Major hospital renovations can be complex in design and scope, therefore presenting the challenge of maintaining a pristine and safe environment for patients within a fully functional hospital. The Banner Thunderbird Medical Center tower addition and expansion in Glendale, Arizona, required seamless planning among all team members in order to be successful.
The $180-million, 470,000-square-foot tower addition and renovation included a new six-story, 200-bed patient care tower with full basement, 84 emergency exam rooms, renovated imaging and interventional space, expanded pharmacy, renovated CSPD, pre-op and PACU, new food services, central plant, and main lobby areas.
Integrated design assist saves time
Banner Health was awarded the project as Construction Manager at Risk and hired both McCarthy Building Companies and NTD Architecture under separate contracts. McCarthy was brought on board early in the design phase to assist in constructability reviews, value engineering, and budgeting to ensure the project met all the needs of the owner without sacrificing budget or schedule.
Using McCarthy's integrated design-assist schedule, the construction document phase and the bid, detailing/shop drawings phase were completed simultaneously, which represented a time savings of approximately four months. This approach allowed the architect and contractor to work together at an earlier stage, which necessitated open communication from the start. “This was the first true use of the design-assist strategy for a Banner Health project,” says Jim Lucas, project executive at Banner Health. “There were modified versions used on other projects in the past, but this project was perfectly positioned in time and scope to fully benefit from an integrated process. We were able to see value very early in the design process with designers, construction managers, and key subcontractors at the same design table working through challenges typically not surfacing until much later in a project.”
BIM provides for seamless construction
Building Information Modeling (BIM) was a key component of the Banner Thunderbird tower addition and expansion project. BIM was completed during the construction document phase and more than 6,000 clashes were detected and resolved prior to permitting. The actual fully coordinated BIM model was submitted along with construction documents for permitting. Critical elements of the BIM process include building extensive 3D virtual mockups to enhance user communication. Heads of departments at Banner Thunderbird were brought in to review the virtual mockups so they could visualize the space and provide feedback prior to the start of construction. This approach alleviated design issues and rework at an early stage, representing cost savings for the hospital.
Using BIM, the McCarthy team also completed miniature mockups of the building enclosure that modeled all the different components of the building's exterior. This is part of McCarthy's quality initiative. Another critical element of the BIM process involves facilities management integration. With any hospital project, it's important to ensure maintenance needs are met. BIM allows designers to make all equipment fit and takes into account the maintenance workers having the ability to access and maintain the equipment effectively. The space that needs to remain clear is identified using BIM and a clash is detected if anything disrupts that space. Through the use of BIM, user needs were addressed during design and coordination versus post construction, the tower addition was completed in just 19 months, the overall project quality was improved, and there were zero changes as a result of proactive coordination and zero time delays due to rework.
Patients come first
Once construction was ready to begin, Banner Thunderbird challenged the McCarthy team to ensure patients at their facility would remain relatively unaware of any construction activity. In turn, McCarthy adapted a “stealth” approach to construction. As part of the renovation, construction workers had to access nine different areas of the hospital. Through effective planning, the construction crews never accessed those areas through the hospital's interior. Instead, crews entered via exterior windows using scaffolding or built false walls that were soundproof and aesthetically pleasing in order to remain invisible.
Another element of the project included the expansion of the hospital's main lobby entrance, which was still in use. The addition represented a three-story expansion located between two patient towers. McCarthy built a construction barrier that measured 150′ long and 45′ wide. Instead of building a temporary barrier, it was constructed with permanent wall characteristics, including insulation for sound and thermal. It was also fire rated and weather tight. From the inside, patients and staff did not recognize it as a temporary barrier. It was painted and completed with handrails and a rubber base that blended with the existing hospital corridors.
“We understood that the renovation phase of this project was going to require very creative methods to minimize noise, vibration, and the overall risk to our patients, staff, and visitors,” Lucas says. “The McCarthy team was able to think ‘out of the box’ and come up with construction access points for all work areas without ever entering the hospital. Work was coordinated around the clock seven days a week with means and methods not commonly seem in the industry to maintain the patient satisfaction ratings of the hospital, an expectation set early by the Banner Health project team.”
As with any renovation project, elements of the scope included major building demolition. The existing lobby was removed along with a portion of the existing emergency department and ambulance drive. To mitigate noise and vibration, tools and methods of demolition were reviewed for each task. For example, the existing concrete decks outside the lobby were sawcut into small pieces and chipped out with small chipping hammers by hand. Traditionally, the concrete would have been removed with larger equipment resulting in significant vibration and noise, which would have impacted patient comfort and care.
Another significant element of the hospital renovation was the installation of a full, temporary modular kitchen on top of an old heliport. The McCarthy team completely moved the hospital out of their existing kitchen space, which eliminated disruption of the kitchen's activities during the renovation process. This solution also shortened the duration of the kitchen renovation by about half, not to mention the difficult phasing and disruption to everyday operations.
In conclusion, the use of BIM technology and smart scheduling methods like integrated design assist are changing the delivery of healthcare building projects. The planning, design, and construction process is being transformed into a more integrated, collaborative, and easier to understand approach for all those involved. The benefits are numerous, including higher quality projects with a greater understanding of what is being delivered. Projects are able to be delivered faster and safer, all while keeping the long-term operation and maintenance of the facility in the forefront. HBI Chris Jacobson is the Project Director for McCarthy Building Companies.
For more information, visit http://www.mccarthy.comHealthcare Building Ideas 2010 Spring;7(2):24-29