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Metrodora Institute Delivers Care For Neuroimmune Axis Disorders In A Boldly Feminine Setting



Metrodora Institute, West Valley City, Utah

The healthcare journey for those with neuroimmune axis disorders is often a frustrating slog, involving multiple specialists, tedious shuttling between appointments, and frequent dead ends. It’s a journey that Fidji Simo, CEO of Instacart, knows firsthand—and the one that led her to co-found Metrodora Institute just outside of Salt Lake City.

“It took many years and a lot of willpower for me to get an accurate diagnosis after getting symptoms dismissed. Even once I got [a diagnosis], I bounced around between several specialists,” Simo told Utah Business in 2021. “Something was structurally broken in how we care for patients with such conditions.”

Simo partnered with Dr. Laura Pace, a rare disease expert, and James Hemp, an interdisciplinary research scientist, to create Metrodora Institute, a medical and research center designed specifically to diagnose and provide long-term treatment plans for these complex disorders.

Opened in April 2023, Metrodora plans to see approximately 20,000 patients annually. Those patients will have the opportunity to submit biological samples to the facility’s biobank and high-density data repository, allowing for focused research to advance care and, hopefully, accelerate cures.

The 60,000-square-foot facility encompasses the 8th and 9th floors of a multiuse office building surrounded by mountain views. Designed by HGA (Minneapolis) and Denton House (Salt Lake City), the design arm of Arete Collective, the institute integrates high-tech, collaboration-friendly clinical, research, and workspaces within a luxurious, high-touch atmosphere.

Designing to address neuroimmune disorders

Neuroimmune axis disorders are quite complex, triggering dysfunctional interactions across multiple body systems, including the nervous, immune, endocrine, and gastrointestinal systems. Long COVID-19 is one example; others include lupus, irritable bowel syndrome, fibromyalgia, orthostatic tachycardia syndrome (POTS), and migraines.

Metrodora reports that 40 percent of adults live with at least one chronic illness due to dysregulation of the neuroimmune axis. An overwhelming 80 percent of sufferers are women. There are currently no cures.

“These patients have chronic conditions that they don’t have answers for,” says Erin LaBrec, medical planner at HGA. “They’re coming to Metrodora from all across the country in hopes that they can find solutions through multidisciplinary care in one location.”

A visit may last several days, during which the patient will be evaluated and undergo treatment by specialists, the primary care team, and therapists across a wide range of disciplines. At the end of the visit, a comprehensive summary and long-term care plan is shared.

The facility includes three care centers across the two floors. On the 9th floor—where the patient journey begins with the main entry, waiting, and check-in experience—is the Center for Multidisciplinary Medicine (diagnostic tests and services, including an infusion center and whole genome sequencing).

The 8th floor houses the Center for Advanced Interventions (an ambulatory surgery center for gastrointestinal procedures, vascular studies, and pain therapies) and the Center for Health Creation (advanced neurorehabilitation programs integrating physical, occupational, speech, cognitive, respiratory, and nutritional therapies) along with research labs.

Each floor has a waiting area upon exiting the elevators; the ambulatory surgery center has its own dedicated waiting space, as well.

“Between the two levels, all the centers interact flawlessly due to a more open floor plan,” says Matt Dickamore, vice president of creative at Denton House.

Supporting a whole-person care model

Collaboration and transparency are key elements to the whole-person care philosophy and the cultivation of an environment where patients feel truly seen. “Creating opportunities and spaces to collaborate was huge,” LaBrec says.

Adds Dickamore, “We wanted to make sure that after [a physician] meets with a patient, they can walk, like, 10 steps and they’re able to confer with another doctor. It’s all right there.”

For example, the ambulatory surgery center, including endoscopy suites and prep/recovery rooms, is adjacent to the research labs. This creates easy access for practical matters such as transporting samples, but it also facilitates frequent, immediate conversations between staff regarding specific patient care.

A group workspace within the surgery center further supports those collaboration efforts; similar team care areas can be found amid the exam/consultation rooms and therapy spaces. For private phone calls or telehealth needs, the design also includes more intimate drop-in offices just off the team work areas.

Transparency for patients gets a literal translation in the design of the team workspaces.

“The institute founders really wanted patients to feel like they had a visual on their own care,” LaBrec says, “and so the work areas are enclosed in glass. You can see the care team in the surgery center, as well as into the lab, to get a sense of all the innovative research and collaboration happening. It really promotes the care efforts all around you.”

The design aims to support the care team, as well; Dickamore remembers how Pace and Hemp described other medical facilities where “it was like they were coming up out of the grave when they left work.”

