June 2021 - BWBR

Maintaining Design Integrity, Fire Safety with Performance-Based Egress Solutions

Posted on June 30, 2021November 19, 2023 by ui-lawson

Got egress challenges? Fire code woes? These issues can have a big impact on project design and success, whether new construction or renovation. The existing components of a building used for one purpose might simply not be up to code for another.

The good news is that performance-based approaches to egress can offer more flexibility and value, as well as help teams strike a balance between safety and fidelity within an architect’s design for a project.

As a former firefighter and EMT, April Musser, PE, CFPS, has more than 17 years of experience as a fire protection engineer and a regional practice leader of fire protection engineering at Telgian Engineering and Consulting. She has presented at numerous conferences and frequently authors articles about building fires and their impact on fire and building codes.

Roger “Lars” Larson, AIA, brings more than 32 years of experience as a licensed architect and code analyst with BWBR to the conversation. He’s a true thought leader, whose deep knowledge is sought within policy and regulatory communities as well as across myriad project types, from health care to high tech, and HAZMAT to industrial.

For Musser, the critical role codes play was brought to life at an AIA event where three architecture firms reviewed a number of adaptive reuse projects, the struggles they encountered, and how they were resolved. All three teams noted how the change of occupancy meant the egress was inadequate, and in one case, it resulted in a complete redesign of part of the structure.

After the presentation, Musser asked each team if they’d considered using a performance-based egress approach instead of the prescriptive code. Their response was somewhat comical. “All of them looked at me like I had grown another head. None of them knew what I was talking about,” she said. “So I recognized that there was a huge need for our architecture teammates to really understand what these options are, so that we can help them resolve these problems at lower cost and maintain their client’s vision.”

But first, what is the difference between “prescriptive” and “performance-based” code approaches?

Musser explained that prescriptive code sets forth a minimum or intended level of protection, plus a method to reach it. But that’s not the only way to get there. She said, “A performance-based approach is when you boil down that intent, and you come up with some sort of alternate means to meet that intent, and provide an equivalent or better level of protection through some sort of alternative method.” Known and broadly condoned by international regulatory bodies as “alternative means and methods,” it’s basically finding a different route — sometimes a better route — to the same solution.

Prescriptive code requirements are based on years of extensive data about how humans move through and respond to fires. Codes such as maximum occupancy, the required width and number of exits, and limiting travel distance and dead-end corridors are all based on this analysis. The goal being, of course, to ensure that people can get out of the building as quickly as possible.

The Power of Fire Modeling

A performance-based approach involves comparing the available safe egress time before a building becomes untenable (the Available Safe Egress Time [ASET]) with what’s required to safely exit (the Required Safe Egress Time [RSET]). Both can be determined through fire modeling that goes beyond the criteria for tenability.

The team analyzes not only the size and location of the fire, but also smoke production and how the smoke layer develops, toxic products of combustion, oxygen concentrations, and visibility, which is often the first tenability criteria to fail. It even accounts for the time it takes occupants of a specific building type — whether a night club where inebriation is in play, or an assisted living facility where dementia could complicate matters — to detect a fire and make the decision to leave the building.

Proving that an approach is valid and getting buy-in from the authority with jurisdiction requires the ability to not just tell, but truly show performance in a real-world (but often worst-case) scenario.

Telgian Engineering and Consulting leverages fire dynamics simulator software to produce a visual rendering for authorities like fire marshals. The software also has the option to show the simulation in a 3D model video, which is extremely powerful.

“[Authorities] can watch how the temperature changes in the compartment. They can watch how the products of toxic products of combustion build up. They can watch the oxygen concentrations, the temperature, and heat-release rates. They can even watch how the visibility declines.”
April Musser, PE, CFPS, Telgian Engineering & Consulting

Larson reinforced the notion that fire modeling not only adjusts for the nuances of different people and places, but also helps bridge the gap between the many disciplines — and the related points of view — that authorities like fire marshals may be coming from, whether it’s the trades or a past life in firefighting. He said, “The firefighters go, ‘Ah, that’s not what happens. No.’ And they can speak for it. Because they see the fire. They’ve experienced the heat. They’ve experienced erratic behavior by some people.” He continued, “But when you show a movie to them, they are going to go, ‘This is really interesting.’ …They’re the ones you have to get to.”

