Consistently ranked one of the nation’s top healthcare builders, DPR’s proven industry experts understand the unique needs and applications of the intricate systems that are the lifeline of healthcare facilities.
DPR Construction used prefabricated modules from Digital Building Components to build temporary bypass hallways to minimize the impact of construction at a major hospital in the Phoenix area. The expansion project will add approximately 580,000 sq. ft. to the existing hospital building, with construction to be completed adjacent to the current Emergency Department (ED).
“We needed to perform major construction work while the busy emergency department remained functional,” said DPR project manager Mike Cummings. “Patients and staff needed access to the hospital, but the building expansion couldn’t be completed without moving the entrances.”
The enclosed walkways routed pedestrian traffic to the hospital’s entrances, allowing patients to access critical care services while reducing disruptions. One hallway provides public access to the ED while the other provides ambulance and helipad personnel access.
With a combined length of approximately 700 ft. and interior dimensions of 8 ft. x 8 ft., each hallway was designed to ensure the comfort and safety of those who use them throughout the two and half years of the construction project. The prefabricated hallways meet stringent code requirements including a two-hour fire-resistance rating in the case of an emergency.
Several building methods were considered for the hallways. Cummings said the project team looked at traditional onsite construction, onsite fabrication, and offsite fabrication. All three options had similar costs, so the project team looked more closely at other factors: safety, on-time delivery, and impact to the hospital staff and patients.
The project team chose offsite prefabrication with components manufactured by Digital Building Components to best meet customer needs. Specifically, this method was projected to reduce the overall schedule by an estimated three weeks. The onsite team could pour concrete foundations to support the module components while the hallway sections – fitted with mechanical, electrical, and HVAC elements – were built in the fabrication shop.
“It took a lot of detailed and upfront coordination with our trade partners, but we were able to cut the installation time in half from what was anticipated for a traditional ‘stick-built’ system,” said Cummings. “This meant less disruption to patients and hospital operations.”
He notes that prefabrication wasn’t used for the entire passageway. The project team analyzed existing conditions and determined that a traditional construction method was more appropriate at the ends of the hallways. Canopies at the connections to the building meant cranes couldn’t drop the modules into place, so those sections were built conventionally. “We used prefabrication where it made the most sense and increased our productivity,” explained Cummings.
The productivity during installation far exceeded expectations and showed off the benefits to building some components offsite. Digital Building installed roughly 12 units a day and completed 47 in four days totaling roughly 520 linear feet with a crew of four. In the end, using prefabrication sped up completion of the temporary hallways by about five weeks and reduced onsite labor by approximately 2400 worker hours.
“We had been considering prefabricating other elements on the hospital too,” said Cummings. “After the successful hallway installation, the value was clear. We received customer approval to move forward with prefabricating the exterior wall panels.”
Healthcare workers are called to serve a cause greater than themselves. They take care of those who are in need, often working 12-hour days with no breaks. And the mothers among them don’t stop when they clock out. They continue their service once they get home to their families, doing everything from helping kids with remote learning to giving comforting hugs.
This Mother’s Day and National Nurses Week, DPR would like to recognize the family and friends of our employees who are medical professionals and put in long hours both at work and at home. We offer our deepest gratitude to those of you who are always there to comfort us, whether at home or in the patient room, and especially in the midst of the greatest healthcare crisis of the century. We trust you with our lives, and we thank you for your compassion and expertise.
Following are a few testaments about the people we are fortunate to have in our lives:
Healthcare leaders are busier than ever, focused on weathering and responding to the worst of COVID-19 and, as things stabilize in their markets, planning for future resiliency.
Coming into 2020, one of the most significant challenges they faced was managing strategic growth during the potential shift from a fee-for-service reimbursement model to value-based payments. Then COVID-19 changed the game and completely disrupted capital spending. Moving forward, the ability to drive hard ROI and benefits from capital expenditures will become even more important and complicated under a system focused on value and the myriad care model changes likely to come in the post-COVID-19 pandemic world.
Two of the largest line items of capital spending belong to technology and facilities (construction), a trend that sees no letting up in the foreseeable future. Interestingly, technology initiatives and construction projects are not always in-sync, which is a problem for organizations that have not yet fully embraced the digital transformation of the care environment.
The resulting disconnects between the digital environment and built environment stymies innovation at scale, leading to less than optimal return on investment.
