For many people living in rural areas, access to quality medical care is limited due to a lack of health care professionals practicing in these regions. In the state of Oklahoma, for instance, approximately one-third of its citizens live in federally designated Health Professional Shortage Areas, which is where physician shortages are most concerning in the U.S.
Fortunately, higher education institutions such as Oklahoma State University (OSU) are working to solve this dilemma. In addition to actively recruiting and training medical students who plan to serve rural and medically underserved communities, last year, the university’s College of Osteopathic Medicine (OSU-COM) opened its new A.R. and Marylouise Tandy Medical Academic Building in Tulsa to bolster medical education and community outreach initiatives.
This $40 million, state-of-the-art development supports hands-on instruction and training within OSU-COM, one of five schools that comprise the university’s Center for Health Sciences (OSU-CHS) program.
Flintco, LLC, based in Tulsa, Oklahoma, served as construction manager on the project, which broke ground in October 2015 and took 20 months to complete. Motivated by the facility’s mission, over 150 donors gave more than $11 million to support construction efforts. The building opened in time to receive students for the 2017-18 academic year and will help to accommodate OSU’s increased medical school enrollment.
Flexible Spaces Enhance Educational Experiences
The A.R. and Marylouise Tandy Medical Academic Building facilitates training, educational programs and camps for thousands of medical residents, nurses, emergency services personnel and other health care professionals from across Oklahoma, as well as students from public, private and charter schools.
Designed by members of the Tulsa office at Dewberry, a national architecture firm, the four-story, 84,000-square-foot structure features the largest, most advanced hospital simulation center in the state, occupying 20,000 square feet and housing four simulation suites for intensive care, birthing, trauma and surgery. The flexible configuration of the suites allows for setup, control, simulation, observation and reporting for a variety of medical applications.
Each suite is equipped with audio-visual recording technology to provide feedback on simulation activities. These spaces also contain high-functioning, programmable simulation manikins that can speak, perspire, blink, breathe, bleed and even give simulated birth. Additionally, students have access to computer programs enabling them to conduct robotic surgeries.
“We visited National Board of Osteopathic Medical Examiners facilities in Pennsylvania to get a clear picture of spaces that OSU’s students would eventually encounter when it’s time to take their exams for licensure as osteopathic physicians, and designed simulated clinic exam rooms to promote familiarity with these tests,” says David Huey, President of Dewberry and Principal-in-Charge of the project.
Jonathan Crump, National Director of Design at Dewberry, explains that traditional medical simulation models work well for nurses and practicing doctors. However, in an academic setting, learning opportunities are optimized when spaces are arranged to allow multiple activities to transpire simultaneously.
Designing a Regional Icon
Positioned on the northwest end of OSU-CHS, the A.R. and Marylouise Tandy Medical Academic Building stands next to U.S. Highway 75, a high-traffic corridor elevated two stories above ground and checkered with billboard displays. The location created a marketing opportunity in terms of maintaining brand awareness for the university. To increase exposure, the construction team wrapped the second, third and fourth stories of the building’s exterior in eye-catching metal panels colored in “America’s Brightest Orange.”
While the vibrant façade was successful in capturing people’s attention, engineers hit a snag when it came time to install equipment on the rooftop.
“The elevated freeway views of the building did not allow for any roof-mounted equipment or penetrations,” says Robert Schatz, PE, a Mechanical Engineer at Lee & Browne Consulting Engineers, Inc., located in Tulsa. “This was overcome by making all mechanical penetrations through the sidewall and locating all mechanical equipment within the building or on the ground.”
The proper design of mechanical, electrical and plumbing (MEP) systems in medical facilities is governed by many health care regulations and technical requirements. As such, having an extensive background in medical facility design can be helpful, notes Matthew Gordon, PE, Principal Electrical Engineer at Lee & Browne.
“Knowing the electrical systems, connections and issues as dictated by experienced surgeons, doctors and other health care providers allowed us to suggest and design the appropriate systems,” Gordon says. Schatz concurs, adding, “Our firm’s experience with central plant design, hydronic distribution and air-handler mechanical room layout proved invaluable on this project.”
