langley memorial hospital high level master plan

LANGLEY MEMORIAL HOSPITAL HIGH LEVEL MASTER PLAN

Coordinated By: Lower Mainland Facilities Management For: Fraser Health

Langley Memorial Hospital 22051 Fraser Highway Langley, BC, V3A 4H4

Issued: September 14, 2015 Version: Rev 1 Appendix Document Update Cost Estimate Dated May 28, 2015 Consultants: Kasian Architecture, Interior Design and Planning Ltd. Architectural

Stantec - Clinical Service Plan and Master Program Bush, Bohlman & Partners Structural James Bush & Associates Quantity Surveyor

LMH HIGH LEVEL MASTER PLAN

LMH High Level Master Plan Final June, 2015 Page 2

TABLE OF CONTENTS

1. Executive Summary & Next Steps ................................................................................. 4

1.1. Introduction ............................................................................................ 4

1.2. Background Planning Context ............................................................. 5

1.3. Strategic Alignment High Level Service Plan and Master Program ..... 8

1.4. Master Programming Fit to Service ..................................................... 9

1.5. Existing Conditions and Challenges ..................................................... 10

1.6. Key Clinical and Infrastructure Priorities ............................................... 11

1.7. Energy and Environmental Sustainability Initiatives ............................. 11

1.8. Information Management and Information Technology ........................ 12

1.9. Land Development Context and Opportunities ..................................... 12

1.10. Recommendations and Next Steps .................................................... 21

1.11. HLMP Document Summary ............................................................... 22

2. Introduction ......................................................................................................................... 23

2.1. Overview Factors Driving Redevelopment .............................................. 23

2.2. Purpose of the High Level Master Plan .................................................. 24

2.3. Vision ..................................................................................................... 24

2.4. Planning Process & Engagement ........................................................... 25

3. Background ........................................................................................................................ 27

3.1. Project Background ................................................................................ 27

3.2. Site Development History in the Context of Community Development .... 27

3.3. Site Services and Regional Role ............................................................ 28

3.4. Demographic Profile of the Service Area ................................................ 29

4. LMH Service Plan & Master Program ................................................................................. 31

4.1. Service Planning Overview ..................................................................... 31

4.2. Master Programming Overview and Output ............................................ 31

4.3. Future Patient Care Service Delivery Issues .......................................... 33

4.4. Service Delivery Adjacencies .................................................................. 38

4.5. Clinical Development Priorities ............................................................... 40

4.6. Other Clinical Service Priorities ............................................................... 40

5. Existing Context Analysis .................................................................................................... 41

5.1. Site Location ........................................................................................... 41

5.2. Context and Relationships ...................................................................... 42

5.3. Community Services & Leasing .............................................................. 44

5.4. Residential Services ............................................................................... 46

5.5. Hospice .................................................................................................. 47

5.6. Mental Health ......................................................................................... 48

5.7. Topography ............................................................................................ 49

5.8. Infrastructure Assessment ...................................................................... 49

5.9. Building Condition Summary ................................................................... 50

5.10. Seismic Assessment Summary ............................................................. 51

5.11. Building Systems Summaries ............................................................... 52

Mechanical Systems Existing Condition .......................................... 52 5.11.1.

Recommend Energy Conservation Measures for Implementation ...... 55 5.11.2.

Electrical Systems Existing Condition ............................................. 58 5.11.3.

5.11.3.1. Recent Changes to Site Wide Electrical Distribution Energy Centre (2010) ............................................................................................................ 62

Building Systems Future Considerations ............................................ 62 5.11.4.

5.12. LMH Capital Investment ........................................................................ 62

5.13. Infrastructure Asset Management ......................................................... 63

5.14. Energy & Environmental Sustainability Initiatives .................................. 67

5.15. Information Management and Information Technology ......................... 70

5.16. Zoning Official Community Plan ......................................................... 71

5.17. Zoning Analysis .................................................................................... 74

5.18. Building Site Statistics........................................................................... 76



5.19. Existing Hospital Buildings.................................................................... 79

5.20. Existing Use Floor Plans ...................................................................... 80

5.21. Building and Site Sections .................................................................... 82

5.22. Site Photos ........................................................................................... 83

6. Urban Planning Analysis ..................................................................................................... 86

6.1. Existing Transportation Analysis ............................................................. 86

6.2. Existing Greenscape and Bluescape Analysis ........................................ 87

7. Development Master Plan .................................................................................................. 89

7.1. Planning Vision & Planning Process ....................................................... 89

7.2. Building and Infrastructure Expansion Requirements ............................. 90

7.3. Site Opportunities ................................................................................... 90

7.4. Site Organization .................................................................................... 92

7.5. Phasing Concept .................................................................................... 94

7.6. Site Sections ........................................................................................ 111

7.7. Floor Plan Departmental Organization ............................................... 114

7.8. Parking Analysis ................................................................................... 135

8. Development Budget & Timelines ..................................................................................... 136

8.1. Phasing Outlook Priorities, Budgets and Timing ................................ 136

8.2. High Level Cost Estimate ..................................................................... 136

8.3. Development Timeline and Dependencies ........................................... 139

8.4. Recommendations and Next Steps ...................................................... 139

Appendices .......................................................................................................................... 140

a. LMH Service Plan and Master Program

b. Additional Reference Documents



1. Executive Summary & Next Steps

1.1. Introduction Langley Memorial Hospital (LMH) is a community hospital in British Columbia offering primary, secondary and a range of specialty services to residents within the Township and City of Langley as well as eastern portions of Surrey. It is a critical care centre within the Fraser Health Authoritys (FH) Acute Care network. A map illustrating FHs network of community and regional hospitals is shown in Figure 1.1-1.

Figure 1.1-1 FH Tertiary Referral and Trauma Centres and Secondary Referral Hospitals

The goal of the High Level Master Plan (HLMP) is to provide a framework for understanding: the role of the campus and the asset potentials with respect to current and projected services; the pressures and challenges of sustaining and continuing to enhance these services and the opportunities that can be built upon to ensure the mandate of better health and best in health care will continue to be delivered.

In developing the HLMP, Senior Leadership, Directors, Physicians, community stakeholders, FH staff and Lower Mainland Facilities Management (LMFM) teams were engaged in assessing the current and future state acute care services.

This HLMP is to be used as a decision support tool by provincial and FH leadership which will inform integrated clinical service plans and capital infrastructure improvements over the established planning horizon. It includes a comprehensive presentation of information relevant to strategic planning for the LMH campus. It furthermore presents priorities for the campus which are driven by risks presented to care services stemming from present building and utility infrastructure deficiencies. Proposed opportunities for the campus are governed by planning principles, and an overall vision for care and community integration.

The HLMP is based on provincial policy for the management of capital assets (Capital Asset Management Framework), informed by Ministry of Health (MoH) and FH Strategic and Operational Plans. Furthermore, it is guided by principles to ensure value for patients and communities are delivered.

Guiding Principles

The following guiding principles have shaped the development options and recommendations presented in the LMH HLMP:

Evidence-Based Design - the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.

Performance Optimization - an opportunity to re-design processes to improve patient care and the overall patient experience.

Master Planning and Integration - to both optimize utilization of resources and enable growth through connectivity across the network of care.

Adaptability, Flexibility and Expandability - to accommodate the rapid cycle of innovation and change in clinical processes.

Innovation - providing for state of the art strategies in the continual improvement of both patient and staff health and wellness.

Strategic Priorities

FHs strategic priorities that have guided the HLMP work are:

Realignment of inpatient care beds to reduce Alternate Level of Care and Length of Stay rates by providing sufficient and appropriate residential and acute care beds to service current and future needs of the population;

Improve the quality and efficiency of primary and acute care services by improving the space, flow and access to those services in the community; and

Risk mitigation of major infrastructure deficiencies.



Factors Driving the HLMP

Although the HLMP is primarily an asset management guideline, the key factors driving the HLMP are related to how effectively and efficiently services are delivered to patients, residents and clients. The questions considered include:

How is the aging infrastructure impacting patient and staff safety along with the staffs ability to meet the ever increasing requirements to deliver the services?

