During hospital construction, constant planning and communication are top priorities for healthcare builders
The foremost focus in upgrading or expanding a hospital is keeping the work concealed from the patients. So says Steve Whitworth, Kitchell’s Healthcare Division manager, about hospital construction.
It’s not like adding or enlarging a store in a retail center, which might force shoppers to step around a construction barrier for a few days or have the piped-in music occasionally punctuated by a floor sander.
“In a mall, people will be inconvenienced. In a hospital, a patient’s health is at stake,” Whitworth says. “In every single project we strive to be invisible. The ability to heal depends on the environment a patient is in. It‘s the only thing that matters at the end of the day.”
The dilemma is that hospitals, as much or more than other commercial real estate structures, need to continuously get bigger and better, he says.
“Planning, planning, planning,” is the key to keeping healthcare facilities humming smoothly while making major renovations, says Jay Stallings, associate administrator at Banner Desert Medical Center, which unveiled a major emergency department makeover in August.
That mantra is echoed by other key players — from hospital administrators to construction engineers — who are continuously upgrading and expanding Arizona’s top hospitals to address medical care’s changing needs and technology advances while keeping the work virtually imperceptible to patients and staff.
Unlike other types of commercial real estate overhauls or tenant improvements, healthcare property renovations come with a whole host of hurdles, from meeting infection control standards to keeping emergency entrances accessible.
The biggest hurdle — no down time.
“What makes a hospital unique, is that it’s a 24/7 facility. There’s never a good time to do the work,” says Sundt Construction’s Russ Korcuska, who has been piloting hospital construction projects in Arizona for two decades.
To maintain top-notch patient care, innovation and expansion is necessary, but upgrading existing facilities means you can’t turn off the power, the water or other utilities, you can’t block fire escape routes or ambulance entrances, you can’t let construction dust or other contaminants get in the air, and you can’t make a lot of noise or cause other disturbances that could impact patients or staff operations.
“If a surgeon is working on somebody’s brain, you can’t be creating vibrations on the other side of the wall,” Korcuska says. “It’s extremely challenging.”
That’s why planning an entire project and all possible contingencies to the tiniest detail before ever flipping a power switch is so critical, says DPR Construction’s Guy Sanders, who is just finishing up Banner Good Samaritan Medical Center’s three-story expansion of operating rooms and pre/post operative care areas.
Especially in renovating older hospitals where documentation of what’s in the ceiling and under the floor is not always complete or accurate, he says. “Knowledge of a campus is critical,” Sanders says. As is double-checking before digging.
During the Banner Good Samaritan project, he planned for alternative power sources to keep all ongoing operations running smoothly based on detailed building documentation. Still, during the planning process, he flipped a breaker and did a walk-through of the whole hospital to ensure the documentation was correct. It wasn’t.
Sanders found some equipment mislabeled and had to do some rewiring — and re-documenting.
Proper planning is crucial
Chris Jacobson of McCarthy Building Companies is just completing a major project at Banner Thunderbird Medical Center. He added a new six-story tower and emergency department expansion in the spot where the old ambulance entrance stood, and then renovated all the newly vacated space after 25 departments relocated to the tower. The project is slated to wrap in January.
It has been a five-year, multi-phased project, with planning for every phase starting almost a year in advance, he says.
Jacobson and his crew had to design everything from infection, noise and dust control to fire exits — and figure out how to get workers and materials in and out of the construction sites without bringing them through the hospital. They plotted everything, “even down to which tools to use.”
“You have to get creative about how to get the work done without coming in with a wrecking ball,” he says.
The biggest challenge was how to keep the existing emergency department functioning while “de-constructing” the old ER entrance. Jacobson says the solution devised in the planning process — building a covered bridge from a new temporary ambulance entry a short distance from the construction site — was key to McCarthy landing the job.
“It was a big challenge that nobody had figured out,” he says.
And that wasn’t the only temporary structure the construction experts had to design and build before even starting the main event. They crafted fire-rated, sound-insulated temporary walls, new directional signage, and a complete hospital kitchen in a trailer.
They even planned and built a temporary super-structure that looked like a massive, free-standing fire escape outside the hospital tower to get workers and materials to upper floors without ever opening a hospital door.
McCarthy used a similar technique for building out Yuma Regional Medical Center’s upper floors, which were pegged for expansion space when the hospital was first built. The engineers planned and built an outdoor elevator and trash chute to keep patients and staff below from commingling with construction workers or debris on indoor elevators.
At Banner Good Samaritan, DPR had to excavate an area between the central power plant and the new expansion. Before bringing in the backhoe, Sanders employed a “vacuum” truck to suck up some of the dirt and expose the utilities.
Among the most interesting planning tools McCarthy engineers use are laser scans of a hospital’s ceilings and floors to find exactly where all the pipes, wires and ducts are located, and 3D modeling software to virtually tuck new utilities amongst the old.
“The old way was you had guys with flashlights and measuring tapes,” Jacobson says.
Sometimes engineers have to detour planned utility upgrades to avoid a virtual collision. That’s much better than having workers face a real utility roadblock and have to rethink routes in the middle of a messy construction site, he says.
If planning is atop the experts’ priority list for minimizing patient disruption during construction, keeping everybody in the loop scores a close second place.
A critical component of both planning and construction stages of any healthcare project is communication with all the stakeholders, says Stallings, whose new triple-sized, state-of-the-art emergency department took seven years from drawing board to debut.
Stallings says involving every hospital department touched by the project from start to finish made the process as painless as possible for them and especially for patients.
“This was a collaborative project with physicians, staff, clinicians, infection control, environmental services,” he says. “All were impacted. We worked hand-in-hand with the architects and construction staff. We had weekly construction meetings, sometimes daily, with all who were impacted.”
“We provide an important service to the community. We couldn’t shut down the emergency department and continue to be a hospital,” Stallings says. “In the moment when somebody needs help, we have to be there. We take that very seriously. Our approach was transparency (to patients), collaboration, a high level of communication and training.”