Another hitch involved major utilities located next to the project site. “The cost of relocating the utilities for a building addition was close to the cost of a proposed elevated pedestrian walkway to a separate building,” explains Crump.
To avoid disrupting the use of existing facilities, the team decided to link together campus buildings with a second-story pedestrian bridge as a bid alternate. Value-engineering enabled the project to come in about $5 million below the schematic design estimate including the alternate, says Crump.
The client considered nearly a dozen bridge design proposals before choosing a medical-inspired concept that cleverly emulates the curvilinear form of vertebra. The segmented elements of the 128-foot-long pathway are engineered for structural efficiency, just as vertebra form segments of the spine.
The building’s interior anatomy is just as intriguing as its architecturally stunning exterior. The first floor houses a hospital simulation center and a tiered lecture hall, while the second floor contains a clinical simulation center and a clinical skills lab. The third floor supports instruction in osteopathic manipulative medicine and the fourth floor features a 3,185-square-foot conference center with a tiered lecture hall and two outdoor terraces.
“There are break-out spaces throughout the building including conference rooms, classrooms and informal spaces within the corridors,” says Crump. “The simulation and active learning programs rely on small-group dynamics and the building was designed to support over 35 break-out groups following the first- and second-year lecture series.”
A+ Project Solutions
Completing a major construction project on an occupied college campus presents a unique set of challenges. Since the academic medical building was destined for the university’s main parking area, temporary parking lots had to be placed quickly for faculty and students to use. Flintco successfully minimized disruptions to the education process by scheduling many construction activities during students’ off hours.
The locale also proved problematic when it came time to install foundational piers, as the campus’ proximity to the Arkansas River complicated structural stability.
“There was significant groundwater and the amount was unpredictable,” says Flintco Project Director Brett Venable. “We utilized cased piers to minimize the water infiltration before concrete placement. Overall this approach was successful, but in some cases we had to use double-cased piers and, in rare instances, we left the casing in place with the pier.”
When the project team discovered several abandoned utilities beneath the construction site, action had to be taken to identify and, in some instances, remove the lines. In addition, medium-voltage underground feeders in the area were found to be undersized and antiquated. Consequently, the utility provider reconfigured its electrical service layout for added redundancy to campus buildings.
Building a Healthier Oklahoma
Undoubtedly, the cutting-edge, intuitive design of the A.R. and Marylouise Tandy Medical Academic Building will serve to elevate the experiences and perceptions of osteopathic students for generations to come. And, hopefully, this new learning space will bolster the university’s mission to attract physicians to Oklahoma’s rural and medically underserved communities.
“The current doctors-in-training are proud to have such a sophisticated facility and are enthusiastically embracing the hands-on learning experiences,” says Pam Taylor, Marketing Pursuit Manager at Dewberry.
Flintco Central Region President Dave Kollmann adds, “The A.R. and Marylouise Tandy Medical Academic Building is a project that makes me proud. Our company’s longstanding partnerships with OSU and other project team members speaks to the success and value this education facility brings to Tulsa.”
Huey concludes: “Working with the university to develop solutions that will help address the shortage of doctors and access to health care in rural Oklahoma was a rewarding task that instilled pride within the entire team. This building offers technology-rich simulation and academic spaces that drive the group dynamics of the program’s new curriculum and will help OSU-CHS achieve its goals.”
Physician Shortages Linked to Higher Mortality Rates in Rural Areas
For nearly three decades, the United Health Foundation (UHF) has identified Oklahoma as one of the unhealthiest states in the nation. The state’s ongoing shortage of primary care physicians limits people’s access to general care and preventative services. According to UHF’s 2017 America’s Health Rankings Annual Report, Oklahoma has close to 130 primary care physicians for every 100,000 people.
A 2017 Centers for Disease Control and Prevention report on physician shortages in rural areas noted higher rates of death due to heart disease, respiratory disease and stroke compared with people in urban areas. Additionally, a ZIP code analysis of major metropolitan areas in Oklahoma found that people in the same city can have life expectancies that differ by as much as 14 years.
Although many factors contribute to these troubling statistics, the common denominator is that Oklahoma needs more primary care physicians to ensure better quality of life for all.
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