How are the health care assets being strategically planned and managed to enable effective provision of future needs for the population in the community and aligned with FHs mandate to deliver services?

For Langley, this means embracing the evolving role of FH not just to provide the setting for acute care services but enabling the continued evolution of an integrated spectrum of care within a community of care model. FH senior leadership has agreed that the LMH campus provides an opportunity to move forward with this new vision and delivery of services defined as:

A Campus of Care which offers a range of care options and services to support the current and future needs of the community. These services include primary, residential, acute care and community services along with support programs to effectively and efficiently deliver integrated services in a caring and sustainable environment.

1.2. Background Planning Context

Existing Facilities

The current LMH facility includes: acute care, adult tertiary mental health, complex residential and convalescent care, hospice and a number of administrative and infrastructure buildings.

The North and South acute care towers were built in 1965 and 1973. Diagnostic and treatment, surgical and inpatient services are located in the North Tower. Inpatient services are primarily located in the South Tower. The towers are connected by an Administrative Wing.

The Cedar Hills, Maple Hills, Rosewood and Marrwood residential facilities were built between 1978 and 1994 and the Marion Ward and Memorial Cottage mental health facilities were built in1949 and 2008.

In its residential care strategy, FH plans to replace the outdated 199 bed residential care facilities (Cedar / Maple Hills and Rosewood / Marrwood); 20 bed convalescent and 10 bed hospice with a new 250 bed Complex Care Residential facility and a new 10 bed Hospice within a 5 year timeframe.

In addition to the health care facilities the campus has an Energy Centre and trailers which are currently used by the Environmental Health group.

Figure 1.2-1 shows the campus site plan along with the current bed count.

Figure 1.2-1 LMH Campus Site Plan and Bed Count

Infrastructure and Risk Assessment

The Facility Condition Index (FCI) compares the condition of each building against its current replacement value. The seismic risk ranks the facility from low to high risk of failure with high including the possibility of loss of life in an earthquake.

LMH Site

(FH Owned)

Foundation Lands

(LMH Foundation Owned Land)



The current assessment of the South Tower and the Administrative Wing shows that they do not meet the minimum health care standards, building code requirements and have a seismic ranking of high risk of failure.

Based on the current state of the residential buildings and the seismic risk of the South Tower these buildings have been identified as a high priority for replacement in the HLMP.

The North Tower has had some seismic and code upgrades over the past years however, this building will continue to require renovations and upgrades in order to meet code requirements, service demands and improve operations.

Memorial Cottage (Adult Tertiary Mental Health) and the Energy Centre buildings are relatively new and are meeting the current needs. However, the Energy Centre will require an expansion to accommodate the additional equipment required in the future.

The temporary trailers, occupied by FH staff, are in poor condition and have air quality and space issues.

Table 1.2-1 Building Infrastructure and Risk Assessment Summary

Residential, Mental Health and Support Services: Memorial Cottage (Mental Health): 2008 | FCI: - | Seismic risk: Low

Cedar/Maple Hills Centre (Residential Care): 1978/81| FCI: 0.60/0.62 | Seismic risk: Med

Rosewood / Marrwood (Residential Care): 1994| FCI: 0.42 | Seismic risk: Medium

Marion Pavilion (Outpatient Psychiatry/ Admin): 1949| FCI: 0.48 | Seismic risk: Medium

Energy Centre: 2010 | FCI: - | Seismic risk: Low

LMH Acute: South Inpatient Tower: 1965 | FCI: 0.27 | Seismic risk: High

Link/Administration Wing: 1973 | FCI: 0.27 | Seismic risk: High

North Tower: 1986 | FCI: 0.27 | Seismic risk: Low NOTE: The FCI values stated below are based on 2003 costs adjusted for inflation to 2015 dollars.

Zoning

The LMH Site is zoned Civic Institutional (P1) which permits: government institutional, childrens day care, assembly uses, hospitals, clinics, recreation facilities, residential accessory and seniors housing among a number of other uses. The Foundation Lands are zoned Suburban Residential (SR-1) which permit limited accessory uses, commercial greenhouses, childrens day care and residential among a number of other uses.

Through the urban analysis it was determined that the Foundation lands should be rezoned to Comprehensive Development zoning (CD) which would allow for an increase in density and the greatest development opportunities. It is estimated that this process would take up to a year therefore, it is important to commence the discussions with the approving authorities in 2015 / 2016.

Due to the Campus proximity to the Langley Municipal Airport, a large portion of the LMH and the Foundation lands has a building height restriction of ~68 meters (height of South Inpatient Tower). LMFM has discussed with industry consultants, to determine whether it is in FHs and the Foundations best interest to further investigate submitting a height restriction relaxation to the Federal Airport Authority and it was determined that this investigation should move forward in 2015 / 2016.

Figure 1.2-2 Zoning

Real Estate & Leasing Strategy

FH utilizes leased facilities to provide a variety of programs and services to the Langley community. These leases are managed by LMFM Real Estate to ensure fit to use, functional alignment, and ongoing upkeep. The first step toward a real estate and lease strategy for the Langley Health Area (LHA) will be to investigate opportunities for service planning alignment, lease consolidation, strategic partnerships and workplace optimization to determine the highest and best use for the space.

FH recognizes an opportunity to build a new Community Health Centre (CHC) in the LHA. Prior to a location being chosen a full market assessment will need to be completed to determine if the CHC should be located on or off the LMH campus. In either case, it is

LMH Site

(FH Owned)

Foundation Lands

(LMH Foundation Owned Land)



recommended that a number of the Outpatient Clinics such as Rehabilitation, Occupational Therapy and Physical Therapy should be relocated from their current location in the LMH Acute building to the new CHC. This work will involve extensive community and clinical consultation with FH leadership, clinical stakeholders, physicians and the community. There is an opportunity to incorporate a Senior Care Centre as part of the CHC if the CHC is located on the site. The visioning and planning work for a Senior Care Centre was not part of the HLMP scope of work. Table 1.2-2 provides a summary of the FH leases in Langley.

Table 1.2-2 Summary of the FH Leases in Langley (March 2015)

Count Health Authority

Lease Name Address City Classification Lease Expiry Date

Area - Rentable

1 FHA

Mental Health - Langley

20300 - Fraser Highway

LANGLEY Clinical -

Mental Health 31-Jul-18 7,773

2 FHA Public Health

- Langley 20389 - Fraser

Highway LANGLEY

Clinical - Public Health

31-Oct-16 11,278

3 FHA Home Health

- Langley 20651 - 56th

Avenue LANGLEY

Clinical - Home Health

31-Dec-19 8,977

4 FHA Public Health

- Langley 9440 - 202nd

Street

LANGLEY (Walnut Grove)

Clinical - Public Health

20-Sep-20 2,766

30,794

Work to Date

The HLMP process has been informed by and builds upon work that has been completed to date on the LMH campus and LMH Foundation lands. Some of these works are described in the following studies and reports which are included in the appendices.

Table 1.2-3 Summary of LMH Studies & Reports Used to Inform High Level Master Planning Process

Report Name Author Date LMH 2003 VFA Report VFA 2003

Fraser Health Acute Care Site Capacity Study Stantec 2007

LMH LDRP Expansion Structural Review Report Bush Bohlman & Partners LLP 2009

LMH Surface Lot Parking Feasibility Study RJC Consulting Engineers 2010

Thermal Energy Conservation Review Cobalt Engineering 2011

Lighting Audit Report Prism Engineering 2011

ToL Murrayville Core DE Study Sustainability and Business Context FVB Energy Inc. 2011

Langley Memorial Hospital Seismic Review Bush Bohlman & Partners LLP 2014

LMH Service Plan and Master Program Stantec 2015

LMH Campus Master Plan Study Structural Audit Report Bush Bohlman & Partners LLP 2015

LMH Chilled Water Study Flow Consulting 2015

LMH Energy Study Report BES Ltd. 2015

LMH 2015 VFA Report VFA 2015

(pending)



1.3. Strategic Alignment High Level Service Plan and Master Program

Within the context and need for creating a sustainable community of health services, FH has a mandate to build integrated communities of care that bridge primary, secondary and tertiary care within the FH region. LMHs extensive linkage both to lower mainland hospitals and the entire FH network is shown in the Figure 1.3-1.

