When Community Health Systems (CHS) acquired the old Trinity Medical Center in Birmingham, Ala., back in 2007, hospital leaders had already been considering a relocation. An undeveloped piece of real estate in the city’s Grants Mill area was the anticipated site for the new build, but a significant downside to the option soon emerged: There was very little commercial or residential development around.

However, about 10 miles away, Birmingham’s U.S. 280 corridor was growing rapidly, offering the retail and rooftops they were seeking. The area also boasted numerous access points to nearby interstates that provided plenty of traffic flow from around the city and the state, not to mention high household incomes, lots of economic development, and even more anticipated population growth.

And as luck would have it, there was also an abandoned hospital construction site.

HealthSouth had broken ground in 2002 on an orthopedic surgery and rehabilitation hospital there, with Brasfield & Gorrie serving as general contractor. By 2003, the project skidded to a halt mid-construction. Faced with the decision of what exactly to do next, Brasfield & Gorrie decided to complete the entire building structure to preserve it for future use.

With a crisis management company brought in and an eventual sale to real estate firm Daniel Corp., additional work was done over subsequent months and years, including finishing the building skin and roof, building out several patient floors, and—most critical—installing mechanical systems including air conditioning.

And so there it was, sitting vacant but intact in 2008, when it came onto the hospital’s radar. It was the perfect spot for what would become the new and renamed Grandview Medical Center. “Had they not finished the structure and created an enclosed entity with conditioned air, this building would have basically been a wasteland for any consideration going forward,” says Keith Granger, president and CEO of Grandview Medical Center.

While recognizing the building’s potential came quickly, achieving it took a whole lot longer.

There was the good, of course: the ideal location as well as a structure built to healthcare specs that couldn’t be replicated for anything close to the cost of acquisition. “There was certainly a huge amount of size and infrastructure work that took place that we could get at a significant discount, whether you’re talking about the land or the facility,” says Drew Mason, chief operating officer of Grandview.

The major downside was obvious, too. “Could you take the building and preserve those elements that had already been completed, knowing that they were going to be, in some cases, approximately 10 years old or older by the time you occupied it?” Granger says.

In the end, the location won out, and the site was purchased; in December 2008, a certificate of need application was filed with the state. However, the filing was hotly contested by local competitors despite its approval at all judicial levels, eventually resulting in a ruling more than four years later by the Alabama Supreme Court that gave a final approval to proceed.


Inside the box
Brasfield & Gorrie was hired to stay on board as general contractor and was joined by architect ESa, and throughout the long wait, the team planned for a groundbreaking that finally came in 2013. The delay, however, offered the benefit of time to navigate a unique project. “In some ways, it was a mixed blessing, because it did allow us to really vet the design through a protracted design process,” says Brian Willer, a former architect with ESa. “There was a lot of due diligence we had to do. There’s a challenge there where you’re taking a box, in essence, and designing within the box and trying to make the best design within that box that you can.”

As for the conditions of that box, about 25 percent of the existing building was 90-95 percent complete, including mechanical spaces and patient rooms on floors 5 through 9 of the 12-story structure. “The other 75 percent of the buildout was anywhere from just pure shell space to some floors pushing 50 percent complete,” says Robert Robison, senior project manager with Brasfield & Gorrie (Birmingham).

Despite levels of completion, plenty of spaces simply had to be demolished. But the project team also wanted to take advantage of what was there—even if perhaps in the wrong place—so it saved just about everything in the process. “Door frames, casework, ductwork, piping … we demo’d it, protected it, and saved it until we got the final set of buildout drawings to see if we could reuse that material. There were 600 door frames we were able to reuse,” Robison says.

Additionally, completed spaces didn’t necessarily meet Grandview’s acute care requirements since the site was originally built as a specialty facility. “We had to do a lot of things to retrofit to make them serviceable for a full-service hospital, whether oxygen tank storage or larger pharmacy distribution rooms—all of the full-service hospital capabilities and the infrastructure for the type and number of patients we were going to have on those floors,” Mason says. “We had to basically blow up several of those cores and redesign the shape of how those support services would help those existing patient rooms on each floor.”

