How Successful Hospital Renovation Teams Optimize a Project’s Schedule and Cost

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March 3, 2015  |  Kevin Barbee, Steve Drane, Matt Smith

The days of greenfield hospital construction are beginning to fade into distant memory. In an environment of scarce capital for facility upgrades, the safe bet is to build conservatively and delay investment in new construction until we have clarity around the timing and direction of inpatient volumes.

With increasing frequency hospital leaders choose to renovate existing space, often converting to different uses in aging facilities, prompting a highly complex construction process. We discuss strategies and best practices that successful hospital renovation teams employ to optimize a project’s schedule and cost.

Field investigation to discover latent conditions and thwart surprises
The discovery of something unexpected during construction is one of the more discouraging things to happen to a project budget and schedule. The more that the contractor and A/E team can examine the existing space during the schematic design phase, the less likely they are to discover an unanticipated condition after construction starts. Late-stage discoveries often trigger unwanted delays and financial consequences. The following field investigation techniques attempt to unearth unforeseen circumstances as early in the project as possible.

Prior to schematic design, verify and update as-built floor plan and section documents
Even when comprehensive as-built documents are available, they don’t provide the “nitty gritty” information describing how components were assembled during construction. Moreover, while they were accurate at the time of a previous major construction project, hospitals usually don’t record subsequent minor renovations to update the as-built set. Confirming measurements and verifying existing infrastructure as they may differ from the as-built set saves time and money because the team doesn’t have to re-draw when a discrepancy appears, or worse, rip out and re-build.

Prior to schematic design, document above-ceiling conditions with laser scanning technology
On medium and large-sized projects, laser scanning is a highly efficient way to document idiosyncratic facility infrastructure in three dimensions. Because it enables the design team to plan more accurately around the existing components, the contractor can perform their work more confidently, cost effectively, and expeditiously. Contractors gain the ability to fabricate more elements in the shop, a more productive and controlled environment than the project site.

Ascertain engineering impacts to the entire campus as well as the project at hand prior to schematic design
One can never assume utility services (power, HVAC, med gases, water pressure) are sufficient to handle a new or renovated project. The engineers must determine how the affected systems dovetail with the entire facility all the way back to the CEP, both at present and as anticipated according to the long range facility infrastructure plan. The project at hand may offer the opportunity to save money and energy facility-wide without expanding existing infrastructure.

Pre-planning on the front end to minimize inconvenience to users
Minimize and manage shut downs
By tying new MEP infrastructure into existing service valves and utilities at the closest line, the contractor has to do a complete system shut down and disrupt caregiving operations. Instead, we have found it preferable to limit the extent of disruption by tying in downstream of a zone valve or service valve.

Avoid moving electrical rooms, main service lines, transformers, panels, and so forth
Whenever possible, designing the new space to avoid relocating electric service saves tremendous expense, effort, and disruption. If relocation is unavoidable, “make ready” projects (such as running new services in existing shafts) minimize downtime during the construction of the main project.

Sophisticated team selection and coordination
A complex renovation project requires a different level of coordination that only a highly experienced team can provide.

The benefit of experience
A construction superintendent with decades of healthcare renovation experience, and, a hospital facilities staff knowledgeable of the existing facility are vital to the design process. (Bonus points for having a facilities staff member on the team who was around when the existing building was built.) From the beginning, their knowledge of the building and field verification expertise validate assumptions as the design progresses. Technical input on conceptual ideas provides real-time feedback on cost and feasibility implications, and pricing options and budget guidance early in the process enables enhanced project control.

Weekly component team meetings
Weekly component team meetings with a predetermined agenda provide structure for ensuring that each discipline is on target with GMP cost and intended schedule as they advance their work. By collectively developing solutions and the associated cost ramifications in real-time, the team minimizes time spent value engineering or redesigning.

Early coordination with Authorities Having Jurisdiction (AHJs) limits backpedaling
Often existing spaces are no longer code compliant in renovation projects, and the AHJ has the last word as to how to address these conditions. Providing the AHJ the opportunity to express their interpretation as early as the initial planning stage enables the team to advance the design based upon what they know is approvable. Without such “solid ground” to work from, the team risks significant redesign time. Regardless of the project stage, treating AHJs as team members increases the likelihood of a favorable outcome.

Revit
If the hospital has a Revit model of the existing space from a previous construction effort (which will become increasingly common) one can virtually investigate solutions on the model without disrupting operations. Investigating “what if scenarios” allows the team to evaluate costs based upon conceptual design alternatives.

An existing conditions Revit model also provides the design team the context, systems, and existing volumes and proportions impacted by the proposed design. The team can develop design options for consideration more quickly with more confidence of constructability.

Closing Thoughts
Stay tuned for our next post describing ways that hospital department heads can lead a phased transition into a newly renovated space.

If you are interested in learning more about how to minimize disruptions to patient care during a construction project, contact Kevin Barbee: kevin@freemanwhite.com

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