On January 17, 1994, a 6.7-magnitude earthquake rocked Northridge, California, with devastating consequences. Its aftermath left more than 60 dead, an estimated 5,000 injured, and an additional 25,000 people found themselves homeless, according to the Federal Emergency Management Agency (FEMA). The incident also generated new state-mandated seismic requirements for healthcare facilities in California.
The Los Angeles County Medical Center, built from 1928 to 1936 (the original facility was actually a two-story brick building that opened in 1878), suffered some damage in the wake of the Northridge earthquake. While the teaching hospital was still operational, it was clear that the facility needed to be replaced or renovated in specific areas to adequately serve the needs of both its patients and staff. A plan for a 946-bed replacement hospital was conceived in 1992, designed by Hellmuth, Obata & Kassabaum (HOK) and Lee, Burkhart, Liu (LBL) as part of a joint association. However, the project had been put on hold due to Los Angeles County budget issues by the time the Northridge earthquake struck in 1994.
Given the damage the existing facility suffered following that seismic event, the 1992 plans and project were reconsidered; it was determined since FEMA funds would be available, in addition to Los Angeles County funds that the project could move forward. The only revision was the choice that an all-acute hospital with 600 beds total would be built versus the initial 1992 plan that dictated 946 beds. More than $400 million in federal and state disaster aid was put into play to assist with funding for the replacement facility; Los Angeles County financed the remainder of funds needed for the project via bonds.
Plans called for the new 1.5-million-square-foot Los Angeles County + University of Southern California Medical Center to take shape on land that sits just south of the original facility. Ultimately, operations and outpatient clinics at the existing hospital (that is still operational) will be relocated to the new facility. Construction on the replacement facility-comprised of a seven-story outpatient building, eight-story inpatient tower, five-story diagnostic and treatment building, and a central energy plant-began in April, 2003, and was finally complete by November 7, 2008.
No small undertaking
The scope of this multifaceted project required the expertise of a construction firm and an architecture firm with extensive experience in the healthcare arena. To that end, a joint venture to handle construction was established-McCarthy Building Companies, Clark Construction Group, and the Hunt Construction Group-joined forces to create McCarthy-Clark-Hunt (MCH), the general contractor for the project. The association between HOK and LBL that was originally set up in 1992 carried over to the 600-bed replacement hospital project.
Keeping teams on both the construction and design fronts in sync proved to be a daunting task throughout the course of the project-particularly from a construction vantage point, according to Tracy MacDonald, vice-president of operations of commercial services for McCarthy Building Co., Newport Beach, California. “Believe it or not, the sheer size of the project and the necessary logistics was one of the biggest challenges,” he said. “Simple things like deliveries needed to be carefully orchestrated and managed in order to prevent chaos on the site and to bring structure to the flow of the work.
“With multiple buildings and hundreds of construction activities occurring each day, involving countless subcontractors, vendors, suppliers, and more than 1,000 tradesmen on any given day, project planning, communication, and coordination was an every-day, every-minute challenge. Then throw inspectors, architects, engineers, $140 million of change orders, and the Office of State Health and Planning Department (OHSPD)-the latter is the governing body over healthcare projects in California-into the mix, and you have quite the scene.”
MacDonald notes that on average, at any given time during the project, there were 60-plus people on the construction team who had to work together despite differing company cultures. “It probably took us a good six to eight months to mesh and come together,” he said. “There were some trials and tribulations at the beginning, but that would have been the case even if the entire staff was with McCarthy.”
While in total, the project was a joint venture between the three construction firms, to streamline some processes, Clark Construction Group was designated to be the managing partner on the project-all accounting went through their system and books, according to MacDonald. MCH held regular daily, weekly, and monthly meeting forums to assess all aspects of the project and each level of supervision. “Communication is always a key success factor, however, given the size and complexity of this project, not to mention the many stakeholders, it was not only vital, but also a challenge,” he said.
Turnover among staff was also a recurring issue that had to be dealt with given that the project took five years to complete. “There was a lot of turnover, and there were lots of changes as the job progressed,” he said. “There were many veterans in the beginning, and then additional personnel were brought in that might have more expertise in certain areas during various phases of the project. Some people also simply burned out after two years, and as a result, we tried to bring in people with fresh ideas while still keeping some continuity on the project.”
“Retaining subcontractors proved to be tricky as well given that at the time of the replacement hospital project, construction was booming throughout California and in nearby Las Vegas, Nevada. “There were not always enough experienced tradespeople to go around and work all the projects in that vicinity at that time,” MacDonald said. “At certain points of the project we would have wanted more dry-wallers or electricians, but construction work was plentiful and the workers were few, so that was a challenge. I think we peaked at about 1,200 tradespeople on that job.”
Meanwhile, on the design front, the HOK and LBL association assigned specific personnel with relevant experience in healthcare design to handle all project management, design, and medical planning, according to Kenneth Lee, LEED AP, principal, Lee, Burkhart, Liu, Inc., Marina del Rey, California. “The remainder of our team structure was equally divided between HOK and LBL staff resources. Our senior management staff met on a regular basis to address issues of schedule, budgets, client expectations, and a myriad of related project management issues. This early and continual dialogue enabled the two firms to anticipate project issues in advance, and to agree on strategies to address them,” Lee said.