The existing structure overall, though, aligned well with Grandview’s expectations, with, for example, the ORs and ICUs largely being in the proper locations. The OR was expanded to bring 30 on line—an easier task on one of the building’s four floors that are three acres each. “We took some of that original footprint but increased the size and scale pretty dramatically and also increased the size of the support services on that floor in terms of prep and recovery and PACU,” Mason says. Grandview also wanted its 72 ICU beds largely centralized on one floor to benefit from shared resources, but adding in those spaces meant siting them along the building’s front curvature, a tighter fit than the OR project.

And long before the construction ever started, all those existing systems that made the building so attractive, from mechanical to electrical to medical gasses, were retro-commissioned over the course of seven months, with everything serviced and parts replaced, allowing all of it to be saved.


Built to last
Opening in October 2015, the 372-bed Grandview Medical Center, including its 930,000-square-foot hospital, 1 million-square-foot parking garage, and 220,000-square-foot professional office building, came in at a price tag of $280 million and several months ahead of schedule.

Not only was the program fit into the building, but opportunities for expansion—even on its just 13.4-acre site—were located, mostly with an eye on planning vertically. “We tried to find pockets where they could grow within their box, and I think we’ve done that successfully,” Willer says. For example, the build-out of 30 ORs was actually an increase from an originally anticipated 20, thanks to identifying usable shell space. One additional floor of shell space was maintained, too.

“Thinking vertically” was put to use with wayfinding, as well. With a massive hospital and equally massive garage for patients to navigate, the solution was to align the floors of the garage directly with the floors where patients would register and receive services, avoiding tra
vel through elevators, connectors, or stairs. “Although it’s a large footprint, there’s one path from east to west that channels the patients, so there’s really no mistake in where you’re going,” Mason says.

The name Grandview is no misnomer, either, with the design taking advantage of stellar views to the east and west from all patient rooms, while a hospitality aesthetic was used throughout and local artwork curated.

A long time in the making, Granger admits that opening day was “a relief in many ways.” But there’s a long history in the making, too. “There’s no question we anticipate this building having a long life—50-plus years. With this particular geographic location, it will be the epicenter of healthcare going far into the future. It connects us to all areas of the state,” he says.

Grandview also recognizes trends to come, with technology in place to allow minimally invasive surgery, mobile physiological monitoring, WiFi capabilities, and telemedicine. It’s also ready for a patient mix a bit different from what’s seen today. “We added 72 ICU beds, which is a pretty high percentage for a hospital of our size. We recognize there will be sick patients and then there will be outpatients, and that will probably be the preponderance of what’s coming into our hospital in the future,” he says.

Jennifer Kovacs Silvis is executive editor of Healthcare Design. She can be reached at jennifer.silvis@emeraldexpo.com.
SIDEBAR: Need for speed
The new Grandview Medical Center presented a complex project combined with the challenge that most face these days: an ownership request for the quickest construction schedule possible.

To answer that request, general contractor Brasfield & Gorrie started by breaking down the project scope into multiple jobs awarded to multiple subcontractors. For example, the 910,000-square-foot hospital was one job, the 1 million-square-foot parking garage was one, the professional office building shell was one and its buildout another, and site work and roadway improvements were also bid out separately. Ultimately, 135 subcontracting companies were hired to finish the work.

That number inspired the team to also find a way to easily communicate between one another and architect ESa. First, WiFi was installed across the 13.4-acre site to support wireless access to documents. All subcontractor foremen and superintendents were required to carry iPads, where BIM models and 8,000 sheets of drawings could be easily and instantly accessed. “The day we would get them from the architect, they were on everybody’s laptop or iPad within 24 hours,” says Robert Robison, senior project manager with Brasfield & Gorrie.

The team also partnered with Auburn University to fly a drone around the building to assess its existing conditions, inside and out. “They could fly that drone up to the glass and inspect the caulk joint between the panels of glass,” Robison says. “That was able to give us a lot of information that we could use in our BIM modeling.”

Other solutions used included the Lean method of “last planner” for scheduling, where each subcontractor was charged with thinking through their scope of work and having foremen and superintendents meet daily to determine what was happening that day, who might be in someone’s way of accomplishing that task, and how to speed things up to get the work done.

Even a simple solution paid off, with all site materials stored on carts instead of on the ground so that when they were needed, it was a matter of wheeling them to where they were needed rather than having to pick them up and move them.

In the end, with the public promised an open by the second quarter of 2016, the effort paid off with doors opening on Oct. 10, 2015.