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.
VCU Health Community Memorial Hospital’s new C.A.R.E. Building opened in February 2018, creating a comprehensive medical center housing clinics, administration, rehabilitation and education services for the residents of southern Virginia and northern North Carolina.
Adjacent to the Community Memorial Hospital in South Hill, Virginia, the $14.4 million, 67,000-sq.-ft. C.A.R.E. Building represents VCU’s commitment to make comprehensive healthcare as accessible as possible for its patients. It is home to physician practices and hospital services including cardiology, pulmonology, family care and orthopedics. The new facility will also house a family dental clinic that is set to open later this year.
To honor the milestone, which occurred by drilling the first production auger cast pile, the team celebrated with all project partners in the Big Room, a collaborative space that physically brings together designers, builders, trade partners and facility operators.
“After a year and four months in preconstruction, we are extremely excited to celebrate the start of construction. We wouldn’t be here today without all our tremendous design and trade partners. Everyone in this room should be very proud to have played a part in this project so far, and I can’t wait to see the project built,” said DPR’s Tim Kueht, during a cake toast to kick off the celebration.
Prior to the ceremony, the entire Big Room team attended a presentation given by UCSF Medical Center’s nurses, doctors and researchers. These monthly presentations inspire and help the project team better understand the greater impact the facility will have on advancing the full spectrum of brain health through research, education and patient care.
In an industry where it is status quo for skilled nursing to be part of continuing care retirement communities, a new kind of skilled nursing and rehabilitation facility is “growing” in Chino, California—Trellis. The first project of a collaborative statewide development program, the 59-bed, 40,000-sq.-ft. Trellis facility in Chino is also the first light-gauge, cold-form steel-frame structure to ever be approved by the California Office of Statewide Health Planning and Development (OSHPD), serving as a template to streamline lengthy aspects of the state agency’s approval process.
“Granite Development approached DPR to be a part of a collaborative team and provide strategic counsel through the entire life cycle of its vision for the Trellis skilled nursing facilities that are planned throughout the state,” said Brian Gracz, who leads DPR’s San Diego business unit. “We are helping them in the earliest stages of development with site assessment and rapid budget feedback for property comparisons, as they focus on creating a new kind of skilled nursing and rehabilitation experience in California.”
The team, which includes Granite, DPR, Darden Architects, Kitchell and others, wanted to avoid the inherent issues of wood structures (e.g., pest control, water intrusion, fire protection), and improve speed of construction, reliability, and scalability of the program. They incorporated a load-bearing digitally fabricated light-gauge steel framed structure through Digital Building Components, which uses digital fabrication to transform computer models directly into precise-to-spec building assemblies.
Benefits of Light-Gauge Steel Framing and Digital Fabrication
Efficiency and Scalability: Off-site digital fabrication enables key components of the light-gauge framing to be produced together in a safe and controlled environment, reducing costs while enhancing safety and construction efficiency. Compared to a traditional wood-frame structure, the team shaved about four weeks off the schedule, and about $100,000 in general conditions cost on the first Trellis project. When multiplied by several facilities across the state, the savings grow exponentially, allowing Trellis to move into the nursing facilities sooner and begin positively impacting the lives of its patients.
Seismic safety: Lighter than concrete, or hot-rolled structural steel buildings of the same height, cold-form, light-gauge panelized structures have proven to be strong and flexible enough to move with seismic activity instead of against it. Last summer, DPR helped assemble the tallest cold-formed, steel-frame structure ever to be tested on a shake table. The six-story building withstood a simulation of 150 percent of 1994’s 6.7-magnitude Northridge, California earthquake, shaking and rocking, but remaining structurally intact and safe. The structure performed so well, the team ended up dismantling it themselves, since it never failed through testing.
Challenges and Design Strategy
OSHPD approvals: Due to the prevalence of wood-frame construction for these types of facilities, the Trellis facility was a first for OSHPD. The regulatory agency’s preference is that structures be built on-site for easy inspector access. To help with the process, the team worked closely with OSHPD to coordinate having an inspector on-site to check and sign off on the first 100 digitally fabricated panels. After that, only 30 percent of the panels needed to be inspected on-site and the first project is expected to be completed in early 2018.
Strategic structural design: California has different seismic zones that affect structural design. To account for that, the team is constructing the Chino facility to meet the seismic requirements of one zone higher than necessary so the exact same structure can be replicated in different locations. Because the designs of the facilities are the same, OSHPD approval time is being drastically improved. In addition, different regions have varying pollution requirements. Designs of the facility were created with and without a diesel particulate filter, so both options could be approved by OSHPD simultaneously.
Since starting the Chino project, the team has gotten two projects approved through OSHPD, and is now working on the third. By the end of 2017, the team looks forward to having three facilities across the state approved–with more to come.