There are several drivers behind the importance of blending the digital and build environments:
Regulatory demands of value-based care for reimbursement and quality of care, which are placing an even greater importance on the patient experience and the location in which services are performed. The uptick in telehealth services during the pandemic has cemented the viability and necessity of digital venues for patient care. How healthcare systems will be reimbursed for telehealth and how they deal with HIPAA will be key moving forward.
Providers closely evaluating capital investments to ensure they create convenience for patients, reduce costs, provide continuity of care, and maintain or improve quality, all of which are critical under a post-pandemic value-based reimbursement.
Technology demands of consumerism (provider and patient) are placing unfamiliar strains on healthcare organizations, operations and technology infrastructure.
Consolidation of provider organizations result in a broad mix of technology systems and physical assets, inhibiting standardized care models and eliminating efficiencies required to thrive in a value-based care model.
As we begin to plan for the future, we have to ask: how can we start being smarter about making it all work together? It’s by connecting the dots between system strategy, clinical operations, technology and facilities planning design and construction that we start to see the challenges and opportunities from multiple perspectives. These insights produce a more comprehensive vision and path to succeed in this new value-based paradigm.
As also seen in the recent RX for a Successful Healthcare Project study, engaging the right internal and external partners early and often will reveal insights to maximize efficiencies in workflow, enhance the provider and patient experience and create spaces that allow provider organizations to optimize capital expenditures and thrive in the new paradigm of value-based care.
Three concepts we believe healthcare providers should consider are:
Build a team and use it – In addition to the management consultants often engaged to guide strategic visioning sessions, healthcare systems should also engage designers and construction managers earlier in the process to provide insight to growth strategies and industry pressures. Viewing these groups as partners instead of commodities provides new perspective with the ability to better align future building initiatives with overall healthcare system goals.
Get into the details – As healthcare systems expand, we’ve seen situations where aligning IT systems with newly-acquired assets are taken for granted. This leads to more time and money being spent, which erodes the hoped-for return on investment.
Use data in new ways – We have more systems than ever to support good decision making and, ultimately, day-to-day operations. The entire lifecycle can be made more efficient, from programs like Modelogix used during preconstruction services or VueOps, which takes existing virtual design and construction tools and leverages them as a true asset management suite.
Putting it all together best positions healthcare organizations to realize maximum ROI for both their facility and digital investments. Ultimately, it will help make the patient and provider experience more seamless, as well, fulfilling the vision we share for the next generation of healthcare facilities.
As much as the word “disruption” gets thrown around by thought leaders, we know this: customers don’t like surprises. Surprises in the course of a major construction project create disruptions that can ripple through a project and an entire customer organization. Surprises in the field can be costly and can affect project schedule.
Even while striving to deliver more predictable outcomes, surprises emerge in the field from time to time. Just as safety incidents can be mitigated through the proper steps taken prior to and during work, DPR believes many costly surprises in the field can be prevented.
By spending a little upfront, projects can often avoid spending more due to unforeseen issues. Too often, those costs look easy to cut in early project stages, leaving little recourse when something unexpected arises.
“Throughout the lifecycle of any project, there are a lot of unknowns,” said Rishard Bitbaba, DPR’s large project corporate service leader. “You wouldn’t want a doctor performing surgery without first looking at scans, using tools to evaluate the best approach and using data from similar situations to inform next steps. Contractors and their project partners have a similar set of tools to get rid of the unknowns before a shovel hits the ground.”
Four specific things can help get projects off to the right start.
Sometimes on projects, what you see isn’t what you get—but it can be easy to take existing conditions for granted.
“It’s inevitable that existing buildings, over years of operations, have made a variety of modifications and upgrades, large and small, to systems that may not be fully captured in operations manuals and the original drawings,” says Hannu Lindberg, DPR’s Virtual Design and Construction (VDC) leader. “But for all project types, at various stages, reality capture can be a great example of spending a little now to save more down the line.”
Reality capture methods like laser scanning of existing conditions involves time, labor and some equipment cost, but by setting the basis for the larger digital model – helping support preconstruction activities ranging from procurement to how the work will be phased – it has larger benefits. While many project teams see the utility of doing this before a project begins, that is often left until the end when it’s almost too late to adjust for the discrepancies. Doing so misses the real value.
“The main reason to keep scanning is to ensure quality and catch errors in the field,” Lindberg says. “If you spent the money to coordinate the building, you should ensure you’re following the coordinated design. And, when you crunch the numbers, the cost of upfront labor is far cheaper than rework, change orders and loss of productivity in the field.”