Figure 1.3-1 FH Acute Care Network

LMH provides a range of primary, secondary and some specialty services, including 24/7 emergency, general and internal medicine, general surgery and select surgical specialties, critical care, obstetrics, pediatrics and adult inpatient psychiatric care. LMH also offers day surgery and other ambulatory, outpatient services, diagnostic imaging, inpatient and outpatient laboratory services. Table 1.3-1 provides an overview of the operational bed counts for the LMH campus.

In 2013/2014, LMH saw 44,421 emergency room visits, provided care to 10,802 inpatients (including newborns) and delivered 1,485 newborns.

Table 1.3-1 Operational Bed Counts for the LMH Campus

Building Service Bed Count

Acute North Surgical 36 Acute North Pediatric 9 Acute North Critical Care 12 Acute North Obstetrical 18 Acute South Medical 87 Acute South Mental Health & Substance Use 18 Acute South Transitional Care (PATH) 34 Memorial Cottage Tertiary Mental Health 25 Residential Care Complex Residential Care 199 Residential Care Complex Hospice 10 Residential Care Complex Convalescent 20

Total Beds 468

Growth and Operational Pressures

The 2014 estimated population of the LHA was 141,000. This area has a rapidly growing population with a 23% projected rate of growth from 2014 to 2025. The sub-population growth rates for the LHA are similar to those for the FH overall; in both cases there is an anticipated growth rate of 13% for child/youth (age



Table 1.3-3 LHA Population Projections

Langley Health Area - Population Projections

Total Population 2014 2025 2035

% Growth 2014-2035

141,361 174,238 204,645 45%

Source:http://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationProjections.aspx

1.4. Master Programming Fit to Service

In developing the Service Plan the clinical staff, physicians and service-delivery leaders at LMH were asked to work in Multi-disciplinary Study Teams (MDSTs) to foster collaboration. Through examining the interdependent functions performed by each service line along the patients journey, a better understanding of what would be required to create an efficient, safe and satisfactory environment with improved patient outcomes was found. The Service Plan component was developed around five patient flow platforms; with each platform based on common patient flows through the acute site. The platforms are:

Interventional and Procedural Services,

Emergency Service,

Maternal, Infant, Child, and Youth (MICY),

Inpatient Services, and

Ambulatory (Outpatient) Services.

The detailed platform dependencies are described in Section 5 and 6 of the HLMP document. The Service Plan is a compilation of information related to clinical service delivery on the LMH campus which was developed to:

Understand the issues and opportunities available within five patient service-delivery streams.

Review the current service delivery models.

Develop the future patient-flow models to optimize service delivery.

The Service Plan combined with service demand projections was used to create the site Master Program which is departmental-level space requirements based on benchmarks established from recent healthcare facility projects, industry best practice, contemporary design standards and guidelines. The Master Program is expressed in component gross square meters (cgsm) which in turn is factored up by 25% to gross buildable areas. Space requirements were developed for right-sizing of the current service volumes and for service demand projected to 2025 and 2035.

The following tables summarize the bed and area projections over the short-, medium- and long-term projections.

Table 1.4-1 Inpatient Platform Bed Projections

Inpatient Platform - Bed Summary

Patient Type Current Projected Growth %

2014 2025 2035 Current - 2035

Medical Inpatient 87 147 213 145%

PATH Unit* 34 - - -

Surgical Inpatient 36 35 49 36%

ICU/CCU/HAU 12 19 26 117%

Mental Health and Substance Use Primary

18 32 39 117%

Inpatient Platform Bed Count Subtotal 187 233 327 74.9%

Obstetrical 18 15 16 -11%

Pediatric 9 5 6 -33%

TOTAL Inpatient Bed Count 214 253 349 63% Mental Health and Substance Use Tertiary**

25 - - -

*Includes PATH Unit requirements in the right sized 2013/14. PATH Unit beds in 2025 and 2035 are not included as they are assumed to be in a non-acute setting **Mental Health Tertiary beds may be housed in an independent location. No demand projections were provided.

The total acute platform area is currently at 13,760 cgsm which is 113% undersized for the current needs. One of the HLMP recommendations is to relocate the non-acute services that are currently being delivered in the acute care facilities which would then allow the opportunity to renovate and reconfigure the acute space and address some of the issues related to the undersized facility.



Table 1.4-2 Platform Area Projections

LMH - Area Requirements (CGSM)*

Type Current

2014 Right-Sized 2025 2035

Inpatient Platform Area 5,060 13,015 15,430 21,645

MICY Platform Area 2,607 2,595 2,010 2,190

Surgical / Interventional Platform Area 1,730 1,950 3,270 4,130

Emergency Platform Area 870 1,920 2,800 3,400

Ambulatory Care Platform Spaces 1,311 944 450 450

Diagnostic Imaging Area 713 810 1,800 2,110

Clinical Support Area 1,060 2,525 3,146 4,415

Logistics Area 3,122 3,823 5,257

Administration, Education, and Control Area 2,417 3,142 4,050

Total LMH Area Requirements (CGSM) 14,000 29,000 36,000 48,000

*Component Gross Square Meter

1.5. Existing Conditions and Challenges

The delivery of services at LMH is negatively affected by the significant gap in quantity and quality of space compared to best practice standards. Based on the clinical evidence and best practice standards the following provides a high level summary of the current clinical and infrastructure challenges encountered at the LMH campus.

The ~45% undersized Emergency Department (E.D.) is causing infection control, safety and operational efficiency issues.

The South Inpatient Tower is past its functional life and is ranked as a high risk of seismic failure and is introducing risk to patient and staff safety and infection control.

The residential care facilities are past their functional life, do not meet current residential care guideline standards and are consequently compromising the delivery of services.

Limited vertical transportation capacity and limited separation of people and materials throughout the Acute Care Facilities is compromising patient safety and dignity and causing infection control issues.

Hospital rooms are not sized in accordance with existing standards (currently 2 - 4 beds per room) and are creating privacy and infection control issues.

Inadequate administrative and meeting spaces throughout the Acute Care Facilities offer less than adequate working conditions and are causing staff and patient confidentiality concerns.

The current hospital registration workflow is causing challenges.

The limited size and inadequate level of security within the pharmacy and medicine distribution systems is compromising medication handling and preparation.

The lack of technology to support electronic health records and local area wireless technology (Wi-Fi) is creating patient movement and tracking challenges.

The over flow of equipment, supplies and inventory from limited storage spaces creates clutter that is preventing safe egress and circulation, and is causing problems with maintaining, sterilizing and locating equipment.

The inability to properly separate clean and dirty material and equipment along with the limited number of hand wash sinks and insufficient patient facilities for hygiene and toileting is creating significant infection prevention and control challenges.

The space allocated for endoscopy and other interventional / investigative procedures are undersized and poorly laid out creating major operational issues related to: flow, privacy, safety and infection control.

Insufficient mechanical / electrical systems and plant infrastructure continually impact the delivery of services. The primary mechanical and electrical equipment that provides service to the majority of the campus is located in the lower floor of the South Inpatient Tower, creating significant risks to maintaining operations under post-disaster circumstances.

Further details describing the challenges and issues on the site are described in subsequent sections of the HLMP.

Figure 1.5-1 LMH Residential Care Facility



1.6. Key Clinical and Infrastructure Priorities

Based on the clinical analysis of the existing and future service delivery and a review of facility conditions, challenges and issues the following combined clinical and infrastructure priorities have been identified:

Emergency Improvement and Expansion: Evidence strongly suggests that the existing environment is not clinically appropriate. Consequently, the improvement and expansion of the E.D. is a high priority on the LMH site.

Energy Centre Mechanical / Electrical Systems Capacity and Service Continuity: Addressing the issues related to the insufficient mechanical / electrical capacity, redundancy and plant infrastructure impact the delivery of services.

