Common Goals Inspire MaineGeneral Hospital Project

June 3, 2014
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A timber canopy highlights the front entry of the building, originally named the MaineGeneral Medical Center and later updated to the Alfond Center for Health in recognition of a donor. Photo: Anton Grassl/Esto. An anchor of the building design was the idea of “healing embraced by nature,” a concept that inspired the creation of numerous opportunities for connections to the outdoors—either on the grounds themselves or from expansive views provided from the interiors. Photo: Anton Grassl/Esto. A rehabilitation courtyard for ambulation therapy provides walkways to help patients get back on their feet. Photo: Anton Grassl/Esto. The integration of indoor and outdoor spaces is illustrated in this view of the cafeteria and outlying activity terrace. Photo: Anton Grassl/Esto. A logical building circulation and clear views outside aid wayfinding, along with a nature theme used to distinguish between the building’s four floors, with “field” on the ground level, “river” on the second, “forest” on the third, and “mountain” on the fourth. Photo: Anton Grassl/Esto. The hierarchy of interiors begins with community functions at the front of the building and progresses inward, with the most acute functions at the back. Each of these departments is organized around a central spine that consists of public (shown) and service corridors. Photo: Anton Grassl/Esto. Patient rooms feature a standardized design, from the headwall down to what’s in the casework drawers. Photo: Anton Grassl/Esto. Family lounges offer a retreat on inpatient units. Photo: Anton Grassl/Esto. Low-maintenance flooring was used throughout the facility, with sheet vinyl and rubber options used to eliminate the need to wax floors, as seen here in the ED waiting room. Photo: Anton Grassl/Esto. The cafeteria showcases the design intent to introduce the materials vernacular of the surrounding region into the building through the use of wood and stone. ust before the facility opened, a donor proposed funding the addition of a “living wall” in the cafeteria. Because IPD allows for project changes on the spot, the team was able to immediately design the feature, hire plumbers to run piping to keep it watered, and execute a contract for maintenance. Photo: Anton Grassl/Esto. The design team toured new hospitals around the country to gather ideas on design features to enhance patient comfort, safety, and healing, such as standardized, private patient rooms. Photo: Anton Grassl/Esto.
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MaineGeneral Health is the amalgamation of a series of mergers over the years that’s created a system of acute care hospitals, outpatient facilities, and home care services in Maine’s Kennebec Valley. And when the time came for leadership to address two aging inpatient sites, its landscape was about to change again.

“We had more than $100 million in repairs that we needed to do to the buildings just to keep them updated but not improve anything for patients,” says Chuck Hays, MaineGeneral president and CEO. “Ultimately, we decided that one new regional inpatient facility was the way to go and started that process.”

The design team of SMRT Inc. (Portland, Maine) and TRO Jung Brannen (TROJB; Boston) was brought on board in 2009 through competitive bidding for the schematic design of a 192-bed, $322 million hospital proposed in MaineGeneral’s certificate of need to the state.

However, when the project got the green light, Hays was looking at the largest construction project in the system’s history as well as in his own career, so he wanted to make sure it was done right. Research of similar-sized projects and their delivery methods zeroed in on what would be another first for Hays: an integrated project delivery (IPD) contract. “I liked the tenets of it. I saw that when it was done right, the results are excellent. So we headed off in that direction,” he says.

 

Team building
Getting from that point to the September 2013 completion of what today is the Alfond Center for Health in Augusta, Maine, meant covering a lot of new ground. To start, ownership had to select its IPD partners and come to terms on a contract.

A major component of IPD as a delivery method is early integration of all team members to streamline—and even overlap—design and construction, but signing a shared-risk contract is what makes it more than just a methodology. Contracts generally give partners equal stake in both risks and rewards so that all are similarly invested in meeting budget and schedule.

With SMRT and TROJB already on board, MaineGeneral needed a builder and subcontractors, but the process of choosing them was a bit different from the norm due to the inherently collaborative nature of IPD, with the attitude of potential team members weighed alongside skill and expertise. “Typically, you think about whether the contractors you select are physically able to do the job. Then you assess whether the bids are apples to apples. Then you realign all that and look at pricing. Now, though, whether best price or not, culture came first. If they didn’t have the flexibility to embrace IPD, then it wouldn’t work,” Hays says.

Ultimately, a construction joint venture of Robins & Morton (Birmingham, Ala.) and HP Cummings (Portland, Maine) was chosen for the job with a number of major subcontractors and consultants also party to the IPD contract. However, because the process was still fairly new in 2010, exactly how risk would be shared was up in the air.

Rather than simply using a standard contract with a modification for IPD or other existing options, the group decided to craft its own, which led to its first team-building exercise. “We were fairly new to the construct and therefore invented it together,” says Ellen Belknap, president of SMRT. “It was no joke putting that contract together from scratch, but the fact that we went through it and we all owned every verse, line, and chapter of it made a huge difference.”

First steps included creating a memorandum of understanding that established the basic principles of the contract and gave each team member an equal seat at the IPD table. Next came lengthier discussions on specifics like insurance, with the parties agreeing to an owner-controlled umbrella policy requiring each member to waive liability in order to take part.

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