Healthcare Innovation recently sat down to speak with John P. Donohue, vice president of entity services at Penn Medicine, to follow up on his provider spotlight with Editor-in-Chief Mark Hagland from our Northeast Summit that took place Thursday, June 16, 2022 - Friday, June 17, 2022, in Boston, Mass. The spotlight focused on Donohue’s work surrounding the Pavilion project and the advances being made at Penn Medicine to position itself for the future.
According to the Penn Medicine website, “The Pavilion has been one of the largest hospital projects underway in the United States and the largest capital project in the University of Pennsylvania's history. The building itself is a massive 1.5-million-square-foot, 17-story facility with 504 private patient rooms and 47 operating rooms. However, what makes it so unique is its design, which centers entirely around patient care. The design relies on the expertise of Penn Medicine's own clinical experts as well as architecture, design, and construction professionals who specialize in health care. The end result is a culmination of years of meticulous thought, collaboration, and research about how to organize clinical care spaces to be effective for both clinicians' and patients' needs.”
How did the Pavilion at Penn Medicine get started?
The Pavilion as a concept started over 10 years ago. We have an aging building infrastructure—most of our buildings are over 100 years old—and as we tried to create a patient experience that's much more hospitality based; we knew that we would have to do something. Conceptually, this probably started about 10 years ago. I think the initial project estimates and board approvals were probably seven, maybe eight years ago, we demolished a hotel that was on that footprint, probably six years ago, and then began the construction. This was the largest concrete pour in the history of Philadelphia, a million and a half square feet or a $1.6 billion project before patient rooms, 47 operating rooms, state of the art technology in the operating room, state of the art technology at the bedside in the patient rooms, such that they can curate their experience while they're with us.
What did you learn working on this project? What were some challenges and what were some lessons learned?
It was an exciting project; it was sort of a career type project [for me]. I had been engaged on the project for about seven years before we opened. So, I got a chance to be at the initial kickoff meeting years ago and saw us all the way through this selection of integrated project delivery approach. I experienced the building of the team itself, the breaking of the ground, and the way that we made decisions in a collaborative manner about what was right for the building. We actually built out a Styrofoam model of one half of the building early on in the project.
Two headwinds we faced in this particular project were significant. One was COVID hitting. One day we've got 700 people working on the site, and the next day, we have nobody working on the site because we had to shut it down pretty quickly. However, we worked through that, got permission to continue construction, put some tools in place to protect our people, but it was a headwind for sure.
The second headwind for us was supply chain issues. In the year right before we were opening up, it became very difficult to get some of the devices that we were looking to put in the Pavilion, but overall, I think the lessons learned were the power of team and the ability to leverage that. The other one [lesson] is that we tend to work very collaboratively with our operational counterparts, there's not a lot of finger pointing. If we run into an issue that's an information services issue, our operational folks chip in and help us overcome it. When there's an operational issue, we [information services] chip in and help overcome it. I think those were the two things that were lessons learned.
Adding a third, when you're building something like this, that's brand new, state of the art, it's sometimes a temptation to overengineer certain things, and we were guilty of that. We probably overengineered the elevator operations, we overengineered our Wi-Fi locks, and at the end of the day we have been backing off some of that engineering, so it'll be a lesson learned for sure.
What was the most rewarding part of working on this project?
Two things jump out at me—one is the ability to be innovative. We had never done work like this at this kind of scale, and we had some folks on our team that were incredibly innovative. The doors were wide open for them to do things differently. We really challenged ourselves and said, “The old way we used to do it doesn't necessarily make sense at this scale.” We did some very cool things with prefabrication and thinking outside the box that served us incredibly well.
The second rewarding thing for me was on the morning that we opened—we moved 400 patients from our legacy facility to the new facility and each one of those patients was accompanied by a care team. I watched them come across in this staggered, sort of orchestrated manner, and it was really rewarding to see the looks on their faces. They knew they were moving into someplace special. There were balloons set up and reception people, it was very exciting to see. Finally, all this work turned into something that impacted people in our community. And that was very powerful for me.
What sets Penn Medicine apart from other organizations who have done a project of this magnitude?
Firstly, our culture. Our culture is one of consensus and that really makes us a little bit different than most organizations I've ever talked to or worked with. We've worked very hard to make sure that before we make a decision, we've got consensus around that decision—a lot of that is to our governance committees and making sure that we really talked to all the key stakeholders.
Secondly, it's a commitment to excellence. When we do things, we make sure that we do them right.
And then third is a commitment to what we said we were going to do. So when we opened, we opened on time and on budget, despite some of those headwinds that I talked about earlier. And that's organizational commitment—you said you were going do it, now do it. We could easily have said we need another two months, we need another six months, but we felt very compelled to open our doors exactly when we said we were going to open our doors. I think that makes us a little bit different than others as well.
What’s next for Penn Medicine?
Now, we're focused on what we call “day two innovations” at the Pavilion—how do we begin to look at taking what we did and building on it to stay ahead? We have voice activation in the rooms and are continuing to take feedback from our patients on what we could be doing better. I would say those day-to-day innovations, where we're not sort of sitting back saying, “Hey, we're done, good job.” We continually stay focused on the next generation of technologies, making sure that we put those into play—tied to that are things like hospital at home and the home care work and expanding our outpatient community reach. Those are some of the things that are top of mind for us right now in priorities.
What trends have you seen in the patient feedback you mentioned?
The ability of the patient to curate their room to their own needs, whether it be temperature, lightning, communications, entertainment, and things like that. It's clearly been well received. But what we're finding is we occasionally have patients, and some of our transplant patients, that are under very difficult circumstances who want something above and beyond what they get through standard delivery. Twice now in the past couple of months we've been able to deliver. Both times were on the weekend, we had a patient with a special request trying to recover from some complex acute surgery, and we were able to, through the dedication of our team and the creativity of our team, to really deliver on you what it was that they were looking for, so that their experience could be a little bit easier on them and their families.