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.

October 28, 2015

UCSF Medical Center at Mission Bay Wins ENR Award

In the last month or so, there's been a flurry of activity around the integrated UCSF Medical Center at Mission Bay project:

  • The 878,000-sq.-ft. medical facility won ENR California’s best healthcare project in Northern California.
  • Members of the project team spoke at the 28th annual Healthcare Facilities Symposium & Expo, held October 6-8 in Chicago, IL. Professionals from all areas of healthcare facility delivery came together to examine the latest trends, perspectives, products and solutions in the market sector. This year’s theme: the intersection of design and wellness. 

At the Healthcare Facilities Symposium & Expo, DPR’s Ray Trebino joined J. Stuart Eckblad, director, design & construction for the UCSF Medical Center’s Mission Bay Hospitals project, and Stantec’s Laurel Harrison, to lead a session on the $1.5 billion UCSF Medical Center at Mission Bay project. The session’s focus: How they brought together a community of more than 1,200 individuals to deliver one of the largest healthcare projects ever completed in the U.S. ahead of schedule and under budget – all while creating an optimal healing environment. Fostering a culture of shared values, vision, behaviors and processes, the team took healthcare delivery to the next level on this world-class project that opened on Feb. 1 this year.

Starting in May 2009—more than a year and a half before construction began—more than 250 architects, engineers and contractors co-located in the Integrated Center for Design and Construction (ICDC) on the 14-acre site to build a high-performing team focused on “first, doing what’s best for the project.” The result is one of the greenest urban hospitals in the nation, which received LEED Gold certification prior to occupancy. The facility was delivered eight days early despite implementing nearly $55 million in changes and passed the California Department of Public Health’s licensing inspections with “no deficiencies” in 2 days, which is unprecedented among new California hospitals (which average 30 days for this process). 

Photo Credit: Rien van Rijthoven

And it seems certain that many healthcare projects will continue to comprise a growing share of the healthcare market landscape in the near future. It’s been three years since DPR published its “Future of Healthcare” study, but the findings and implications from this yearlong survey of executives and leaders in healthcare and the A/E/C industry remain highly relevant.

As we look to the future of healthcare, we also look back at the close to 1,300 hospital/medical center projects that DPR has completed in the last 25 years (since our birthday in July).

*This blog post is part of a series that celebrates DPR's silver anniversary and focuses on 25 great things from the company from over 25 years. Here's the last one. Follow #DPR25 on social media to learn more.

July 15, 2015

High-Stakes Medical Center Project Exceeds Expectations

“No surprises” was the DPR team motto on the St. David’s North Austin Medical Center expansion project. In one of the most complex and high-stakes projects that many DPR team members had ever taken on, careful planning and communication were crucial for reaching intense schedule milestones.

This $34 million, multiphasic project included an intensive 95,000-sq.-ft. vertical expansion of this fully operational hospital in Austin, Texas. Some of the work was often directly in the middle of the most sensitive areas of the hospital, such as the neonatal intensive care unit.

Although confronted with many challenges, the team not only completed the work on an accelerated 12 month schedule, but also took extraordinary measures to minimize impact on the medical center’s existing operations. The team truly lived its motto, delivered predictable results and exceeded the owner’s high expectations on the project.

Get the full story here and learn even more in the extended case study.

Photo Credit: Brian Mihealsick

June 14, 2015

UCSF Medical Center at Mission Bay: Integrated Project, Integrated Delivery

The UCSF Medical Center at Mission Bay in San Francisco is the nation’s first integrated project of its size and scope, according an article published by Healthcare Design, a resource that reaches, informs and influences key decision makers responsible for healthcare facilities.

The 289-bed, six-story, 878,000-sq.-ft. campus is home to three specialty hospitals:

  • The 183-bed Benioff Children’s Hospital with urgent/emergency care, primary care and specialty outpatient services.
  • The Betty Irene Moore Women’s Hospital offering cancer care, specialty surgery and 36-bed birth center.
  • The 70-bed Bakar Cancer Hospital for adults.

The team, which included DPR and Stantec, also built the project using an integrated approach—working together nearly 18 months prior to the start of construction to virtually design and construct the facility in the Integrated Center for Design and Construction (ICDC) onsite. Techniques including target value design, building information modeling (BIM), model-based estimating, and lean methodology allowed the team to reduce costs without reducing scope.

“There’s a lot of interest beyond our shores about how we were able to do this and how it can be adopted into other places,” UCSF Director of Design and Construction Stuart Eckblad told Healthcare Design. “I think we’ve made a significant contribution in how people are thinking about their buildings…and instead of thinking about the cost, thinking about the value.”

Completed late last year and opened on Feb. 1, the project has achieved LEED Gold certification and won a Fiatech CETI award for scenario-based project planning, as well as been spoken about at numerous national conferences, including ASHE PDC in San Antonio in March.