Residential Care Replacement and Senior Care Centre: The existing residential care facilities are outdated and do not comply with current Residential Care Guidelines. In addition, the population demographic trends indicate a need for increased residential care capacity. Therefore, providing a new residential care facility that aligns with the functional setting to the complexity of care and increasing the capacity will enable reduction of acute backlog, more effective services and the right care in the right environment is a high priority.

South Inpatient Tower Replacement: Given the rating of the seismic integrity of the tower along with the clinical issues with the 4 bed / room, infection control, inadequate space for delivering the acute services the replacement of the South Inpatient Tower is ranked as a high priority after the E.D. expansion.

Interventional and Procedural Services: A need to provide well-designed facilities that enable effective service delivery through co-location while being responsive to technological and other evolutions is critical to the sustainability of the health care system.

CHC - Possibly with Urgent Care Capacity: A CHC is a priority as it aligns with the provincial direction to reshape health care service delivery to a community based system that in turn will reduce reliance on acute care. It should be noted that the detailed community health care planning was beyond the HLMP scope of work.

Figure 1.6-1 Ambulance and Main Entrance to the North Tower

1.7. Energy and Environmental Sustainability Initiatives

The LMFM Energy & Environmental Sustainability (EES) team is responsible for providing leadership on Energy Management and Environmental Sustainability for the four Lower Mainland Health Authorities. The goal of the EES team is to unite the four Health Authorities in a commitment to reduce health cares environmental impact, while increasing the health and well-being of British Columbians.

In consultation with key stakeholders and in conjunction with an evaluation of best practices within the healthcare sector, the EES team has set a strategy to achieve greater environmental stewardship by focusing on 10 strategic areas which include: Culture of Stewardship, Water Conservation and Restoration, Energy Conservation and Climate, Sustainable Supply Chain, Zero Waste, Zero Toxicity, Active and Clean Transportation, Healthy Land and Food, Regenerative Design and Transparent Reporting. For additional information refer to Section 6 of the HLMP.

The LMH electricity intensity is below average compared to the FH Acute Care sites, however the natural gas use is resulting in LMH having the highest overall EUI in the Fraser Health Region.

Like many communities in BC, the Township of Langley completed a feasibility study to examine the technical and financial aspects of a District Energy (DE) system within their community. One of their focus areas was the Murrayville Core, which includes the LMH site. In 2011, they concluded that a Biomass DE system would provide a competitive heating service to their customers. LMH would represent over 40% of the total, and thus considered a priority potential customer. Recent communication with the Township of Langley, confirmed that they would like to move this forward however, they currently have other priorities.

Regardless of a potential partnership with the Township of Langley, EES recommends that a DE system, using alternative technology, should be further investigated as an option in the future redevelopment plans of the LMH campus.



1.8. Information Management and Information Technology

The LMH Information Management (IM) Strategy and Information Technology (IT) Master Plan has not been included in the HLMP scope of work. Therefore, this will need to be completed in the next phase of planning.

An IM Strategy and supporting IM and IT Master Plans are developed from the functional program and future state service plan. These plans ensure that the operations are an integrated part of FH and provincial healthcare system and the specific needs of the site are taken into account including making improvements in unison with the redevelopment to improve clinical outcomes or service delivery.

The IT Master Plan, which explicitly deals with the wired and wireless network infrastructure items correlated to building designs, supports the IM Strategy and is used to develop the Business Plans

From the IM Master Plan IM Capabilities are established. Programs will have their specific needs however, the following Capabilities are mandatory as they form the foundation of the clinical services and operations:

Clinical Information Systems: core systems such as MEDITECH, Profile and Paris,

Health Information Management: includes patient and health records management,

End Use Devices and Network Services including video conferencing and Tele health, and

Building and Security Services: include access control, surveillance systems and nurse call and the integration of these.

1.9. Land Development Context and Opportunities

HLMP Development Goals

The visioning framework used to develop the LMH HLMP includes regional and site imperatives, programming priorities, and critical principles and values. The following benchmarks are indicators of a Campus of Care:

Integrating complementary uses,

Cultivating partnerships through facility adjacencies and the on-site building portfolio,

Establishing connections to the community,

Reflecting local culture,

Encouraging healthy lifestyles,

Creating connections and accessibility to the existing greenspace, parks and trails, and

Creating further connections between the campus components.

Integrating a range of complementary uses is a central benchmark for achieving the Campus of Care vision on the LMH and Foundation lands. Accordingly, building expansion and site opportunities have been identified based on these respective land uses:

Acute care,

Residential care,

Senior care

Mental health care,

Community health care,

Mixed uses (i.e. commercial and / or residential uses), and

Green space.

Figure 1.8-1 shows the campus divided into development opportunities. The acute care zone is the center of the campus with future acute care expansion taking place to the east and south of the existing North Tower. The land to the east of 221A St. (Foundation lands) provides a development opportunity for a CHC, mixed-use / offices and / or residential care facilities.

The land that fronts onto the Fraser Hwy provides an ideal location for a mixed use development which could include a CHC, offices or other income generating opportunities.



Due to the elevation change from the west property line to the acute care zone (> 14m) the development opportunities through the green space are limited with the exception of an area in the center of the green zone. Further analysis and discussions with the Township of Langley will need to take place prior to moving forward with any development opportunities in this zone. The green zone is ideal for a wellness area which would include trails, gardens, etc. connecting the community and the campus.

The north zone along 52 Ave. could be used for a hospice, residential care facility, seniors care centre or seniors / market housing.

Figure 1.9-1 Site Opportunities

Site Organization

Current Traffic and Parking

The main access into the LMH campus is from 52nd Ave. to 221A St. and from Fraser Hwy with right turning access in and out. These access routes are shared by patient, staff, service and ambulance vehicles. The acute care loading dock is located at the northwest corner of the

North Tower on Level 0. The ambulance entrance to the hospital is located at the east side of the North Tower on Level 1.

There are significant access and flow issues on the site related to:

The current one way, single lane ring road on the west side of the acute care building,

Ambulance vehicles sharing the same route into the site as the service and public vehicles, and

Not a clear direct access into the site and Emergency.

There are 710 parking stalls on the Foundation lands and approximately 248 stalls on the FH land. Based on the information received from Lower Mainland Integrated Protection Services the LMH and Foundation lots optimal occupancy is ~85% at peak times. The LMH and Foundation lots are running ~70% at peak times.

The public transit system provides service along Fraser Hwy and 221 A St. with bus stops adjacent to the acute care zone and along the south boundary of the site.

Future Site Organization

The HLMP scope of work did not include an in-depth traffic and parking study however; this work will be required for rezoning and will be a used to support the decisions made relating to the phasing..

Figure 1.8-2 shows the proposed future service and public vehicle circulation along with the major greenway spines through the site connecting the community.

The site circulation is based on providing a widened, ring road for service vehicles allowing access to the acute care and plant services back of house. In addition, there would be a spine road running through the site for public access.

The Township of Langley has plans to construct a Fraser Hwy pedestrian overpass located at 221A St. which will provide better pedestrian access to the campus and the civic amenities south of Fraser Highway.

For the purpose of developing the high level options, it was assumed that each development parcel would provide the required parking within the parcel boundary. The parking could take the form of reworking the existing surface parking, underground parkade and a new parking structure.



Figure 1.9-2 Site Circulation

Parcel Plan

In developing the parcel plan several assumptions have been established:

Retain P-1 Zoning on the LMH site for each subdivided parcel, and

Rezone Foundation lands from SR-1 to a new zoning which aligns with intended use such as CD Mixed-Use.

A total of 11 parcels have been identified for subdivision, with six parcels on FH lands and five parcels on Foundation lands as shown in Figure 1.9-.3.

Figure 1.9-3 Parcel Plan

Note: The layout of acute care facilities shown corresponds with phasing option 2.

Site Development Options, Phasing and Costs

During the master planning process numerous development options were considered of which three are described in the HLMP. Options 1, 2 and 3 have similar 20 year plans however, they differ in the size of the E.D. expansion in the 0-5 year phase and the timing of the South Inpatient Tower Replacement.

The phasing timelines in the HLMP are based on the time from initial approval of the project to the completion of construction.



