Tag Archives: Kitchell Healthcare Division

Hospital Construction - AZRE Magazine November/December 2011

Please Do Not Disturb: Hospital Construction Zone

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.

Finding solutions

Banner Thunderbird Tower - AZRE Magazine November/December 2011Unlike 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.”

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www.dpr.com
www.kitchell.com
www.mccarthy.com

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AZRE Magazine November/December 2011

Pediatric Hospital, AZRE Maagazine May/June 2011

Healing Young Bodies: Building a Pediatric Hospital

Building a Pediatric Hospital

At a pediatric hospital, the healing process should begin as soon as Mom or Dad drives up the driveway to look for a parking space. That’s where it all begins for the young patient and his or her family. And that’s where the differences begin when it comes to building a pediatric hospital, as compared to a “traditional” facility.

After completing three pediatric hospitals in Arizona within the past two years, Kitchell has refined strategies and tactics regarding these special hospitals, which have become ever more complex as technology advances and medical care evolves to treat increasingly acute patients.

Over the past two years, Kitchell has been CMAR (Construction Management At Risk) for Banner Desert Medical Center’s Cardon Children’s Hospital in Mesa, the recently opened Diamond Children’s Center at University Medical Center in Tucson and Phoenix Children’s Hospital.

Fortunately for hospital architects, engineers and builders, there is solid research to draw upon to guide the development of the most effective, functional children’s medical campuses.

Transformation by Design, produced by the National Association of Children’s Hospitals and Related Institutions (NACHRI), reviewed 320 evidence-based design studies published in academic literature. This report concludes “the physical environment of healthcare settings affects the clinical, physiological, psychosocial and safety outcomes among child patients and their families.”

The No. 1 goal as builders is to produce a stress-reducing, healing environment, while reducing the chances of infections and medical errors. There are several issues to consider when constructing pediatric hospitals:

Pediatric IPD

Bringing all stakeholders, including young patients who are “frequent fliers” at the hospitals, as well as owners, architects, engineers and contractors, into the pre-design phase has proven highly beneficial to construction outcomes. The theme, Through the Eyes of a Child, drove the entire Cardon Children’s Hospital project. And Diamond Children’s Medical Center hosts two ongoing advisory councils comprised of children and teens. Initiatives like these ensure children’s perspectives are always front and center.

Phoenix Children's Hospital, AZRE Magazine May/June 2011Motifs/Theming

Theming to engage and entertain is certainly the most obvious defining characteristic of a pediatric hospital, but how to achieve the right tone, taking age-appropriateness into consideration, is far from obvious. Creating a sense of comfort and fun for a toddler is very different than creating a sense of coziness and relaxation for a teenager, both of whom will be sharing space. Some hospitals cultivate a playground/amusement park feel, while others try to maintain a more staid, yet welcoming youth-driven atmosphere. Cutting-edge technology is being utilized to bring “edutainment” and social media options directly into patient rooms.

Noise Maintenance

A quiet environment may reduce recovery time. Rubber flooring with high STC acoustical ratings has replaced vinyl sheeting predominantly used in the past.

Creative Materials

Multiple textures, varied artwork and soothing finishes reinforce the healing process. Highly durable, vibrantly colored terrazzo flooring is currently very popular. Natural elements, such as whimsical water features, are a dynamic way to bring the outside in (and engage the senses of hearing, smell and touch, as well as sight) to what has traditionally been a cold and sterile place.

Lighting

Studies show natural lighting helps babies heal faster. The industry is coming up with creative ways to integrate natural lighting with state-of-the-art LED interior lighting that enables healthcare staff to perform their jobs effectively, but is also pleasing to the patients — a huge leap forward from the harsh cathode lighting of the past.

Pods vs. Private Rooms

What is better for the youngest patient and family, a private room or a pod arrangement? This is actively being discussed right now. The benefits of private rooms seem obvious, but healthcare experts value the interactive nature of community-oriented pod set-ups, which are conducive to family-to-family interaction. After all, no one can relate to a family’s ordeal better than another family simultaneously going through the same challenges. Current designs have trended toward private rooms, but family areas, clinical programs and hospital-directed family support groups have promoted the “community” healing benefit for the young patients.

Space

At pediatric hospitals, more space is needed to accommodate more than one family member. For example, ample space is available for fold-out beds and private guest showers in patient rooms. In general, there are more “soft” spaces for siblings and other family members. The most critical issues to consider when constructing or expanding a pediatric hospital? All involved need to minimize negative impacts to the recovering patients. “The patient comes first,” says Mike Wolfe, a Kitchell project director. “If you or a loved one had the misfortune to be in a hospital that was undergoing construction, would you want a construction crew to be jack-hammering concrete in the middle of the night? Working in and around children’s hospitals requires extra sensitivity and flexibility to work around patients’ needs.”

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Some Unique-to-Pediatric-Hospital Construction Features

  • Expanded kitchens to fulfill children’s menu preferences (pizza, stir-fry, etc.)
  • Treatment rooms on each floor so patient bedrooms are “pain-free” safe havens
  • Wireless Internet access for each patient and their families
  • Interactive play/family spaces on each floor
  • Teen activity rooms
  • Lactation rooms
  • Auditorium/stages for children to see performances, concerts, graduations
    or have parties
  • Meditation rooms
  • Healing gardens
  • Toy stores

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 AZRE Magazine May/June 2011