Musser agreed. “You don’t want to make assumptions, and then bring it to the fire marshal with the results. And then they disagree with your assumptions. So I always tell people, the first step is we’re going to sit down with code officials, we’re going to show them how the process works, we’re going to go through our assumptions with them, we’re going to get their buy-in there… You know, you don’t want to put the cart before the horse. And this is one where it’s super important to get those code officials involved from the beginning.”

There are seemingly endless cases for using the performance-based approach. One team designed an atrium with geometry that was proven through fire modeling to allow smoke exhaust to be completely removed by smaller fans that require less energy from emergency generators. Another team designed a museum-turned-event-space with an egress that was based on it only being used as a museum. Each design team will study the modifications needed and help the owner make sound decisions about a safe and cost-effective way forward.

Top Tips for Performance-Based Success

Musser acknowledged the limitations of the performance-based approach and offered insights on how to surmount them.

Get a team that’s very familiar with performance-based design. They’ll think outside of the typical scenario when choosing a design fire to model with, and they’ll consider every detail.
Be prepared to answer all questions from Authorities Having Jurisdiction (AHJ). Every project needs AHJ buy-in, and AHJ will have a lot of questions, especially if it’s a building type that they’re not familiar with reviewing or approving. Be ready to explain how the models work, the inputs, variables, and constants. Help them see how it’s safe.
Start performance-based design early in the concept and understand the timing and costs. While small models can run relatively quickly, some larger and more complex models can run for up to three weeks. It’s an iterative process that takes time. It also comes with a higher up-front cost, but a good partner should help clients do an initial assessment and help them understand whether or not this up-front cost is likely to pay off.
Understand that there’s no guarantee of results — but true expertise can get you close. While a firm can give clients a good idea of whether or not their performance-based approach is going to fit the bill, results are never guaranteed. There’s no way to know with certainty that the AHJ will accept it. However, there are steps you can take to get a realistic picture, and along with enlisting an expert partner, involving code officials from step one is always a great idea.

New Leadership Roles at BWBR

Posted on June 16, 2021November 29, 2023 by ui-lawson

BWBR is pleased to announce Jason Nordling, AIA, as the firm’s newest director and Tricia Eiswald, SHRM-SCP, as BWBR’s newest principal.

Nordling is a principal at BWBR whose career at the firm spans nearly 20 years. He was recently elected to BWBR’s board of directors and he joins the six-person board six years after he was named principal at the firm.

Eiswald, BWBR’s Human Resources Director, was recently named a principal in recognition of extraordinary leadership with the firm. She joins a leadership team of 21 principals.

An employee-owned firm with nearly 45% of staff being shareholders, BWBR is one of the largest and oldest professional services firms in the region providing architectural, interior design, and facility advisory services.

Joining BWBR in 2002 as a project manager, Nordling is shaped by his passion for serving the wellbeing of others through exceptional care environments. Combining his architectural experience with his rural community upbringing, Nordling approaches each design through a pragmatic and human-centered lens while aspiring to build long-term client relationships. He is a graduate of North Dakota State University and Concordia College.

Eiswald joined BWBR in 2019 as the firm’s first Human Resources Director, bringing strategic experience for staff development, recruiting, talent management, and the employee experience. With involvement on multiple BWBR committees, such as the Equity Task Force, Investment Committee, Operations Committee, and the Leadership Council, Her insight and leadership are positively impacting every aspect of the organization. Eiswald is a graduate of Bethel University and is a Society of Human Resource Management Senior Certified Professional.

Preparing Healthcare for Site-of-Care Shifts

Posted on June 15, 2021December 27, 2023 by ui-lawson

Stakeholders across the healthcare industry are thinking about site-of-care shifts. Which services are likely to look completely different in the not-so-distant future? What are the driving forces and indicators? And how can healthcare providers and organizations prepare for clinical services to move away from the hospital and into settings like ambulatory surgery centers (ASCs) to meet the demands of the evolving outpatient landscape?