Consider scanning and as-built verification together on a given project. Weekly scans of work put in place for a period of four months could run $46,000 – exactly the kind of money that looks easy to trim on a line-item basis. What if each scan found 10 minor issues that could be quickly addressed before they became $80,000 in major rework costs over the same time period?
Similarly, it might seem like spending $22,000 annually for a drone to capture aerial progress photos for site mapping is unnecessary. The same task with five field crew members and equipment could end up costing upwards of $52,000.
“These things add up,” Lindberg says. “For things like scanning and aerial progress mapping, before work commences, it might seem like trimming $68,000 upfront is cost savings and a better short-term trade off. But, if that results in spending more than $130,000 later in avoidable rework… I’m not sure anyone wants to have to explain that to their supervisor…or owner, for that matter.”
Reality capture can also prevent surprise costs and increase ROI through better overall productivity, quality control, and by reducing waste (in both materials and processes).
Mechanical, electrical, and plumbing (MEP) scopes typically account for 25% to 40% of a project’s total construction costs and drive the operating costs during the facility’s life. Since MEP systems have a significant impact on project budgets, they are often the first scopes that teams look to reduce in the early stages, often without the guidance of a MEP professional.
“Too often MEP systems are taken for granted in early stages of a project,” says Joe Dillingham, one of DPR’s leading MEP coordinators. “We’ve seen assumptions about these systems during design and buyout that lead to costly redesign and rework during construction.”
Bringing MEP professionals into these early stages reduces project teams’ reliance on assumptions when making decisions that affect construction all the way through facility operation.
Often, project teams do not bring on MEP professionals until the commissioning phase, when addressing issues hampering a system’s performance adds cost that could have been avoided with more oversight from the beginning. Even during this late stage, MEP professionals frequently save expenses from hitting clients’ bottom lines.
Blair Calhoun, another MEP professional at DPR, recalls a time when a warehouse manager called him to voice safety concerns with a recently commissioned tenant improvement. Her staff had difficulty navigating almost a 1/4 of the space because it lacked adequate lighting. After some investigation, Calhoun discovered the owner’s recently departed PM had opted to save upfront costs by not replacing the preexisting lights and the project's coffers were tapped. Calhoun asked the electrical subcontractor who previously submitted a proposal to replace the outdated existing lights with contemporary, high-efficiency ones for an estimate of the energy saved with the new lights. The team ended up showing the warehouse manager that the $22,000 change order would be paid for in less than three years from the savings on monthly electric bills, a true win-win.
Recently, DPR’s MEP and data groups began analyzing nearly 40,000 “Requests-For-Information” (RFIs) related to MEP trades from over 1,700 projects. Fundamentally, an RFI indicates an unwanted break in the flow of required and accurate data. The disruptions in data flow often lead to lost production time and pose threats to the quality and predictability of project outcomes. The groups are planning a rigorous analysis to find insights to shine a light on issues affecting MEP upfront costs that ultimately lead to lower total costs for clients.
Things like a truly engaged owner, project partners co-located in a “Big Room” and more were among the nine key indicators DPR identified for executing successful healthcare projects. Another is having the right team who exhibits the Lean principle of “Respect the Individual.” The traditional, more siloed approach to project delivery, where a contractor comes into the process after design is finalized and many key decisions have been made, though, puts the teambuilding starting blocks farther back. In doing so, things like design management fall by the wayside and there isn’t proper time to organize both the design and building team members.
“On a large project – half a billion dollars, say – success depends on organizing a large team up front and how they will make decisions,” said DPR’s Chris Dierks, one of the company’s Lean leaders and a project executive. “The larger a project, the larger potential issues could be if they’re not tackled early on. So, we always recommend getting the teams together early and spending some time and money upfront to not only properly organize as one team but also to focus on developing relationships to head off anything down the road. Strong relationships directly tie to strong trust.”
You can’t implement a successful Design Management process without this sort of team. High-level discussions that combine the customer’s goals, the designer’s vision and the contractor’s knowledge of what is constructible can only benefit from high levels of trust. What’s more, one of the most effective tools for cost control strategy is Target Value Delivery (TVD) and how projects organize and manage the design and preconstruction efforts. The value can be initial cost, total cost of ownership and user experience, which then informs design decisions, means and methods, project sequencing, and cost priorities with accountability to all parties to maximize value in a quantifiable way.