The collaborative spaces in Metrodora include windows for natural light, comfortable furniture, decorative light fixtures, and other tangible details to avoid “back of house” vibes.

“Even in the locker room, the staff have beautiful showers. They have beautiful bathrooms,” Dickamore says. “Everything was considered.”

Serving a mostly female clientele

Metrodora Institute goes all in to recognize its mostly female clientele, starting with its namesake, a female Greek physician from 200-400 A.D. who wrote an influential medical text called “On the Diseases and Cures of Women.”

“There’s power in femininity, power in women,” Dickamore says. “[Pace and Hemp] wanted to create a space that was not only different as far as the services they provided, but also different in the way that it feels. For patients who’ve been going from one medical facility to the next for years, we wanted them to walk in and think, ‘This is something new.’”

Curved sofas and lounge chairs with ottomans, gentle lighting, and soft materials set a spa-like tone in the main lobby. Inspired by Pace’s elegant black wardrobe, the interiors team incorporated chic dark tones (including black wallpaper), then offset them with neutral, textured hues. In the lobby, 45 gold-toned pendants hang delicately from the ceiling, designed to look like rose petals blowing in the wind.

Other artwork in the facility tells subtle stories about the history of Utah, the power of collaboration, and hope.

Quarter-curve archways frame the main hallways. Windows are everywhere to maximize the 360-degree views of the Salt Lake Valley, Oquirrh and Wasatch Mountains, and Kennecott Copper Mine while bringing in daylight and helping patients orient themselves.

HGA, Denton House deliver bold design

Teaming up HGA, with its depth and breadth of healthcare design experience, and Denton House, known more for luxury residential and hospitality work, helped Metrodora Institute deliver on its design goals of immersive care and comfort.

“There were a lot of questions back and forth between the two teams,” LaBrec says. “Especially in the surgery center, which has much more stringent requirements. There’s a learning curve: How do you make it feel like it’s not a clinical space but also meet all the guidelines, and address facility and maintenance concerns, too?”

That meant conversations about hiding medical gases and equipment in the prep and recovery rooms, for example, and integrating crash rails and wall protection along corridors for stretcher movement.

Sourcing fabrics and surfaces for healthcare was another learning experience for Denton House, but Dickamore says that post-COVID, the options have opened up.

“We used a lot of natural stone, as well as quartz, which is very cleanable,” he says. “And many fabric mills now have lines that are bleach-cleanable but don’t feel like they are. We were able to dig through our vendors and find bleach-cleanable velvets and chenilles. So, the overall aesthetic is really comfortable and soft.”

Considering the long-term pain, frustration, and disappointment endured by so many people with neuroimmune diseases, Metrodora is hoping that this attention to detail—and dedication to research—will mark a turning point in its patients’ journeys.

Kristin D. Zeit is a contributing editor at Healthcare Design and can be reached at kristinzeit@gmail.com.

Metrodora Institute project details

Completion date: April 2023
Owner: Metrodora Institute
Total building area: 60,000 sq. ft.
Total construction cost: $13.8 million
Cost/sq. ft.: $268
Architect: HGA, Denton House
Interior designer: Denton House
General contractor: Layton Construction
Engineers: Dunn Engineering (structural), EELD (electrical), B&D (MEP and medical gas)
Medical consultant: HGA
Builder: Layton Construction
Art consultant: R Cline Arts, Denton House Design Studio, Sue Barratt
Carpet/flooring: Patcraft, Regency Royale, Masland
Fabric/textiles: Momentum Textiles, Larsen Textiles, Bernhardt Textiles, Herman Miller, Perennials, Brentano, Moore and Giles, Pollack, Three Sheep, Arc Com, Stratford Hall Textiles, Luna Textiles, Tiger Leather, Maxwell Fabrics, Kravet
Surfaces—solid/other: Daltile, Bedrosians, Tile Bar, Crossville, Eleganza Tile, Arizona Tile, Bellezza Ceramic, Schluter, Patcraft, Shaw Contract, Tarkett, Bering, Prosoco

Project details are provided by the design team and not vetted by Healthcare Design.

Improving Nurse Productivity Via Design



Among all the stakeholders who stand to benefit the most from thoughtful design of healthcare spaces, nurses are right near the top, arguably only behind patients. And with nurse turnover at an alarmingly high rate—Healthcare Finance News reported the number at 27.1 percent in January—the healthcare industry is paying close attention to ways to stem that tide.

