans.

 

 

2.2. Departments

 

WROMSC will be operating on a comprehensive array of clinical departments for an efficient and cost-effective patient care. The following departments and clinics will run smoothly, and harmoniously through interdepartmental consultation and multidisciplinary cooperation as needed.

 

● Department of Gastroenterology

     Gastrointestinal tract, liver, pancreas, biliary tract diseases, etc.

 

● Department of Hematology-Oncology

     Multiple myeloma, leukimia, bone marrow transplants, hemopathy, aplasticanemia, etc.

 

● Department of Thoracic Surgery

     Lung and esophageal cancers, surgery for lung diseases, pneumothorax, etc.

 

● Department of Cardiology

     Angina pectoris, coronary disease, hypertension, cardiovascular interventional procedures, cardiac arrhythmia, etc.

 

● Department of Infectious Diseases

     Infectious diseases, fever of unknown origin, lymphadenitis, tuberculosis excluding respiratory TB, travel medicine, etc.

 

● Department of Pulmonary and Critical Care Medicine

     Pneumonia, lung cancer, asthma, tuberculosis, sleep apnea, allergies, etc.

 

● Department of General Surgery/Gastro Surgery Liver & biliary duct, pancreas and stomach surgery, colon & anus disorders, organ transplants, stomach cancer, liver cancer, etc.

 

● Department of Orthopedic Surgery

     Gonarthritis, joint replacements, arthroscopy, spinal disorders, hip joint disorders, pediatric surgery, etc.

 

● Department of Breast and Endocrine Surgery

     Breast cancer, thyroid glands, parathyroid glands, adrenal glands, melanoma, sarcoma, etc.

 

● Department of Neurosurgery

     Brain tumor, pituitary tumor, intervertebral disc and pediatric neural disorders cerebral palsy, epilepsy, skull lesions, etc.

 

● Department of Vascular Surgery

     Transplant Surgery, venous disorders, etc.

 

● Department of Endocrinology & Metabolism

     Diabetes, thyroid problems, endocrinopathy, osteoporosis, arthritis, rheumatism, etc.

 

● Department of Pediatric Surgery

     Hernia, digestive disease, disease of the rectum, congenital deformities, organ transplants, etc.

 

● Department of Nepgrology

     Kidney failure, kidney transplants, nephritis, hemodialysis, glomerular diseases etc.

 

● Department of Thoracic & Cardiac Surgery

     Heart disease, valvular heart surgery, coronary artery bypass, heart transplants, etc.

 

● Department of Plastic Surgery

     Facial skeletal contour surgery, scar removals, cosmetic surgery, plastic reconstructive surgery of breasts, body contour surgery, etc.

 

● Department of Obstetrics & Gynecology

     Gynecological diseases and cancer, menopausal disorders, obstetrics, etc.

 

● Department of Child & Adolescent Psychiatry

     Child and adolescent mental disorders, attention deficit disorder, autism, learning disabilities, anxiety disorder, etc.

 

● Department of Diagnostic Pathology

     Lymphoreticular system, molecular pathology, transplant pathology, Immunopathology, oncopathology, etc.

 

● Department of Ophthalmology

    Carteracts, glaucoma, opthalmoplasty, retinal and corneal disorders, myopia and astigmatism correction, etc.

 

● Department of Dermatology

     Skin tumors, laser treatment, allergies, atopic dermaitis, etc.

 

● Department of Family Medicine

     Multiple symptoms disorders, psycho-somatic symptoms, behavior Modification theraphy for adulthood diseases, immunization, etc.

 

● Department of Otorhinolaryngology Head & Neck Surgery

     Laynx tumors, craniopharygiomas, sinus, sinusitis, voice disorders, dysomia, Deafness, etc.

 

● Department of Physical Medicine and Rehabilitation plain in joints, traumatic brain injuries, sports in juries, general & pediatric & Cardiopulmonary rehabilitation, etc.

 

● Department of Urology

     Urinary tumors, kidney transplants, impotence, bladder disorders, etc.

 

● Department of Anesthesiology

     Anesthetic management, post-operative pain management, etc.

 

● Department of Pediatrics

     Asthma, congenital fever, immunodeficiency, muscular and developmental disorders, stunted growth, childhood leukemia, etc.

 

● Department of Radiology

      Interventional radiology, angioplasty, cerebra-neural radiology, abdominal radiology, abdominal radiology, etc.

 

● Department of Pediatric Cardiology

     Pediatric cardiac disorders, congenital heart disease, fetal cardiac disorders, etc.

 

● Department of Radiation Oncology

     Gynecological tumors, genito-urinary tumors, craniopharygiomas, pulmonary tumors, lower stomach tumors, brain tumors(stereotactic radiotheraphy), etc.