Barry Fleisher knows a thing or two about follow-up. In his 15-year career as a neonatologist specializing in newborn intensive care at Lucile Packard Children’s Hospital Stanford, he helped develop a high-risk infant follow-up program. The program recognized that the end of each baby’s hospital stay was the beginning of the rest of his or her life, and made sure that infants and children grew and developed healthily after they left the hospital.
After retiring in 2003, Fleisher focused on another passion, photography. Attracted to the idea of capturing beauty in hidden places and telling stories through a series of work, he wound up in places where he genuinely enjoyed being, whether it was a coastal fishing village on the Peninsula or the bustling streets of San Francisco.
It was serendipity when he realized his former home, the Lucile Packard Children’s Hospital Stanford, was expanding. More than doubling the size of the current facility with an added 521,000 sq. ft., the expanded facility allows the hospital to meet increased demand for pediatric and obstetric care.ation grows. Returning to document the work at the institution he cares for so deeply, Fleisher began to photograph construction progress once a week at the project starting in March 2014.
Trained by DPR in jobsite safety and always accompanied by a spotter, Fleisher has captured the physical intensity, the humanity as well as the details of building. His photo of the daylong demobilization of a tower crane was one of the winners of ENR’s 2016 “Year in Construction” photo contest.
With a father, brother and uncle who were in the construction business, Fleisher helped with construction and land surveying jobs during summers in high school and college. Construction is in his blood, and he remains fascinated by the level of complexity and detail that goes into making structures that serve a purpose, that support life. From his perspective of patient care, along with his past medical research on the behavior and development of pre-term infants, Fleisher is especially attentive to the importance of environment in healing.
“The Lucile Packard Children’s Hospital Stanford team put an incredible amount of thought and detail into making sure the space puts family first and whenever possible, brings nature into the healing process. Although the workers I met onsite won’t be involved in patient care, their role in creating a space that will help sick kids feel better is extraordinarily important to them,” Fleisher said. “It adds to the spirit that was literally built into the hospital, brick by brick, by their effort and dedication.”
In his observations of building–sometimes for hours at a time–Fleisher gained a newfound appreciation for “the beauty and intricate nature” of construction. With multiple trades working in the same area, all the pieces operate in tandem, like a finely tuned machine, to prevent injury, improve efficiency and successfully deliver a project.
In his photography, Fleisher has always believed in building a series of work that tells a story until it’s finished. When the hospital opened this year, Fleisher admitted it feels bittersweet to leave the jobsite and the friends he has made there. It is rare for a construction site to be professionally captured in such chronologic detail as Fleisher has, by faithfully arriving once a week, every week, for the past three years–with the same dedication and drive he used to create the high-risk infant follow-up program at the very same hospital many years ago.
Fleisher doesn’t think he’ll photograph another construction project, or hospital project after Lucile Packard Children’s Hospital Stanford.
“This project has been a once in a lifetime opportunity for me. The layers of personal meaning that this hospital has for me, where my life and career were for many years, could never be repeated anywhere else,” he said. “I hope that I’ve contributed to documenting the history of the great things that have, and will, be built here.”
Unlike his other photo series that tell a story until it’s finished, Fleisher’s photos of the hospital actually do the opposite. His photos tell the story of the new Lucile Packard Children’s Hospital Stanford rising from the ground up, and even though the building is finished, its story is not.
We are proud to kick off our Celebrating Women Who Build blog series with the story of Gretchen Kinsella. Gretchen is DPR’s youngest project executive in the Phoenix region, managing the largest project that we have ever built in the area—the $318-million renovation of Banner University Medical Center Phoenix (BUMCP).
Starting at DPR in 2002 as an intern, Gretchen found herself assigned to a project that didn’t offer the challenges she was looking for in her internship. She was honest and candid with her intern mentor; she wanted more challenges, responsibilities, problems to solve. She wanted to build great things.
Gretchen was moved to another project. “If you want to be heard, you need to continue to speak up and be confident in your own capabilities, whether you’re a 25-year veteran or an intern in your first week on the job,” she said.
Gretchen’s story continues to be one pushing limits. Her first full-time project at DPR was Banner Good Samaritan Hospital (now BUMCP, the project she is building today). She was given a lot of responsibility, because she asked for it. She continued to raise her hand for challenging projects as she progressed to becoming a project engineer, project manager and project executive.
And 15 years later, she chose an OB/GYN that delivers at BUMCP because she felt there was no better place for her personally to bring her daughter into this world. She was coming full circle, with the child she gave birth to at the site of the project she helped create (in one of the very same rooms she built back in 2004).
Read Gretchen’s full story, “How to Ask for What You Want and Find Your Voice in a Male-Dominated Industry,” on ENR.