Options 1, 2 & 3 Phasing 0 5 yr:

Option 1, 2 and 3 identify the need to replace the existing 199 bed Residential Care, 20 bed Convalescent and 10 bed Hospice facilities with a new 250 bed Complex Residential Care facility and new 10 bed Hospice within the first five years. Through extensive analysis it was identified that the new Residential Care facility could be located either on the Parcel 1 or Parcel 11 and the Hospice on Parcel 1 or 2 as shown on Figure 1.9-3. Both of these projects are considered to be independent of each other and therefore, could commence simultaneously.

Figure 1.9-4 Option 1, 2 and 3 Phasing 0 - 5 Yr.

Options 1, 2 & 3 Phasing 3 - 5+ yr:

Options 1, 2 and 3 identify the need to complete the CHC market assessment and procurement process to determine if the new CHC should be located either on or off the LMH Campus. Parcel 5 has been identified as a suitable location allowing easy access off Fraser Hwy. This new facility would include Rehabilitation, Occupational and Physical Therapy services which are currently located on Level 0 of the Inpatient Tower. There is also an opportunity to incorporate a new Senior Care Centre within the CHC if it was located on the site. Figure 1.9-5 shows this option.

Figure 1.9-5 Option 1, 2 and 3 Phasing 3 - 5 Yr.



Option 1 Phasing 2 5+ yr:

Option 1 proposes to construct a new 1 storey E.D. to the east of the North Tower which would accommodate the right-sized program. The new E.D. building would maintain a direct connection to the existing North Tower with an internal corridor connecting the new E.D. to the D.I platform. Access to the new E.D. would be from a relocated main building entrance at the south end of the link building. The new ambulance access point and parking bays would be relocated to the north end of the new E.D.

Following the new E.D. expansion a number of renovations would take place: DI, Ambulatory, etc.

Figure 1.9-6 Option 1 Phasing 2 5+ Yr.

Option 1 Phasing 5 15 yr:

Option 1 proposes to construct the new South Inpatient Tower Replacement to the south of the new E.D. and Link expansion. Refer to Figure 1.9-7 and 1.9-9 for further phasing details. This work would include reconfiguring the platforms and renovations to the North Tower.

Figure 1.9-7 Option 1 Phasing 5 - 15 Yr.



Option 1 Phasing 15+ yr:

This phase includes expansion of the acute care platforms including E.D. to the 2035 program area.

Figure 1.9-8 Option 1 Phasing 15+ Yr

Figure 1.9-9 Option 1 Phasing Summary

Refer to Table 1.9-2 and 1.9-3 for Option 1 costing estimate, priority ranking and phasing.

Parking

A summary of Option 1 Phased Parking Plan is shown in Table 1.9-1. The HLMP parking analysis shows that the required parking can be accommodated through a combination of surface, underground and a new parking structure. A preliminary estimate shows that the parking structure would need to accommodate as much as 1300 stalls however, this number could be reduced pending the number of underground parking levels that are constructed. Further details of the parking analysis for Option 1, 2 and 3 are in the HLMP Appendix.



Table 1.9-1 Option 1 Phased Parking Plan



Option 2 Phasing 2 - 10 yr:

Option 2 proposes to commence with the replacement of the existing South Inpatient Tower in year 2 and a new 2 level E.D. (right sized / 2025 program) with Surgical Interventional located on the 2nd level commencing year 3. The phasing of Option 2 is further detailed in Section 7 of the HLMP.

Option 3 Phasing 2 5 yr:

Option 3 proposes to commence with a new 3 level E.D. to 2035 program east of the North Tower in year 3. This would include the ICU, CCU, HAU / Medical Inpatient on the 2nd level and Surgical on the 3rd level of the new build. The advantage of this option is that MICY and Surgical would be on the 3rd level with the 2nd level of the North Tower renovated to accommodate Medical Inpatient. The new Inpatient Towers would be 4 levels verses 5 levels in Option 1 and 2. This Option includes a 2 level parkade below the E.D. expansion and below the new Inpatient Replacement Tower. The phasing of Option 3 is similar to Option 1 which is further detailed in Section 7 of the HLMP.

Option 2 and 3 Phasing 12 20 yr:

Options 2 and 3 have similar final development plans with the facilities being renovated and built out to the 2035 programs. In these phases a new Inpatient Tower (2035 program) would be constructed to the south of the Inpatient Tower Replacement and the North Tower being renovated to accommodate the 2035 programs. A 2 level parkade would be constructed below the new Inpatient Tower (2035 program). Refer to Section 7 of the HLMP for further details.

Development and Capital Investment Plan

The capital investment plan outlines the estimated costs and potential phasing of the development options. Table 1.9-2 summarizes the costs which are based on a Class D Estimate prepared by a Quantity Surveyor. Refer to Appendix for the detailed estimate.

Table 1.9-2 LMH HLMP Site Development Estimate



Table 1.9-3 Option 1 Priority Ranking, Budget and Timeline Summary



1.10. Recommendations and Next Steps

It is anticipated that the LMH HLMP will be endorsed to support ongoing service and facility planning which will align, define and develop solutions for best value investment.

As the document is operationalized, additional studies will be carried out to confirm the priorities, goals and constraints identified herein. Future planning efforts will continue to require the input of stakeholders, FH leadership and staff and governing authorities both at the Township of Langley and within the MoH.

In June, 2015 the following Option 1 recommendations were endorsed by the FH Executive:

1. Senior Care Centre and Residential Care: Commence negotiations to develop partnership opportunities with the LMH Foundation for a build-to-suit a lease-back Residential Care facility modelled after the White Rock / South Surrey Peace Arch Foundation Agreement. This would include preparation of a Short Form Business Plan and the planning for a Seniors Care Centre.

2. Hospice: Commence negotiations with a private donor for a build-to-suit lease-back Hospice Facility on the LMH site. This would include preparation of a Short Form Business Plan.

3. Infrastructure Upgrades: Proceed with a Business Plan for upgrade of the Energy Centre and other priority building systems.

4. E.D. Upgrades / Expansion. Proceed with a Business Plan for expansion and improvement of the E.D. and related renovations.

5. South Inpatient Tower: Investigate how to best address seismic issues related to the South Tower. Following the investigation an implementation plan will be required.

6. CHC: Proceed with preliminary planning, stakeholder and community consultation, and real estate assessments for a CHC.

7. Building Height Restriction: Commence investigation and process to receive relaxation on the height restriction of the FH and Foundation land in order to advance expansion of facilities.

The implementation of these recommendations will be dependent on the community partnerships and the funding model approved by FH and MoH.

List of Next Steps:

1. Senior Care Centre and Residential Care: Commence negotiations to develop partnership opportunities with the LMH Foundation for a build-to-suit a lease-back Residential Care facility modelled after the White Rock / South Surrey Peace Arch Foundation Agreement. This would include preparation of a Short Form Business Plan and planning for a Seniors Care Centre.

2. Hospice: Commence negotiations with a private donor for a build-to-suit lease-back Hospice Facility on the LMH site. This would include preparation of a Short Form Business Plan.

3. Infrastructure Upgrades: Proceed with a Business Plan for upgrade of the Energy Centre and other priority building systems.

4. South Inpatient Tower: Investigate how to best address seismic issues related to the South Tower. Following the investigation an implementation plan will be required.



1.11. HLMP Document Summary

The HLMP is divided into the following sections:

Introduction provides an overview of factors driving the redevelopment of LMH and purpose for the development of a HLMP.

Background describes the health care system context, role of LMH and demographic profile of the service area.

LMH Service Plan and Master Program illustrates the future-state service-delivery models, service demand projections and issues. It outlines space requirements up to 2035 and describes clinical development priorities.

Existing Context Analysis shows current land and facility utilization, potential opportunities and infrastructure issues.

Urban Planning Analysis provides assessment of impact on urban environment and potential opportunities.

Development Master Plan defines a framework for renewal of facilities based on risk mitigation, service delivery needs and site opportunities.

Development Budgets & Timelines provides preliminary impact assessment of cost for development.

Appendices - Includes the reference documents.