This is our bold new reality, as described by the Advisory Board’s Megan Director. With a patient journey that can more often leave the hospital out of the picture for everything but acute care, the Advisory Board forecasted a nearly 3% decrease in five-year inpatient growth projection, and an almost 13% increase in outpatient growth forecast for 2020-2025.

Now is the time to reimagine care delivery outside the walls of a hospital, and to proactively adjust strategic, operational, and financial plans to seize the opportunities presented by the “next normal.”

The Ambulatory Care Landscape in 2021

According to Director, “The fact is more services are being provided that do not require the overnight stay and acute care of a hospital.” We’re at the intersection of regulatory and payer pressure — all of which have only been compounded by the pandemic — resulting in the desire among payers, patients, and providers to avoid the hospital at all costs.

Patients and providers are getting more comfortable with non-hospital settings, and the obvious benefits don’t hurt. Along with lowered risk for contracting COVID-19 and other diseases, lower copays and increased access are attractive for patients. Physicians see the business opportunities of freestanding sites of care and are adjusting their planned capital expenditures accordingly. Furthermore, hospitals benefit from having higher capacity for those truly higher-acuity procedures that are best performed on-site.

Four Site-of-Care Shifts to Watch Now

1. Diagnostics and non-invasive services are moving off-campus.

There is a sense that many programs for low-acuity diagnostic services have “gotten a bit too comfortable on campus,” according to Director. This is due to the higher reimbursement rates and the logistical convenience of managing most patients and services at one site. However, from the patient experience standpoint, the hospital setting comes with higher copays, longer wait times, and inconveniences like transport and parking. Providers are trying to identify services that can take place off-campus where appropriate.

Then there’s the small matter of reimbursement. Per CMS’s site-neutral payment policy, which Director describes as “a thorn in the side of many health systems,” she says, “If a hospital has an HOPD or hospital outpatient department that is further than 250 yards from the hospital building, and it was built or acquired after November 1 of 2015, then they will only be paid 40% of the traditional hospital outpatient payment rate.”

Purchasers are also steering way from higher-cost providers. For health plans, this could mean denied authorizations for on-campus imaging services like CT and MRI that could have safely taken place elsewhere.

Further, there’s the looming presence of intense competitors who are keen on owning more of the healthcare continuum, including some purveyors of what Director calls “ultimate convenience,” or primary care that offers minimal copays but maximum accessibility.

Innovative retail clinics like Walmart, CVS, and Amazon are not just setting patient expectations for convenient, non-hospital care. They’re also expanding their services like chronic care management to directly compete with hospital business.

Director says hospitals and health systems should position themselves to be “meeting and matching” these competitors, particularly freestanding care locations. And they should think about the pricing and accessibility of diagnostic services from the standpoint of patients-turned-consumers who are increasingly price shopping to find the best deal.

2. Procedures are shifting to ASCs and office-based labs.

For physicians, ASCs are an increasingly attractive prospect due to ownership opportunities, payer incentives, and higher throughput and patient volume resulting from higher operational efficiency.

For patients, ASCs offer significantly lower copays and out-of-pocket responsibility for the same procedure, along with convenient access and parking, appointment availability and ease of scheduling, minimal wait time, and less risk than the hospital setting of exposure to COVID-19.

There are two service lines in particular that are seeing a lot of activity and interest from an ASC standpoint. Because CMS has approved total hip and knee replacement in an ASC, freestanding orthopedic settings stand to capture more of the market. With the 2019 CMS approval of diagnostic cardio-vascular caths, patient and provider demand for these lower-cost facilities is ramping up.

3. Home-based delivery of acute and post-acute care is on the rise.

While the stay-at-home trend for both acute and post-acute care was well underway pre-COVID, the pandemic certainly added fuel to the fire. There is now a long list of services spanning the care continuum that have the potential to shift to the home. However, there are a range of practical and regulatory constraints that we must contend with — especially for those receiving home-based senior care — including clinical limitations like multiple comorbidities requiring high-licensure staff. There are personal and environmental challenges that make home care infeasible for some, and there’s still a lack of reimbursement, especially for some services that go beyond acute provider care into long-term care management.