 

● Department of Neurology

     Strokes memory loss, dementia, epilepsy, seizures, sleep apnea, syncope, movement disorders, etc.

 

● Department of Nuclear Medicine

     Nuclear oncology, nuclear neurology, nuclear cardiology, etc.

 

● Department of Neuropsychiary

     General psychiatry, panic disorder, symptomatic depression, insomnia, senile dementia, etc.

 

● Department of Clinical Pathology

     Transfusions, transplant immunology, diagnostic hematology, cytogenetics, etc.

 

● Department of Orthodontics

     Oral faciomaxillary surgery, operative dentistry, prosthodontics, pediatric Dentistry, implant dentistry, periodontics, etc.

 

● Emergency Care Center

     Emergency medical service, etc.

 

 

2.3. Scope of the Project

 

The planning team will be entrusted with the challenge of considering what services would be required in the next 10 to 20 years in terms of :

 

● Patients' needs

 

● Anticipated developments and trends

 

● Services required

 

● Impact on research

 

● Changes in utilization of services

 

● Design considerations for a new facility

 

 

A new vision of the future and the vision for patient services at WROMSC can be summarized in three themes :

 

a. Patients and family are central to the organization of care.

 

b. The WROMSC will offer care and research of the highest quality.

 

c. Strong network partnerships are essential.

 

In planning, it is essential to make careful and explicit assumptions about the context in which the WROMSC is likely to be operating as follows :

 

a. There will be a coordinated and comprehensive primary care system in which people will have access to a primary healthcare physician.

 

b. More care will be provided not in hospital but in the community; within the hospital, more care will be provided through outpatient and day programs.

 

c. The number of specialists being trained will decrease and the lines delineating professional boundaries will change.

 

Health services in WROMSC will be greatly enhance if provided in a network in which each patient has coordinated access to the entire continuum of care, ranging from prevention to detection, diagnosis, treatment, and rehabilitation. In such a system of the future, to care for patients successfully will mean that care must be coordinated between all points of service provided by the WROMSC and other providers ;

Decisions regarding the appropriate site of treatment must take into account the nature and capacities of patients and family ; and the entire system must be comprehensive, coordinated, and caring designed to meet patient and family needs.

 

 

Within this system of coordinated, comprehensive care provided within a network of services, the WROMSC sccs its role :

 

● as a health center with a mission of patient service and research.

 

● offering care to patients across the lifespan the only such health center in Seoul.

 

● as a provider of specialized care in the regional health network, with a high concentration of services demanding specialized expertise, skill, technologies, or other resources.

 

● as an active partner in the health of the diverse community it serves.

 

 

An important task of the planning committee is to forecast service volumes, focusing particularly on the reference date of 2005, when the WROMSC would open. Taking into consideration expected changes in population and demographics, and using a combination of past utilization trends and the most of indicators in AppendixⅡ(Statistics for Hospital Management) was is appropriately sized, the WROMSC will continuously monitor these assumptions to adjust the new facility size as necessary.

 

TIMETABLES

 

The project is being conducted in accordance with the following programs :

 

PROCESS / MILESTONE

PERIOD / TARGET

So called WRO Medical Center(WROMSC)

April 2002

The Board and the Planning/Steering

April to Jun 2002

Committee established.

Jun 2002

Planning/Feasibility Study

Jun to July 2002

Finance Application

July to August 2002

Site Preparation and Purchase of Land,

October 2002

Design and Construction started.

November 2002

Computers, Medical Equipment, other

April 2004

Furnishings selected and start buying.

Recruitment of Staff and Selection (H/R)

October to December 2004

Training and Preparation. Layout of all facil.

January to February 2005

Construction completed and WROMSC Opening

February 2005

 

 

Project Process

 

The steering committee is providing overall guidance for the Project. A Project team, led by the project director, will be responsible for project brief, facilitation of the project development, presentation to the board, and contract negotiations with the preferred contractors. The project director will review and monitor the performance of the WROMSC against the agreed contractual obligations during the design and construction phase.

 

 

2.4. Human Resources

 

After several months of preparation, planning processes can be set in motion to carry out all the studies required. Given the complexity of issues and the magnitude of scope in each aspect of this project, the quality of people enlisted to carry out the project should be a critical success factor. In this project, planning staff, consultants, volunteers, and staff of the partner hospitals, will involve. Among the planning staff, a variety of expertise is represented, including architecture, project management, and computer systems. Volunteers are at the heart of the WROMSC project, who serve both the board and the planning committee. Among them, we will include WROMSC staff from community-based healthcare organizations who will be recruited to participate. Here as well the recruitment process will be carried out with care. Hundreds of staff, including physicians, nurses, other health professionals, researchers and non-professional employees, is participating actively in developing and validating a vision for the future of the WROMSC.