February 17, 2015

The ‘Domino Strategy’ Of Healthcare Renovation & Reuse Projects

It’s no secret that healthcare facility dollars are at an all-time premium. Changes to federal Medicare and Medicaid funding to hospitals, combined with uncertainty about impacts of the Affordable Care Act, mean that now—more so than ever—owners must make every dollar invested in their facilities count.

As capital program budgets have tightened, renovation and adaptive reuse projects have surged. That trend stands in sharp contrast to the early- to mid-2000s, when mega-sized replacement hospital and expansion projects were booming.

Today, healthcare owners with limited dollars are taking smaller “bites at the apple” with targeted, strategically planned, smaller volume renovation and reuse projects.

The focus is on maximizing vital inpatient services by moving them into spaces previously occupied by less urgent ambulatory services and administrative spaces. Those, in turn, are being moved to lower-cost medical office building (MOB) facilities.Valuable hospital space is being reclaimed for high-demand critical patient services like cardiac cath labs, neonatal intensive care beds and more.

‘Domino’ Projects

The strategy behind shifting and reusing space in fully operational facilities may be likened to setting up a game of dominoes. The order in which an owner undertakes each needed renovation project—or domino —impacts the projects immediately before and after it. Place them in the most effective order (or with dominoes, at the correct angle), and they will fall in smooth succession achieving the desired result. Put one out of order or at the wrong angle, however, and the domino trail—the owner’s capital facility budget, that is—may lose momentum and deliver a less satisfying outcome.

So how are successful healthcare owners prioritizing and expending their limited capital dollars to most effectively meet the needs of an ever-growing patient base? And how do they decide which project should take precedence (i.e., how should the dominoes be stacked) to meet both patient demand and their own business objectives?

Savvy owners understand the value of a “big-picture” outlook. Sometimes it can be difficult to see beyond the demands of day-to-day operations, however, to develop a comprehensive, long-term strategy.

Early Involvement Adds Value

That is where bringing a highly knowledgeable, experienced team on board early can reap the greatest benefits. The right team can help find efficiencies and preserve capital by setting up the most effective “domino plan” for a series of healthcare remodel and reuse projects in a given facility.

A prime example is the series of successive reuse projects DPR Hardin is performing for a confidential client in Greenville, SC. Commonly referred to as the “domino projects,” DPR Hardin’s work there has included an adaptive reuse of third floor hospital space to create a gastrointestinal (GI) unit for inpatient use. That project was enabled by first moving all outpatient GI functions to an MOB outside the hospital. Another project entailed moving doctors’ office space that previously occupied a wing of the hospital to the nearby MOB, making way for a project to add six more neonatal intensive care unit (NICU) beds.

DPR Hardin similarly is helping Piedmont Hospital in Atlanta strategize and construct the most effective reuse of some of its space. One project is moving administrative and executive offices out of the hospital to an MOB, freeing up hospital space that will be converted into additional neonatal ICU units.

Pinpointing Constructability Issues, Schedule Impacts, Conflicts

At Piedmont Hospital and on other projects, DPR Hardin’s early involvement in the strategic planning and development of healthcare remodel and adaptive reuse projects is delivering clear benefits. By coming on board from the beginning and working collaboratively with the owner and design team, DPR Hardin helped uncover constructability factors related to existing conditions of previously occupied space. The team also helped the owner leverage efficiencies in moving or adding building systems or relocating medical gas lines—elements typically associated with healthcare reuse projects.

An experienced contractor also offers capability to survey or laser scan existing space to uncover unknown impacts of a proposed project. That was the case on another project for the confidential client in Greenville, SC—the vertical expansion and relocation of a portion of the MRI department.

Designed to relocate two MRIs from the basement level to three floors above to better serve inpatient needs, the project was planned to go directly above the hospital’s kitchen. Existing conditions of the ceiling space above the kitchen were unknown, however. Brought on board early, DPR Hardin laser scanned the space and discovered that extensive structural work would be needed. The project team was able to devise a seamless solution well in advance of start of construction to avoid disrupting the vital 24/7 kitchen operations.

The bottom line? Having the right domino strategy in place can make a big impact in the successful completion of renovation and adaptive reuse projects. 

February 10, 2015

BIM-Enabled Virtual Reality at VA Hospital Renovation

At a renovation project within a working hospital at Virginia Commonwealth University Health System (VCUHS), DPR is using Oculus Rift goggles to let end users virtually walk through BIM mockups. The team broke ground on this beta technology, which was originally created for the video games industry.

Using the goggles, end users (doctors and nurses, in this case) can explore the finished space and give feedback before construction begins. Given the portability of the system, the team can set up user feedback sessions easily and quickly, which is essential given the hospital staff's limited availability as well as space constraints.

How has the team's use of this technology benefitted the project?

  • Creating an immersive virtual mockup using Oculus Rift cost just a fraction—less than 15%—of what was originally budgeted for a physical mockup.
  • Virtual walk-throughs yielded more than 35 suggested changes (including added storage space and moving equipment).

Get the full story here.

Photo Credit: Mollie Shackleford

January 29, 2015

Data Centers and Beers…What’s the Connection?