“TVD presents unique challenges over the course of a long project planning effort including ambiguity about timing of decisions, and a tendency to revisit previous decisions when the value is not clear and quantifiable,” Dierks said. “It’s really shifting costs. It’s heavier upfront, but the payoff, ‘the value,’ comes from implementing the right strategies and processes to identify and bring resolution to arising issues so they never materialize in the field.”
The departure from “typical” project startup costs can be a barrier and overcoming it takes an honest appraisal of the stakes in the field.
“I get it. If you’re a customer, you hear ‘teambuilding event’ or ‘building a Big Room’ and you think, ‘sounds like a lot to spend upfront for … what, exactly?’” Dierks said. “It takes seeing how it unlocks the full toolbox of Lean concepts and processes to make the entire project more efficient. [Efficiency] meaning where trust is so high that everyone is aligned and wrinkles are ironed out quickly, with quality in mind, to deliver that cost certainty, again ‘the value,’ ultimately desired by the customer.”
The root of all of these, however, is the long-standing ways construction has been procured and the traditional relationships among project partners. To take advantage, a perspective change is required on all parts.
“Our industry has been called ‘slow to change’ when we’re actually seeing more tools and technologies that can change project outcomes in positive ways,” Bitbaba said. “What has been slow to change is the traditional model of construction so we can properly leverage these new tools.”
Behavior change may not have a dollar cost, but there is certainly a mental cost. No one likes change, but more than enough projects using alternative delivery setups – ranging from design-build to more robust integrated project delivery agreements – to show the way.
“Too often, the new ways of working are being assumed to just work under the traditional, more siloed ways of working,” Bitbaba said. “Owners have to have a mind shift to where they seek to be more engaged early and not be afraid to get into the details, rather than questioning some of the details.”
Bitbaba recalls times when customers wondered why so many superintendents’ hours were needed in preconstruction phases or that terms like TVD were just something a contractor would do.
“The engagement makes the difference,” Bitbaba said. “It’s easy to look at worker hours or assume it will all go to plan, but when a contractor submits the RFI that a wall in a design wasn’t included in project budget, are you going to wish you had considered more engagement upfront? Likely so.”
Which is why Bitbaba likens the entire process of “knowing the unknowns.” Essentially, when all project partners are aligned and working together, using all available tools from VDC to field expertise to working in new ways, it allows projects and the people that make them happen to be more nimble when outside forces are thrust upon us.
“We can’t control the rain,” Bitbaba says. “Let’s work together early on in projects to control the things we can so the only surprises are if the weather forecast is wrong.”
Healthcare providers and staff members are under significant and increasing pressure like never before. Healthcare systems across the country have identified both current and projected needs, including:
repurposing existing spaces
installing triage tents
transitioning entire floors into negative pressure environments
creating modular units outside of healthcare facilities
“Facility needs vary greatly by region to keep up with patient care as capacity surges; there is no one-size-fits all strategy or solution,” said Sean Ashcroft, who serves as a co-leader of DPR's National Healthcare Core Market. “We are actively collaborating with our industry partners such as Digital Building Components, SurePods, other prefabrication and modular partners, architects, and clinicians on an individualized basis to examine and implement appropriate measures, including rapid deployment solutions and renovations of existing spaces.”
Modular and Prefabrication Collaborating with prefabrication and modular partners, Digital Building Components and SurePods, DPR’s team of healthcare construction experts have created several solutions for hospitals looking to add temporary beds and staff support spaces in response to the increase in short to mid-term capacity needs. Together, these teams have developed an extensive range of modular, mobile, partitioned and tented solutions, all of which have been designed with input from healthcare customers and can be delivered within a short timeframe.
“DPR is ready as-needed with both capacity and materials to implement these solutions upon request,” Ashcroft said.
Renovation in Operational Spaces for Increased Capacity Healthcare customers nationwide are also seeking to make fast renovations to existing space.
For example, DPR converted an empty floor into a COVID-19 overflow ward in just three days for a major Houston healthcare system. With active staff in the area and through numerous utilities make-safes, DPR’s self-perform work crews converted the floor to a negative air space, rearranging numerous doors, walls, and offices to eliminate exposure when the unit goes into operation.
Another customer is currently considering reopening decommissioned-but-licensed beds, as well as looking at converting unlicensed beds into intensive care units, and ambulatory surgical centers into spaces for non-COVID-19-affected patients.
