Mastering the Multi-Campus Planning Process

Scripps Health Master Plan

Each year the Healthcare Facilities Symposium brings together a diverse cross-section of designers, providers and collaborators to educate, inspire and elevate healthcare design. As one of several scholarship recipients from across SmithGroup, I had the opportunity to join a session presented by my colleagues from Los Angeles on tackling the challenges of a multi-campus masterplan.

Beginning a decade-long relationship as Executive Architect for Scripps Health, SmithGroup first developed a strategic, multi-campus master plan for the San Diego-based, non-profit system to support their $2.6 billion capital program. Together with the Scripps team, SmithGroup drove the strategic realignment and redevelopment of Scripps Heath’s three largest campuses in San Diego, Encinitas, and La Jolla.

My California colleagues, Chai Jayachandran and David King, as well as Scripps Vice President of Construction and Facilities Bruce Rainey, MHA and Issam Khalaf of Jacobs Engineering, addressed the challenges faced by Scripps Health as they contend with major regulatory deadlines, a growing market, and the need to align services with demand.

Scripps has a long history in Southern California as a top-tier, non-profit system, and its mission and values acknowledge that heritage while reflecting a future-forward approach. This aligned well with SmithGroup’s future-forward mission and helped create a shared value proposition of “...always the right care, at the right place, at the right time…providing the right space, in the right place, at the right time.” To embark on this endeavor with multiple stakeholders and at such scale, defining shared goals and vision very early on was essential.

The effort was largely driven by forces currently impacting the healthcare industry and in California in particular, within the context of long-term planning for a more ideal future. This includes lowering Scripps’ operating costs due to policy and coverage changes as well as shifting from volume- to value-based delivery through an improved system of care. It is indicative of the trend toward a more consumer-driven approach, decanting services to outpatient settings for convenience and lower costs.

For Scripps, this was defined by their long-term planning for 2040-2050. This long-term thinking includes building for flexibility to adapt to future changes while transitioning from the current to future state. With regard to regulatory requirements, OSHPD (California Office of Statewide Health Planning and Development) required clear goals; for example, to build minimum-code administration areas in expensive OSHPD inpatient space only where essential, and decant remaining admin space to non-OSHPD buildings.

This encompasses rightsizing the program for inpatient, ED, observation, and surgery within the hospital. In essence, don’t overbuild or over-bed since the community has capacity, but build in growth potential at each facility.

With the requirement by state law to upgrade all seismically-outdated acute healthcare spaces by 2020, California has some of the newest—and most expensive—healthcare facilities in the country. The average cost of OSHPD-reviewed space is $1,500 or more per square foot, which makes decanting services to outpatient facilities a strategic opportunity.The planning strategy also allows Scripps to create more cohesive campuses that fill in missing gaps throughout the larger system. Of particular importance was creating additional space for further expansion or development, the proverbial “empty chair” needed for future flexibility. Mr. Rainey stated, “I need to give someone in the future the ability to fix my mistakes. That is future proofing.” Acknowledging that future-proofing requires ample space and the acceptance of mistakes helps to clarify priorities across the system and speaks to a culture of continual improvement.

I need to give someone in the future the ability to fix my mistakes. That is future proofing. 

Bruce Rainey, MHA
Vice President of Construction and Facilities, Scripps Health

With over 100 user group meetings covering the three major campuses and 22 functional areas, SmithGroup’s interdisciplinary team had a daunting task ahead of them. But tackling all three campuses concurrently had advantages as well. To ensure a high level of care, having staff trained consistently with little variation requires design standards. Across such a large and complex system, creating systemwide design standards was particularly helpful as SmithGroup applied the planning and design strategies across all three sites. By relying on Scripps’ standards to organize and plan spaces across the multi-phase project, the team was able to leverage economies of scale, which helps with purchasing and procurement with vendors. Over the long-term, this will also help with maintenance and operations given the servicing of standardized systems and equipment.

The master plan also addresses the growth and development of each campus. Each campus has differing strengths and weaknesses, and specific program requirements and facilities in various states of use and age.

For the Scripps Mercy San Diego campus, a multi-step implementation plan includes building a new MOB, maintaining an operational ED and renovating an existing historic office building while executing a new 650,000-square-foot replacement hospital. Scripps Memorial Hospital Encinitas requires a new MOB and acute care facilities, demolishing some existing buildings to create additional space. The plan for the La Jolla campus adds a new hospital tower alongside a recently built tower and demolishing older facilities.

In the space of less than a year, the combined Scripps/SmithGroup/ Jacobs team shepherded this master planning process through to completion. Architects have been selected for implementation projects at all three sites and are moving forward with pre-design—a remarkable achievement given the complexity, scale, and compressed time frame.

This multi-campus masterplan for Scripps Health was a terrific opportunity to showcase SmithGroup’s integrated design approach to long-term challenges. Not only will this endeavor have a profound impact upon the built environment of the greater San Diego region for generations to come but it will significantly improve the lives of patients, staff, and residents across Southern California.