For National Nurses Week (May 6-12), Healthcare Design reached out to the Nursing Institute for Healthcare Design (NIHD) to discuss some of the pain points affecting nurse efficiency, comfort, and satisfaction in the workplace.

Here, NIHD member Sara Francis, a registered nurse and director of planning, design, and construction for Atrium Health in Charlotte, N.C., identifies three such issues and how good facility design can improve nurse productivity.

Nursing pain point #1: Workflow inefficiency

Nurses do a lot of walking, and facility design plays a big role in just how much. One way healthcare designers can reduce travel distances is by making sure items most frequently used—medication, equipment, and medical supplies deployed in patient rooms—are situated as close as possible to their point of use. Says Francis, this helps “eliminate the hunting and gathering aspect for staff.”

Standardization of patient rooms also contributes to better efficiency for busy nurses. Francis cites same-handed rooms (those in which the bed, bathroom, caregiver space, technology, etc., are in the same layout from room to room) as beneficial.

The use of universal design and having rooms that are adaptable depending on the level of a patient’s acuity are also nurse-friendly design choices.

Nursing pain point #2: Low-performance workspaces

“Support caregiver performance and well-being by increasing daylight, visibility, and collaboration with others,” Francis says. Well-designed on-stage (e.g., nurses’ stations) and off-stage (break rooms) spaces will help nurses create connections with other caregivers, patients, and families.

The off-stage spaces play an important role in supporting nurses and should be treated thoughtfully. “Ensure break rooms have varied seating: high tops, low tops, recliners, plus access to exterior views,” Francis says. “And a separate bathroom from the break room when possible.”

To take caregiver support even further, accessible respite rooms can help stressed-out nurses decompress, rest, and recuperate from difficult situations. Additional options that support holistic health and wellness include outdoor walking paths and comfortable dining areas for staff.

Nursing pain point #3: Safety and security

“With an increase in workplace violence, safety and security are always a top design priority for our teams,” Francis says, stressing the importance of “visibility to patients, family members, visitors, and, most importantly, other staff members should you need assistance.” She adds that open core design has helped tremendously with this.

Technology can also be implemented (and designed for) to enhance safety, Francis says, such as RFID for staff tracking and duress alerts; ability to lock down units; and virtual patient monitoring to minimize the use of 1:1 sitters in patient rooms.

And whatever safety measures are put in place, Francis says, the unit staff must receive “intentional education” to understand those security aspects and exit strategies.

For more on design to support nurses, see the following articles:

How Design Influences Healthcare Staff Burnout

Listen Up: Controlling Noise in Healthcare Spaces

At Bat: Nurses Step up to Design Plate

Photos: Healthcare Design Forum, Park City, Utah



The third annual Healthcare Design Forum took place Sept. 5-7 at the St. Regis Deer Valley in Park City, Utah. Healthcare Design‘s editorial advisory board convened with the 2018 HCD 10 Award winners and other invited professionals from the healthcare industry to discuss key issues, consider new perspectives on design, and enjoy one another’s company in the beautiful mountainside setting. The event was made possible by sponsors Carolina, Kalisher, KI, Kimball Health, Kwalu, MedSpace, Mohawk Group, Paladin Healthcare, Porcelanosa, Shaw Contract, Sunbrella, and Whitehall Manufacturing. For more information about next year’s HCD Forum, contact Publisher Kristin D. Zeit at kristin.zeit@emeraldexpo.com.

August Issue Survey Open to HCD Readers



Healthcare Design has teamed with Harvey Research Inc., an independent research firm, to conduct an online survey of its readers. The survey will take no more than a few minutes of your time, and all respondents who complete the survey will be entered in a drawing for a $100 gift card. Any information you provide will be kept strictly confidential and used only for statistical analysis. To take the survey, click here: August HCD survey.

 

 

 

 

 

 

New England Is Calling



Last year at this time, I was getting pretty excited about our upcoming Healthcare Design Forum. It was our first one, scheduled for early September in Santa Rosa, Calif., the heart of Sonoma wine country. This was something different for Healthcare Design—an exclusive networking and educational event that both went outside the normal scope of CEU-type sessions (covering more off-center topics and unique perspectives) and also dug deeply into issues at the heart of what healthcare designers face every day. It was designed to be intimate and reasonably paced, a lively and thoughtful mix of conversation and inspiration and fun. Also: wine tasting. And vineyard tours.