2. Introduction

2.1. Overview Factors Driving Redevelopment

Strategic Context

The LMH HLMP considers and is informed by various layers of strategic inputs, including those articulated by Government of BC, MoH, FH Executive, Fraser Health Strategic Plan, Regional Councils and leadership bodies, the LMH Foundation, LMH site leadership, LMH (Multi-Disciplinary Study Teams) and other partners such as local government.

Ministry of Finance

This project aligns with the Ministry of Finance (MoF) Capital Asset Management Framework (CAMF) standards. CAMF describes the government's objectives and policies for planning and managing publicly-funded capital assets such as schools, hospitals, and buses. The LMH HLMP project has applied the CAMF guiding principles and methods throughout the project in order to ensure efficient use of capital.

MoH Strategic Plan

The project aligns with the overall purpose the MoH Services in terms of ensuring that quality, appropriate, cost effective and timely health services are available to all British Columbians as stated in the Ministry of Health 2015/16 2017/18 Service Plan. Specifically, this project aligns with the MoH goals as follows:

Goal 1 Support the health and well-being of British Columbians.

- Objective 1.1 - Chronic disease is the largest cause of death and disability represents the largest proportion of the burden of disease, and drives a significant part of downstream health costs in B.C. Evidence suggests that, over time, a primary disease prevention and health promotion agenda can make progress in improving the overall health of the population.

Goal 2 Deliver a system of responsive and effective health care services across British Columbia

- Objective 2.1 A provincial system of primary and community care built around inter-professional teams and functions.

Goal 3 Ensure Value for Money

- Objective 3.1 - A performance management and accountability framework that drives continuous improvement in the health system.

- Focus on operational management excellence through continuous improvement.

- Continue the delivery of quality services or products and the enabling organizational functions in the areas of primary and community care, surgical service and rural health services delivery.

As the population grows and demands on FHs hospitals increase, facilities such as LMH require investment in redevelopment so that they can effectively maintain service capacity and implement new standards for clinical care, communication, and technology.

The HLMP provides a consolidated documentation of the current state of services and facilities, the projected changes to the catchment population, the vision for the future, and clinical changes and capital investments required to reach future goals. It indicates the strategic directives for the continued development of the hospital over a 20 year planning horizon. Accordingly, the document is aligned with standards set by various levels of government and governance bodies.

The following are the strategic directives for the LMH site, which guide the proposed development plan:

Role in Fraser Health Network: LMH is a secondary referral hospital within the FH Network. It is positioned geographically between two tertiary hospitals including Surrey Memorial Hospital and Abbotsford Regional Hospital and Cancer Centre, in addition to providing primary healthcare services the LHA population, it offers support to these tertiary facilities.

Population Changes: the LHA will experience a +65% increase in population over the next 20 years. This growth will be primarily experienced among children/ youth 16 16 years in age and (+29%) and seniors +65 years in age (+41%).

Role in health care system: Focusing on excellence in primary care services, in addition to acute care and a range of support programs required to establish a unique Campus of Care in the suburban / rural communities of Langley.

Clinical Service Plan and Master Program: the Clinical Services Plan and Master Program prioritize the redevelopment of the E.D., South Tower, Residential Care and Interventional and Procedural Services over the planning horizon of the project, in addition to evaluating a business plan for the development of a CHC to support LMH. The Master Program identifies a significant expansion area requirement for LMH over the next 20 years.



Site Specific Challenges include:

- Capacity of Electrical and Mechanical Systems: the existing service systems are operating at capacity, and require upgrade and expansion to support any additional facility area on the LMH site.

- Functional Life of Existing Buildings: a number of the existing buildings, including the South Tower, Residential Care Facilities and Marion Ward Pavilion are reaching the end of their functional life.

- Limited Expansion Area adjacent to Acute Facilities: There is limited area directly adjacent to the Acute Care Facilities for expansion due to the location of Residential Care facilities.

- Lack of Community Integration: Limited pedestrian and active transportation connections exist between the LMH site and the surrounding community.

- Limited income generating uses on site: Limited methods for leveraging land resources for income generation are employed on the LMH site, despite a relatively large unused land area.

- Height Restrictions: Proximity to the LMH site to the Langley Municipal Airport limits maximum new construction height to three storey.

- Undesignated ambulance, service, patient, staff and visitor access: LMH site is divided into two distinct sites with 221A Street running north to south. Both the LMH and Foundation sites are located south of 52nd Avenue and north of Fraser Highway. Fraser Highway is one of the major east-west arterials which connect the Township to the City of Langley (to the west) and Abbotsford (to the east). There is limited site access from Fraser Highway to the south as such ambulance access is restricted to westbound traffic. Fraser Highway also creates a separation boundary from the adjacent community and limits pedestrian access.

- Topography: There is a significant (31 m) change in elevation from the western to eastern boundaries of the LMH site. The change in elevation is most pronounced by a west-facing slope directly west of the Acute Care buildings and north of Memorial Cottage.

2.2. Purpose of the High Level Master Plan The HLMP creates a long term vision for a facility to inform optimal site infrastructure decisions and to focus on generating value for site users and health service providers in four key areas:

Service alignment, quality and efficiency;

Asset lifecycle management (value & risk);

Highest & best use of facility and land; and

Identification of achievable short term high priority project solutions.

The HLMP process includes the identification of opportunities to improve facility and operational conditions that are achievable with available financing. Aligned with a vision for the site and driven by existing operational risks, capital project requirements are identified and placed in context for decision makers. Through this approach, phased investments offer a means by which to achieve the overall vision for the site.

2.3. Vision The vision for and focus of the LMH site from a service profile and characteristics perspective is ultimately borne out of the service needs of the populations served by LMH as well as the role that LMH plays within the Fraser Health Community of Care (CoC), regionally and provincially. To that end, the Clinical Service Plan (CSP) completed in January 2015 confirms the inpatient bed requirements, surgical suite requirements, and the clinical and support services needed to accommodate the projected service demands out to 2025 and 2035. Since preparation of the CSP and as part of the HLMP process, the vision for the LMH site has evolved based on regional and site imperatives and inputs, as well as staff and provider perspectives regarding characteristics of great hospitals. Figure 2.3-1 below presents the visioning framework that evolved during the course of the LMH HLMP.



Figure 2.3-1 Site visioning framework for the LMH site, including key inputs and outputs

2.4. Planning Process & Engagement The HLMP process utilizes five stages, these are as follows:

1. Define: Identify and define the issues or improvement opportunity. In high level master planning, the issues or opportunity often relates to healthcare service process improvements to safety, quality, access or productivity that can be enabled with changes to the infrastructure.

2. Measure: Gather data that measures the performance of the facility and site to support current and future patient and operational requirements, provide optimal value to Fraser Health and the wider community and create acceptable levels of risk to stakeholders.

3. Analyze: Analyze the data to determine the nature and causes of facility and site performance issues that adversely affect the utility and value of the facility and create unacceptable levels of risk, service quality or inefficiency.

4. Improve: Develop achievable strategies and project priorities to optimize, sustain, enhance and renew the facility and site infrastructure so that it provides and an adaptable environment in the short, intermediate and long term that is consistent with the needs of the patients, service providers and community.

5. Control: Utilize the HLMP to guide asset management and investment activity on the site and continually refresh the HLMP so it remains relevant.

The following guiding principles have shaped the options and recommendations presented in the LMH HLMP:

Evidence-based design - the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. Evidence based design enables demonstrated improvements in the organizations outcomes, economic performance, productivity, customer satisfaction and cultural measures.

Performance Optimization - the development of the facility provides an opportunity to re-design processes to improve patient care and the overall patient experience. This leads to better clinical outcomes improving the safety, quality, delivery; increased efficiency; and an improved patient experience.

Master Planning and Integration - integration provides for accessibility and seamless layering of services and purpose to both optimize utilization of resources and enable growth through connectivity across the network of care. Integration takes place in terms of strategy, planning and service delivery looking not just within sites but across communities.