 

WROMSC HUMAN RESOURCES PLAN (The 1st year)

 

Description

Job Class

Sub-total

Remark

Physicians

Specialists & G.P.s

57

To be increased

Nurses&

Assistants

Registered Nurses

Nurse Aids

175

102

Incl.night duty

Pharmacists &

Assistants

Pharmacists

Assistants & Aids

2

4

A.N.aids

Pharmacists&

Assistants

Physical Therapists

15

Laboratory Technicians

20

Radiology Technicians

20

Medical Record Technicians

5

Dental Hygienist

5

Administrators &

Assistants

Administrators &

Clerk Dietitian

56

4

Engineers&Assistants

Safety & Fire-detection Eng.

2

Heat Control Engineer

2

Drivers

10

All Other Personnel

Cooks & Meal Distributors

20

Exc. outsourcing

Total

500

 

* Increase of staff :

 

Key staff will be recruited through internal training and education. Others will be employed by open appointment.

 

 

2.5. The Creation of New Facility

 

One of the most vital resources available to WROMSC staff and patients, and to the community at large, is the built environment. Its quality contributed fundamentally to the capacity of health care professionals and researchers to carry out their work. Hospital buildings are net neutral environments.

 

When well designed, they contribute significantly to positive health outcomes and productive use of other resources such as time, money and equipment. The mandate will include assessing the functionality of specific clinical areas, and comparing the hospitals against best practice in construction of new facilities. We will assess the ability of the facilities to support the mission of the WROMSC functionally over the coming years, and to ensure that it remain equal to the best of its peer group for several decades. To carry out such an assessment, a sample of approximately 37 functional areas would be assessed.

 

The results would then be considered in the light of the results of the planning processes for patient services and research, and the appropriate decisions taken. The main objective of this study was to evaluate the technical and functional characteristics of the project as to how it compares against an anticipated new model for 21stcentury health care facilities.

 

It is important op note that the time frame and budget for this were necessarily limited. The functional evaluation focused on 37 departments in each facility. These generally included Intensive Care(neurological, coronary, surgical and medical), Therapeutic Services(operating rooms, hemodialysis and endoscopy), Diagnostic Services(radiology, nuclear medicine, ultrasound & neurophysiology and clinical laboratories), Ambulatory Services(trauma, medical & surgical emergency and day surgery), a typical patient care unit and Support Services(pharmacy, sterilization and distribution systems). Overall, these functional areas occupy about one-third of the overall area of the facilities. Other areas were not assessed within the mandate of this study. This new facility concepts for future health model are focused on creation a facility environment that is easily accessed, human in scale, genuinely addresses the needs of the patients and families, accommodates the special concerns of caregivers, and integrates the activities of clinical research with patient care. Creation of a healing environment that recognizes the connection between the mind of the patient and the body's response to treatment is fundamental to these new concepts. These future facilities will, as a tool for healing, augment the caregiver's effectiveness in treating patients. Facilities that have the appropriate functional adjacencies, that promote and enhance communication, and that are adaptable to future needs are essential components of a more cost effective and affordable health system. Construction costs are estimated at $131 million, which represents direct construction costs only. This cost did not take into account taxes, indirect costs, medical equipment, furnishings or other devices.

 

 

As shown in AppendixⅢ.

 

Medical Equipment, the project amount includes approximately $112.5 million for equipment ;

however, this will require further assessment, and may need to be adjusted upward. Also not included are costs related to information systems, which could be large but are difficult to assess at this time and will depend to some extent on infrastructure decisions taken by the Board.

As presented in this feasibility study, the following features would characterize the envisioned new facility :

 

● Functional efficiency ;

     or the ability to achieve appropriate relationships between the major components of the complex.

 

● Ambiance / human scale ;

     This relates to the sense of proportion that supports good psychological and emotional integration of persons into the environment, and provides a secure sense of orientation for users and visitors.

 

● Flexibility ;

     This refers to the easy and economical adaptation of space to changing needs after the building is completed.

 

● Ease of access ;

     This is achieved not only by direct access to a metro station, buses and roadways, but also good spatial organization to achieve clear segregation between different categories of traffic.

 

● Ease of Phasing ;

     This refers to how well the site lends itself to phasing of construction.

 

● Access to daylight ;

     Essential in a true healing environment, daylight is introduced through windows, atria, and open courtyards ; large floor plates are to be avoided.

 

● Landscaped grounds ;

     The effects of pleasant views of nature on health outcomes have been well documented and form part of all new hospital design.

 

● Cost effectiveness ;

 

WROMSC buildings must incorporate appropriate infra-Structures for cost-efficient operation.

In selecting a site for a general hospital, the pertinent criteria relate not only to location and accessibility, but also to the architectural qualities of the envisioned facility. In terms of size, the appropriate site between 10,000 to 13,000 square meters was considered, although larger sites were preferred, for architectural considerations.