In Virginia, DPR modified 100 existing patient room doors for a long-term healthcare customer to add viewing lites, allowing care providers to observe patients while limiting direct exposure to the virus.
“While there are numerous infrastructure challenges to consider in the conversion of spaces such as hotels and dorms into medical facilities, for some healthcare systems preparing for an influx of patients, these options are on the table,” said Ashcroft. “Larger spaces such as convention centers would be a primary preference, because they can be set up quickly with fewer caregiver and logistical impediments. And while many healthcare systems are still first looking at existing medical spaces at this point, all of these are feasible alternatives, and DPR stands ready to work should any of our healthcare customers choose to move forward with these options.”
Remaining Diligent and Prepared “We want to be someone our customers can count on when things are fluid,” reflected Ashcroft, speaking on what the future holds. “As the COVID-19 pandemic continues to develop and evolve, DPR will remain a steady, dependable, and highly collaborative partner to create the best possible solutions for their unique and rapidly changing circumstances. We recognize and respect that each and every situation will have its own challenges and solutions, and we are committed to continue working together to respond thoughtfully and diligently to the COVID-19 crisis.
“We are grateful for our dedicated and skilled workforce and trade partners. Our project teams are working in ways to ensure safety, while also knowing the work we’re doing will position doctors and medical staff to make a meaningful difference in their communities. It’s a lot of pressure to handle and the crews are handling it amazingly well.”
Editor’s Note: This story was updated on Sep. 4, 2020.
DPR installed 10 prefabricated modules for the National Institutes of Health (NIH) in Bethesda, Maryland. The Tumor Infiltrating Lymphocytes (TIL) Cell Processing Modular Facility, where the National Cancer Institute (NCI) delivers cutting-edge cancer treatment, is the first large-scale, fully prefabricated and modular multi-module cGMP manufacturing facility of its kind ever built in the United States.
The prefabricated modules were supplied by subcontractor Germfree’s Ormond Beach, Florida, manufacturing facility. The modules, which span an average 14 x 40 feet each, include a cell processing suite, cleanroom lab space, a cold storage room, office and work spaces and more.
Construction crews undertook an extremely complex rigging procedure to move the modules into place. It involved a carefully choreographed sequence of rigging and hoisting the 40,000- to 50,000-pound modules some 35 to 40 feet into the air, over the structural steel exterior building envelope and through the open roof to set them in place on their foundations.
Magnifying the challenge, the entire operation took place a mere 40 feet from two adjacent, fully operational medical and research buildings. Vibration monitoring required close coordination with users in adjacent buildings to ensure that sensitive activities were not affected. “The logistics of planning the rigging was extremely complex,” commented DPR Project Executive Jeff Vertucci. He noted that the decision to construct the building’s exterior structural steel frame prior to installing the modules – essentially building the structure from the outside in – helped the team keep to schedule even as elements of the project changed. It is just one example of the solution-oriented approach adopted by the DPR-led design-build team working in concert with Germfree, architect Perkins & Will, and owner/end user, NIH and NCI.
“We were already well into design and planning when we collaborated with our customer to recalibrate the scope for NIH, while also retaining a schedule that met their needs,” Vertucci said. “By enclosing the building and getting structural steel erected before the modules showed up, then reworking a rigging plan to drop the modules in through the roof, it made the rigging much more challenging but allowed us to save at least three months versus a traditional approach.”
That solution worked so well that NIH has asked DPR to re-sequence another job they are currently building on campus, the six-module CCDTM project, using the same approach, according to Vertucci. This DTM Modular Facility is using the same Germfree components as the TIL Facility.
As DPR’s seventh project on the NIH campus, the TIL facility is a groundbreaking project in the world of cancer treatment. DPR Project Manager Ignacio Diaz said the facility’s lifesaving mission has provided the design and construction team extra motivation to work collaboratively and overcome an array of challenges in order to get the project up and running as quickly as possible.
“This is one of those jobs that did not need much outside influence to motivate people,” Diaz commented. “Cancer is such a common thing; virtually everybody is touched by it. The fact that we are building this facility that really impacts almost everybody is powerful. It gives us more incentive to finish fast so the end users, the researchers, can get to doing what they do – curing cancer, or at least helping to do so.”