Adaptability, Flexibility and Expandability - facilities and infrastructure need to accommodate the rapid cycle of innovation and change in the development and implementation of clinical and work processes. Design for flexibility reduces obsolescence and increases effectiveness of clinical services enabling both increased capacity and improved health outcomes.

Innovation - enabling and embracing innovation means providing for state of the art strategies and the development of future strategies in the continual improvement of both patient and staff health and wellness. This means providing not only for the best care of patients and families but the best work environment for staff.

Sustainability and High Performance Integrated design - hospitals and communities need to be healthy places that enable healing within and interconnected and integrated environmental context. As in nature, systems should be designed to be open ended learning systems. Renew-ability and regeneration are key to community, corporate and individual health. Integrated



design enables optimization of means and resources by leveraging results from integrated systems.

Input into the Clinical Services Plan, Master Program and Master Plan has been provided by stakeholders at the following opportunities during progress of the project:

Clinical Services Plan

- Multi-Disciplinary Study Team Workshops: Current State and Future State by Platforms

- Physician Current State Summary Report out (DoFP/site physicians)

- Physician Engagement Session #1Master Planning current state (DoFP)

Master Planning Engagement

- Infrastructure Review and Master Planning

- Engineering Reports Review

- Engineering Priorities Review

- Master Plan Gaming Session

HLMP Development Plan Report Out

- LMH Site Engagement

- Update and Information Session

- LMH Site Leadership Meeting

- External

o Health Community Partnership (multiple updates)

o Collaborative Services Committee (multiple updates)

o LMH Foundation (multiple updates)

o Meeting with local Mayors

Full list of LMH HLMP Participant Engagement activities can be found in Appendix b.



3. Background

3.1. Project Background The Langley Memorial HLMP project was initiated January 2014 by LMFM. The project is part of a larger effort to conduct strategic capital planning within the FH Acute Care Network, and occurs in conjunction with HLMP efforts for each of the twelve hospitals within the FH portfolio. The HLMP for LMH is one of the final sites to be reviewed by LMFM within the FH network.

Combining clinical service planning, space programming, asset management, urban planning, facility and capital planning methodologies, the HLMP offers a long term strategic directive which recognizes the dynamic nature of the changing healthcare operational environment.

This approach to planning for healthcare facilities allows for transparent and defensible facility decision making. It furthermore allows for the identification of short term priority projects which are achievable within existing capital resources.

The HLMP is informed by previous efforts to date on the development of the LMH and Foundation land sites, including:

Fraser Health Site Capacity Study, 2007 (Stantec)

Surface Lot Parking Feasibility Study, 2010 (RJC Consulting Engineers).

3.2. Site Development History in the Context of Community Development

The original LMH opened summer 1948 in the location of the existing Memorial Cottage. The hospital was positioned along the new Trans-Canada highway (now Fraser Highway) which bypassed the rural community of Murrayville. At the time of the opening of the hospital, the City of Langley area was referred to as Langley Prairie. The area was incorporated in 1955.

The hospital quickly outgrew its original building footprint and in 1965, a new Acute Care building, which included what is now known as the South Tower, was constructed. The Acute Care facilities were expanded shortly after the incorporation of Township of Langley (1973) in 1975. These facilities were expanded again in the late 1980s to include the Administration building link and North Tower.

The original nursing residence, the Marion Ward Pavilion (now utilized for Mental Health services), was built in 1949. A second Mental Health building, Memorial Cottage, was constructed in 2008. The original Cedar Hills and Maple Hills residential care buildings were constructed in 1978 and 1981 respectively. In 1994 two additional residential care facilities, Rosewood and Marrwood, were constructed. The most recent major project on site was the addition of a new Maternity Clinic and renovations to the existing Maternity unit, which occupy

the third floor of the North Tower. The replacement value of the Acute Care building, Marion Ward and all of the existing residential care buildings on the LMH campus, according to the 2003 VFA report, is ~$103.5 million (2003 dollars adjusted for inflation to 2015 dollars). The City and Township of Langley continue to offer a unique opportunity within Metro Vancouver for an affordable and rural lifestyle to residents.

Since the incorporation of the community, the City and Township of Langleys populations have grown as a result of a thriving agricultural economy, rural and suburban lifestyle opportunities and transportation links to the core of Metro Vancouver (formerly the Greater Vancouver Regional District) (see Figure 3.2-1).

Photo-1 LMH (circa 1948)

Photograph courtesy of Langley Centennial Museum-Photo #20091602



Figure 3.2-1 Existing Buildings

3.3. Site Services and Regional Role LMH is an acute-care community hospital that is operated by the FH; one of six health authorities established by the provincial government to administer health care services in British Columbia (BC). Based on the current provincial population, FH is the largest of the provinces health authorities providing a full continuum of services to more than 1.6 million people, or one third of the provincial population, within a geographic area that stretches from Burnaby to Boston Bar in the Fraser Valley. The population served by FH is growing at a rate greater than any other BC health authority. To health care services, FH currently operates 12 acute care hospitals with approximately 2,300 acute care beds and operates service contracts for approximately 7,800 residential care beds. In addition to the acute hospitals and residential care beds, FH has an outpatient clinic and surgical care centre and numerous leased facilities to support home care and community service delivery.

FHs annual operating budget was $3.3 billion in 2014/15. It is governed by a board of 9 directors and has approximately 22,000 staff, 2,500 physicians and 6,500 volunteers.

Fraser Health provides services through an integrated network of hospitals comprised of:

Community hospitals that provide to the local community emergency care, inpatient care, a range of secondary care services, outpatient services, and other health services with linkages to primary care in the community.

Tertiary referral centre/trauma centres that, in addition to providing care to the local community, deliver acute and specialized tertiary/trauma services to a broader population. These centres provide the full continuum of acute, tertiary and trauma services to treat the most acutely ill patients from FH and across British Columbia requiring levels of care more complex than what is offered in community hospitals.

Community general hospitals, [such as LMH] are an important component in the health care service delivery system; they are integral to both the hospital network and by providing linkages to community-based home-health, mental health, public health, and residential care services through the following:

Emergency services (excluding specialized trauma);

A range of inpatient services to provide episodic care for populations such as; general medical, pediatrics, mental health/psychiatry, general and some specialized surgical;

Diagnostic services including laboratory and imaging;

Access to sub-specialty services via telehealth and/or visiting specialist clinics;

Receiving patients from tertiary centers after specialized care/procedures prior to discharge to home.



Services that directly link or transition patients from acute/episodic care to community-based care.

LMHs connections to the other community and regional hospitals of Fraser Health are shown in the diagram below along with key linkages to sites in the provincial health care network that provide highly specialized services (see Figure 3.3-1).

Figure 3.3-1 FH Acute Care Network

A map illustrating FHAs network of community and regional hospitals is shown in Figure 3.3-2.

Figure 3.3-2 FH Tertiary Referral Centres, Trauma Centres and Secondary Referral Hospitals

3.4. Demographic Profile of the Service Area LMH is situated in the Langley Local Health Area (LHA), which includes the City of Langley and the Township of Langley (including Aldergrove, Fort Langley, and Walnut Grove). LMH primarily provides acute and community-based health services to the residents of these communities, as well as a proportion of the proximal population of east Surrey (See Figure 3.4-1).

Figure 3.4-1 Langley Local Health Area

The population projections for the LHA show consistent and strong growth of approximately 65% in the next 20 years (see Table 3.4-1). In 2011, Langley had a population of 134,000 residents with a median age of 40 years and a similar age-sex distribution as FH overall. A growing community, Langleys total population is projected to increase by 31 percent over the next ten years, which will make it FHs fastest growing LHA (see Figure 3.4-2).

Different age groups will experience growth at different rates, with Langley expected to see the biggest jump in the number of children/youth 16 compared to other LHAs in FH (see Figure 3.4-3). Langley will see a 29% increase in the number of children and youth 16 by 2021, compared to 15% for FH overall. Growth in the number of seniors 65+ is expected to surpass growth among children and youth, but at a pace slower than for FH overall, with Langley projected to see a 41% increase compared to 46% for FH overall. With such growth in numbers, older adults will represent an increasing proportion of the total population. By 2021, the proportion of seniors (65+) will increase from 16% of the population to 18% whereas the child/youth (16) population will remain around 19%.



