Insights on the New University of North Dakota School of Medicine and Health Sciences Building

This September 20, HTE correspondent Marty Kauchak conducted an exclusive interview with Joshua Wynne, MD, MBA, MPH, the vice president for Health Affairs, Dean, of the University of North Dakota School of Medicine & Health Sciences, regarding the school’s newly opened building. An overview of their discussion follows.

This August a new $124 million, 325,000-square-foot, four-story University of North Dakota School of Medicine and Health Sciences building in Grand Forks, ND opened for instruction with the building fully functional. Indeed, the Medical School class of 2020 arrived on August 1 to start classes and all other healthcare community learners are also taking classes in this new structure.

Dean Wynne noted there were two imperatives for constructing this building. In one instance, North Dakota, as a rural state, has a distribution problem with its healthcare providers, with more of these professionals in the cities and fewer out on the state’s prairie regions. “That’s been a real challenge and that has been exacerbated by our aging population and the oil boom,” Wynne said. Concurrently the Healthcare Workforce Initiative was developed to address the state’s healthcare workforce challenges. Two of the initiative’s pillars supported by this new facility include providing the capacity to train more healthcare providers – by about a quarter overall – and improving the efficiency of the healthcare delivery system. Wynne clarified, “We don’t deliver a lot of care, but we train a lot of people who deliver a lot of care. It is clear if we could get people to work better on inter-professional teams and improve teamwork, that would reduce inefficiencies, improve coordination, lower costs and improve patient outcomes.”

And in retrospect, the department leader said the initiative’s pillars supported quite readily by the new Medicine and Health Sciences building would have strained the previous physical plant, which was operating above national norms for efficiency, and was unable to house all university healthcare departments – providing yet another challenge to conducting inter-professional education.

Wynne further observed the new facility was delivered on-time and on-budget.

JLG Architects, designed the four-story building in partnership with Perkins+Will and Steinberg Architects. The architectural designers are collaborated with PCL Construction/Community Contractors (PCL/CC), chosen by the University of North Dakota to provide construction manager at-risk services for the project.

Overarching design components for the building also included flexibility with an eye on tomorrow’s healthcare community horizon. “This anticipated where things were headed in medical education rather than building a building for today – anticipating tomorrow. It is quite high tech but is important as flexible as we could make it,” Wynne pointed out.

Another aspect of the building’s flexibility permits classrooms to be arrayed in different configurations and, more important, permit the building to adapt as teaching modalities evolve through the next decades.

This author asked Wynne to provide some early returns on investment (ROI) on the $124 million building. The first ROI is the confident, compassionate and communicative healthcare workforce that will be trained and educated in this building that will help North Dakota and the region. A second ROI (financial), is the deferred costs on the 60-year old building formerly used by the department were expected “to be enormous.” Wynne continued “A brand new building will obviously have much reduced, deferred maintenance costs. And while we don’t have a fully certified, completely ‘green building’, we use that technology in the building so the relative technology costs will be less as well.” The building will also support research. As federal government grants typically have indirect cost returns associated with them (facility and administration (F&A) fees), Wynne continued, that because of the way F&A is calculated, “having a new building that was built by the taxpayers of North Dakota will result in the future, in an increase in our indirect cost return and the building will ‘generate money’, if you will, to help support research endeavors in the future.”

Jon Allen, MD, FACP, an associate professor of Medicine at the university and Director of ND STAR (North Dakota Simulation, Teaching and Research Center for Healthcare Education), extensively coordinated  the latest learning technologies to be used by learners in the new building, and the optimum physical layout of rooms to accommodate training devices and other equipment.

Some HTE readers may be aware that ND-STAR designed and implemented SIM-ND, a statewide, mobile education system using high-fidelity human patient simulators to train pre-hospital and hospital personnel.

Wynne further observed the new buildings’ classrooms and instructional rooms run the spectrum from the standard sort of traditional, small-group, learning rooms to the most up to date, small group, high tech environment. “From the point of cost and efficiency we do not use the highest tech in each and every student study space – it wouldn’t be necessary, appropriate or cost-effective. Rather we have a gradation of sophistication that matches the needs of the learner,” he added.

Asked to provide lessons learned for other community organizations embarked on constructing new healthcare buildings, Wynne emphasized the single most important thing is “To build the building that meets your educational research and service needs. Don’t build a beautiful building and then try to adapt the space to what you want to do. It has to be the other way around. The analogy in business (and we’re in education) is budgets don’t determine programs, programs determine budgets.”

The university official then highlighted the importance to “minimize own space and maximize flexible space.” Noting that team science and team approaches to education are clearly preferred today and are the optimal way to learn, “therefore having an office that belongs to me is the antithesis of that. What we have put in the building and believe in this, is to make it as adaptable and as common space as possible. We do that with carrels instead of individual offices. In our research space we have open labs instead of individual labs, and we’ve moved the offices out of the research labs and clustered the offices together rather than having them embedded into the research labs which leads to ‘silos’ and lack of collaboration.

Wynne further suggested that new designs maximize opportunities for collaborative interactions. In the case of the new University of North Dakota medical building, a grand staircase was constructed in the middle of the building to not only encourage students and staff to exercise, but to allow parties to continue their discussions – which often are limited or end when individuals enter an elevator.

“Point number four, and without getting into a deep discussion or debate about the future of libraries in buildings, I would say we were aggressive in limiting the amount of stack space, especially for journals and maximizing the use of specialists (librarians and data specialists). We moved them out of the library and embedded them with the users – faculty, staff and students – throughout the building. While libraries are essential in buildings like this, they don’t look the libraries you and I grew up with,” he concluded.