4. Outpatient care is being delivered virtually.

One bright spot of the pandemic was how quickly policymakers moved and the healthcare ecosystem responded to give more patients access to care via telehealth. The technology has value far beyond primary care visits, such as provider-to-provider consultations, training, or a specialist paying a virtual visit t in a rural or underserved area.

Director urges health systems to start asking themselves how telehealth might help solve problems, how it could support the larger strategic aims as a business, and to explore how it can be used to support many different service lines and system goals. For instance, telehealth can protect and reserve hospital capacity for truly acute services, or to expand patient access to improve care management across the continuum and reduce the total cost of care.

Additionally, Director invites us to ask and answer some hard but necessary questions: “Are we democratizing access bringing care closer to marginalized communities? Are we advancing equity through these services? In fact, our fear is that if we’re not careful, it may do just the opposite.” For those without broadband access, for example, adopting telehealth is a major challenge. So, Director encourages the entire ecosystem to think proactively about how to bridge the digital divide.

Where Imagination Meets Rigor: Tips for Future-Proofing Your Strategy

Even though the ambulatory space is growing overall, some types of facilities have a more positive outlook than others. Naturally, providers are trying to determine the most appropriate use of sites like micro hospitals and freestanding emergency departments. The key is to think a few years ahead — through the nuanced lens of your specific market — about the implications of these trends and their impact on current investments. Here are some of Director’s top recommendations:

Make outpatient payment and regulatory policy an ongoing focus.
Beyond merely staying educated, conduct opportunity analyses and scenario planning exercises, tune into what matters to commercial plans, and anticipate their mechanisms to take advantage of lower-cost sites.
Benchmark your facilities and market to understand your position compared to others in your state and nationally. Look at whether your investments align with forecasted demand.
Evaluate the competitiveness of your ambulatory footprint and your virtual readiness. What are your competitors doing in this space? Are there new market entrants? How do you meet the virtual demands of your consumers?
Ask yourself: If an ASC opened down the road today and started doing procedures, how would we compete? What would our message be to patients and referring physicians? How do we make sure that we are always staying one step ahead of the market?

With these tools, questions, and considerations in hand, healthcare providers and designers can proactively work together to reimagine care delivery outside of hospitals, and, ideally, better serve the people in each community and population.

David Voller, MBA, former senior operational planner, is an experienced facilitator and operations leader with a demonstrated history of producing revenue, reducing operating costs, implementing new systems, developing strategic goals, and building cultures for change through redesigning operations. Prior to BWBR, David had more than 20 years of work at hospitals and health systems, including Mayo Clinic and Gillette Children’s Specialty Healthcare.

Redefining the Special Education Environment

Posted on June 8, 2021November 19, 2023 by ui-lawson

Back in 2013, Hanna Kuehl, CID, LEED AP, Steve Berg, AIA, and the team at BWBR were given a brand-new challenge: to reimagine a special education environment. I had the pleasure of sitting down with them for a behind-the-scenes look at how it all came together.

First came the research. The team reviewed case studies and evidence-based reports to uncover the elements of an ideal special education environment, which proved difficult but left a big opportunity to lead the industry and help set a new standard. They toured existing spaces to gain a deeper understanding of the problems that needed solving. They also held visioning workshops, a highly collaborative process that engaged staff, teachers, administration, and most importantly, students.

“This served as a way for us to really begin the process of identifying what the hopes and dreams of all of these individuals are for a state-of-the-art facility like this,” Berg said. “And also, what are some of the fears and the challenges that they’ve had through working in these environments?”

The team surfaced a wealth of “stories and struggles,” and underwent an “immersion process” that embedded them in the student environment. They wanted to experience firsthand the functionality of the space, and to map out how students transition throughout their day and the hurdles they encounter.

“Ironically, many of the design features are nearly invisible when you step inside one of these school facilities. And that’s frankly OK,” said Berg. “Reducing environmental stimuli is so important for this student population. So, looking at how can we improve the HVAC systems to minimize sound and triggers for students, enhancing the lighting environment — simple things that mean so much and improve the daily lives and educational growth of students. So, we start there.”

