Building based on a modern heatlhcare design works best when the contracting firm works as a dedicated, flexible member of the design team. We observed this when we constructed the new Ambulatory Care Pavilion at the Children's Medical Center of Dallas, which offers families a new level of outpatient care. The project consisted of the complete renovation of the fourth and fifth floors of the Children's Pavilion and the addition of a 30-foot pedestrian sky bridge that connects the fifth floor of the Pavilion to the existing parking structure. It was built around a concept that brings medical specialists into one centralized location.

Each floor is approximately 65,000 square feet with four patient reception areas. The fourth and fifth floors are connected via back staircases for the staff for faster navigation. The facility also has a large public atrium, a Family Resource Center, and a multipurpose room—features that are not typical in the average ambulatory care center, making the facility more welcoming and easier for families to navigate.

The floors are set up in “neighborhoods,” which are clusters of services and pediatric subspecialties developed around common patient needs. The neighborhood design allows patients to visit multiple specialties in one location, resulting in a more expeditious process and shorter waiting times. The clinics and exam rooms are located in the center of each floor, and administrative offices and specialty areas—such as patient education, nutrition, audiology, and therapy—are located around the perimeter. This design splits traffic for an easy flow.

Creating a unique space

The project included the demolition of a portion of The Men's Apparel Market, which was situated next to the existing building, to make room for the expansion of the Children's Medical Pavilion. The project team—which in addition to Gilbane also included HKS, Inc., as the architect/structural engineer and Meinhardt Consulting Engineers—converted the fourth and fifth floor of the Pavilion from retail space to medical exam rooms, doctors' offices, and support spaces, and constructed a new exterior wall that created a six-story atrium. We removed the existing six-story escalator and replaced it with two passenger and two hospital-sized elevators, and constructed a new entry drive with canopies to make it easier to find the entry to the facility.

The patient rooms differ from traditional ones in that the use of technology was a major driver for many construction decisions. We included customized workstations in each patient room that are used by physicians in place of large patient files and charts. Permanently installed computers are actually hidden in each room when tucked under the desk, resembling a cabinet door when closed. When pulled out, the computer monitor can be flipped up, allowing access to a keyboard tray and mouse. There is also a wall-mounted screen to allow the physician to share information with the family.

There are four distinctive areas per floor called “touchdown” rooms for the staff. These rooms are essentially an office away from an office. Doctors can quickly stop over between patient visits with their laptops or use one of the provided computers to input notes. The hospital is a teaching facility, and the touchdown rooms serve as a gathering place for doctors and students to discuss patient cases. The touchdown rooms also contribute to reduced waiting time for patients and their families because doctors don't have to go back to their offices to input or look up patient information.

Addressing challenges

Working within an occupied space is always a challenge. Since the project team was working on three out of the six floors of the existing building, and the first three floors were occupied throughout the entire project, we had to take special care to not disturb those employees.

When the team had to install new plumbing fixtures on the fourth floor, the rough-in work had to be incorporated from the third floor ceiling. This work was performed at night and on the weekends to avoid conflict with the normal workday of the administrative and senior management staff (whose offices are located on the third floor). We covered the furniture and floors so no debris or dust would fall on the finished surfaces. All of the work was completed without incident.

Another bump in the road involved the discovery of existing columns during demolition that conflicted with the new design. We also found floor openings that were not planned on! During each and every challenge, the design team worked with us to resolve the issues and remain on schedule. In some cases, additional structural steel pieces had to be added, while other cases involved demolition. In all cases, the project continued to move forward.

Quality across the board

For design and quality purposes, we created several mock-ups of patient exam rooms. The design was modified and perfected thanks to input from doctors, nurses, and technicians. Because mock-ups were used, the hospital staff had the opportunity to verify their needs and expectations of the final project before installation, saving everyone time and money.

We also built exterior wall mock-ups, mainly for quality purposes. There were some issues with the large red spheres that sit on top of columns in the registration areas on the fourth and fifth floors. Getting these approved proved to be a challenge because of the finish. The intent was a high-gloss finish, but the original design used wooden spheres. Unfortunately, the wooden surface did not allow for a shiny finish so the material was changed to metal and the desired look was achieved.

Another quality element was the construction of a two-hour fire-rated temporary wall before the adjacent building was demolished to create a waterproof exterior wall. After demolition, Gilbane built the new building's atrium and took down the temporary wall as we went.

Safety as a value, not a requirement

There were 202,832 hours and 357 days worked on the job without a single injury—not one OSHA or lost-time recordable incident. We attribute this success to our overall approach to safety on the job. We imparted our safety values onto the trades and empowered them to take care of themselves on the job.

From the project superintendent to the project engineer to the project manager, buy-in to our safety values was necessary across all contractor supervision and ultimately from all of the workers. Activities that helped foster this team approach included weekly contractor meetings, Gilbane orientation, safety celebrations of milestones, and consistency among the core contractors.

Success as a team

As the saying goes, when people work together, they can accomplish anything. The success of this project was a result of team effort involved. The client, design team, trade contractors, and construction manager all went into this project with the same goal—to deliver a first-class children's hospital on time and to the specified quality. We approached challenges fairly, with the goal of resolving the issue so that the schedule was met without compromising design quality. Our success was validated by the fact that the same team will build out the sixth floor once programming needs are finalized. HD

John Castilla is a Vice-President at Gilbane Building Company with more than 29 years of experience managing construction projects from their initial planning stages through site selection, design, bidding, and construction. He has been with Gilbane since 1984 and specializes in complex healthcare projects within the company's Southwest region. Gilbane Building Company

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