Six months in advance I visited the venue, toured the potential sites for the HCD 10 Awards dinner (another fun highlight of this new event), and worked with our operations team to shape each day’s agenda. I researched and secured our keynote speakers. The sales team secured our sponsors. We booked all the venues and planned the team-building exercises, opened registration, and signed up our editorial advisory board members—the heart of this endeavor—to attend. And we invited others to apply to attend, as well; as I mentioned, this was to be an exclusive event, centered on high-level healthcare design professionals ready to roll up their sleeves and contribute as much as they’d take away from our two-and-a-half days together.

By July, I was eager—and anxious—to see how it would all play out. And in September, when it finally came, I was not disappointed. Our attendees and sponsors got it immediately. Everything we hoped would come out of the event, did. And everyone said they couldn’t wait to do it again next year.

And here we are! Planning the 2017 Healthcare Design Forum was even more fun this time around, because we had something concrete to build on and great suggestions from those involved. Everything is in place: Sept. 6-8, at the gorgeous Cliff House Resort on the southeastern tip of Maine, our editorial advisory board will once again convene with our generous sponsors and other qualified attendees to learn, play, and be inspired. Also: Lobster. And more wine.

Interested in joining us? You can find all the details—the full agenda, site specifics, etc.—at HCDforum.com. Attendance is by invitation only, so if you’d like to be invited, just send me an email (kristin.zeit@emeraldexpo.com) with your name, title, organization, and a couple of sentences about the role you play in designing healthcare spaces. I’d like to give a special thanks to our HCD Forum sponsors at press time, which make this event possible: KI, Kwalu, Mannington, Mohawk, OFS Brands, Porcelanosa, Shaw Contract, Sunbrella, and Whitehall Manufacturing. We do have a few more sponsorship spots open, as well; contact me for details.

HCD CitySCENE Chicago: Photos



Healthcare Design held its third HCD CitySCENE networking event of 2017 in Chicago on June 13. Design and building professionals from organizations including Advocate Heath Care, AECOM, CallisonRTKL, Cannon Design, Erdman, Gilbane Building Co., HED, HOK, Midwest Health, Mortenson Construction, Perkins+Will, University of Chicago Medicine, and more came together at Drumbar in Chicago. The two-hour event was sponsored by Dupont, Kwalu, Mohawk, and Shaw Contract.

These sponsored events are free for qualified healthcare design professionals to attend (vendors and manufacturers must be sponsors). For more information, go to the Events + Competitions section of the Healthcare Design website. The 2018 HCD CitySCENE event dates and locations will be announced later this year.

HCD CitySCENE Dallas: Photos



Healthcare Design held its second HCD CitySCENE networking event of 2017 in Dallas on May 17. Design and building professionals from organizations including CallisonRTKL, FKP Architects, HDR, HKS, Perkins+Will, Stantec, Hart Gaugler + Associates, Jacobs, and more came together at Quill Kitchen + Cocktails in Dallas. The two-hour event was sponsored by Dupont, Kwalu, Mohawk, and TLC Engineering for Architecture.

Healthcare Design has scheduled one more CitySCENE event for 2017, in Chicago (during NeoCon) at Drumbar from 6-8pm on Tuesday, June 13. These sponsored events are free for qualified healthcare design professionals to attend (vendors and manufacturers must be sponsors). For more information or to request an invitation, go to the Events + Competitions section of the Healthcare Design website.

HCD Hosts First 2017 CitySCENE Event In Nashville



Healthcare Design kicked off its HCD CitySCENE networking events for 2017 in Nashville, Tenn., on March 22. Design and building professionals from organizations including ESa; Gould Turner Group; Skanska; Gresham, Smith and Partners; Southeast Venture; Smith Seckman Reid; and more came together at the Sky Loft space at Sambuca restaurant in Nashville’s trendy Gulch neighborhood. The two-hour event was sponsored by Dupont, Kwalu, Mohawk, OFS Brands, TLC Engineering for Architecture, and Shaw.

Healthcare Design has scheduled two more CitySCENE events for 2017, in Dallas on May 17 and in Chicago (during NeoCon) on June 13. The locations for these events will be announced soon. These sponsored events are free for qualified healthcare design professionals to attend (vendors and manufacturers must be sponsors). For more information or to request an invitation, go to the Events + Competitions section of the Healthcare Design website.

Design That Embraces Everyone, Always



As the March issue went to press, the team behind Healthcare Design and Environments for Aging was simultaneously preparing for the EFA Expo & Conference in Las Vegas (Feb. 26-March 1). As such, the senior population has been on my mind a lot lately—as it should be for everyone who works in designing public spaces.

