exp: Health City Cayman Island

New construction of a hospital/health care facility

By exp August 17, 2015

Engineering firm: exp
2015 MEP Giants rank: 14
Project: Health City Cayman Island
Address: Grand Cayman, Cayman Islands, United Kingdom
Building type: Hospital/health care facility
Project type: New construction
Engineering services: Commissioning, retro-commissioning; Electrical, power; Fire, life safety; HVAC, mechanical; Plumbing, piping; Technology design
Project timeline: 12/31/2012 to 3/1/2015
MEP/FP budget: Classified


The project involved the design and construction of a new greenfield hospital on Grand Cayman (a British territory). The hospital is a joint venture between India-based Narayana Health and U.S.-based Ascension Health. The hospital is a health care destination and provides world-class services at a fraction of the cost of U.S.-based health care.

Challenges included coordination among several groups in multiple countries including the hospital staff based in India, equipment suppliers located in both India and the U.S., code authorities/authorities having jurisdiction (AHJs) located in Grand Cayman, and the design team located in the U.S. Furthermore, hospital design is a composite of both Indian and U.S. practices. Both U.S.-based codes/standards and Cayman-based building codes were used by the designers and enforced by the local AHJ, however, this hospital staff is Indian-trained and have some health care delivery models that differ from U.S. practices. Finally, the owner desired that the hospital be Joint Commission International accredited.

Furthermore, the hospital was built on a small Caribbean island where building materials common to health care construction were not often available. With the high cost of shipping to the island, as well as the possible delay associated with shipping time, careful consideration was given during design to the use of material and construction requirements.

From an engineering perspective, a major challenge involved the need to provide a building that maximized the use of power and natural resources in a very hot/humid climate with a high electrical power and water cost (three to four times that of much of the U.S.). This occurred in an environment where power reliability can be suspect and where hurricanes are a major threat.

Finally, the design and construction schedules were very aggressive for this project. Design was completed within 6 months and construction was completed in approximately 1 yr.


To accomplish the integration of an international team of building owners, designers, and code requirements, a detailed design charrette was held early in design. This meeting included all stakeholders including India-based staff, U.S.-based designers, Caymanians, and major subcontractors. At this stage, design intent was determined earlier than in the typical design process, building materials were decided upon, and review of U.S.-based health care design standards and India-based health care practices were reviewed to ensure compatibility. Furthermore, general contractor Deangelis Diamond Healthcare Group teamed with local Caymanian contractor Clan Construction to help understand local building practices and forecast labor needs.

To help ensure an aggressive design schedule, engineering design often had to proceed prior to important information being available (such as major hospital equipment selection and placement). Due to Exp’s extensive health care experience, engineering design proceeded based upon the experience with similar greenfield hospitals and major additions. Using benchmarks and best practices refined from previous work, designers anticipated engineering infrastructure needs. Once further information became available later in design (and sometimes even into construction), assumptions were confirmed and revisions/tweaks to infrastructure occurred when needed.

To help improve the construction schedule and maintain quality on site, several additional steps occurred. This was especially important for this project as any modifications in the field likely required new material to be shipped from the U.S. This would lead to higher construction costs and delays to the schedule. The following steps were implemented:

  • Preconstruction cost-analysis of major systems
  • Prefabricated bathrooms for all patient bedrooms were designed early, constructed in the U.S., and shipped to the job site
  • Intensive preconstruction coordination including full 3-D review of major engineering systems. All systems were designed and computer-modeled prior to fabrication of materials.

To provide an energy-efficient building in a remote Caribbean island (with high humidity and heat) subject to hurricanes and with high-cost utilities such as water and power, the following was included in the engineering design:

  • Rain collection and storage in cisterns for greywater, fire water, and irrigation
  • A dedicated outdoor air-handling system to pretreat outside air
  • Design of the HVAC system to allow for future connection to a planned seawater air conditioning system
  • Design of electrical system to accommodate future photovoltaic connection
  • Design on on-site water and sewage treatment
  • A standby generator capable of powering the entire building (in addition to the code-required emergency generator)
  • Exterior building systems designed to withstand impact from airborne projectiles

After construction and commissioning was completed, Exp visited the hospital once it was operational for approximately 3 mo. The team surveyed the hospital with the facility maintenance team to understand their operational issues and challenges and made some building controls modifications based on this experience. This helped to further dial-in the hospital to ensure proper operation of the engineering systems based on real-world conditions.