Pint, 6-pack, 36-pack or keg? 

In DPR's latest white paper—The Convergence of Healthcare and IT—the considerations that go into deciding whether to lease or own a data center are compared to buying beer.

Selecting the right data center solution for managing electronic health records—or combination of solutions—has serious business consequences for owners. The right option depends on a company’s size and need. 

Choices range from the "full service data" option of leasing servers from cloud providers (like buying a pint at a bar) to the "do it yourself" option of owning and operating one's own data center (like purchasing a keg). 

Read more here or read the full white paper, written by DPR's Hamilton Espinosa, David Ibarra and Mark Thompson. 

Photo Credit: David Cox

January 1, 2015

Which 3 Healthcare Trend Predictions Are Ringing True Today?

Published 2 years ago, DPR's "Future of Healthcare" study identified the most significant, long-term trends in healthcare and its impact on facilities. The study was a yearlong effort to interview and survey more than 40 executives and leaders in healthcare and the architecture/engineering/construction (AEC) industries.

Some of the findings included:

  • Prediction #1: Renovation and adaptive reuse will increase;
  • Prediction #2: Outpatient services will continue to be the focal point for growth; and
  • Prediction #3: Technology/data intensity will be crucial. 

DPR is now seeing these trends manifested in the healthcare projects it’s working on, particularly those that are coming to its Special Services Group (SSG)

SSG is DPR’s team of builders who focus on quicker and smaller-scale projects. Of DPR's 7,500 completed smaller-scale projects (valued in the $5 million or less range), about 20% were in the healthcare sector. 

Read more about healthcare trends here in the latest issue of the DPR Review newsletter. 

An example of adaptive reuse, Texas Children’s Outpatient Therapy and Specialty Care Clinics were constructed in 17,500 sq. ft. of an existing suburban strip mall in Houston. (Photo by Jud Haggard Photography)

February 20, 2014

Self-Perform Work and More at UHS Temecula Valley Hospital

As detailed in this short article, DPR's self-perform work was an important part of building the 35-acre, ground-up Universal Health Services (UHS) Temecula Valley Hospital.

This extensive project case study provides even more insight into the 177,508-sq.-ft., five-story, greenfield hospital tower project.

Using integrated project delivery (IPD), the team delivered the 140-bed hospital, which features all-private rooms, a 20-bed intensive care unit and six high-tech surgical suites. Completed ahead of schedule, the project also finished at an estimated 40 percent lower “per bed” cost than the average new Southern California hospital facility.

Photo courtesy of Lawrence Anderson Photography, Inc.

“The project was very dynamic,” said Michael Fontana of Fontana Associates, the company acting as the owner’s representative. “We kept changing the way we looked at things, the way we processed information and the way the work flowed. There were all kinds of solutions we discovered to make productivity go up.”

January 29, 2014

Chinese Hospital Replacement Project: A Day in the Life

The 100,000-sq.-ft., 54-bed, ground-up Chinese Hospital Replacement project is in full swing in the heart of San Francisco's Chinatown.

To get a sense of what the day-to-day has been like on the project, check out the Day in the Life: Big Logistical Challenges, Small Urban Site pictorial feature in the latest DPR Review newsletter.

Interesting facts: The original Chinese Hospital was the birthplace of martial arts legend, Bruce Lee. Also, San Francisco's Chinatown is the largest in North America.

Watch the building as it comes to life here in real time, courtesy of the OxBlue construction camera.

Photo Courtesy of Jerry McKinley (also project superintendent)

October 15, 2013

Doing More with Less in Healthcare

Healthcare owners continue the conversation on doing more with less and providing more value. During The Registry’s “The New Health Care Environment” event in San Francisco, the panel–made of healthcare owners and experts–provided insight on how the Affordable Care Act is affecting the healthcare industry.

Panel members from left to right: Carladenise Edwards from Alameda Health System, Heather Chung from SmithGroupJJR, Pete Delgado from Salinas Valley Memorial Healthcare System, John Kouletsis from Kaiser Permanente, and me (Hamilton Espinosa from DPR)

Here are 10 big takeaways from the event:

  1. Building may be different than it has been in the past. 
  2. The A/E/C industry needs to provide flexible building infrastructure so owners can use buildings for as long as possible (60 years rather than 25-30 years).
  3. Healthcare owners are looking to reuse existing building stock where possible.
  4. Value is important to owners (lean project delivery was mentioned as an example).
  5. Reform is incentivizing owners to incorporate technology. 
  6. Providers want to use technology to tailor the experience to patients’ preferences (integration into phones/social media, home care, etc.). This will result in the need for IT infrastructure and potentially more data centers.
  7. The trend will be more towards outpatient facilities with hospitals reserved for the sickest patients.
  8. With healthcare reform, people will be getting more choices and providers are looking to move to a consumer model.
  9. The system is transitioning to wellness care. 
  10. Hospitals will need to provide evidence-based data to show what treatments are successful.