Ninety minutes outside of Raleigh, NC and Richmond, VA, the 70-bed Virginia Commonwealth University (VCU) Health Community Memorial Hospital (CMH) in South Hill, VA had a challenge. Because of the large construction boom in North Carolina and southern Virginia, the number of qualified med-gas installers in the area have more than enough work to keep them busy in their respective cities.
After the downturn of 2008, many experienced construction tradesmen left the field—for good. According to the Bureau of Labor Statistics, national skilled construction employment is down 19 percent from its 2007 peak, with the decline particularly stark in areas strongly affected by the housing bust. Now with construction roaring, many new, inexperienced workers have entered the job market, and–as with any new employees in any industry–need time to train and develop, increasing the importance for contractors to have self-perform work and prefab expertise.
The DPR team working on the design-build, 170,000-sq.-ft. replacement hospital found a creative solution for its dearth of labor, while still using a local subcontractor, as well as a way to improve overall efficiency: using prefab strategies for patient headwalls, med-gas zone valves and central utility plant skids and piping.
The DPR team used prefab strategies for patient headwalls, med-gas zone valves and central utility plant skids and piping, including this prefab chilled water piping. (Photo courtesy: Rob Johnson)
Every patient bed in the hospital required framing, med-gas, electrical rough-in and wood blocking at the head of the bed to accommodate the patient needs and provider care. With 70 identical beds, the team designed and constructed the headwalls off-site about 50 miles away, with pre-manufactured piping, electrical and wood blocking in a panelized wall system, which was then transported to site and installed in the patient rooms. The team then built the rest of the walls around the headwalls, and connected the overhead piping to the in-wall piping. What makes the headwalls notable is that many were back-to-back so one prefab wall accommodated two patient rooms.
Other prefabrication efforts on the project included skids and piping for the boiler and chiller plant that were shop-fabricated and shipped fully assembled to site. What would normally take months to complete, took only days in the field.
The DPR team carefully kept track of hours saved by the prefabrication efforts, turning VCU CMH into a proving ground for the efficiency of prefabrication, with the data to back it up.
Prefabrication efforts on the project included skids and piping for the boiler and chiller plant that were shop-fabricated and shipped fully assembled to site. (Photo courtesy: Rob Johnson)
When compared to traditional in-field methods and production rates:
Prefabricated headwalls increased efficiency in med-gas piping production by 70 percent and in-wall electrical increased rough-in productivity by 20 percent.
The prefabricated boiler and chiller skids saved 86 percent of on-site hours.
Significant portions of mechanical and plumbing throughout the building were prefabricated in-shop, saving over 10,000 man-hours on-site.
“We find it rare to have prefabrication measured in such an empirical way as we have done at VCU Health Community Memorial Hospital. We believe in this, and with the support of our trade partners, we are proving the efficiency of prefabrication,” said DPR’s Rob Johnson. “We are excited to explore and study additional prefabrication strategies on future DPR projects.”
Back-to-back headwalls enabled one prefab wall to accomodate two patient rooms. (Photo courtesy: Rob Johnson)
The prefabricated headwall strategy not only improved production rates and overcame a labor shortage issue, it benefited the project on the second-floor patient wing where in-wall rough-ins became the critical path at a critical point in the project. Having that work already complete mitigated a potential delay to the overall project schedule, allowing DPR to recognize another tangible benefit to prefabrication.
The DPR team will continue to push the envelope and prove the efficiency of other prefab strategies on future projects in big ways—always adapting, solving problems and moving ever forward.
To truly develop a lasting relationship with a medical center, you have to be prepared to assist in whatever way is necessary to help them succeed, whether it is to provide a budget, complete a large expansion or come back to move something as simple as a door.
Palomar Medical Center in Escondido, California, a project DPR completed in 2012, recently selected DPR to build two new projects, valued at $200,000 each: retrofitting the existing labor-and-delivery floor and adding a neonatal intensive-care unit to the same floor.
Palomar Medical Center accommodates up to 360 patient beds, 12 operating rooms, a 50-room trauma center, a 60,000-sq.-ft. undulating green roof and a 40,000-sq.-ft. central plant.
San Diego business unit leader Brian Gracz, who was the project executive on the original Palomar Medical Center, recently chatted with commercial real estate publication GlobeSt about what it takes not only to build great things, but build great relationships.
With five unique women’s health service lines planned for the institute, each discipline’s professional and personal experiences informed the overall design of the project. The patient-oriented approach resulted in a two-story, 45,800-sq.-ft. facility with abundant natural light, seamless patient flow and inviting clinical areas.
Located on the Boca Raton Regional Hospital’s campus, adjacent to the former health and wellness institute, and designed by HKS Architects, the facility offers clinical, holistic and educational programs that support women’s unique medical needs.