Impacts of the change in demographics are captured in the service demand projections and documented in the LMH Service Plan & Master Program.

Table 3.4-1 LHA - Populations Projections

LHA - Population Projections

Total Population 2014 2025 2035

Growth 2014-2035

139,815 186,136 230,561 64.9%

1) Source:http://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationProjections.aspx

X

Figure 3.4-2 Population Growth

Figure 3.4-3 Langley District Population Distribution

139,805 186,136 230,561

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

2014 2019 2024 2029 2034

Langley HealthArea PopulationProjection

Fraser HealthAuthorityPopulationProjection

*LHA: Projected Population increase by 64.9%



4. LMH Service Plan & Master Program

The LMH HLMP provides a vision for future redevelopment of the LMH campus of care. One of the key inputs into the LMH High Level Maser Plan is the LMH Service Plan & Master Program, which provides the clinical service delivery foundation for site development.

The Service Plan & Master Program was developed to answer the following major questions:

What services are provided at the site now and how might that service mix change in the future?

How might service delivery change in the future?

What physical adjacencies enable patient-centered service delivery?

What is the anticipated demand for services to be delivered at LMH in the future (2025 and 2035)?

How much space will be required to deliver services over the various planning horizons?

4.1. Service Planning Overview A key resource used to answer questions #1, #2 and #3 above were Multi-Disciplinary Study Teams (MDSTs). The MDST approach draws on the experience and knowledge of stakeholders from the following groups:

Program and site leaders related to the direct patient-care services delivered within the platform,

Physicians,

Clinical support services,

Ancillary support services, and

Clinical services with upstream or downstream impacts/dependencies (e.g. the Surgical Program was invited to participate in the Emergency Service MDST).

The MDST stakeholders groups were formed around the following five common patient platforms:

1. Interventional and Procedural services;

2. Emergency services;

3. Maternal, Infant, Child, Youth services;

4. Inpatient services; and

5. Ambulatory Care services.

(The specific constituents of the five MDST teams are listed in the appendix of the LMH Service Plan & Master Program)

Through a focused workshop the MDST participants mapped out current-state service delivery models, which served the following objectives:

Identification of facility/infrastructure challenges and issues that impacted current service delivery at LMH; and

Identification of other challenges and issues that impacted current service delivery at LMH; (e.g. process or resource).

In addition to the two objectives noted above, the creation of the current-state service delivery models in the first workshop were used as a baseline to develop future-state service delivery models at a second MDST workshop. In addition to the input of the current-state model and MDST participants, the future-state service delivery models were also informed by current industry trends and review of best-practices done by the consultant (Stantec Architecture).

There were two primary purposes in developing the future-state service-delivery models:

To document the future vision for service delivery at LMH; and

To identify the facilities/infrastructure and other key enablers for effective service delivery.

4.2. Master Programming Overview and Output The Master Program quantifies the space requirements for all identified service delivery components on the campus; this includes the delivery of direct patient care services and all of the associated clinical, auxiliary, and administrative services required to support direct patient care services. The Master Program is developed through understanding of all of the services (direct and support); quantifying the demand for service, and estimating the area requirements at a departmental (or equivalent) level.

Through the Service Planning stages the services were identified and validated, and then a number of resources were utilized to develop the service demand projections:

The Fraser Health, Business and Analytics (HBA) department provided demand projections for services such as: Emergency visits and Inpatient days.

The Fraser Health, Surgical Information Systems (SIS) department provided demand projections for surgical services.

Development of demand projections for services that do not have standardized or corporate Fraser Health protocols were done based on provincial population age/growth projections overlaid on historical service-specific volumes.



All service demand projections are detailed in the LMH Service Plan & Master Program and for brevity are not shown here, however, because inpatient bed counts are the primary driver of overall space needs in the acute facility, and because they provide the reader a good cue to the role of the site in health care service delivery, these data projections are provided in the table below (see Table 4.2-1). (The reader is directed to the LMH Service Plan & Master Program for all other service demand projections.)

Table 4.2-1 Inpatient Bed Summary

Current Growth %

2014 2025 2035 Current - 2035

Medical Inpatient 87 147 213 145%

Surgical Inpatient 36 35 49 36%

ICU/CCU/HAU 12 19 26 117%

Mental Health / Substance Use Primary 18 32 39 117%

LDRP Obstetrical 18 15 16 -11%

Pediatric 9 5 6 -33%

PATH Unit* 34 43 63 85%

Total Inpatient Beds 214 253 349 63%

Mental Health and Substance Use

Tertiary**25 - - -

Inpatient Bed Summary

Patient TypeProjected

*Includes PATH Unit bed counts in current Total Bed Count, however, PATH Unit beds are not included in Total Bed Count for

2025 and 2035 because they are assumed to be in a non-acute setting.

**Mental Health Tertiary beds may be housed in an independent location. No demand projections were provided.

With the information provided through the service planning and the service demand projections (questions #1 - #4 above), the consultant generated a Master Program that estimates the areas required by program/department; based on the service-delivery model and utilizing contemporary space planning benchmarks. These area estimates are documented in the Master Program table below (see Table 4.2-2).

Table 4.2-2 Master Program Area Requirements

LMH - Area Requirements (CGSM)*

Type

Current 2014

Right-Sized

2025 2035

Inpatient Platform

Medical Inpatient 2,700

5,655 9,555 13,845

PATH Unit** 2,890 3,655 5,355

Surgical Inpatient 1,070 2,340 2,275 3,185

ICU/CCU/HAU 430 960 1,520 2,080

Mental Health & Substance Use 860 1,170 2,080 2,535

Total Inpatient Platform Area 5,060 13,015 15,430 21,645

MICY Platform

Obstetrics / SRMC 1,575 1,710 1,425 1,520

Obstetrical / Gynecological Clinics 688 80 120 120

Pediatric Inpatient 765 425 510

Pediatric Clinics 40 40 40

Total MICY Platform Area 2,607 2,595 2,010 2,190

344

Surgical / Interventional Platform

Major OR Procedures

Major OR Procedures 725

PACU (Level 1 Recovery) 164

Level 2 Recovery (Day Care) 241

Interventional Radiology N/A

Endoscopy N/A

Level 2 Recovery (Day Care) Included above

Total Surgical / Interventional Platform Area 1,130 1,950 3,270 4,130

Interventional Radiology & Endoscopy

800 1,200 1,600

1,150 2,070 2,530

Emergency Platform

Emergent/Urgent Medical and Emergent Mental Health 870 1,920 2,700 3,300

Clinical Decision Unit Area 0 0 100 100

Total Emergency Platform Area 870 1,920 2,800 3,400

Ambulatory Platform

Medicine Cluster

Surgical Cluster

Cardiology Cluster

Mental Health & Substance Use

Other Clinics Cluster

Outpatient Rehab (PT/OT/SLP/Respiratory) 534 534 0 0

Total Ambulatory Care Platform Spaces 1,311 944 450 450

777 410 450 450

Diagnostic Imaging

CT Scan 135 405 405

Radiography 170 765 1,020

Fluoroscopy 85 85 85

Digital Mammography 70 70 70

Digital Breast Specimen Imaging 70 0 0

Ultrasound 210 350 420

Echocardiogram 70 210 280

Total Diagnostic Imaging Area 713 810 1,885 2,280

106

607



Clinical Support

Pharmacy 242 561 699 981

Lab 404 1,122 1,398 1,962

MDR 414 842 1,049 1,472

Total Clinical Support Area 1,060 2,525 3,146 4,415

Logistics

Material Management - 561 699 981

BioMed - 94 117 164

IT - 19 23 33

Environmental Services - 187 233 327

Food Services - Production - 1,216 1,515 2,126

Food Service - Cafeteria - 748 932 1,308

Laundry - 28 35 49

Maintenance & Operations 270 270 270 270

Total Logistics Area 270 3,122 3,823 5,257

Administration, Education, and Control

Facility Administration 270 444 444 444

Meeting / Conference Area 276 281 350 491

Medical Teaching and Education - - 450