Healthy hospital success
With hospital projects, it is imperative that engineers get everything exactly right—after all, the lives of patients treated in the health care building may depend on it.
Richard Heim, PE, LEED AP, Mechanical Project Engineer, RMF Engineering Inc., Baltimore
Tim Koch, PE, LEED AP, Electrical Engineer, HDR Inc., Omaha, Neb.
Nolan Rome, PE, LEED AP, Senior Vice President, ccrd, a WSP | Parsons Brinckerhoff Co., Phoenix
Raymond Schultz, PE, Project Engineer, CannonDesign, Grand Island, N.Y.
Kunal G. Shah, PE, LEED AP, RCDD, President, PBS Engineers, Glendora, Calif.
Tommy Spears, PE, Vice President of Design Solutions, TME, Little Rock, Ark.
CSE: Please describe a recent hospital project you've worked on.
Richard Heim: I was recently part of a hospital expansion project in Mt. Vernon, Va., where RMF Engineering provided mechanical, electrical, plumbing (MEP), construction administration, and commissioning services. The existing hospital had two major needs: more private patient rooms and low-temperature orthopedic operating rooms. A portion of the building was extended into a patient tower with three new floors, one of which remained a shell space to be fit-out later, as well as a mechanical penthouse above to serve the space. Additionally, an expansion was added at ground level for two orthopedic operating rooms with a basement mechanical room below to serve the space. Similar to the patient tower, this included a shell space for future fit-out of additional operating rooms.
Tim Koch: The new Parkland Hospital, located in Dallas, is a $1.27 billion health care facility replacing the existing 60-year-old community hospital. The HDR+Corgan Joint Venture team led the design for a master plan of a new 64-acre health care campus, as well as for the 2.1 million-sq-ft replacement hospital. The project consisted of an 862-adult-bed full-service acute care hospital, outpatient center, office center, parking for 6,000 vehicles, central plant, and other support facilities to achieve a new health care campus. Our imperative was to design a health care facility that wouldn't be limited by space and function in the future. We knew we must be flexible in our designs today to meet the needs of tomorrow—new technologies, new diseases, and even potential terrorist threats to our community.
Nolan Rome: Most recently, I led a group that finished the design of a new emergency department, campus power service, centralized campus generator service, and parking garage at the Banner—University Medical Center Phoenix campus. These are the first phases of an urban-campus master plan that includes a 15-story vertical expansion on top of the new emergency department, separate loading dock, and central energy plant expansion to be designed in early 2016. The project was designed with an integrated co-location arrangement with Banner Health, HKS architects, DPR construction, and daily subcontractor design integration from WD Manor mechanical contractors and Cannon and Wendt, the electrical contractor.
Kunal G. Shah: The Kaiser Permanente Moreno Valley Medical Center emergency department expansion and remodel project includes approximately 10,000 sq ft of addition and remodel to add 16 treatment bays to increase the total bays to 28.
Tommy Spears: Our company is currently designing a new hospital in Conway, Ark., for Baptist Health System. The new, $26 million facility will be approximately 208,000 sq ft and features numerous innovative design elements and construction methods. The 3-story facility will consist of 100 in-patient beds, seven operating rooms, and a Level 3 trauma center emergency room. To maximize efficiency, the facility will feature a variable-primary chilled-water and heating-water system, as well as variable air volume (VAV) with unoccupied/occupied controls in areas with high air-change rates. The building will also be equipped with an energy-management system that will allow problem diagnosis and corrections remotely, as well as a fully coordinated BIM model. Patient comfort features, including flexible exam lighting elements and bedside controls for HVAC and lighting, were also a high priority in the design.
CSE: What business development techniques are you using to gain hospital clients and/or projects?
Shah: In the fierce and competitive health care market, it is very important to showcase our relevant experience ensuring our prospective clients that our team can provide the support needed to deliver a project on time and within budget. Much of our business is through repeat work with our long-standing and loyal clients. Our goals are to serve them with the highest level of engineering service to afford the opportunity to be considered for future projects. To market to new facilities, we work with our contacts and administrators within the facilities to understand the architects working within their facilities and try to open lines of communication to have the opportunity to show our experience. We understand that this business is one based upon relationships, where relationships are key to success. In this light, we just appreciate the opportunity to develop such a relationship on a project or task. Thus, our position is that no project is too small.