“Our design drew upon a culmination of prior healthcare space planning and focuses on providing a calming and safe experience for women going through medical procedures,” said Tatiana Guimaraes, senior medical planner for HKS Architects. “All of the spaces are planned with sensitivity for privacy and comfort, much like the calming environment of a spa, versus a medical facility.”
It was just like any other prom – a cafeteria was blanketed in foliage and turned into a jungle expedition; there was a DJ, dancing, carnival games and chaperones. But this prom took place in a hospital, not a high school. And the kids were both past and present patients of Lucile Packard Children’s Hospital Stanford in Palo Alto, California.
Behind the scenes, DPR employees built and painted wooden divider screens for carnival booths, while more team members transformed the first floor of the hospital into a lush jungle-scape. Other DPR volunteers ran ring toss and softball games during the prom itself, energized by how excited the kids were to enjoy themselves and not be “patients” for just one day.
The prom is just one example of the DPR project team’s high level of community involvement, as they build the nation’s most technologically advanced, family-friendly and environmentally sustainable hospital for infants, children and expectant mothers. Scheduled for opening in 2017, the Lucile Packard Children’s Hospital Stanford expansion will nearly double the size of the current facility, adding 521,000 sq. ft. and allowing the hospital to meet increased demand for pediatric and obstetric care as the Bay Area population grows.
Inspired by their client’s mission to align people and resources to provide extraordinary patient and family-centered care, as well as DPR’s vision to be integral and indispensable to the communities in which it operates, the DPR project team has shown their commitment to help the children at the hospital in any way that they can.
Ranging from building balsa wood models, visiting the hospital school, dressing up and painting faces for a Halloween “Trick or Treat Trail,” donating to the Summer Scamper fundraising walk benefiting Lucile Packard Children’s Hospital Stanford, to visiting with Packard Children’s “Patient Heroes,” the team has found that their volunteer efforts offer them the unique opportunity to interact and open two-way communication with the end users that the hospital will ultimately be impacting – patients, parents, teachers, nurses, doctors and hospital staff. They are able to see firsthand the day-to-day impact of the rooms they’re building, answer questions about construction from curious kids and integrate themselves into the hospital community.
“We fill a unique void of being able to interact with the children on a different level by talking to them about how the new main building of the hospital will affect them. When we see how impactful the new facility is going to be on their lives, it encourages us to have perspective and realize why we are putting in so much hard work on-site to make this happen,” said DPR’s Maggie Grubb.
In addition to helping lift the spirits of Packard Children’s patients, the project team’s efforts have also built a strong sense of community, both with their hospital neighbors and their own colleagues. DPR team members will often run into teachers and staff they’ve met through volunteer activities at a nearby coffee stand and be able to say hi and catch up about progress.
“Not only are we helping patients of Lucile Packard Children's Hospital Stanford, but we found a really positive way to spend time with each other and these truly inspirational kids. It helps us feel good about what we’re working on,” said DPR’s Mike Kenney. “The challenges we face daily really aren’t that bad when you put into perspective how tough these little kids are. It is so rewarding to spend 2-3 hours with people who genuinely appreciate you.”
So that prom wasn’t an ordinary prom, these kids aren’t ordinary kids, and this is no ordinary project team. Sometimes, the whole is greater than the sum of its parts. And sometimes, ordinary people can do extraordinary things.
ENR’s Best of the Best Projects identified the best of design and construction achievement across the country among projects completed between June 2014 and June 2015. Regional winners were chosen in 20 categories and from there, the top winners in each category were moved up to the national competition. Judges examined each project in terms of teamwork, safety, innovation, quality and overcoming challenges in order to truly distinguish the best from the best.
At the 8th annual Best of the Best Awards ceremony, DPR proudly accepted the Best of the Best Healthcare award for the UCSF Medical Center at Mission Bay. In 2015, the medical facility was also named ENR California’s Best Healthcare Project in Northern California.This project was the result of a high-performing team dedicated to adapting to change without making sacrifices to cost, quality, or schedule – truly exemplifying all the key aspects that ENR was seeking in a Best of the Best Project.
To complete the eight-year long project, the team used an integrated project delivery (IPD) method to keep the schedule and budget on track. Since the project’s beginning, more than 250 architects, engineers and contractors co-located in the Integrated Center for Design and Construction (ICDC) on the site to build a team focused on efficiency, collaboration, and quick decision making. The $1.5 billion medical center, delivered eight days early despite $55 million in changes, passed the California Department of Public Health’s licensing inspections with “no deficiencies,” which is unprecedented among new California hospitals.
The UCSF Medical Center at Mission Bay project is a true example of a team committed to overcoming challenges while maintaining the highest levels of safety, innovation, and quality – and ENR agrees!