Q&A: Penn Medicine Senior Leader on the Pavilion Project

Innovation in health care recently sat down with John P. Donohue, Vice President of Entity Services at Penn Medicine, to follow up on his featured provider with Editor-in-Chief Mark Hagland from our Northeast Summit on Thursday, June 16, 2022 – Friday, June 17, 2022, in Boston, Massachusetts. The spotlight was on Donohue’s work around the Pavilion project and the strides being made at Penn Medicine to position itself for the future.

According to Penn Medicine website, “The Pavilion has been one of the largest ongoing hospital projects in the United States and the largest capital project in the history of the University of Pennsylvania. 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 is entirely focused on patient care. The design draws on the expertise of Penn Medicine’s own clinical experts, as well as architecture, design, and construction professionals who specialize in healthcare. The end result is the culmination of years of meticulous thought, collaboration, and research on how to organize clinical care spaces so that they are effective for the needs of both clinicians and patients.”

How did the Penn Medicine Pavilion start?

The Pavilion as a concept began more than 10 years ago. We have an aging building infrastructure, most of our buildings are over 100 years old, and as we try to create a much more hospitality-based patient experience; we knew 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 in that space probably six years ago, and then we started construction. This was the largest concrete pour in Philadelphia history, one and a half million square feet or a $1.6 billion project before patient rooms, 47 operating rooms, cutting-edge technology in the operating room, technology tip to bedside in patient rooms, so they can heal 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 a kind of career project [for me]. I was involved with the project for about seven years before we opened. So, I had the opportunity to be at the kick-off meeting years ago and walked us through this selection of integrated project delivery approach. I experienced the team building itself, the opening up of the ground, and the way we collaboratively made decisions about what was right for the building. In fact, we built a Styrofoam model of half the building at the beginning of the project.

Two headwinds we faced on this particular project were significant. One was the COVID hit. One day we have 700 people working on the site, and the next day, we don’t have anyone working on the site because we had to shut it down pretty quickly. We fixed that though, got permission to continue construction, put some tools in to protect our people, but it was a sure headwind.

The second headwind for us was supply chain issues. In the year just before we opened, it became very difficult to get some of the devices we were looking to put into the Pavilion, but overall I think the lessons learned were the power of the team and the ability to harness that. The other [lesson] is that we tend to work in collaboration with our operational counterparts, there are not many accusations. If we run into an information services issue, our operational people step in and help us get through it. When there is an operational problem, [information services] intervenes and helps to overcome it. I think those were the two things that were lessons learned.

Adding a third party, when you’re building something like this, which is brand new, state of the art, sometimes it’s a temptation to over-design certain things, and we were guilty of that. We probably over-engineered our elevator operations, we over-engineered our Wi-Fi locks, and at the end of the day, we’ve been rolling back some of that engineering, so that’s bound to be a lesson learned.

What was the most rewarding thing about working on this project?

Two things catch my attention: one is the ability to be innovative. We had never done work like this on this kind of scale, and we had some people on our team who 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 cool stuff with prefab and out-of-the-box thinking that served us incredibly well.

The second rewarding thing for me was the morning we opened: we moved 400 patients from our legacy facility to the new facility and every one of those patients was accompanied by a care team. I saw them cross in this wobbly, orchestrated way, and it was really gratifying to see the looks on their faces. They knew they were moving to a special place. There were balloons installed and reception people, it was very exciting to see. Ultimately, all of this work turned into something that impacted people in our community. And that was very powerful for me.

What distinguishes Penn Medicine from other organizations that have undertaken a project of this magnitude?

First of all, our culture. Our culture is one of consensus and that really makes us a bit different than most organizations I’ve talked to or worked with. We’ve worked really hard to make sure that before we make a decision, we have a consensus on that decision, a lot of that is for our governance committees, and to make sure that we really talk to all the key stakeholders.

Second, it is a commitment to excellence. When we do things, we make sure we do them right.

And the third is a commitment to what we said we were going to do. So when we open, we open 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 to 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 them. I think that also makes us a bit different from others.

What’s next for Penn Medicine?

Now, we’re focusing on what we’re calling “day two innovations” at the Pavilion: how do we begin to consider taking what we’ve done and building on it to stay ahead of the curve? We have voice activation in the rooms and we continue to get feedback from our patients on what we could be doing better. I’d say those day-to-day innovations, where we don’t sit around saying, “Hey, we’re done, good job.” We continually stay focused on the next generation of technologies, making sure we put them into play; Linked to that are things like home hospital and home care work and expanding our outpatient community reach. Those are some of the things that we have in mind right now in terms of priorities.

What trends have you seen in the patient feedback you mentioned?

The patient’s ability to cure their room to their own needs, be it temperature, lighting, communications, entertainment, and the like. It has clearly been well received. But what we’re finding is that occasionally we have patients, and some of our transplant patients, who are in very difficult circumstances and who want something beyond what they get through standard delivery. Twice in the last few months we have been able to deliver. Both times were on the weekend, we had a patient with a special request who was trying to recover from a complex acute surgery, and we were able, through the dedication of our team and the creativity of our team, to really provide him with what he needed. it was what they were looking for, to make their experience a little easier for them and their families.

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