Presented by Bob Ruebusch, Senior Project Manager Office of Design & Construction

Florida Hospital Snapshot  Part of Adventist Health Systems faith-based non-profit nationwide 44 hospital chain  8 Campuses in Orlando under one license with 2,377 licensed beds  Approximately 40% of entire AHS system’s revenue  Largest hospital in US (by patient visits per year, over 1 million)  ODC – In-House Program Manager 2

 Affordable Care Act (Obamacare)  Changing Demographics  Changing Reimbursements  Technology  Physician Alignment  Sustainable Design  Integration  Workforce Shortages  Convenience  Expandable  Changing Clinical Needs  Home Care Support  Cost Containment - Value 3

Two Distinct Visions with Some Common Themes: 1. The Really Nice “Cookie Cutter” Model 2. The Whole Health Campus Model 4

 Treating More People for the same $  HCAHPS - The patient votes how much you get paid  Modularity / Standardization / Universal Concept  Efficiency / Flexibility / Expandable  Building Systems Integration  Sustainable Design  LEAN  More Ambulatory Patients  Safety  Process Driven  Physician SWARMs  Decreasing Bed Count  Manages “Chronic” Illnesses more efficiently  Outsourcing Models - CVS ED? 5

 Big MOB  Modeled after Large Inner City Public Hospitals  Kaiser Permanente  Evidence Based Design  Computerized Planning Programs  Less Costly / LEANest / Most Efficient / Fewer Employees 6

 More Patients for Same $  Patient Surveys Determine Payment  Modular Designs / Universal Concepts  Efficient / Flexible / Expandable  Building System Integrations  Front of House / Back of House  Sustainable  LEAN  More Ambulatory  Safety 7

 Whole Health Campus with Wellness Emphasis  Efficient but Family Focused  Wellness / Health Ctrs Onsite  ED / ASC / POB Onsite  Cancer Care Onsite  Retail Community Services  Child Care Onsite  Focused on Ambulatory Care & Medical Retail. (It just happens to have a Hospital)  Hospitalization = The Failure of the “Whole Health” System 8

 LEANer  More efficient than now  More family-focused  Retail Campus look  Focused on wellness to drive down cost 9

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1. Nurse Call Replacement 2. Lab Expansion / Renovation 3. OB Unit 4th FL 4. Inpatient Unit 7th FL 5. OR / Surgery Expansion 6. Install MRI in Old Lobby 7. North Market Ortho Practice 8. ED / ICU Study 9. IV Start Room / MOB / Outpatient Radiology 12

 CT Addition  Dr Alonzo 13

1. Global Robotics /ENT Head & Neck Surgery 2. Door Security Upgrade 3. Fire Issues / Atrium Evaluation 4. Parking Garage 5. L & D Triage Expansion / Renovation 6. Cath Lab Expansion 7. Fitness Center Interior Reno 8. MOB 9. Pharmacy 10. 5th FL Beds 11. Lobby Admin / HR Interior Renovation 14

1. 5th FL Build Out PCU 2. East Master Plan 3. East Pharmacy 4. ED Expansion 5. Replace Portions of Roof w/Suprema 6. FH East Rehab (3rd FL MOB) 7. CDU Renovation b Infusion Suite 15

1. KSM Bed Tower / CEP / Connector 2. Urology Table Installation in OR 3 3. KSM ED Expansion 4. KSM OP Neurology Practice Buildout b Infusion Suite 16

1. AHS Florida Division Headquarters 2. Women's Hospital 3. CEP to EOB Chilled Water Connection 4. Pediatric Prep & Recovery (POPS) 5. Miscellaneous Engineering 6. 3rd FL Med Plaza / Dean Cole Practice Expansion Orlando 7. Orthopediatric Urgent Care Center Princeton / 2nd - 5th FL Corridor Renovation Project 9. Suite 401 Dr Fals Princeton Bldg 10. Panera Lobby Extension HV MOB 1st FL 11. Marketplace Outfitters 12. Adventist University Fire Alarm Upgrade 13. Orlando Parking Garage (1,241 spaces) 14. Ginsburg 12th FL PCU 15. Nuclear Med / MR 1st FL 16. Orange King Sign 17. Orange / King Street Widening 18. OR's 14, 15, 19, 20 Peds 1 N PACU 19. Nutritional Services Call Center 20. Perimeter Lockdown 17

21. Peds 1 N PACU 22. Peds CVOR / CVICU Elevator 23. Radiology Master Plan 24. INR / 75% Complete 25. ProFil 3rd FL TRI Build-Out 26. Gamma Knife Relocation 27. Welch Café Renovation 28. Ginsburg 4th FL Bathrooms South Renovation 30. Women's Grease Trap Relocation 31. Women's Underground Utilities Relocation 32. Nurse Call Upgrade 33. Children's Lobby Office 34. Cardiology Security Modifications 35. CVOR Central Process Decontam Room 36. G-7 Ultrasound 37. Dispatch Relocation 38. Enclose Alcove Across from ED Imaging Rm Central Pharmacy Distribution Center 40. Imaging Residency Program b Infusion Suite 42. New Laundry 18

1. I Am Safe Project 2. Winter Park Master Planning 3. Surgery Conference Room 4. Cancer Center Expansion 5. Women's Pavilion 1st Floor Build Out 6. South Wing 24 bed Expansion 7. Women's Center in Dr. Breit Building 8. Patient Wall Lighting & Fire Pump 9. Parking Garage (770 Spaces) 10. Endoscopy Relocation & Renovation 11. MRI Equipment Install & Renovation 12. ED / OBS Care Renovations 13. Replace Exterior Directional Signage 14. North Tower Master Plan Study Only 15. Build-out 1st FL Baby Place for Imaging 19