HOK and LBL further enhanced communication on the job site by creating a distinct project office. “This project office was structured as an independent design practice, with its sole objective being the design and project management of the Los Angeles County + University of Southern California Medical Center project,” Lee said. “In this fashion, all staff could focus on a single project, without the distractions of other competing project interests, and all communication was similarly singularly focused.”
It is well-known within the healthcare industry that California's seismic codes dictate specific requirements for facilities within that state. However, Los Angeles County put in a request to the design team that the new facility should be able to stay up and running amid a major earthquake so it could ultimately serve as a “lifeboat” for the surrounding community, according to Alicia Wachtel, vice-president of healthcare, Hellmuth, Obata + Kassabaum, Inc., Culver City, California. “The four components of the project were structurally designed to address their function on a daily basis as well as during a major seismic event,” she said. “This approach is reflected in the building design. The Diagnostic and Treatment Building [430,000 square feet] was designated as a ‘life boat’ of the facility since it accommodates all of the essential functions needed in the aftermath of a major event. As such, the D&T is base-isolated. Base isolation allows the critical and delicate functions performed in this building to proceed without interruption, even during the event.
“The Outpatient Clinic [334,000 square feet] and the Inpatient Building [681,000 square feet] are ‘fixed-based’ buildings-the connection of these fixed-based buildings to the moving base isolated D&T presented interesting technical and design challenges,” Wachtel said. “The structural elements supporting these buildings, especially the cross braces, were strategically located around the perimeter of the buildings in order to allow internal flexibility for the facility and adaptability of use. This structural exoskeleton was a component to be accounted for in the composition, placement and size of the exterior openings.”
MacDonald adds that the D&T's 76,650-square-foot base will allow it to shift with any seismic movement. “A base isolator is a huge rubber cushion that separates a foundation and the building above it-consider it like a shock absorber in a car. It allows the building to sway up to 28 inches in either direction, and a metal panel moat around the buildings not only allows for that movement, but helps to absorb additional impact during an earthquake,” he said.
The fourth component of the project, a 60,000-square-foot Central Plant is a single-story building that is built below grade, but it features reinforced-concrete throughout the structure, as well as a utility tunnel to the D&T Building.
The seismic technology and the various code requirements laid out by OSHPOD for the Los Angeles County + University of Southern California Medical Center project were of critical importance, but the construction and design teams were ready for the challenge since they deal with seismic issues on most all projects in that region. “While the seismic requirements were a huge part of the project, and California is more stringent than in other parts of the country, most contractors in California that specialize in healthcare are familiar with the challenges involved. However, it certainly makes projects more costly than those in other parts of the country,” MacDonald said.
Achieving clarity through design
The main goal of the design was to connect the new facility's past community mission with its modern role. “There was an early consensus of achieving a facility design that reinforced the civic role of the institution, could continue to serve an important community mission for 50-75 years, could retain and attract competent staff, and that would create a contemporary appearance for the new medical center in a responsible manner since public funds were being used,” Lee said.
Clarity of circulation was another design objective for this project. “Simplicity of circulation, directness, and the skillful use of natural light to mark key circulation elements were successfully achieved in our design,” Lee said. “Also, the unbundling of like services into distinct buildings was another design goal. To this end, all outpatient clinical functions are housed in an ambulatory care building, which was less costly to construct and that required less governmental review time. This building shared, with the separate Inpatient Tower, all of the more sophisticated ancillary services that were accommodated in a base-isolated Diagnostic and Treatment Building.
“In addition, we were able to economize on costly space, medical equipment, and specially trained staff by achieving a sharing of ancillary services-Imaging, Special Procedures, Surgery, Pharmacy, and Lab,” Lee noted. “All of the licensed beds were accommodated in a separate patient tower, which was vertically stacked to achieve an efficient floor plate.”
Both HOK and LBL worked together to ensure that the new hospital's architecture and interior design were complimentary and compatible. “Given the many ethnicities and patient cultures served by the institution, there was a strong need to create an interior atmosphere and wayfinding strategy that relied on intuitive directions rather than signage,” Lee said. “The finishes and materials selected also had to remain resistant to the considerable wear and tear normally associated with public healthcare institutions.”
The three buildings are linked via an Automated Guidance Vehicle System (AGVS) or robotic system that delivers food and linens to various departments. The AGVS runs the length of the north side of the complex, utilizing a common corridor there where its 36-inch-wide carts can actually interpret whether doors are opened or closed.
Finally, flexibility in the replacement facility's design was also imperative due to the lengthy duration of the total project. “Planning, programming, and design over a long-term period are inherently challenging and reinforce the need for maximum flexibility and adaptability. Over an 11-year period, advances in medical technology and protocols of care are inevitable,” Wachtel said. “The challenge is to acknowledge that such changes will occur and that the facility is designed to adapt to new realities without becoming obsolete.” HBI