The team continued to take important cues from a behavioral health standpoint in featuring not only better ways for students and staff to navigate the physical space, but also to navigate the school day itself.

In addition to an enhanced fire alarm system that uses a calm voice rather than a blaring horn and strobe light, BWBR swapped traditional linear corridors for more meandering pathways. The team placed breakout rooms near classrooms that students can choose to use to self-regulate, read a book, or look at nature.

Even the furniture was chosen for its ability to adapt to the moment. “Depending on the activity that’s supposed to occur, the rooms can take on different attributes,” said Kuehl. “There might need to be desks, there might need to be soft seating. If everything is durable and flexible, it can be interchanged as much as possible.”

Elements like purposeful visual cues in hallways to ease transition times, specialized door locking hardware, and card readers to save staff the trouble of fumbling for keys all made for a safe and easy-to-use facility. Safety is especially crucial for students who sometimes feel out of control in their bodies and experience elopement, which occurs when a student leaves the supervision of their teacher.

Elopement is a familiar concept to me because my son has special needs and attends one of the BWBR-designed schools. My kiddo elopes when he gets upset. This behavior can endanger his safety, so the locks remove that option. My son actually told me that he likes knowing this because it means that elopement is not an option. It gives him a sense of security that he can’t put himself in danger.

A Therapeutic Learning Environment is About More Than Adaptability and Safety — It’s About Belonging

For my son, a truly well-equipped therapeutic learning environment is the difference between isolation and connection. He enjoys being part of something bigger, rather than feeling separated from the rest of the population. His biggest struggle in life is feeling different, which a lot of these kids probably struggle with.

While the BWBR team centered students’ safety and comfort, the needs of their especially caring and devoted teachers and staff were also a big priority. Berg described “a space that is truly dedicated for staff for their self-care.” He said, “Everyone has challenges throughout the day, throughout the week, and to have a safe place to go is so incredibly important. So, simple break rooms and a place to collaborate with your peers is greatly needed. But also, special rooms that are just quiet and a place of respite. So, instead of going to your car to get away from a situation that may have happened, now you have a comfortable place to be, and a safe place to be.”

Elements Repeated, Identities Shaped, and the Future of Design for Special Education

The BWBR team has repeated a number of elements to reiterate their success in therapeutic learning environments, including durable materials that don’t off-gas as much and produce less odor and disruption, access to daylight to stay connected to nature, and an entry sequence that ensures a secure path with proper locking mechanisms.

Perhaps one of the most surprising and inspiring developments carried forward from that first 2013 project was how BWBR helped the school create a sense of identity and pride where there was only stigma. The uniqueness of the school’s nature-based environment was reinforced through images, language, colors, and the names of the spaces. It even morphed into a butterfly mascot and logo.

“We heard stories of many students that needed to go and visit the butterfly every day. That was part of their path, that was part of their journey, that they went and traced it with their fingers, and were able then to start their day and move on.”
Hanna Kuehl

Mascots are traditionally seen in general education settings. The BWBR team saw no reason that a special education community should feel any less proud or connected to an identify than any other school.

“There was one student that was so connected to that and had such a success story in this new environment that his parents got him a letter jacket with the school name on it,” said Kuehl. “And he wore it to school every day with such pride on his face because he found his place, he found his area of success, and was so proud to share that with everyone. And that is just so heartwarming for us to understand that architecture and design can really lead to influencing people’s lives like that.”

My son is proof of that influence. To families like mine, the kind of research, creativity, and compassion that went into the design of his school make all the difference. BWBR closely tracks the policies that govern special education sites, which are thankfully evolving to meet the real-world needs of students, teachers, and staff. For now, research remains key to achieving the shared goal of continuous improvement. Post-occupancy surveys help BWBR understand the elements that best support therapeutic environments and the specialized spaces that make them successful.

The team continues to study how design influences behavior, how teachers use the spaces, and how some of what they’ve learned from special education might help make other environments more functional and inclusive. Kuehl said, “Our hope for the future of this and other environments is just to create a more welcoming and flexible space for all users.”

Month: June 2021