Leveraging Expertise to Move Project Forward
With a footprint spanning approximately 6,000 sq. ft., the TIL Cell Processing Modular Facility is supported by an auger pile foundation drilled as deep as 30 feet. The structure has three levels: a bottom floor “crawl space” that follows the existing site slope, containing gas piping that includes the supplies of Carbon Dioxide (CO2) and Liquid Nitrogen (LN2) to the facility; a first floor comprising the 10 prefabricated modules; and a mechanical floor above. The mechanical level contains the building’s HVAC system, including two air handling units and two exhaust fans, electrical conduit for building controls and power systems, IT infrastructure and more.
Since being awarded the project in October 2017, DPR leveraged its design management capabilities, its technical construction skills and its off-site construction management expertise to help keep the project moving forward while contending with underground utility rerouting, logistical challenges and tight site access, among other things. When the owner needed to make extensive programming changes to reconfigure the facility’s planned workflow during the design phase, DPR worked to re-sequence the project’s construction processes in order to make up some of the lost time.
Construction formally kicked off on the TIL Facility jobsite in August 2018, just two months after the off-site module prefabrication work was getting underway at Germfree’s Florida manufacturing plant.
Modular Construction Delivers Quality Benefits
Off-site construction has provided significant quality and quality control benefits, according to Vertucci. Both the modules and the majority of the building systems were prefabricated off-site.
“I think ultimately NIH & NCI ends up with a phenomenally high-quality, state-of-the-art project when this is completed,” Vertucci commented. “Building this in a controlled environment in a warehouse manufacturing facility, by Germfree technicians who do this work all the time, makes the quality excellent.”
Adding to the quality control benefits, DPR self-performed significant portions of the work with its own crews, including all exterior framing, sheeting, vapor barriers, doors, masonry and various other items.
Push Towards Completion
The project team also had an integrated commissioning plan to allow the owner’s Commissioning Qualification and Validation (CQV) agent to start with commissioning of systems earlier and more time to work through the NIH document reviews that come with the cGMP facility requirements.
DPR also handled all scientific equipment procurement on the project for the owner, a turnkey approach to project delivery that adds additional value for the client. This integrated approach ensured that DPR’s scientific equipment team handed over a project with the necessary components needed for the research program the space is being used for.
Pressures customers face are changing as their industries evolve. At the same time, construction is employing new technology and delivery methods to address these challenges, all while delivering value for customers.
In that context, some of DPR Construction's core market experts tried to answer this key question for the year ahead: “What’s one thing that will change customer outcomes in 2020?”
"Putting data back in data center construction. Customer-specific data analytics, business improvement metrics and collaborative platforms will improve project delivery for our customers, bringing them online faster, no matter where they’re deploying new facilities." - John Arcello
"VDC and Prefabrication. Robust VDC programs will let us show tenants and developers spaces sooner, provide synchronized visual schedules so they can see visual plans as we build and help enable virtual quality control programs. VDC and will also enable quality prefabrication that helps guarantee schedule, addressing a key pressure for customers throughout the sector, from offices to hospitality facilities." - Andrea Weisheimer
"Optimizing construction as healthcare providers face reduced operating margins. Reimbursement rates are decreasing and as a result healthcare systems are forced to operate at razor thin operating margins. At the same time, spending on technology is almost equal to normal capital expenditures. Through early design collaboration, lean delivery and prefabrication, we can increase efficiency, maximize value and make sure providers are getting the most ROI both in construction and facility operations." - Hamilton Espinosa
"Collaborative design/build delivery with a focus on design management. With public money/fixed budgets adding pressures to institutions more than ever, owners require cost and schedule certainty. Through the DPR design academy and the use of programmatic estimating and Modelogix, we will show how design management can ensure certainty when all of the moving parts of a project work together." - Tracy de Leuw
"Driving down the cost of cleanrooms in new ways. There are practical modular solutions that address both functional requirements inside of the room along with structural support requirements outside of it. Additionally, design management, minimizing air changes per square foot of manufacturing area and exploring less expensive – yet durable/cleanable – surface materials will provide new ways of delivering these spaces." - Scott Strom
DPR Construction broke ground on the brand new $350 million, state-of-the-art Children’s Hospital of Richmond at Virginia Commonwealth University (CHoR at VCU), kicking off a four-year project that will deliver a world-class facility dedicated exclusively to the care of kids.
More than 250 people from the local community as well as hospital employees, donors and state and local lawmakers turned out for the groundbreaking event, marking start of construction on a facility designed to provide the highest level of care for children throughout Virginia.