Rome: We believe in strong personal relationships and maintaining a reputation through design integrity and team collaboration. Innovation with our project teams and a history of repeat support for our clients, including architects, owners, and contractors, provide the avenues for growth and development that we look for.
Koch: We believe that owners get the most value from an integrated design team focused on their project goals. Our teams focus on quality and on-time deliverables. We understand with projects that "change happens," and the more we communicate (and know what to communicate) the better the outcome. A shared voice and responsibility from all parties provides an efficient design of a successful building. Great design leads to clients for life; designing successful buildings and systems within those buildings leads to repeat clients/customers. When you consider that this entails all aspects and disciplines of a project design team being engaged in the project from schematic design all the way through construction, this simple objective can be challenging. More than 65% of HDR clients are repeat clients, and we have multiple clients that we have worked with for 30 or more years. This is proof that great design of successful buildings is one of our biggest marketing techniques.
Spears: The only technique that TME has found to be continuously successful is pure customer service. Our company has been built on the foundation of customer advocacy, which compels us to constantly adapt our methods and services to meet the needs of our clients at any given time. We seek out innovative ways to help our clients to continue to build their hospitals to meet the demands of today's health care environment. We put more design emphasis on the 75% cost associated with owning and operating the equipment in the facilities rather than the 25% cost to construct the systems. Any company can design a facility with the highest standards for energy efficiency, only to have those items value-engineered out of the project. Our focus is to help our clients understand the overall lifecycle cost of each aspect of the design and find alternative financing mechanisms that allow them to have a building that functions efficiently and allows them to provide the best possible service to their patients.
CSE: How have the characteristics of hospital projects changed in recent years, and what should engineers expect to see in the near future (1 to 3 yr)?
Raymond Schultz: It seems that all projects are fast-tracked from a design perspective. Engineered systems design begins earlier, and elements impacting building massing and performance should be agreed upon before the building shape is set. Locating main mechanical rooms, louvers, roof-mounted air-handling units (AHUs), cooling towers, chimney stacks, oxygen tanks, transformers, and fuel tanks prior to generating the first renderings can help avoid difficult conversations later on. We are beginning to see Lean processes and techniques embedded in the design process, and contractors are integrated early on. Their insight to equipment location, material applications, staging, and prefabrication help champion MEP requirements and streamline the design/construction process.
Rome: The integrated project delivery (IPD) approaches that we have been involved with in projects across the nation are showing proven improvements for the use of project capital and quality of work. Studies on building envelope and comparative energy analysis for equipment are helping to make informed decisions earlier in the process and to make better use of project capital upfront. I believe the next 1 to 3 yr and beyond will show integrated involvement from the owner's consultants. Integration of owner-furnished equipment, furniture, low-voltage systems, etc. to the design process will provide for better decision making for capital expense and construction coordination.
Spears: What we are seeing now, and expect to continue for several years in hospital construction, is a fairly even mix of new construction, renovation, and facility infrastructure projects. For many projects, hospitals are moving away from the traditional design-bid-build process to IPD and Lean construction, as these work better for many of our clients to maximize value. Design-build project delivery also has been popular for some clients due to a fast-track nature and quick delivery of the project to owners. The continued increase in facility infrastructure projects is due to the growing maintenance requirements of antiquated systems and a stronger focus on energy cost savings as hospitals struggle with the never-ending challenge of providing quality health care with rising costs and tightened budgets.
Shah: We have seen that schedules and budgets are compressed intensely. With the limited funding and resources that many medical facilities have, they have to make each dollar go further. Thus, we must ensure that our designs are meeting the programmatic goals, but at the same time allowing flexibility to allow for expansion or further development as funds flow. Further, we see a much more integrated team approach to the hospital projects, where the design team and contractor are engaged early and regularly to ensure a project is efficiently designed and built. This early teaming allows the entire construction team to be collaborative and remove the contentious stigma associated with design team-contractor interactions. We have been fortunate to be a part of many great design-build teams where this relationship flourished and resulted in a successful project.