We talk about the statistics surrounding the aging baby boomer population a lot, so I won’t go into them again here. But indulge me in reminding you that as the segment of senior Americans grows significantly over the next decade, the concept of “environments for aging” will expand well beyond independent and assisted living communities and nursing homes. Every environment needs to be a senior environment, including retail stores, government buildings and corporate offices, and cities and towns.

Of course that means healthcare facilities, too. The older the patient, the more likely she is to have one or more impairments that need accommodation. Now combine that with the proliferation of ambulatory care facilities, which is likely to translate into hospitals largely handling only the highest-acuity cases. You know what group needs the most acute care? Right. Seniors.

But the challenge for all designers is how to meet the needs of this group in a way that still welcomes and embraces people of all ages and abilities. The concept of universal design is a promising start: Championed by architects, product designers, engineers, and environmental design researchers, its goal is design that can be used by “all people, to the greatest extent possible, without adaptation or specialized design,” according to the Center for Universal Design at NC State University in Raleigh, N.C. The point is seamlessness throughout a space rather than a few alternative options here and there.

For healthcare, it means going beyond ADA and building codes and looking at every area from the parking lot through the lobby and all the way through discharge for ways to accommodate (and comfort, and delight) anyone. We’re already on a roll with the inclusion of more natural light—one common universal design principle—wherever we can get it. But wider doorways, no thresholds, clear entries, acoustical controls, and thoughtful furniture and fixture choices can be incorporated much more broadly, whether it’s a massive hospital campus or a small eye care clinic.

Architects and product designers alike have a real opportunity to get creative as they learn to look at every space through the eyes of multiple users, and I’d love to hear more about what you may have in the works already. For other insight and ideas regarding universal design and healthcare, check out The Center for Health Design’s recent brief on the topic (go to Healthdesign.org and search “universal design”), as well as our article in the November 2016 issue’s Monitor section on the Mary Free Bed YMCA, a universally designed hospital, YMCA, and wellness center project.

Good News For Patient Safety



Reducing the incidence of healthcare-associated conditions (HACs)—a term that includes infections, falls resulting in injury, and basically anything else in which a consumer in a healthcare setting ends up worse off just by showing up—has been very high on the priority list for hospital systems over the past several years. And the good news is the efforts seem to be paying off.

In December 2016, the Agency for Healthcare Research and Quality (AHRQ) released its scorecard on rates of HACs between 2010 and 2015. The preliminary estimates show a 21 percent decline during that period—3.1 million fewer incidents than would have occurred if 2010 rates had held steady.

The upshot of this? An estimated 125,000 fewer patient deaths and a savings of $28 billion in healthcare costs.

The 21 percent drop can largely be attributed to fewer incidents of adverse drug events, pressure ulcers, and catheter-associated urinary tract infections. All other infections, falls, and events combined accounted for about one-fifth of the total drop.

The report suggests that the decline, at least in part, might be due to the financial incentives created by Medicaid/Medicare; public reporting of hospital-level results; and other public and private initiatives to improve healthcare quality and patient safety. And that last part is where you—designers, architects, providers, and product suppliers—come in.

There are plenty of architectural and interior design solutions that seek to reduce falls and allow for easier, more effective cleaning to cut down on the spread of infections. Product manufacturers are hard at work on innovations in materials for textiles and high-touch surfaces. There is existing research that strongly supports the efficacy of these solutions: the antimicrobial properties of copper, silver, and even a new line of paint; the sanitizing properties of UV lighting; and more. But we need a lot more research, a lot more proof—and then we, as an industry, need to continue to shout it from the rooftops.

Because while the HAC numbers may be dropping, the overall number of incidents is still extraordinarily high. Design interventions and the types of building products specified, realistically, aren’t likely to have an effect on all kinds of HACs. But patient falls and the spread of certain types of infections? We as an industry can help that. And as this latest report shows, the payoff is significant in terms of both dollars and lives saved.

As design teams have taken on more of a consultant role in many matters (and may take on even more as the new administration starts implementing healthcare policy changes), it’s in your best interest to stay abreast of the very latest research on patient-safety design efforts and product innovations to reduce HACs. Better yet: Conduct this kind of research yourself, and share it with your peers. Persuade your clients to keep track of data that can contribute to this type of research, and share it with their peers. Talk to the manufacturers you regularly work with, vet their product claims, and work with them to conduct more research…and, yes, share it with their peers. Share it with all of us.

Click here to read the full report from AHRQ. And for an excellent discussion of some of the newest breakthroughs in products designed to reduce healthcare-associated infections, see “The Battle Against Healthcare-Associated Infections” by ESa’s Sam Burnette, from the October 2016 issue of Healthcare Design.