Located adjacent to the award-winning outpatient Children’s Pavilion on the VCU Medical Center Campus and rounding out a full city block dedicated to children’s services, the new hospital will replace existing pediatric inpatient unit beds and will consolidate inpatient and emergency care in one place. The 20-story, 500,000-sq.-ft. facility will provide trauma and emergency care services. It includes 86 private rooms, plus 10 observation rooms for acute and intensive care as well as new operating rooms, imaging capacity, emergency department space, a rooftop helipad and various amenities for patient families. There are four levels of below-ground parking.
DPR’s scope of work includes ground-up construction of the new hospital tower as well as some renovation work on the existing facility to support acute care services. Safety is a major priority during construction, which is taking place on a project site located in the heart of downtown Richmond and surrounded by medical facilities on the VCU campus that remain in full operation.
Designed by HKS Inc., the new Children’s Hospital is part of CHoR at VCU’s comprehensive, long-term plan for serving pediatric patients while also supporting research and educational opportunities. The new facility represents far more than just a building for young patients and their families – it offers hope and comprehensive health care services, regardless of their ability to pay. Numerous amenities are designed with those families in mind, including playrooms, performance spaces, Ronald McDonald House Charities rooms and outdoor gardens and spaces for collaboration and education.
The Children’s Hospital Foundation is conducting a $100 million capital campaign to support construction of the new hospital. At the groundbreaking, the Foundation announced it will match the first $25 million in donations.
“Our vision is to be a top children’s hospital by 2022,” said Marsha D. Rappley, M.D., CEO of VCU Health System and senior vice president for health sciences. “All children of all communities deserve world-class care in a warm and welcoming environment. This beautiful new facility designed in partnership with our community puts children and their families at the center. It is the first important step in our pathway to becoming a top children’s hospital.”
The project is slated for completion by late 2022.
Editor’s Note: This story was updated on April 20, 2020 to acknowledge the fluidity of the COVID-19 public health crisis. As events continue to unfold, DPR is actively working with its healthcare customers nationwide to help them meet their needs.
This October, NorthBay Medical Center in Fairfield, CA began admitting patients to its new 80,000-sq.-ft. north wing, unveiling a state-of-the-art facility that was delivered on time and under budget by a highly collaborative, DPR Construction-led project team that included design partner LBL (now Perkins Eastman). Achieving those benchmarks was the product of leveraging an integrated delivery approach along with strategic use of virtual design & construction and prefabrication.
The new three-story wing, which connects to the existing 1992 building on each floor, encompasses 22 patient rooms, eight high-tech surgical suites, a 16-bed Pre-Op/PACU, diagnostic imaging, kitchen and dining area, as well as a new central sterile department. The project also included a 20,000-sq.-ft. remodel of the Emergency Department – all completed while the hospital remained in full operation.
Co-locating in the Big Room
Delivered using elements of Integrated Project Delivery, or IPD, DPR worked alongside the owner, designer Ratcliff Architects, LBL (now Perkins Eastman), structural engineer Thornton Tomasetti and other key team members to complete the highly challenging project on schedule and under budget. The team co-located onsite in an open, big room environment that fostered collaboration, innovative problem-solving, and quick decision making.
“NorthBay’s belief in the integrated team, having us all there on site every day and being able to make timely and well-informed decisions were all keys to our success,” said DPR Project Manager Stephanie Jones-Lee. “If there was an urgent item that came up that we needed a solution to, we could just walk over to the architect or engineer, get the subcontractor on the phone and hash it out right there.”
The high level of communication and shared problem-solving helped reduce the number of RFIs and submittals and moved them forward much more quickly than might be expected for a project of this size and complexity, according to DPR’s BIM project leader Jonathan Savosnick.
“Almost all of our RFI’s were confirming RFIs, meaning we had already talked through the issue with the design partners before we sent it in for documentation purposes,” he said. “I think that made a huge difference on this project and made the process a lot faster, easier to prioritize, and more successful.”
The project incorporated several innovative or first-of-its-kind features. It was the first OSHPD-regulated project to employ the prefabricated ConXtech structural steel system. Akin to a “Lincoln Log” type of assembly, major structural components of the ConXtech system are prefabricated offsite and then delivered to the jobsite for quick assembly in the field.
“Because everything gets fabricated in the shop, it is safer, faster, and there is a lot less welding and field work to put it in place,” Jones-Lee said.
