When the UCSF MedicalCenter set out to combine three of their laboratories into one, Reid Rosehill, MS, MLS(ASCP)CM, lab manager of clinical laboratories, didn’t quite know what he and the rest of the clinical laboratory were in for. Not only did the lab still need to operate during the renovations, but the design changed for reasons that he couldn’t fathom—like the weight of the refrigerated storage module. The construction team couldn’t just put it anywhere. It had to go where the building could support such a heavy item, and that placement determined key elements of the lab design. “You’d never think about how something is too heavy for the floor,” he said.
Remodeling a lab can be a frustrating, tedious, and at times surprising process, but one that’s becoming increasingly common as small, cramped spaces for each kind of laboratory have fallen out of fashion, and as automation of clinical laboratory processes have become more common.
If change hasn’t come for your laboratory yet, it may soon. According to a report from research firm MarketsandMarkets, the global lab automation market size is expected to grow from $4.3 billion in 2020 to $5.5 billion by 2025.
“It’s daunting when you’re faced with an older facility. You have HVAC issues or mechanical, electrical, and plumbing issues, or you know that your pure water isn’t pure anymore, and you have a series of small rooms for all your activities and you want to put a new line in there,” said Marilee Lloyd, AIA, senior laboratory architect/planner at HED, who has been working on laboratory designs and remodels for more than 30 years. “It can be mind-numbing and overwhelming.”
Communication between stakeholders—from bench laboratorians to construction project managers to hospital administrators—can help ease the process. “People just want to know what’s going on,” said Rosehill. “If the team is aware of what’s coming and they understand that there are benefits at the end of the tunnel, including a nice, new automated lab they get to work in, they’ll have more patience with the process.”
Work Together From the Start
When Stanford Healthcare set out to remodel a 11,400 -square-foot space into a new clinical laboratory, everyone had to be at the table from the start of design, said Raffick Bowen, PhD, MHA, MLT(CSMLS), DCLCHEM, FCACB, DABCC, FADLM, codirector of the clinical chemistry and immunology laboratory at Stanford Healthcare. “We made sure to have all key stakeholders involved. That meant not just electricians and the architect, but lab staff—and not just higher-ups.” That included clinical lab scientists and “key personnel who would be working at the benches.” The team continued to have stakeholder meetings once a week, which allowed the plans to be scrutinized from both the construction feasibility and the lab functionality points of view.
Bowen said they also used mock simulations “where we pretended you’re a tube going through the lab,” he said. They helped because “sometimes those computer simulation models don’t really reflect what’s going on in the lab.”
Rosehill also made sure to share the initial design drawings with the team and asked for their input, telling them “there’s no guarantee I can give you everything you want, but what are your thoughts?” He kept getting their input throughout the process, especially as things shifted and changed.
While lab directors might feel out of place when speaking to construction and design professionals, especially if they don’t know some of the lingo, it is an important step for the finished product to be the best possible solution for their needs, Lloyd said. Talking up front about a potential issue or needed shift early in the process can also avoid costly changes later.
“We try to ask a lot of questions about equipment and try to understand all of the lab’s services,” Lloyd said. “It’s not just the weight and size of items or their intended location but also how they’re going to get into the building.”
Laboratory professionals won’t need to suddenly become construction experts either. Most hospitals and healthcare systems will provide a construction manager or an “owner’s representative,” who comes to the job from a construction or design background but works for the parent company. That person represents the interests of the laboratory and also the hospital administration, and is the go-to person when solving surprises—like finding pipes in a wall when they aren’t on a drawing—and dealing with design changes and potential cost overruns. This role also will help coordinate utility shutdowns (things like power, water, and air conditioning) which can affect multiple floors and multiple departments.
Expect Changes, and Be Flexible
If your lab is located inside an older building, expect the unexpected, Rosehill said. Their 3,000 square foot laboratory is located in a building first constructed in the 1950s. “Everybody tries to do their homework in the beginning and look at the ceiling and behind walls, but until you start demolition, you don’t know what’s there,” he said.
Their design changed multiple times, and the placement of automated lines had to move according to what the building allowed. The project budget wasn’t big enough to strengthen the foundations of the building, so the refrigerated storage module and HVAC unit could only be positioned in limited spots based on what the building could support. “We had to work with our engineers to identify where we could place it and then redo our entire line configuration,” he said. He also made sure to keep a project journal with key decisions and discussions documented in case he needed to reference them in the future.
Bracing for the complexity of a remodel, and focusing on the benefits of the temporary pain, can help staff get through the renovation, too, Rosehill said. That’s especially true if your laboratory is being renovated in phases instead of moving from one space to another. For UCSF, half of the space was remodeled at a time, which meant that managers’ offices were moved to a different floor and some testing benches were put in a different room. Once the first half of the work was finished, they moved into the renovated part and vacated the old space so it could be renovated, too. “It was pretty disruptive for a while. Our team had to transport samples to two different rooms. But it was doable,” Rosehill said.
The remodeled lab opened in mid-2020. Rosehill said automation hasn’t fixed every issue the lab had, and having staff learn an entirely new system when their lives were already disrupted by the pandemic was a unique challenge. But the new space is a less siloed laboratory with automated lines. They’ve seen improved turnaround times, increased capacity, and they experienced fewer errors and delays.
Stanford’s new lab went live in 2018, and they’re already making changes by adding new equipment and reconfiguring the space to accommodate it. Bowen said he learned from the remodel process how important it is to have everyone involved. He might know what items he wants, but the vendor is going to know what kind of electrical outlet and other support systems their equipment will need and can communicate that with the design and construction teams. “Before we moved on, we made sure we got sign off from everyone,” he said.
While the construction process can be mystifying for people who are more used to working with assays and centrifuges than RFIs and change orders, clinical lab staff are still essential to the process, and Lloyd said that construction and design professionals should never talk down to the people who will be the end users of the new space. “It’s important for us to be able to come in and just take it step by step,” Lloyd said. “It’s like peeling an onion. Yes, sometimes you want to cry, but it’s important to understand all those layers so we’re understanding the whole.”
Jen A. Miller is a freelance journalist who lives in Audubon, New Jersey. @byJenAMiller