The project also was one of the first hospitals in California to incorporate brand new ARTIS pheno operating room (OR) equipment – a major change order introduced midway through construction when the equipment supplier discontinued its previous version of the OR equipment.
The team quickly adapted to the challenge.
“The new equipment added a lot of electrical conduit on the second floor, below the operating rooms,” said Savosnick. “We were in the middle of building out that second floor when we learned about the change.” They worked collaboratively to re-sequence the work and incorporate the new design solution.
Additionally, DPR employed laser scanning to verify existing conditions in the overhead ceiling space in the Emergency Department area, as well as in the Central Utility Plant. While BIM coordination was integral to the project’s success, accessing patient rooms in the still fully operational emergency department to laser scan for BIM coordination was a complicated endeavor.
“Doing BIM coordination for an existing facility that is in use was a big challenge,” Savosnick said. The team used HEPA carts and deployed field investigators to access above-the-ceiling areas in order to gather the information needed to update the model.
The VDC program had other extensions that delivered value. The team used virtual reality to review access issues and verify clearances on the roof with NorthBay facility engineers. Marking the first time that NorthBay had used VR on a project, the technology helped resolve potential conflicts before work was ever installed in the field.
Healthcare construction projects are inherently complex, challenging and often downright difficult. DPR Construction embraces these challenges as opportunities to advance the company’s learning and continual improvement.
DPR took an in-depth look at seven highly technical, complex hospital projects completed in California between 2011 to 2018 which, resulted in the Rx for a Successful Healthcare Project study. The goal? Identify what makes a healthcare project a success and what could be done better.
DPR engaged a third-party consultant, Site Plus, to conduct independent interviews with owners, design partners and internal DPR team members from the projects being studied. Both commonalities and diversities existed, resulting in a strong sampling of healthcare projects. Consistent patterns were found in the successful projects, including a high level of collaboration and integration, a very engaged owner, and an environment promoting continual improvement over time.
Participants of the study were asked to "define a successful project." Interestingly, answers concentrated on or included "people" rather than just project metrics as an important element. Building on the successful collaboration and integration of project teams and needs, the study suggested that the three quality pillars of budget, time and quality could all be delivered successfully, challenging an often-touted industry myth to the contrary.
Participants were also asked, "What words come to mind when you think of this project?" Responses evoked highlights—and lowlights. The most frequently mentioned words were: challenging, fun, collaborative, trust and complex. Ultimately, themes, patterns and key differentiators were identified from the interviews and consolidated into nine key indicators for project success.
When all nine key indicators are present, the study found there is much more likelihood of an aligned and resilient team who will work collaboratively to overcome challenges and be successful. DPR shares these indicators with the goal of aligning project collaborators and integration in successful project delivery, and designing and building better, high-performing buildings.
9 Key Indicators for Successful Healthcare Construction:
1.Truly Engaged Owner: More engagement leads directly to success. Successful projects have a hands-on owner present, with the ability to make timely decisions and then keep to those decisions.
2. Project Mission and Value: Establish collective goals as a project team. Develop the purpose, vision, project goals, and key performance indicators at the onset of the project. In healthcare, the vision is typically about the higher purpose of the patient and the project as a community benefit.
3.Co-Locate (The Big Room): Team member committment from the beginning. The study revealed the "Big Room" enhanced a common understanding of values and goals, a foundational culture, the tenacity to keep improving, and the ability to make definitive decisions quickly.
4. Right Team/Right Mix: Assess team dynamics and recalibrate along the way. Experience may win the project, but it's the right people on the team who will lead to the greatest success.
5.Act Swiftly When Necessary: Be ready to change and act quickly. A person may have certain attributes that contribute to one of the project goals, but if they don't embrace ALL project goals in an open and unrestricted manner, it will set up barriers.
6.Invest in the Team: Tailor team building and purpose to specific team dynamics. Ongoing team building, both formal and informal, does lead to better team dynamics. The successful projects made the time to pause and recalibrate.
7.Share Knowledge and Set Goals: Successful projects push to be better. If you aren't keeping score, it's just practice. Add the priority of continuously getting better by asking, "Is there a better way?"
8.Lean Construction Methods: Use a discipline of best practices. Tools like Pull Planning, Target Value Design and A3/Choosing by Advantages Decision Making are some of the items used in successful projects in varying degrees.
9. Authorities Having Jurisdiction: Understand, accept and work with regulations. Regardless of project location or authority having jurisdiction, inspectors are key to the process. Understand their requirements and make them a part of the team.